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MICHIGAN STATE UNIVERSITY
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MICHIGAN STATE UNIVERSITY
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MICHIGAN STATE UNIVERSITY
THE JOURNAL
OF
MENTAL SCIENCE
^pttblisjitb bg ^atjjoritg of tfje
gtssoriafion of pebital Officers of ^sglurns anb hospitals
for % litsant.
EDITED BY
C. L. ROBERTSON, M.B. Cantab.
VOL. VIII.
I
LONDON:
JOHN CHURCHILL AND SONS,
NEW BURLINGTON STREET.
MDCOOLXIII.
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i
u In adopting our title of the 4 Journal of Mental Science, published by authority
of the Association of Medical Officers of Asylums and Hospitals for the Insane/ 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 appropriate; and that, moreover, we do not deal in mental science,
which is properly 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 admit that
metaphysics may be called one department of mental science, we maintain that
mental physiology and mental pathology are also mental science under a different
aspect. While metaphysics may be called speculative mental science, mental phy¬
siology and pathology, with their vast range of inquiry into insanity, education, crime,
and all things which tend to preserve mental health, or to produce 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 relation 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 main¬
tain that our Journal is not inaptly called the 4 Journal of Mental Science/ although
the science may only attempt to deal with sociological and medical inquiries, relating
either to the preservation 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
mechanician 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 cultivate; 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 acquainted with the higher
branches of astronomical science, but it is the practical part of that science as it is
applicable to navigation which he is compelled to study/'
J. C. Bucknill.
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THE JOURNAL OF MENTAL SCIENCE.
No. 41. APRIL, 1862.-^, 3 Vol.YIIL
Notes on Asylums and the Insane in France and Belgium. (July
and August, 1861.) By W. Cahmichael McIntosh, M.D.,
Certificated Student in Medical Psychology and Mental Diseases,
University of Edinburgh, Assistant-Physician and Superin¬
tendent, Murray's Royal Asylum, Perth.
At a time when so much public interest is manifested in lunatic
asylums and their inmates, it scarcely requires the memory of the
illustrious Pinel, Esquirol, and Guislain, or the knowledge of what
has been done by the present Morel, Baillarger, Ealret, Moreau, &c.,
to tempt one over the Channel, more especially when a visit to the
far-famed Gheel is contemplated. So in July and August last,
having leave of absence from my duties to spend some weeks in
rest and recreation, I resolved to find both in a visit to the French
and Belgian asylums, having learned by experience that to travel
without an object is neither profitable nor pleasant. Believing that
what interested me, and regarding which my curiosity had some¬
times been excited at home, might not be devoid of interest to
others, I made “ notes" regularly of what I observed, recording
facts and impressions on the spot and on the day, rather in the
order of observation than of coherence, and striving only to observe
well, and to state the exact truth.
The first institution for the insane I visited was the well-known
Bicetre, an establishment solely occupied by males. This appears,
on the whole, to retain a good deal of the old prison or barrack look
about it, and much of the building is very antiquated. It stands in
a bare, airy position, at some distance from the barrier of Paris, and
does not look very inviting from any point of view. The grounds are
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circumscribed, and surrounded by a high wall, and this, together with
the care and vigilance of the attendants, makes escape exceedingly rare,
in fact, the interne said, “ impossible. The entrance gate faces the
west, and has side lodges attached. Immediately within this is the
airing court for male paupers (not lunatics), who were squatted on
the seats in all directions, or took airing under the shady trees which
lent a refreshing coolness to the somewhat sultry atmosphere. The
quarters of these paupers were very comfortable, their beds being
arranged in long wards, evidently with a most scrupulous care for
order and cleanliness. Several old men were sitting at their bedsides
reading; they spoke cheerfully, and seemed happy and contented.
The bedding was excellent, and beneath each bed a sliding iron
drawer was attached, for holding the effects of the occupant. They
have access to a very small library on the north-west side of the
court. The latter had enclosed flower plots and shrubs, as well as
rows of fine trees, the intermediate portions being paved with cause¬
way stones. Benches were scattered here and there, and were gene¬
rally filled by groups of the paupers. One old man was an excellent
example of chorea, his arms and face twitching and jerking in all
directions.
The workshops belonging to this department are on a great scale,
and embrace many trades. Several blind men were at work here,
filing horns, working in iron-wire, &c., most industriously. Other
men make clothes-pins, work in iron and brass, or follow the occu¬
pations of painter and joiner. They appeared quiet and happy.
One came out and spoke a little English, and was proud to be able
to speak to a foreigner in his own tongue; he had formerly been in
England. A powerful steam-engine pumps water from a very deep
well into a reservoir. The bottom of the well and the iron descent
ladders are seen by the aid of an efficient reflector placed at its
summit.
In the hospital for medical and surgical cases (non-lunatic) most
of the beds were occupied. They each had a set of curtains of pearly
whiteness, which, with the neat, clean bedding, and waxed oak floor,
gave the place an air of tidiness and comfort. Some of the females
in attendance on these wards seem very young.
The lunatic portion of the establishment is separated from the
others by high walls and gates. We first entered an airing court
planted with pollard lime trees, which screened the inhabitants alike
from the warm sun and passing shower; while flower mounds, neatly
railed off, added beauty to the otherwise prison-like court. There
were a great many patients walking about, some quiet and melan-
oholic, others obstreperous and forward. None of these had on
camisoles. Opening under a vqranda on the south side of the
court were the single bedrooms for the troublesome patients. They
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and Belgium , by Du. W. Carmichael McIntosh.
had a dismal aspect, were without windows, and bolted and locked
from the outside; two bolts, one above and the*other beneath the
lock, added security and solidity to the door when shut. The bed¬
ding in these, however, is good; the under mattress is of straw, the
upper of wool. One accustomed to the flat bed of British asylums
is struck with the deep aspect presented by them hare and elsewhere
throughout these establishments; the bedclothes and mattresses are
about two feet in depth. At the south-west comer of this airing-
court, there was a small ward, containing two beds, the occupants of
which were in a state of acute mania,—one of three weeks’ duration.
The most furious had his camisole tightly round him, securing arms
and hands, while stouter bands firmly fixed him to the bed. He was
a young man, and he writhed his powerful muscles till the whole bed
quivered, spitting fiercely at the wall or the passer by, as an outlet to
his imprisoned vigour. His iron bed had sides about eighteen inches
in height, and softly padded; one of them folded down. The other
patient was equally well fastened to the bed, but his arms were drawn
straight by the sleeve ligatures being tied to the foot-rail. No argu¬
ment could persuade the interne that it was possible to do without
restraint in such cases.
The ordinary dormitories had an infirmary look, as well as the
superior beds and bedding generally throughout the house. The
floors were for the most part of polished oak, and some had the
central portion paved with tiles. A cylindrical stove occupied the
centre.
The ordinary airing-courts were much like those above described,
and canvass dresses might be seen here and there amongst the occu¬
pants. The refractory-court was paved with causeway stones, and had
a double row of trees in the centre, with an awning or veranda at each
side. Tour or five patients had on camisoles; one, an idiot, was firmly
bound to his chair.
In one kitchen, and in several of the dining-rooms, I had an
opportunity of witnessing the laying out of the supper. The dishes
were the ordinary large, heavy, earthenware plates, shaped like a
saucer; the drinking vessels were neat glass tumblers. In one, an
infirmary ward, the diet consisted of meat and vegetables, with
about a glass and a half of wine; in others, bread, red currants, and
wine. The whole of the dining-rooms had their tables carefully laid
out and ready before the patients were admitted. A large piece of
bread lay at the head of each for division into nine, that being the
number apportioned to the table. The spoons were of tinned iron,
and of a moderate size. The tables are of neat construction; the
top having an edging of wood, the rest of wax cloth.
The clothing of the patients was of divers kinds and colours, and
in some cases rather shabby. Some appeared as soldiers, others as
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artificers and labourers—jnst according to their trade; many again
had coats of blue pilot cloth of a nautical cut.
They apparently had no games for their exercise and amusement,
but spent their energies in the airing courts; an arrangement by
no means beneficial to their health. No comparison can be made
with the spacious airing grounds, daily games, and general atten¬
tion to open air exercise, so common in well regulated asylums at
home.
In the idiot and epileptic department were many very young, almost
infants; their wards seemed crowded. Malformed beads abounded
amongst these children. Special care seemed to be devoted to their
training and improvement. A music school with its apparatus, and
a teacher, demonstrated their belief in the potency of this useful
agent. In the writing class I saw a number of the ordinary patients
(not idiots) occupied at their copies, either writing, scribbling, or
sketching. One man was quite an adept in ink sketches, and his
figures and houses were very characteristic, putting me in mind of a
certain gentleman in a Scotch asylum, who paints figures out of pro¬
portion, and places ships in their immediate vicinity no larger than a
boot. Elderly females attended on the idiotic and epileptic children,
and the appearance of their charges was very creditable. The beds
were neat and tidy, and the wards as well ventilated as circumstances
would permit. Their exercising grounds are good, and have these
several arrangements:—First, a horizontal ladder, along whose bars the
patients swing for the purpose of exercising the muscles of their arms
and body generally. Secondly, a circular swing, like that used in
our school play grounds. Thirdly, a balanqoire, with bars at different
heights. This apparatus consists of bars having transverse handles at
each end, and moving through an upright pole. Two children seize
the opposite ends, one pressing down while the other springs into the
air, and they go on with this see-saw motion. Fourthly, a wooden horse
with padded leather back, and having in front a mound of soft gravel.
A boy, taking a race, performed a sort of leap-frog exercise over this,
alighting on the soft gravel in front. In another portion of the
gymnastic court thete were two strong upright beams of wood with
a cross bar at the top, from which hung two strong, twisted wire cords,
having a ring at the extremity. Behind this stands a platform and
stairs. A patient mounts up on this, and has the rings of the wire
cords put into his hands; then with the impetus he swings forward
with force into the air, passing between the upright poles, and drop¬
ping on a gravelly cushion in front. It appeared rather a violent sort
of exercise. Besides these, there were leaping-poles, ordinary seated
swings, vaulting-bars, and other arrangements. In the interior of a
large court-house, appended to the east end of this exercise ground,
were numerous articles for gymnastic purposes, and of special avail
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and Belgium^ by Dr, W. Carmichael McIntosh.
in bad weather. Two were somewhat curious; one, a bar with
wooden balls at each end, was seized with both hands, and used by
bending the arms backwards over the shoulders, thus strengthening the
scapular and pectoral muscles; the other was shaped like a ninepin,
and the patient whirled a couple of them (one on each side) with
velocity. It would certainly be prudent to “ seek a secure retreat,”
when a number are undergoing this exercise.
The portion devoted to criminal lunatics is separated from the
rest by high walls. The airing courts for these are very confined,
and the health must suffer accordingly. The building is of a circular
form, with the apartments radiating from a central kitchen. A pas¬
sage runs round the latter, from which the patients are seen through
a high iron railing. Inside the railing is a space for exercise, which,
in every division, opens into two chambers—each containing its
patient. They were in their rooms by the time I arrived (after
4 p.m.); some paced the space to the outside of their chamber,
others were busily engaged at the newspapers.
In the quarters for the ordinary lunatics, the baths were numerous
and closely set in their bath-rooms, and hot and. cold water supplied
to each by stop-cocks worked by keys. Two patients were fastened
in baths, the water in which was certainly not over 45° Fahrenheit
(for they had been in them for some considerable time). The appa¬
ratus for the douche was attached to each, and the attendant—to
illustrate the working of the method—set a cold heavy plunge on the
head of one of the poor fellows, fastened beyond escape beneath, a
proceeding which caused intense distress to the recipient. It was
stated that they found the douche of great use in repressing fury, and
in carrying out habits of discipline. The patients were left in the
baths.
The Bicetre seems an excellent institution for confining lunatics,
but is defective in many points of essential importance.
Salpetriere .—The classification of the lunatic patients (all females)
in this establishment is carefully attended to, a fact which accounts for
the calmness pervading the general airing courts, and the unharmed
and flourishing aspect of the flowers and shrubs, which are only pro¬
tected by a slight railing. The courts are large and excellently
shaded with trees, beneath which many females were seated sew¬
ing, &c.
The dormitories throughout were very neat and clean. The cen¬
tral stoves had a coating of white porcelain, and a place for heating
bedding in cold weather was on the top of each. The bedding con¬
sisted of two mattresses, the lower of straw, the upper of wool; and
sometimes two of the latter deepened the bed more than usual. The
other clothing was of the ordinary description. For the wet patients,
they had a drawer with a brass utensil, and when this was not neces-
saiy, the drawer was used as a receptacle for clothes and other effects.
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By the side of many of the beds there was a neat marble-topped stand
with a door, and in this a compartment for the clothing, &c., of the
patient. No special arrangements existed for the washing of the
patients; probably the attendants' quarter, at the end of the ward,
served for suoh purposes, as I saw several so engaged. An attendant
sleeps in each dormitory. There were some nice open verandas, where
the females engaged in their work, and the paralytics reclined in
chairs, protected from the sun's rays, enjoyed the fresh air.
In a refractory court there were trees but no shrubs, and the seats
were quite loose. The women were certainly, on the whole, pretty
decent, and though a few sabots were lying about, they conducted
themselves very quietly at visit. The refractory court of M. Baillarger
was peculiar in having isolated dwellings for noisy patients. The
doors of these opened by a sliding lateral movement, and the floors
are laid with the usual polished oak. The bedsteads were of iron,
each possessing good, clean bedding, with mattress of straw; one
or two had wool mattresses. There was no window, so that the
apartment was quite dark when the door was shut. No urinous
odour was perceptible in any of these places; in fact, there was a total
absence of this throughout the establishment. Numerous flne trees
dotted this airing court.
The idiots and epileptics had somewhat the same arrangements
for gymnastic exercises as at the Bicetre, the wooden horse, of course,
excepted. For the lalanyoire also the females require a special dress,
for obvious reasons. These wards, under the charge of M. Moreau,
were very interesting. The beds of the epileptics were well padded,
and some were on the floor between the others. The ceiling of this
and several other apartments seemed very low, but the antiquity of
the edifice accounts for such deficiencies. Many of the epileptics
were busy making charpie, engaging in this occupation when quite
incapable of doing anything else. The females of the Salpetriere, in
general, supply the whole of the Parisian hospitals with charpie. In
this ward there were a good many wooden beds, but M. Moreau
stated that they were being gradually done away with. In this de¬
partment there was a young epileptic girl, who acted occasionally as
interpreter, and who spoke English well. She was a very happy
and contented creature, and seemed to like all around her. She
told me that many of her companions had to be put in a camisole
when ill and excited, and innocently added, that she herself required
one last night. It appears that she is subject to severe paroxysms
of excitement, being a most intelligent and industrious girl in the
intervals.
The windows were of the ordinary description, and fastened by
bolts, many being readily opened by the patients. When I asked
if they never escaped, they replied, seldom, as they could get no fur¬
ther than the court; besides the troublesome were duly secured.
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and Belgium, by Da. W. Carmichael McIntosh.
The paralytics generally appeared ranged in rows of chairs in the
airing courts and balconies, and the cases of general paralysis in the
wards of M. Baillarger were* the subjects of a special investiga¬
tion. Several had on camisoles, and others were strapped to their
. chairs.
In the apartments appropriated to the agites, many of the beds
had rings for securing the patients at night.
I saw many of the patients at their morning meal {dejeuner). The
tables were in all cases carefully laid out before the patients entered.
Earthenware dishes were the vessels in general use, of the same shape
as those at the Bicetre. Neat, strong tumblers likewise constituted
the drinking vessels. In the case of the very violent, they had pew¬
ter plates, with a projecting piece or ear, at each side. The spoons
were of galvanised iron, but in M. Moreau’s of wood. Nickel silver
forks of the ordinary shape, and common steel knives, were lying
about; the latter having a blunt point. No fear was entertained
with regard to these. Wine, bread, beef, and vegetables constitute
the dejeuner. They have two diets a day, and all seemed to have
abundance of food.
In the ward devoted to the reception of the new patients, light
seemed deficient ; several were in Bed. This arrangement renders
their subsequent classification an easy matter.
The kitchen formed a lofty oblong apartment, having the furnace,
boilers, stoves, &c., in the centre. There were four or five male
cooks busily occupied here, and large quantities of excellent mutton
and beef were lying about. The arrangements in this department
augur well for culinary cleanliness and quality. They have no bakers,
as bread can be got much better from Paris. The meat-safe was by
the side of the kitchen.
The laundry arrangements are on a most extensive scale, and ap¬
pear excellent. The washing-tubs are in long rows in stone hollows
or troughs; and in addition there are large oblong basins of stone,
into which pure water spouted from a central pipe. A large number
of women, perhaps about eighty, were engaged in laundry duties.
Near the east door of this there are two steam boiling machines, into
each of which 700 drape, or sheets, can be put at once. Each con¬
sists of a large copper cylinder, about four feet in height, and in the
centre of which a piston is in motion, causing the boiling water to
well out over the clothes with every descent. The cover is balanced
and pierced to permit the passage of the piston rod. The drying
green is extensive and good; instead of rope, they have the con¬
necting medium between the poles of galvanised iron wire, which
is now so generally adopted. Besides out-door drying, they have
steam drying on a great scale.
Of the large store-rooms for packing the washed and new clothes,
the order, neatness and taste were pleasing. Every article was care-
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fully folded (with a due regard to symmetry), and placed in its appro¬
priate shelf with the greatest regularity. The shelves were quite
open, the only protection to the clothing being a cotton screen; ven¬
tilation would thus seem to be attended to after the articles were put
in store. In most of our British asylums the labour and care
bestowed on making the shelves so attractive would be considered
somewhat extravagant, but far other are the Parisian ideas. Open
slides hoisted articles from the ground floor to this apartment.
Beneath this is the sewing room, in which a large number of females
sat round tables making and mending, superintended by a matron
and assistants. Besides this, there was another large sewing room in
one of the wards, where upwards of 150 patients were actively and
quietly working.
They sometimes have walking parties of the quiet patients, but
few or no amusements. From all I could learn, few lunatic females
work in the garden, or attend chapel.
By the kindness of MM. Tafforin and Carle, internes of MM.
Moreau and Baillarger, I had the opportunity of seeing some of the
life of the Parisian interne alibiiste. They are somewhat advanced
students who enter asylums not because they intend to become spe¬
cialists, although some do, but allured by the large practice and the
reputation of illustrious physicians. Their duties are similar to those
of our assistant-physicians, though by no means so responsible
or onerous. In their official visits, they wear white aprons with a
front pocket. They attend such classes as they wish at the respective
Parisian schools of Medicine, but of course do not all leave the insti¬
tution at once. Their rooms are ranged together in a single row,
and are small, old-fashioned quarters indeed, but comfortable enough.
In each you might distinguish the ruling passion of the occupant,
whether it might be for books, or for preparations of anatomy
and natural history, or for the less professional musical instru¬
ments, games, &c. They take meals together in an apartment
far removed from their sleeping-rooms, and a happy party they
make, laughing, chatting, and joking, as if the meal depended on
their merriment.
On a shelf in one of the lobbies were numerous plaster-casts of the
heads and necks of the insane, originally commenced by Esquirol.
The advantages of such casts are very obvious; but if casts of the
exterior and interior of the cranial vault had also been preserved, the
collection would have been much more valuable. In regard to this,
a method which I follow in the Perth Asylum (suggested by Professor
Goodsir) is commendable from its simplicity. In post-mortem cases,
a cast is taken of the face shortly after death; then, at the examina¬
tion, one is taken of the exterior of the cleaned bony arch, and
another of the interior. In cases where no post-mortem is procured,
the cast of the face only is obtained. By the outside cast of the
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cranium we have the most important points in the configuration of
the head, by that of the interior, the general form of the hemispheres
of the brain.
In this establishment pet animals for the amusement and cheering
of the patients were deficient; a great many fine specimens, how¬
ever, were crowded together in cages at the dwelling of the porteress,
but, of course, were private property.
Hospice St. Yon, Rouen.—This lies at the outskirts of the city, and
is well fenced by high walls. Entering the porch, I was conducted
to the bureau of M. Morel, who stated that there were many points in
this asylum not at all to his satisfaction, but that the establishment at
Quatre-Mares was much superior; unfortunately, however, I had no
time to visit the latter. The Hospice St. Yon contains both private
and pauper females. The interne conducted me round the establish¬
ment, first visiting some pauper dormitories for the ordinary or quiet
patients. They were in exact order ; the beds of the usual great
depth, and very tidily made ; the practice of pinning or folding the
sheets tightly conduced greatly to the general neatness of the apart¬
ments. The windows were of two kinds, ordinary ones, such as
exist at the Bicetre and Salpetriere, and windows guarded by strong
iron netting. The floors of the dormitories were paved with tiles,
and the dining-tables usually occupied the centre. Geraniums, bal¬
sams, and other flowers, grew luxuriantly on the tops of stoves, while
numerous crosses and Roman Catholic emblems of various descrip¬
tions garnished most available projections and niches. The religious
element is powerful in this fine old city, and it is no less so in its
lunatic asylum; Sisters of Mercy or Secure act as matron, house¬
keeper and attendants. It is doubtful whether it is right to im¬
press the insane so continually with religious feelings, as is done in
France. The tables occupied the centre of the wards, and here, again,
I saw them laid out for the meals. For the gdteux there were heavy
metal dishes, shaped like those in Paris, and with the lateral projec¬
tions ; this class had knives and spoons to a certain extent. The
orderly patients had porcelain dishes, glass tumblers, knives, and
spoons. There seemed to exist no dread of knives, some of which
were very sharp at the point and edge.
I must confess that I was by no means favorably impressed
with the religious element in the shape of attendants either here
or elsewhere on the Continent; besides, it can be easily seen that,
having a sort of respect due to their sacred order in this country,
their value as attendants upon the insane is materially affected.
In the ordinary hospitals they are doubtless invaluable, though,
it would appear, with a few exceptions. A friend in Brussels
told me of a lady of rank who acted as sceur in an hospital to
which he was attached, and whom only by the greatest firmness
could he get to attend to medical orders; for she considered that her
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Notes on Asylums and the Insane in France
rank and wealth were quite sufficient guarantees for her knowledge
in medicinal and hygienic affairs.
The general airing courts were pretty Well filled, and the patients
tolerably quiet as I passed. The courts presented a central space
with trees and flowers, and a porch or veranda extending round three
sides, beneath which the sleeping room and gallery doors opened.
The court for the turbulent had fewer trees, and bore evidence of
violence and mischief; it was only separated from the others by a
slight stake railing, but it appeared that this was sufficient. The
private airing courts are certainly pleasing to any lover of nature,
—lofty, spacious trees, beautiful flower-plots, shady walks and
arbours, afford alike a fascinating picture and a composing pri¬
vacy. Several ladies were enjoying the refreshing shade of the
trees as they plied their fingers in knitting, or reclined on appro¬
priate seats.
The single rooms for the dirty and troublesome patients had mat¬
tresses of straw or sea-grass. They were cell-like, had a bad odour,
and the floor (wooden) was uneven and by no means closely jointed.
There was a padded room for the very refractory, having its canvass
painted: it seemed to be in use. On some beds in the dormitories
there was a silk coverlet filled with feathers—said to be for the
gateux.
A separate dwelling at the back is devoted to the best class of
patients, and Sisters of Mercy abounded here. On the ground-
floor there is a visiting-room for patients* friends, which has quite
an elegant appearance, and here as elsewhere, crosses, &c., abound.
The bed-rooms are very neatly furnished, with good mahogany bed¬
steads—two in number, one for a patient, and one for a soeur, or
convalescent; some chairs and a heating apparatus, with a netting at
the fireplace, &c. There was a strip of carpeting at the bedside, but
the rest of the floor was neatly waxed. The beds, in some instances,
were placed on each side of a recess, thus making the apartment into
a bed-room and a day-room. In these apartments the water-closet
consisted of a simple night-stool, and nothing more, and this
sufficed for a gallery. The bed-rooms and dormitories of the mid¬
dling classes were tidy, the former, as usual, with two beds, but by
no means crowded, as the apartment was spacious.
The baths were in a separate building; they had douche and
arrosoir ,'—two of the latter together, which, being held by handles,
could be directed against the face or any other part of the body at
will. The ordinary shower-bath fell from the roof. One douche-
pipe spirted a powerful stream of water horizontally or obliquely.
The waste water from this flowed over the pavement into an adjoining
apartment, which itself formed a complete bath of considerable
dimensions (about twelve feet long, seven or eight broad, and about
four feet and a half deep). A door at each side gave entrance to
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the bathers, and from each of these apertures a flight of steps led
down to the bottom of the bath. An iron railing guarded each stair
and surrounded the margin of the bath. In this the patients have a
cold bath for a tonic, and, according to the interne , no accident
ever occurred in it, though it certainly seemed too deep. The
garden is large, and is cultivated for the most part by the patients :
rhubarb, asparagus, &c., flourished luxuriantly. The laundry is in
a brick edifice separated from the rest. Bad odours were rather
common in some parts of the house. A few canaries were the only
animals kept as pets. The boarders get a drive into the country
now and then, but the paupers, as usual, are rather deficient in
gymnastic exercises, or indeed exercise of any kind. A circular
swinging coach was the only article of the kind visible. .
Mahon d*Alienee a Lille {dee hommes ).—This building is situated
at some distance beyond the strongly fortified barrier of the town,
and is surrounded by richly laden fields. It is the property of the
monks, who reside and fill most of the situations therein. The
building is a brick one, and was begun thirty years ago, additions
being made from time to time as occasion required; and at present
a very large addition of galleries, dormitories, &c., is busily pro¬
gressing, roofed and ready for the plasterers. There were twelve
patients in the edifice at first, now there are six hundred.
On entering the gate I found several monks, who informed me
that the doctor of the establishment was absent. The superior,
however, conducted me round, and, by the help of a patient who
spoke pretty good English, I got on nicely. Passing through a court
in the centre of two long wings, we first entered a large day and
dining room to the right. This was moderately filled with patients,
some playing at dominos, others reading the newspapers. The
latter are fastened through a longitudinal slit in a slight bar of
wood, bound by a screw with a triangular key, and fastened to the
table by an iron chain. The keys of the doors were all triangular,
and the same key turned the screws in the belts, wrist, and foot
straps, newspaper fixings, &c. This was called the bourgeois gallery.
It might be fifty or sixty feet in length, and had dining tables along
the sides, with forms. A bagatelle and a few other tables also
existed. At the further end of the apartment a library with glass
doors showed that due attention was paid to the comfort and
instruction of these patients. A stove occupied the centre. The
windows throughout' the house had broad iron gratings cor¬
responding to the panes, invisible from the inside when the window
was shut, but appeared prison-like when the latter was swung open.
The superior thought highly of this arrangement, and pointed it out
with evident satisfaction. Attached to this room is an airing court
with flowers and trees, and paved with bricks. Many of the patients
seemed in an advanced and abject state of dementia.
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The dormitories and day-rooms throughout were superabundantly
supplied with crucifixes, &c., which were generally grouped at one
end. At the first division of the infirmary, they had quite a little
chapel (not separated by walls from the rest), with carpeted floor,
raised platform, candles, &c. &c. In general, the dormitories for the
orderly bourgeois and paupers had this arrangement:—on each side
of the long ward were ranged the beds, with a stove in the centre.
The bourgeois had carpeting between the beds, and a strip in the
centre of the ward. The beds were, as usual, neat and clean, and
the frames in all these were of iron, the mattresses of straw and wool,
as in the Bicetre, and the bed generally of the ordinary deep aspect.
In one or two of the pauper dormitories there was a central row of
beds as well as the two lateral, thus crowding into one enormous
ward some sixty or seventy insane men. They were much too
crowded, but of course this will be remedied when their present addi¬
tions to the building are finished.
In the dormitories for the gdteux, the beds had straw bags.
Attached to each of these beds is a strong leathern strap, with a
wristlet, for securing the arm of the patient at night. Tor the
epileptic I saw no special beds, but probably they might exist. Some
of the epileptics had on padded hats, and even then their faces were
cut and bruised.
The scene in the dormitories for the paralytic and furious was
distressing; camisoles, straps, wristlets, leg and ankle locks every¬
where abounded. Patients were tied in chairs, so that they could
scarce move a muscle but. those of the head, nor did they fare much
better in bed. The long strings of the camisoles came into useful
requisition here, lashing the arms and body to the sides and foot of
the bed. Many were being taken out of their chairs by the freres,
and put to bed at this early hour (about 4 pan.). The chairs are
solid, wooden articles, of a cumbrous appearance, with a raised
portion of the seat between the knees, and a foot-board; straps with
buckles hung from them in numbers. These patients appeared for
the most part in-a very abject condition; in fact, in such a state as
I never saw the insane before. The mattresses in these cases were
of straw. This paralytic ward was in great disorder, and the air
very bad. The superior opened several windows as he passed.
The idiotic and epileptic patients were mostly in the day-rooms,
some with leg-straps, others with wristlets. In one corner sat a
poor idiot with a leathern pinafore, which hung from the root of the
neck to his middle; it was bedaubed with his last meal, and wet with
saliva. Camisoles were quite common both in these and other
wards, as were likewise canvass dresses; the airing courts attached
to this department had also a good sp rinkling of both. The
superior was quite astonished when informed of the state of lunatics
in this and other countries, and eagerly inquired as to the method
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and Belgium, by Db. W. Cabmichael McIntosh.
of treating the furieuse. This officer is changed every three
years, for what reasons I do not know, but one would imagine
that such an arrangement cannot result in much benefit to the
patients.
Many new wards were shown unfinished, and some so far advanced
as to have beds, and those of a good shape, and of iron. Ventilation
did not seem to be adequately cared for, either in the old or the
new premises. The apartments were heated by open stoves.
Entering a room on the ground floor, whence issued loud screams,
I found two miserable beings, yet in the vigour of manhood,
fastened to chairs. One had his face all bruised, and a deep cut over
the left eye,—the blood from which matted his hair and besmeared
his face, while he kept up a series of fiendish yells, gnashing his
teeth in bitterness. He had on a camisole with straps in all
directions, and was in a very filthy condition. The other patient
did not appear so much bruised, but was equally dirty. The apart¬
ment was small, badly lighted, wet and odoriferous; and there
they were locked in, each keeping the other company as he best
might.
The galleries for the higher class patients appeared to be mostly
empty. The bedrooms in these had waxed floors, two beds, one
better than the other, and simple furniture. They were out of order,
however, and unoccupied.
The kitchen is large and in tolerable condition. Upon a side
table lay about twenty fat Cochin-China fowls of gigantic propor¬
tions, and the odour of the place was certainly good. Monks were
busy acting as cooks, cutting beef, bread, &c., and their portly
figures told that they did not quite exhaust themselves at the shrine.
They had numerous fine copper boilers with balanced covers. On a
table was fixed a rotatory knife-machine for cutting the soup bread
into, thin fragments. The loaf is put in a groove which moves for¬
ward every turn, and the wheel rotated by a handle, when the thin
slices are pared off with rapidity, and are collected in a box beneath.
In the grounds outside, the trees and flowers were good, but the
opportunities for exercise and amusement lamentably deficient. The
only game they seem to have is rather a peculiar one, viz., rolling
wooden wheels about ten inches in diameter along a broad ditch at
a certain mark, beyond which is a pit. To run the wheels as near
the mark as possible, and to be careful not to allow them to fall into
the pit, are the aims of the players, Running about amongst the
trees was a splendid assortment of Cochin-China fowls, and the
superior seemed proud of his “ Brahmapootras,” as he styled them.
A few patients were assisting some masons in repairing a brick
wall which had tumbled throughout its entire extent, and afforded a
good view of the asylum farm and its crops. This, indeed, is a rich
part of the country, and certainly I never saw better grain. The
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Notes on Asylum s and the Insane in France
soil, capable and fertile, is coaxed to its utmost by attention and good
farming. The horses of this neighbourhood are likewise excellent,
and the cattle large and heavy.
The laundry is quite rudimentary, consisting of several large tubs
clustered in two small apartments, in a separate building. The
superior, however, explained that this was used only for the dirtiest
linen and clothes, the rest being sent regularly to a laundry in the
town. The patients act as washermen. The linen throughout the
house was stated to be changed twice a week. They possess
extensive farm buildings, which likewise include a bakehouse, shops
for carpenters, blacksmiths, &c. Some of the patients assist at these
occupations, or work in the house and garden, but there seems to
be a great deficiency in the affording both of work and exercise.
Many of the attendant monks were rather old men, and did not
seem suitable for such a place. The medical officer and the superior
monks reside in a separate house at the porch, and in this there is a
good library.
Hopital St. Jean, Brussels.—The most interesting portion of this
to the alienist physician is that devoted to the reception of the insane,
before transmitting them to Gheel. This consists of a dormitory and
a range of single rooms, apart from the general hospital. In the
dormitory, which is unoccupied at present, are the ordinary iron
bedsteads and the padded epileptic ones. The single rooms are
rather small and dingy. A passage runs along either side, permitting
a view of the interior from a grated window on the one hand, and
through the inspection apparatus in the door on the other. In the
centre of these was a fixed table, in one corner a seat, and in another
an arrangement for a soil-pan, communicating with the passage. A
low bed occupied one side. These places had a dull, jail-like appear¬
ance. At the further extremity of the row, a padded room of the
ordinary description existed. In a press adjoining this were many
articles of coercion—handcuffs, anklets, camisoles, straps, &c. Some
curious mouthpieces attracted my attention; the wooden gag was
broad, covering the lips as well as the mouth, and to the central
aperture a silver oesophagus tube, like a thick catheter, about six
inches in length, was fixed. There were several varieties of feeding
apparatus, but the most that can be said of them is, that they were
all very strong. The only patients in these quarters at this time
were—a female (a case of chronic mania) in one of the cells; and
two men, subjects of delirium tremens, who were enjoying the
air under a fanciful dome in the centre of the little airing court.
There is a trusty attendant, who conveys the patients to Gheel and
elsewhere.
Gheel .—To a stranger en route from Herenthals to Gheel, every¬
thing is novel. Leaving the railway at the former place, he enters
a curious old coach, drawn by two rope-hamessed horses, whose
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and Belgium, by Du. W. Carmichael McIntosh.
every tug threatens to snap the hempen traces. An uncouth
countryman in a blouse is our driver, and, after a few stoppages, we
are fairly on the track. The centre of the road is paved from
Herenthals to Gbeel, but the sides are left soft for the cattle wag¬
gons. The country around is much divided, and portioned out into
little strips to suit the cultivator or peasant farmer, presenting a
chequered arrangement of the fields as between Rouen and Paris,
though less seen, as the ground here is level. Crops seemed, on the
whole, very good, and consisted chiefly of wheat, oats, rye, potatoes,
flax, buckwheat, and clover. Woods of oak, elm, poplar, and alder,
dotted the pleasant fields, and here and there the deep green of the
Finns sylvestris recalled our own woods at home. The roads are
generally very straight, and quite flat, so that it is not uncommon
to see a mile or two of the line of march in front of you ; and their
sides are bordered with a row of oaks or other trees, planted at
regular distances, giving them a very characteristic appearance. In
the gardens of the peasants were cabbages, potatoes, ordinary peas
and beans, French beans, &c., and often some hemp and a patch of
an umbelliferous plant. Vines grow, here and there, on the walls
of the cots, but the grapes seemed small and poor.
The inhabitants were busily engaged with their harvest operations,
reaping the grain with a peculiar weapon, half hook half scythe, and
assisting with a pronged stick, which acted as hook carrier when
going home.. They have rather an untidy method of binding and
stacking, and generally cut out the field or patch before proceeding
to the latter operation. In many parts, sheaves of flax stood drying
in the sun. In ploughing, they use oxen and horses (the latter
singly), and the plough is single handed. The soil is very easily
worked, and it is a mistake to suppose that the arable portions are
not fertile. After removing the wheat, they plough the stubble
immediately, and sow a second crop for cattle forage.
The houses of the peasants in the neighbourhood of Gheel are of
various kinds. In the country they are not uncommonly made of
osier work, plastered with mud, and thatched with straw or reeds.
Generally, however, bricks are the building materials, and they have
the usual outside folding shutter, so common on the Continent. No
particular neatness characterises those abodes, and the same may be
said of most of those in the outskirts, and anywhere but in the
central street of the town. Offensive ditches, putrid gutters, which,
in some instances, course .right out of the wall of the house, dung-
heaps, rubbish, wood, and various obstructions are common. Even
osier houses are by no means extinct in the town of Gheel itself,
and the dirty, squalid appearance of the interior of these is in keep¬
ing with the exterior. Tiles of a flat shape, and thatch, constitute
the roofing.
Just berore entering the town you pass the new infirmary, on the
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Notes on Asylums and the Insane in France
right, close to the highway, which leads into a street with several
shops and workshops, together with some larger and more pretending
edifices. The inner end of this opens into a large square, having
the church and spire of St. Amaud at the further side, with a figure
of the Saviour on the cross at the railing, and decorated with a lamp
in the evening. By either side of this edifice you pass on into the
principal street, which carries you right through the town.
Before giving our observations on Gheel and its present condition,
it may not be uninteresting to relate a few facts regarding the popu¬
lation, gathered from the last report (1859) of M. Bulckens, the
medical superintendent, and published separately this year (1861).*
The insane population of Gheel during the last five years, dating back
from 1860, has been the following:—in 1855, there were 778
insane; in 1856, 765; in 1857, 801; in 1858, 790; in 1859,
800. This shows an increase during every year except 1856, in
which the number fell to seven below that of the previous one. He
attributes the rise, not to the increase of the insane amongst the
population in general, but to the precautions adopted by the admi¬
nistration for the public welfare.
With 800 insane, scattered among 11,000 inhabitants, the town
and neighbourhood are of more than passing interest to the psycho¬
logist, because the system pursued at Gheel has earned for the place
a very extended reputation, and has given rise to the proposed
modifications of our asylums into detached blocks of buildings,
styled cottage asylums, &c. Many such schemes have originated in
the somewhat prevalent notion that the institution at Gheel is the
beau ideal of good treatment for the insane. But there are many
disadvantages and drawbacks modifying such a supposition, which
are only too patent to the practical investigator. Moreover, so far
are the authorities—medical or other—from supposing that the
system there pursued has been unexceptionable, they have recently
erected a considerable asylum (called an infirmary), in which the
noisy, very dirty, and sick, are to be treated. They thus clip the
"air libre ” from a certain portion of the community, and assimilate
the whole system to that proposed by several original (and other
would-be) schemers for the amelioration of the insane in this
country, viz., a central building of some size, with detached cottages.
At Gheel, the patients may be conveniently divided into two great
classes:—1. Those in the town; 2. those in the country. More
minutely into:—1. In the hamlets in the centre of the village are
divers insane, curable and incurable, whose physical state or moral
* Various able articles on the Gheel question have appeared in the ‘ Journal of
Mental Science,’ and the ‘ Psychological Journal,’ &c., by Drs. Browne, Coxe, Mun-
day, Stevens, Sibbald, and others, while French and Belgian literature is voluminous
on the subject. The above was out of my hands before 1 was aware of Dr. Coxe’s
recent paper.
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and Belgium , by Dr. W. Carmichael McIntosh.
reclamation render them the special recipients of frequent and con¬
tinuous attention. 2. In the houses next these are to be found the
imbecile, mischievous idiots, maniacal, the excited, demented, and the
paralytic. 3. In the third section, composed of houses at a distance
from watercourses, are placed, as far as convenience will allow, the
epileptic. 4. In the houses still more remote, in the habitations on
the moors, hard by the woods, are the violent, the turbulent, furious,
the indecent, and all those who require special measures of disci¬
pline.* M. Bulckens makes the following commentary on the latter
cases:—“Exercise is an instinctive craving of the maniacs; we
isolate them, but we permit them to have free air for the unreserved
use of every muscle, for their vociferations, for their gestures. Their
excitement, meeting no obstacle, shows itself freely, but it is not
long in exhausting itself. Having no other hearers than the woods,
the moors, and the feeble report of the neighbouring echoes, the
insane are but little encouraged to repeat their boisterous conduct.
So true is it that a man, in a state of reason as well as in a state of
madness, often requires an audience for the production of certain
bizarre actions, and to find a stimulant to his eccentricities.”
For taking charge of the 800 lunatics, there were, at the last
general census, 617 nourriciers or peasant attendants. Of these,
280 have one chamber for the insane; 297 have two chambers; 32
have three, and 8 have four. The colony is divided into four
sections, which, without being precisely limited, are nevertheless
practically adopted. Amongst these are scattered the 11,206 in¬
habitants, who possess 1,913 houses. The town includes about a
third of the whole houses and nourriciei'8. The following table from
M. Bulckens' report, gives us the occupations of the nourriciers, and
may prove useful for comparison:
Husbandmen. 372
Shopkeepers . 25
Shoemakers . 17
Tailors . 14
Joiners and Cabinet-makers. 16
Wheelwrights .. 5
Gardeners . 7
Bakers . 8
Butchers. 5
Weavers. 7
Day-labourers . 10
Tavern-keepers. 32
Locksmiths and Blacksmiths . 7
Dressmakers. 4
Lacemakers . 8
Barbers . 5
Sabot-makers. 9
Masons . 4
Slater. I
Turner (wood) . 1
Dyers. 2
Rope-makers. 2
Saddlers. 2
Tanners. 2
Millers . 3
Braziers. 3
Carriers. 4
Canteen-keeper. 1
Employes connected with common
affairs and the insane . 10
Justices of the Peace. 2
Teachers. 5
Veterinary Surgeons . 2
Apothecaries. 2
Doctor . 1
Manufacturer of Tobacco. 1
Householders. 10
643
# ‘ Rapport sur 1’etablissement d’Alienes de Gheel/ par M. le Dr. Bulckens, 1860.
VOL. VIII. 2
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Note* on Asylums and the Insane in France
M. Bulckens paints the relations of patient and nourrieier in glar¬
ing colours, averring that they live on terms of brotherly equality*
The lunatic is not regarded as a person of inferior mind. “ The free
life and family community, set apart for our insane, presents a spec¬
tacle, truly remarkable, daily unfolding scenes the most touching.
It is in short, a phenomenon worthy of admiration, and perhaps
without analogue in the world, in that we have about 800 insane, of
different nations and tongues, placed in different social conditions,
having different manners, customs, and religious observances, circu¬
lating freely in the midst of a population of 11,000 inhabitants,
composed of Flemish countrymen, simple, modest, and sincere
Catholics; to see such a number of insane, male and female, living’
in complete security, in families, and enjoying with a kind of dis¬
cernment, the liberty which is accorded them." Nor is he less
enthusiastic in defending them from all aspersions as to “ degene¬
ration by contact." “It is incontestable that the continuous con¬
tact of so great a number of individuals bereft of their reason in
divers degrees, that such cohabitation and intimate relations impress
a characteristic stamp cm the nourrieier», which distinguishes these
inhabitants from the other communities in the country. In irony,
the originality of the Gheeloise character is too frequently ascribed
to the affinity of causation betwixt their moral dispositions and the
state of the unfortunates whom they receive with so much kindness.
That is a grave error, since, for many centuries, the inhabitants of
Gheel have exercised with impunity the charitable functions which
Providence seems to have devolved upon them. Far from finding
a people subject to the influence of a long-continued morbid degene¬
ration, we encounter a vigorous population, and intelligent ami
valuable sick-nurses, who have preserved intact both their moral
conscience and their reason." “ Independently of the robust con¬
stitution which characterises the Gheeloise, they are distinguished
for their excellent moral dispositions, for a native virtue, simplicity,
and aptitude, and for their affectionate feelings, which induce
them to exercise for their fellow-creatures true charity without
ostentation."
By the kindness of M. Bulckens, the Medecin-inspecteur, I
visited, in company with him, throughout the town, numerous cases
of dementia, melancholia, chronic and periodic mania, epilepsy,
idiocy, &e. Many of the females were cheerfully engaged sewing,
others winding flax for spinning, preparing vegetables for food, or
attending to the children. The male patients assisted the nourriciers
at their various trades, such as tailoring, mason and joiner work,
sabot making, or rocked the cradle and did house work. In one
apartment sat a female melancholic, aged sixty, with folded arms,
refusing to work, in a dejected and comfortless condition. Many of
the patients came from the back apartments, while others were
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and Belgium, by Dr. W. Carmichael McIntosh.
brought from the gardens. A suicidal melancholic sat on a chair in
a dirty back court, sullen, obstinate, and perverse; she seemed dirty
and neglected, but in keeping with the premises. A young hysteric
woman appeared in another dwelling, with a saffron poultice to an
inflamed eye, speaking pleasantly and intelligently; a contrast to
her nourricier, a young Gheeloise woman. In the street were
several imbeciles, carrying the children of their guardians with great
glee, and evidently quite in their dement. This maternal instinct
is often extremely well shown amongst the insane. In the Perth
Asylum there are two very strongly marked examples. One, a case
of erotomania, for a year or two carried a large doll, which she
attended with most assiduous solicitude. It was her companion by
day and night, and she was never happy without it. She heard it
speak during the night, and repeated its sayings to me in the morn¬
ing. Regularly at meals she attempted to feed it with a spoon, and,
at last, having effected an entrance into its mouth, was quite
delighted to see the liquids disappear in its interior. This, however,
proved anything but agreeable, as it was stuffed with horsehair, sea
grass, &c., which materials soon began to rot, and cause a putrefying
odour. The face got damaged with her constant feeding, and gave
way, and a second head fared no better. She was refused another;
and I found her one morning with a certain vegetable, which she
had procured from the kitchen, duly installed on its shoulders,
carved and embellished with coal eyes. The doll had ultimately to
be removed, a circumstance which plunged her into great grief for a
time, and she begged hard that it might have a decent funeral. Its
shade appeared to her in visions for many a day; and she solaces
herself at present by carrying a small carved image in her pocket,
which she also endeavours to feed. The other, a case of dementia,
now carries her “ baby,” of which she is, on the whole, more careful,
the most conspicuous defect being the loss of the paint from its face
by constant kissing. When at chapel, or other place to which she
is not permitted to carry it, she lays it carefully on bed or sofa,
otherwise it is her companion day and night. Where insane females
can be trusted with living children, the effects of fostering this
instinct would seem to be beneficial, conferring contentment and
happiness on such patients, who are led away from the thought of
their own circumstances in expending their energies for another.
Upon a log in the principal street sat an imbecile man, blind of
an eye, and beside him a boy, who was annoying him by putting
sticks and rubbish on his shoulders and neck. This brings out
another point in the Gheeloise treatment, viz., the annoyance and
irritation many must receive from the thoughtless young, who are
surely not so widely different from those of other countries. I
observed several such cases. Some of the loquacious females were
profuse in little complaints, which they recited to the amiable
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Notes on Asylums and the Insane in France
doctor. A lad of twenty presented himself on the road in an
excited condition, accusing some one of tearing his blouse, ill using
him, and bruising his ear and temple. Certainly the upper part of
his right concha was bloody and bruised, but the lad was stated to
be of an obstinate temper and unruly disposition. The interior of
the houses in the town presented very novel features. The great
preponderance of the religious element was striking. In every house
religious statuettes, figures of Christ on the cross. Virgin Mary and
Child, crosses, rosaries. Catholic trinkets, bedecked with flowers and
resplendent with gold leaf, red and blue, garnished the recesses,
shelves, glass cupboards, and prominent portions of every wall. An
eight-day clock of gaudy aspect, rows of plates and glasses, were also
common. The real old Flemish dwelling, however, is met with in
perfection only in the surrounding country. The inhabitants (female)
were engaged in domestic duties, or sat working the famous lace of
this district. I did not see any of the patients occupied at the latter
work, though it is probable they assist.
At the back of one house, on the right side of the principal street,
was a female with her hands muffled in leathern gloves, continuous
with a belt which bound them to the waist, while her ankles were
tied in the usual way. A chain and straps bound her to the out¬
house. One cannot well understand how this occurs in the free
colony of Gheel; surely it is the “ air libre ” system with a ven¬
geance. There she stood all day, I suppose, for the spot had an
air of constant use; nor could she move further than a pace or two.
Her case was one of periodic mania. In this neighbourhood were
several idiotic boys, whose heads, ears, and forms were no less
deviations from the symmetry of nature than their minds from the
normal standard. The patient in most cases was evidently one of
the family, but often an inferior one. On our road to the “ petit
infirmerie ” we met a man with a young woman (a puerperal case)
who had wandered from her nourricier. I afterwards saw her in her
home.
The infirmary is a one-story brick and tile house, with small
apartments, containing stool chairs and iron beds. The female in
attendance turned out a number of hand and foot locks, muffs, &c.,
which seemed in present use. No patient was seen in the house at
this time, but I was not in all the apartments. At a second visit I
made a more minute investigation, and found the bedding and apart¬
ments very clean, the floors covered with pure white sand, arranged
in an artistic manner round the furniture. There were two or three
wooden baths of the ordinary shape. In this house, as in several
others, there existed an apartment, at present in use, devoid of light,
except such as entered by the open doorway, and, of course, when
occupied by the patient, it was quite dark—no, I must not say it
was quite dark; for, on shutting the door, I found that a ray of light
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and Belgium, by Dr, W. Carmichael McIntosh.
entered by an aperture on a level with the floor, through a gutter—an
arrangement forcibly reminding one of the eoonomy of the stable.
There was no defence to this opening, it was always patent. How¬
ever great may be the advantages of this aperture in regard to the
washing and “ air Libre" system, yet the apartment is only suited
to re mind one of bygone times, when our insane were huddled in
cellars and cavities beneath stairs, lighted and fed through an aper¬
ture in the door. An excited female, disposed to wander, engaged
the attention of the woman in charge at my second visit. Of this
erection M, Bulckens says, “In spite of all its defects, our little
infirmary has many a time been a great assistance. In a case suffi¬
ciently frequent—that of refusing food, a tendency to suicide, a
propensity to mischief, excitement and maniacal fury—we have
obtained remarkable succour. We have the well grounded hope that
the results will be still more numerous and favorable when the large
infirmary is opened.”
The new infirmary is a large brick edifice, just built, but not yet
finished internally. The foundations are of dark grey granite. It
looks well from the front, though the closeness of the gates and
lodges gives it rather a prison-like aspect; it faces the north-west,
and the road from Herenthals to Gheel. At each side a large pro¬
jecting wing, connected by the front railing, bounds the entrance
area. Two small lodges, each of a single apartment, are situated at
the gate. Altogether it reminds one of an asylum rather than an
infirmary, and certainly its internal arrangements savour more of the
former than the latter. It is, in fact, an asylum in every sense of
the word, and more guarded than any of our British institutions of
a like nature ; while the want of a fine lawn, large garden or grounds
(there is but a small portion of ground recently planted belonging
to it), makes it appear harsh and jail-like. Its appearance, however,
will be much improved in future years by the growth of the trees
and hedges. Bolts and locks, with keys en suite, and other arrange¬
ments for security, are quite in unison. An asylum at Gheel seems
a contradiction, but assuredly such it is. This building is not a
retreat for the invalid and ailing, but its whole economy is adapted
rather to the furious and troublesome than to the sick and bedfast.
In a sense, it is no longer the free Gheel, whence alienist physicians
might mark our cumbrous institutions for attack, and contrast the
perfect liberty, the confidence, and respect—the lot of the Gheeloise
patient—with the stricter seclusion, mistrust, and all but degradation,
which we show to our insane. But we do not assert that Gheel has
changed for the worse ; by no means ; it has just come to that state
of matters (a central building with surrounding cottages), the con¬
sideration of which is so stirring psychologists in this country just
now, and resulting in the promulgation of experienced and matured
judgments, or else in the vapourings of “ original ” theorists. Gheel
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22 Notes on Asylums and the Insane in France
has seen the disadvantages of treating all cases on the same principle,
and has built the present edifice as a tacit recognition of former
deficiencies, and the exhibition of a laudable spirit of improvement.
The bold advocate for the destruction of all large asylum buildings,
and the substitution of th c, patronage familial , sees the very keystone
of his fabric gone. The ridiculer of the air libre and Gheel system
rejoices, perhaps, in seeing his prediction fulfilled. But the more
moderate alienists recognise a judicious measure and praiseworthy
progress in this most interesting spot.
The building, then, is situated on a sandy spot at the outskirts of
the town, about six minutes 5 walk from it3 centre. It has a supply
of pure and driiikable water, in fact “ il satisfait h toutes les condi¬
tions de salubrite et d'hygiene.” Entering at the front door, we
find on either side (for the building is symmetrical) the kitchen and
culinary apartments. Running backwards from the centre are the
bath-rooms, with a covered veranda facing the airing court, which is
in the same line on each side. The baths are three in number on
each side, of zinc, and surrounded by a layer of bricks. The parti¬
tions between them, as usual, do not reach the roof. Hot and
cold water come from two pipes, meeting in a cavity at the foot
of the bath, though the contents do not mix. Each sends its cur¬
rent into a channel along the top of the bath, whose cavity it enters
by a row of small apertures extending nearly to the other end.
At the one extremity there is an indentation for the head. In
another bath-room is a loose copper bath for the gateux , with canvas
cover, jugular aperture, and numerous straps. The laundry is con¬
centrated into two apartments just behind the middle of the front
building.
The next transverse range of building (proceeding from before
backwards), consists of a row of single apartments for the new
comers. They are characterised as “ Les chambres d’observation, au
nombre de quatorze, sont r^serve^s aux malades entrants, qui n 5 y
sejourneront que le temps n^cessaire & Tetude de la maladie dont ils
sont atteints.” These are rooms about twelve feet long and eight
feet broad. In one comer is an aperture over a pan, with an open¬
ing into the gallery on the south side. The door of each has a
strong lock, besides a bolt above and beneath it. A window, very
prettily barred, admits secondary light, and places the occupants
under surveillance. The floors are of well-jointed oak. The corridor
on either side of these apartments is wide and spacious, the windows
looking into the airing courts. The panes of these were of such a
construction that, if broken, they would easily permit the passage of
a man. In these, as in the windows throughout the house generally,
the lower portions opened readily, affording free aeration, but guarded
by the cast iron balcony. The apartments resembled those in the
female asylum at Ghent, Hopital St. Jean, Brussels, and others.
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and Belgium, by Dr. W. Carmichael McIntosh.
which have been the models, though I think they have slightly im¬
proved on them, in space at least.
Not a single watercloset exists in the house, and this must prove
disagreeable. That the attendants should always be ready to run
when there is any filth in the pans is rather more than can be ex¬
pected ; and it must favour an unhealthy tendency during the warmer
parts of the year. The pans are an imitation of waterclosets, but
want most of their good qualities. The abundance of water stated
to be present might have tempted another arrangement.
In the airing courts on each side of the bath and laundry range,
as mentioned, there is a nice veranda, which is paved with hard
bricks. Close to this is an iron pump of good construction, at the
service of the patients, and this must prove a great boon to the
inmates during the heats of summer. During winter, however, the
slippery mass formed round it might cause disagreeable consequences.
In the two airing courts behind these the pumps are partly of wood
and partly of iron, and are situated in the corner.
. The building at the rear is for the noisy and outrageous—“ Les
deux pavilions d'isolement seront affecfrss aux malades qui exigent
un isolement temporaire, soit pour calmer leur paroxysme mental, soit
par mesure de securite publique."
The other accommodation consists of two chambers, each for five
beds, to be used as infirmaries for the sick; six apartments capable of
holding twenty beds in alL The larger dormitories appear to be
well ventilated; apertures exist in the ceiling and walls, as in
Guislain's Asylum at Ghent. The apartments for single patients look
well, as also the attendants' rooms. The refectoire beneath (on the
ground flat) is cheerful and spacious. All these have ordinary deal
flooring.
The principal stair is of the fine grey granite, and quite spacious,
affording a splendid leap for a patient so inclined. On the first
landing there is a store room. A flight of wooden steps leads to
the attics, but these are probably intended for lumber.
The east wing in front is destined for the house of the medical
superintendent, the west for the bureau and business apartments.
All the windows, which open on the swing principle, shut by keys,
except of course the lower part with the iron balcony, which is at the
will of the patients. The doors have double locks ; a small round
key, and a larger intricate one beneath. There was no provision for
fires in the dormitories, &c., but stoves will probably be added ere
this. Besides the front gate, there are other two opening into the
airing courts hehind.
Dr. Bulckens kindly sent one of his secretaries to act as my guide
in investigating the surrounding country, and with him I visited
many cottages, both in and out of town. In addition to this I
examined many houses of patients alone, or rather along with my
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Notes on Asylums and the Insane in France
father, paying especial attention to their internal arrangements for
the lodgement of the unfortunates. In the country, many of the
patients were engaged out of doors, gathering or chipping firewood,
herding the cows or attending to the children—the favorite occu¬
pation. A female met us at the west end of the village, gaily sing¬
ing, and apparently quite unconcerned at the passers by. Many of
the women were in bed, having retired to their apartments for quiet
and sleep, a habit and privilege which seems prevalent, especially in
the case of corpulent women. The bed-closet doors are often
fastened on the inside, so that no interruption may happen them.
The bed-closets—for they were nothing else in most cases—were
universally of meagre dimensions, and generally badly lighted and
worse ventilated. The bed occupied the best half of the apartment in
most; a mattress of wool (once of feathers) reposed upon another
of straw, or else a bag of chopped straw was superincumbent to loose
wheat or other straw. The bedding was rather coarse, akin to our
packing, and widely different from that given to paupers in other
parts of the Continent. Coarseness, however, is subservient to
cleanliness, but unfortunately the bedding often seemed anything but
pure. The generality of the windows or apertures in these closet*
were barred with iron or wood stauncheons, which effectually pre¬
vented the exit of the patient, while there existed a bolt on the out¬
side of the door rendering matters comparatively safe there. The
beds were of wood, and like most of the houses in the country neither
new nor inviting. The clothing of the female patients often hung
about the apartment in all directions, and appeared rather dirty. The
whole arrangements for the patient's lodging seemed apart from the
others, and by no means mixed with that of the family, who occupied
beds in other apartments. The housing of the patients at night is
evidently a thing of security, not domesticity; and when the external
air is excluded by the shutting of the window, the place must present
an insufferably close atmosphere, by no means in consonance with
Pair libre. In no case did I see two beds—for one of the family
and a patient, or for two patients; all were separate. There is no
doubt that the patient derives great benefit by mixing with the
family during the day, but it must be remembered that all is not
freedom, even at Gheel. Sometimes the sleeping apartments of the
patients had to be scaled by clambering up a precipitous and ladder-
Hke stair (even in the town), and were then found on a level with the
lumber loft, &c. Frequently they were situated on a higher level
than the ground floor in general use, and had to be reached by steps
nailed to a slanting trap door, which led to a suspicious, cell-like
apartment beneath, with a grating in the outer wall for light and
ventilation. I asked my conductor if they never put their patients
in these when excited; he said it would not be permitted. The
apartment did not appear altogether designed for peats or sticks, for
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and Belgium , by Dr. W. Carmichael McIntosh.
neither soiled its whitewashed walls; in charity, however, we
will suppose that it is not occasionally put to the above-men¬
tioned use.
It is stated that, of the quiet patients, those engaging in agri¬
cultural labour, or otherwise suitable for the country, are sent
thereto; but a man with anklets, who was wandering quietly about
in the halting and shuffling way his bonds permitted him, showed
that some were not thus selected. The guide feelingly pointed out
that they were nicely padded, and did not seem to think them at all
troublesome. The remarks on restraint made by Dr. J. Sibbald
in his able article on Gheel, in the “ Journal of Mental Science,”
April, 1861, p. 43, appear to me to be very apposite, and I shall not
enlarge further on this point. Many of the patients, both male and
female, were engaged cleaning potatoes, &c., with knives, and their
clothing often seemed rather dirty. It does not contrast very much,
however, with that of their nourriciers, since the latter are by no
means remarkable for tidiness. The idiotic portion, with the
exception of the children, had the dribbled breast and filthy appear¬
ance characteristic of the same class as they formerly appeared in the
outlying portions of Scottish territory. The old male patients seem
to have a predilection for nursing the children, and are sometimes to
be met with them in their arms outside, or sit indoors rocking the
cradles most carefully, reminding one forcibly of the pictures drawn
by the describers of husband drudges. In the country some of the
male patients lie at the roadside basking in the sun. One, a
soldier of the line under the great Napoleon, and who had weathered
the terrible Russian campaign but to pass the remnant of his days
at Gheel, was peculiar in averring that he did not care much for this
neighbourhood. He talked with glee of the French victories under
his former chief, hated the Russians, but liked the English for their
money and roast beef, commodities I dare say by no means abundant
amongst the Gheeloise peasantry. Almost all expressed themselves
quite pleased with Gheel, and seemed at home in the harvesting and
other out-door occupations. In one house, I found the patient
seated in a very small apartment, dimly lighted and closely shut, and
in which I could scarcely stand upright; around him were piled
heaps of small deals, having apertures cut in them. To pile, alter,
and repile them, and to make a few coronets of twigs, was the sole
occupation of this man. He never went out to walk; and, in fact,
would not; his case was not the only one in which the free country
air would be of little avail, except when it entered their huts. I
passed a paralytic near the house of the “ Harmonie,” towards the
west end of the town, who was busily engaged uprooting the grass
from the side of a ditch, and he did so with great success; he rose
afterwards, and commenced tearing the leaves from a hedge in front
of the houses : no one took notice of him, and he took little heed of
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20 Notes on Asylums and Ute Insane in France
me while sketching him and some houses in the neighbourhood, and
I left him as keenly engaged at his work of destruction as ever. A
little further on a gentleman accosted me in broken English, and
asked if I would like to see his Swiss sketches; he was evidently a
patient ( pensionnaire) i and the box which he turned out contained
nothing but a perforated stand, and a little wooden cube.
The cottages of the Flemings keeping patients in the country are
rather primitive, still retaining much of the characteristics mentioned
by the distinguished Lunacy Commissioner, Dr. W. A. F. Browne,
in his visit to Gheel, twenty-three years ago.* Each has its garden of
ordinary vegetables, and its sunk well, over which stands a long
weighted pole swinging on an upright beam. From the upper end
of the oblique pole hangs a chain and hook; having suspended the
bucket on the latter, the cottager pulls down the high end of the
pole by the chain, thus letting the bucket descend into the water,
when it is filled he has nothing to do but to let go the chain, and
the bucket rises in virtue of the loaded extremity of the pole. A
furious and powerful watch-dog welcomed you with bark and spring
as you passed, and had not the chain been sufficient, many would not
have belied their wolf-like aspect, as one or two loose ones we
met clearly demonstrated. Attached to the cottages of those having
land is the bam, which in many cases they were busily filling . We
are accustomed in Britain to see the grain of farmer and cottager
alike put into stacks, close to'the homestead, but here it is otherwise;
the small quantity of land held by each rendering the storing of it
under a roof quite feasible. The carts are drawn sometimes by oxen,
at others by horses. Attached to the house are the stable, byre,
and other erections necessary in country life. At or near many of
the houses you might see a stagnant pool, abounding in fine AJgse
and interesting microscopic specimens of various kinds, Dytisci and
Bull-frogs, while over it skimmed the gaudy Libellulse, cutting their
way through myriads of flies. The house itself is usually built of
bricks, and the roof still remains "large, deep, and thatched.”
The interior was in keeping with the exterior quaintness. The door
generally ushered you into the principal apartment, in which the fire
occupied the ground between two spacious jambs, and over it I some¬
times saw a large iron pot suspended by a novel arrangement. A
wooden post with a pivot in the ceiling and another in the floor,
gave out a powerful horizontal bar (crane fashion) about twelve or
thirteen feet in length, from the extremity of which dangled the
iron pot. The advantage of this primitive affair one housewife pro¬
ceeded to illustrate; opening a narrow, horizontal deal flap in the
opposite wall of the apartment, and also an ordinary door continuous
with one end of this slit, she swung round the huge crane, the pot
* Vide ‘Med. Critic and PsychoL Journal,’ April 1861, p. 218.
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and Belgium, by Du. W. Carmichael McIntosh.
at the extremity of which passed through the doorway, while the
radius, as it were, entered the horizontal slit, thus permitting the
pot to describe a segment of the circle in the other apartment or
byTe. In other houses, a small iron crane, with a nitched pen¬
dant of iron, supported the vessels. The extensive jambs gave
refuge to many articles of culinary and domestic use, nor was it
uncommon to see a chair or two in the same locality. Along the
mantlepiece are ranged ordinary plates of crockery ware (an improve¬
ment on the pewter of 1<S38), and, indeed, the whole aspect of the
place was quaint and original. Another apartment or two, one of
which is the patient's bed-room, of no less primitive appearance,
complete the edifice. In many of the peasants' houses around the
town I saw another peculiar heating apparatus, doubtless resulting
from the nature and scarcity of their fuel. It consists of a little
cylindrical stove, which opens at both top and bottom; from the
upper end a flattened horizontal tunnel proceeds, and this is the
portion used for general cooking purposes. Wood, peats, and brush¬
wood form the usual fuel. In the typical Flemish dwellings, the
peats were symmetrically ranged in their large open fireplaces.
The inhabitants throughout are very kind and hospitable, and
behave remarkably well to strangers ; indeed, one is struck with the
civility and politeness of these rustics.
As regards the hygiene of Gheel and its neighbourhood, the state
of filth everywhere abundant, except, perhaps, in the central street,
gives one no very exalted opinion. Assuredly in no British village,
with half the interest attached to it, would such a state of things
be permitted. Stinking ditches, collections of manure, putrid
pools, &c., abounded in the outskirts and back dwellings of the town.
I saw a good many cases of skin disease of the face and mouth in
the young children playing about the roads, and this is not to be
wondered at. From the before-mentioned report, we learn that
during the four years—1856, 7,8, and 9, smallpox, cholera, influ¬
enza, dysentery, and typhoid fever, have reigned epidemic at Gheel.
In 1857, during the first quarter, smallpox occurred with virulence.
The lunatics, however, were spared; only four had it, and those in a
mild or varioloid form. During the third quarter of the same year,
cholera occurred; many of the insane had it, but without any dis¬
agreeable result. In 1858, during the first quarter, a persistent
and intractable influenza, complicated with grave affections of the
organs of respiration, attacked both lunatics and inhabitants. During
the third quarter of 1859, dangerous fevers, typhoid affections, and
dysenteries, made great ravages in the neighbouring districts. Pre¬
cautionary measures were taken at Gheel; attention was directed to
cleanliness, hygiene, and diet; and, although many of the inhabitants
of Gheel became victims of the epidemic, yet none of the insane
succumbed. Of 257 deaths, which occurred in these four years.
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Notes on Asylums and the Insane in France
107 were from cerebral affections; 70 from diseases of the chest;
30 from affections of the abdomen ; 50 from other maladies. This
gives a large proportion of brain diseases, even amongst a commu¬
nity of the insane. Of these, there were 27 cases of sanguineous
congestion; 7 of serous congestion; 11 of ramollissement cere¬
bral; 43 of general paralysis and ramollissement cerebral; and 19
of epileptiform convulsions.
Throughout, the patients seemed to have plenty of food. The
bread for the paupers is dark rye bread, occasionally having a few
currants; sometimes it is much darker than at others. For the
better classes the bread is white. In one house, while getting a
sight of the patient's bed room which happened to be darkened, the
opening shutter disclosed a considerable number of loaves of very
mouldy rye bread, which, jf they were intended for the lunatic, showed
a certain amount of carelessness. The moisture exhaled by the
sleeper had caused the growth of the fungi.
The clothing of the .pauper patients was little commendable,
being frequently very dirty. It is stated that “ most of the men
wear, besides a complete habiliment, a blouse of blue linen, others a
great coat; the females wear—some gowns, others jackets and
cloaks of cotton.” For shoes, most of the same class wear the
sabots. Although it is affirmed that the clothing of the aliens much
resembles that of their guardians, yet I could always distinguish the
peasant women by their long brown cloaks and hoods (when they had
them on), and by the greater prevalence of the quaint lace caps with
their pendent sides amongst the older females.
The religious element, as before mentioned, is conspicuous at
Gheel. Roman Catholic emblems, such as a full-sized figure of a
turbaned knight slaying the devil as he issues from beneath the dress
of a handsome lady engaged in her devotions. Saint Dymphna with
the evil one in chains, pictures, small churches, here, there, and every¬
where, form a very striking feature in this colony. In the country
you see curious toy-like articles in glass boxes stuck on trees at the
meeting of roads, &c., apparently as objects of veneration to the in¬
habitants. Almost all the insane are Roman Catholics; only twenty-
one are Dissenters, Protestants, and Israelites. The lunatics attach a
great value to the frequenting of religious exercises. More than 300
insane assist regularly, on Sundays and fete days, at Divine ordi¬
nances. A small number daily frequent the churches. The church
of St. Dymphna, the patroness of the insane, is most resorted to by
the patients.
Means for amusement are by no means so abundant. There are
several billiard-rooms, one just at the entrance of the village, to which
the patients have access. You also see some in the inns occasionally,
but it is stated that they are not allowed to purchase an intoxicating
amount of liquor.
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and Belgium , by Dr. W. Carmichael McIntosh.
La Maison des Femmes Alienee , Ghent.—This edifice is situated
not far from the centre of the town, near the Quai aux Violet tes, and
in proximity to a manufacturing house, which thunders forth a dis¬
agreeable din. Just as I was inquiring for the physician, M. Ver-
meulen, he entered, and with the greatest kindness and courtesy he
showed me round the house. After seeing the surgery, which is a
pattern for neatness and tidiness, and has an extensive supply of
medicines, we entered a square airing court for the tranquil, over¬
looked by a balcony with workers, and having on the left (west)
a row of tidy single apartments, which were allotted to the most
deserving patients as a reward. There were flowers and trees in
the centre of this airing court; the rest was paved. The rooms for
the noisy patients were like those at Gheel in some respects. The
barred, unglazed window opened into the corridor, and they had each
a bed of the usual construction. In one or two instances leather
wristlets lay on the beds. These apartments were dingy and unin¬
viting, though there was nothing which offended the sense of smell.
For the dirty patients, the mattress was divided into three portions,
and stuffed with straw. The central one readily lifted out, disclosing
in some cases an India rubber portion, with a hole in the centre; in
others, a sloped zinc bottom, with aperture and funnel. The elastic
was convex when the bed was empty, but the weight of an occu¬
pant makes it hollow in the centre, thus forming a slope to the
funnel, which opens into a metallic vessel beneath. Wool and straw,
or wool partly mixed with horsehair, formed the contents of the two
ordinary mattresses, and the bedding everywhere throughout the
house appeared good; the bedsteads were of iron. The infirmary
beds had in all cases white side-curtains; several phthisical, idiotic,
and convalescent cases were the occupants. Carpets were frequent
in the pauper dormitories and sleeping-rooms, and where these were
absent, sand, arranged artistically, besprinkled the floors. Stands at
the side of the beds were common, and one division, containing two
shelves, was appropriated by the patient for sundries. In some cases
the Hoots were of oak, in others of ordinary deal. The apartments
were ventilated by apertures in the roof and walls, as well as by the
stone gratings, which had communication with the external air.
In a large oblong apartment sat fifty or sixty females busily en¬
gaged in the manufacture of lace, happy and smiling. They plied
their fingers most industriously, and the profits of such work must be
considerable. Besides those congregated here, many others in the
galleries and airing courts were sewing, knitting, or making lace.
Pictures abounded in the large workroom, and throughout the house
generally, chiefly, however, of a religious character. Statuettes,
crosses, and Roman Catholic articles of many kinds, constantly met
the eye. Near the work-room I saw one melancholic pouring in
great tribulation over her prayer-book.
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Notes on Asylum and the Insane in France
I witnessed the dejeuner of about eighty or ninety pauper females
in a large oblong refectoire, whose ceiling, like that of most other
parts of the pauper division, seemed low. The plates and spoons
were all arranged previously, and the tin drinking vessels filled with
the sour beer of the country. The soup, which contained a great
quantity of bread, was also ready in large jars, and the bread cut
before the patients were admitted. Their plates were of metal, and
very heavy. There was some little confusion, but not much, with,
so large a number of the insane. *
The paralytics, when out of bed, were fastened for the most part in
chairs, with a flat bar in front. In the idiotic and epileptic division
were many very young children; one pretty little thing, subject to
several epileptic fits daily, seemed a general favorite, and ran
to every one, soliciting kisses. Some of the noisy and trouble¬
some had on camisoles, and straps fastened with the triangular
screw. In the school-room for these were numerous large, coloured
diagrams on rollers, with hundreds of figures of beasts, birds, fishes,
flowers and fruit, articles of furniture and decoration. Each of the
patients is taught to repeat certain of these at sight. Besides
these there were the ordinary articles in general use in the school¬
room, boards, desks, &c.
The kitchen for the paupers seemed very good; the lower part of
its walls are composed of white glazed tiles, procurable from Amster¬
dam, Rotterdam, &c., at a moderate price. This is a feature worthy of
notice, as placed at the back of boilers, &c., in fact, all round the
place, it ensures perfect cleanliness with a trifling effort—a state of
matters so desirable in a kitchen. The kettles and culinary vessels
in general were of brass. In the laundry, and general store-room,
the clothes were well arranged, but far from equalling the neatness
of the same department at the Salpetriere.
In the balconies, which were protected by a strong netting of ele¬
gant pattern, were many fine flowers in vases, and the females seemed
to take great delight in working beside them.
The apartments for the private patients were next visited. In an
airing court stood one large woman suffering from valvular disease,
bound round the waist with a leathern strap, her wrists being attached
to this on each side by a belt and screw. She was stated to be very
violent. Several rather excited patients were loose at this time, and
when I passed again through this airing court, one was fastened with
straps to her chair. The court, though small, had nice plots of
flowers, shrubs, and trees, with shady arbours. On the south side of
this are situated the single rooms for the excited patients, containing
the ordinary bed, a piece of carpeting, and with the barred, unglazed
window opening into the corridor for observation. The day-rooms,
saloons, parlours, and bedrooms of these and the higher class
patients, were all of the best description, and were tastefully furnished
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and Belgimn, by Dr. W. Carmichael McIntosh.
both with articles of use and luxury. Fine mahogany furniture,
alabaster statuettes, and vases with flowers under glass shades, gave
an air of elegance to the rooms. Mahogany washing-stands and acces¬
sories, white porcelain basins, rich bedsteads, curtains of various
colours, looking-glasses, pictures, &c., made the bedrooms scarcely
differ from those of a private house. In a spacious lobby stood a nice
bookcase, filled with elegantly bound books. Picturesque scenes,
viewed through an eye-piece, were mounted on stands for amusement.
In the drawing-rooms and parlours are many large mirrors, glass
and china ornaments, and paintings of the Flemish school—the reli¬
gious element predominating. Some of the high-class windows
looked into the streets, only protected by the green and red Venetian
blinds on the exterior, and which readily pulled up, permitting a view
of the street to the right and left. Reflectors, projecting from the
windows, also showed the passers more minutely. The ladies had
several newspapers, and illustrated periodicals of various kinds.
Attached to the apartments for the highest classes is an elegant little
chapel, most expensively fitted up and ornamented. Amusements
and luxuries seemed to be well cared for in this part of the house.
The kitchen belonging to the private apartments was in keeping with
the other arrangements. The airing courts for these have large
pictures, representing country scenery, waterfalls, &c. Some of
them are situated at the back of little arbours of shrubs and trees,
or have a canvas awning in front to shield the patients from the sun.
In a court next the street, most of the walls were covered with these
pleasant pictures of rural life, so that, even in this narrow space, the
occupants might revel in the sight of waterfalls, mills, trees, shrubs,
and flowers. A little fount, set on at will, was in the centre of one
court.
The large general chapel had the usual structure. Separated from
the further end is an apartment intended for the paupers, who get a
glimpse of the priests or others officiating only through a dingy iron
grating. This arrangement did not seem at all pleasing, and had the
aspect of being suited for criminals, not ordinary lunatic patients.
The official staff in this asylum is composed entirely, of sceurs.
La Maison Sancte le Strop, Ghent.—This is situated at a distance
from the town, by the side of the canal. It is built of brick, and at
present large additions are being made to it. M. Vermeulen had
the kiaduess to accompany me hither, and go round the premises
with the superior. It is for male private patients only, and, as usual,
the monks act as attendants; the latter wear tight, leathern cowls.
i3y the side of the porch is a range of new buildings, in an
advanced state, consisting of porter’s house, visiting-rooms,
saloon, &c. The bedrooms throughout the asylum are for the
most part excellent. The plainer apartments, however, appear
somewhat small; having a wooden bed, which by folding thrice
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Notes on Asylums and the Insane in France
form a chest-of-drawers appearance when shut. In the sleeping-
rooms of the higher classes, which were in a separate establishment,
a mahogany bedstead, chest of drawers, or wardrobe, neat basin-stand
with toilet requisites, nice table, and altogether elegant furniture, ren¬
dered the apartments quite handsome. Beligious pictures, crosses,
looking-glasses, glass and china ornaments, exhibited a considerable
taste for display. Attached to some of the larger rooms is a small
one for a frere. Many of the beds had an apparatus for elevating
the one end for ease and in the case of sickness. Those of wood had.
a music-stand or desk process of elevation, with a bar and niches.
In the iron bedsteads the arrangement was much more complicated
and expensive, in fact, the bed was raised by regular machinery. In
turning down a bed to exhibit the structure of the zinc tunnel for
the dirty, a set of leathern wristlets and straps came into view, much
against the will of the superior, who looked anything but pleased at
their appearance. There were no proper water-closets in the house,
the substitutes being night-stools.
The day-rooms and parlours were also richly furnished, and most
had a neat bookcase and books. Very fine views of the town, and
surrounding country rendered the prospect from many of the windows
attractive and cheerful. The railway to Bruges and Ostend
passes on the other side of the canal, and affords variety to the
inmates. In a saloon for amusement were several gentlemen at
cards, one playing very nicely on the piano, and others amusing
themselves at dominos. Adjoining this is a billiard-room and its
occupants. Many of the patients reclined under a veranda, reading
or smoking. This portion of the building, allotted to the highest
class, is detached from the others, thus having greater privacy and
quietude. The day-rooms are tastefully and expensively got up, and
abound with pictures and ornaments. The dinner happened to be
laid in one apartment. For this they had nice plates and dishes,
knives of the ordinary kind and pretty sharp forks, spoons, large
sharp-pointed carving knife and fork, and all the conveniences and
elegancies of good society. The rests for the knives and forks were
of blue glass, and the whole had a very pleasing look.
The stairs in most cases are of the ordinary character, and carpeted;
the lowermost step in the best quarters being of black marble. There
was a slight barrier to prevent jumping down the well of the stair in
one case, but it was rather inefficient, and seemed more for ornament
than use.
Their baths are of the usual form and construction (resembling
those in the female asylum at Ghent, &c.), and are surrounded
by bricks. Apparatus for douche and arrosoir is present. I was
surprised to see a bed in one bath-room, but the doctor explained
that this bath-room was for prolonged immersions in hot water, with
cold to the head, and that the patient was sometimes kept in for five
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and Belgium , by Dr. W. Carmichael McIntosh.
or six hours, requiring thereafter the bed for recovery—a considera¬
tion by no means startling. These baths are composed of zinc; and
where a lid was present, it was secured by pieces of flat iron rod,
having the ends bent at a right angle, and tightened or loosened by
being slipped on to a wider or narrower portion.
In the airing court for the gateux there were several camisoles in
use. There are idiot boys in the establishment, but I did not visit
their apartments.
T'he garden seemed very fertile; ordinary vegetables and fine
flowers flourished in luxuriance. Nice, shady trees characterised the
airing courts. A very prominent and pleasing feature in the latter
is the abundance of pet animals. Tame blackbirds hopped about
the airing court of the gateux; bird-cages, with linnets, canaries,
thrushes, parrots, &c., abound in the rooms and outside in the
veranda. In the arboreal and tasteful airing court of the best class
of patients are fine aviaries of elegant construction. In these were
silver pheasants, jays, turtle doves, quails, blackbirds, continental
passeres, canaries, and a curious variety of the partridge, with a hooked
beak. All these flourished in their respective apartments, or roosted
under the common dome. A rockery and a small fountain decorated
the interior of one of the aviaries.
Guislain’s Asylum, Ghent.—This is a comparatively recent asylum,
erected under the superintendence of the illustrious Belgian alienist.
It is at a little distance from the city, at its north-west extremity, and
is reached by a fine drive beneath an avenue of beautiful trees, which
tower by the side of the canal from Ghent to Ostend; the building
faces this, and has a good appearance, in spite of its bricks. It was
built in 1852, for 150 male patients. The approach is quite bare,
and a contrast to that in its neighbourhood. On entering the gate,
you are in the convalescent and business court, having on the left the
chambers of the medical officer and visiting-rooms; on the right, the
bureau of the business department, director's room, kitchen, &c. In
the saloon, adjoining the visiting-rooms, are a number of good oil
paintings, left by Guislain as a legacy to the institution; in addition
to these, he left other pictures, books, and many thousand francs.
Passing on through the infirmaries, we first entered the airing court
for the idiotic and epileptic boys, and I had an opportunity of seeing
them at drill. A soldier is hired for this purpose, and he performs
his task with zeal and energy. About sixty boys were ranged in a
double row, and at the»word of command went through various evo¬
lutions, bending or rather thrusting their arms upwards, horizontally,
and downwards, whirling first the one, and then the other, stooping
and raising their bodies in a manner calculated to bring many mus¬
cles of the back and thighs into action. Some were very young;
others about fifteen or twenty. Two freres assisted at the pro¬
ceeding; one exhorting the lazy and awkward, the other going
VOL. VIII. 3
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Notes on Asylums and the Insane in France
through the movements with the boys. It was an interesting sight,
indeed, and they went through the movements exceedingly well,
though the clouds of dust which swept through the hot airing court
rendered it by no means an easy task to witness or undergo. In this
court there was a swinging-boat, a few parched trees, and a dressing-
house. In the school-room of these children, there were numerous
large maps with figures of animals, &c., as in the female asylum in
the same city. Alphabetical and arithmetic tables in multitude,
harmonium and other musical apparatus, all had their respective
places, and gave evidence alike of the wisdom of the physician and
the advantages of the pupils. An attendant sat in the centre, binding
some books. Writing-desks and forms occupied the rest of the
apartment. Tor exercising the arm, shoulder, and back, there were
long, weighted boards, with cross handles at each end. A pupil
seized either extremity, and balanced the bar upwards and down¬
wards.
The dormitories of the epileptic and idiotic children had generally
three rows of small beds. Ventilation in these, as in the other apart¬
ments, was accomplished by apertures in the ceiling and central
stove. A tumbler with a night-light is also set in an aperture in
the wall, which is tunnelled from beneath, and has an outlet by a
chimney above. The light is protected in front by glass. In the
dormitories for the ordinary adults, a piece of carpeting lay between
each bed. The bed frames are composed of iron; bedding not so
deep as in Paris; mattresses of wool and straw, or the wool one was
partly mixed with horse-hair—an arrangement, according to the
interne, very commendable. The ordinary apartments and refectoires
were large and spacious, with high ceilings in all cases.
In the airing court for the dtornents and paralytic, some of the
patients had long blue dresses, others with their arms in sac sleeves
and lashed to their chairs, which had the bar in front. I did not see
any with the ordinary camisole , though several were quite as securely
fastened. In this airing court, the central grass plot was railed off
with stakes, and in the enclosure were two fine white swans, and a
piece of water six or seven feet long. Magpies hopped up and down
on the trees, on appropriate sticks, and there were several other
birds. Thus, although not permitted to have the use of the grass-
plot, the patients had always fresh subjects of interest. A verandah
at the north-west side afforded those in the chairs shelter from the
sun. Under a porch, a frere and an assistant^acted as barbers, and
we came upon a number going to the baths, one or two with their
arms tied. The interne .averred these had "evil intents,” and
avoided them. The baths are like those described at Gheel, and
were the models from which the latter were constructed. The airing
court for the tranquil (in the centre of the establishment) presents
chicken, turkeys, pigeons, guinea-fowl, and other interesting pets.
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35'
and Belgium , by Dr. W. Carmichael McIntosh.
This furnishing with living objects of natural history, was a marked
feature throughout, and cannot be too highly commended. In
Britain, it is often pitiful to see the deserted and bare look of the
airing courts in some asylums, in which the patients have nothing
to interest them beyond each other’s sufferings. Noble trees, the
growth of many years, are cut down because one or two climb thereon,
or for fear of suicide; and few pet animals are encouraged; yet the
same physician who thus shuts his eyes to the influence of nature
may be a most strenuous advocate for more questionable forms of
merely temporary interest and amusement, and scruple not to regard
as * narrow-minded’ those of more moderate views. No benefit
results to the insane by rendering the ordinary airing courts like
those of a jail. The patients in the present case eagerly took ad¬
vantage of their excellent courts, and seemed in general happy and
contented. The grass-plot was neatly cut, and vigorous young trees
made the place quite pleasing.
The airing court for the noisy and furious is in the form of a
semicircle, with their apartments at either side; the baths occupy
the centre of the curve. A colony of pigeons flourished unharmed
in a pole dovecot, while plenty of flowers, shrubs, and trees, made
the court one of the most lightsome in the premises. Posts, with
transverse bars and projecting pins, formed part of the arrangements
for manufacturing flaxen ropes; one patient turned a wheel, and
others payed out the tow. In the outer wall are many grated aper¬
tures through which the patients may view the surrounding country,
and watch their quieter neighbours bringing in the grain and
stacking it.
The dining-rooms are large and well ventilated. They use prin¬
cipally metal dishes, with spoons and forks, but no knives. This is
not on account of the danger of the knives, at least the interne
said so.
Several of the apartments were only occupied by empty bedsteads.
Throughout the house the latter were entirely of iron, except for the
gdteux, and where a wooden board formed the guard at the head and
foot. The gdteux had wooden bedsteads and straw mattresses in
three divisions, with the usual zinc slope and tunnel beneath the
central portion. The single chambers for the turbulent had an
aperture about two feet long, on a level with the floor, for washing
out the apartment, and certainly there was no urinous odour.
The windows need not be again described, as they formed the
pattern for those at Gheel. The general clothes’ store was
very well kept, and a large quantity of the new materials, towels,
strong dresses, and sheets, was the product of native industry.
In the workshops several carpenters, eight or ten weavers, and
one or two wool-pickers, were busily employed. There is no
night attendant on the tranquil, but in the infirmaries, and
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36 Notes on Asylums and the Insane in France and Belgium.
amongst the dirty there are watches. There did not appear to be
any other watercloset than open privies near the farm, at least
I did not observe them. The lavatories are excellent. The reli¬
gious element occasionally appeared, but not so much as usual. The
chapel is spacious and of the ordinary description, and a frhre sat
wrapt in his devotions. There was nothing like asylum uniform in
the clothing of the patients j on the contrary, variety was the rule.
Attached to the asylum is a kitchen garden, and a small farm.
Many of the patients were engaged with the frhes conveying the
grain into the farm-yard. A brother went at the harrows with a
pair of excellent horses in the immediate neighbourhood. The
farm-buildings are good, with separate compartments for hens, turkeys,
sow and pigs, &c. The byre was occupied by eight or ten fine
cows ; and the usual furnishings of a farm were abundant. Next
the farm buildings is an airing court for the unruly boys, flanked by
a row of privies.
This asylum certainly reflects great credit on its distinguished
originator, who brought the experience of a lifetime spent amongst
the insane* to bear on its construction.
The Institution of M. Masse , at Bruges.—The limited time at
my disposal, rendered my visit to this asylum very hurried, so that
I have few notes to detail. It stands near the south-eastern barrier,
and has existed about 200 years ; additions and alterations being
made according to the exigencies of the times. It is a retreat for
rich and poor of both sexes. The pauper airing courts are rather
confined, but their inmates seemed cheerful and happy, and they
clustered round the father to have some sweetmeats. Those for the
private patients are large, and have nice arbours. The internal ar¬
rangements were much the same as in the Ghent asylums, only the
ceilings were much lower, and the apartments smaller. The dormi¬
tory beds for the’paupers had side curtains. The kitchen pre¬
sented everything in excellent order, and they had a good bread¬
slicing machine. The white porcelain tiles were again favorably
spoken of. A nice separate chapel appears to be insufficient, so that
a new one is contemplated. The farm buildings are good, though
untidy, and they possess twenty cows and four horses. Convalescent
and recovered patients were engaged mending carts and officiating as
general carpenters.
The camisole de force, wristlets, and anklets, were in pretty general
use, and the superior advocated their employment most eloquently.
A library and periodicals furnish amusement for those who care. To
the higher class patients drives into the country are occasionally
given, and to the others walks. There are billiards, cards, &c.
Beyond the barrier they have a farm of sixty acres, but little ground
in the immediate neighbourhood of the asylum. The attendants are
freres and secure.
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On the Pathological Anatomy of the Brain in Insanity.
By Adam Addison.
The Essay to which teas awarded the Prize offered by several Superintendents of
Asylums—formerly Assistant-Physicians in the Royal Edinburgh Asylum —
to the Students of Dr. Shads Class, Session 1861.
“ Man is not born to solve the problems of the universe, but to find out where
the problem begins, and then to restrain himself within the limits of the compre¬
hensible.”— Goethe.
The great progress which medicine in general has made daring
recent years, must in considerable part be ascribed to the anatomical
direction it has assumed. The study of pathological anatomy has
entirely changed the character of medical science, which, instead of
a chaotic medly of unfounded theories and ingenious hypotheses,
the fruits of speculation, is now a philosophic system resting on a
firm foundation of facts with mutual and definite relations. To such
an extent has the pathological investigation of disease been carried,
that, in the ordinary maladies which attack the body, the instances
are now exceptional where we cannot demonstrate certain gross,
palpable changes of structure having an invariable causal connection
with functional disturbance. By bringing diagnostics to our aid,
we can also in many cases predict with confidence and precision the
nature and extent of the lesion which will, be found after death.
But the triumph does not cease here. In conjunction with chemistry
and the microscope, pathological anatomy has passed from the gross
alterations of organs, and succeeded in elucidating the processes and
changes which take place in their ultimate elements; and Virchow,
bringing to the subject all the zeal and instinct of genius, has given
us an insight into the arcana of cell-life, and laid down the compre¬
hensive generalisation as the basis of a new pathology, that the
cell is the ultimate agent by which, both in health and disease, struc¬
tural and functional alterations are effected. All the practical de¬
partments of the healing art have participated more or less in this
progress. Medicine proper, or that branch which restricts itself to
the study of internal diseases, has separated itself more and more
from dynamics, and found a natural explanation of its symptom¬
atology in anterior changes of structure; while surgery and mid¬
wifery, with their outbranching specialities, are daily becoming more
anatomical in character.
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Me. Adam Addison, on the Pathological
But whilst we are congratulating ourselves on the present promise
of medical science as a whole, there is one very important element
of it which, pathologically, at least, forms an exception to the general
state of progress, namely, insanity. This department may still be
considered the “ terra incognita” of pathology, the land of adven¬
ture to the future investigator, which allures with the prospect of
brilliant discoveries, and the solution of problems hitherto insoluble.
In common with its sister branches, the investigation of the patho¬
logy of insanity took an anatomical direction; and, judging from the
magnificent results which were achieved in the former, it was quite
natural to expect that the key to the different forms and symptoms
of mental disease would be found in alterations of the cerebral tissue.
With the minute study of the membranes of the brain, it appeared
as if a new epoch had commenced for the whole pathology of in¬
sanity, and it had therewith acquired a kind of rational, somatic
basis. And, indeed, it may be said without exaggeration, that the
theory of Bayle, and all which followed it in the literature of medical
psychology, was the most decided step by which it joined itself to the
general movement of medical science. But, unhappily, notwith¬
standing the plenitude and the apparent significance of the anatom¬
ical phenomena which the labours of the most distinguished alienists
in all countries have brought to light, the expectation of a rational
somatic pathology has not as yet been realised, and pathologists have
failed to bring out of the facts at their hand other than a contradic¬
tory or negative result. When we come to compare and to bring
them into connection with the symptoms of mental disease—for a
true pathology cannot stop short with the mere registration of ana¬
tomical details, we enter upon a field of doubt and conjecture,
without any guiding light or beaten path, surrounded on every side
by the dangers of error; and though all the teachings of physiology,
all the past history of pathological anatomy in its connection with
etiology, confidently assure us that this is the only direction by
which we can reach the goal of a scientific pathology, yet the con¬
fusion is so great, and the difficulty of evolving order out of the
chaos so immense, as to make this labour at once the most compli¬
cated problem and the highest effort that have ever engaged the
attention of the metaphysician and the physiologist.
The causes that have led to this disproportionate progress of
medical psychology as compared with the other branches of medi¬
cine, lie mainly in the subject itself. In by far the greater
number of cases, death occurs many years after the commencement
of insanity, which it is not uncommon to find extending over
periods little short of a lifetime. Meanwhile, the symptoms both
in the nervous system and in other parts of the body have
been undergoing a variety of alterations. Some which at first
were strongly pronounced have become milder in character or
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Anatomy of the Brain in Insanity. 89
have altogether disappeared, while others of an entirely different
kind have been ushered in. Thus, various diseases have arisen,
pursued their course, and left their effects upon the cerebral
substance. When at length death removes the unhappy sufferer
from the stage, a number of important changes are found to have
taken place in the brain, but it is generally impossible to trace back
the history of these abnormalities, to fix the date of their origin, and
to establish a relation between them and the symptomatological
phases through which the disease has passed. It is true that in a
considerable number of cases we have an opportunity of examining
the brain shortly after the outbreak of insanity, when it is still at its
height, as in cases of acute mania which have rapidly succumbed to
exhaustion or accidental diseases. Here it might naturally be ex¬
pected that we should find structural changes sufficient to account
both for the immediate cause of death and the more remote cause
of the mental disturbance, but the deviations we do meet with are
often such as occur in diseases which leave the integrity of the
mental functions untouched. As Dr. Flemming very aptly observes,
“we are in the same position, in which one would find himself
without a guide upon the field of a recently fought battle—given
over to a feeling of melancholy wonderment at the carnage and
devastation which give evidence of the violence of the struggle, but
not of the operations whose theatre he surveys."
An equally important cause of the unsatisfactory state of the
pathology of insanity lies in our imperfect knowledge of the minute
anatomy of the nervous system. Of all organs, the brain is least
known, either anatomically or physiologically, and, consequently,
the medical psychologist cannot be expected to detect slight devia¬
tions from a normal standard he does not possess. Hence has
arisen the assertion that very often not the slightest irregularity is
to be found in the brains of persons dying insane. Upon this
point, however, the best authorities seem agreed, that such state¬
ments are only a proof either of the peculiarity of the ideas enter¬
tained as to what anomalies are essential for the production of in¬
sanity or of the incompleteness of the anatomical examination, and
that a careful necroscopy, were we in a position to make it, could
always detect sufficiently important deviations from the normal
state. In connection with this point, it ought to be taken into
account that the brain and nervous system are under very different
conditions from those of other parts of the body. In the latter all
vital manifestations occur only as material alterations, visible and
palpable; hence even the slightest deviations are manifested in a
material product. But in the former they are immaterial, in so far
as the product of their activity is neither material nor visible, but
only thought, sensation, and volition; and, in accordance with the
same law, disease less frequently gives rise to a material product in
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Mb. Adam Addison, on the "Pathological
the nerve-cells. The reason of this we find explained in the follow¬
ing passage from Virchow’s ‘ Cellular Pathology/ He observes,
“ That in all those tissues which are subject to important fnnctions,
we find those functions are chiefly due to very delicate changes of
arrangement or, if you wish it expressed in more precise terms, to
minute changes of place in the minute particles of the internal
matter, the cell contents. In these cases, therefore, it is not so
much the real cell in its pure form that decides the question, as the
specific matters with which it is provided internally—the chief agent
is not so much the membrane or the nucleus of the cell as the
contents.”
“ It is these which, when exposed to certain influences, become
comparatively rapidly changed without our being always able mor¬
phologically to detect any trace in the arrangement of the contained
particles. We cannot perceive any definite chemical change, or any
alteration in the nutrition of the parts; we only see a displacement
or dislocation of the particles, which, however, probably depends on
some slight chemical change in the molecules composing them.”
It will at once suggest itself that these conditions are competent to
explain the failure of pathological histologists in detecting any re¬
markable changes in the nervous tissue in mental diseases, while, at
the same time, it may be used as an answer to those who deny the
somatic origin of insanity in the absence of appreciable microsco¬
pical alterations.
The complexity of the subject is still more increased by the fact
that the brain in the pathological conditions of its parts preserves a
character of almost undivisible unity, so that structural alterations of
different kinds are associated with similar functional disturbances,
while on the other hand dissimilar deviations of function accompany
similar organic lesions. Thus in mania, melancholia, and dementia,
any psychological consistence between the symptoms and the post¬
mortem appearances cannot be established. Nor, indeed, in a
clinical point of view, are these forms separated from each other by
any sharp line of demarcation. The same thing holds good in
general paralysis, which clinically occupies a much more favorable
position than the others. It is now generally believed that this is a
distinct disease, whose symptoms, course, and prognosis, can be pre¬
dicated with confidence. Indeed, it was the discovery that general
paralysis of the insane is constantly associated with anatomical
alterations of the cerebral tissue which first led to the opinion that
organic lesions are really the essential causes of all mental disorders,
and it was hoped that by starting with it as the first step of a classi¬
fication, all diseases of the mind might acquire the much-desired
somatic foundation. But even as regards general paralysis, in which
the anatomical lesions are so striking, the difficulties which stand in
the way of the realisation of so beautiful a scheme are far from incon-
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Anatomy of the Brain in Insanity.
siderable. For it cannot be concealed that not only are the patho¬
logical appearances inconstant in undoubted cases of this disease, but
that the same alterations are found in the most exquisite degree in
other forms of insanity. A most convincing proof of this occurred
last summer in the Edinburgh Royal Asylum. In the case of a boy
of twelve years, afflicted with epileptic dementia, a most exquisite
example of a general paralytic's brain was observed. It presented
all those appearances which have been exclusively associated with
the “ delire ambitieux,” the white, fleshy, thickened, and gelatinous
arachnoid, with adhesion of the pia mater to the cortical substance
and an extreme and general atrophy of the convolutions. But in
this case it need scarcely be stated that there were no symptoms
of paralysis or monomania of grandeur. This and observations
of a similar nature are sufficient to show that, pathologically at
least, general paralysis does not present any anatomical features by.
which it can be distinguished from other forms of insanity. The
foregoing facts obviously preclude anything like an attempt to
describe the pathological phenomena of psychical diseases in “tout
ensemble” groups, labelled with the names of special forms; for
that would be & mere arbitrary classification which has no existence
in nature. The most convenient and natural plan will therefore be
to inquire—1st. What pathological alterations are found in the brain
of persons dying insane ? 2nd. What relation do these individually
have to the mental symptoms, and lo the whole disease ?
The following is a brief summary of the structural alterations
which have been described as most frequently met with in the brains
of the insane. They are: adhesions and thickenings of the cranial
bones; Pacchionian granulations; osseous projections and deposits in
the meninges; thickenings and opacities of the arachnoid, with serous
effusions into the meningeal spaces; similar collections in the ven¬
tricles of the brain; partial or extensive hypersemia of the brain and
its membranes; unequal consistence of the cerebral substance;
vascular dilatations and varicosities; papillary excrescences on the pia
mater; discolorations of the cortical substance to ash and yellow
gray, of the medullary to gray and yellowish white; softening of
the medullary matter, sometimes to a diffluent mass; so-called
apoplectic cysts in different stages of metamorphosis; increased
specific gravity of the brain substance; general and partial atrophy;
destruction of the brain by suppuration; ossification of the arteries,
tumours, &c., &c.
Of all these abnormalities those which relate to the vascular
system are entitled to the first place. They are included within the
extremes of hypersemia and anaemia.
Congestion is perhaps the most difficult point in the whole
pathology of insanity. Eor a long time it has been the custom to
ascribe a great role to it in the causation of mental disorder; and.
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although adverse opinions have not been wanting, the theory that it
is a factor in the production of psychical disease appears not without
foundation. It is only expressing an every-day experience to say
that this condition is a frequent post-mortem appearance in autopsies
of the insane; and it is impossible to turn over many pages of
asylum registers, or consult any book upon the pathology of insanity,
without finding minute descriptions of congestionary phenomena.
Sometimes it is in the dura mater, which presents a difmsed blush,
and its surface is covered with varicose vessels and dotted over with
multitudes of red points, the result of capillary rupture. In this
condition it is sometimes found to be thicker than usual, parchment¬
like, discoloured, and adherent to the cranium or the arachnoid. At
other times congestion appears more pronounced in the arachnoid,
which presents large masses of dilated veins; Guislain describes it as
having the aspect of an inflamed conjunctiva. More frequently, how¬
ever, the hypersemia of this membrane is found after death to have
been apparently expended in the production of the milky-coloured
spots and the opaque, thickened parts with the serous infiltration
between it and the pia mater, so often met with under such con¬
ditions. The pia mater is very frequently thickened, and easily
separable from the brain substance, particularly when it has a tough,
leathery character; but in general paralysis it is almost regularly so
adherent to the cerebral matter, that portions of the latter are carried
away on attempting to strip it off. Its vessels are seen to be
enlarged, varicos, and gorged with blood. In intense congestion
the brain substance presents a pinkish or violaceous hue, and on
incision is found to be beset with a multitude of small red points,
the puncta vasculosa; it also feels remarkably doughy to the touch.
In the majority of cases, however, these appearances are not to be
observed in so great intensity. Of thirty-four cases of acute mania,
taken from the pathological register of the Edinburgh Royal Asylum,
fourteen showed a well-marked congestion of the pia mater, with a
pinkish or violaceous hue of the brain substance; in the remainder
the hypersemia appeared more limited and partial, prominent at some
points, and at others passing into absolute absence of vascularity.
In two or three instances the only appreciable changes were slight
thickening and opacity of the arachnoid, which may be regarded as
the products of an extinct hypersemia. Indeed, unless the brain is
examined at the very acme of the congestion, it will often be found
that the over-supply of blood has been expended upon the altered
tissue and the exudation, while there is some reason to believe that
nothing disappears sooner than congestion; so that the absence of
injection is no proof of its not having been present before death.
The hypersemia may be either active or passive, but in most cases the
colour communicated to the tissues is not sufficiently characteristic
to admit of the distinction of the one from the other. It is onlv in
V
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Anatomy of the Brain in Insanity. 43
very intense congestion with a general injection of the vessels that
these two conditions can be distinctly determined—the active by the
deep reddening of the cerebral tissue, and the passive by the
engorgement of the veins. This question is therefore in some
respects without the pale of pathological anatomy, and must be
answered indirectly by conclusions based upon the symptoms
observed in the living. The predominant character of passive con¬
gestion is depression, with a general diminution of functional activity;
the senses react slowly and weakly, and the flow of ideas is torpid;
the patient comprehends with difficulty what is said to him; his
answers follow slowly, apparently unwillingly, and with the expression
of indifference. These symptoms perfectly correspond in their
character to those which are observed in passive congestions of other
organs, namely, a general depression of function. In active
hypersemia, on the other hand, we find an opposite state of matters.
Exaltation is here the characteristic feature. It is attended by
extraordinary restlessness and movability; all the functions of the
brain are exaggerated, the susceptibility of the senses increased, the
formation of the ideas and fancies quickened. But the condition of
the brain of the insane is distinguished from that of the sane not
merely by increased activity, such as a quicker and more lively play
of imagination and thought, but rather by its depraved and per¬
verted action. The more hasty does the latter become, the less does
it attain completeness. The sensations follow so quickly that the
attention cannot control them; an idea is scarcely generated before it
is obscured by another; a thought is not cogitated before it is
carried away by a train of others equally fleeting. In general the
symptoms of exaltation are combined with those of depression. The
reason of this is easily seen when we consider the condition of the
vessels demonstrated by the microscopical observations of Schroeder
Van der Kolk, Ekker, and Elbers. These writers have published
observations to the effect that, in certain forms of mental disorder,
particularly mania and the “ delire ambitieux,” the capillary vessels
are found dilated and varicose. Some vessels under the microscope
appear to be enlarged, while others are considerably contracted, or
retain their normal calibre. Some are dilated to three or four times
their usual size. When this condition becomes chronic, venous
dilatations, varicosities, are developed in the gray matter. Hence it
is evident that neither the effect of the irritation nor the stasis of the
blood are uniformly spread over the whole organ. In some parts of
the organ active assimilation of the blood with increased function
will be going on, while in others the stasis has already put an end
to it and given rise to depression. Owing to the structural pecu¬
liarities of the brain, these conditions may disappear in one part and
be transferred to another—a fact which explains the great alterna¬
tions in the symptoms of cerebral congestions. Thus exaggerated
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Mr. Adam Addison, on Ike Pathological
action predominates and intermits, sometimes here and sometimes-
there, in organs of quite heterogeneous function; now it shows itself
in an over-activity of certain senses, then in the domain of the ideas,
and again in uncontrollable action of the will.
The relation of congestion to insanity has been made the subject
of lively discussion, in which it has been argued that nothing is
more deceptive than the assumption that a hyper®mic condition of
the brain can give rise to mental disorder. Some, like Engel, have
gone so far as to deny the possibility of deciding whether congestion
of any organ, and especially of the brain, originates before, during,
or after death. Those who incline to metaphysical theories assert,
that it may be the consequence of insanity, as seen occurring' in so
many mental emotions within the bounds of health, or it may be
what Yirchow calls a collateral phenomenon, that is, the noxious
influence affecting the brain may at the same time disturb its func¬
tion and its vascular condition, and that in all cases it is impossible
to say whether the injection of the vessels is not produced after the
commencement of the disease by the vociferations and violent
behaviour of the patient, or during the paroxysm of death. It is
added, that the frequent occurrence of congestions and obstructions
of the cerebral vessels, as in diseases of the heart and lungs, without
any disturbance of the mind, prove that these conditions are not
merely possible, but in most cases the actual ones.
Taking our stand on broad, physiological principles, it may
legitimately be concluded that a case is made out for a causal
relation between congestion and insanity in the perfect correspond¬
ence of the symptoms during life, and the post-mortem appearances
with the phenomena which we can experimentally produce in organs
accessible to objective perception. To those who make the ob¬
jection that congestions of the brain occur without giving rise to
mental symptoms, it may be answered that, when such do arise,
they are merely mechanical conditions, and that it is not asserted that
the pure, naked over-supply of blood constitutes the whole process of
insanity. Physiologically and pathologically, congestion is not the
only thing required that an increase should take place in the nutrition
of a part j besides the increased quantity of olood, it is necessary
that "particular conditions should obtain in the tissues (irritation),
altering the nature of their attraction for the constituents of the
blood, or that particular matters should be present in the blood
(specific substances) upon which definite parts of the tissue are able
to exert a particular attraction” (Yirchow). It is quite consonant
with our present physiological notions and our knowledge of insanity
to believe that some ultimate u irritability,” constitutional or ac¬
quired, resides in the nervous tissue of the insane, which, on the
addition of another link, rapidly developes into disease of the mind.
These two are necessary and essential links of the same process.
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Anatomy of the Brain in Insanity.
mutually dependent. Thus the narcotic poisons, when brought into
direct contact with the nervous tissue without the intervention of the
circulation, exert no narcotic effect. This experiment, though it
leaves undecided whether the process of narcotism commences first
in the nerve fibres or in the vessels, appears to prove that the
medium of the circulation is necessary for the action of these
matters. It is highly probable that the first step in the process of
insanity is an irritable state of the nerve-cells, but it is just here the
“ problem beginsand as Dr. Bucknill has stated, and the foregoing
experiment confirms it, the connection between cellular and vascular
change is of so intimate a character, that it is difficult to assent to
the proposition that pathological conditions of the cerebral vessels
are to be viewed as secondary phenomena. The positive philosophy
of the nineteenth century has set its ban upon all attempts to
discover ultimate causes, and we shall do well to “ restrain our¬
selves within the comprehensible," which in this case is congestion.
The occurrence of Anemia of the brain in the insane has been
proved by post-mortem examinations, as well as by observations
made on the living. In the dead body this condition is indicated by
a very pale cortical substance, extremely few vessels on the upper
surface, and still fewer in the meddllary matter. In the brains of
aged persons the deficiency of blood is recognisable on making a
section, in the wide, open mouths of the empty vessels throughout
the brain substance generally; in the bodies of younger individuals,
the vessels are often contracted in some parts and dilated in others.
The perverted action of the brain often takes the form of dementia,
or dementia with excitement, and in slighter degrees a melancholic
direction. Anaemia, as a temporary condition, is sometimes asso¬
ciated with a temporary melancholy in lying-in women. But it is
rare to meet with a pure and general anaemia of the whole brain.
Thus we often find that while the large, external vessels of the
cerebral surface are bloodless, those in the interior of the medullary
substance are gorged to their ultimate ramifications; the medulla
oblongata is often covered with over-filled capillaries, while the optic
thalamus and the corpus striatum present not the slightest vas-
_ cularity. It was long a puzzle to pathologists why, in states of
general anaemia, the symptoms during life should be those of active
congestion, namely, exaltation and increased function, and the brain
after death should be found with all the characters of anaemia.
This difficulty has been solved by the discovery of a condition which
Virchow terms ischaemia, or partial anaemia combined with
hyperaemia. It is due to contraction of the veins, the capillaries, or
tne arteries. When the vessels become contracted, from whatever
cause, it is obvious that the course of the blood will be interrupted
—that a stasis will take place j consequently, below the contracted
part the brain is deprived of its supply, while above it the blood
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Mr. Adam Addison, on the Pathological
accumulates in extra quantity, and, being obliged to distribute itself
in the lateral vessels, on the principle of compensation, gives rise to
an over-fulness of the adjacent parts. Yirchow also points out that
this condition of the vessels is also generally combined with a venous
hyperemia, which he regards as the contra-distinguishing sign from
states of simple anaemia. These observations are particularly
valuable, because they explain why conditions of anaemia and.
hyperaemia respectively are accompanied by symptoms so exactly
similar that they cannot be distinguished from each other. They
are of an indefinite and mixed character. States of depression and
exaltation alternate and intermingle with each other. The latter are
said generally to predominate, but are often accompanied by a peculiar
expression of deep and painful suffering.
Equally interesting and important, as bearing upon the causation
of insanity, are the causes to which Yirchow ascribes ischaemia. It
may originate from mechanical obstructions, thrombosis, &c., and also
from dynamic conditions, of which the most frequent is probably
spasm of the vessels, when their calibre is diminished by contraction
of the muscles.
Among others still more applicable to mental diseases, we find
narcotics (alcohol, opium, &c.)* asphyxia, paralysis, hyperesthesia
(including over-irritation, in consequence of mental strains) cold,
electricity, and mental emotions with a depressive effect.
It has been a disputed point whether the narcotic poisons give rise
to perversion of the mental functions by altering the conditions of the
circulation of the brain through irritation of the nerve fibres or the
vascular walls, or by the introduction of a poison injurious to nutri¬
tion, or at least by some power peculiar to themselves of decomposing
the blood. Yirchow having in view some experiments of Schroeder
Yan der Kolk and Ekker, appears to look upon these poisonous
effects as due to an ischaemic condition of the brain produced by their
administration; although he is doubtful whether the ischaemia is to be
regarded as an effect of the agony, caused by the long contraction of the
muscles of the vessels—or whether it preceded the death struggle.
It has already been shown that in all probability the medium of the
circulation is necessary to ensure the action of the narcotics, and it is no
violent assumption to conclude that some of their symptoms are
caused by a condition of ischaemia. It is equally probable that the
poisons engendered in the living body, as the rheumatic, the gouty
and puerperal conditions of the blood, may act in much the same
manner, and should be placed on the same category as the narcotics.
Mental emotions, too, besides their spasmodic effect upon the quanti¬
tative relations of the circulation in the brain, are perfectly calculated,
from their known propensity to derange the secretions and excretions
and alter the quality of the blood, to give rise to conditions of ischaemia
by irritation. Of course in all these cases we are still obliged to
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Anatomy of the Brain in Insanity.
assume a special and specific irritability of the nervous tissue,
shrouded in the mystery of ultimate causes and individual idiosyn¬
crasy.
Anaemia is also met with as a secondary condition, the result of
induration, which exercises a pressure upon the vessels ramifying
through the indurated part. It generally originates from the hyper¬
trophic induration consequent on injury. It is associated with
sleeplessness, perverted mental action, and a morose, melancholy
humour.
The next point for our consideration is that of haemorrhage. Effu¬
sion of blood into the sac of the arachnoid is not a very unrare occur¬
rence. Haemorrhagic extravasations into the deeper parts of the
brain are occasionally met with in monomania. In one case of mono¬
mania of unseen agency, the right optic thalamus contained a cavity,
about the size of a hazel nut; while, on the left side, a recent haemor¬
rhage—the immediate cause of death—had torn up the corpus striatum
and optic thalamus, the clot being separated from the ventricle by a
thin layer of cerebral substance, which had given way at one point,
the external wall of the sac being formed by the cortical substance
only. In general paralysis, the corpora striata and optic thalami are
sometimes found puckered, this being due to a loss of substance
resulting from contraction of apoplectic cysts; section of the organs
reveals numerous small cavities, surrounded by yellow softening.
What relation, then, do these haemorrhages bear to the mental
disease ? At first sight, these appearances appear to be among the
brightest triumphs of pathological anatomy in insanity. Effusion of
blood, pressure and irritation of the brain—what more is required
for the explanation of mental derangement ? On a nearer view, how¬
ever, important doubts are suggested as to this connection. First of
all it is essential to determine the time at which the extravasation
took place. When a fresh, moderately-sized clot is found after long
duration of the disease, it is obvious that the latter cannot be due to
the haemorrhage. It is more difficult to form an opinion when only
the remains of the extravasation are found, namely, false membranes,
and when apoplectic symptoms have occurred before the patient has
been placed under medical observation. In some cases of this kind,
it certainly appears as if the apoplectic symptoms had given the first
impetus to the insanity, and as if it had dated from them. To the
cases given by Bayle, it may be well to add the two following, from
the ‘ Report * of the Edinburgh Royal Asylum, for 1855.
History. —A. B—, a reader for the press, of sober and industrious
habits , fell into general bad health from over-attention to business.
About a year previous to admission into the asylum, he lost his speech
and the power of his left side, for the space of a quarter of an hour.
Previous to this no mental derangement was observed. After the
first seizure, similar attacks occurred about every three weeks, but
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Mr. Adam Addison, on the Pathological
gradually diminished in their duration; and, at the time of admis¬
sion, they only lasted two or three minutes. His memory became
gradually impaired, his speech faltered and his gait was affected.
The delusions so characteristic of general paralysis took possession of
his mind about four months before coming to the asylum. During
his residence in the asylum he became gradually fatuous, and general
paralysis became more complete. He died after having been in the
nouse seven months. During the last four days of his life he lay
in a semi-comatose state, with the flexor muscles of his hands and
arms permanently contracted, and his jaws firmly locked. On exa¬
mination after death, a thick false membrane was found beneath the
dura mater on the left side; it completely covered the hemisphere,
with the exception of the base. The membrane was nearly twice the
thickness of the dura mater, of firm consistence, and apparently well
organised; over its surface there were many dark patches, which
appeared to be old clots of blood. A false membrane was also found
on the right side; but it was thin and delicate, and was limited to
the upper surface of the hemisphere. There were about two ounces
of fluid beneath the arachnoid, and one ounce in the lateral ventricles.
There was also a granular condition of the lining membrane of the
ventricles. The nervous substance of the brain did not present any
abnormal appearance.
Remarks. —The points of interest in this case are—How was this
false membrane formed ? and. When was it formed ? In answer to
the first of these questions, there can be little doubt that it was the
result of extravasation of blood. At first sight, it may appear more
uncertain when this haemorrhage took place. It will be observed,
that the first apoplectic seizure wa3 of short duration, and that the
hemiplegic symptoms were only of temporary duration. We know
that a similar lesion is not unfrequent in new-born children, as a result
of pressure on the head. In those cases the paralytic symptoms are
also temporary. The fact is explained by the pressure being uni¬
formly spread over the surface of the brain, and not confined to one
point, as in haemorrhage into the brain itself.
A similar lesion was noticed in the Appendix to last year’s Report.
History. — J. S —, was a tailor, of sober and industrious habits.
Ten years previous to admission he had a seizure somewhat like an.
apoplectic fit. Soon after this he was obliged to give up work, on
account of impairment of vision. His friends observed, also, that
his temper was much altered from this date; he became irritable and
discontented. About a month previous to admission he had another
seizure, after which his mind was greatly affected; he displayed the
characteristic symptoms of exaltation, and was violent and abusive to
his family. During his residence in the asylum, he had many con¬
gestive attacks. He became generally paralysed, and was completely
amaurotic.
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Anatomy of the Brain in Insanity. 49
A year after admission, or eleven after the invasion of the malady,
he died in a condition similar to that of the last case.
Post-mortem .—A false membrane was found to extend over the
entire superior aspect of the cerebrum. The arachnoid had a
granular appearance. There was very little fluid in the sac, pia
mater, or ventricles. The spinal canal contained about five ounces
of fluid. The spinal cord appeared unusually soft; and about the
middle of the dorsal region, there was a portion of the nervous
matter of a yellowish red colour, and softer even than the rest of the
cord. In this, as in the former case, there was no apoplectic seizure,
or well-marked paralytic symptoms, to indicate the existence of any
extensive haemorrhage; the reason is undoubtedly the same—its
occurring in the sac of the arachnoid, and spreading over the entire
surface of the cerebrum.
Similar appearances, preceded by similar symptoms, were also
found in another case of general paralysis during the past winter.
Between the dura mater and the pia mater a membranous layer was
found, of a brownish yellow colour, nearly a quarter of an inch
thick at some parts. It covered the whole of the cerebrum, but was
not so thick towards the base of the brain. It was comparatively
free from both dura and pia mater. In the middle fossa of the
brain, on the left side, there was a similar layer of organised lymph
thrown out upon the external side of the dura mater, between it and
the bone. The pia mater and arachnoid were thickened, and adhered
firmly to the gray matter; the thickening had a milky appearance.
The gray matter was pale, and divided into two layers by a well-
marked line, and softened, but not to such an extent as to be washed
away by water.
As opposed to the significance of these facts, it is asked, how
comes it that so many haemorrhages into the substance of the brain,
as well as between the membranes, are not followed by insanity ?
Here we are again obliged to have recourse to a special irritability
or disposition to insanity. Indeed, nothing is more common than
to find individuals who have an hereditary tendency to disorders of
the mind suddenly becoming insane after a slight attack of apoplexy.
On the whole, however, it is the general rule that cranial haemor¬
rhages in the insane occur first in the course, and not before the
commencement of the malady, which has a disposition to haemor¬
rhage among its consequences. It is not improbable that the con¬
vulsions and spasms so often occurring in the course of mental dis¬
eases are oftener the cause than the consequence of haemorrhage.
In general paralysis especially, the vessels are atheromatous and
fatty, and will easily burst when the strain upon them is very in¬
tense. Common epilepsy often terminates in cranial haemorrhage.
Inflammation .—Acute inflammation of the brain, resulting in
suppuration, red and yellow softening is very rarely met with in the
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Ma. Adam Addison, on the 'Pathological
insane, and when it does occur, it bears much the same relation to
insanity as haemorrhage; but the so-called subacute inflammations
of the membrane are much more frequent pathological phenomena,
and have given rise to considerable discussion. These conditions,
however, never go beyond irritation and hypersemia, whose products
are circumscribed induration, opacity, thickening, and adhesion of
the membranes. When the disease proceeds from inflammation of
the m ening es, it is communicated from the pia mater to the gray
substance, which at the acme of the inflammatory process is softened,
but, as it subsides, becomes indurated and adherent to the investing
membrane, so that the latter cannot be removed without bringing
away pieces of the adhering brain substance. Another condition of
the brain, which results from these inflammatory attacks, and perma¬
nently remains, is a varicose dilatation of the vessels. This state
of the vessels is thought to cause atrophy of the parts of the brain
substance in which they ramify. These appearances, in a slighter
degree, are tolerably common in cases of acute mania; but as they
are also found in the brains of the sane, and little or no importance
is ascribed to them, they may be regarded as possessing no value in
this form. In general paralysis, however, in which they are met
with in most exquisite examples, they have been regarded as very
important anatomical facts, and have given rise to several theories,
of which that of Bayle has, perhaps, been most widely prevalent.
This pathologist states that, in his opinion, general paralysis of the
insane is the result of a primary chronic meningitis, very often
combined with consecutive inflammation of the cortical substance
of the cerebral convolutions. It is not due to a general induration
of the brain, as was asserted by Delaze, since this condition is found
in scarcely one-fifth of the cases; it is not the consequence of a
premature encephalitis (Calmeil), and, finally, it is not the result of
inflammation of the gray substance. The paralysis and delirium of
the first period, or the period of the monomania of grandeur, Bayle
ascribes to congestion of the pia mater, and in some measure to the
chronic phlegmasia of the meninges—a double lesion, which simul¬
taneously compresses and irritates the brain. The second period of
the mania depends upon an increase and extension of this inflam¬
mation; it is at this stage that the false membranes form. The
excessive agitation, the epileptiform attacks, and other convulsive
motions of all kinds, which supervene during this period, are the
effects of a consecutive inflammation of the gray substance of the
brain. The third period, that of dementia, with very considerable
general paralysis, great weakness of the intellectual capacity, and
suppression of ideas, is the indication of great compression of
the brain, depending on the continuous progress of the serous
effusion which is due to the meningitis. The weak point of Bayle*s
theory is, that it lays far too great stress upon mere mechanical
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Anatomy of the Brain in Insanity.
conditions, such as pressure and irritation. It is very easy to per¬
ceive how the exudation of an acute-meningitis can give rise to
paralysis and convulsive symptoms by its pressure upon the cortical
substance, but it is not so easy to explain how meningeal inflamma¬
tion can excite delusional ideas.
If such were the case, we should be prepared to expect some simi¬
larity between the delirium of meningitis and that of the general
paralytic; but the maniacal symptoms observed in the latter re¬
semble common mania much more than meningeal inflammation.
The most prevalent view at the present time regards this so-called
inflammation as a secondary condition, due to a chronic phlegmasia
of the whole brain. The frequent serous effusions, caused partly by
atrophy of the brain and partly by other causes, under such dys-
cratic conditions, possess a very irritating character, and cannot fail,
from their pressure and irritation, to give rise to inflammation,
tension, and thickening of the meningeal coverings. But if any
further proof is required that these thickenings, opacities, and ad¬
hesions, as well as the inflammation by which they are caused, are
purely secondary phenomena, and are not concerned in the produc¬
tion of the “ delire ambitieux,” it will be found in the fact that
these pathological appearances are found in the highest development
without any delusional ideas. I have already referred to an inte¬
resting case of this kind, and will now give it in detail. As already
said, it was in the case of a boy of twelve years of age, the subject
of epileptic dementia. He is described as being a healthy boy till he was
two years old, when he had a “ teething fever.” He then had con¬
vulsions for the first time. Since then he has had fits almost every
day, and sometimes many in a day. At first he fell down, but
latterly he merely laughed, trembled, and ran during the paroxysm.
No symptoms of paralysis could be detected in the voice or the
gait. On opening the skull, the medical officer exclaimed in as¬
tonishment that it was an exquisite example of a general paralytic
brain. The dura mater was very adherent along the sutures. Skull¬
cap ordinarily thick, somewhat irregular; four and a half ounces of
fluid under the dura mater, between which and the arachnoid there
intervened a false membrane, vascular and thicker than the dura
mater. This false membrane was adherent all over the surface to
the dura mater, and in many places to the arachnoid. The latter
membrane was very much thickened, especially over the anterior
lobes; this thickening extended downwards, as far as the corpus
callosum, along the horizontal fissure, Over the anterior lobes it
presented a white, fleshy, gelatinous and cedematous appearance.
The vessels of the pia mater were in many places enlarged, varicose,
and plugged up by fibrinous clots. The convolutions were pale,
anaemic, and extensively atrophied, and the gray matter could be
stripped as a continuous membrane off the white substance. As in
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general paralysis, the lining membrane of the ventricles over the
optic thalamus and corpus striatum was thickened and minutely
granular, and the pia mater was adherent to the gray substance at
different parts.
The conclusion deducible from the foregoing case requires no
comment. I have yet to refer to another theory, viz., that inflam¬
mation resulting in adhesion of the pia mater to the cortical sub¬
stances is the immediate cause of mania in general. Now this
appearance is scarcely ever observed except in general paralysis, and
it would not be in accordance with strict scientific rules, to apply it
to all forms of mania. Another objection is urged, that all wounds
involving loss of brain substance can only heal by such adhesions,
while they are rarely followed by insanity. This is a species of ar¬
gument which has been too much used with reference to mental
disease, and it seems never to be taken into account that the patho¬
genetic processes of insanity are diseases sui generis , as much so as
two fevers due to different specific causes. The one great fact for us
is, that a diffuse inflammation of the gray cortical substance extending
over many convolutions, is never observed without eminent disturb¬
ance of the mind.
Effusion .—The consideration of serous effusions conveniently and
naturally follows that of the inflammatory exudations. Insanity,
associated with effusion into the meninges of the braih, is of very
frequent occurrence. In 411 cases collected by Dr. Skae, subarachnoid
serous effusions were found 202 times, and similar collections in
the sac of the arachnoid 171. Effusion is not the ultimate condi¬
tion of the brain upon which insanity depends, for the serous collec¬
tion is itself the consequence of a prior disease. No one asserts
that mania, melancholia, and dementia are accompanied at their
commencement by serous effusions; the most which is alleged is,
that that suppressed or exhausted activity of the brain which takes
the form of dementia may partially be caused by the effusion. The
seat of the serous collection, rather than its nature, influences the
form in which insanity expresses itself. When it is located princi¬
pally upon the upper surface of the brain, it is generally attended
with great restlessness and fidgety imbecility.
When it is in the lateral ventricles, the loss of mental power keeps
an even pace with the increase of the fluid. When the ventricles
become full, the patient sinks into complete dementia, and death
takes place by serous apoplexy. Great weakness of the limbs, and
paralysis of some parts, are frequent symptoms. The brain sub¬
stance is bloodless, and in seme parts appears harder than in others.
Very probably the granular appearance of the living membrane of
the ventricles in general paralysis has some connection with these
fluid collections, though in what way further investigations must
determine. It is highly probable that the great part of these serous
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Anatomy of the Brain in Insanity.
effusions is first exuded in the stage of death, else we should find
symptoms of pressure upon the brain developed much more fre¬
quently than is the case. To meet this objection, it has been said
that the brain gradually accustoms itself to the pressure while the
6erum remains. But in order to prove this, it must be shown that
symptoms of pressure have been present for a considerable time
during life, and disappeared very slowly. Such conditions, un¬
doubtedly, very often take place, but not always. A great number
of cases, especially those without paralysis, never manifest any
symptoms of pressure during life, while all general paralytics have
a longer or shorter soporous stage in which the serum may probably
be effused for the first time.
Effusion into the substance of the brain—oedema cerebri—is a
condition which has been found in connection with mania and
dementia. It is said to occur primarily, but more frequently it is
the result of serous collections in the ventricles, which, owing to the
thinness of the lining membrane, pass by endosmosis into the sub¬
stance of the brain. Albers states that it is regularly found in com¬
bination with effusion into the cavities of the brain, when the
ependyma or lining membrane remains normal, or is atrophied and
thickened. That such is not always the case is proved by the
autopsy of the following case of dementia. The ventricles of the
brain were not over-dilated, and did not contain more than the usual
quantity of fluid; their lining membrane was sightly thickened and
opaque. A large quantity of yellowish-looking fluid was found
under the arachnoid. The gray matter was extremely pale, the
white substance soft and oedematous, the water- running off copiously
with every cut of the knife, and rapidly collecting into small lakes in
the concave, uneven parts made by the incision. There was oedema
of the extremities. The last fact favours the supposition that
oedema cerebri may have no other connection with the brain disease
than merely an accidental concomitant of a general oedematous state
of the body. This is also borne out by Dr. Hagen, who has met
with it eighteen times; in all instances there was either oedema of
the lungs, hydrothorax, oedema of the heart, softening of the spleen,
or it had been preceded by oedema of the extremities or diarrhoea.
Dr. Hagen cannot confirm the statements which authors have made
respecting its importance. Proper stupor was observed in none of
the cases; the forms of disease were mania and dementia, but they
presented nothing constant in their symptoms. A kind of stupor
sometimes set in simultaneously with and mixed up with the sopor
preceding death. He directs attention to the fact that stupor
occurs without any oedema, and that the latter does not occur exclu¬
sively in connection with this condition, but is also found in others,
as has been demonstrated by Aubanel and Thore in * General
Paralysis/
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Mr. Adam Addison, on the Pathological
Next to effusion comes softening. This is seldom an independent
disease of the brain. Insanity, associated with cerebral softening
and caused thereby, is a very rare phenomenon. Softening of the
brain substance does not in itself give rise to mental disease, but is
only an accidental alteration added thereto. In this complicalion
the insanity is to be regarded as due to perverted action of the mind,
and the symptoms of softening as independent or accidental pheno¬
mena. Loss of mental power, dementia, imbecility, and monomania
with exaltation, are caused by conditions of the brain, which at the
termination of their pathological development result in softening;
but the foregoing forms of mental disease are not caused by the
latter in itself. Softening of the superficial layers of the gray
matter is found in encephalitis and oedema, but not very often.
Accordingly, when dementia exists, it is to be referred far more to
irritation of the nerve-cells and atrophy consequent thereon than to
softening. Cerebral softening, according to its different causes,
induces very different trains of symptoms; the inflammatory is
accompanied by phenomena indicative of encephalitis, only the pain
is less; that resulting from extravasation of blood and serum is
attended by symptoms similar to those of apoplexy or fainting; and
softening occasioned by obliteration of atheromatous vessels is indi¬
cated by attacks of giddiness and apoplectic seizure arising from the
previous loss of the cerebral functions. But in all these cases the
cerebral softening is only local, and destroys the activity of that
function peculiar to the affected part. In softening of the gray
matter of the convolutions, we find loss of memory and of imagi¬
native faculty; the patient exhibits want of decision, and a less than
usual readiness in the exercise of his judgment; altogether there is a
marked decrease in the energy of the intellectual functions. In
softening of the white substance we observe paralysis of the limbs
and tongue, of the face and the eyes—what is termed general
paralysis—when the softening affects a large extent of the white
matter, as the posterior part of the centrum ovale of Vieussens, the
optic thalami, the corpora striata, and the floor of the lateral and
third ventricles, or only paralysis of one of these parts, or of several
combined, when they have suffered singly or in combination.
Severe pains are experienced in the paralysed parts. As in all
paralysis, the general nutrition suffers, and that of the paralysed parts
in particular, the digestion and the action of the bowels. No
tissue of the paralysed part remains normal when the paralysis has
continued any length of time, all atrophy fall off in volume and
weight, and present a considerable interstitial deposit of fat between,
the normal constituents of the tissue. The prognosis must be very
unfavorable, for it is but seldom that the softened brain substance
heals; and when it does, it is only by passing into induration. When
this takes place, spasm of a tonic kind is caused in the paralysed
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Anatomy of the Brain in Insanity.
limbs. Softening caused by inflammation and extravasation of blood
heals directly, but the atheromatous very seldom. Red and yellow
softening are rarely met with in the insane, and occur not more fre¬
quently, perhaps less so, than in others.
Induration .—Induration of the brain is generally limited to
certain parts of the organ; we find mention made of an induration
of the whole brain, consisting in a certain tough property of the
cerebral tissue observed in some cases of typhus fever; but as it is
not known whether the insanity which occasionally follows this
fever is associated with this alteration or not, it may be left out of
view. Authors usually describe induration of the brain occurring
—1st, as a scrofulous infiltration; 2nd, as a fibrinous deposit after
local inflammations and apoplexy, in the form of a very hard cicatrix,
round which the brain-substance is altered and presents a yellowish-
green colour; 3rd, as a sequela of softening. The white substance
is the principal seat of these partial indurations. They are oftenest
found in the centrum ovale of Vieussens, in the optic thalamus, and
in the anterior lobes. The cerebellum also presents indurations, the
consequence of apoplexy. The form of insanity associated with
induration is usually melancholia and dementia. The first symptoms
are giddiness and uncommon weakness of the limbs, which-are
affected with extraordinary stiffness and an imperfect kind of spasm,
seldom disappearing until the induration is removed or reduced to a
minimum. In aged individuals the symptoms are generally those of
senile dementia, with great restlessness and trembling of the limbs,
impaired memory, and sometimes difficulty of speech. In those
indurations, the sequelae of apoplexy, a transition from paralysis to
spasm, or a combination of Both, is not uncommon. The spasm
occurs as epilepsy.
Hypertrophy .—Hypertrophy of the brain is met with in two
forms in the insane; in the first the organ is merely distended by an
over-accumulation of blood; in the second there is an actual
increase in the volume of the cerebral substance. These conditions,
more especially the latter, are often found associated with melan¬
cholia ; and when this is the case we frequently find a very extensive
and beautiful development of the convolutions. Sometimes they
present the most exquisite arching of their upper surface, at others
they are flattened by the pressure of the cranium. Certain alterations
of the nervous tissue are stated to have been observed in hypertrophy.
Many places of the gray matter appear harder than usual; the veins
are dilated, forming microscopic varicosities, and some of the smallest
are enlarged to four times their ordinary calibre. It is not unrea¬
sonable to infer from this condition of the vessels, that they must
exercise a pressure upon the nerve-fibres and the multipolar ganglia,
and thus an imperfect paralysis of the gray matter will be pro¬
duced. At the same time the fatty matters of the cortical substance
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Mb. Adah Addison, on the Pathological
increase, and a great number of granules and granular bodies are to
be observed in it, altering its colour to a yellowish-gray, or even to
brown. In many places which appear hard and somewhat depressed,
small blood-red spots of the size of a needle’s head occur, consisting
of blood-corpuscles, granules, and sometimes crystals of hsematine.
They are only small extravasations of blood, which are remarkable
from their small size and great number. It has often been observed,
that in insanity associated with hypertrophy the patients exhibit a
tendency to suicide, a very dull, obstinate disposition, and an inca¬
pacity to collect and retain their thoughts. Under this head it is
convenient to notice Dr. Skae’s observations as to the relative
increase in the weight of the cerebellum to that of the cerebrum in
the insane generally, but more particularly in general paralysis.
These extend over 199 cases, of which 98 were males and 101
females. From the average of the whole it was found that the
cerebellum in the males bore the relation of 1 to 6*74 in the insane,
and 1 to 7*06 in the sane; in the females, 1 to 6'64 in the insane,
and only 1 to 7 in the sane. It ought to be noticed that the
relative increase in the weight of the cerebellum does not seem to
have been caused by a simultaneous loss of weight in the cerebrum,
for the cases experimented on appear to indicate an increased
absolute weight of the whole brain as compared with the sane. In
connection with this point, the same writer has pointed out that the
specific gravity of the brain substance, as a whole, is higher in the
insane than the sane; and, what is still more curious as confirmatory
of his foregoing observations, that the specific gravity of the
cerebellum attains a greater increase in relation to that of the
cerebrum, than it does in persons dying sane. Under these circum¬
stances, Dr; Skae asks, “ whether it may not be inferred that the
cerebellum is the organ through which we exercise self-control—•
control over the volitions and successions of our thoughts, as well as
over the voluntary muscular movements—a perturbed volition, or a
loss of self-control, being of all others the most essential, charac¬
teristic, and pathognomonic feature of insanity ?” All things con¬
sidered, it appears no very violent assumption to regard the increased
weight of the cerebellum as a species of hypertrophy.
Atrophy .—Of recent years considerable attention has been directed
to this condition of the brain, and at one time it appeared to have
the special mission of founding a peculiar species of mental disease.
German writers describe two kinds of cerebral atrophy. In the first
it is uniform, extending over a greater or less extent of the brain,
with a diminished volume of the atrophied part. In the second it is
what is called interstitial—that is to say, the parts on the whole
retain their original size, but the solid constituents of the brain sub¬
stance decrease and atrophy—this is termed marasmatic atrophy.
The former is generally associated with induration, and extends
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Anatomy of the Brain in Insanity.
uniformly from the great hemispheres to the optic thalami and
corpora striata. It is a secondary process, and very often results
from inflammation of the pia mater, which partially closes up the
vessels of the brain. The space which the brain does not occupy is
filled with fluid. The second, or marasmatic form, is often accom¬
panied by senile arachnoiditis, and, upon section, shows wide openings
of stearotic vessels.
The most interesting fact connected with cerebral atrophy is its
relation to general paralysis, in which there is a disposition to regard
it as preceding the paralysis of muscular motion and the “ delire
ambitieux.” If there is any such connexion, it can only be with
marasmatic atrophy, which is rather a pathological process than an
anatomical fact. Numerous cases are on record to prove:—1st, that
atrophy of the brain-substance is observed without any previous
symptoms of paralysis or the “ delire ambitieux2nd, that mono¬
mania of grandeur occurs in its most perfect types without paralytic
phenomena ; 3rd, that the same delusional ideas are observed with
and without paralysis of the tongue, when no atrophy was recog¬
nisable after death. So long as these three facts are not disproved,
they serve to show that cerebral atrophy, as an anatomical fact, has
no fixed or definite relation either to general paralysis or to mono¬
mania of grandeur, or to the two diseases combined.
The exact experiments of Dr. Bucknill upon the absolute atrophy
of the brain in insanity, made by comparing the quantity of water
which the brain displaces, with the capacity of the cranium, seem to
have conclusively determined that all conditions of dementia are
associated with a certain degree of cerebral atrophy; for, although
it may not be the primary cause of insanity, it is quite in accord¬
ance with physiological notions that the nerve-vessels, when placed
in conditions of mal-nutrition, should undergo an atrophic process,
and thus be rendered incapable of functional activity. Without
hazarding any theory, it may be said that we find atrophy of the
brain associated with dementia, sometimes combined with a de¬
lirious sort of insanity, paralysis of the tongue and body, impaired
sensation, and a considerable diminution of the natural heat. It
has been observed that the cranium is sometimes thicker on the
atrophied side.
Osseous projections and deposits. —In the falx, and adhering to the
cranial vault, masses of bone are not unfrequently met with, mea¬
suring several inches in size, and weighing from half an ounce to an
ounce and a half. Their average thickness is stated at about one to
three lines. Although these formations are generally the result of
various antecedent pathological process, still they are calculated,
from their size, to injure the cerebrum by their pressure and irritation,
to alter its nutrition and give rise to a varicose hyperaemia. In
this way they may render insanity permanent.
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Mr. Adam Addison, on the Pathological
Dr. Meyer, of tlie Hamburgh asylum, has succeeded in tracing
back the pathological process, to which these osseous formations are
due, to the Pacchionian granulations. These he regards as the
starting-point of the deposits, found in the falx, the transverse
sinuses, and the frontal part of the dura mater. The ossification
always commences with a chalky incrustation of the epithelial cover¬
ing, consisting wholly or in greater part of carbonate of lime. As
the process advances, the superficial layers of connective tissue ad¬
joining the incrustated epithelium, become involved. Numerous,
very small chalk granules, are to be observed between the fibres,
which are stiff and brittle, and have lost the disposition peculiar to
connective tissue to form wavy or curly bundles. When the su¬
perficial layers are completely ossified, the central bundles often
retain their natural structure and flexibility intact, and the ossifica¬
tions are connected to the arachnoid by their thin, fibrous pedicle.
After penetrating the dura mater, and forming more or less extensive
depressions in the cranial vault, these villous-like processes readily
grow into its internal surface, and after its removal project from it
in the form of stalactite osteophytes. When they are not wholly
ossified, they are easily distinguished by a certain flexibility, as well
as by their fibrous pedicle from the osteophytes of the external
layer of the dura mater, which forms the periosteum of the internal
plate of the skull. Large pieces of bone are formed by the grow¬
ing together of adjoining groups, often from opposite sides of the
falx, through foramina and thinned places which have resulted from
the growth of the Pacchionian granulations.
Ihe osseous deposits found in the falx would appear to have most
influence upon insanity. Proceeding, as we have seen, from the
arachnoid, they always cause a more or less considerable pressure
upon the subjacent hemispheres. In the parts subjected to their
pressure and irritation, the pia mater has been observed beset with
numerous dilated vessels, and these vascular alterations are continued
into the brain-substance, which in some places is indurated, in others
softened, and almost always somewhat atrophied.
The form of mental disease most frequently associated with these
conditions is melancholia. Imbecility is sometimes found connected
with the smaller deposits; but in both cases, the condition of the
membranes, irritated by a dyscrasic nutrition, appears to have a far
more disturbing effect than the ossification itself. The great thick¬
ening, often parchment-like character of the meninges, not unfre-
quently combined with ossific deposits, shows that the nutrition of
the brain must have suffered in a very high degree. Ossification of
the arteries has been found in dementia. I observe, from the patho¬
logical register of Morningside Asylum, that osseous formations are
occasionally met with in cases of monomania, particularly of sus¬
picion.
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Anatomy of the Brain in Insanity.
Scrofula, tubercle, cancer, and other tumours. —These conditions,
it must be confessed, are very rare in the insane, certainly not less so
than in the sane, in whom they are found to cause in only a small
fragment of cases some unessential and variable disturbances of the
mind, generally not going further than depression and weakness of
memory. These facts appear to favour the theory that there must
reside in the nervous system of the insane an ultimate irritability of
tissue, which tumours and other neoplasms may develop into disease.
Scrofulous deposits occur in the brain in infiltrated and isolated
forms, but the former are the more frequent. They are to be met
with in the arachnoid and pia mater, forming white specks, consist¬
ing of sandy, granular bodies. Isolated scrofulous tumours are
generally developed in the brain-substance. This condition of the
brain is occasionally found in dementia of the scrofulous, in con¬
junction with serous effusion, and may possibly have some connec¬
tion with cretinism. In some rare cases, insanity appears to depend
on tubercle of the brain, either primarily deposited in that organ, or
transplanted thither during the course of pulmonary phthisis. In
184 cases of insanity, associated with tubercle of the lungs. Dr.
Clouston, of the Edinburgh Royal Asylum, found it only once. Disease
of the mental functions resulting from primary cancer is very un¬
frequent, because cerebral cancer itself is so exceedingly rare. When
it does occur, it oftenest takes the form of meningeal cancer; and so
long as it is of small size, it gives rise to no very important symp¬
toms. As its growth progresses, it occasions symptoms of pressure
and atrophy of the brain, and by degress weakness of memory and
perverted judgment show themselves, until at length absolute de¬
mentia is ushered in. But in many cases this is an exaggerated
statement; the disease often stops short with a kind of torpor of
the intelligence, which from time to time breaks forth in fitful
gleams of reason. Sometimes small cancerous tumours act like
foreign bodies in the brain, and cause spasm, and pain, and epilepsy.
They also give rise to inflammation of the membranes, and serous
effusions into the meninges.
Insanity is occasionally found in association with hydatids of the
brain, and fibroids of the dura mater and arachnoid. These, like
tumours in general, besides functional disturbances of the cerebral
functions, give rise to many and various abnormal expressions of
the intellectual faculties, such as impaired memory, the confounding
together of recollections, incapacity for minute and sharp reflection
and judgment, and, finally, dementia.
Mania and monomania are not observed in connection with
tumours of any considerable size; these paralyse the brain too much
by their pressure and irritation to permit of these symptoms being
developed. Hygromata and cysticerci have been found in the choroid
plexus, and encephalo-cysts in the brain-substance. Fibroids are
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Pathological Anatomy of the Brain in Insanity.
developed from the pia mater and arachnoid, and from the lining
membrane of the ventricles. Besides the general symptoms
already mentioned, when they are situated upon the corpus stria¬
tum or optic thalamus, they cause hemiplegia, squinting, and
impaired speech; while symptoms of cerebral congestion are not
wanting.
The last subject is abnormalities of the cranial bones. We
observe that in insanity the skull is often unusually thick, and its
diploe entirely filled with osseous matter. It is generally believed
that this condition, if not quite an accidental occurrence, originates
during the progress of the disease. There are some exceptional
cases, however, of short duration, in which it is obvious that the
thickening could not have taken place after the commencement of
insanity. Some advocates of mechanical theories have represented
this condition as giving rise to mental disease by pressure and con¬
striction of the cerebral movements, but it is probably an indication
that the bones are involved in the same process which affects the
brain. It does not speak in favour of this view that this sympathy
of the bones nearly as often takes the form of atrophy and thin¬
ning, in which, of course, there can be no pressure; but, indeed,
both phenomena are met with in the sane. According to Virchow,
atrophy of the cranial bones gives rise to weakness of intellect and
impaired memory. Hyperostosis of the skull would appear to have
some relation to atrophy of the brain-substance, being often found
on the atrophied side; but whether as a consequence or a cause has
not been satisfactorily determined.
Deviations in the structural build of the skull appear to be of
considerably greater importance, being one of the chief peculiarities
of cretinism. It is often larger or smaller than it should be, and
very unequal in its different diameters. These abnormalities are
often found in the insane, and some of them are due to the ossifica¬
tion of the sutures. As regards the relation of these cranial de¬
formities to insanity, it is evident that they cannot be a proximate
cause, because they exist a long time before its outbreak, and they
are also found in the sane. As a prominent instance, it may be
mentioned that the sutures of Lord Byron’s skull were found ossi¬
fied at his early death. They may, however, be regarded as a pre¬
disposing cause. Stahl, who has paid considerable attention to this
subject, points out that the premature closing of the sutures is not
caused by pressure upon the brain, but, on the contrary, is an indi¬
cation that the organ has grown in and away from the bones in
certain directions, and thus permitted their ossification. The
symptoms are different according to the degree of deformity. Cre¬
tinism sometimes sets in immediately, or at first there may be
nothing more than a slight deficiency of natural sharpness, some¬
times obstinacy and unmanageableness, until, under the pressure of
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The Genesis of Mind, by Db. Henby Maudsley. 6l
the conditions of life, the insufficient intellect completely breaks
down, and insanity is ushered in.
This closes the review of the pathological appearances in insanity,
and the result which is deducible from the whole foregoing observa¬
tions is so evident, that it is scarcely necessary to express it. The
pathological lesions of the cerebral tissue are not the final and ulti¬
mate causes of insanity; for in all cases it is necessary to assume a
special and specific irritability of the nervous tissue peculiar to the
insane. This granted, they then assume their legitimate position as
secondary causes, and take their place with the pathological pheno¬
mena of the body in general. In making this assumption, it will be
found that medical psychology takes up no position inconsistent with
the facts we possess in relation to the causation of disease. In tracing
back a disease to its ultimate source, we never get beyond the ex¬
citing or secondary causes. We have established pretty clearly that
almost every individual and every family has a “ predisposition” to
some special malady, constitutional or acquired. There the “ problem
begins,” and we wisely fall back upon the exciting causes which de¬
velop this “ predisposition” (as we in our ignorance call it) into
active disease. The same holds good in insanity; there is an ulti¬
mate and peculiar idiosyncrasy, constitutional or acquired, which,
under certain conditions, such as congestion or anaemia, is rapidly
developed into mental disease, and these abnormalities in nutrition,
in their turn, give rise to pathological alterations of the brain-sub¬
stance which deprave or destroy the functions of the mind.
The Genesis of Mind. By Henby Maudsley, M.D.
(Continued from vol. vii, p. 494.)
It might seem unaccountable that, notwithstanding the com¬
mon sense of mankind has in all ages recognised the existence
of intellect in animals, certain philosophers should always have
been found to repudiate the vulgar opinion; were it not that
experience proves there is much truth in the description which
Condillac gives of the philosophers, as “ men who love much better
• an absurdity that they imagine than a truth which all the world
adopts.” Though Plato tells us that in the golden age men derived
all their knowledge from communication with beasts, and though
the little understood and much misunderstood Egyptians of old
paid divine honours to certain animals—not, as is sometimes super*
ficially concluded, on account of their brute wisdom, but really
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as living symbols of Divine intelligence, which they embodied and
instinctively displayed—yet the Cartesian philosophy actually denied
sensibility to animals, and designated them living machines. For
such unmerited ignominy they have, however, been more than com¬
pensated by writers who, like M. Charles Bonnet, maintain the exist¬
ence of immortal souls in them, and predict for them a future world
and a happier destiny.* The ancients would appear generally to have
entertained a somewhat similar opinion; for, without referring to
the doctrine of metempsychosis, we have the authority of Homer,
who represents Orion as chasing the souls of stags over the plains of
hell. And modem instinct, when not perverted by the prejudices
and conceit of learning, never fails to acknowledge the rationality of
brutes. According to a Scandinavian aphorism, the bear has the
strength of ten men and the sense of twelve; and the Bed Indians
are so impressed with the intellectual powers of this animal that,
whenever they have killed one, they scrupulously strive to appease
its manes with various important ceremonies. They deck out its
head with various trinkets, and make a long speech in which the
courage of the departed is praised, its living relatives profusely com-
S limented, and a hope expressed that the conduct of its slayer has
een satisfactory both to itself and them.t The intelligence of civi¬
lisation may dismiss with a smile of pity or contempt such barbarous
displays; but the most advanced intelligence will not forget that
there is some substratum of truth beneath every superstition, by
virtue of which it lives. As no nation ever yet worshipped a piece
of carved wood or chiselled stone otherwise than as a symbol of the
Great Incomprehensible, by which both barbarous and civilised men
are surrounded; so we may rest satisfied that the Bed Indian only
labours to propitiate the ghost of the bear because he has at times
found, to his cost, that its intelligence has surpassed his own. The
extremes of attributing too much and too little intelligence to ani¬
mals will, however, be alike avoided by that sincere and unbiassed
observation which, while discrediting all exaggerated theories, wil¬
lingly recognises the undoubted existence in them of intelligence in
its rudimentary form, and strives to point out the evidences of its
gradual development through them.
* “ Are not these dumb friends of ours, persons rather than things ? Is not their
soul ampler, as Plato would say, than their body, and contains rather than is con¬
tained ? Is not what lives and wills in them, and is affectionate, as spiritual, as
immaterial, as truly removed from mere flesh, blood, and bones, as that soul which
is the proper self of their master ? ” ( 4 Horae Subsecivae/ 2nd series, by J. Brown,
M.D.)
“ Who knoweth that the spirit of man goeth upward, and that the spirit of the
beast goeth downward to the earth ?” (Ecclesiastes, c. iii, v. 21.)
“ There is in every animal’s eye a dim image and gleam of humanity, a flash of
strange light, through which their life looks out and up to our great mystery of
command over them, and claims the fellowship of the creature, if not of the soul.”
(Ruskin.)
t 4 Natural History of Mammalia/ Rev. J. G. Wood.
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As we carry investigation upwards through the mammalia, a very
marked advance is observable in the development of the cerebrum.
Commencing with the simple brain of the marsupials, which is desti¬
tute of convolutions, and even inferior to that of the parrot, we
ascend quite gradually upwards to the largely convoluted brain of
the monkey, which most nearly resembles that of man. A mean
comparison of the weight of the brain to that of the body in mam¬
mals, birds, reptiles, and fishes, will show strikingly the great in¬
crease which takes place in that organ amongst the higher animals.
As a result of his own observations, and of a careful collection of the
observations of others, Leuret concluded that the relation between
the brain and the body was.
In fishes . as 1 to 5668
In reptiles .. 1 to 1321
In birds . ] to 212
In mammalia . 1 to 186*
That the intelligence of the mammalia as greatly surpasses that
jf the animals below them as these figures would lead us to antici¬
pate, there would be no difficulty in demonstrating, even if men were
left out of consideration. But it is not desirable to leave men out,
and so to violate nature by arbitrarily ignoring a progression which
undoubtedly exists. Although in his cultivated state man may ap¬
pear so far beyond any other animal in intelligence, that no figures
representing the height or breadth or depth of his brain, as compared
with that of the animal, will at all adequately express the important
functional differences between them, yet as we trace human deve¬
lopment backwards towards its origin these differences become less
marked. Not only, however, is the Bosjesman infinitely less intelli¬
gent than the European, but his type of brain is of an inferior order;
so that his intelligence, under the best circumstances, cannot possibly
equal that of a well-developed European. Nature has pronounced
him of a lower grade, and has assigned him the humble position of a
link leading to something higher. It is true that information is yet
wanting on the extent of variation exhibited by the brain among the
different races of mankind; but such differences as there are between
the highest and the lowest races are undoubtedly of the same order
although less in degree than those which distinguish the human
from the simian brain. The brains of savages seem, indeed, to remain
for the present to prove that the gradual progression which is ob¬
servable in the development of an individual brain has been the rule
- in the development of the brain of mankind; while there is every
probability that as the individual organ passes out of the inferior
into the superior state, so the inferior brain of the savage is inexor-
# ‘Leuret/ op. cit., p.423. These figures are here given for the purpose of a
general illustration. They have not any special value, as Gratiolet has pointed out,
because the relations of the different parts of brain are not taken into accouut.
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ably doomed to pass away and give place to the superior organ, which
exists in certain parts of the world. By a law of progressive develop¬
ment inferiority is extinguished in the species. And though the
brain of a Bosjesman, being in harmony with its conditions in Africa,
serves its purpose there, yet we have only to imagine it placed
within the skull of an European in the circumstances of civilisation,
and the result would be called imbecility or idiccy. Regarding the
order of progression in nature, it would appear inevitable that it must
sooner or later be superseded by the higher type of brain which exists
upon the earth. Ages have elapsed while this process of replacement
has been going on, and ages may elapse before it is completed, but
the inference is none the less just on that account; for nature regards
not time, and condenses into a single life processes which, at one time,
have required epochs for their evolution. So great a potentiality has
the foetal brain of man, for example, that in the course of a few weeks
it passes tlirough and beyond all the stages of brain-development
represented in the successively advancing orders or individuals of the
mammalia. Similarly, also, wheu brought into the conditions of a’
favorable activity does the human brain reflect, as it were, in a year’s
time the various stages of advancing intelligence in the animal king¬
dom, and the ages of time which the geological records prove to have
been necessary to the development of such intelligence therein.
In selecting examples of the intelligence of the mammalia, there is
the greatest difficulty in determining where to begin and where to
end; the illustrations are so many, so varied, and so interesting,
that, overwhelmed by the number, and yet attracted by the interesting
variety, the prospect of a judicious choice is hopeless. As the dog,
of all animals, has been brought into the closest converse with man,
and has thus been subjected to the most patient education, it affords
the most striking instances of rational development, and even exhibits
remarkable illustrations of a sort of moral feeling. Nevertheless,
attentive observation will discover other individuals in the mam¬
malian class which possess the rudiments of as great intelligence as
the dog, but which, never having been so highly trained through
~ generations, do not afford such remarkable exhibitions thereof as
an animal which seems to have been educated to the utmost extent
of its possibilities. The elephant appears to be one of the most
gentle and intelligent animals by nature; Aristotle maintained that
it surpassed all other animals in its power of comprehension, and it
was thought worthy by the Eastern disciples of metempsychosis to
receive the souls of the Indian emperors. Its character is gentle
and peaceable; it lives on vegetable food, and, except at certain
periods of the year when it is veritably mad, it never attacks but
when provoked. In captivity it becomes, when treated with kind¬
ness and intelligence, a most valuable servant; and its keepers often
maintain that it understands everything that is said to it. But so
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high an innate sense of justice has it, that it is well known to be a
most dangerous thing to break faith with it; its vengeance is sure,
and sometimes fatal. The tailor who, instead of offering the usual
biscuit, mischievously pricked its trunk with his needle, was simply
deluged with a shower of dirty water from the offended organ, but
the fife of him who cruelly treats the lordly brute is likely enough to
be sacrificed to its anger. Some elephants are undoubtedly also
highly sensitive to music, and will manifest by their expression and
movements their sympathy with the tender or passionate character of
the melody. But they are not animals which propagate in‘captivity,
and, though eminently sociable arid living usually in companies,
when the time of love comes on, each male, accompanied by a female,
retires to the depths of the forest, moved thereto, as it would seem,
by a sentiment of modesty. Wherefore it is not possible with the
elephant to accumulate the effects of education through generations,
os is so usefully done with dogs. Not that any one of the latter
animals ever transmits the actual results of its education to the
progeny, but it scarcely admits of question that the acquired intelli¬
gence of the parent does impart an increased educability, within
certain limits, to the offspring, and sometimes even implants itself as
a new instinct in the constitution. The same law is seen in
operation in a more marked manner and on a more important scale
amongst mankind. Few, if any, believe that the individual
Bosjesman or native Australian, though placed under the best Euro¬
pean tuition, could possibly be educated to the average point of
European intelligence; but it would be quite at variance with the
view which man has of his nature and his destiny to suppose that
the native Australian or the Bosjesman might not, by the influence
of education and favorable conditions through many generations, be
elevated to the grade of the ordinary European intellect.
What effect the influence of human reason working through
generations might have on the elephant in developing the possibilities
of its type, though interesting as a speculation, is not of great prac¬
tical moment; for the examples of elephantine intelligence which
already abound are of so remarkable a character as to excite much
wonder that any one should be found content to refer them to
instinct. Sir Emerson Tennant mentions a pair of elephants that
were accustomed to labour together in piling wood, and which had
been taught to raise their wood-piles to a considerable height by
constructing an inclined plane of sloping beams, and rolling their
logs up these. In the same work on Ceylon, he also tells of meeting
face to face, in a narrow path, an elephant without any attendant,
which was carrying a heavy beam of timber; it was grunting in a
very dissatisfied way, because the narrowness of the path compelled
it to bend its head constantly to one side in order to let the wood
pass, and thus caused it much exertion and inconvenience. As the
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pathway was too narrow to permit Sir Emerson, who was on horse¬
back, to pass, the elephant flung down the timber and forced itself
back into the brush-wood, so as to leave a clear passage. “ My
horse still hesitated; the elephant observed, and impatiently thrust
himself still deeper in the jungle, repeating its cry of ‘ urmph,' but
in a voice evidently meant to encourage us to come on. Still the
horse trembled, and anxious to observe the instinct of the two
sagacious creatures, I forbore any interference; again the elephant
wedged himself further in amongst the trees, and waited impatiently
for us to pass him, and after the horse had done so, tremblingly and
timidly, I saw the wise creature -stoop and take up his heavy burden,
turn and balance it on his tusks, and resume his route, hoarsely-
shouting, as before, his discontented remonstrance.” Here, at any
rate, we shall not be inclined to dissent from the opinion of Locke,
when he says, with reference to the question whether elephants and
dogs think, that “ they give all the demonstration of it imaginable,
except only telling us that they do so.”
Some will strenuously hold, and with much reason, that dogs do
tell us that they think, or at any rate that they strive very hard to
do so; and it must be impossible to look down into the intelligently
beaming eyes of a pet terrier, without feeling at times a real pity for
it—pity for its inability to express that which plainly it is eagerly
panting to tell. And how joyous is the creature if its inarticulate
eloquence be understood, how happy and abandoned in its delight!
It seems as painful a thing for a dog not to be understood, or to be
misunderstood, as it is for a mortal. “ If Pliny's elephant repeating
its lesson in the moonshine is not to be credited, nor Ptolemy's stag
who understood Greek, nor Plutarch's dog who could counterfeit the
very convulsions of death, nor that goose which was disciple to a
philosopher, what shall we say to an ape that could play chess, or of
another that had learnt some touches upon a guitar. But let who
will judge of Francis the First's dog; that king, having lost his gloves
as he was hunting, and having sent him in search of them, and he,
after a tedious inquiry, returning without them, being reprimanded
by his master, runs directly to Paris, and leaps up at a stall where
he had formerly observed gloves hang out, and tears down a pair and
carries them three leagues back again to the king.”* We remark
here in the dog an accurate comprehension of its master's injunctions*
persevering efforts to fulfil them, grief of dog's mind at the master's
displeasure on account of its want of success, an accurate remem¬
brance of the place where similar gloves were exposed, and a deter¬
mination to supply at any cost its master's necessities. Every one
may imagine for himself the ideas or notions which must have
passed through the dog's mind, and the order of their succession, in
the accomplishment of its difficult task. In his interesting “History
* The reference is lost; but it was to some old book by a ‘ Gentleman of Quality. 1
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of Mammalia,” the Rev. J. G. Wood, amongst other wonderful anec¬
dotes, relates the following of a comical little dog which he met with,
and which he believes to have been the barbet—a diminutive variety
of the poodle. It was not larger than an ordinary rabbit, and was
a most amusing and clever little animal, "readily picking up acquire¬
ments and inventing new accomplishments of its own. He would
sit at the piano, and sing a song to his own accompaniment, the
manual, or rather pedal part of the performance being achieved by
a dexterous patting of the keys, and the vocal efforts by a prolonged
and modulated howl. He could also 'talk' by uttering little
yelps in rapid succession. Like all pet dogs, he was jealous of
disposition, and could not bear that any one, not excepting his
mistress, should be more noticed than himself. When his mistress
was ill, he was much aggrieved at the exclusive attention which was
given to the invalid, and cast about in his doggish brain for some
method of attracting the notice which he coveted. It is supposed
that he must have watched the interview between medical man and
patient, and have settled in his mind the attraction which exercised
so powerful an influence upon the physician; for just as the well-
known carriage drew up to the door. Quiz got on a chair, sat up on
his hind legs, and began to put out his tongue, and held forth his
paw as he had seen his mistress do, and evidently expected to be
treated in a similar manner. His purpose was certainly gained, for
he attracted universal attention by his ruse.”
In place of multiplying, as might be easily done, the examples of
animal intelligence, it will be satisfactory to select such instances as
evince emotional feeling on the part of brutes; and the more so, as
the existence of the latter, when of a higher character than a mere
passion, may be regarded as a proof of the existence of a correlative
intellectual power.* It has been said that animals “ seem destitute
of sympathy with each other, indifferent to each other’s sufferings
or jdys, and unmoved by the worst usage or acutest pangs of their
fellows. Indeed, if we except some associated labours in the insect
class, principally referring to the continuation of the species, and
securing a supply of food, and some joint operations of the male
and female in the higher classes, animals seem entirely incapable of
concert or co-operation for a common end.”f Such a statement is,
however, much too general, and stands in need of considerable
limitation. Not to mention those wild creatures which unite toge¬
ther to hunt down an animal that would speedily destroy any indivi¬
dual of them, there are undoubted instances of co-operation for mutual
help under unusual circumstances, even amongst humble animals.
* By speaking of mere passion, it is intended to denote the low self-feelings, the
lowest emotions—the Egoistic as distinguished from the Altruistic emotional life, as
Comte would have it.
f 4 Lectures on man.’ Lawrence, p. 202.
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A gentleman, seeing two stoats in the path, picks up a stone and,
flinging it, knocks one of them over. The other uttered a loud and
peculiar cry, which was answered by a number of its companions
that rush upon the assailant, running up his body to get at the
neck. He was compelled, after in vain fighting against them, to
put his hands round his neck and to run away. He ran four
miles, and when he arrived at his own stables, five stoats that
had hung to his body were killed by the servants; others had
dropped off as he ran. The common brown rats are capable of a
wonderful combination, and when they do act in concert become
formidable. They have been known to attack a cat, and to inflict
such serious injuries, that the latter had to be killed. Dogs afford
some remarkable instances of active sympathetic aid rendered to one
another. A certain dog, in the eager pursuit of a rabbit, got fixed
in a hole; two friendly dogs remained with it night and day, till
by their exertions they had extricated it. A peaceable and not very
brave dog, in passing a butcher’s shop, was smartly punished by a
terrier that rushed out of it; but it had a friend, a well-bred bull-
terrier, to which it was observed to be particularly attached for some
days after its misfortune, and when next it passed the butcher’s shop
it was accompanied by the terrier. The butcher’s dog rushed out
as before, but was received by the friendly terrier, and tumbled over
and over amidst the joyful barks of its former victim.* Other such
cases are on record; and a very interesting one is related by
Mrs. S. C. Hall. “Neptune, a large Newfoundland, had a warm
friendship for a very pretty retriever. Charger by name, who, in ad¬
dition to very warm affections, possessed a very hot temper. In
short, he was a decidedly quarrelsome dog, but Neptune overlooked
his fnend’s faults, and bore his ill temper with the most dignified
gravity, turning away his head and not seeming to hear his snarls or
even feel his snaps. But all dogs were not equally charitable, and
Charger had a long-standing quarrel with a huge bull-dog, I believe
it was—for it was ugly and ferocious enough to have been a bull-dog—
belonging to a butcher. It so chanced that Charger and the bull¬
dog met somewhere, and the result was that our beautiful retriever
was brought home so fearfully mangled that it was a question whether
it should not be shot at once; everything like recovery seemed im¬
possible. But I really think Neptune saved his life. The trusty friend
applied himself carefully to licking his wounds, hanging over him
with such tenderness, and gazing at his master with such mute
entreaty, that it was decided to leave the dogs together for that
night. The devotion of the great dog knew no change; he suffered
any of the people to dress his friend’s wounds or feed him, but
he growled if they attempted to remove him. Although after the
* A case precisely similar was communicated to the writer on the most reliable
testimony.
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lapse of ten or twelve days he could limp to the sunny spots of the
lawn, always attended by Neptune, it was quite three months before
Charger was himself again; and his recovery was entirely attributed
to Neptune, who ever after was called Doctor Neptune—a distinction
which he received with his usual gravity.” Now,Neptune himself was
not a quarrelsome dog, but sedate, dignified, and peaceable; butas soon
as Charger was fully recovered, the two set off together, furiously fell
upon the bull-dog, and did not leave it till they had killed it. The
anecdote evinces an amount of compassionate sympathy, of kindly
and assiduous attention, a patient forbearance, and a co-operation in
the execution of desperate punishment, which testify to an unex¬
pected emotional sensibility, as well as to considerable reasoning
power. Neptune was the good Samaritan in season; but he was
also the determined executor of an avenging justice; and though
his justice, like the primitive justice of mankind, was certainly a
vengeance, it was still a vengeance called forth by a feeling of moral
indignation on account of a friend's wrongs, and, at any rate, executed
in complete abnegation of self. Another instance of active animal
benevolence is given by M. de la Boussanelle, a captain of cavalry.*
A horse in his company being very old, had worn its teeth quite
away, so that it was no longer able to chew its hay or to crush its
oats. For two months it was actually fed by the two horses that
stood one on each side of it; they masticated the hay, and then
placed it before the old infirm animal, and so likewise with the oats.
He affirms that the entire compa ny, officers and soldiers, witnessed
the fact, and could testify to it. We have no name whereby to de¬
scribe this kindly feeling and active sympathy amongst animals; for
man has appropriated the honour thereof to himself, and calls it
humanity—which is part of his system; for when he has done any¬
thing so abominably vicious and unnatural, that no brute ever did
the like, he calls the act brutal.
That animals possess imagination is proved by the fact that they
dream, which children seem not to do for a year or two after
birth ;t and that dogs as well as some birds of prey doubt, is made
manifest when they will not pursue the game, sometimes because it
is too fax off, and at other times appear undecided whether to do so
* ‘Observations Militaires,’ Paris, 1860, quoted by Gratiolet, * Anat. Comp, dn
Syst. Nerv., &c., 9 p. 642. Gratiolet relates how two young bears were to be poi¬
soned by throwing to them strong doses of arsenious acid in their food. To save the
mother, she was shut up in a cage; the young ones, however, to console their mother,
carried portions of the food to her. 4 Des Homines £minents, et, entres autres, M. de
Blainville furent temoins du cette scene, 9 p. 642.
f According to Aristotle, children do not dream in earliest infancy—only do so
when they are about four or five years old. In another part, however, he says that
the new-born infant dreams, but only remembers its dreams later on in life. Burdach
says, the child at the breast dreams, but forgets its dreams till about seven years old.
Gratiolet, however, clearly recollects having dreamed when about three years old.
(Gratiolet, op. cit., note, p. 497.)
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or not. Other animals exhibit like hesitation and deliberation.
“ The mules of South America,” says Humboldt, “ when they feel
themselves in danger stop, turning their heads to the right and to
the left. The motions of their ears seem to indicate that they reflect on
the decision they ought to take. Their resolution is slow, but
always just, if it be free.”*
Coleridge was accustomed to regard the dog as the most affec¬
tionate of animals, and he is said to have remarked that “ the dog
alone of all brute animals has a ertpyi) or affection upwards to man.”+
Though it is scarcely correct to say that it is the only animal which
exhibits an affection upwards to man, as even the unwieldy hippo¬
potamus becomes excessively fond of its sable attendant, there can be
no question that the dog manifests such a feeling in a higher degree
and in a more varied manner than any other creature. Marvellous
and truly affecting examples testify to its intense love for its master;
persistent neglect and continued ill treatment quench not the deep
passion; and the brutal master's life has not unfrequently been
saved by the faithful intelligence of his ill-used, and, one might
almost say, humane, dog. It will guard carefully its master’s property,
dreading his reproach, and hoping for his approbation; it will avenge
his insults ana minister to his wants; it will die bravely in his de¬
fence, or pine away in slow grief over his grave. The sorrow and
self-control, too, which outlast hunger in animal nature must be
very great; and as dogs, left in some charge, and not duly relieved
therefrom, have, from a sense of duty, dwindled down almost to
skeletons, or have actually died rather than desert their posts, their
moral restraint must not be lightly esteemed.
The phrenologists have, with their accustomed dogmatism,
denied the sentiment of veneration to animals; but the creature
of an inferior type of intelligence, evidently sometimes not
merely fears but venerates the superior creature, and amongst
those animals of the same class which choose an experienced chief
and obey him, there is the clearest veneration for his superior
wisdom. But if every other animal was left out of consideration,
it would seem impossible to doubt the dog’s veneration for man.
As Burns has said, and as Bacon said before him, “ Man is the
god of the dog.” Now the native Australian believes his deity to
be inferior to the white man—regards it as vanquished, dethroned,
and buried under the earth, existing even there only by sufferance.
And as we do not question the existence of intelligence or of moral
feeling in the native Australian, though he entertain such absurd
notions, but rather discover the rudiments of both intelligence and
moral feeling in him, it behoves us rightly to make all fair allowance
in estimating the moral and intellectual faculties of the dog, which,
* ‘ Aspects of Nature.’
t • Table Talk.’
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however much inferior in type, are yet more truly and legitimately
developed in its aspirations, than are those of the native Australian
in the direction which they take. It is with the superior being,
man, that it rests, what shall be vice to his dog and what virtue; he
may teach it to refrain from taking that which it should not have,
or he may teach it to steal with great cunning, and to look on suc¬
cess in such business with satisfaction. The master, in fact, makes
the moral sense of his dog; and, just as the unhappy infant, born
in an atmosphere of thieving, and nourished amid the unfavorable
circumstances of a general immorality, grows up with a “ moral
sense,” the good of which is evil, or rather with an “ immoral
sense,” so the dog which has been subjected to the education of
rascality inevitably works according to the system in which it has
been developed, and worships the divinity that has presided over
it.* There is a well-known story of a drover who used to steal
sheep by the help of his dog. His plan was to indicate to it by
some gesture the particular sheep which he wished to have, and then
to send on the flock under the care of his dog, himself lagging be¬
hind. The clever animal contrived to mix the flocks, and, in the
separation of them, to carry off the desired sheep. Of course, if
the loss was discovered, it was put down as a mistake of the dog;
but if not, the drover soon put his own mark on the sheep. Even
the clever shoplifter does not sometimes disdain the assistance of a
suitably trained dog, which in its thieving simply acts according to
its light. On the other hand, Hogg, the “ Ettrick Shepherd”
tells how he has known a cur-dog to mount guard night and day
over a dairy full of milk and cream, and never so much as touch
the milk or permit a cat or rat to do so either. It is evident, then,
that the conscience of the dog is mainly derived, though whether
its existence presupposes the presence of an original moral germ
implanted in the canine constitution, is a question that may well be
left to the consideration of those philosophers who maintain, in the
case of the human subject, that the development of moral idea pre¬
supposes necessarily the rudimentary existence; of moral sentiment.
The well-trained dog’s conscience, so plainly rebuking it when it
has sinned, surely no one can refuse to acknowledge. When the
animal has, from some strong temptation, betrayed its master*s con¬
fidence, how painfully conscious does it appear of its delinquency !
With what a look of disgrace it shrinks away from the accusing
eye—with a feeling seemingly compounded of fear, shame, grief,
with a tinge of remorse, severally indicated in the timid shrinking,
♦ “ Oh Lord! how I do love thieving: if I had thousands I would still be a thief,”
once exclaimed an unrepentant young female criminal, whose innate “ moral sense”
had unhappily taken flight somewhere. For evidence of the utter hopelessness of
reforming many criminals, see reports of governors of gaols; for evidence of the cun¬
ning cleverness of these unreforraable rogues, see reports of chaplains of gaols.
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the conscience-stricken tail dropped between the legs, the sorrowful
imploring countenance, and by-and-by the repentant, reconciliation -
inviting wag of the reviving tail.
It would not be an easy task, it would be, perhaps, impossible,
to prove that the primitive moral sense of which the dog is possessed,
diners in anything but degree from that of mankind. Reflection
upon the nature and origin of the moral sentiments seems to indi¬
cate that their existence depends upon the condition of mental
development. They are moral cognitions, and the highest cognitions
to which the mind can attain. Thus, for example, the highest
moral feelings in man are feelings arising from certain abstract
ideas—benevolence is the agreeable feeling springing from the idea
of accomplishing the good of another, esteem is the pleasing
emotion springing from the idea of the virtues of another, and so
with other sentiments—they are all the correlatives of certain ideas
which are evolved in the course of an advanced intellectual develop¬
ment. Now, it is evident that man only can be affected agreeably or
painfully by abstract ideas, for the brute cannot receive them, and of
course cannot feel them. Neither, however, it must be kept in
mind, are the inferior human races able to receive any but simple
ideas. The native Australian has no words in his language cor¬
responding to justice, virtue or sin, and he is utterly incapable of
receiving the abstract notions which these words excite in the culti¬
vated European mind. An act of generosity or mercy would be
almost, if not quite, as incomprehensible to this miserable savage as
to a dog.* In like manner the early inhabitants of the earth had
not any abstract language; when they thought of an act of justice, it
was as some visible act performed by some deity. So that when we
say that the moral feeling of the dog is confined to the concrete, and
not to the concrete particular, but, inasmuch as it is capable of
general ideas, to the concrete general, we only signalise a degree in
its development a little lower than that which characterises the
lowest human being. In fact, the moral cognitions are very imper¬
fect, or altogether wanting, in early mental development, whether we
trace it as it takes place in the animal kingdom, or in the child, or
in those barbarians of the present day who represent the childhood
of humanity. And what has been a little while ago said of the
differences in the development of the brain among the different races
of mankind, may be repeated of the differences in its function. The
intellectual differences between the lower and the higher races, though
less in degree than, are yet of the same order as, those which distin¬
guish animal intelligence from the lowest human intelligence.
* Touching the moral sense in man, it may not be inappropriate to quote here what
J. S. Mill says, when speaking of religious belief—“ a case instructive in many ways,
and not least so as forming a most striking instance of the fallibility of what is
called the moral sense; for the odium tkeologicum t in a sincere bigot, is one of the
most unequivocal cases of moral feeling.”—(' On Liberty/) J. Stewart Mill.
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by Dr. Henry Maudsley.
The examples which have been given of canine psychology appear
to indicate the existence in dogs of the rudiments of emotional feeling
of the higher order, which further observation may not prove to be
so plainly displayed by animals that certainly seem to be superior to
them in intelligence. In fact, the monkeys, though surpassing all
the lower animals in intellectual powers, by no means equal the dogs
in that sincere but rudimentary appreciation of moral relations which
some of the latter exhibit. The higher animal seems, for the most
part, to use its superior powers only for selfish and mischievous
purposes; and there is all the difference between the cunning mon¬
key and the well-trained, honest dog, that there is between the sim¬
plest, dullest peasant—kind, hearty, and sound to the core —and the
clever educated thief, who is utterly incapable of realising moral
truths, and uses his advantages only for the more successful gratifi¬
cation of his depraved passions.* Or more justly, perhaps, might
the monkey's intelligence be compared to that displayed by certain
demented or idiotic human beings, who, dead as it were to outward
relations, are yet capable of very remarkable exercises of cunning in
the gratification of self.
It is, incidentally, a reflection not a little striking, that the
various mental characteristics of the different species of animals
are sometimes manifested by different individuals amongst man¬
kind; so that the fable of metempsychosis, which was Indian,
Egyptian, and Grecian, may, to those who look beneath the surface
of forms and words, appear to have a real signification. As in
his bodily organization, so in his mental phenomena, man contains
all that has gone before of the same kind. In some we have the
gentle, patient, intelligent endurance of the elephant, in others the
savage and cowardly cruelty of the tiger; some exhibit the stealthy,
desperate, creeping cunning of the panther, and not a few are endowed
with the obstinacy of the ass; one has the undemonstrative and gene¬
rous courage attributed to the lion, while another may boast of the
ignominious humility of the jackal, that waits upon the lordly beast.
Some depraved mortals may manifest the characteristics of one of
these animal types, and others those of another; but by far the most
common form of human degeneration is that in which the animal
propensities generally, in place of being subjugated to the control of
a developed intellect and well-formed will, actually govern the intel¬
lect and will, and degrade them, as in the monkey, to their ignoble
service. But this, though right seemingly for the monkey, is cer¬
tainly not right for man; for while the evolution of the type of the
* If it be asked, whether the monkey is really, then, mentally higher than the dog,
the reply is, that it is of a higher type, though of a lower development, than the
domesticated dog. The effect upon the latter of human influence through genera¬
tions has been not only to bring out all the possibilities of its type, but seemingly to
impart to it some of the virtue of the human type; so that the number of its ideas is
increased, and snch ideas as it has are more acutely felt, as canine emotions testify.
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former appears to consist in the development of reason within the
circle of self, the just evolution of the human type undoubtedly con¬
sists in development out of self—in that realisation of the moral
relations of the universe, which constitutes the highest intellectual
and moral development.
The foregoing considerations lead us to remark that it is a mistaken
waste of power to attempt by education to assimilate any animal to
man; for the true education of every animal is to realise the possi¬
bility of its particular type—fully to display the teleiotic idea which
it embodies. The difference of mental species is as important a fact
as the difference of bodily species; and not till a way of compassing
the transmutation of the latter has been discovered need there be
any hope of transmuting the former. Accordingly, as might be
expected, no amount of education during one generation has any
effect in humanising the simian character ; for although monkeys are
gentle enough in youth, when, as we have seen, they are least
removed from the human type, they almost invariably become mis¬
chievous, selfishly cruel, and utterly unmanageable as they grow up.*
Though subjected to the most severe and steady training, the monkey
cannot be prevented from stealing; however keenly alive to the
grievous consequences of the act, it cannot resist it; steal it must,
and steal it will, for its reason is the slave of its passion. Du Chaillu
gives an interesting account of a young chimpanzee, which he
caught and which he named “ Joe”; and which acquired quite natu¬
rally, he says, two of the vices of civilization, stealing and drunken¬
ness. It would enter his room in the morning, and, if he appeared
to be asleep, would straightway make its way to the sugar-basin; if,
however, he was awake, the cunning creature jumped on to his bed
as though eager to be caressed. Sometimes Du Chaillu would feign
to be asleep when it came in, and suddenly to wake up; Joe, if he
had not already got as far as the sugar-basin, would jump on the bed
seemingly oveijoyed at its master’s awakening; but if he was in the
act of depradation, Joe made off at his utmost speed. He ultimately
fell a victim to a bottle of brandy, which he had contrived to steal.
It may be observed that what the dog must be taught with much
care and patience to do well, the monkey artistically accomplishes
quite naturally, and cannot be taught to refrain from doing. It can¬
not apparently acquire moral control. Whether by the influence of
education through many generations, the character of the monkey
might not be raised to a higher moral standard, is not so certain,
and not likely, any way, to be decided.
Numerous examples might be given of the innate moral depravity
♦ As the physiognomy of the young chimpanzee is much more human than that
of the full-grown animal, so the mental phenomena of the young are much nearer the
human type than those of the full-grown chimpanzees; as the latter grow up, they
develope into the specialities of the monkey type.
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by Dr. Henry Maudsley.
of the quadrumana, which in some amounts to downright moral in¬
sanity. Thus the mandrill—Papio inaimon—is very easily excited
to anger, and sometimes boils up into such a storm of fierce and
vicious passion, that it has been known to fall down lifeless. It
moreover, unlike most other monkeys, cherishes its rancour, and will
maliciously pretend to have forgotten the offence in order to wreak
its vengeance the better on a favorable occasion. In its passion it
may be compared to the maniacal child, or to certain idiots, who, in
paroxysms of violent anger, will sometimes fall down in actual con¬
vulsions. Again, a well-authenticated tale is told of a true baboon,
which played various tricks for the pecuniary benefit of its master.*
It used regularly to steal its own food; and the way in which on one
occasion it got the better of a date-seller was admirably ingenious.
Simulating a fit, it fell down as if in great pain, and rolled about the
ground in apparent convulsions. But every writhing of its body
brought it nearer and nearer the basket of dates, and when it came
within reach of them, it emptied the basket with its hind feet, engag¬
ing the attention of the vendor meanwhile by its strange grimaces.
Another curious story, perhaps not quite so well authenticated, is
told of the same animal. Its master had taught it to watch the
cooking of his dinner while he was engaged in his occupation away
from home. One day he put a fowl in the pot, and left it in charge
of the baboon as usual. ^Curiosity overcoming the guardian, it took
off the lid of the pot ; the savoury odour which rushed out proved
too much for its virtue ; it tasted the fowl, took a little more and a
little more, until it finally demolished the whole. Bemorse there¬
upon followed; and a deadly fear fell upon the unfaithful servant.
Something must be done to conceal the crime; and its ingenuity
was sharpened by its fear. Bolling itself in the dust so as to cover
nearly the whole body with a uniform coating thereof, it gathered it¬
self into a heap with its hands and knees upon the ground, so as to
present the appearance of a rough block of stone, with two pieces of
raw meat on the top (the posterior red callosities). Some kites,
attracted by the smell of the fowl, and seeing what they thought to
be two pieces of raw meat, immediately pounced upon the fancied
prize. A quick grasp, and one of them was caught, and, notwith¬
standing its struggles, forced into the boiling pot. The psychological
character of the monkey is so well revealed in the story that it de¬
serves to be true, whether it is so or not. One may add, that man
is not the only being who is capable of using other animals for his
amusement; for Humboldt tells of a Capucin monkey which was
accustomed to catch a pig every morning,, and, mounting on its
back, to ride it for the rest of the day; even while the pig was
feeding in the savannahs its rider kept its seat.
* Rev. J. G. Wood, op. cit.
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The simiadse exhibit in an extravagant manner all the inferior
kinds of emotion, fear, jealousy, envy, hatred, malice, and all unchari¬
tableness ; but they do not seem to be capable of the higher emo¬
tions; although, in their exceeding .cunning, they will, from an
interested motive, at times feign a kindness and benevolence which
they do not sincerely feel. A papion, whose wife had died, was the
father of a little one that had been born in a menagerie. The young
creature was unhealthy, stunted and rachitic; and it slept every
night in the arms of its father, who gave it the greatest possible
care. It was the object also of particular attention on the part of
other monkeys, which not only forbore injuring it in any way, but
caressed it in all sorts of ways. For this kind attention, however,
those who observed the matter were quite certain that it was solely
indebted to a lively dread of the long teeth and great strength of
its parent. The manner in which a new arrival acquires its right of
domicile in a cage of monkeys is singular. Almost all the old resi¬
dents are inclined to quarrel with and persecute it, but they take
good care, before doing so, to examine the length of its teeth, and
to make themselves acquainted with its strength. The quarrelsome
habit compels the keeper to have the little animals separate, unless
some larger monkeys are willing to constitute themselves their pro¬
tectors. Now, the cynocephali, though naturally cruel enough, hap-
S en to be rather fond of little ones, and, as^they are of a changeable
isposition, they prefer the new arrivals to those that have been with
them for some time. Advantage is taken of this, and the monkeys
that need protection are placed in the same sleeping cage with them;
there is no fear then for the little ones.* It would not be wise to
credit the cynocephali with much real kindness, this good habit of
theirs notwithstanding; it may be that the explanation of the capri¬
cious and short-lived affection is to be found in the malicious delight
which the big animal feels in disappointing the cruelty of the smaller
bullies, and in the self-satisfaction which it derives from the exercise
of its despotic power. Such motives for a capricious kindness are
not altogether foreign to human nature.
Injustice must not, however, be done to the monkeys, lest in the
present state of opinion the accusation be made of irreverence to our
remote progenitors. The monkeys of the New World are generally
of a gentler disposition than those of the Old World, and some even
approach to amiability of character. Thus the Ateles is a gentle
creature, and susceptible of a high degree of cultivation; it is not so
capricious in temper as other monkeys, is affectionate, and attaches
itself strongly to those whom it takes a fancy to.f It is a remark-
* Leuret, op. cit„ pp. 536, 537.
t The Rev. J. G. Wood (op. cit.) gives a long account of a pet one.
A remarkable thing about the Ateles is, that its brain exhibits both the 1 premier
pli de passage ’ and the 4 deuxietne pli de passage ’ of Gratiolet—the convolutions
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able circumstance, that in all the countries in which the larger apes
abound, stories are told of their carrying off women, and the inha¬
bitants believe the tales; the large baboon, the gorilla, and the chim¬
panzee, are all said to have carried off women to the woods. In
favour of the story there is certainly this to be said, that male
baboons in captivity make a great distinction between their visitors,
preferring much the ladies to the gentlemen. Sometimes they are so
jealous as to fall into a great passion when any particular attention
is paid to a lady in their sight. This propensity was made the
means of recapturing one which had escaped from its cage in the
Jardin des Plantes. Several unsuccessful attempts had been pre¬
viously made, and some of the keepers severely wounded, when one
of them hit upon a plan. There was a small window at the back of
the animal’s cage, and as the baboon passed backwards and forwards
in front of the cage, the keeper brought a young lady to the window
and pretended to kiss her. This was too much, and the animal
bounced into its cage in a great rage, and was secured.*
It has sometimes been said, that man alone amongst animals is
able to laugh from joy or to shed tears of sorrow. And it certainly
would not be well to trust to the laugh of the so-called laughing
hyaena, lest a like evil befal us to that which happened to a boy who
( )ut his fingers through the animal’s cage; it snapped them off, swal-
owed them, and then continued its rollicking laugh. But in
addition to the assertion of Le Cat, that he has seen the chimpanzee
both laugh and weep, we possess the reliable evidence of Humboldt,
who says of a small American monkey :—“ Its physiognomy is that
of a child; the same expression of innocence, the same arch smile, the
same quick passage from joy to sadness. The Indians assert that
this animal weeps like a man, and the observation is very correct.
The large eyes of the mqnkey are moistened with tears the moment
it exhibits great terror or lively distress.”f
There isnoless a resemblance between the early emotions of the infant
and those of the monkey than there is between their physiognomies,
inasmuch as the first emotions of the child are of the simplest kind and
of the lowest order; sensational pain and pleasure pass in the most
gradual way into the emotional grief and joy which spring from per¬
sonal discomfort and personal gratification. After a little while, anger,
jealousy, pride, envy, and other self-feelings display themselves; in
which come to the surface in the 4 external perpendicular fissure/ and bridge over
the chasm in man. The second convolution is invariably absent in both the autiiro-
poid apes, but invariably present in man; the first, Gratiolet says, is only found in
man, the orang and the ateles. Dr. Rolleston has, however, shown that the first is
not always apparent in men and the orang, and is sometimes present in the Chim¬
panzees. (See ‘ Nat. Hist. Review/ No. II, art. xx.)
* Op. cit., Leuret. The odd circumstance is, as some one has remarked, that
the baboon should be able to distinguish the female when dressed.
f 4 Aspects of Nature/
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The Generi* of Mind,
fact, that constitutional impulse to maintain and develope existence,
which has hitherto worked unconsciously in the organic processes,
now having entered into consciousness, strives in a like manner to
maintain individual comfort and increase individual power. Conse¬
quently every child must at first be, and is, eminently selfish; and it
is only when the organic conscious impulses, as one might designate
the lower emotions, are enlightened, controlled and properly directed
by a rightly developing reason, that they receive their gratification in
the indirect pleasure which the happiness of others and the realisation
of moral relations bestow. Cruelty might seem to be innate in the
child, but it is with it really as it is with the monkey, with the
lowest barbarian, or with the cat as it tortures the mouse ;* while
there is a positive delight in witnessing the spectacle of struggling
suffering, a consciousness of the pleasing affection of self by the
object, there is not, by reason of the low state of mental develop¬
ment, any penetrating consciousness of the condition of the not-self ;
confined, as yet, within the domain of self, there is no realisation by
the mind of the suffering actually inflicted. The ideas which correlate
the feelings of compassion, sympathy, benevolence, and other such
holy states of consciousness, have not yet been developed in the
mind ; and it is utterly impossible, therefore, that there should be
any such feelings. By the fear of punishment children are taught
to abstain from acts of cruelty long before they themselves feel the
horror of such acts, just as the chimpanzee is taught to avoid the
sugar-basin from the same cause; but just as the chimpanzee will
steal sugar if it fancies that it can do so without being found out,
and will exercise much ingenuity in preventing discovery, so, like¬
wise, children, fearful of an open indulgence in acts of cruelty, will
devise stratagems for compassing a secret indulgence—not yet
feeling the acts to be inherently wicked, but dreading only the danger
to ^themselves therefrom. Whether in such inflicted suffering is
implanted in the child the first germ of the sense of obligation, which
in time expands into a moral sense, whether, in fact, the conscience is
first derived and afterwards becomes self-sustaining, as some philoso¬
phers maintain, or whether the development of moral ideas presup¬
poses the rudimentary existence of moral sentiment, as others hold,
are not questions to be entered upon here, where all that need be
said is, that whatever conclusion be arrived at with regard to man¬
kind, must be true in a lower degree of animals, must, in fact, be
applicable to developing mind in nature as well as to developing mind
in individual man.f
* It is so unlike animal nature to torture the prey before killing it, for the mere
pleasure of witnessing its struggling agonies, that this habit of the cat is remarkable,
and seems, indeed, to indicate man’s hand in the matter. A good deal might be
said in favour of its being an acquired instinct—a practice first taught by man, and
afterwards transmitted as an instinct.,
f The disputes upon these questions seem, in some degree, to be sustained by the fac-
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Even if the practical difficulties in the way of the development, by
human influence, of the chimpanzee'’s nature were not, as they are,
insuperable, but really admitted of the attempt, there is every reason
to believe that it would be impossible to expand the simian type into
the evolution of those higher ideas which correlate the nobler
emotions. The child, on the other hand, when well-born and
healthy, passes through the natural course of a deepening and
widening insight to the higher mental state, and therein leaves the
highest qnadrumana immeasurably behind. While the destiny of
man plainly is to bring himself, by development outwards, into the
most intimate relations with nature—including in that term his
fellow man—the monkey’s nature is, and seemingly ever will be, to
regard all nature solely with reference to its own personal grati¬
fication. The instinct of self-preservation, and the lowly passions
which are the earliest manifestations of it in consciousness, dominate
supreme in the simian nature. It is not altogether a flattering
reflection for man, that he, with the perfect pattern of a divine man¬
hood so long before his eyes, should yet be so very far from having
arrived at his true relations with his fellow-man—should yet be loiter¬
ing at so early a stage on the path of his destined progress.
The quick passion, the vices, the cruelties, and the other evidences
of an uninformed moral sense which the young child discovers, are
invariably observable also in the infantile mind of a barbarous people j
and a most painful reflection, suggested by the contemplation of the
great potentiality of the human type is the fearful degeneration, to
which, from arrest or perversion of development, it is subject. When¬
ever an organism, or part of an organism with a high potentiality is
arrested short of its proper development, it is less valuable, less capa¬
ble of its function, less of a truth, if one might so speak, in the uni¬
verse than an organism, or an organ thereof, which, though of a
lower type, has arrived at its full development. This is true also of
the development of mind; and something might, by the ingenious,
be said in favour of placing the Roman Emperor, who made a consul
of his horse, below the horse which he so ennobled. Though the
undeveloped state of the human mind, as seen in the barbarians of
the present day, and in the barbarous ancestors of now civilised
nations, offers to our investigation emotion only of the simplest and
lowest kind—little differing apparently in dignity from that of the
lowest animals—yet we observe that, by reason of the higher type, it
is perverted in a way which never happens amongst animals. The
capability of great development is the capability of great degenera-
titioua importance of certain words. Moral feeling,lilce every other state of conscious¬
ness, is necessarily a relation, the two elements of which are the individual and
external nature. That the power comes solely from either element is evidently,
then, a ridiculous supposition ; but, as we know that, as a matter of fact, a rightly-
developing individual does, and must, arrive at moral feeling, it is surely plain that
he has the potentiality of it—call this moral germ, or what we will.
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tion; and while the bee or the beetle makes no mistakes, man's his¬
tory is a history of his errors. “ Have not there been whole nations/'
says Locke, “ and those of the most civilised people, amongst whom
the exposing their children and leaving them in the fields to perish
by want or wild beasts, has been the practice, as little condemned or
scrupled as the begetting of them. . . . And are there not places,
where, at a certain age, they kill or expose their parents without any
remorse at all?"* There are numerous records testifying to like
things being done at the present day. Dr. Krapf tells us+ that “ a
woman of the Wanika tribe had given birth to two children, one of
which had six fingers and no nose or lips. In conformity with cus¬
tom, the parents took it to the chief, who strangled and burnt it, as
a Rogo or misbirth." “ Twins," says Major Burton, | “ are usually
sold or exposed in the jungle, as amongst the Ibos of West Africa;
and if a child cuts the two upper incisors before the lower, it is
either put to death or sold to the slave-merchant." Mr. Consul
Petherick thus speaks :§—“I am informed by theNeam Nams, who
seemed to glory in their reputation of cannibalism, that their aged,
and, indeed, all when supposed to be at the point of death, were
given up to be murdered and eaten." They always feast on their
fallen enemies; and if a slave runs aways, he is, if caught, invariably
killed and eaten. Du Chaillu again paints harrowing pictures of the
cruel tortures which are inflicted by the tribes of Equatorial Africa,
under the influence of their superstition; and superstition is but one
mode of perversion of the human type, of such power in its evil
workings as to destroy at times the strongest instincts in nature.
Even the mother’s love for her offspring is annihilated thereby.
Cannibalism Du Chaillu found to be a common practice, the living
of one tribe being in the habit of regularly eating tne dead of another.
And yet, in the midst of civilisation, sprout up more disgusting, more
brutal and degrading exhibitions of vice than those which darken
the reputation of the barbarian; insomuch that Nero, Caligula,
Heliogabolus, and men of that stamp, whose names in modem times
are legion, may actually blush if, in that abode set apart as a recep¬
tacle for perverted types, they meet the savage Australian, the be¬
nighted African, the miserable Andaman Islander, or the stunted
Bosjesman. For after all there is a certain passionate simplicity in
# 4 On the Human Understanding/ vol. i, p. 162. Bohn’s Ed.
t Op. cit., p. 193.
J 4 Lake Regions of Central Africa,’ p. 116.
§ ‘Travels in Egypt and Northern Africa.’
He found a curious custom prevailing near the Equator, where women are so scarce
that there was not a girl above eighteen, who was not already married or betrothed.
The marriageable girl is always sold to the highest bidder, and after much wrangling,
an agreement is made as to how many days in the week the marriage shall hold
good. If for four days, the wife is at liberty for the remaining three to enjoy a free¬
dom from all matrimonial obligations.
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the cruelty of barbarism, an animal impulsiveness in its vice, a child¬
like unconsciousness of the enormity, which make the crime fall far
short of the refined vice and complex brutality of the higher develop¬
ment. Disgust at the pitiable spectacle sometimes presented by the
latter must not, however, excite us to disown the superior type, and,
moved by the morbid sentimentality which, after the fashion of
Rousseau, lauds the comparative simplicity of barbarism, to exalt
unduly the miserable savage; to do so would surely indicate as great
a want of philosophical insight as it would do to praise the animal
which cannot make a mistake above the human being who makes his
thousands. The question of an individual's responsibility must be
kept apart from the question of his position in the general plan of
nature's development.
A careful and sober consideration of the very long way which the
lower races of mankind are from that which seems the destined aim
and goal of human progression, and a reflection on their fundamental
constitutional inability to advance for any great distance on the path
of progress, may reconcile us in some measure to the disappearance
of barbarous nations from off the earth. While investigating the
growth and development of mind, it is impossible not to feel a sort
of satisfaction as we follow its degeneration amongst barbarians into
extinction; for when the change, as in them, is not upwards, it must
needs be a change downwards; and in place of observing the deve¬
lopment, there is nothing for it but to watch decay—in place of
tracing the ytvtmq of mind, we must unhappily witness the <j>9opa
thereof. What wonder that a sober gladness greets a death which
terminates so painful a decay ! Men do, indeed, pass upwards with
feet red with the blood of their fellows; for the extinction of great
nations, and the failure of countless individual lives seem to be neces¬
sary dispensations in the inevitable progress. Humanity does not, it
is plain, any more than the individual, burst at once into its perfect
efflorescence; and in the long process of development, extending
through ages and ages, nations that have failed to advance or that
have succeeded in going wrong, drop off and become extinct, as the
dead passions drop away from the scarred trunk of a rightly de¬
veloping individual character. As the tree struggles upwards towards
light and air, branch after branch dying and dropping away, so that
in time a stem is raised, and the leaf-crowned head exalted above the
emanations of earth into the pure regions of a clear atmosphere; so
man, mortifying passion after passion, and suffering them one after
another to dry and drop away, raises the scarred stem of a strong
character into a healthy moral atmosphere; and so, likewise, human¬
ity, in its progress upwards, fashions the supporting stem only by
sacrificing the early branches *
* Two centuries ago, the Indians of North America numbered about 16,000,000
or 17,000,000 souls, without including those of Mexico. The present Indian popu-
VOL. VIII. <3
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82 The Genesis of Mind,
The broad reflection which reconciles us to the disappearance from
the earth of barbarous nations may in some degree mitigate the pain
which is inflicted by the grievous spectacle of individual mental dege¬
neration amongst civilised peoples. In the fierce and active struggle
for existence, and for a development which is sometimes not the most
just, the weakest are thrown down and fall into helpless madness; but
even their fall is to the profit of the mass, and general advance is
obtained at the cost of infinite individual suffering. As it is mani¬
festly the aim of mental development to bring man into intimate and
harmonious relation with the rest of nature by means of a patient
investigation of physical laws, and, if possible, a living realisation of
moral laws, it is no marvel, indeed it appears inevitable, that those
who, either from inherited weakness, or from unfortunate circum¬
stances, have been rendered unequal to the design of existence should
be ruthlessly crushed out as discords in nature. For, as in the stu¬
pendous progression of the race, whole nations drop away like dead
branches from the living tree, so amongst nations, individuals decay
and fall down in crowds, as the dead leaves fall from the living
branch. The observation which recognises in the fall of the leaf the
evidence and result of the growth of the branch, may acknowledge, in
insanity, mental growth throwing off decaying reason, and therein
revealing its own life. That insanity is a comparatively rare afflic¬
tion amongst barbarous nations may then be the result of their
undeveloped state; and although it may probably become rare, or
perhaps altogether disappear on the advent of a true civilisation, yet
in the present condition of nations that are deemed to be advancing
the frequency of its occurrence is scarcely a matter for wonder. When
the relations are multiplied, the chances of disorder are increased,
and where the struggle is hardest, and help is not at hand, more of
the feeble must suffer.
From the general tenour of the foregoing observations with
regard to the development of mind, it might be anticipated that in
the degeneration of the highest intelligence there would appear tq
be a reversion to the lower form of human intelligence, or even
sometimes to the type of animal mental development. It is
necessary here, however, to distinguish between the idiocy which is
produced by arrest of development and the insanity which has
occurred in a full-grown brain, with a fairly developed mind; in the
former case we do sometimes discover an approximation to the lower
types, or rather to the general plan from which all the special types
deviate, while in the latter we see only a higher type marred, pain-
lation is estimated by the Abbe Domenech (‘Seven years’ Residence in North
America’) at 2,000,000.
In the last report issued by the Colonial-office on the past and present state of
our colonies, an account is given of fourteen persons, all adults, aborigines of Tasmania,
who are the sole surviving remnant of ten tribes.
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fully exhibiting its higher features in the character of its degradation.
Malacarne professes to have counted the laminae of the cerebellum,
and to have found them to be less numerous in idiots than in men
of intelligence. Now these laminae are less numerous in the chim¬
panzee and in the orang than in man, and markedly fewer in other
monkeys; so that there is, so far, an approximation by some idiots
to the monkey type.* Again, a character in which the monkey’s
brain differs from that of man, is that the under surface of the
anterior lobes in the monkey is excavated in consequence of the con¬
vexity of the orbital arches. Gratiolet has found this character
well marked in a microcephalic idiot, aged seven, although when the
smallness of the head is extreme, the smallness of the frontal lobes
renders the excavation less apparent. The simplicity and the sym¬
metrical disposition of the convolutions, which also distinguish the
brain of the quadrumana from that of man, are sometimes observed
in small-headed idiots; they have been noted also in the brain of the
Bosieswoman and in that of the Hottentot Venus. In fact, as Dr.
Bolleston observes, in the lower species of apes, and in the lower
varieties of man, simplicity and uniformity are the rule, while
in the higher species of apes, and in the higher varieties of
the species, man, variability is the rule, and uniformity the
exception. Though in the conformity by some idiots to the simian
disposition of the convolutions, there may be an arrest of cerebral
development at an animal stage, yet it would be by no means
correct to suppose that in all cases of microcephalic idiots the atro¬
phied hemispheres have the foetal form. And, indeed, if the
most recent observations on the development of the convolutions in
the foetal months, are to be trusted, we must acknowledge that even
though the hemispheres have a foetal character they must still differ
greatly from the simian form. Gratiolet, after attentively comparing
the brain of monkeys with that of men, has found that though in
adult age the arrangement of the cerebral folds is the same, and that,
therefore, if we were to stop here, there would be no sufficient ground
for separating man from animals in general, yet “the study of
development calls for an absolute distinction/’t While the temporo-
sphenoidal convolutions appear first in the brains of monkeys, and
those of the frontal lobe afterwards, precisely the reverse takes
place in man—the frontal convolutions appearing first, and the
* Gratiolet remarks that Malacarne must have examined congenital idiots; for
the laminae are less numerous in the foetus than in the new-born infant, and less so
in the latter than in the adult; they increase up to a certain age, and, therefore, if
development be arrested, they will be less numerous. (Op. cit., p. 90.)
Paget mentions an idiot’s brain, in which there was complete arrest of develop¬
ment at fifth month of foetal life: there were no posterior lobes, and the cerebellum
was only half covered. * Lectures on Surgical Pathology,’ p. 3.
f In a paper read before the ‘ Societe d’Anthropologie’ lately. It is evident that
on this subject we may expect, ere long, some important information from Gratiolet,
who has already done so much for cerebral anatomy.
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temporo-sphenoidal afterwards; so that “ no arrest in the progress
of development could possibly render the human brain more like
that of monkeys than it is at adult age ; far from that, it would
differ the more the less it was developed.”
When we find, however, from observation, that a human being
may, from an arrest of cerebral development, be destined to pass
through life with a brain so imperfect as to be little better than that
of some animal, we do not anticipate any higher manifestation of
intelligence in him than is observed in the animal. But as a matter
of fact, some idiots have brains that are folly formed, and to all
appearance want nothing in development, and yet are much inferior
to the brutes in intelligence. Some of them have no .language
whatever, cannot move, seem insensible to pain, are not able to take
or chew their own food, are destitute even of the instincts of self-
preservation and propagation, and much more of any sentiment of
morality; they are capable only, in fact, of the organic functions, and
seem to belong more to vegetable than to animal life, though they
want even the struggle for existence which every vegetable has. In
these cases it may well be remembered, as has been before said, that
the functional development of the brain, as the organ by which man
is brought into relation with external nature, only takes place very
gradually after birth, and that it may, therefore, be quite possible
that some unfortunate cause may produce an arrest of development
immediately after birth as well as a few months before that event.
As it is universally acknowledged that there is a great difference
between the nervous force of different people, independently of any
difference in size of the nervous mass, it is readily conceivable that the
completely formed brain may lack force—may be deficient in, or
almost destitute of, that nervous energy by which it is rendered
capable of responding to the force around it. The organic con¬
structive force which at times performs such strange freaks in the
womb—as for instance, when it forms well the whole of the foetal
organism with the exception of the brain, seemingly forgetting that
Organ, or more likely not having the energy necessary to produce it
—may well be supposed to exhaust itself sometimes in the develop¬
ment of the nervous substance, and to have no force left for the
endowment of it with the nervous power essential to its develop¬
mental progress in the new and trying relations of its life in the
“womb of time.” “It is not sufficient,” as Dr. Buchez remarks,
“ that man be engendered carnally in order to be perfect; he must
be engendered spiritually also.”
From the vegetative idiocy we might pass through every degree
of lessening imbecility up to ordinary human intelligence, and trace
a progress very like that which has already been displayed in the
development of animal intelligence. In such an occupation, it
would be remarkable how plainly at times there crop out in the
degenerate type of mankind traces of the animal. Pinel published
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by Dr. Henry Maudsley.
the case of an idiot, who was something like a sheep, both in respect
to her tastes, her mode of life, and the form of her head. “ She had an
aversion to meat, but ate fruit and vegetables greedily, and drank
nothing but water. Her demonstrations of sensibility, joy or trouble
were confined to the repetition of the ill-articulated words f be, ma,
bah; ’ she alternately bent and raised her head and rubbed herself
against the belly of the girl who attended her; if she-wanted to
resist or express her discontent, she tried to butt with the crown of
her head; she was very passionate. / Her back, her loins and shoul¬
ders were covered with flexible and blackish hairs, one or two inches
long. She never could be made to sit on a chair or bench, even
when at meals—as soon as she was placed in a sitting posture, she
glided on the floor; she slept on the floor in the posture of animals.”*
"One of our pupils/’ says Dr. Howe, “besides all the marks just
mentioned, which give him a strong likeness to the monkey, has,
moreover, the long arms of the ape; he moves about with his head
and shoulders stooping, and his arms hanging forward, as though he
were going to drop on all fours. One of his pleasures is to climb
upon a desk or high place, and leap through the air with outstretched
limbs upon some one’s neck and to cling round him, not as a common
child does with his arms alone, but twining his legs about him, as
though he were one of the quadrumana.”t An idiot sometimes
ruminates like a cow, bringing up his food and masticating it a
second time; another howls when he is hungry, does not eat, but
swallows his food, and licks up the crumbs like a dog; when he
wishes to recognise any one he begins by smelling at him, as, accord¬
ing to Humboldt, the Peruvian Indians distinguish in the night the
different races by their quick sense of smell.
A curious instance of the manifestation, or, as some would say, of
the resurrection of an animal instinct, was afforded by an idiot
woman who was great with child by some miscreant; as no assist¬
ance was at hand at the time of her delivery, she gnawed through
the umbilical cord as the beasts do. Major Burton tells us that
among the East Africans the child is carried on the back, a sheet or
skin being passed round it, and that “ even in infancy it clings like
a young simiad.” The native Australian female, who is perhaps the
lowest of womankind, carries her child, similarly suspended, and
throws her elongated pendulous breasts over her shoulder for it to
suck, and, kangaroo-like, perhaps to hold by.J
* Esquirol, 4 Des Maladies Mentales.’
f 4 Report on the Causes of Idiotcy.'
t The inferior races, in other points of structure besides that of their brains, exhibit
approaches towards the monkey type. In the chimpanzee the parietal and sphenoidal
bones are prevented from coming in contact by an intervening projection of the tem¬
poral bone. Many negro skulls have been observed by Owen to have the same con¬
formation, whereas in the Caucasian, the sphenoidal and parietal bones are in contact
for about half an inch. Again, the middle turbinate bones in negroes form large
globular protuberances in the nose, whereby the surface of the olfactory membrane is
much increased, and the African, like the brute, has an acute smell. In the ape the
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The Genesis of Mind,
In the degeneration which takes place if a higher race of men be
badly fed, badly clothed and housed for a generation or two, there
is, according to some, an undoubted approximation to the monkey
type of figure. Whether this be so or not, there can be no doubt
that when men are well fed, and well clothed, and their intellects
systematically cultivated, their looks become more lofty and noble,
and they pass farther and farther away from the monkey type. The
true development of conscious mind and the degradation of it, are
both alike faithfully reflected in the action of the unconscious
organic force. About 200 years ago a number of people were driven
by a barbarous policy from the counties of Antrim and Down in
Ireland towards the sea-coast, where they have ever since been
settled, but in most miserable circumstances, even for Irishmen.
The consequence has been that their features are repulsive, their jaws
project, their mouths are large, their noses depressed, their cheek¬
bones high, their legs bowed, and their stature extremely diminutive.
“ These, with an abnormal slenderness of the limbs, are the outward
marks of a low and barbarous condition all over the world; it is par¬
ticularly seen in the Australian aborigines.”* Again, the Cagots
were a class of men found scattered along the coast of France from
the north to the south; they were sunk in the deepest poverty and
abasement, and treated with the greatest contempt and abuse. In
the eleventh century they were bequeathed and sold as slaves, and
although just admitted to be human beings they were compelled to
enter a church, being reputed leprous, through a small door
specially made for them, to have special seats and a special holy-water
font.f This utter moral and intellectual abasement was truly re-
flqcted in the miserable physical degradation which threatened almost
to bridge over the chasm between man and the animals. Happily
for mortals, however remarkable may be the animal characteristics
of their extreme degradation, nature seems to have made sure
provision for the speedy extinction of the degenerate results; for she
puts the ban of sterility on the morbid type, and thus, in place of
reverting to an animal type which might be fertile, plainly manifests
the design of extinguishing human degeneration.!
bicuspids are planted with three fangs; in the Caucasian there is but one fang, which
is, however, formed by two being united; in the negroes, the two fangs are distinct.
Concerning other interesting points in this approximation, reference may be made to
White On the Regular Gradation*) from whom Lawrence (‘ Lectures on Man’) has
profited. White was, however, clearly far too eager to approximate man to the
monkey; for he distinctly asserted that “ the orang-outang has the person, the manner,
and the actions of man”—in such opinion being confirmed by Lord Monboddo, who
maintained that “ the orang-outangs are proved to be of our species by marks of
humanity that are incontestible.”
* f Vestiges of Creation.’
f Esquirol, op. cit.
X This consideration may be regarded as militating against the supposition of any
descent by man from the monkeys. For if by the operation of favorable external
conditions, man has been brought to his present level, why should he not, by the
operation of unfavorable conditions, go back to the monkey's level ?
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by Dr. Henry Maudsley.
As idiocy, when not congenital, is an arrest in the functional
development of the brain at an early period, and as we have already
seen that the intelligence of early infancy differs from that of the
animals, not in what it actually is, but in what it potentially may be,
it is eyident that an early arrest in the development of human intel¬
ligence may correspond somewhat closely to the complete develop¬
ment of an animal’s intelligence. Accordingly some idiots are like
certain humble animals, while many .more—the great majority of
them—psychologically resemble the monkeys. And this monkey¬
like character of idiotic intelligence will not seem altogether unac¬
countable, if we remember that one cause of idiocy in a human
brain rightly developed at birth, has been supposed to be a want of
nervous force; the want, in fact, of that higher potentiality whereby,
under suitable conditions, it expands into its special functions, such
force as may be available in this deficiency earning the functional
development no higher than the monkey’s level. It is the custom
of idiots to use such powers of intellect as they have for the grati¬
fication of their passions, and to that purpose they will at times
display intelligence of which they would not have been supposed
capable—will even, now and then, make advantageous use of their
simplicity in order the better to deceive. Their reason, monkey-like,
works entirely within the circle of self, and the defective mind cannot
rise to the height of those higher emotions which are the expressions
of a conception of moral relations. The abnormal state of a superior
organ brings it to the level of the normal state of a corresponding
inferior organ. Chariot, “ un simple d’esprit,” amongst other
occupations, is crossbearer at the funerals at the Asylum, and
receives on each occasion an allowance of tobacco for his work.
Well, when he hears the passing bell he dances with delight; if he
knows that some one is dying he roams about restlessly, impatiently
counting the minutes of the sufferer’s agony; and if he can manage
to slip unobserved to the bedside, he will reproach him bitterly for
not dying fast enough.”* Chariot was plainly rather a superior idiot,
but he may still be regarded as a type of that low order of in¬
telligence which concerns itself solely with the modifications of self;
for although it is true that all intelligence first arises in such modi¬
fication, yet it attains development only by attention to the causes
thereof; that is, by the investigation of the relations of the not-self.
Sensation is at first pure self-consciousness, but perception advances
out of it in the development of world-consciousness; and, in like
manner, in a higher sphere the lowest intelligence is occupied with
the subjective affection, while the higher intelligence labours to bring
the individual into the closest possible relations with the objective,
An examination of the stories told of wild men, as of Peter the Wild Boy, and of
the young savage of Aveyron, proves that they were cases of defective organization—
really, therefore, * pathological specimens,’ as Lawrence observes.
* Morel, ‘ Etudes Cliniques sur les Maladies Mentales.’
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The Genesis of Mind,
and, by a wide insight into his fellowship therewith, to subordinate
the misleading self-feelings to those higher feelings which spring
from the recognition of himself as a part of nature, ful fillin g the end
and purpose of existence in advancing the general good. As in the
early perception there is the revelation of a self and a not-self, so in
an early stage of a truly developing intelligence there is the reve¬
lation of a moral self and of moral relations.
In the painful and humiliating spectacle of human degeneration
which is witnessed in the breaking down into madness of a mind
seemingly well-developed, there is no such approach to the animal
type as is occasionally exhibited by congenital idiots. The mighty
are pulled down, but the might is manifest even in the wreck. And
as the ruins of imperial Rome are more solemn, mournful, awe-in-
spiling, than those of the Indian wigwam village, or as the bare
branches of the dying oak, outstretched as in bald rugged agony and
mute reproachful entreaty towards heaven, are more deeply im¬
pressive than the dropping petals and fading leaves of the rose-tree,
for which it seems only natural to die; so the spectacle of the man
of great intelligence falling down mad in the joyous activity of busy
life is infinitely more sorrowful than that offered by the congenital
idiot, or, perhaps, even that presented by the decaying nation of bar¬
barians. But, as has been before said, the capability of development
is the capability of degeneration, and the superiority of type is
proclaimed in the extent and variety of perversion to which it is sub¬
ject. As the human body, by virtue of its great specialization
of parts and delicacy of organization, is more liable to disease and
subject to many more diseases than the animal body, so likewise the
human mind, being so far exalted in its just development above the
animal mind, is, by reason thereof, subject to the possibility of a
much greater degradation. Even the madness of man, then, declares
his superiority. But such is the benevolent purpose of nature that
no efforts whatsoever can perpetuate a morbid human type; for
although the offspring of degenerate parents is a further degene¬
ration, the evil soon corrects itself; and, long before man has
descended to the animal level, there comes an incapability of pro¬
ducing offspring, and the morbid type dies out. Insanity, of what
form soever, whether mania, melancholia, moral insanity, or dementia,
is but a step in the descent towards sterile idiocy, hs may be
experimentally proved by the union of mentally unsound individuals
for a generation or two. Morel relates the history of one family,
which may be shortly summed up thus :
First generation.—Immorality. Alcoholic excess. Moral brut¬
ishness.
Second generation.—Hereditary drunkenness. Maniacal attacks.
General paralysis.
Third generation.—Sobriety. Hypochondria. Lypemania. Sys¬
tematic delirium. Homicidal tendencies.
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hj Dr. Henry Maudsley. 8*j
Fourth generation.—Feeble intelligence. Stupidity. First attack
of mania at sixteen. Transition to complete idiocy; and probable
extinction of the race.*
Not only, however, does idiocy die out, but—additional blessing
—it dies out soon. According to the best estimate that could be
made by the American commissioners, the average duration of life
amongst congenital idiots is not more than twelve years. And
Dr. Howe adds:—“ Idiots of the lowest class perish in great numbers
in infancy and childhood; fools last longer, and simpletons attain to
nearly the ordinary longevity. Perhaps it is safe to say, that the ordi¬
nary longevity of the lowest class of idiots is not more than six years.”+
. It is almost impossible to avoid expressing a grateful admiration
of the wise, sure, and merciful provision of nature by which dege¬
nerate min d is so quickly blotted out. The complete absence in
some idiots of the instinct which is so powerful in all animals, the
instinct of propagation, and its futility when present in others, are
certainly facts of deep significance in the economy of nature.
Though the instinct impels the lower animals blindly to the accom¬
plishment of acts necessary for the continuation of the species, its
sphere of action is not limited by so lowly a function in man. As
a mere animal impulse, prompting the continuation of the kind, it
still moves the individual to that which shall result in the propaga¬
tion, at any rate of his influence, and in part also of his individuality,
through time. We find, however, that instincts, which work only
unconsciously in the lower animals, enter into consciousness in man,
and, thus illuminated, manifestly acquire a nobler development and
a larger circle of action. The self-conservative impulse becomes in
consciousness that self-feeling which lies at the bottom of all our
emotions and, indeed, of conscious individuality; and, in like
manner, the propagative impulse, in consciousness, not only makes
the individual acquainted with its sexual design, but prompts the
highest intellectual action for the continuation of his influence
through time. It is by its power that man consciously labours for
the future, that day after day, even when sinking into the grave, he
irresistibly believes in a future, that he lays up stores which his
* Op. cit.; also, i Traite des Deg£nerescences physiques intellectuelles et morales
de l’espece humaine, et des causes qui produisent ces variety maladives/ Catherine
de Medicis amused herself with making marriages between dwarfs ; they were
always sterile. Giants are commonly impotent, and both giants and dwarfs ordi¬
narily die early, according to J. G. St. Hilaire. 4 Hist, des Anotn. de FOrgP
The French psychologists, who have just reported on Gheel, state, as I am informed
by Dr. Bucknill, that in all the pregnancies of lunatics there the male parent has
always been sane.
t 4 Report on the Causes of IdiotcyP
The various monsters that are formed by the greater or less union of two foetuses
generally die soon after birth, even when no cause is apparent why they should do so.
Nature clearly does away with them to preserve the genuine figure of human frames.
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The Genesis of Mind,
reason assures him he will never himself enjoy; that he aspires to
leave a name in the world's history; it forces even the most selfish,
to some extent, out of the small circle of individual selfishness, even
if it be only into the little larger circle of family selfishness; and it
seemingly lies at the foundation of that instinctive belief in immor¬
tality which some uphold, that every nation, however barbarous,
more or less distinctly has. Some might wish to describe it as but a
particular manifestation of the self-conservative instinct; and such
a description would be just enough in the philosophy which regards
the best moral action as, what in the long run it surely is, the highest
selfishness. Man, must, however, plainly first gain the force, be
selfish in acquiring, before he can use it, become moral in applying.
And, regarding the purpose of the propagative instinct, and its late
effective appearance in individual development, we appear necessi¬
tated to conclude that its aim, when fully developed in consciousness,
is rather to control the feeling of self, and to expand the power of
self in a wider diffusion. It may be described as the impulse of
mind to continue and develope in nature, active and energetic while
man is advancing, but contracting more and more the circle of its
action as he degenerates, until it is reduced to its primitive condi¬
tion of a mere animal impulse for propagation, which in mankind
is the idiotic stage immediately preceding its final extinction.
The physical degeneration of a sexual impotency is surely re¬
flected in a corresponding moral degradation. It plainly is not the
purpose of nature to extinguish the animal in man, but rather to
exalt it, to ennoble it and develope it in the moral and intellectual;
insomuch that, whenever by nature or art, man is deprived of the
power of propagation, he becomes a degenerate being, whose career
ends in desperate vice, or in madness, or in suicide. The perfect moral
man must be of perfect physical development. Eunuchs are said to
be the vilest creatures of the human race, cowards, deceitful, envious,
and vicious. “ Castrated persons have many defects which are pecu¬
liar to them; they have a bad odour, a yellow colour, furrowed
cheeks, and feminine voice; they are unsociable, deceitful, and ras¬
cally, and are never known to practise any human virtue."* Black
eunuchs, according to J. 8. Beauvoisins, are brutal animals, and live
like wild boars in their lairs. “ These ferocious animals seem to
think that they may do what they please, and are ready to sabre
those -who do not get out of their way.”+ Even those who, in civi-
* 4 Conn d’Op^rations,’ par Dionis.
t 44 On sait que let etranques sont, en g£n£ral v la claase la plaa vile de Fespece
humaine; laches et fourbes, parcequ’ils sont faiblea; envieux ei mechants, par¬
cequ’ils sont malheureux.”—‘Rapports du Physique et du Morale de FHomme/
p. 322, by P. J. G. Cabanis,
It may be said that there have been instances of eunuchs, as during'the decline
of the Roman Empire, who have been remarkable for great intellectual power ; but
the objection does not much affect the opinion with regard to the propagative in-
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by Dr. Henry Maudsley.
iised life, though not wanting power, are yet prevented by the un¬
fortunate circumstances of an artificial mode of living from the
natural and complete development of the procreative instinct, in the
happy feelings of affection and the unselfish activity which flow
from the results of its legitimate exercise, fall oftentimes into an
unhealthy state of mind; and it might be soberly argued that
much vice, crim^ and madness, are attributable to that cause.
Nevertheless, when such unhappy consequences follow, though in
some measure a reproach, it must not be deemed an unmitigated
reproach to civilisation; for they clearly happen, not because there
is no refuge from an apparent evil, but because, from ignorance or
a self-indulgent indolence or a constitutional weakness, the right
remedy is not used, because the ever-prompting instinct is not con¬
sciously directed in the moral and intellectual sphere to some aim
of general usefulness, which might afford a vicarious satisfaction to
its blind longing.
As, notwithstanding the painful sufferings and trials which expe¬
rience proves to him make up the most of his life, man clings closely
to existence by reason of the powerful instinct of self-preserva¬
tion, so he is impelled by the instinct of propagation to continue
his kind, notwithstanding the miseries which he well knows must
ever befall it, and to labour patiently for the future, notwithstanding
the knowledge of so much profitless labour, and so little real ad¬
vance, through the many ages of the past. But, happily, there is
some gleam of encouragement; for, however slow the progress, all
observation proves that mankind is advancing. The beings of the
present civilisation are evidently superior to those of any past
civilisation, and the beings who now make barbarism appear to be
disappearing from the earth. The researches of modem science have,
too, established sufficient grounds for the assumption that man
coexisted with the animals found in the diluvium, and that many a
barbarous race may have disappeared, before historical time, with the
animals of the ancient world, “ whilst the races whose organization
is improved have continued the genus.”* The various fragments
of human crania, with the circumstances under which they were
found, and especially the discovery of his works—as the flint im¬
plements are supposed to be—certainly supply strong arguments
for maintaining the geological antiquity of man. The Neanderthal
fragment of cranium and the skulls found in several parts of Ger¬
many, with the extrordinary prominence of their superciliary ridges
stinct; for (1) it is the moral development that ia most affected by the physical
degradation from which eunuchs suffer; and (2) it is known that eunuchs some¬
times have the instinct, and vainly attempt what they have not the power to
perform.
* See Prof. Scbaafhausen on the ‘ Crania of the most Ancient Raees of Man,’ in
Art. xvii, No. 2. ‘Natural History Review/ from ‘Muller'B Archives/ 1858.
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and their exceeding narrow and low foreheads, approach nearer to
the monkey type than the crania of the lowest surviving human
race.* And the conclusions which the Abbe Frere drew from his
large collection of crania were, that the capacity of the skull had.
increased in modem times, and that while in the most ancient races
the occipital was the most, and the frontal region the least deve¬
loped, “ the increase in the elevation of the latter marked the tran¬
sition from.barbarous to civilised man.”+ So that, although we have
not the positive evidence of the brqin itself, we have sufficiently
strong evidence, in the character of the cranium, that the races of
primeval times were inferior even to the lowest existing race; and
the records of the past, as well as the observations of the present,
fairly entitle us to uphold a gentle progression in the physical
development of mankind.
An important consideration presents itself as to the way in which
the material improvement functionally expresses itself. Can we
truly recognise a general growth of mind, a widening of the
thoughts of men, through the ages ? That the cerebral development
has plainly declared itself in intellectual progress, will scarcely
admit of question. The general store of knowledge is increased
upon the earth, and each individual is much wiser than his remote
progenitor. And yet, with great intellectual development, there has
been something wanting; for, although there have been many nations
that have attained to great knowledge, yet they have one after ano¬
ther gone the way of destruction—mind has advanced to a lofty
height only to suffer a greater fall. It needs not any deep scrutiny
of the histories of the departed nations to show that they lacked
one thing, and that, a faithful and practical recognition of the moral
laws of the universe. A learned writer of the present day, who has
travelled over nearly all the world—over whose head the great
Niagara has dashed, who has “ spent months amongst the Trappers
in the bushwho has “ smoked the pipe of peace with the Austral
savages in the prairies, and with the polished Arabs on the plains
of Palestine f who has “ fought with the savages, and discoursed
with the high priest of Mecca ” who has “ seen tempests on the
Pacific, and tornados on the plainwho has done battle with the
tiger and the wild boar, and could show scars that he has not escaped
* Prof. Busk observes of these skulls, that they do not belong to the bracliy-
cephalic type, and cannot, therefore, be referred to the short-headed race or races
which, there is much reason to believe, constituted the earliest of the existing
European stocks.’
t Quoted in ‘ Nat. Hist. Review.’
Dr. Pritchard’s comparison of the skulls of the same nation at different times in
its history led him to the conclusion that the present inhabitants of Britain, “ either
as the result of many ages of greater intellectual cultivation, or from some other
cause, have, as I am persuaded, much more capacious brain-cases than their fore¬
fathers.” (• Physical History of Mankind,’ vol. i, p. 305.)
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scathless,” states briefly the results of his inquiries and observations
thus : “ In every part of the globe I found the “ many” degraded
and miserable; and the “ few” miserable and luxurious. On the
one hand ignorance and servility; on the other, cunning, rapacity,
and power.” True of the present, this is yet more true of the past;
and the ghost of many a departed nation might well utter to the
nation of to-day the solemn warning of . the fallen Wolsey :
Mark but my fall, and that that ruined me.
Of small avail was the mystical knowledge of the Brahmin, who has
made, perhaps, greater efforts than any other mortal to comprehend the
incomprehensible; when it revealed not to him that the Sudras was of
equal dignity with himself in creation. Little good was there in the
wonderful science of the Egyptians, which disdained not to build such
gigantic follies as the pyramids by the compulsory labour, and at the
cost of the lives, of thousands upon thousands of slaves. Grecian
intellect still works notably in the present day; but neither Grecian
intellect nor Grecian art could save Greece from decay. Those who
poisoned Socrates, when through him wisdom raised her voice in the
streets of Athens, were plainly not going the wise way to life, but the
foolish way to death.
The Boman Empire, so great in the false greatness of military
glory, was some 1250 years from the time of Komulus in growing
and in dying ; but it has long since gone. In the year 476 or 479
after Christ, the last emperor, Bomulus Augustus, contemptibly called
Augustulus, disappeared, and Odoacer, a barbarian, reigned over
Borne. The senate then, in their own and the people's name, con¬
sented that the seat of the empire, which had ignorantly devoted
its power to destruction, should be transferred from Borne to Con¬
stantinople, where, in the fullness of time, the Saracens gave an
account of it. Constantine Paleologus there bravely met the Turks
in the breach, and perished amidst the ruins of a dynasty and empire,
which he was unable to save. His self-immolation availed nothing,
and for 400 years the crescent has been planted on the cathedral of
St. Sophia. That which now constitutes the greatness of Britain, at
* one time constituted the greatness of Tyre, whose “ proud piers lie
scattered in the main”; and though the piers of England may yet be
sound, and her wooden walls untainted by decay, it may be well,
before making an example of England, to remember that the battle
of Hastings was only fought some 800 years ago, and that 800 years
is not a long period in the history of a nation, and is a very short
period in the history of the world.
It may be that the nation, like the individual, has a term assigned
by nature to its existence, and that, how carefully attentive soever it
may be to the physical and moral laws, it must still after a time decay
and die. It is plain, however, that the experiment has never yet
been fairly made; for though there have been in most nations certain
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wise and virtuous men, who have sincerely acknowledged and faith¬
fully proclaimed the vital importance of obedience to the moral laws
of nature, and have often died sacrifices to their convictions ; yet the
mass has ever been, as the deaths of the prophets prove, ignorant,
savage, and degraded. And of what avail is the progress of the indi¬
vidual if the whole nation remains hopelessly behind ? It is true
that we, looking back from our vantage groimd on history, may be
able to assign the individual his due position in the plan of the deve¬
lopment of mind—may be able to trace the progress of mind through
him in a stagnant nation, as on the surface of still water we recognise
the motion of the undulation when the water itself makes no progress.
Nevertheless, it is a deeply gloomy and unsatisfactory supposition
that this must ever be the method of progress; and when we reflect
that moral principles are not merely intellectual speculations, but
actual laws of nature, as certain and uniform in their operations as
are the physical laws, there is every reason to anticipate that as the
recognition of the physical laws has added so greatly to the power
and comfort of mankind, so the practical realisation of the moral
laws in the conduct of life will increase the happiness, advance the
mental development, and, perhaps, insure the stability of nations.*
That which appears to have oeen so fatally wanting amongst the
nations that have passed away, is none the less a fatal want in the in¬
dividual who lacks it. 'To say the best of him who has failed intel¬
lectually and morally to develope, or who has degenerated, is to say
that the world is no better by his existence. He has eaten, has
drunk, has slept, has propagated, and died ; and if any advance is to
come out of him, it is left for his posterity to make under the inhe¬
rited difficulties of his deficiencies. The natural course of a just
* It is not always easy to understand what ideas some philosophers wish us to have
with respect to the relation of the physical and moral laws in the universe. Dr.
Whewell, whose writings it would be almost presumption to praise here, says that
physical laws are laws according to which things are and events occur; but moral
laws are laws according to which actions ought to be. And are not physical laws
really laws according to which men ought to act, if they wish to act successfully ?
A man may break his neck easily if he chooses to ignore the existence of a law of
gAvit&tion, and so such or a like event may be . And similarly, also, by ignoring *
the existence of moral law an individual comes to a certain punishment; and pain,
disease, suffering, remorse, in himself and in his posterity, are events flowing from
the infraction of moral law. The greater influence of the human will in determining
events under the moral laws than under the physical laws does not establish any
essential distinction, in the mode of action of the former, in nature; for the human
will, however free it may be called in its own sphere, is clearly contained in the wider
sphere of nature, and acts according to laws which are derivative from the more general
laws of nature. It appears, indeed, that the physical and moral laws are so corre¬
lated, that the action of one plainly revenges the infraction of the other. When,
therefore, Dr. Whewell speaks of the attainment of a knowledge of nature as the
* Idealisation of facts / and uses the ‘ realisation of moral Ideas ’ to express the con¬
stant progress of humanity, we are prone to attribute the seemingly untenable dis¬
tinction to that bias which leads him to underrate, and so painfully to fail in doing
justice to, Locke.
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mental evolution is to fashion, in the highest moral sphere, a power¬
ful will out of that fundamental reaction which we trace upwards in
organic action, in reflex action, in consensual action, and in emotional
impulse. And if it be said, that every one will in the end, philosophy
notwithstanding, act according to the dominant feeling, or, in other
words, according to the strongest motive, the reply is that the nature of
the dominant feeling will be determined by the condition of intellectual
development. That which in one of little knowledge or limited per¬
ception produces a pleasurable feeling, and is provocative of a certain
action, will in another, who discerns the moral relations of it, pro¬
duce a painful feeling, and excite quite a different action; and,
again, objects which in an undeveloped mental state are painful, may
in the developed mind, alive to all their relations, produce pleasure,
and action in accordance with such dominant feeling. It is plain,
then, that men shonld rightly be able to give a reason for the faith
that is in them, even for the faith in their feelings; and it is quite
as necessary for proper mental action that there should be a co-ordi¬
nation of the emotions, as it is that there should be a co-ordination
of the movements of muscles for proper physical action. Insanity
is often plainly traceable as the natural termination of mental action
that is not upwards; and like as individuals suffering from certain
bodily disease, as chorea, are unable to control the incoherent mus¬
cles to a desired aim, and have been said to suffer from muscular in¬
sanity ; so certain of the insane are afflicted, from want of will force,
with an inability to co-ordinate their feelings, and might be said to
suffer from convulsed and incoherent feelings. Besides acquiring a
knowledge of the physical laws and power thereby over external
nature, it is evidently necessary that man should obtain a knowledge
of the laws of mental development and power over his own nature.
Any individual development which is not in that direction, however
fashionable it may be, is as false as that of the departed nation, and
will not conduct to those high mental conceptions which correlate
the sincere and vivid convictions of the highest moral feeling.
It may be said by those who are sceptical with regard to human
progress—and it is sometimes said in the way of scornful reproach—
that the principles of morality have been the same from the begin¬
ning of the world, and as well known to mankind through all its
history as they are at the present day.* There has ever been a wise
* Buckle's * History of Civilisation.'
“ La morale de toutes les nations a et6 la mSme.” (Condorcet.)
“In der Morale-philosophie sind wir nicht weiter gekommen, als die Alten.”
(Kant.)
“ Morality admits no discoveries. . . . More than 3000 years have elapsed since
the composition of the Pentateuch; and let any man, if he is able, say in what
important respect the rule of life has varied since that period. Let the institutes
of science be explored with the same view—we shall arrive at the same conclusion.
Let the books of false religion be opened;—it will be found that their moral system is,
in all its grand features, the same," &c. (Sir J. Mackintosh.)
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and virtuous minority, which has always been swallowed up in the
foolish and wicked majority. Meanwhile, it may be said, as men are
thus coming and going, nature's changes go steadily on. The
mountains are day by day disintegrated; the peak we see “ shedding
its flakes of granite on all its sides, as a fading rose lets fall its
leavesand everything seems to indicate that a gradual and de¬
structive change is taking place, which must sometime render the
earth unfit to be the dwelling-place of man. Have we any reason,
then, to believe that the good will overtake the evil before the end
comes ? What evidence is there that man will not be swept away
as an animal incapable of advance beyond the narrow limits of his
present development; while the lives and works of the virtuous mino¬
rity, and the achievements of science, remain only to mark his aspi¬
rations, as certain rudimentary organs in some animals indicate their
efforts after a higher organization, and are prophetic of a higher
species ? When the "everlasting hills” are decaying, and the foun¬
tains of the solid earth are unsure, is it not possible that the race of
man may be swept away, and the wreck thereof remain to mark a
geological stratum, and to build the foundation of a millennium of
higher beings ? Nevertheless there are some reasons why we should
reject such a sorrowful and scornful philosophy.
Our investigation of the development of mind has shown that the
natural course thereof is to bring the individual to those conceptions
of his relations in nature which, viewed on the intellectual side, are
the highest generalisations concerning the physical phenomena of
nature, and which, on the moral side, are truly cognitions of the
moral course of nature. Man has relations to the universe of matter,
which he labours to discover, and since Bacon’s time has been suc¬
cessfully discovering; but he has relations also to the universe of
souls, which he must likewise labour to discover. Moral cognition
is, then, an end to be attained in the natural course of a truly advancing
mental development. And if the human race is not doomed to dege¬
nerate and perish, but is destined to develope and abide, it is to be
presumed that not a favoured few only, but the whole race, must
necessarily develope into the high state of moral cognition. It be r
hoves us not to be impatient, because the result seems still so far
distant, but rather, calmly reflecting that “ centuries are but seconds
in the great process of the development of advancing humanity,”
patiently to hope for this realisation of our moral ideal.*
We are not without evidence that the race is progressing in moral
improvement. Looking at the facts as they are, it seems impossible
* “In what condition do I leave the world,” writes Humboldt in 1853, “ I who
remember 1789, and have shared in its emotions? However, centuries are but
seconds in the great process of the development of advancing humanity. Yet the
rising curve has small bendings in it, and it is very inconvenient to find oneself in
such a segment.of its descending portion.” (Letters to Yarnhagen von Ense.)
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to deny that the civilisation of to-day is greatly superior, in its prac¬
tical morality, to the moral condition of the world at any other period;
and regarding the very intimate relations which exist between the
physical and moral laws of the universe, it is certainly impossible to
believe that the great intellectual development which is taking place
in mankind will not be faithfully and clearly echoed in moral advance¬
ment. Since man has quite recently devoted himself to the only
method of gaining true knowledge by a patient investigation of the
laws of nature, he has acquired the power of controlling and using
for his purposes those natural forces before which in his infancy he
fell prostrate in deepest terror and veneration. Unmindful of
Neptune's anger, he now rides safely over the fury that at one time
overwhelmed him, and guides with quiet confidence his frail vessel
through the ocean's lashing rage to a sure haven; he skims with
wondrous speed the rugged surface of the earth; and even directs to
his humblest purposes that terrible lightning-force before which he
once grovelled in uttermost helplessness and abasement. And is
there not great moral progress in this improved attitude ? Save in
certain baroarous parts, men no longer now build altars to appease
the fury of the hurricane, or offer sacrifices to propitiate the anger of
the pestilence; for they have discovered that both hurricane and pes¬
tilence pursue their devastating courses in accordance with fixed,
unchanging laws. In place, then, of the miserable superstition,
praying to nature, there is the intellectual effort to bring human life
into harmony with nature; in place of degeneration and destruction
from ignorance of, and disobedience to, the physical laws, there are
development and salvation from knowledge of, and obedience to,
them. But it is simply impossible that man should place himself in
faithful obedience to the physical laws without bringing himself more
or less plainly into subjection to the moral laws; he clearly cannot
bring himself into complete harmony with a part of nature but
by bringing himself into harmony with the whole of nature.*
Since he has acquired a knowledge of the laws by which certain
diseases come, he has endeavoured to prevent them; but as the indi¬
vidual cannot do that for himself without doing it at the same time
for others, he must, were it necessary, even without merit of his own,
be made moral. But it is not required of him to do good on com¬
pulsion ; for as soon as ever men have attained to a sincere, intellec¬
tual recognition of the causes and laws of events, there inevitably
springs up the correlative moral cognition—the intellectual cognition
of their duties with regard to the events. Accordingly, we observe
that, with advancing intellectual development, great efforts are being
made by the favoured few to improve the condition of the poverty-
stricken many—by attention to sanitary principles to improve their
physical state, and by education to make them wiser, happier, and
* Denn wo Natur in reinen Kreise waltet
Ergreifen alle Weiten sich. (‘ Faust/ p. 367.)
VOL. VII. * 7
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better. It has been made manifest, too, that it is cheaper and more
philosophical to prevent crime than to punish it, and so reformatories
and ragged schools are taking their places in establishing that empire
of love which is to cast out hate. When we reflect on how great a
part-of the vice, crime, and disease amongst mankind is palpably
produced by disobedience to the physical laws of nature, it seems
impossible that, when men were in complete ignorance of these laws,
they should have successfully carried into effect the principles of
morality.* And it may fairly be supposed that systems of morality,
of unquestionable excellence in themselves, have failed adequately to
influence the mass, solely from the impossibility of an intellectual re¬
cognition of them by the mass—an impossibility which was mainly, of
course, owing to the low state of mental development, but which may
in part also be attributed to the method by which truths, which should
have been made intellectual convictions, were dogmatically enforced
as maxims not to be inquired into or questioned, although inquiry and
questioning could only have added to their certainty. Now, how¬
ever, in the intellectual development which results from observation
of the causes and laws of events in the physical and moral world, we
have a certain guarantee of moral progress. And this should teach
us how fearful a thing it would have been if the principles of mo¬
rality had not been the same from the beginning; forasmuch as
mankind would then have been loosed from the sure anchor which
has mercifully held it during the blind struggles of infancy to pass
to immediate destruction. Happily the moral laws are as sure as
the physical laws; and what we have the best reason to believe is
that there is in humanity a large amount of undeveloped mentality,
which, when developed, shall be effectual in practically realising the
long-known and long-neglected principles of morality.
That the development through which nature is progressing points
to a more complete realisation of moral law in connection with intel¬
lectual progress, would seem to be indicated by the reflections which
palaeontology suggests. The fossils of prodigious size show that the
animals of extinct species were much larger and more destructive
than any which exist at the present day. Savage animals, that are
now banished to the dark places of the earth, at one time roamed
over the whole surface thereof. The lion, which must now be sought
in its distant lair, then existed in England and in Germany. The
* J. Hollingshead, in his 4 Ragged London in 1861/who has lived amongst the poor
and knows their ways, says:— 44 The simplest forms of insurance are neglected by
them .... early reckless marriages are contracted—marriages, as I have said before,
that are as much a dissipation as gin-drinking or any other abomination. Children
are produced without thought, set upon their feet without clothing, taught to
walk, turned into the street without food or education, and left to the ragged school,
the charitable public, or the devil. . . . They increase and multiply, and all for
what ? To become paupers; to glut tbe labour market; to keep their wages down
at starvation point; to swell the profits of capital.”
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existing sloth of South America was then represented by the gigantic
mylodon and megatherium; the armadillo by the huge glyptodon,
one of the smaller species of which measured nine feet in length.
The dipratodon, which was the representative of the kangaroo in
Australia, had a skull which was three feet in length; and the
ihylacoles, a carnivorous marsupial, was not inferior in size to the
lion. Destruction seemed to be everywhere the law of nature. The
experience of the present day, on the other hand, proves that there
are very few animals which may not be tamed and made use of by
man; and the existence of societies for the prevention of cruelty to
animals indicates that he, at any rate, is becoming alive to the duties
under which he lives with regard to other animals. The disappear¬
ance from off the earth of those vast and formidable creatures of
palaeontological ages, together with the changes that are taking place
on the earth at the present day, seem, then, to be prophetic of an
empire of love, and dimly to foreshadow a far distant period when,
perhaps, “ the lion shall lie down with the lamb, and a little child
shall lead them." As regards man, in truth, there can be no ques¬
tion that, if nature is to progress in mental development through him,
love and virtue must replace cruelty and vice; taught by the records
of the past, that the nation which has used the sword has hitherto
perished by the sword, he must contentedly beat his sword into a
ploughshare. For that which palaeontological reflections suggest,
and which history, pointing again and again the moral, produces the
conviction of, is that which simple scientific observation of the natu¬
ral course of the development of mind compels us gladly and confi¬
dently to anticipate; it is the realisation in general practice of those
sublime principles which revelation has inculcated. And such, hap¬
pily, will be the functional expression of the superior type of brain
amongst modem civilised nations.*
That which is true of nations is plainly none the less true of the
units forming them. Fulfilling the law of progression from the
comparatively general perception of the material properties of a few
simple objects to the more special perception of the complex
relations of many objects, the individual mind advances in time to
the conception of moral relations, and manifests itself in the moral
sentiments, sense, cognitions, or feelings. The lower animal has
evidently a perception of the highest object, namely, man, but it is
for the most part only a simple perception of him as a material
object, whilst the perception which one human being, when rightly
developed, has of another is, as it embraces his moral relations, a
much more complex result. To the perfection of this result indivi-
* Regarding which we might call to mind the gentle character—rudimentary moral,
as it were—of the Ateles, which alone amongst monkeys has those convolutions gene¬
rally considered characteristic of the human brain—the ‘ premiere pli de passage/
and the 1 deuxierae pli de passage.'
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dual mental development rightly progresses; and whosoever, from
feebleness, indolence, or frailty, stops very early on the way, is very
much in the position of a Bosjesman looking at a tree as compared
with an accomplished botanist regarding the same object. Though
man is endowed with a noble birthright, he must labour hard to
assert it; for it is by no means sufficient for him to open his eyes
upon the world, but absolutely necessary that he look into it. He
is gifted with sight that he may by his own exertions get insight,
and the most successful intuition is founded on a very careful and
continued previous mental training. Now, if the individual fails to
assimilate his inner conscious life to the wondrous intelligence of
nature; that is, if he simply fails in mental development, and no
more, his posterity may, under favorable circumstances, continue the
development ; but if he not only fails to advance, but actually goes
backwards, there is every probability that his posterity will continue
the retrogression; and that, as in the nation so in the family, nature
will do away, for reissue under better auspices, with degenerate
and unavailable material. By the law of causality evil must produce
its kind. So close and delicate, too, is the relationship amongst
mankind, that many innocent people are miserably affected by the
degeneration of one man, whether degenerate in crime or vice or in
disease. He may verily be said to keep back the universe by so
much. On the other hand, the great and good man not only, as
Solomon says, " leaves an inheritance to his children's children," but
beneficially affects all with whom he is brought in contact, and the
universe advances so much by him. As, according to geology, the
most important mountain ranges lift up and sustain on their sides
the beds of rocks which form the inferior groups of hills around
them, so likewise the strong and moral man lifts up and supports
the weight of multitudes of inferior mortals. In the great re¬
volutions of the world, whether political, social, religious, or purely
intellectual, we discern the central peak issuing from the heart of
nature, and the lower surface range of hills resting on its sides. But
every individual who is labouring sincerely and faithfully after the
just development of his faculties, however humble his sphere may
be, is to some extent aiding the onward progress of nature, which is
then developing through him. And though he may not rise to the
towering height of a world's hero, his service is not forgotten of
nature, but his good deeds have their place in the plan of develop¬
ment, and go on working through all time.
In the innate eagerness of men for knowledge, and their restless
pursuit of truth, and in the intense gratification which their labour
affords them, we seem again to recognise the benevolent purpose
which has, from the beginning, been striving to advance life to a
higher grade. And as if more surely to effect this, it has been
ordained that happiness shall not attend the acquisition of know-
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ledge so much as the pursuit of it.* Man does not feel so great
satisfaction on reaching the goal as to induce him to stay there;
but he does feel so great a pleasure in struggling for it, that when
the course is over he is eager to start again. And this he joyously
does, though he has but the faintest possible notions of the end for
which he is labouring under the sun. Sufficient is it for each one
to feel that, with the definite aim of the development of his moral
and intellectual nature before him, he must work definitely for that
object, must pursue with quiet constancy his course, “ like a star
without haste, yet without rest in other matters, outside his orbit
and beyond the reach of his faculties, being content to “ stretch
lame hands of faith,” and “ faintly trust the larger hope.”
As far as we can judge, the force of the universe is a constant
quantity. Nothing appears to be added, and nothing is taken away.
When the force of man is augmented in mental development, it is
evidently at the expense of the forces of nature; and when man dege¬
nerates, nature increases at his expense. The correlation which is
believed to exist between the physical forces may well be supposed
to exist between them and the mental or vital force. Speculation on
this matter is, however, of no avail, and must always come back to
the place where it has been times and times before. We can say no
more now than what Euripides said in the ‘Olympiads’—“All things
are but a mingling and a separation of the mingled, which are called
birth and death by ignorant mortals.” Love is the creative power,
viewing it on the moral side, which mingles and makes harmony,
while hate is the destructive power which separates and makes
discord. With the progressing development of nature love seems to
be increasing at the expense of discord, and manifest order to be
superseding seeming confusion, or rather, advancing knowledge is
becoming conscious of the love that there is in every apparent evil.f
In fact, the wider and deeper our insight becomes, and the more
clearly do we perceive love working in every event of nature, all-
embracing, all-supporting, all-powerful. It will be man’s glory and
the accomplishment of his destiny to reflect in his life the clear, pure
light of love, instead of the coloured reflection which his infirmities
now produce. ,So doing, he will realise the possibilities of a type
* Ancients and moderns have often expressed this truih, as Sir W. Hamilton, in
liis 4 Lectures on Metaphysics' shows. 44 Si je tenais la verity captiv6 dans la main,
j'ouvrais la main afin de poursuivre encore la v£rite,” said Malebranche.
f On which subject we may very properly refer to the grand utterance of the
4 Pater profundus * in Goethe’s 4 Faust/ commencing
“ Wie Felsenabgrund mir zu Fussen,”
&c. Sec. & c. &c.,
and ending
44 Sind Liebesboten, sie verkunden
Was ewig schaffend uns uniwallt.”
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Report on Gheel by the Commission of the
which, in the possession of so great and noble a potentiality, is
exalted immeasurably beyond all other types in nature.
“ Arise and fly
The reeling Faun, the sensual feast;
Move upward, working out the beast,
And let the ape and tiger die.”
Report on Gheel by the Commission of the Medico-Psychological Society
of Paris , read at the sitting of the Society , December 3C Uh, 1861.
[The Trench alienists, as deeply interested as we have been in this
country, in the much-mooted question of the value of the Gheel
system, have preceded us in an earnest and praiseworthy effort to
solve it with an impartial and educated judgment. At the meeting
of the eminent Medico-Psychological Society of Paris, held in July
last, the society formed a commission to visit Gheel and to report.
The commission consisted of the following eminent alienists :—MM.
Michea, Moreau, Mesnet, and Jules Talret, Trel&t and Baillarger.
The report has been drawn up by M. Jules Talret. The multiplied
writings upon Gheel which have hitherto been put before the general
and medical public have dealt, for the most part, only with the sur¬
face of the system, and too frequently with its sentimental appear¬
ances ; this careful consideration, therefore, of its merits and
demerits, founded upon a minute investigation made by a commission
of eminent psychologists, is of great value. The early pages of the
report, in which the details of the Gheel system are described, have
been omitted by us, because they do not differ materially from the
descriptions given in these pages by the able pens of Dr. Cox and
Dr. Sibbald, and even in the present number by Dr. Carmichael
McIntosh.— Ed.]
We have to record the favorable impression which we have
received from the inspection and examination of many of the
nurses* of Gheel, of the public spirit which reigns among the
inhabitants of this colony, and the conduct of the majority of
them among their patients, without dwelling upon unfavorable
instances (happily exceptional) of nurses who are unfaithful to
their trust. These acts are, however, now severely checked; they
become more and more rare in proportion as the central administra-
* We have in this paper rendered the French nourricier by the word nurse , which
scarcely, however, seems to convey the exact meaning ; a stricter translation would
be foster-father; it is used in the paper to signify the person in charge of the
lunatic.
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tion exercises a more active and efficacious control over the most
distant cottages, as well as over those houses which are in the centre
of the town.
Another fact equally worthy of note, that is authenticated by ques¬
tioning the inhabitants of the commune of Gheel, is the surprising
unanimity which prevails in all their replies relating to the infre¬
quency of accidents, whether formerly or now. On questioning the
inhabitants, even those who have not the insane living with them,
upon the frequency of accidents in the colony, everywhere the same
answer is given. All affirm that accidents of every kind have always
been very rare at Gheel, and that they are more so at present than
formerly. By dint of research we can only discover five or six mur¬
ders committed by the lunatics since the beginning of this century.
The fact of the burgomaster killed by a lunatic, mentioned by many
authors, is in the memory of all; but it is needful to interrogate
many individuals before arriving at the knowledge of other facts of
the same nature. The acts of violence exercised by the lunatics
upon other patients, or upon the inhabitants of the town, are neces¬
sarily more frequent than the completion of murder; but, after all
the evidence, they also would seem to be far less frequent than would
be supposed at first sight, according to the fear which lunatics left
at large would inspire.
Incendiarisms, or attempts at this crime, have at various times been
somewhat frequent in the commune; but it must be remarked that
there was no evidence to prove they were always to be attributed to
the lunatics; in truth, when a conflagration takes place through
negligence or want of care, every one is ready to accuse the lunatics
rather than the other inhabitants, and this suspicion is not always
well founded. As regards suicides, the official statistics note a very
small number every year, in proportion to the whole amount of
lunatics in the colony; there are even some years in which no
suicide occurs. The number of pregnancies of lunatic women
is very small, if we compare it with what we might expect it to be,
with the degree of liberty which the lunatics enjoy, and with the con¬
tinual association of the different sexes, even in the same house. And
it is a remarkable thing, according to the information we have col¬
lected, that the pregnancies are always the result of connection with
strangers, or the inhabitants of the commune with the lunatics, and
never by intercourse with each other.
The results furnished by the official statistics, or by the verbal
testimony of some of the inhabitants of Gheel, are insufficient to
determine with certainty the real number of accidents which arise
from the contact of the lunatics with the whole population of a
town under exceptional conditions of liberty. Many causes of error
may prevent the truth from becoming known, the nurses having an
interest in hiding the accidents caused by the lunatics, for which they
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may be considered responsible. Moreover, there exists in this respect
among the inhabitants of the commune a joint responsibility which is
very remarkable. It is explained by the community of interest which
unites together all the inhabitants of a town of which the lunatics
constitute almost the sole wealth, and by a kind of common self-
respect which constrains all, willingly or unwillingly, to uphold the
colony in the presence of strangers, to enhance its merits, and to dis¬
guise, as much as possible, its deficiencies, and its dangers. We are far
from being blind to these causes of error. We are even disposed to
think, without having certain proof, that the accidents of which we
have spoken may be more frequent in the commune of Gheel than
the inhabitants themselves avow, or than are noted by the official
statistics. But whatever the exact and precise number of these acci¬
dents, what we think we may affirm is this, that they are extremely
rare in proportion to the whole amount of the lunatic population,
especially if we consider the facilities open to the patients to commit
them, and the large amount of liberty which they enjoy.
By studying with impartiality the position of the lunatics in the
commune of Gheel, we come to the conclusion that its disadvantages
have been much exaggerated, and that, especially since the reforms
that have been instituted of late years, the patients are, as a whole, in
a better condition than a,priori could be believed.
We certainly do not partake the exaggerated enthusiasm of cer¬
tain partisans, who have gone so far as to make Gheel a sort of ideal
paradise of madmen, where the lunatic finds himself surrounded with
all those advantages impossible to be met with elsewhere.
We are about to pass in review the serious disadvantages which in
our opinion this colony presents, and which are not only of the nature
of transient imperfections, but are inherent in the institution itself.
But these serious deficiencies do not prevent us from acknowledging
the advantages which the colony possesses for certain classes of
patients. We cannot enumerate the whole; this inquiry would lead
us too far. It is enough to note the two principal ones, upon which
the advocates of this colony have chiefly rested, of which, however,
they have strongly exaggerated the importance; we mean the liberty
of movement left to the lunatics, and the life in common with the
families of the townspeople and the peasantry. These two essential
characteristics of Gheel distinguish it from all other institutions for
lunatics; whatever their form or nature, asylums can never supply
the like advantages in the same degree, and they are, in our opinion,
for certain lunatics incontestable ones. But these once acknow¬
ledged, we cannot help remarking that the advantages of Gheel, upon
which such eloquent pleaders have dwelt, are far from being suitable
for all patients, and also from being as absolute and unlimited as
they would wish to make them.
And first, in relation to domestic life, a residence in the midst of
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Medico-Psychological Society of Paris.
strangers can never become for all lunatics an absolute equivalent to
family life at home. Without doubt it may be affirmed, as the de¬
fenders of Gheel have done, that in a therapeutic point of view the
position of lunatics in a family of strangers combines all the advan¬
tages described by authors in favour of isolation—separation from
things and persons which have.contributed to produce the malady,
and which continue to feed and maintain it; removal to a different
position and new surroundings; without always offering the disad¬
vantages which the partisans of Gheel attribute to the seclusion of an
enclosed asylum. But if this argument has any value in relation to
recent cases susceptible of cure, it loses much of its weight as applied
to most of the chronic cases to be observed at Gheel. It cannot be
denied that in a certain number of cases, especially among the women,
residence in the midst of a strange family however kindly disposed,
cannot completely compensate them for removal from their own
families or from their native country. Consequently, the family life,
so worthily praised in certain respects, is not exempt from trouble and
annoyance; to a certain degree, it resembles isolation in an asylum
for certain patients capable of feeling the misery of separation from
their families. It is precisely these patients who would be most
susceptible to the feeling of its comforts.
With respect to the liberty of the lunatics, which has been made
so great a merit of at the colony of Gheel, it is of much conse¬
quence to remark how far it is from being absolute, how much, con¬
sequently, this advantage, which is considered superior to all the
rest, is attended by numerous restrictions which greatly limit the
exercise of it. Doubtless, liberty of movement exists at Gheel for
the lunatics to a degree which it would not be possible to realise in
an ordinary asylum. These patients usually go about without being
followed in the houses, in the streets, and in the fields.. There are
no insurmountable walls, no closed gates, to intercept their move¬
ments. Nothing savours of the rules or discipline of an asylum,
the obligation of submission under pain of punishment to a regula¬
tion, or marching to the bell or the drum. Each patient is left to
himself, to his caprices, and to the natural bias of his delusions, with¬
out being opposed. Without considering the therapeutical side of
the question (which, however, has great value, and which ought
here and everywhere to predominate over all others) it is just to say
that for certain lunatics this is a benefit which they greatly appre¬
ciate, and which some enjoy even more than other benefits which
they can obtain in asylums. But the need and the sentiment of
liberty, are they so general among lunatics as we are led to believe ?
Are these patients similar in this respect to ordinary prisoners?
Is the liberty at Gheel really so complete for them as is pretended ?
Such are questions which it is very needful to discuss.
In visiting an asylum of lunatics, one is impressed at first sight
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with the great number of patients who claim their liberty. This
desire is indeed very general. There are, besides, certain lunatics
who, without expressing it as noisily as others, nevertheless ex¬
press it with vivacity. But we think that here, as in many other
things, one is led astray by appearances; the continued clamour of
those lunatics who demand to have their liberty deceives as to the
real number of patients who are very eager to go out. When from
this point of view we attentively examine all the lunatics of a large
asylum we are soon convinced that many among them, entirely
dominated by their malady, live concentrated in their inner world, with¬
out seriously disquieting themselves as to their place of abode, and
that they are infinitely more preoccupied with the object of their
delusion than with the desire to go out. They are in an asylum
precisely what they would be out of one, or anywhere. Take them
from the asylums and remove them to Gheel, they will be neither
more happy nor more wretched; they will there display the same mani¬
festations, without troubling themselves at all about their removal.
At Gheel, where there are a large number of incurables, there are
many patients of that class who are happy, but who would be the
same in this respect in an asylum, since they do not appreciate the
blessing of liberty nor feel its value. The ardent desire for liberty
is most apparent among the insane during the acute stages of
their disorder, at the period of convalescence, or during the lucid
intervals of those who are subject to intermittent attacks. WTien
it is too intense and too exigeant in these unhealthy conditions, it
also frequently denotes the near approach of an attack, or the in¬
completeness of the convalescence and the danger of a relapse.
Many chronic lunatics, on the contrary (and these are the patients
most commonly met with at Gheel), do not really suffer from the
privation of liberty; and, consequently, they do not enjoy, as sup¬
posed, the benefit of it, nor can they appreciate its value. This
liberty, which gives evident satisfaction in a certain number of
cases, and is greatly desired in others, is more extended at Gheel
than in any other asylum; it is, however, far from being absolute
and unlimited, as is wrongly imagined when one has not visited
Gheel, and has only read the works of literateurs or the novelist on
this subject. The quiet and harmless lunatic is, doubtless, , at liberty
to leave the house and to walk in the country, without being constantly
followed by an attendant, as is the custom in all asylums; but it is
not sufficiently noticed that, notwithstanding this liberty of move¬
ment, he is really under guardianship, and plainly in an inferior con¬
dition with regard to the rest of the population. He is, unknown
to himself, surrounded with a vast net of surveillance, which en¬
velops him everywhere; and, although not evident under the form
of walls, gates, gratings, and attendants, it is not the less real ; it
constantly imposes limits to his liberty, and obliges him constantly
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Medico-Psychobgical Society of Paris.
to live in an atmosphere of moral and material restriction. In fact,
at Gheel the lunatic is far from enjoying the same amount of liberty
as the other inhabitants. Because he is a patient, he forms a part of
the population which excites in the rest a kindly pity, and on account
of which he receives the right of protection which is constantly
exercised towards the lunatic by the mere effect of the superiority
of reason over folly. This general surveillance, exercised at all
times by the sane population upon the insane, is not one of the least
attractions of Gheel for the attentive observer. It is really a very
curious phenomenon. It explains the mystery which Gheel offers to
those who have not yet visited it. It is asked, how is it possible to
give to the insane the same degree of liberty granted to the sane;
and how is it that, under such conditions, when patients are left to
themselves without any surveillance, accidents are not of more frequent
occurrence ? But this theoretical idea, which makes the colony of
Gheel an incomprehensible mystery, does not express the reality.
This mystery is explained by the general fact that 800 lunatics are
under the protection and the surveillance of 10,000 inhabitants. The
latter are always ready to guide and support them; they check them in
the manifestation of violent or disorderly acts; like children, they guide
them at will, whether it be by gentleness, by craft, or even by severity,
and thus avert the mischief they might do to themselves or others.
. But this protection extends only to the patients who move about
in town or country, and who are in reality the fewest in number. The
nurse is, in short, the real and responsible attendant on the lunatic.
It is to him that the lunatic is confided, for whom he must answer to
the family and the authorities; he must know where he is and what
he does; he must forbid him to leave the house when it would seem
to be injurious, and avert from him whatever may occasion disturb¬
ance or public scandal; he must make him return at the hour of
meals, and at a suitable time in the evening, that lie may not wander
in the fields or pass the night from home; in a word, he must pre¬
vent his escape. The nurse is not only morally responsible for the
acts of his patient; he is deeply interested in preventing him from
doing wrong, that he may not lose him, that he may not be removed,
and that fines and penalties may not be imposed. The nurse is, then,
the real guardian of his patient, and it would be untrue to say that
at Gheel the lunatic is not guarded. He is watched, not only by
the nurse himself, but by the whole family. If he is allowed to go
out alone, it is that confidence is reposed in him; immediately the
keeper entertains fear about him he is not again left; he goes with
him and follows him everywhere, as an infirmary attendant would do,
or else he keeps him in the house by art or by force, as he would a
child; he shuts him up in his cell; he ties him to his bed, puts on
the camisole, the iron belt, or the shackles. This is the amount of
liberty which is permitted to the lunatic at Gheel. If to these
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Report on Gheel by the Commission of the
various restrictions are added the police regulations, which, under
certain circumstances, interdict the lunatic from the public-house,
from balls, from the purchase of tobacco, of drink and of many
other things, from sending letters by the post, &c., regulations which
oblige them to return in good time to the house, and which give
authority to the guards of section to compel their return, it is clear
why the guarantees for their security are stronger at Gheel than else¬
where, and also stronger restrictions upon their liberty than appear
at first sight to exist.
Notwithstanding the reservation we are compelled to make in
relation to the two principal advantages which are dwelt upon by the
partisans of Gheel, we willingly acknowledge that the family life
and liberty to move about are, in a certain number of cases, a real
benefit not to be found in the best-conducted asylums. Yet these
advantages are only ensured to them at Gheel under exceptional cir¬
cumstances, which are far from being exempt from serious disadvan¬
tages now to be considered.
The most serious disadvantage of Gheel, that which in our opinion
is predominant and which greatly counterbalances its advantages, is
that thefact of placing lunatics in thefamilies of peasants scattered over
a wide territory is in itself the negation of all active and individual
therapeutics, either moral or physical . It may be answered that, in
regard to isolation, the beneficial influence of things and persons,
exercise in the open air, and occupation, the patients at Gheel are in
as favorable circumstances as those in asylums ; but even in regard
of general treatment, exercised by personal and local circumstances,
the total absence of order, of rules and discipline, to which all
alienist physicians have attached great importance, must be looked
upon as a most lamentable deficiency in the interior organization of
Gheel. No physician, habituated to the charge of lunatics can
admit (as M. Jules Duval has done in his work) that it is always
good for the amelioration of the intelligence or the feelings, that the
patients should be completely abandoned without counterpoise to the
unrestrained flow of their frenzied ideas, to the mastery of their
morbid inclinations, and to the free manifestation of their disorderly
acts. Certainly it may be replied that liberty is in some sort a
counterpoise to itself, and that the more the insane have the liberty
to act as they like the less will they abuse it, and the more will they
restrain themselves ; that occupation, carried out as it is at Gheel on
so extensive a scale, is a powerful agent of order and discipline, and
acts as a counterpoise to the tendency of the insane to self-concen¬
tration and to nourish their delusions by dwelling upon them. It
may again be said that in the best asylums many of the lunatics
are left to idleness, and follow, even as they do at Gheel, without in¬
terference, the course of their frenzied ideas, yet we cannot admit the
absolute falsehood of all that in this respect the most able physicians
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have said and written in every country for more than half a century
upon the influence of the rules, the order, the discipline of asylums;
in a word, upon the surroundings of the lunatic, influences which
made Esquirol declare that a well-organized lunatic asylum was the
most powerful therapeutic agent in mental disease. We cannot
forget all that has been written upon the general treatment of
lunatics, upon the slow and continued action of the external circum¬
stances which surround them, the medical atmosphere which they
breathe, and which everywhere envelops them; we cannot believe
that all which constitutes the foundation of our modem science is
absolutely false; that we must exclaim, like the exclusive partisans
of Gheel, that free air and liberty suffice for the treatment of the
insane; that to abandon delusion to itself, and to abandon the in¬
sane to the free and complete manifestation of their ideas, their
desires, and their acts, without any medical intervention, ought to
be considered as the ideal and the ne plus ultra of the therapeutics of
mental disorders.
But it is not only under the aspect of general treatment that Gheel
appears to us inferior to asylums for patients who are susceptible of
any amelioration; it is especially so as to individual, physical, and
moral treatment. Certainly there have been great ameliorations in
the medical department, especially of late years. Leaving the lunatic
entirely to the care of the nurse is not practised as it used to be; an
efficacious medical control and action are felt at the furthest extremity
of the colony as well as in its centre. This is an evident improve¬
ment, and we are happy to render full justice to the physicians of
section who zealously visit the lunatics, and to the physician in¬
spector who manifests in his difficult functions an activity, a desire to
benefit, and a profound knowledge of his patients, which is truly sur¬
prising in the midst of very considerable material difficulties. But
every one will agree with us, that eight hundred lunatics, spread
over a circuit of nine leagues of country, in isolated habitations, are
far from being placed in the most favorable conditions for the phy¬
sician to exercise a really salutary influence, either upon the patients
or the nurses themselves. Whatever be the amount of activity ex¬
pended on such a work, it is beyond human skill to accomplish. Do
what you will, the medical intervention must reduce itself to general
superintendence, to a central direction, and cannot be exercised indi¬
vidually upon certain lunatics who have need of the direct and per¬
sonal attendance of the physician. Doubtless these constitute the
smallest number; since, in the state of our imperfect knowledge of
mental disease, the individual, physical, or moral treatment, yet plays
but a feeble part even in our best asylums. But notwithstanding
this lamentable void in actual science, a physician, worthy of the
name should never despair of progress, should never abdicate the
rights of the future or aid in arresting the advance of science. He
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Report on Gheel by the Commission of the
would act thus if he proclaimed that the best system to follow in the
treatment of lunatics, the ideal of mental therapeutics, consisted in
placing the patients at great distances from each other and from the
physician intrusted with that care, to confide them to a multiplicity
of nurses, almost exempted by their number and their remoteness
from all medical direction, and to place them in local circumstances
where all the resources which the physician finds united in an asylum
are absolutely wanting. The village of Gheel cannot, in our opi¬
nion, support a comparison with our asylums, when we examine it
from a therapeutic point of viaw. Neither the devoted attention of
the physicians, who have undertaken this difficult task, not even the
establishment of an infirmary which will be however a real im¬
provement, can wholly remedy this immense deficiency in the colony,
which is so closely bound up with its very constitution. It can only
be effaced by transforming the infirmary into a real asylum, and by
admitting all the lunatics into it for treatment. This will be de¬
serting the principle which lies at the foundation of the colony, and
which its advocates vaunt so highly. It will be to deny the thera-
E eutic efficacy of the free air and family life system, and to ac-
nowledge with us that Gheel can only be of service to chronic
lunatics for whom there is no hope of cure. The considerations we
have just brought forward on the disadvantages of distance and the
dispersion of the patients in a medical point of view, apply equally
to the surveillance and the precautions which have been taken to
ensure the security of the lunatics and of the other inhabitants. We
certainly admit as an incontestable fact, since observation demon¬
strates it, that accidents of all kinds are very unfrequent at Gheel,
much more so than could be supposed apriori. But this concession
made to the truth of observation does not go so far as to proclaim
that the system followed at Gheel offers stronger guarantees for the
surveillance of nurses and patients, and for the security of all, than
the more perfect system carried out in our best asylums. The ob¬
stacles arising from the too great dispersion of the patients, the con¬
siderable distances to be traversed, especially during winter, the
small number of agents appointed to watch over the patients and
nurses, are so indisputable, that if serious accidents are not more fre¬
quent than in asylums, it is at least impossible but that abuses of all
kinds must necessarily be of more frequent occurrence. The patients
have too many facilities for carrying out violent or injurious acts, the
uurses who would take advantage of them, denying them things
which are indispensable or maltreating them, can too easily escape
the vigilance of the authorities for these abuses not to be more fre¬
quent than they are said to be ; and it is plain that in our establish¬
ments the attendants who neglect their duties are more closely and
continually watched in all the details of service than the nurses of
Gheel can be, especially in the outlying hamlets.
ty Google
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Medico-Psychological Society of Paris, 111
After the disadvantages which, in our opinion, are apparent in the
colony of Gheel, under the head of treatment and the security of the
lunatics, we must also remark upon those which relate to the welfare,
moral and material, of the patients. These are based upon the
advantages of liberty in the open air, family life, and of field
labour, so especially praised in the colony of Gheel as superior to
enclosed asylums, and for which the benefits of treatment and the
guarantees of security which the asylums present are sacrificed.
But even from this point of view the welfare of the lunatics at Gheel
leaves much to be wished, especially for a certain number. It is in¬
ferior in many respects to that which is every day attainable in asy¬
lums. Thus, the chronic, quiet, and inoffensive patients, to whom
the system at Gheel is peculiarly suitable, are worse off as to nourish¬
ment, clothing, personal care, and material resources of all kinds,
than they are in public asylums. Lunatics who are of uncleanly
habits, the destructive, or those attacked with incidental disorders,
are certainly not so well cared for as in ordinary asylums. In short,
refractory or dangerous patients, or epileptics, all those, in a word,
who excite fears of any kind, are incontestably worse off and less
happy at Gheel than in asylums; it is necessary, from the very effect
of the general system of liberty, to carry out in such cases more
severe and continued measures of restraint than those employed for
the same patients in ordinary asylums.
To these disadvantages inseparable from the system itself must be
further added some secondary disadvantages which it would be more
easy to remedy, such as the too intimate association of the two sexes
which exists even in the same house, the insufficient classification of
the lunatics of various categories in the different hamlets (a classifica¬
tion already commenced, it is true, by M. le Dr. Bulkens), the too great
number of patients sometimes found collected in one family, and,
lastly, the inconveniences frequently arising from the patients not
speaking the same language as their nurses. It is therefore seen
that if the colony of Gheel presents some incontestable advantages
for certain chronic lunatics, it is nevertheless far from being exempt
from grave disadvantages, and that it does not merit (as its ardent
advocates say of it) to be raised to the rank of being the exclusive
method of public beneficence to the lunatic.
This colony, as it is actually organized, is neither so good as its
enthusiastic partisans have pretended nor so bad as its systematic
adversaries have affirmed. It is a mode of public assistance to the
insane, which has its advantages and its disadvantages. It is especially
suited to those numerous lunatics who have reached .an advanced
period of chronicity, who are usually tranquil and inoffensive, whose
periods of excitement are infrequent, and who need neither assiduous
care and treatment nor energetic measures of repression. But for
those patients who, in the acute attacks of their malady, are really
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Report on Gkeel by the Commission of the
dangerous to themselves or to the public safety, for those whose state
of disease needs constant care or continued medical treatment, no
circumstances can, in our opinion, supply the place of the moral and
material advantages which the lunatic now finds in our well-organized
asylums. The physicians and the administrators of this colony are,
however, perfectly aware of the deficiencies of the system they have
extolled. Therefore they have demanded an infirmary wherein to
receive new patients, such as have need of active treatment or much
personal attendance, as well as the excited, or those likely to trouble
the public order and security. Further, they have established a rule,
which not only permits, but makes it imperative, to send to the
other asylums in Belgium homicidal lunatics, suicides, incendiaries,
erotics, all who are likely to cause disorder or scandal of any kind
to public manners, and, last, those who by their active and con¬
tinued attempts at escape necessitate the constant employment of
means of restraint. The administration has truly felt that chains
and excessive means of repression are a blot upon the colony,
an infraction of the principle of liberty, and an inevitable con¬
sequence of this very liberty. Thus, by organizing the infirmary
and by the most stringent application of the law relating to patients
disposed to escape, they hope to be able gradually to diminish the
number of lunatics who need these means of restraint, and are thus
deprived altogether of the benefits of the system of the colony.
The conclusion that we must draw from the examination of the
colony of Gheel is widely different from that of its partisans or its
detractors. We do not see in this mode of relief to the lunatic an
entirely different system to that of our asylums, a method to be
adopted exclusively or rejected as absolutely bad. We believe that
the system of family life and of liberty in the open air adopted at
Gheel for ages, and that system which has been in use in a pro¬
gressive manner in asylums for half a century past, do not necessarily
exclude each other to such a degree that a decision in favour of one
would inevitably condemn the other. We believe, on the contrary,
that with the exception of the two differences, important, doubtless,
but not fundamental, which exist between the colony of Gheel and
our existing asylums (liberty to go about and living in the midst of
families not insane), these two systems, far from being absolutely-
opposed, are but the realisation, more or less perfect, and by different
means, of the same principles which have presided over the
improvements of our establishments for the insane for sixty years
past.
What are really the principles which Pinel inaugurated at the end
of the last century, and which have been developed since that time
by all those who, in every country, have contributed to ameliorate the
lot of the lunatic ? May they not be summed up in this general
reflection, that the best means of contributing to the well-being and
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Medico-Psychological Society of Paris.
treatment of these patients, consists in allowing them as much
liberty as possible—all the liberty, in a word, which is compatible with
their proper security, and that of society ?
To abolish by degrees in the site, the structure, and regulations of
asylums, all that which recals the prison, or even the hospital; to
make them resemble more and more the ordinary habitations of
common life, only to preserve that which appears absolutely indis-
pensible; to give the lunatic by every means the appearance of
liberty, when the reality cannot be accorded; to avoid by. a me¬
thodical classification the contact of those patients who are most
excited, to have patients as rarely as possible isolated in their cham¬
bers or their cells, to make them live together in common rooms, and
take their food at the same table; to furnish them both indoors and
out with all kind of occupations and recreations, and especially with
exercise in the open air; to occupy them principally and physically in
agricultural labour; to diminish by degrees the amount of mechanical
restraint, and even at last to discontinue its use altogether; to calm
the nervous excitement of some patients by letting them expend it
out of doors in liberty of movement, instead of endeavouring to
restrain it by useless means of repression, which only increase and
foster it; and finally to endeavour to utilise the exuberant force of
some lunatics, instead of allowing them to spend it in the pure loss
of disorderly movement; such are the fundamental principles of
modern asylums in every country. And are.they not the same which
are in use at Gheel, with variety of means but identity of purpose—
the same which the admirers of that colony have committed the
error of attributing to it, as if it alone possessed them ?
In place of opposing the colony to the asylum as two systems
which necessarily exclude each other, they ought in our opinion to
be considered as two different applications of the same principles, and
as two different forms adapted to realise them. From this point of
view only secondary and not fundamental differences have to be
sought for between the colony and the asylum.
It only remains to examine which of these two forms realises these
principles the most usefully, which best conciliates the interests of
the individual with those of society, and the exigences, often contra¬
dictory, of the well-being, security, and the treatment of the lunatics.
It remains to determine for what cases of. mental disease the one
or the other system is the most advantageous, and to find a middle
term to conciliate them; it is this which has been tried at Gheel, and
that which is yet being tried there. By the earnest organization of a
central administration, and of a regular medical service, Gheel has
already made a step towards the system of our asylums. By the
establishment of an infirmary, which will be open next year, another
advance will be accomplished in the incessant movement which
brings Gheel to resemble the organization of our establishments. On
-VOL. VIII. 3
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"Report on Gheel by the Commission of the
the other hand, the best organized asylums tend from day to day to
accomplish perfection in increasing the amount of liberty granted to
the patients; and in this respect they may derive'inuch profit from the
example which is set them by Gheel.
In this double movement, in an inverse direction, the progress of
each system will consist; Gheel can only improve by drawing towards
the closed asylums, and these in their turn can only improve by pro¬
gressing with slow prudence, but with perseverance, in the path of
liberty. Where ought this double movement to stop? What is
the precise point where the best practical solution of this difficult
problem can be found—the greatest possible amount of liberty
which can be granted to the insane without injury to their welfare,
their safety, and their treatment ? This is a question which cannot
be determined at present, and which only the future will be able to
solve. In our opinion, Gheel has more to gain by copying from
asylums, than these by taking example from Gheel, but on this
delicate point opinions will greatly differ; some prefer the asylum
system, others that of free life, but there is a neutral ground upon which
the most divergent opinions may meet. This neutral ground is a
system in which it is admitted that the two methods, far from
excluding each other, are but the complement one of the other. But
the colony to be really useful cannot dispense with the asylum as an
infirmary, and an asylum cannot be perfect without the adjunct of
a colony. But which .element ought to predominate ?—Ought the
infirmary, as at Gheel, to be annexed to the colony, or would it not
be better to make the colony an adjunct and natural complement of
a well-organized asylum ? Here differences will arise, and each one
will desire the predominance of one or the other, according to his
predilections.
Such is the general impression which our visit has left us of the
colony of Gheel. The system may, then, to a certain extent be adopted
as one mode of public beneficence for certain chronic cases of
insanity; but unfortunately the position in which the patients are
placed at Gheel can scarcely be realised in any other locality. Gheel
is the product of centuries, the result of long tradition transmitted
from generation to generation, and can never be reproduced in other
countries.
Where can be found moral and material conditions which make
Gheel a place altogether exceptional and unique?—A territory of vast
plains, with no natural features calculated to inspire fear for the
insane left at large, with the exception of a small river at one end of
the commune far from any habitation; a wide belt of heath sur¬
rounding the commune, and forming an obstacle to the escape of
patients and to the ready entrance of strangers; houses of generally
one storey in height, grouped together and dispersed in hamlets, with
a central town in which a trading community exists, without, how-
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Medico-Psychological Society of Paris. 115
ever, any important manufacture which could attract an unsettled
population, injurious to the order and welfare of the lunatics; the
inhabitants, whether townspeople, farmers, or peasants, belonging to
a mild, calm, and benevolent race, of almost patriarchal manners,
and habituated to field labour; and lastly, a circumstance of the
highest importance, and the rarest of all, a population which during
centuries has contracted by tradition the habit of taking care of the
insane, and which, far from fearing them, or being apprehensive of
permanent contact with them, possesses on the contrary the incli¬
nation, the tact, and all the aptitudes which are necessary for the
care of such patients ! This certainly is a combination of circum¬
stances altogether exceptional, which it is almost impossible to find
united elsewhere. In Belgium and other countries, isolated attempts
have been made to imitate the Gheel system. Some inoffensive
lunatics have been placed with peasants in the hope of procuring for
them welfare and liberty at a cheaper rate than in asylums. Guislain
tried this several times in the province of Ghent. These attempts,
however, have almost always failed, in consequence of the repugnance
of the people of the country, who were too much in fear of the
insane to retain them, or even in consequence of the refusal of the
local authorities, who would not permit patients in any way capable
of troubling public order and security, to remain in their communes.
At the present time, and with the prejudices existing in all classes
against the insane, and with the apprehension, to a certain extent
legitimate, which the insane inspire in all those around them, one
cannot hope to realise in another country the extraordinary pheno¬
menon presented at Gheel of 400 insane persons moving freely about
in the midst of a population which tolerates them without fear and
without emotion.
But if it should appear that such an attempt could not now be
realised, one ought not to despair of accomplishing it at some future
time. If one cannot imitate it upon the large scale, one can at least
attempt partial and restrained applications of it, lie that proposed
by Roller, in the neighbourhood of asylums. We should especially
endeavour to derive information from this colony, in order to make
perfect the general system of our asylums as to the liberty granted,
and to realise under another form the system of colonization for the
insane of which Gheel offers so remarkable an example. This is the
true practical result of our labour, upon which, in conclusion, we
cannot prevent ourselves from insisting.
The most important practical result which we can draw from a
visit to Gheel is, that many chronic lunatics may enjoy without
danger a much greater amount of liberty than is supposed possible,
even in the best organized asylums.
What is the degree of liberty at which in the present state of our
knowledge it is right to stop, in order to reconcile the needs of security
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with those of the welfare of the patient ? This is a point upon which
great difference of opinion may well exist, and which future experience
alone will be able to determine with precision; at the present time,
however, it may be affirmed that in our asylums, notwithstanding the
immense advance made since the commencement of the century,
some progress in this respect is possible. The example of Gheel
will be useful in showing that many lunatics are less dangerous than
is supposed, and in indicating some practical means in procuring
for them a larger amount of liberty without danger to the common
safety. Already, the physicians and officials of asylums in every
country have made various attempts in this direction. In England,
some lunatics have always been placed in the workhouses, and many
institutions, public and private, have endeavoured to establish for
certain patients “ the cottage system ,” that is to say, the use of
isolated houses for the patients, either within the limits of the asy¬
lum or in its neighbourhood. In Germany, also, for a long time
past, some exceptional patients have been placed by their relations,
or by their physicians, to live with tradespeople, clergymen, medical
men, or peasants; and M. Roller (in the report on Gheel in the
fifteenth volume of the 'Journal of Psychiatry’) has registered a
vow, to disembarrass the lunatic establishments of their superabun¬
dant population, by confiding certain chronic and inoffensive patients
to the families of peasants in the neighbourhood of asylums, whom
the physicians might easily visit, and exercise surveillance, useful both
to the patients and peasants to take charge of them. But such mea¬
sures are altogether partial and insufficient, often even injurious to
the patients, and, moreover, they can only be applied to a very small
number of the insane. The only method of realising for a great
number of the insane this idea of a mixed system, in which the
patients could enjoy a larger amount of liberty than in asylums,
without, however, being left to chance either in their own families
or those of strangers, consists in the neighbourhood of the es¬
tablishment of agricultural farms under a special direction, with
regulations and organization less severe and complicated than those
of asylums for treatment, and in direct and constant relation with
the central asylum. The physician would choose the patients who
could be employed with advantage to themselves or to the establish¬
ment on the work of the farm, and he would at any time be able to
send back to the central asylum any patients whose mental or
physical state required the renewed treatment of that establishment.
This idea was conceived and executed in 1828, at the farm of
Saint Ann, by M. Eerrus, but at the present time it has almost fallen
into disuse there. It has been also applied with more or less success
in the large establishments of all countries ; but no where has it
been realised in a more complete manner than in the colony of
EitzJames, established in 1847, by MM. Labitte, as an adjunct to
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Medico-Psychological Society of Pari*.
their private asylum of Claremont (Oise). We regret that we cannot
here examine in detail its organization, and the advantages which it
may present for chronic lunatics, provided that therapeutic intention
is never sacrificed to agricultural advantage. In ending our report,
we must briefly refer to this method of the system of colonization
as applicable at the same time to augment the welfare of the insane,
and to diminish the charges upon the departmental administrations,
which can scarcely meet the constant increase of their expenses.
When occupied in ameliorating the lot of the unhappy beings con¬
fided to his care, the physician ought without doubt never to permit
himself to be guided exclusively by considerations of economy; but
when it happens, as in the present question, that the means proposed
satisfy at the same time the demands of economy, of philanthropy,
and of science, the physician can only endeavour to promote their
general application. In every country, the progressive increase of
the number of lunatics, the inevitable over-crowding of the esta¬
blishments for their use, the inadequacy more and more manifest of
the more important asylums, whose number of patients for whom
they were provided is constantly being exceeded; in one word, the
urgent necessity of extending help to the greatest possible number
of the insane, without exceeding the financial resources which can be
employed for that purpose—all these considerations impose upon
those who are occupied in ameliorating the condition of these un¬
fortunates, the necessity of discovering better methods of reconciling
the demands of science with the limited resources of taxation, and
of thus becoming able to help the greatest possible number of the
insane at the smallest possible cost. Lunatic colonization under one
form or another, appears to us the best solution of this difficult
problem. It is only necessary to avoid exaggerating its importance
and desiring to employ it indiscriminately in all cases. Lunatic
asylums, constructed according to rules fixed upon by physicians of
all countries since the commencement of the century, will always be
in our opinion the best means of extending care and protection to
the insane during the acute phases of their disease. But for the
large number of the insane who have passed into a state of chronic
disease, who have become generally inoffensive, and who offer but
feeble chances of cure; one may ask whether public benevolence to
the insane may not take four different forms ? and, in conclusion,
we submit to the society the four following questions :
1st. Is it possible to send back to their own families certain
patients whose condition is greatly improved, and who appear to
threaten no danger, and yet to keep them under official protection)
practised under the form of pecuniary help and of moral and
medical advice? This would be to extend to chronic and harmless
lunatics a measure which has already been taken for the convalescent
insane ; it would complete the work of patronage of the insane at
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"Report on Gheel.
home after leaving asylums, which has been in operation at Paris
for twenty years, which extends its assistance to nearly 1100
persons under its protection every year, and which has been imitated
with more or less success by physicians and directors of asylums both
in Prance and abroad.
2nd. Is it possible to place separately certain lunatics, selected by
the physicians, to dwell in the families of townsmen or peasants in
the neighbourhood, and under the surveillance of the asylum physicians,
as M. Roller has proposed to do ?
3rd. Is it possible to attempt the creation of a new Gheel, that is
to say, of a village for the insane, with a regular central organiza¬
tion of good medical service, and an infirmary, but with the express
reserve to place only chronic patients in it, and to exclude from it
all lunatics who are under treatment, or excited, or who threaten
any danger to themselves or to the public security ?
4th. Lastly (and will not this be the most practical, and gene¬
rally applicable method ?), is it possible to annex to the asylums for
the insane an agricultural farm, receiving patients from and sending
them back to the asylums as need may arise, under the advice of the
physician ? This agricultural farm, distinct from the asylum, although
in constant relation to it, will perhaps be able, by industrial and
agricultural labour on a large scale, to supply all the wants of the
asylum, to make it in some measure self-supplying, and thus able,
as M. Billod says in his recent pamphlet on the expenses of the insane,
to exonerate the departments in some degree from the large sub¬
sidies which they are obliged to furnish every year for asylums for
the insane ?
Such, gentlemen, are the questions which your commission has
thought it right to present to you at the end of their report, as the
practical conclusion of the investigation which you have charged
them to make into the svstem practised for centuries in the colony
of Gheel.
(Signed) Ch. Loiseatj,
Special Secretary
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The Revised Rules of the Irish Government for the letter Control of
District Lunatic Asylums in Ireland .
We perceive with no ordinary satisfaction that our talented and
straightforward Secretary, Sir Robert Peel, has put his hand to the
plough in right earnest, by carrying, on 16th January, 1862,/or-
titer et suaviter, through the Irish Privy Council, the revised rules
for Irish Asylums, cancelling the stupid and contradictory ones of
27th March, 1843.
These revised rules put an end at once and for ever to divided
responsibility. Such disreputable freaks as occurred from time to
time in Maryborough Asylum are at an end for ever; or if indulged
in, must now be suppressed with a strong and steady hand.
Let us hope that all parties will now set themselves in good
earnest to elevate their asylums to a high and honorable standard.
There are able and worthy men in and attached to these great insti¬
tutions, and they fortunately have over them Dr. Nugent as senior
inspector, from whose hands the programme of these rules emanated,
and for which he merits the fullest praise. Dr. Hatchell is also an
excellent and amiable man, who merits the confidence of the various
officers in this department. To the medical superintendents of Irish
asylums (for such is the official name by which they are hencefor¬
ward to be known) we say, be courteous, considerate, and for¬
bearing to your colleagues. To the consulting medical officers we
say, accept frankly the office now guaranteed to you by the Irish
Government, and let no question be raised which might point to
assimilation to England by any crotchetty or snappish conduct
towards the essentially chief medical officer of four institutions.
We take leave of the subject for the present, with one remark,
namely, our unqualified approbation of Rule 19, which renders
the double qualification a sine qua non for all future resident medical
superintendents ; and we trust that, on no pretext whatever, will the
Irish executive depart from it. A qualification as to age should
also have been attached to Rule 19, and for the obvious reason of
protecting the executive against undue parliamentary pressure.
J. F.
By the Loud Lieutenant and Council of Ireland.
Carlisle.
Whebeas by an order made on the 27th day of March, 1843,
certain general rules and regulations were established for the good
conduct and management of the several district lunatic asylums in
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120 Revised Rules of the Irish Government for the letter
Ireland; and by orders made respectively the 13th of April, 1841,
the 15th of February, 1847, and the 14th of October, 1853, certain
further general rules and regulations were established for the good
conduct and management of those asylums.
And whereas it is expedient that the said rules should be rescinded,
as well as all bye-laws founded on them.
Now we, the lord lieutenant and privy council of Ireland, by
virtue of the powers given unto us by the statutes in such case
made and provided, do order and direct that the said several rules
and regulations, and all bye-laws founded thereon, be rescinded,
and that for the future good conduct and management of such
asylums, and for defining the duties of the different officers con¬
nected therewith, the following rules and regulations be substituted
in place thereof.
The Board of Governors.
I. —The board of governors of each asylum, three members
whereof shall form a quorum, shall meet regularly on a fixed day,
and at a fixed hour, to be determined by the governors, once in
every month, (or oftener, should it be deemed necessary or advisable,)
for the discharge of the ordinary business of the institution; and
every such board shall examine into all fiscal details and the general
management of the asylum; and after an inspection of it by two
or more governors, shall enter on the minutes of the day's proceed¬
ings a report of its state as to cleanliness, regularity, and order,
and the condition of its inmates, stating how far their well-being
and comforts are attended to.
II. —Should a board not assemble on the ordinary day the resi¬
dent medical superintendent shall issue summonses for a meeting on
that day week.
III. —Special meetings may be summoned at not less than four
days' notice for any particular object upon a requisition to the
resident medical superintendent to that effect, signed by two or
more governors, or by one of the inspectors.
IV. —A full and accurate copy of the minutes of proceedings of
every meeting of the board shall be transmitted to the inspectors
within four days from the day of meeting; the board shall also
transmit to the inspectors the quarterly accounts and estimates of
expenditure, and all applications for the advance of moneys for the
current asylum maintenance.
V. —All tenders for contracts, whether accepted or rejected,
signed as such by the chairman of the board at which they have
been opened, shall be duly forwarded to the office of the inspectors
for examination and approval. All receipts for disbursements in
regard to current expenditure, duly authenticated by the the board,
shall be sent to the commissioners of audit in London.
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Control of District Lunatic Agslums in Ireland . 121
VI. —The general dietary shall be regulated by the board, sub¬
ject to such alterations as the inspectors may think fit from time to
time to recommend. The medical officer shall be at liberty to pre¬
scribe such extras as they may deem necessary.
Admission , Treatment, and Discharge of Patients.
VII. —Persons labouring under mental disease, duly certified as
such by a registered physician or surgeon, and for whom papers of
application are filled up in the prescribed form, to the satisfaction
of the board, shall be admissible into district asylums, after having
been examined by the resident medical superintendent.
VIII. —No patient is to be admitted without the sanction of the
board, except by order of the Lord Lieutenant, or in case of urgency,
when the resident medical superintendent, or in his absence, the
consulting and visiting physician of the asylum, may admit upon
his own authority, stating on the face of his order the grounds upon
which he acts.
IX. —The board may require an engagement to be given in
writing for the removal of any patient, to be signed by the friends
of the patient, or the magistrate, clergyman, or other responsible
person who signs the application for admission.
X. —Patients, except where special reasons to the contrary may
exist, are to be clad in the dress of the institution, and their own
clothes are carefully to be laid by, to be returned to them on their
discharge.
XI. —The patients shall, on admission, be carefully bathed and
* cleansed, unless otherwise directed by the resident medical super¬
intendent. They shall be treated with all the gentleness compatible
with their condition; and restraint, when necessary, shall be as
moderate, both in extent and duration, as is consistent with the
safety and advantage of the patient.
XII. —Strict regularity shall be observed with respect to the
hours for rising in the morning and retiring for the night; that for
rising being fixed at six o'clock from the 1st of April to the 30th of
September, and for retiring at an hour not earlier than half-past
eight o'clock, nor later than nine for the same period. During the
winter six months the patients shall rise at seven, and retire not
earlier than seven nor later than eight o'clock.
XIII. —The like regularity must be observed with respect to
meals; in no case shall the number of meals be less or more than
three, and they shall be supplied during the summer six months at
the following hours, viz.: breakfast at eight o'clock; dinner at one
o'clock; and supper at six o’clock;—and during the winter six
months at the following hours, viz.: breakfast at nine o'clock;
dinner at two o'clock; and supper at half-past five o'clock.
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122 Revised Rules of the Irish Government for the better
XIV. — On the admission of a patient the resident medical
superintendent, or, if he shall be absent on leave, the consulting and
visiting physician, shall make himself acquainted as far as possible
with the nistory of the case, and note the same down in the general
registry; he shall also examine into the bodily condition of the
patient, who is to be placed in an appropriate division, and carefully
attended to, both medically and personally.
XV. —Patients may be visited from time to time by their friends,
with the permission of the resident medical superintendent, and as a
general rule between the hours of 12 and 4 o’clock, p.m.
XVI. —No patient shall be discharged without an order from the
board, on a certificate signed by both medical officers, stating the
then mental condition of the patient; and no lunatic transferred to
an Asylum from gaol, by warrant of the Lord Lieutenant, as dangerous,
shall be set free or handed over to his friends as ceasing to be
dangerous, except on a joint certificate to that effect, from both
medical officers; but in the interval between the meetings of the
board it shall be in the power of the inspectors, or one of them, to
order the discharge of any patient (not being a criminal lunatic
placed in the asylum under an order of the Lord Lieutenant); but no
such order shall be made, except at the request of the resident
medical superintendent, until after a personal inspection of the patient
by the inspector making it; and in every case the order shall be in
writing, stating the grounds on which it is made, and shall be
deposited with the resident medical superintendent, to be kept by him
among the records of the asylum.
XVII. —On the discharge of patients who have no available
means, the board is authorised to allow the expense of their journey
home.
XVIII.—Patients confined in the central asylum at Dundrum and
removable therefrom, under the 12th section of 8 & 9 Vic., cap. 107,
shall, if insane, at the expiration of their period of imprisonment,
and if liable to be treated as pauper lunatics, be transmitted after
due inquiry by the inspectors, to the district asylum, to which, as
pauper lunatics, they shall appear to have been admissible previous
to their being taken into custody. In the absence of any such
definite information, they shall be transferred to the district asylum
of the locality, in which the offence with which they were charged
was committed. Lunatics so tranferred to district asylums may be
discharged therefrom by order of the board of each asylum, as if
they had been originally admitted by it.
Resident Medical Superintendent.
XIX.—-The resident medical superintendent shall be duly qualified
as a physician and surgeon,
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Control of District Lunatic Asylum in Ireland,
XX. —He shall superintend and regulate the whole establishment,
and is to be intrusted with the moral and general medical treatment
of its inmates, for whose well-being and safe custody he shall be re¬
sponsible ; and he shall at all times devote his best exertions to the
efficient management of the institution.
XXI. —He shall engage all servants and attendants, subject to the
approbation of the board ; and fine, suspend, or with the sanction of
the board or inspectors, dismiss them for infraction of rules or
neglect of duty. In cases, however, of drunkenness, insubordination,
or cruelty, he may peremptorily dismiss any attendant, reporting the
name of the party and the cause of dismissal to the inspectors
within four days, and to the governors at their next meeting. He
shall take care that no servant or attendant be engaged by him who
is under twenty-two or over thirty-six years of age, and who has not
the most satisfactory testimonials as to sobriety, good temper, and
morality.
XXII. —He shall, before one o’clock, p.m., inspect the whole es¬
tablishment daily,— dormitories,— dining-rooms,— kitchen,—laun¬
dry,—stores, &c. He shall go through all the divisions, and see
that they are orderly, well ventilated, and of a proper temperature.
He shall carefully examine each patient who may seem to require his
advice, or to whom his attention may be directed. When going
round the female divisions he shall be accompanied by the matron or
head nurse, who shall direct his attention to any matter worthy of
notice.
XXIII.—He shall take care that all the officers of the institution
acquit themselves of their respective duties, and in any case of
their neglect, he shall report accordingly to the board at its next
meeting.
XXIV. —He’shall also visit the male divisions after the patients
have retired to rest, and satisfy himself that they are safely and com¬
fortably located for the night.
XXV. —In complicated or_difficult cases of mental disease, or any
case requiring particular treatment, he shall freely comnpinicate
with the consulting and visiting physician, and concert with him the
most judicious mode of treatment which should be adopted.
XXVI. —He shall never be absent from the asylum at the same
time with the matron, nor ever for the night without special leave
from a board of governors or the inspectors, and upon every such
absence he shall enter in the book the date and period; and inform
the consulting and visiting physician, who for the time shall exercise
a general supervision over the establishment.
XXVII.—He shall be careful that the following books are kept
with regularity, and that they are at all times ready for inspection,
viz.—
1. The General Registry.
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2. The Registry of Discharges and Deaths.
3. The Medical Journal.
4. The Morning Statement Book, which shall contain a return
of the number of patients divided according to their sex and
chargeability,—the names of those admitted and discharged,
specifying their mental condition,—the names of those who
have died,—the number employed,—the names of those who
may be under mechanical restraint or seclusion, and the
causes thereof,—the number under medical treatment,—the
hour and duration of visits of the respective officers, to be
recorded by themselves. The daily return to be counter¬
signed by the resident medical superintendent.
5. The Want Book, in which, previous to each monthly meeting,
all articles required for the use of the asylum shall be
entered for the approval and signature of the chairman.
6. The Minute Book, containing a full and faithful record of the
proceedings of the board.
7. The Letter or Correspondence Book, in which shall be en¬
tered the dates of all letters received, and copies of all letters
written on business of the institution.
8. The Application Book, in which shall be entered the parti¬
culars of the several applications for admission.
9. The Memorandum Book for such observations and reports as
any of the governors or officers may think necessary to
insert in it.
XXVIII.—He is to take care that the minutes of each meeting
are fully and accurately transcribed; that all communications di¬
rected by the board are written, and despatched in due course;
that any returns or information required by the inspectors be fur¬
nished to them without delay; that all accounts of the institution
are kept in accordance with the regulations of the inspectors; and
that the bills and vouchers are regularly prepared and submitted to
the governors at their meetings. He shall be responsible for the
disbursement of such money as may be placed in his hands by the
board. *
XXIX. —All contracts and bonds of agreement shall be made in
his name, and he shall exercise a general supervision over the various
articles contracted for as to quantity and quality ; and if of inferior
quality or deficient in quantity, he is authorised, should he feel fully
justified in so doing, to procure an equivalent supply elsewhere at
the contractor's expense.
XXX. —He shall report at each meeting on the general condition
of the establishment, and direct the attention of the board to any
matter that may tend to the well-being of the patients, and the effi¬
cient management* of the institution.
XXXI. —He shall prepare annually, not later than the 31st of
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Control of District Lunatic Asylums in Ireland.
January, a general report to the board on the condition and expen¬
diture of the asylum during the preceding year, which shall be pub¬
lished as the board may direct.
Consulting and Visiting Physician.
XXXII.—The consulting and visiting physician shall attend at
the asylum three days in the week, and on every day in those asy¬
lums where the number of patients shall exceed 200; the regular
hour of attendance beiug in the interval of from ten to one o’clock,
unless otherwise arranged, by mutual consent, between the medical
officers. On his arrival he is to communicate with the resident
medical superintendent, in company with whom he shall visit all
patients labouring under bodily disease, whose course of treatment
he shall direct, and any who are in seclusion, or under restraint.
He shall also see such patients as may have been admitted since his
preceding day of attendance, and any others whom he may desire to
visit.
XXXIII.—He shall attend at all times when called on by the
resident medical superintendent, and afford such advice and assist¬
ance as may be required of him, whether to patients, officers, or
servants, and daily in cases of acute illness, and accidents of a
dangerous nature. He shall, once, at least, in each fortnight,
examine with the resident medical superintendent, into the mental
condition of every patient in the asylum.
XXXIV.—He is on every day of attendance to enter in the
morning statement book the hour and duration of his visit.
XXXV.—When requiring leave of absence, he shall make appli¬
cation to the board, in order that, if it be deemed necessary, a duly
qualified substitute may be provided in his place.
XXXVI.—In conjunction with the resident medical superinten¬
dent he is to examine into the mental condition of every patient
before being discharged, and consult with him thereon, before signing
the necessary medical certificate. Should the inspectors d^em it
advisable, the consulting and visiting physician shall attend daily at any
asylum, irrespective of the number of patients in it, and affom them
any information they may require.
XXXVII.—In every asylum a case book shall be kept in the
office, in which the history of important cases shall be entered, with
such observations as the medical officer in immediate charge of them
may consider useful and interesting.
XXXVIII.—When a surgeon is specially attached as such to a
district asylum, he is to attend on accidents of a serious character,
perform operations when necessary, and take charge of cases purely
surgical. The patients under his immediate care should, if possible,
be treated in the infirmary, and his visits are to be regulated as
those of the consulting and visiting physician.
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Chaplains.
XXXIX.—When no regular chapels are attached to an asylum
the board shall direct a suitable place to be temporarily allocated to
religious worship.
The chaplains are to attend on Sundays and holidays to officiate
according to their respective creeds. They are to visit the institu¬
tion once in the week, at least, to administer religious instruction
to those who, in the opinion of the resident medical superintendent,
may be susceptible of its influence. They are sedulously to avoid
all subjects of controversy. In case of illness they shall attend when
called on. Each chaplain is to keep a book at the asylum, giving
the result of his religious ministrations, to be submitted to the board
at its meetings, and to be retained in the office.
The Matron.
XL.—She shall reside constantly in the asylum, and shall exer¬
cise immediate superintendence over the female department, but in
position and authority subordinate to the resident medical superin¬
tendent, to whom she is to report daily its condition, and any irre¬
gularity or misconduct that may occur within it.
XLI.—She shall take care that cleanliness, both in person and
dress, is strictly attended to, and shall have particular regard to the
rooms in which sick, refractory, or idiotic patients are confined.
XLII.—She shall employ the female patients as advantageously
as possible to themselves and to the establishment, and in every
way endeavour to promote their comfort and well-being.
XLIII.—She shall examine the different apartments in the female
divisions every day before eleven o’clock; and shall walk through
the corridors after the patients have retired to bed, and see that
every patient is safely and comfortably located for the night, and
that the nurses are in their proper divisions.
XLIY.—She shall accompany the resident medical superin¬
tended and the consulting and visiting physician when visiting
the female division of the asylum, and receive from either of them
any instructions he may deem advisable as to the treatment of the
patients.
XLV.—She shall look after the inner clothing, bedding, linen,
&c., &c., of the patients, see that they are kept in good repair, and
shall take care that, without waste, there is a regular supply of
sheeting, stockings, shirts, &c., &c. When she notices a deficiency
she shall apply, by a written requisition, to the resident medical
superintendent for such articles as may be required, and for which
she shall be accountable on their receipt from the storekeeper, to
whom she shall return all condemned or worn-out articles, to be
disposed of by order of the board.
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Control of District Lunatic Asylum in Ireland. 127
XLVI.—She shall pay strict attention to the state of the laundry,
and to the order and regularity in which it is conducted, and exer¬
cise a general superintendence over the culinary department, the
cleanliness of the dairies, pantries, &c., &c.
XLVII.—At meal hours she shall inspect the female refectories,
and promote habits of regularity, decorum, and cleanliness among
the patients, and due attention on the part of the nurses.
XLVIII.—The matron is to consider herself an officer of great
trust, and must sedulously watch over the good conduct and becom¬
ing demeanour of the female servants and attendants. She shall not
absent herself from the asylum at the same time as the resident
medical superintendent; nor at any time without the special per¬
mission of the board or the inspectors.
The Apothecary.
XLIX.—He shall attend daily at the asylum before two o'clock,
or whenever required by the resident medical superintendent. He
is to compound all prescriptions, entering them in the general pre¬
scription books in full, and inscribe the necessary directions on each
parcel legibly. He shall take care that all medicines not used or
which shall be counter-ordered shall be returned to him. He is to
assist in the infirmary, or in any other part of the institution where
his services are needed, but shall not prescribe for patients.
L.—He is to take stock twice in the year, and make requisitions
to the board through the resident medical superintendent. Sur¬
gical instruments and those employed for restraint are to be kept in
the apothecary's shop, to which no person unauthorised by either
of the medical officers shall on any pretence whatever have access
in his absence.
Clerk and Storekeeper.
LI.—He shall attend daily in the office, under the directions of
the resident medical superintendent, and take charge of the various
books in it. After each meeting he shall make an accurate tran¬
script of its proceedings, to be signed by the chairman of the next
board. He shall copy letters written on official business, and file
those received. He shall keep all accounts, examine receipts and
vouchers, see that the bills are in accordance with the contract prices,
and have them in order and readiness, to be submitted at the usual
meetings.
LII.—He shall have charge of the stores of the institution, and
receive the same, and be accountable for the quantity and quality, so
as to show the issues of every sort, ordinary as well as extras, and
check the issues and consumption with each other.
LIII.—He shall keep an account of the clothing, both male and
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female, exhibiting in a clear maimer the quantities from time to time
received, the articles delivered out, together with the divisions in
which such articles have been supplied, and is on no account to
issue any articles from store in lieu of any other article of the same
kind, without a written order (to be filed) from the resident medical
superintendent or matron.
LIY.—He shall keep an account of the receipts and issues of coals,
candles, soap, &c.,&c., also an inventory of the furniture, beds, bedding,
house linen, &c., &c.
LV.—He shall sign the pass-books kept by the various con¬
tractors for milk, bread, meat, &c., &c., on the delivery of each
article, and is also to keep a pass-book to be signed by the contrac¬
tors, in w hich the quantity delivered shall be entered.
LVI.—He shall attend for the issue of stores; and in the daily
delivery of food to the cook he shall take particular care that the
quantity is proportionate to the demand in the different divisions as
specified in the dietary book, and that ample time is allowed for the
cooking and preparation of the various meals.
LVII.—He shall, as far as possible, see that no misapplication of
food or other articles occurs after having been issued from the
stores, and is from time to time to observe the male patients at their
meals, and judge whether they have received their regular allow¬
ances. Twice in every year, viz., in March and October, and oftener
if required, he shall take stock under the direction of the board,
and make out an accurate return in detail, of the aggregate receipts
and issues during the preceding six months, or any other required
period.
Servants and Attendants.
LVIII.—The servauts and attendants, both male and female,
shall be directly responsible to the resident medical superintendent,
and shall observe habits of cleanliness, order, and subordination, as
w r ell as the most unvarying kindness towards the lunatics placed
under their charge.
LIX.—They shall never absent themselves from their divisions so
as to leave the patients unguarded, nor shall they attempt mechanical
restraint, seclusion, or the use of the shower or pluuge bath, with¬
out express direction from either of the medical officers. The pre¬
sence of a servant or attendant, in the case of baths being given,
shall be imperative.
LX.—In the morning they are to see that the patients are properly
washed and dressed, and at night that due regard be paid to their
comfort.
LXI.—They are to be present when the patients are at meals.
They shall pay particular attention to the clothing and becoming
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Control of District Lunatic Asylum in Ireland. 1&9
appearance of the patients; and shall contribute all in their power,
both in and out of doors, to their amusement and occupation.
LXII.—They shall be answerable for the safe keeping of the
lunatics under their care, and in the event of escape, attributable
to any negligence on their part, shall be liable to a fine, or to
dismissal.
LXIII.—At the male side they shall report daily to the resident
medical superintendent, the conditions of their respective wards and
corridors; at the female, to the matron; and shall keep a diary in
reference to the patients.
LXIY.—They shall, in their communications with the medical
officers and matron, state all the circumstances relating to each
patient within their knowledge, and study, as much as possible,
the character and peculiarities of the diiferent lunatics under their
charge.
LXV.—They are to be responsible for the cleanliness and
care of bedding, linen, &c., &c., in their respective divisions, and
when repairs are wanted, shall report the same; at the male side, to
the resident medical superintendent, at the female, to the matron.
LXVI.—They are to deliver out the foul linen of their divisions
to the laundress on the appointed days with a docket, specifying the
description and number of articles, and are to compare the docket
with the clean linen when returned, and are to report any neglect on
the part of the laundress.
LXV II.—They are to keep their own presses and private, rooms
in a state of regularity and cleanliness.
LXVIII.—No servant or attendant is to be permitted egress from
the institution, without the sanction of the resident medical super¬
intendent, or in his absence, if a female, of the matron, if a male, of
the clerk and storekeeper, with the sanction of the consulting and
visiting physician, by a written pass; and on no account are the
children of any domestic to reside in the asylum.
LXIX.—They are on no account to receive any perquisites, either
in money or value, from patients, or from the friends of patients
admitted to the asylum ; any infraction of this rule is to be followed
by immediate dismissal.
LXX.—They are to avoid any harsh or intemperate language to
patients, and must, by steadiness, kindness, and gentleness, endea¬
vour to contribute to that system of moral government upon which
the value of the asylum depends.
The Cook.
LXXI.—The cook shall take care that in the morning before
half after seven o’clock} the kitchen be in regular order, the fires lighted,
vol. vm 9
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180 Revised Rules of the Irish Government for the better
and everything prepared for her business: she shall receive from the
storekeeper the different articles to be prepared as food for the
patients and attendants, and be particular as to the quantity required;
it shall be her duty to see that the meals are properly dressed, and
ready at the particular periods specified for delivery.
LXXII.—She shall keep all the utensils employed by her with
the greatest cleanliness, and never omit, before retiring to rest, to
have the boilers well scoured, and the kitchen and scullery thoroughly
ventilated and purified.
LXXIII.—She shall not allow loiterers, whether patients or
attendants, to remain in the kitchen.
The Laundress.
LXXIY.—The laundress shall take charge of the patients em¬
ployed to assist her, and, when their business is over, snail see that
they return to the safe keeping of the attendants in their respective
divisions.
LXXY.—She shall keep a book, to be called the u Laundry
Book,” in which are to be entered, under separate heads, the various
articles, soap, blue, starch, &c., &c., received by her from the store¬
keeper ; and also a book containing an exact list of the foul clothes
to be washed and returned by her weekly to the different divisions ;
any requisition or cause of complaint, in her department, is to be
conveyed by her to the matron.
The Porter.
LXXYI.—The porter shall have charge of the hall and adjoining
public apartments, and have them kept with neatness and order ;
also the entrance and grounds immediately in its front.
LXXYII.—In the morning, during the summer months, he shall,
at half-past five o’clock, ring the bell to call up the servants and
attendants; during the winter, at a quarter before seven.
LXXYIII.—At night he shall see that all the doors are locked,
and the different yards duly protected, in summer, at nine o’clock,
p.m. ; and in winter, at eight, p.m. He shall then deposit all the
keys intrusted to him with the resident medical superintendent.
LXXIX.—When called on he shall assist in taking charge of the
male lunatics, under the directions of the resident medical supeinten-
dent, and render himself generally useful.
Land Steward and Gardener.
LXXX.—He shall attend at the hours named by the medical
superintendent to receive the different classes for their respective
labours.
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Control of District Lunatic Asylum in Ireland.
LXXXI.—He shall take charge of all the implements used on
the farm, and be accountable for them. He shall superintend the
lunatics when employed on the grounds, and assist the attendants
generally in the care of them.
LXXXII.—He shall make no purchase whatever of seeds, shrubs,
&c., &c., neither shall he employ hired labourers without directions
to do so from the board.
LXXXIII.—He shall keep a book containing an account, from
month to month, of the expenditure on the faam and garden, and of
the produce thereof; he shall enter in it the number of patients em¬
ployed, as well as the amount of vegetables delivered by him daily
for the use of the asylum.
LXXXIV.—He shall be responsible for the-neatness, order, and
cultivation of the grounds, and the good condition of the farm.
LXXXV.—He is to obey all orders he may receive from the
resident medical superintendent, in regard to the patients under
his charge, and in no case absent himself from his duties without
leave.
Gate Keeper.
LXXXVI.—He shall take care that the gate-house and ground
adjoining it, are at all times kept in a state of neatness and order.
LXXXYII,—He shall not admit any stranger without entering
the name and the object of the visit, neither is he to permit any ser¬
vant belonging to the asylum to go out, except on a pass, with the
name of the party inscribed thereon, signed by the resident medical
superintendent, or in his absence, by the matron or clerk, with the
sanction of the consulting and visiting physician.
LXXXVIII.—He shall enter the date of all passes, together with
the hours of return in the gate porter's book, which is to be brought
up every morning to the office for the examination and signature of
the resident medical superintendent, without whose sanction no ad¬
mittance or exit shall be allowed to any non-resident officer or servant
except through the public entrances.
LXXXIX.—He shall be at all times most cautious in guarding
against the unauthorised introduction of spirituous liquors or cordials
of any kind, or any other article which may be prohibited by the
board, and shall promptly report to the resident medical superin¬
tendent any case of impropriety of conduct which may come under
his observation.
XC.—In case any misunderstanding shall occur between the
officers attached to an asylum with reference to their respective
duties, and the mode of carrying them out, or to the meaning of the
foregoing rules, the subject of misunderstanding shall be referred to
the inspectors, who are to communicate their decision to the board
of governor,
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Dr. Stevenson Bushnan, on the
XCI.—No question relating to increased expenditure, to altera¬
tions in the staff or management of an asylum, to the sub-division
of old or creation of new offices, or to any other subject of impor¬
tance, shall be taken into consideration, without a month’s previous
notice; and no resolution of the board affecting the discipline or
management of an asylum as established by the present rules, shall
take effect, if contrary to any of them; nor, though conformable
thereto, until after it shall have been submitted, through the in¬
spectors, to the chief or under secretary, and shall have received
the approval of the Lord Lieutenant.
XCII.—In any district lunatic asylum in which the person at
present holding the office of manager is not a medical man, the fore¬
going rules shall not come into operation until he shall cease to hold
that office; and, in the mean time, the rules hereinbefore recited shall
remain in force in such asylum.
Given at the Council Chamber, in Dublin, the 16th day of
January, 1862.
Maziere Brady, C .
Robert Peel.
N. Ball.
R. Keatinge.
James Henry Monahan.
Joseph Napier.
William Keogh.
J. D. FitzGerald.
R. Deasy.
G. Brown, General.
Thos. O’Hagan.
On the Practical Use of Mental Science .—By J. Stevenson
Bushnan, M.D., Fellow of the Royal College of Physicians
of Edinburgh; late Senior Physician to the Metropolitan Free
Hospital; Resident Proprietor of*Laverstock House Asylum,
near Salisbury.
{Read before the Southampton Medical Society, ith February , 1862.)
Mental Science, in the forms under which it usually exhibits
itself, is a subject of extreme generality. It deals with the phe¬
nomena of consciousness, as these are common to the whole human
race. It hardly takes into account those peculiarities of the mind,
from which individual character is formed ; nevertheless, in the
practical application of mental science, it is with individual character
that we are for the most part engaged. Shall we, then, conclude
that the prevailing systems of mental science afford no insight into
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183
Practical Use of Mental Science.
^he practical uses of that science ? Certainly not—and for this very
sufficient reason, that the peculiarities of individual minds bear bat a
very small proportion to the operations which arise in obedience to
laws affecting all the sound-minded members of our race. Hence,
in the study of the practical uses of mental science, while it is in¬
cumbent upon us to fix a strict attention on the general laws of
thought, means must at the same time be sought to bring to light
the limits of the range, within which these laws, in particular minds,
suffer modification.
In short, the chief practical use of mental science is to enable us
to deal with and to influence individual minds. Let a man be ever
so well acquainted with his own mental constitution, he will have
made but very small progress in the means available for a practical
psychology. He may, indeed, have become thoroughly conversant
with all the mental phenomena, which are common to him with the
whole human race ; but if he has studied himself only, he will run
a great risk of falling into the error of including his own mental
peculiarities among the universal laws of human thought. It is true
that the study of mental phenomena by reflexion on the subjects of
one's own consciousness may serve greatly to extend the reach of
thought, and to give acuteness to the intellectual faculties; but no
pains taken in this direction will suffice for the attainment of a
knowledge of human nature in the sense of an acquaintance with
individual character. To reach such a knowledge, the student must
apply himself to the observation of individual men, and his progress
•will be proportionate to the opportunities which he may enjoy of a
large intercourse with society under ever-varying circumstances. Nor
can there be any doubt that an intimate familiarity with the general
principles of scientific psychology will initiate him in the readiest
inodes of turning such opportunities to advantage, and serve to
abridge the labour of perusing the hidden lines of thought, and the
startling peculiarities of motive unceasingly offered to his attention.
He already knows that, in obedience to the general laws of human
thought, every act of mind must be introduced by a previous act of
mind, and what he wishes to learn is what are the ordinary links in
every man's prevailing currents of thought. He must now be con¬
tent to acknowledge that, when he was taught that all the relations
of thought could be reduced to such heads as contiguity in time and
place, cause and effect, and the like, he was made acquainted merely
with the alphabet of that language which he is now striving to read
—and that, before he can attempt to determine what course of
thought will arise under given circumstances in the mind of any
individual, he must have had the means of ascertaining something
of the modes in which that man's thoughts are accustomed to array
themselves.
Thus practical psychology, as superadded to scientific psychology,
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Dr. Stevenson Btjshnan on the
might be described as the exercise of converting the general laws of
suggestion, laid down by metaphysicians, into particular instances,
falling under those laws, discoverable by the study of the individual
minds of men throughout human society. This is a kind of pursuit
which will encounter the reproach of being wholly opposite to induc¬
tive science. Nevertheless, it is a mode of investigation which in
many departments of knowledge is essential to reaching the truth.
It is far from being unknown even in natural history. How many
well-distinguished groups, both in the vegetable and in the animal
kingdom, have been made out of what seemed at first to be but one
•perfect family—how many species out of what seemed at first one
well-marked species ? In the mineral kingdom, look at such words
as spar and gem which were originally employed each to signify a
small group of resembling stones; yet how has each multiplied into
a vast ftynily but by a more and more particular scrutiny of each of
the older members of the two groups ? Turn to political economy—
how many general laws, which at one time appeared complete and
incontrovertible, have by the larger and larger investigation of
special cases been broken down into almost endless details. And to
a more limited extent, the same is true of the principles of morals.
Parse, so to speak, any particular example of a train of thought
by the rules of suggestion, such as contiguity of time and place,
cause and effect, and the like—nothing is easier than to dissect the
train into its several members and to state the category under which
each member falls. But reverse the case and reflect how far the
train could be continued, were the first member only given, by any
amount of consideration of these rules of suggestion. Witness such
a string of thoughts as the following, taken almost at random from
Shakspeare:
“ Pistol. —Then you, Mrs. Dorothy; I will charge you.
"Dorothy. —Charge me? I scorn you, scurvy companion.
What! you poor, base, rascally, cheating, lack-linen mate! Away,
you mouldy rogue. Away, you cut-purse rascal! you filthy bung,
away! By this wine, PU thrust my knife in your mouldy chops,
an you play the saucy cutter with me. Away, you bottle-ale-rascal!
you basket-hilt state-juggler, you ! Since when, I pray you, sir ?
What, with two points on your shoulder ? much ! Captain! thou
abominable damned cheater, art thou not ashamed to be called
Captain ? If captains were of my mind, they would truncheon you
out, for taking their names upon you before you have earned them.
You a captain, you slave; for what ? He a captain ! Hang him,
rogue! He lives upon mouldy stewed prunes and dried cakes. A
captain! These villains will make the word captain as odious as
the word occupy, which was an excellent good word before it was
ill-sorted; therefore captains had need look to it.” ' -
It were very needless to point out how special the links of sug-
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Practical "Use of "Mental Science.
gestion are in a discourse like this. They fall indeed under the
general laws—but they are so peculiar as to be thoroughly the pro¬
perty of the individual mind. Nevertheless, it belongs to practical
psychology to make an approach at least to anticipating such a train
of thought as that just cited, when the prevailing turn of the indi¬
vidual mind has been indicated.
How, then, are we to proceed to gain insight into the links of
suggestion which are customary in individual minds ? It is to be
understood that a preliminary step is an acquaintance with all that
scientific psychology teaches concerning the nature of human feel¬
ings, thoughts, emotions, and passions. After this preparation, in
the following enumeration will be found some of the most obvious
means, by which a greater and greater facility of penetrating into
the recesses of other men's thoughts may be acquired. Among these
means stands pre-eminently the careful scrutiny of the characters of
those, whose minds are specially laid open to us in the intercourse
of life. I would next mention the selection for frequent study of
those systems of scientific psychology, in which the principle of sug¬
gestion plays an unusually prominent part. Of this description in
particular is the system of Dr. Thomas Brown. I would in the
third place direct attention to the consideration of the question, how
far certain physiological conditions of the living body are capable of
modifying trains of thought. I would lastly point out what a bound¬
less field for exercise in the elements of individual character is pre¬
sented in literature, whether imaginative, or historical and bio¬
graphical, as well as in the annals of crime as found in the judicial
proceedings of every country. To the illustration of these several
topics I now proceed.
If a minute could be made of all the operations of a man's mental
nature from the earliest period of consciousness—a considerable
time probably before birth—down to the last consciousness which *
preceded death; and if this could be done with respect to any large
number of individuals, what a curious set of psychological pictures
would be obtained! We should be able to trace minutely the
several steps in the development of the infant mind; the rise of
fundamental thoughts—some inspired by instinct, some wrought
out by rudimentary reasoning; the daily growing knowledge in the
child of the component parts of his own frame; his gradual ap¬
proach to the discovery of the broad line of demarcation between
self and an external world; the wonder of the boy as the nature of
the things around thickly flashes upon his view ! Then would ap¬
pear the beginnings of the nice variations of individual character
which show themselves so early in the period of youth—the bents,
the dispositions, the secret thoughts, with the modes in which these
are nourished by external circumstances—the seeds of the good and
the evil of the after-character in manhood. Then what a singularly
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Dr. Stevenson Bushnan, on the
vivid anatomy of the man's spirit would be presented! what secrets
revealed in reference to the prime and latter stage of life! What a
commentary would such minutes be on the lucubrations of our poets,
our moralists, our philosophers! how would it illustrate these! how
would it transcend them all I
If then it be self-evident that the possession of such pictures of
the human mind and character would be of invaluable service to all
whose business it is to deal with human nature—and in particular
to the legislator, the divine, the lawyer, and the physician—it de¬
serves consideration to what extent that science should be held in
estimation which, in default of such a gift in all its perfection, has
for its object to present pictures of the same kind, if not complete,
yet in large and unmistakeable fragments. That science is Psy¬
chology. It rests upon such minutes of the human mind and
character as individuals, in all time past, have been able to supply
from their personal experience; that is to say, from the observation
of self. Inferior as psychology necessarily is to the pictures I have
supposed, it makes the nearest approach to them in point of utility
which men can possibly reach, and the more it is cultivated the
nearer it absolutely identifies itself with them. Psychology exhibits,
in a very complete manner, the general plan on which the operations
of the human mind proceed; while the acknowledgment of inferi¬
ority which must be made on its behalf, in comparison with such a
gift as the pictures I have supposed, refers chiefly to what is of
the last importance—the numerous peculiarities of individual minds.
There can be no doubt that the value of the pictures would lie essen¬
tially in their vivid representations of peculiarities, such as the de¬
scriptions of psychology have hitherto embraced to a far too limited
extent. But this particular department—that is, the peculiarities
of mind in individuals, botli belongs to psychology and, with due
discrimination, is, beyond doubt, capable of extensive cultivation. It
is, in short, the practical part of psychology, and, as such, is directly
available for the purposes of all who, in the business of life, are
required, to any large extent, to study human nature. If it be plain,
then, that the attainment of these pictures is beyond our reach, it is
incumbent on all who feel the want of them to apply themselves to
psychology, and to make it their endeavour to enlarge that part of
the science which relates to the peculiarities of individual minds.
But, before proceeding farther in this line of discourse, let us
recur, for a few moments, to the supposed minutes and pictures of
the operations of mind throughout the lives of a number of indi¬
viduals, with a somewhat different purpose. Though such a picture
cannot be produced in the full perfection of its details, yet a fair
outline of it can be imagined, and it is such an imaginary outline
which psychologists make use of in their attempts to methodise the
phenomena of the human mind by reducing them to groups. This
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methodising or grouping of mental operations, and the settling of
the rules which, more or less, certainly determine the order of the
succession of such operations, constitute psychology proper. The
method of arrangement, and the laws or rules referred to, have been
viewed in different lights by different authorities; and, indeed, the
cultivation of psychology should not be regarded so much as being
the mere study of the mode of grouping mental phenomena and the
laws of their succession adopted by particular authors, but rather as
being the consideration of the imaginary pictures above referred to
and the practising of one's self in throwing the phenomena, now
into one set of groups, now into another set, according to every dis¬
coverable kind of tie or relation between them.
It is often made a complaint against psychology that so many
different methods of arranging the phenomena of mind prevail in
the works of the most esteemed authors. It is, doubtless, an incon¬
venience that the nomenclature is not more fixed, and, in so far as
words are used in different senses by different authors, there is good
ground for complaint. But it is quite possible that writers on psy¬
chology may vary their methods of arrangement, without confusing
their readers by employing words otherwise than in their ordinary
and received sense. With this restriction, there can be little doubt
of the advantage which has resulted to psychology from the attempts
of authors to throw mental phenomena, now into one set, now into
another set of groups. It is not even necessary for the advantages
attainable by the frequent variation of these groups of phenomena,
that the principle on which the methods proceed should be abso¬
lutely correct; for more distinct views are often obtained by looking
at such phenomena in every aspect in which they can present them¬
selves, than by confining our attention to that aspect which is nearest
the truth. For example, there are serious objections sometimes urged
to representing all the operations of which mind in its largest sense is
susceptible as so many states of mind, or so many states of consciousness.
Nevertheless, it cannot be doubted that that mode of speaking has had,
in a particular degree, the effect of clearing away the confusion caused
to the student by the terms faculties, powers, feelings so currently used
in the older modes of arrangement. In short, so long as conscious¬
ness was described as a mental faculty, co-ordinate with memory,
imagination, judgment, and the like, there was a fertile source of
perplexity introduced into every arrangement of the mental opera¬
tions in which consciousness held such a place. But since it has
been generally taught that consciousness is not a separate faculty of
the mind, but a condition attendant upon every sensation, feeling,
thought, emotion, passion, volition—in short, upon every state in
which the mind can exist, the unity of the substance mind is at
once made apparent to the student, and the true nature of conscious¬
ness brought out, even if the phrase “ states of mind ” should be
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Dr. Stevenson Bushnan, on the
subsequently abandoned and entirely left out of the arrangement
finally adopted. I should remark, that in what has just been said
the consideration of the new ideas which have sprung up as to un¬
conscious cerebration is, for the present, postponed.
Again, though there are many valid objections to adopting the
arrangement of mental phenomena proposed by Dr. Thomas Brown,
yet there cannot be a doubt as to the study and debate of that
arrangement being in the highest degree conducive to the clearer
apprehension of the real character of phenomenal psychology. The
jftrt of Dr. Brown’s arrangement to which I particularly allude, is
that in reference to what*he terms Intellectual states of mind. Dr.
Brown regards all the intellectual states of which the human mind
is susceptible as reducible to two conditions, namely. Simple Sug¬
gestion and Relative Suggestion. “ Our perception or conception of
one object,” Dr. Brown says, “ excites, of itself, and without any
known cause, external to the mind, the conception of some other
object, as when the mere sound of our friend’s name suggests to
us the conception of our friend himself ; in which case the con¬
ception of our friend, which follows the perception of the sound,
involves no feeling of any common property with the sound which
excites it, but is precisely the same which might have been induced
by various other previous circumstances, by the sight of the chair
on which he sat, of the book which he read to us, of the landscape
which he painted.” This is Simple Suggestion. “ There is a sug¬
gestion of a very different sort, which, in every case, involves the
consideration not of one phenomenon of mind, but two or more
phenomena, and which constitutes the feeling of agreement, dis¬
agreement, or relation of some sort. I see a dramatic representation.
I listen to the cold conceits which the author of the tragedy, in his
omnipotent command over warriors and lovers of his own creation,
gives to his hero, in his most impassioned situation; I am instantly
struck with their unsuitableness to the character and the circum- -
stances.” ( f Brown’s Lectures on the Philosophy of Mind,’ vol. ii, p.
179.) This last is one of Dr, Brown’s examples of his Relative Sug¬
gestion. Again, he says, “ With these two capacities of suggested
feelings, simple and relative—which are all that truly belong to the
class of intellectual states of the mind—various emotions may con¬
cur, particularly that most general of all emotions, the emotion of
desire, in some one or other of its various forms. According as this
desire does or does not concur with them, the intellectual states
themselves appear to be different; and by those who do not make
the necessary analysis, are supposed, therefore, to be indicative of
different powers. By simple suggestion, the images of things,
persons, events, pass in strange and rapid succession; and a variety
of names, expressive of different powers,—conception, association,
memory,— have been given to this one simple law of our intellectual
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nature. (Ibid. 180,181.) Again, "Whether the relation be of
two, or of many external objects, or of two or many affections of the
mind, the feeling of this relation, arising in consequence of certain
preceding states of mind, is what I term relative suggestion ; that
phrase being the simplest which it is possible to employ, for ex¬
pressing without any theory, the mere fact of the rise of certain
feelings of relation, after certain other feelings which precede them,
and, therefore, as involving no particular theory, and simply ex¬
pressive of an undoubted fact, being, I conceive, the fittest phrase.”
—(Ibid., p. 430.) ♦
The arrangement adopted by Dr. Brown is well adapted both to
illustrate the true nature of what have been termed powers and
faculties of the human mind, and to point out the practical advan¬
tages of seeking to frame minutes or to delineate pictures of what
passes in the mind during trains of thought.
Dr. Brown objects to the phrase “ association of ideas,” main¬
taining that successive states of mind are suggested and not as¬
sociated. If the association of ideas be regarded as including all
the circumstances which determine the succession of mental states
in what is called a train of thought, the notion that phrase conveys
is undoubtedly too limited. When we hear the name of a friend
pronounced and the appearance of that friend immediately rises to
the mind, there is unquestionably a connexion between the two
states which is entitled to the name of an association; for the two
phenomena have often existed together, simultaneously, or in suc¬
cession, in the mind before, or have been associated. But when I
look at the portrait of a stranger for the first time, and that portrait
seems to have a resemblance to a particular friend, whose appearance
immediately rises into my mind, there is obviously no association,
but only a suggestion, since the stranger’s features and the appear¬
ance of my friend never before co-existed in my mind. Suggestion,
it is plain, applies to both cases, and therefore, unless it be desirable
to keep the two cases distinct, it is the preferable word.
The laws of suggestion taken as a whole, to which the train of
our subject here draws us, carry us into the very pith and marrow
of practical psychology. The startling proposition—and it is not
less true than startling—here is, that man has no voluntary power
over any one thought. Every present state of mind is the sug¬
gestion of some previous state of mind; nevertheless, thoughts do
not succeed thoughts like a long chain of connected events in
physical nature; they do not follow each other under definite im¬
pulses like wave upon wave. Among the many states of which the
human mind is susceptible, there are the states of volition and desire
and these states have other states of mind for their objects, so that
volition and desire, as it were, over-rule and control the ordinary rules
of suggestion, and thus a man, by the regulation of volition and desire
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De. Stevenson Bushnan, on the
may become in a great measure master of his thoughts. Besides
the influence, however, of the states of mind of which a man is
conscious, in the determination of the succession of thought, there
is reason to believe that organic states of the living frame some¬
times, to a greater or less extent, assume the mastery.
Nothing is more familiarly known than the effect of what are
called good and bad, high and low spirits on the trains of thought
in individuals. Good and bad, high and low spirits are obviously
merely organic or purely physiological states of the living body. In
certain temperaments high spirits, in certain other temperaments low
spirits are habitual. High spirits and low spirits are expressive
terms, but in the present day have no physiological signification,
being merely a bequest from the language of a physiology of former
times. They correspond, however, without doubt, to organic con¬
ditions of the system dependent on variations in the activity with
which some of its important functions are performed. Here, then,
it is manifest that the laws of suggestion, as respects the succession
of states of mind, are over-ruled and modified by purely corporeal
conditions of the living frame.
But there is an additional view on this subject which introduces
us to a wholly different mode in which the succession of thought may
be modified by purely organic causes. It cannot be doubted that
every change in the current of thought is accompanied by a strictly
corresponding change of a material kind in the nervous centre—
by an alteration of some unknown description in the condition
of the organic atoms composing the portion of the nervous centre
concerned in the state of mind which has arisen. It is true that
this change on the vesicular nervous matter, corresponding to suc¬
cessive operations of mind, has of late been regarded as merely a de¬
composition of part of the organic solid into its inert elements, or
into an inert compound designed to be thrown forth from the system
by some of its emunctories. If this were the sole change, it is not
easy to see how any vestige of it should remain in the nervous system,
such as could concur with the mental principle, in its after repro¬
duction as a state which might be recognised as one previously
present to the mind. But many considerations render it highly
probable, if not certain, that the change, whatever it is, leaves some
trace of a permanent kind behind it; and if this be admitted, a
fertile cause is obtained of many phenomena in the succession of
thought, under peculiar circumstances, not otherwise easily explicable.
For example, let us attend for a moment to the phenomena in febrile
delirium, in intoxication, in dreaming, and the like. What an
activity of mind is often discoverable in febrile delirium!—for fifteen
or twenty days an almost unceasing outpouring of disjointed thoughts
may occur, often of the most extravagant character, where perhaps
no two could be said to have become connected by a previous coin-
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141
cideuce in the mind during health. In the stillness and darkness
of the sick chamber during a severe attack of fever, there are few
impressions made of a kind to originate vivid sensations, while the
sensations arising from local bodily disturbances are of a very
uniform character, so that there is absolutely nothing in the
shape of impressions on the organs of sense correspondent with
the variety and activity of the thoughts rushing onwards in mad
career. What then is discoverable in such a case within tho
head to account for so great an activity of thought? There
is an increased momentum of the circulation of the blood througe
the cerebral vessels, an augmented development of heat, artd
doubtless a more rapid decomposition both of the fibrous and vesi¬
cular nervous substances. There are, indeed, no facts from which
we can infer that an increased impulse of the blood on the vesicular
matter can call its function into activity; but as the fibrous matter
is, like the nerves themselves, a conducting apparatus, a strict analogy
cannot but subsist between them. Hence it is not improbable that
the impulse of the blood on the conducing nervous substance within
the head, just as the impulse of the blood on the optic nerve causes
visual effects, may so affect the vesicular substance to w£ich it
extends as to revive or reproduce states of mind altogether inde¬
pendently of their original order and connexion. The proposition so
deduced may be in other terms thus stated; every act of mind
leaves behind it in the vesicular nervous substance a permanent
material trace or effect—the existence of this trace is probably
essential to the revival of that act of mind by suggestion, that is by
means of another act of mind; but while it continues, it seems pro¬
bable that if that trace or vestige be organically affected in some
certain modes, the corresponding act of mind is revived contrary to
the ordinary rule by suggestion. Could this mode of viewing the
subject be established, it would be a step in advance of no small
importance in the pathology of mental diseases. The idea is not only
in strict analogy with the series of facts of which an instance from
vision was given above, but is in general keeping with the laws of
nervous action.
Again, in intoxication and dreaming, how many considerations
are there in favour of the outrageous trains of thought, common to
both, being the effect rather of material impulses on the nervous
apparatus than of anything coming under the name of suggestion.
But to take up the bearing of the view started above on insanity.
On the supposition that thought succeeds thoughtmerely by suggestion,
how inexplicable is the torrent of unconnected ideas which in many
cases of mental derangement is uninterruptedly poured forth ! If, on
the contrary, it be found that every mental operation, sensation, per¬
ception, remembrance, or imagination leaves a material vestige in the
nervous centre, which vestige being rendered active, at a future time.
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Db. Stevenson Bushnan, on tie
by a merely physical impulse, can renew the corresponding mental
operation, how close is the representation afforded oy this view, to
the phenomena of insanity. There can be no doubt that insanity
depends, in every instance, on a deviation of the organism of the
nervous centre from its normal condition. Too little is known of
the intimate nature of organic parts to entitle us to say that insanity
is in every case a real structural change on the nervous substance.
The term “ structural” should not certainly be employed unless in
respect to changes which are within the range of the microscope.
By which it is to be understood that merely inferred alterations of an
organism are not to be described as changes of structure. In every
organic part whether in health or disease there are molecular changes
going on, and when such molecular changes are inferred to have
become morbid, it seems at first sight reasonable to include them in
the expression—morbid alterations of structure. But this is to destroy
entirely the use of the old term “ functional,” as applied to diseases—
which though perhaps never strictly correct in its original sense, is of
great convenience. There still, is and probably will be for many
years to come, room for the distinction of diseases into functional
and structural, though it must be confessed that the structural every
day makes new encroachments on the functional. As regards pa¬
thology it is surely not unreasonable to refuse to allow that a part is
structurally changed, if after death the microscope cannot detect the
alteration; and as respects practical medicine, it is not unreasonable
to affirm, that that part has been only functionally affected if it return
to its former state of a living solid, independently of suppuration or
any like process.
While then, I say, that insanity depends in every case on a de¬
viation of the organism of the nervous centre from its normal con¬
dition, I think it wrong, or at least premature, to say that every
case of insanity is the result of an organic alteration. The numerous
manifest morbid changes on the nervous parts within the head which
have been detailed in cases of insanity by crowds of observers, as
found after death, have thrown very little light on the actual state
of the brain in that disease. No doubt there is a coincidence be¬
tween great deprivation of the power of mental operation during
life and extensive morbid change, as in fatuity and dementia. It
can hardly be doubted that where the parts concerned in thought
have lost their structure, the power of thought should be lost>—but
such cases throw no light on the aberrations of thought where the
mental power remains in its fullest activity. It is quite probable,
then, that when there is deprivation of mental power, morbid altera¬
tion is discoverable. But it is equally probable that where there is
undue activity, there is only morbid organic action, and that, if
after death in such a case there is extensive morbid alteration found,
the latter is not. the immediate but only the remote cause of the
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disease by creating disturbance of action in adjacent parts of the
brain. Here, then, is an ample field of investigation. It is mani¬
festly an essential point in the history of every case of mental de¬
rangement to detect in what respects the patient has lost mental
susceptibilities previously possessed, as well as to examine how
far new activities have been developed. Again, it may be pos¬
sible in many cases to determine by attention to the character of
a patient's trains of thought how far it is probable that their
current is determined by the ordinary laws of suggestion in
health, or whether it is more probable that the prevailing course
of mental phenomena is the result of physical causes acting within
the brain on the vestiges left by previous mental operations.
The subject of latent cerebration which I passed over near the
commencement of this paper, not unaptly concurs with the dis¬
cussion in which we have been last engaged. The idea of “ latent
cerebration," or what may be termed thought out of the dominion
of consciousness, manifestly took its rise from the doctrine of the
reflex action of the nervous system. It is vain to deny that
Marshall Hall first placed the doctrine of reflex action on a dis¬
tinct and intelligible footing. There were floating ideas bearing
on the subject for nearly a century before he announced his dis¬
coveries ; but they did not take a sufficiently definite shape. It
bad long been observed, that an impression made on one part
of the living frame was succeeded, as a rule, by a definite motion in
some other part of the frame more or less distant. This fact was
variously explained. Those who held that the impression on the
first part was conveyed to the nervous centre, and that the motion
took place by the effect of an influence transmitted from that centre
to the second part, made the first step towards the acknowledgment
of reflex action. The difficulty was to get rid of a sensation in
respect to the impression, and of a volition in respect to the mo¬
tion. This difficulty plainly arose and obstinately continued to pre¬
sent itself only because physiologists confined their attention too
exclusively to the human body and its actions. Further, the diffi¬
culty was increased, because in some of the instances placed under
the same head, a distinct sensation was discoverable as attendant on
the impression, while no trace of a subsequent volition appeared.
Thus in the case of the impression of a strong light on the retina,
followed by a contraction of the pupil, there was a sensation conse¬
quent on the impression, but no volition could be ascertained to pre¬
cede the contraction of the pupil, though that, beyond doubt, was
the effect of muscular action. On the contrary, in the impression
made by the presence of venous blood on the nerves of the lungs
followed by the contraction of the numerous muscles concerned
in inspiration, there was in ordinary cases, and, above all, during
sleep , no trace either of sensation or volition. So clearly, how-
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Da. Stevenson Bushnan, on tie
ever, was it seen that the impression made on one part was
the cause of the motion in the other, in such instances as those
just indicated, that for some time before Marshall Hall an¬
nounced his mode of viewing the difficulty, it became common
to'speculate on what now seems an absurd notion, that there
might be sensations without consciousness, in order to find some¬
thing in the shape of a cause to interpose between the impres¬
sion and the motion. "What Marshall Hall really did, was to save
physiologists from speaking of sensations without consciousness, or
of volitions without consciousness. For what are his reflex actions
but effects after impressions in all respects like to sensations, except
in being unattended with consciousness, followed by effects in all
respects like those of volitions, except in being unattended with
consciousness ? Accordingly, just before Marshall Hall announced
his method, it had become common to resolve the phenomena of a
sensation into: 1, an impression on a sensitive part; 2, a transmis¬
sion of this impression along a nervous filament to the spot of the
nervous centre with which that filament is connected; 3, an organic
change in that part of the nervous ceutre; 4, a corresponding state
of consciousness; and to resolve a volition into—1, a state of con¬
sciousness; 2, a transmission of an influence generated by
that state of consciousness along a motor nervous filament; 3,
an impression or stimulus made by that influence on the fasciculus
of motor fibres on which it is distributed; 4, a movement by the
contraction of that fasciculus. And it had become clearly seen by
many physiologists that in respect to many acts, the state of con¬
sciousness was not essential either to the effect of what is now called
the afferent nerve, or to that of what is now called the efferent nerve.
(See on this subject f Bushnan on Instinct/ p. 100, 101, Edin.,
1837). This then was the origin of the doctrine which ascribes to
the nervous centre an endowment by which acts, strictly analogous
to mental acts, are performed, such as had before been believed to be
essentially dependent on a conscious principle. Nor are these acts
merely isolated movements—for in many instances the movements
constitute the means applicable to extensive ends. What, for example,
is more complex than the perfect act of vomiting in man ? how many
muscles distant from each other are called into simultaneous and
concordant activity ?—and yet all that large effect results from an
impression made on the nerves of the stomach or of the upper part
of the gullet. But as soon as such view s became established in
human physiology, it seemed at once manifest that the numerous
instinctive acts of the animal world at large, by which so many im¬
portant ends are accomplished, are precisely of the same character—
that impressions are made on sensitive nerves, and that the move¬
ments necessary for the established end are produced by motor
nerves.
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It was not surprising that a new impulse should he given by such
doctrines, so that even thought began to be regarded as, under some
circumstances, independent of consciousness. Dr. Laycock claims
the credit of having first taught the doctrine of a reflex function of
the cerebrum, while Dr. Carpenter has adopted views in which
thought is regarded as arising from the operation of certain parts of
the brain unattended by consciousness. This is what Dr. Carpenter
terms unconscious cerebration. The present is not an occasion to
attempt to distinguish between the views of Dr. Laycock and those
of Dr. Carpenter—it is enough that both teach, in the words of Dr.
Carpenter—that much of our highest mental activity is to be
regarded as the expression of the automatic action of the cerebrum,
and that it may act upon impressions transmitted to it, and many
elaborate results such as we might have attained by the purposive
direction of our minds to the subject without any consciousness on
our parts. “ Looking,” he adds, “ at all those automatic operations
by which results are evolved without any intentional direction of the
mind to them, in the light of reflex actions of the cerebrum, there is
no more difficulty in comprehending that such reflex actions may
proceed without our knowledge, so as to evolve intellectual products
when their results are transmitted to the sensorium and are thus
impressed on our consciousness, than there is in understanding that
impressions may excite muscular movements through the reflex
power of the spinal cord, without the necessary intervention of sen¬
sation.” (See ‘ Laycock/ vol. ii. Appendix.)
The subject of reflex action is one of the highest interest, and well
deserves to engage our attention. It is, however, rather a part of
physiology than of psychology, and the interest which attaches to it
arises from the special offices which it assigns to certain parts of the
nervous system. It does not develope any new line of thought—
that is, any line of thought unknown to the old psychologists, who
cultivated their science without so much as determining whether
there were a material frame or no. They did not ignore genius, they
did not ignore capacity, they did not ignore high talents, they did
not ignore cleverness—and whence, their partisans will say, did the
products of all these qualities of mind come ?—surely they arose in
the minds of the fortunate possessors without any consciousness of
the source “ whence they originated.”
Were numerous pictures of individual minds, such as were referred
to at the commencement of this paper, within our reach, they would
exhibit all those peculiarities which in literature constitute what is
called character, whether in real history or fictitious writing. It
will not be disputed that in the study of pyschology, particularly in
reference to the turn of thought in individuals, much is to be learned
from those works of genius which owe great part of their celebrity
to the faithful delineation of special character. Even the heroic
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Dr. Stevenson Bushnan, on the
personages of Homer and Virgil, limited as the pictures of their
thoughts are, are not without their use in the respect referred to.
Achilles, Agamemnon, Menelaus, ./Eneas, Turnus, are so many well-
distinguished characters, exhibiting particular turns of thought, in
perfect accordance with psychological rules. Ulysses is Homer's
most laboured character, and here undoubtedly a correspondingly
large insight into human nature is afforded. Merely to touch on
modem times, how infinite in number and variety are the lessons
in the course of human thought, emotion, passion, to be gained from
the pages of Shakespeare! Nay, even in the higher specimens of
that large department of modern literature, the Novel, there is an
incalculable amount of minute psychological instruction in reference
to individual character. If any one express a doubt as to the accu¬
racy of knowledge of this kind derived from such a source, the an¬
swer is—that kind of literature is, in fact, to a great extent a record
of the individual experience of the writers in the intercourse of real
life.
When from fiction we turn to the actual history of the world and
of the men who have figured in the world, we find everywhere vast
stores of psychological knowledge laid open. Here the utmost ex¬
tremes of human character prevail. It becomes, indeed, a question on
many occasions in real history whether the characters of which we read
belong to the physiological or to the pathological department of
human nature. In short, the perversity of some historical charac¬
ters is such as to suggest the existence of mental derangement as
the only solution of the difficulty. To discuss the crimes of history
with a view to determine the soundness of mind of the actors, would
be a very ungrateful task.
To these several considerations on the effect of physiological con¬
ditions of the living frame to modify trains of thought, I will only
add, that the temperament of the individuals will sometimes furnish
an important clue to the nature of the modification.
Nevertheless, in an age like this, in which frequent attempts have
been made to infer the existence of insanity merely from the single
perpetration of an enormous crime, such a discussion is by no means
useless. When there is a distinct motive for a crime, however
great—that is a motive which can be understood in an intel¬
lectual sense, and not the mere gratification of a morbid propen¬
sity—there is little difficulty in the case. Any amount of wicked¬
ness, for example, is perfectly compatible with the gratification of
ambition, without subjecting the actor to the imputation of mental
derangement. But when we contemplate the useless cruelties of a
Nero, a Caligula, a Domitian, our faculties stand aghast at the spec¬
tacle, and refuse for awhile to resolve the question as to their cause.
It has been thought by some philosophers, that Nero's career admits
of an explanation; namely, that his two first great crimes, the
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poisoning of his brother Britannicus, and the putting to death of
his mother Agrippina, being of a political character, are explicable,
and that thus his moral sense was blinded to the enormities of which
he was afterwards guilty, often from the merest whim. The same
kind of explanation is sometimes put forward for Domitian—but
Caligula's case admits of no alternative but absolute depravity or
insanity. This opens a wide field of psychological enquiry, into
which our limited time forbids us to enter farther. I will only say,
that it is to be feared that the plea of insanity cannot often be justly
urged in behalf of great historical crimes. When the human character,
originally bad, is freed from restraint by absolute power, and has
once become familiar with blood, it seems, tiger-like, to know no
bounds to the cruelty of which it is capable.
Fortunately history presents other aspects of the human character
from which psychological knowledge can be drawn than the revolting
aspect which we have just been considering. There, all that is great
and good in human nature finds its place. On that the mind may
dwell with complacency, while it drinks knowledge from a pure
stream. And the same observations apply to the extensive records
of biography.
Another fertile source of individual character for the study of prac¬
tical psychology is the record, in every country, of criminal jurispru¬
dence. The crimes of the infancy of society are chiefly acts of vio¬
lence committed from such motives as find free scope in such
a state of life. As society advances, new crimes become developed,
and there even arises a population bom to crime. The extent to
which this hereditary tendency to criminal acts can be corrected, is
a question of the utmost moment in a condition of the social state
like that which at present exists in this country; nor can psychology
denude itself of a large share in the settlement of that question.
This is, however, too much a matter of detail for the present occa¬
sion. Again, when crimes of violence are committed in this age
without sufficient apparent motive, there arises the nice question
whether the criminal be or be not of sound mind. In such a ques¬
tion psychology has a large share—not in the determination of what
the law actually is, but what it ought to be. Here there are three
most important questions with all of which, though not by any means
in the same degree, psychology is concerned. First, as to the evidence of
the existence of insanity in the criminal; secondly, as to the amount
of responsibility in the several forms of insanity; and, thirdly, as to
the expediency of punishment in the insane. And in aU these
-three cases it is manifest that it is individual character which is con¬
cerned.
I referred before to the tendency in our time to infer insanity
merely from the magnitude of a crime committed without sufficient
•apparent motive. This tendency in the public mind seems now to
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Dr. Stevenson Bushnan, on the
be on the wane. Some years ago it was at its height, but various
circumstances have contributed to emancipate public opinion from
the influence of some enthusiasts who were continually holding up
the execution of persons of an eccentric character for capital crimes
as instances of judicial murder. No one will expect to find such
men as Ravailliac, Fenton, Bellingham, quite like other men; the
inquiry into their previous history will be sure to bring to light
peculiarities of conduct or character such as excessive benevolence
may interpret into indications of a tendency to mental derange¬
ment. But had such men been suspected of insanity before their
crime, and an inquisition set on foot, 'the peculiarities of which
they might have been found to be possessed would not have been
held at all sufficient to warrant their being pronounced insane. This
This state of things would undoubtedly be found to exist in the
major part of such instances. And if this be the case, the public
are not fairly dealt with when crimes of this kind are committed.
If a man confined in an asylum for the insane commit murder, he is
unquestionably entitled to whatever mitigation of punishment the
plea of insanity can afford. But if, being at large, he commit
murder, the plea of insanity should not be accepted, unless the
insanity be distinctly proved. In the former case, indeed, he cannot
be tried, since the law holds insanity a bar to trial for any crime;
but, in the latter case, it commonly happens that the culprit is tried
and convicted, while the plea bf insanity is put forward in bar of
punishment. Whatever may finally be the authoritative determina¬
tion on this important question, it is evident that the public mind is
still unsettled in regard to it—it is a question which specially
belongs to the medical profession, and yet it is one with which the
profession, so long as a minute study of psychology makes no part
of its education, is unable to cope.
The same may be said of the second question referred to above,
namely, the responsibility of the insane in regard to crimes. Here
the public are equally in want of enlightenment. It is a question
of the utmost moment. We know, how great differences exist among
those labouring under mental derangement as to the appreciation
of right and wrong. We know that those who, affected with hope¬
less dementia, are incapable of perceiving this distinction, are gene¬
rally, at the same time, incapable of committing deliberate crimes.
But nothing is more certain than that in a large proportion of the
insane there is a sufficiently clear perception of right and wrong.
For unless this were true, where would be the foundation of the moral
treatment now so happily substituted in our asylums for the coer¬
cive measures of former times ? But as respects crimes committed
by the insane, there are many questions still unconsidered, and unde¬
termined. To whom is the public to look for a final adjustment of
such a question ? It is a question belonging to practical psychology.
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The medical profession alone has sufficient practical experience of
insanity to investigate such a question with effect. The public will
put trust in the decisions of the medical profession as soon as the
general voice pronounces that the medical profession, as a body, is
really a tribunal competent to deal with psychyological questions.
The third question referred to above is the expediency of the
punishment of the insane for public crimes. The medical profession
has less to do with this question than with the two previous questions.
It belongs in particular to legislation and jurisprudence. Neverthe¬
less, if public opinion ever come to respect the decision of the medical
profession on psychological questions, there can be no doubt that the
medical psychologist will have much to say on this subject. This ques¬
tion, as to the expediency of subjecting the insane to legal punish¬
ment, will probably ere long engage the public attention. It is
hardly credible how many lives are every year lost by the hands of
the insane ! Men begin to perceive that they have too long suffered
their opinions on the subject of punishment to be guided by the
ravings of a few philanthropists destitute of all principle but a
mawkish sentimentality. The present state of the law does not
settle this question—for the law, in exempting the insane from trial
on the ground of inability to plead, does not fix what amount of
mental derangement is necessary for the attainment of this privilege
of exemption. The question, therefore, is open. One thing is certain,
that the great rule for the repression of crime in society is unfailing
detection joined with unfailing punishment. This is, in the end, true
mercy. Could this course be carried out, of how much additional
happiness would it be the parent ? Of how much misery would it
stop the career ? The true nature of punishment has often been
pointed out—perhaps the day may come when public opinion will
recognise its truth. In punishment there is nothing of vengeance
for crimes—vengeance is left to the Almighty Judge of all the earth
—society has no particular right to take a man's life—but it cannot
exist unless it exercise its unquestionable power to protect itself by
whatever means experience shall show best adapted to that end.
It seems plain, then, from the various and somewhat desultory
considerations which I have set before you, that psychology should
constitute an indispensable part of a medical education. The ques¬
tion will then arise, whether the future medical man should study the
psychology of the schools of metaphysics, or the psychology of the
schools of physiology. It is far from a determined point whether it
would be advantageous to unite these two forms of psychology under
one course of study—or whether it is not likely to be conducive to
the future progress of the science at large, that each should be culti¬
vated apart by its own appropriate means. It appears to me, how¬
ever, to be a thing quite beyond question—that the medical man
should be minutely acquainted with the views taught under both
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Dr. Stevenson Bushnan, on the
forms of this science. It is in this way only that he can attain that
standing and pre-eminence among the learned for which the other
parts of his education, and the intimate acquaintance with human
nature afforded by his professional pursuits, contribute so great
facilities.
The psychology of the metaphysician is a system of the knowledge
of the human mind founded exclusively on the evidence of every
man’s consciousness—it acknowledges nothing as true but what is
derived from this source.
Physiological psychology is the knowledge of the functions of the
nervous system in the animal kingdom, obtained through whatever
channel may appear worthy of confidence. The latter, therefore,
includes the former, and has a much wider scope. But it is neces¬
sary for the physiological psychologist to understand and respect
the limits within which the psychology of the metaphysician is con¬
fined, that he may be able to debate with him numerous questions
on the grounds chosen by the latter.
Por example, while the physiological psychologist holds all debate
as to personal identity and the existence of an external world unne¬
cessary, he must be prepared to understand the difficulties on those
heads entertained by metaphysicians, and to assist them in the solu¬
tion of these difficulties.
It is manifest that all the preliminary difficulties of the metaphy¬
sician arise from his fear of assuming as self-evident things which he
thinks can be established by reasoning back to ulterior principles.
The physiological psychologist seldom encounters this kind of diffi¬
culty, because the more immediate instrument of his progress is
observation, and because it is the discovery of facts alone with which
he expects his labour to be rewarded; so that he takes everything for
an ultimate fact, which is not manifestly founded on something with
which he was previously familiar. The physiological psychologist
would no more think of seeking proof in favour of personal identity,
and of the existence of an external world, than he would propose to
offer proof that the eye sees or that the ear hears. The two latter
facts have long had on their behalf the universal belief of mankind,
and as to the the two former doubts respecting points, they were
never heard of except among metaphysicians. Many such doubts
manifestly owe their origin to the exclusive attention given by them
to reflection on the phenomena of consciousness, to the nearly total
exclusion of all consideration of the “concrete Ego,” or bodily
self.
If there be one thing more certain than another in human
thought, it is the toothache under which I labour to-day sug¬
gesting the remembrance of that I suffered from a year ago, is a
consciousness including the conviction that I am the same I who
suffer to-day, and the same who . suffered a year ago. The belief here
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is inherent. It is a first principle—it excludes all reasoning—all
argument. No doubts as to personal identity ought ever to have
arisen among pure metaphysicians. These doubts probably first arose
from some suspicion, even in the earliest ages, that the body was not
the same matter at one time as it had been at a previous time, and thus
the question being started, it was inadvertently taken up by meta¬
physicians, who did not even allow the body any place in their
speculations.
As to the evidence of the existence of an external world, it is one
of those questions which have very much exercised the acumen of
metaphysicians, but very uselessly as to the results. If metaphysi¬
cians confine themselves to the study of the immaterial "Ego,” that
is, to reflection on the pure phenomena of consciousness, it is mani¬
fest that no proofs of the existence of an external world could ever
come within their reach. But they might have confessed this neces¬
sary defect in their system without any detriment to their pursuit of
the philosophy of the human mind. For the mere supposition that
all things are ideal, would not change by a hair’s breadth the several
relations discoverable among the objects of human knowledge. There
would still be the same broad distinction between sensations and
emotions, between remembrances and the things remembered, be¬
tween desires and the objects of desires, between passions and the
objects of passions, as under an opposite system. If, on the other
hand, metaphysicians admit the concrete “ Ego,” or the bodily self
in their system, and trace the development of ideas in the progress of
childhood, they will undoubtedly discover evidence that, at an early
period, the infant did not discriminate self altogether from external
nature, but that, after a time, this distinction is fully attained—yet
whether by reasoning, or by pure instinct, it maybe impcs.-ible to
determine. This, however, is the process undoubtedly which every
infant goes through—and this is, after all, what philosophy has finally
reached, namely, that the belief in an external world rests on the
co mmo n sense of mankind, that is, on the conviction which arises in
the breast of every child in the progress of its study of self and the
things around, during the important period of self-education.
In short, there is plainly no more difficulty in the admission that
such convictions as the belief in personal identity and the belief in
the existence of an external world are the result of special endow¬
ments, than there is in the acknowledgment of the undeniable facts
that it is in consequence of special endowments that the child
creognises the differences of colours by the eye, the differences of
sound by the ear, the differences of smell by the nose, the differences
of taste by the palate, the differences of temperature and the differ¬
ences in magnitude by the skin and muscular system. Man, in
short, is born endowed with certain susceptibilities destined to be
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called forth under corresponding conditions—when these conditions
arise, the predetermined result follows.
It seems evident from these, and similar considerations, that what
was termed above physiological psychology bears most on a practical
psychology. It will be seen, from the general tenor of the observa¬
tions which I have offered in this paper, that I regard a practical
psychology as essentially the psychology of individual minds. It is
a subject confessedly still in its infancy. It has not been possible,
for that reason, to treat of it in a very connected or systematic form; .
but unless, I deceive myself, I have been able to point out some of its
distinctive features, and to indicate to the medical observer some of
the sources whence he may draw improvement in a department of
knowledge so essential to the proper treatment of all those diseases
in which an estrangement of the mental faculties is concerned.
The New Lunacy Bill.
The introduction of this important measure so soon after the inter¬
minable and wearisome Windham case, has led to the too hasty
supposition that the Lord Chancellor has been induced to prepare
his Bill mainly in consequence of what occurred in that case, which
was indeed a fine exemplar of the evils of the system which are sought
to be remedied.
But in truth these evils had long been well recognised, and
although Lord St. Leonards’ Act of 1853, is admitted on all hands
to have been a most wise and skilful measure when it was enacted,
it is now scarcely disputed that the time is over-ripe for new amelio¬
rations of the law. That this is so will scarcely be denied by any
one who has taken the trouble to read and consider the evidence
given before the Commons’ " Select Committee on Lunaticsand
the same fact is indicated by the two Lunacy Bills introduced by Sir
Hugh Cairns, and by the late Lord Campbell. The readers of these
pages will perhaps also remember a letter on this subject of Chancery
lunatics, addressed by the editor to the chairman of the Select Com¬
mittee, in which letter the great evil of the needless cost of lunacy
inquisitions was dwelt upon, and such remedies were recommended
to be applied as had suggested themselves to the writer in his limited
knowledge of the subject.
We take some credit for having suggested in this letter one of the
most important improvements in the manner of conducting lunacy
trials, on which the Lord Chancellor has now placed the authoritative
stamp of his opinion, namely the proposal that the alleged lunatic
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shall be examined by the Court before any evidence is taken. ‘ Journal
ofMental Science/ No. 35, p. 133.
The beneficial import of this change in the law, if indeed it is a
change in the law, and not merely a legislative order to change a bad
custom, cannot be over-estimated. The present rule to examine the
alleged lunatic at the end of the proceedings, reminds one of nothing
so much as of that celebrated discussion which took place in a
learned society, on the question propounded,—why a fish, placed in
a vessel full to the brim, did not make the water overflow, and did
not add to the weight ? and which, after learned reasons had been
exhausted in explanation, a man of vulgarly common sense proposed
to test by observation;
If in lunacy trials it is made compulsory on the Court to examine
the alleged lunatic at the commencement of the proceedings, it will,
we think, be found that this simple change will exclude much of
that pseudo-scientific evidence to which the Lord Chancellor takes
such reasonable objection. It is not in the nature of things that
a judge and jury will be able to examine for themselves into the
state of mind of an alleged lunatic, without forming a very strong
opinion upon the subject; and this would especially be the case
when that opink n formed was positive, namely, when the existence of
the lunacy was obvious. In the case of Mrs. Cumming, for instance,
“ whose lunacy was obvious the moment she appeared before the
jury,” if this examination 4 had taken place at the commencement
of the proceedings, what psychological ingenuity could have ex¬
plained away the existence of the delusions which she had avowed ?
In such cases, after the existence of mental unsoundness had mani¬
fested itself to the observation of the jury, not only medical but
general evidence would become superfluous, and the subsequent pro¬
ceedings would resolve themselves into mere matters of form, and
be abbreviated/*) such dimensions as the presiding judge might deem
right.
When on the other hand, in this examination the judge and jury
were not able to observe the signs of unsound mind, they would
scarcely venture to form a decided opinion that such unsoundness
did not exist until they had heard the evidence tendered by the
petitioners. But if this evidence was not sufficient to show the ex¬
istence of that insanity which the Court had been unable to observe
for itself, even then the trial would be cut short in the midst, a
verdict negativing the insanity would be returned, and all the time
and cost of the defence would be spared.
The rule that the alleged lunatic shall be examined by the judge
and jury before the commencement of the proceedings, would pro¬
bably carry with it another result of great importance, namely, that of
altogether preventing the fact of insanity being sent to be tried by a
jury in some instances where a lunatic is a mere puppet in the hands
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The New Lunacy Bill.
of attorneys or of others who influence him to oppose a petition and
to demand a jury trial for their own selfish purposes. When a
person who is unquestionably a lunatic has unfortunately come
under the control of some unprincipled attorney, or of some other
person deriving improper interest from the management of the
lunatic's affairs, although the lunatic may be a mere puppet, he is
liable under "the present system to be induced to resist to the utmost,
and at all cost, the most well-intentioned measures for placing him
under the guardianship of the Court of Chancery. But if such
persons, having the control of a lunatic, knew that the first step taken
m a jury trial into the state of mind, would be a personal exami¬
nation made by the Court, it does seem reasonable to expect that
they would avoid the censure which would attach to them for
conduct so obviously injurious to the lunatic, and to which they
would, at all events, lose the inducement offered by prospective bills
of costs.
Another provision in the Lord Chancellor's Bill, directed to lessen
the time and cost of lunacy trials, is that by which he limits the
evidence tendered in proof of the lunacy to a period of two years.
We entirely concur in the wisdom of this measure. This limitation,
indeed, is to be at the discretion of the judge, and the noble Chairman
of the Board of Lunacy mentioned in the debate the instance of a
particular form of lunacy, namely, that of latent suicidal or homicidal
mania, in which, no doubt, this discretionary power would be used.
It has occurred to us that there are two other circumstances under
which this discretion placed in the hands of the judge may be usefully
exercised. The first of these is, where it is claimed to tender evidence,
not of the existence of insanity two years before the date of the in¬
quisition, but of the cause of the insanity stated to exist at the time
of the inquisition. To give an example, if a man has had a coup de
soldi, from the effect of which he is afflicted with that dangerous
form of insanity often resulting from this cause, in which the passions
are more disturbed than the intellect—in such a case it might be
very desirable to allow evidence to be given of the exciting cause of
the lunacy, although it occurred at a period antecedent to the limit
of two years. The other circumstance would be where the alleged
lunatic has been for a long time kept away from observation, either
by his own act or by that of interested persons.
Instances of this kind are not uncommon. We have had recent
occasion to give evidence respecting the insanity of a man, whose
friends were kept for years away from him by the woman with whom
he lived. Suspicions existed that he was insane, but there was no
proof. One day, however, he escaped, and was brought to us by the
police in an advanced state of general paralysis.
In Sharp v. Macaulay, the lunatic had shut himself up for thirty
years. (See this Journal, No. 19.) We think, however, that in
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cases of this kind, it is better to provide legal facilities for giving
persons named by the Court of Chancery due access to an alleged
lunatic, who is under seclusion or control, rather than to extend the
limits of time for evidence. And this, indeed, is done by the
eighteenth clause, which empowers the Lord Chancellor to send the
visitors to visit persons alleged to be insane, and to make in¬
quiries and reports in reference to them. But is this clause suffi¬
ciently imperative on the persons to be visited ? If so, this will be
a very important and useful addition to the power of the Court,
which can only now act by consent. The question, after all, is
strictly that of the mental condition of the person at the time of
the inquisition; and if he is proved to be of sound mind at that
time, all the evidence in the world that he was of unsound mind
even the week before cannot be worth a nutshell. Evidence going
back from the date of the inquisition can only be of value either
in so far as it describes a confirmed state of mind, which, may
fairly be presumed to continue up to the time of the trial, or else as
it gives account of antecedent states of mind and body, which may be
viewed as causes of the existing state.
And now we must come to that provision in the Lord Chancellor’s
Bill by which he limits medical evidence. At the first blush of this,
we were inclined to feel professional vanity not a little wounded;
but we are bound to ask, not whether the provision is flattering,
but whether it is calculated to promote the public interests, by ren¬
dering judicial proceedings more certain and simple. The broad posi¬
tion taken by the Lord Chancellor is, that in inquisitions of lunacy
the question mooted is the existence or non-existence of certain
states of mind, as a matter of common observation; it is not whether
these states are or are not conditions of disease, but whether it is a
fact that they exist; and he maintains that the proof of this fact
must depend on that kind of evidence which appeals to the under¬
standing, and which gains the belief of common men, unlearned in
the subtleties of physiology or metaphysics. In order successfully
to controvert this view of the question, the least that it would be
needful to prove is, ist, that states of idiocy, lunacy, and unsound¬
ness of mind, are always states of physical disease; and and, that
medical men are always able to recognize them as such in conse¬
quence of their professional knowledge and skill.
Now, we^ in common with the great majority of medical - men, do,
upon grounds satisfactory to ourselves, verily believe that all these
states of mind are owing to conditions of physical disease. But even
here, in this very first step of the argument^ we feel conscious of
stretching the meaning of the word disease in order to include many
cases of congenital and hereditary insanity; so that it would be
more exact to say that we recognize these states of the mind to
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be due to abnormal conditions of the physical organism, rather
than to conditions of disease. Moreover, and this is fatal to our
argument, many eminent men among us do not believe that insanity
is invariably caused by any physical condition whatever. The somatic
theory of insanity, even in this country, is not yet undisputed master
of the field. There are eminent physicians who teach thajt insanity
is a disease of the soul, as there are others, who hold the extreme
opposite view, that crime is always owing to disease of the body;
and there is at least one distinguished person who incoherently main¬
tains both opinions to be true. We must, therefore, confess that
we are scarcely in a position to expect the world to receive as es¬
tablished on undeniable proof this very first platform of our position.
We are winning ground, it is true, year by year, but it is but a
short day, in the history even of our own country since the dis¬
eases of the mind were by no means recognised as the peculiar pro¬
vince of the medical man; since such asylums as did exist were the
worst of goals, and those who ruled over them were the com¬
monest of gaolers. It is only within this very year that the laws
promulgated by Government for the lunatic asylums in Ireland have
been made to recognise the principal officers as medical men. This
also is a very remarkable fact in regard to the pretensions of medical
men to exclusive knowledge of diseases of the mind, that, with the
exception of the University of Edinburgh, there is not one medical
school in the three kingdoms which provides any teaching of, and
without exception, not one which requires any study of, mental dis¬
ease. If the belief is so widely accepted that insanity is always a
physical disease, and that all laws affecting the insane ought to
recognise the exclusive knowledge of medical men, is not this neglect
of insanity by the medical schools utterly inexplicable ?
The fact is, that the knowledge of insanity as a disease is yet in
its infancy, and successive generations will have to devote them¬
selves to the investigation of its phenomena, before it can be expected
to grow into the strength of maturity. In the mean while, physicians
have one or two truths to accept—the first of which is, that while
their theories of the nature of insanity are most useful as instruments
in scientific pursuits, they are of no value in judicial investigations ;
and the second is, that the empirical knowledge which many medical
men have acquired by devoting themselves to the daily observation
of the characteristics of insanity, and which is of unquestionable value
in judicial investigations, cannot be said to be exclusively their own.
Intelligent but utterly unlearned head-attendants, by living among
the insane, become conversant with jtheir moral and intellectual
peculiarities, so that they would be able to tell a judge and jury
whether these peculiarities did or did not exist in a particular case,
not so well certainly as a physician with the same amount of em-
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pirical knowledge, yet so as to express facts in a manner which
can be understood by common men. A foremast-man may speak of
common facts occurring at sea as accurately as a captain.
To be understood by common men—this, happily for English¬
men, is an essential requisite of all evidence in our courts of law,
and it is one which medical witnesses must fully accept. Although
they have surrounded their studies with technical words and specu¬
lative theories, until their use becomes a mental habit—in courts
of law, unless they strip their opinions to the nakedness of common
sense, and of the plainest language, they will fail to express the
truth which they have to tell in a manner worthy of themselves and
of the acceptance of their fellow-men. Now, the plain expression
of an empirical knowledge of observed facts relating to the state of
mind of an alleged lunatic is the very thing which the provision
contained in the Lord Chancellor’s Bill aims to substitute for those
speculative views and theoretical opinions which have, in lunacy
trials, been the cause of so much waste of public time and patience,
and of so much discredit to our profession. The following is the
intention of the Lord Chancellor, expressed in his own words:—
“ He had been told that his clause excluded medical testimony in
these inquiries, but it did no such thing. He did not exclude the
evidence of what a witness might have himself seen, heard, and
observed. What he wished to exclude was, the evidence of specu¬
lation, fancy, and idle theory, not warranted by any inductive rea¬
soning founded on facts.” If the clause does succeed in fulfil-
ling this intention, medical men who devote themselves to the study
of insanity, and who honestly wish to express what they know on
the subject and no more, will have good cause to thank the Lord
Chancellor for removing them from a false position, and placing them
in the one they ought to occupy as witnesses in lunacy trials.
The words of the clause by which this exclusion of speculation and
idle theory is to be effected are—“ Nor shall the opinion of any
medical practitioner be admissible as evidence of the insanity of such
person.” Would not the sense, however, be made clearer by a change
m the or do verborum, thus : "Nor shall the opinion of any medical
practitioner of [as to ?] the insanity of such person be admissible as
evidence” ?
There can be no reasonable doubt of what the words mean as they
now stand, but a casuist mi g ht argue that the words exclude from
evidence any opinion of a medical man, which would be almost tanta¬
mount to his exclusion from the witness-box, for even common wit¬
nesses cannot be restrained to the logical limits of the matter of
fact.
“By a matter of fact,” says Sir G. C. Lewis, in his admirable
work on ‘ Authority in Matters of Opinion/ “ I understand anything
of which we obtain a conviction from our internal consciousness, or
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The New Lunacy Bill.
any individual event or phenomenon which is the object of sensation/'’
" The essential idea of opinion seems to be that it is a matter about
which doubt can reasonably exist, as to which two persons can with¬
out absurdity think differently.” Strictly, then, a witness might not
be able to say that a person was furious or talked incoherently with¬
out expressing opinions. To stick to fact, he would have to say that
the man had knocked him down, and that he could not understand
what he said. To save quibble, therefore, it would seem desirable to
define the opinion which it is intended to reject, which would be
sufficiently done by the slight verbal transposition suggested.
We must, in conclusion, venture to express the opinion that a
court of law sometimes needs as much to be protected from the medical
science of the barristers as from that of the physicians; for, accord¬
ing to what we have observed and experienced, the fine theories and
hard words of the doctors are usually drawn out of them, more or
less against their will, by the cross-examining barristers, who cannot
afford to sacrifice the exhibition of the modicum of science which
they have got up for the occasion. As an instance, a friend of ours
had to give evidence at the last winter assizes against a youug
woman charged with the murder of her infant by a blow fracturing
its skull. The counsel for the defence endeavoured to make him
admit that the injury might have been caused by pressure against
the 08 uteri , " the bone of the womb,” as he learnedly translated
it to the jury. "We have avoided technical terms thus far,” said
the doctor, " but do allow me to remind you that os means a mouth
as well as a bone/’
Whenever we have been drawn into seeming pedantry it has been
in cross-examination; and it was in cross-examination that Dr.
Winslow hit upon the ethico-pathological definition of Windham’s
insanity as a "paralysis of the moral sense.” Realty we ought, in self-
defence, to insist upon the publication of the questions to which the
replies are given for which we sometimes get laughed at. Let us,
however, never forget Bacon’s golden maxim—" Loquendum ut
vulgus , sentiendum ut sapientes.”
APPOINTMENT.
Mr. S. W. D. Williams, M.R.C.S., &c., son of Dr. Williams, of
the Gloucester Asylum, has been appointed Assistant Medical Officer
to the Northampton General Lunatic Asylum.
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THE JOURNAL OF MENTAL SCIENCE
No. 42. JULY, 1862. Vol. VIII.
Cases illustrating the use of the Roman Bath in the Treatment of
Mental Disease . By C. Lockhaht Robertson, M.B. Cantab.,
Honorary Secretary to the Association of Medical Officers of
Asylums and Hospitals for the Insane. (With a ground plan
of the Roman Bath at the Sussex Lunatic Asylum, Hayward’s
Heath.')
In the Journal of Mental Science for July , 1861, there is a
review (which I wrote) of Mr. Erasmus Wilson’s work on the
Eastern, Turkish, or, more properly, Roman bath.* Besides
* Distinction between the Roman and Turkish Bath .—Mr. Wilson generally uses
the term Turkish bath in speaking of the hot-air bath. As used, however, in Eng¬
land, the hot-air bath resembles more the Roman than the Turkish, and for all
sanitary and remedial purposes, the more we approach the Roman usage of the bath,
the better shall we fulfil its indications.
A very few words will show how materially the two processes differ. The Roman
bath was a tonic and bracing agent, fitted for the use of the great people who in¬
vented it; the Turkish bath is an enervating process, just suited for the effeminate
Turk. The bracing of the body by cold water was the end of the Roman process;
the luxurious cooling of the body by the slow action of the air, the bather the while
indulging in the use of narcotic stimulants, is the summary of the Turkish bath. It
is important that the distinction between these two forms of the hot-air bath, the
Roman and the Turkish, should be insisted on. Much of the popular prejudice
against the use of the bath, and the contrasts drawn between its health-giving use
and that of a good day's hunting or shooting, result from the popular and just
notions of the effeminacy of the modern Eastern bath, with its abominable process
of shampooing and its luxurious ease and enervating cooling process. Only let the
English public know that the revival of the bath in England is accompanied with
the tonic and bracing practices of the early Roman bath, and these prejudices will
soon yield, and the bath become a national institution in our towns, a necessary
in our country houses, and a therapeutic agent in every hospital and asylum in the
land.
VOL. VIII. 11
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Use of the Roman Bath in the Treatment of
entering into the general history of the revival of the bath in England,
and of the method of its administration (as now used in London), a
ground plan and description is given there of a Roman bath erected by
the Visitors of the Sussex Lunatic Asylum, on my representations of
its possible efficacy in the curative treatment of mental disease. Eor
facility of reference I reprint at the end of this paper this descrip¬
tion of the Havward’s Heath Bath, with the illustration.
I must refer to that review for a statement of the history of the
Roman bath; of its use in the ancient world, and of its modern
adaptation in Turkey. I would also refer to a long extract from
Mr. Wilson’s pamphlet, giving an excellent description of “ the
operation of the bath”
I wish now to record the results which have followed the use of
this powerful remedial agent during the six months (June, 1861—
February, 1862), exclusive of repairs, which it has been in use. As
any accident would have been fatal to its future prospects, I have
used much more than ordinary caution in the selection of cases for
treatment by the Roman bath.
1 have had no serious accident, nor anything more alarming than
a slight faintness, relieved at once by removal to the Frigidarium
(ground plan, c, p. 173).
The method of its use. —I have made experiments on the use of
the bath at different temperatures, from 120° to 180°, both on
my own person and with the patients. In a thoroughly well-venti¬
lated bath (such as the Hayward’s Heath bath is), and with a due
supply of moisture, I believe a temperature of 145° will be found
the most efficient. A higher temperature causes an unnecessary ex¬
citement of the circulation, and at lower temperatures the action of the
skin is so slow that the patients get wearied of sitting, and restless.
At 145° to 150° about twenty minutes ensures a full and free action
of the skin. The patient is then bathed in perspiration; every pore
of the skin acting. In cases submitted for the first time to the
influence of the bath, I practise effusion of tepid or warm water
before going into the Calidarium.
The state of the wet bulb thermometer deserves attention. It
ought not to stand higher than 110°. Watering the hot tiles will
at any time reduce this thermometer ten degrees.
I generally administer the Roman bath twice a week, and in
delicate cases once a week. About twenty minutes is the average
time spent in the Calidarium.
The patient is then passed on to the attendant in charge of the
Lavatorium, where he is soaped all over, and then, according to the
case, has either the two-inch cold douche over him (avoiding the
head), preceded by a pail of tepid water, or else one of the milder
cold-water applications. The two-inch douche is, however, by no
means so alarming as it sounds. I have known the most delicate
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ladies use it, and with success, in uterine disorders with a relaxed state
of mucous membrane, &c., and I have myself repeatedly used this
douche with pleasure, as have also many of my friends.
I have tried various experiments as to the relative cost of heating
the bath, and I find it cheaper to keep it constantly heated (banking
the fire up at night) than only to heat it for use on certain days of
the week. Our consumption of coke is one bushel per day.
General results of treatment by the Roman bath .—The most
striking physiological action of the Roman bath, when continued
over a series of weeks, is a steady improvement of the function of
nutrition, shown by marked and often rapid increase of weight.
In my own case, after keeping for ten years previous at the same
weight, I have gained one and a half stone weight during the
twelve months that I have pretty regularly used it, and 1 have
observed the same result in other cases of persons in health using it
for a continuous period. The headache, which is often complained
of in the early baths, passes off when the action of the skin is
thoroughly re-established.
The improvement in the clearness of the complexion and the re¬
moval of all slight eruptions and such like blemishes of beauty,
renders the Roman bath the best cosmetic I know of. I have suc¬
cessfully impressed this fact on one or two of our female attendants.
I am sure if young ladies who frequent balls in the very low dresses
now in fashion, knew how the tint and texture of their shoulders,
&c., would be thus softened to the eye, they would regularly, in
the ball season, resort to the weekly use of the Roman bath.
Another of the most frequent physiological results of the con¬
tinued use of the Roman bath is the restoration of the uterine
functions to healthy regularity. The value of such an indication and
result of treatment in cases of mental disease can hardlv be overrated.
My best‘success has been with cases of melancholia with great
depression and refusal of food. Cases of maniacal excitement, on the
other hand, have not usually benefited by the treatment.
In looking over the cases which have been, more or less, under
treatment in the Roman bath during the six months it' has been
in use here, I find a considerable variety in the results. The cases
in which its action has been most beneficial are in those of melan¬
cholia with refusal of food—a common and wearisome form of
mental disease, and the favorite subject hitherto of the opium treat¬
ment.*
* I have one of these old opium cases, which I removed from a London licensed
house, and in which 1 was obliged to give twenty grains of solid opium a day, so
confirmed had the poisonous habit become. When the drug was withdrawn or
lessened, acute maniacal symptoms, with strong suicidal tendency, supervened. For
the last three months I have discontinued the opium and given the bath twice a
week with rather an improvement in health and mind.
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Use of the Roman Bath in the Treatment of
In most of the chronic cases which have been regularly submitted
for a consecutive time to the action of the Roman bath, there has
been a marked increase of weight and flesh, the result of im¬
proved nutrition. Some very broken-down old cases have thus
been partially benefited.
I. In the male department, besides one or two experimental trials
I have had fifteen cases under regular treatment in the Roman
bath, of which cases I proceed to give a short summary.
Pour of these cases I nave given pretty fully, in order to show the
course of the symptoms under treatment.
Case 1. — Melancholia , with delusions and a suicidal attempt; great
emaciation and loss of strength; treatment by opiates and pail
douches; subsequent use of the Roman bath , with steady im¬
provement of nutrition ; subsidence of the delusions and partial
restoration of mental power and health ..
C. P—, No. 601, male, set. 44, single, admitted 13th of May,
1861.
History. —A man of temperate habits. The exciting cause of
his disease, was six months' imprisonment for felony, from which
he was released two months before his admission in a depressed state
of mind. Shortly before admission he attempted to commit suicide
by throwing himself down a well 180 feet deep, at the sinking of which
he was employed.
State on admission. —On admission he was in a most reduced state
of health, with an anxious expression of countenance, refusal of food
(which continued a fortnight), and a variety of delusions as to his
being haunted by the devil, the hopeless nature of his malady and of
his prospects of recovery. There was a considerable injury to the
right leg, occasioned by his fall down the well. Very restless nights.
He took a mixture of quinine, iron, and acid. On the 15th May a
tepid and cold pail of water were ordered daily at bedtime, with a
partial improvement in his rest and sleep. He continued very de¬
pressed in mind and feeble in body, unable to occupy himself or to
divest his mind of the hopelessness of his case and of his lost condi¬
tion. Appetite poor. He had a pint of porter, two ounces of
whisky, beef tea, two eggs, daily, and as much of the ordinary diet
as he would eat.
On the 4th of June the Roman bath was opened for use, and he
was sent to it. He took it three times a week for the first fortnight,
but as it seemed to increase the depression, it was reduced to
twice a week. This treatment has been continued up to the pre¬
sent date (February, 1862), but as the bath was two months under
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repair with alterations, &c., the treatment of two haths weekly may
be said to have been followed for six months. The improvement
has been slow but steady. He has decidedly gained flesh and weight.
Instead of mere skin and bone, he is now a stout, well-fed man. He
occupies himself in household work in the wards. His delusions have
entirely left him, and he is apparently of sound though weak mind.
I do not consider him cured; indeed, I doubt his being fit for work in
the world, and probably a return to his former occupation and low asso¬
ciates in the livery stables of Brighton would result in a return of
the symptoms. Still here is a case in which there was refusal of
food, extreme melancholia, and utter loss of health, restored to a state
of cheerfulness, usefulness, and good bodily health; a comfort and
help to the other patients in the ward, instead of being a burthen
and anxiety to those in charge of him. If this had been my only
success with the Roman bath, I should consider that the trouble and
cost had been profitably expended.
Case 2. —Melancholia ; obstinate refusal of food; debility ; opiate
treatment; slight benefit; use of the Roman bath ; marked and
steady improvement .
T. R—, No. 445, male, set. 40, married, admitted October 17th,
186 °.
History. —Insanity, hereditary on his mother’s side. First symp¬
toms, five weeks before admission ; exciting cause, the immoral con¬
duct of his wife. A man of good character and sober habits. Made
a slight attempt to cut his throat. Had refused all food for five
days past.
State on admission. —Much emaciated and reduced. Does not
appear to comprehend what is said to him. Obstinate refusal of
food. Circulation low, extremities cold, restless and sleepless.
Occasionally passed his evacuations unconsciously.
During the months of October and November he continued in a
miserable state, hardly able to stand, refusing his food, and requiring
always to be fed. He had some opiates at night, but without any
benefit. He also took 3ss lemon juice three times a day, and had
a tepid and cold pail of water at bedtime. This treatment was
continued during the. winter, with slow improvement, retarded by
occasional return of the refusal of food.
On the 4th of June he began the Roman bath, first twice a week,
then once a week, and now he takes it on alternate weeks. The im¬
provement has been very marked. He is now a strong, able-bodied
man, working daily on the farm. There is still a morbid slowness
of thought and depression of mind.
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Use of the Homan Bath in the Treatment of
Case 3. —Melancholia ; at the verge of death ; refusal of food; use
of the Roman hath ; recovery of bodily health ; mind in a state
of dementia.
T. L—, No. 513, set. 39, male, married, admitted June 27th, 1861.
History. —A farm-labourer. First attack. Mind is said gradually
to have been giving way for the last six months, in consequence of
discomfort in his situation and anxiety to satisfy a hard, exacting
master. Has attempted to injure himself and others, and for
the last few weeks previous to admission refused all food. Not
hereditary.
State on admission .—Very much reduced in strength; pulse
feeble, 116. Apparently at the verge of death from the effect of the
journey; unable to answer any question or to understand what is
said to him. Obstinate refusal of food. He was placed on beef-tea,
stimulants, and an occasional warm bath. His progress was very slow,
still he gained ground. In September he was strong enough to be
carried to the Eoman bath, and he has since had them twice a week.
His mind remains in a very depressed state, but his bodily health
has greatly improved, he eats and sleeps well, and he has for the
last week joined the working party, on which he is reported to be
efficient.
Case 4.— Melancholia ; very reduced state ; refusal of food ; use of
the Roman hath ; considerable improvement.
T. T—, No. 578, male, set. 39, widower, admitted December 31st,
1861. ...
History .—The third attack of mental disease, having previously
been under treatment at Colney Hatch and Banning Heath. A ship¬
builder by trade. Worked in Chatham Dockyard after his discharge
from Colney Hatch. He relapsed, however, and was sent to Barming
Heath, but after his discharge thence he did nothing, and was not
considered by the parish authorities as quite recovered. The original
exciting cause of his disease was grief at his wife’s death. Insanity
hereditary on his mother’s side. An excellent workman, and always
bore a high character.
State on admission .—In a very reduced state of health; refusal
of food; nervous and suspicious; will not answer questions; no
sleep for several nights. Opium (Taylor’s Liquor Opii) seems to
increase the nervous symptoms. Tearing his clothing and getting
up all night. The refusal of food continued for several weeks; great
emaciation and loss of strength.
January 5th, 1862.—The opium discontinued, and the patient car¬
ried down twice a week to the Eoman bath, he not being strong
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enough to walk. The restlessness so great that an attendant took
the bath at the same time each of the first five times. The skin
acted freely from the first. The improvement was more rapid than
in case C. P—. After the first five baths he walked down himself, and
then began to show an interest in the proceeding, assisting to dress
other patients, &c., &c., while at the first he could neither dress nor
undress himself. He has steadily gained flesh and strength. He
works cheerfully in the wards; appetite good; sleep good. Conver¬
sation rational, but there is still considerable mental depression. I
still look for considerable improvement in this case.
The following male cases which have also been under treatment in
the Roman bath may be more briefly alluded to, in illustration alike
of its failure, of its use in conjunction with other remedies, and also
of its use in chronic mania in improving the habits and consequent
comfort of the patient, though, of course, employed without any hope
of cure.
In a case of recent acute mania, P. P—, No. 498, who was cured
of the maniacal symptoms with the packing in the wet sheet, but
who had a relapse from the premature visit of his wife, which
threatened to end in dementia, the use of the Roman bath did
harm, owing to the great depression invariably resulting from it. I
put P. P— subsequently through all sorts of treatment, and without
any visible improvement. I at last committed him to the curative
influences of expectant medicine, fed him well, and kept him warm,
and by degrees his mental powers returned, and he recovered, and
is now (Pebruary 15th) working in the carpenter’s shop, and will
shortly be discharged cured.
In the case of S. T—•, No. 549, who was admitted in a state of
recent dementia, following an attack of acute mania which had been
ignorantly dealt with by the union authorities, I was very sanguine
that a careful use of the Roman bath would result in his recovery.
He is a young man of good constitution and rather a languid circu¬
lation. He had ten baths, given twice in the week, with, however,
the result of materially increasing the unfavorable symptoms of his
case, inducing also refusal of food, extreme restlessness, and tearing
of his clothes. He was one of the few patients who appeared alarmed
at the process. . I ngxt tried the cold douche in this case, but was
equally unsuccessful. Left without treatment, he is quiet, but appa¬
rently hopelessly demented.
In the case of W. II. C—, No. 287, with fixed delusions and a
good deal of consequent irritation and violence, the symptoms were
undoubtedly aggravated by the use of the Roman bath. The cold
douche at bedtime had rather a soothing effect, but the case is
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Use of the Roman Bath in the Treatment of
passing into one of general mania, with occasional violence. There
is also albumen in the urine and some dropsy.
J. B—, No. 109, is a case of chronic mania of many years'
standing, which was attended with a great deal of noisy talk and
excitement. The use of the Boman bath for a month removed all
excitement and noise, and he now works daily on the farm. That
his mind is unimproved I need hardly add.
J. L—, No. 560, is a case of senile mania, recently admitted in
a state of great excitement. Previous to admission there had been
violence to others. He had the Boman bath for a month, and en¬
joyed it very much. The excitement abated after the first bath or
two, and he continues calm and collected unless when he is led to
talk about his family grievances.
S. N—, No. 562, is a distressing case of melancholia, with delu¬
sions bearing on his health, and occasional fits of great excitement. The
Boman bath was used for many weeks, but, except for about a couple
of hours immediately following its use, no effect was produced.
Packing thrice daily in the wet sheet, followed by the pail douche,
has, on the othec hand, materially relieved the urgent symptoms.
In a case (J. K—) in which the peculiar smell from the skin of
lunatics was extremely unpleasant, reminding one of the odours of
the old private licensed houses, and in which the steady use twice a
week of the warm bath and soap, and a daily cold douche bath, had
failed in remedying the nuisance, I found that a few weeks' treat¬
ment under the Boman bath entirely succeeded. The case was one
of dementia, .occurring in a young man as the sequel of sunstroke, in
the West Indies. His habits on admission, about two years ago,
were very dirty, but this a month's careful night-nursing had long
ago cured. But that terrible smell—as adherent and peculiar as
that of the fox—remained until very recently, when I thought of
trying the powers of the Boman bath on it.
Last summer the Visitors admitted forty sailors from the Naval
Lunatic Hospital at Haslar, principally refractory Irishmen, ignorant
of order or discipline, violent, and many of them dirty in their habits.
I have had four of them under treatment in the Boman bath.
Case. 1.— J. S— arrived from Haslar in a very excited state.
He tore his clothing, spent hours in loud shouting, ate grass and
any filth he could put his hands on, and was dirty in his habits.
After three or four weeks' treatment with the Boman bath he gra¬
dually became calmer, clean and orderly in his habits, and, although
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there was great weakness of mind, his conversation became rational,
and he rapidly gained flesh. His nights were quiet, and he was
placed in an associated dormitory. He is a young man about thirty
years of age. Suddenly one morning he had an apoplectic seizure.
I treated him with stimulants, and in a few days he was about
again, but his mental power was gone, and partial paralysis of the
left side remained. Since then he has, after each time slowly im¬
proving, had two similar seizures. This is the only case in which I
have seen any untoward symptoms even distantly connected with the
use of the Roman bath. Whether the bath was the exciting cause
of the apoplectic seizure, or whether it resulted from the previous
cerebral disturbance, it is difficult to say. I have felt it due to truth,
to record the facts as they occurred.
Case 2.—W. B—, described as a dangerous, violent lunatic,
arrived from Haslar handcuffed, and, on being released, at once
knocked an attendant down, and from time to time renewed such
and similar feats. He took twelve Roman baths (two a week as
usual), and he has for some months now been perfectly calm and
orderly in his conduct, all irritation having thus been removed.
Case 3.—R. R—, an old man, subject to recurrent mania, very
noisy and troublesome, but not violent, under his attacks. Tolerably
sane in the intervals. Had been frequently transferred to and fro from
Greenwich Hospital to Haslar. The day after his arrival one of
these attacks came on and ran its usual course of noise, filth,
and destruction; a most troublesome case. He was treated with
the wet sheet and cold pails. A second attack was cut short in
a very marked way by the use of the Roman bath. In the inter¬
vals of his attacks he is employed with the working .party on the
farm. The last attack lasted ouly three weeks instead of six weeks
as before, and was much modified in its unpleasant symptoms.
Case 4.—W. F—, a case of melancholia with suicidal tendency
(he cut his throat when with the fleet), arrived from Haslar in an
extremely depressed state, with refusal of food, emaciation, and such
symptoms. He has taken the Roman bath twice a week for about
four months, and he appears to me now to be convalescent. He
has joined the working party, and has gained weight and strength.
Such cases of melancholia appear undoubtedly to benefit from the
continued use of the Roman bath.
II. I now pass to the record of the cases which in the female
department have been under treatment by the Roman bath.
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Use oj the Roman Bath in the Treatment of
Case 1.— Melancholia; attempt at suicide; no delusions; great
emaciation and debility; treatment by steel and *aloes and
porter; subsequent use of the Roman bath, followed by resto¬
ration of the menses and steady improvement in mental and
bodily health.
S. D—, No. 524, female, single, set. 39, admitted 3rd August,
1861.
History. —Twice attempted suicide before admission. Hereditary
predisposition to insanity; first attack of three months’ duration.
State on admission. —A quiet-looking woman, extremely depressed
in spirits; no delusions; bodily health reduced; great emaciation;
pulse feeble, tongue foul, &c.; sleeps pretty well.
She had at first some aloes and steel and porter, but she made
little or no way under this treatment.
The end of October she began the use of the Roman bath, and she
has since continued, with occasional intermissions, to Take it once a
week. The menstrual functions were in January restored, and she has
since kept regular. She has gained in flesh and strength, and is more
cheerful, but still liable to fits of depression. She states herself
that the baths have done her much good. I hope she may recover
sufficiently to be intrusted to the care of her friends. The here¬
ditary taint and form of the disease are unfavorable to a permanent
restoration to mental health.
Case 2. —Acute melancholia; obstinate refusal of food; improve¬
ment under the use of aloes and steel and porter ; relapse from
fright; symptoms obstinate and persistent; use of the Roman
bath; steady improvement (no cure).
H. M—, No. 395, female, set. 57, married, admitted July 24th,
186 °.
History. —Attempted suicide before admission. Cause of disease
unknown. An industrious woman; a laundress.
State on admission. —Extremely gloomy and depressed, refusing
to reply to questions; circulation languid; gastric derangement;
refusal of food, requiring to be fed. Under the use of aloes and
steel and porter, a marked improvement took place after a few weeks,
and she went to work in the laundry. A fire taking place in one of the
drying closets alarmed her much, and a relapse occurred (September
26th, 1860). Erom this date until June, 1861, she continued in a
most trying state, requiring constantly to be fed; taking quantities
of stimulants and yet getting no better. She lost strength and flesh,
and oedema of the lower extremities set in (no albumen). I gave
her up, and thought she could not live many weeks. I thus felt her
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to be a fit subject of an experimental trial in the Roman bath (June
4th, 1861).
The effect was, as usual, only gradual. She has taken the bath
nearly regularly ever since then, with a steady improvement in
health and condition. She is again a strong, able-bodied woman,
and regularly takes her food (ordinary diet with porter). She also
works a little at cleaning in the galleries. I have not yet ventured
to send her back to the laundry, fearing the influence of her associa¬
tions as to the fire there.
Case 3. —Acute mania, result of mental emotion shortly after delivery ;
partial recovery under the use of morphia and the wet-sheet
treatment; continued suppression of the catamenia ; use of the
Roman bath ; perfect recovery of mental and bodily health.
J. R—, No. 528, female, single, set. 19, admitted 12th August,
1861.
History. —Was confined of an illegitimate child nine weeks
previous to her admission, and the week after returned to service,
when believing (though falsely) that a remark of her mistress pointed
to the discovery of her lapse, she had a sudden attack of acute mania,
for which she was at once sent to Hayward's Heath.
State on admission. —A young woman of strong frame and good
constitution. Very incoherent, incessantly talking and shouting;
pulse 100, weak; face flushed, head hot, skin dry and hot; general
health shaken by her confinement and mental shock. For a week
she was treated with large doses of morphia and stimulants. She
was menstruating at the time, and the wet sheet was, therefore,
inapplicable. The excitement continued, as also the sleeplessness,
with but little intermission. The wet-sheet treatment was then
cautiously applied and continued for a month, the morphia being at
the same time given (as much as six grains in the twenty-four hours).
At the end of the month she again menstruated, but her mind was
still far from sane, although some improvement was to be traced.
The morphia was then omitted and the water treatment persevered
with for about seven weeks longer, when her mind recovered so far
that she was viewed as convalescent. There had, however, been
no menstruation since the second time after her admission, and her
health was shaken by the prolonged mental disease and treatment.
She began the Roman bath in August, and continued it for three
months twice a week. After four baths the menstrual functions
were restored and continued regular. She gained immensely and
rapidly flesh and strength, went to work in the laundry, and was, on
the 27th December, discharged cured, and in better bodily healt
and stouter than she had ever been.
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Use of the Roman Bath in t/te Treatment of
Case 4. — Puerperal mania ; second attack ; great depression of mind
and spirits; opiate treatment at first; subsequent use of the
Roman hath; recovery; partial relapse from premature dis¬
charge.
E. D—, No. 505, female, set. 32, married, admitted 28th May,
1861.
History. —Wife of a carpenter; had a previous slight attack after
her first confinement, four years ago, which was treated at home.
The present attack came on gradually after her confinement, eleven
weeks previous to her admission, with symptoms of moral perversion
in dislike to her child and husband, followed by fits of extreme
depression and crying, alternating with violence and excitement.
State on admission. —A delicate, nervous person; complains of
great sleeplessness; face flushed; frequent fits of crying; very un¬
settled.
Had an opiate for a few nights, on which she slept; some days a
little better, and again next day depressed as before; no delusions.
Porter and extra chop ordered.
On the 21st June she began the Homan bath, twice a week, and
continued it for a month without much improvement.
She then, however, began to gain flesh and to mend. The fits of
depression became less frequent, and she was generally more cheerful
ana contented. She kept well, and, on the 31st of August, she was
discharged cured.
Her discharge took place earlier than I should have wished. I
weakly yielded to the pressure of her husband and herself, and the
result was a relapse a few days after her return home. The symp¬
toms were not, however, so serious as to require her removal to the
asylum.
»
Case 5.— Mania (recent ) from exciting preaching ; weakness and loss
of health; suspended menses ; use of the Roman hath ; remark¬
able and rapid restoration of health; no mental improvement.
J. C—, No. 511, female, single, set. 20, admitted June 19th,
1861.
History.*— Much difficulty in learning anything of her history,
except that at some vague period between three months and three
years her mind was said to have been upset by some lay preacher of
the gospel in Brighton. She herself can give no account of it.
State on admission. —In a state of mania; restless, excited, in¬
coherent in conversation, rambling on religious subjects, much
reduced in health, emaciated, pulse feeble, tongue pale, &c. She
was treated with aloes and steel and porter. She became a little
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calmer, but no mental improvement took place. Any attempt to
employ her increased the excitement. No appearance of menstru¬
ation; very weak in health. The end of August she began the
Roman bath, and by the 17th September menstruation was restored.
She continued the bath for three months, and has menstruated regu¬
larly ever since September. She gained enormously in flesh and
strength. The bath was continued till December. She is now
(February 15th) in robust health, uterine functions regular. This
case is, however, an instance of great and wonderful improvement of
health under the use of the Roman bath, unattended by any mental
progress. She is still very excitable, and her mind so perturbed
that she cannot give any connected history of herself. A girl of
good education and appearance. She employs herself at her needle.
She has now no treatment, there being no further indications of
treatment to fulfil. I very much doubt of her recovery.
Besides the five cases here detailed I have accurate notes of other
eight cases which have been subjected to this treatment.
C. S—, No. 522, was a case of acute mania, which, during a year's
treatment at Bethlehem, had passed into apparently confirmed de¬
mentia. On admission she was inattentive to the calls of nature,
both by day and by night. Menstruation suspended. A strong,
healthy young girl. Cannot answer the simplest question correetly.
She has been under treatment with the bath for more than three
months. Her habits are improved, but no change whatever has
taken place in her physical or mental condition. She has not men¬
struated. She is still under treatment, although I hardly hope for
any result.
M. P—, No. 526, a girl off the Brighton streets, with acute mania
and uterine excitement. The most patient use of the cold-water
treatment, both the cold wet sheet and the continued hip bath, have
failed to effect the slightest improvement. The same may be said of
a course of opiate treatment, of digitalis, of warm bath. She had a
dozen of the Roman baths without any benefit. Indeed, if anything,
they rather seemed to increase the excitement.
M. B—, No. 494, a very troublesome, dirty case of acute mania
in an old woman, which was treated chiefly with opiates and got
calmer, has had her general health materially improved by the use,
for two months, of the Roman bath. She is now under treatment
with cold pails at bedtime, with the view of procuring rest and im¬
proving her habits.
S. C—, No. 462, is another very troublesome case of mania
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Use of the Roman Bath in the Treatment of
coming on during pregnancy and continuing after delivery, with
destructive and dirty habits. Here the Roman bath did no good at
all. Two cold pails at bedtime procured more rest than any opiate
in this case, and she has by the aid of time improved in her habits.
M. J —, No. 187, the most intractable case of mania, with emo¬
tional excitement, in a woman about 55, which I ever met with.*
The bath was persevered with for three months without the slightest
benefit. She subsequently died suddenly, and a post mortem revealed
unsuspected fatty degeneration of the heart. It was well she did
not die in the bath.
M. L—, No. 383, an interesting young girl, with emotional
excitement and obstinate suppression of the catamenia, contrary to
my hopes, derived no benefit from the bath. She was subsequently
removed to Hoxton House.
M. C—, No. 238, a case of mania, which lapsed into dementia,
with dirty and destructive habits, was another case which derived no
benefit from this treatment.
Lastly, M. P—, No. 490, may be referred to as a case of mono¬
mania which recovered, and in which the fading of the delusion was
simultaneous with great improvement in strength and increase of
weight under the use of the Roman bath.
* I took the opportunity of a visit he paid me, of consulting my friend, Dr.
Sherlock, on this case. He advised porter and extra meat diet, which she got, but
without any mitigation of the symptoms.
Hayward’s Heath, Sussex.
March, 1862.
ty Google
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Mental Disease, by Dr. C. Lockhart Robertson. 173
GROUND PLAN OF THE ROMAN BATH ERECTED AT THE
SUSSEX LUNATIC ASYLUM, HAYWARD’S HEATH. June, 1861.
10 feet.
a. Hot-air room. ( Calidarium .) G. Chimney.
B. Washing-room, with hot and cold douche H. Windows,
pipes. ( Lavatorivm .) I. Doors.
c. Dressing-room. ( Frigidarium .) j. Washhouse.
d. New drying-closet. k. Old drying-closet.
e. Stoke room for furnaces of bath and l. Laundry.
drying-closet, with furnace mouth. m. Washhouse yard.
e. Furnace and flue enclosed in hollow n. Hot-air apparatus of
channel. drying closet.
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Use of the Roman Rath in the Treatment of
Descriptive Notice.
The principles of the construction of the bath are, after all, not
very difficult to master. We have recently constructed one at
Hayward’s Heath of the most simple and inexpensive kind. It was
built as a lean-to to a new wash-house, so that the chimney-flue and
stoke-hole were constructed to hand, and only two walls out of the
four had to be built. The total cost, including laying on the water,
douche-pipes, &c., was under £50. It is, I beneve, the cheapest
bath which has yet been built. The annexed ground plan will,
with a few words of explanation, show the kind of arrangements
necessary.
The entire building is thirty feet long by ten feet wide, and is
divided into three compartments of nearly equal size (letters a, b, c),
each being lighted with a window. In the hot-air chamber the
window of thick ground glass is a fixture, and the fresh air is
admitted by one of Sherringham’s ventilators fixed in the upper part
of the north wall. I am not acquainted with any ventilator so
well suited for the admission into a room of the external air as that
of Sherringham. The flue extends round the four sides of the room,
passing under the door and up the wall across into the chimney of
the new drying-closet. The flue is four feet high, and is built in a
hollow air-channel, so as to give out as much heat as possible. The
centre of the chamber is paved with tiles. The flue forms a good
seat, with a board placed on it. By placing a curtain across the
upper part of the chamber, and over the furnace (f), a laconicum, or
inner hot chamber, is at once procured. The outside walls are hollow
and lined with sawdust. The roof is ceiled under the rafters, with a
sheet of sawdust between. The height of the chamber—a lean-to—
is at the highest twelve feet, and at the lowest nine feet. The
extraction of the foul air is best, I believe, attained by opening a
soot door in the ascending flue; this, with Sherringham’s ventilator
open, makes a ready, simple, and easily regulated change of air in the
chamber. A copper tank in one comer both keeps a constant supply
of water, warm enough for the douche, and also by evaporation aids in
diffusing moisture in the chamber, which must further from time to
time be increased by the use of a watering-pot on the heated floor
tiles. This hot-air chamber can in four hours be heated, if desired,
to a temperature of 200°
The next room is the washing-room (b), or lavatorium, which is
sunk a step lower than the level of the calidarium or frigidarium, and
supplied with a drain to let the waste water off. In the washing-
room we have introduced several pipes of a shower-rose, with hot and
cold-water, and two douche-pipes, one of two inches and the other of
one inch diameter. A couple of pails of water, when an attendant is
at hand, is more convenient, and to many insane patients less alarming.
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than the douche-pipe. The dressing-room (c ),frigidarium, opens on
to the washhouse yard, and is both the entrance-room and dressing-
room. It is rather smaller than is desirable, but still large enough
to cool oneself in by the aid of the open window.
I have estimated the cost of this bath at £50. I have since had
to spend £10 in building the flue round the calidarium (f, f), with
fire-brick and fire-clay. The original flue, built in ordinary brick and
mortar, fell in. Then, in any future calculations, it must be remem¬
bered that I had free of cost the main chimney flue, which was built
for the drying closet; that the drainage was there; the water just at
hand; and that, being a lean-to, I had only two walls to build. But
in most public establishments some such handy comer can be
found. I would at any rate be willing to contract (were I a builder)
for a Roman bath of the size and dimensions of the one at Hayward’s
Heath, complete in every detail, for £150. How easily the in¬
terest of this sum may yearly be wasted in drugs of very fanciful
reputation and high price.
'Postscript, May 20, 1862.
I have been favoured by the Inspectors of Asylums in Ireland
with a copy of their Eleventh Annual Report (March, 1862). In
their notice of the Cork Asylum, they thus comment upon the intro¬
duction there of the Roman bath:—
“ It (the Roman bath) has now been in operation for over twelve
months, and so successfully that similar baths may well be adopted
in other asylums. The resident physician reports very favorably of
its tranquillising effects, whilst for general use it has, in a great
measure, superseded the common tepid bath, it being daily employed
on an average, by about thirty patients, who take it in succession
through the house, unless in particular cases there be reasons to the
contrary. On inquiring from the lunatics themselves, we find that
it is agreeable to the great majority, and some even regard it as a
luxury.”
vol. vm.
12
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The Problem of Mind, propounded to Metaphysics and Science.
I. La Vie dans VHomme, par M. Tissot, 1861.—II. Tableaux de la
Vie Animale, par M. Vogt.— III. Le Cercle de la Vie, par
M. Moleschott. —IV. Force et Matiere, par M. L. Buchner.
—V. Le Monde en tant que volonte et representation, par
M. Schopenhauer. —VI. Anthropologie, par M. Herman
Fichte. —VII. Nature et Idee, par M. Carus.
I. Life in Man. —II. Pictures of Animal Life. —III. The Circle of
Life. —IV. Force and Matter. —V. The World as far as Will
and Performance. —VI. Anthropology. —VII. Nature and Idea.
Of late years, science has analysed more closely, than beforetime
was practicable, the relations connecting the organic with the in¬
organic world. It has demonstrated that the substance of animated
beings does not differ from that of inert and insensible bodies; life
lays hold of its materials in the physical world without thereby
altering their fundamental properties, and death returns them un¬
impaired to that abyss of material substance, whence they have been
for a moment abstracted to be clothed in ephemeral forms. Science
has made a further step; she is not content to prove the true and
lasting identity of the simple bodies diffused through the inorganic
and the organic kingdom; by a re-union of all the parts she has
formed, if not a living being, at least the constituent parts of organ¬
isms ; she has not formed a flower, a fruit, or a muscle, but she has
made the chemical principles from which they are extracted. Will
she go yet further? Will she be able some day to control or order
those mysterious forces which unite these principles, so as to make
of them true organisms, and combine these organisms together, and
cause them to co-operate in the formation of a common and indi¬
vidual action? We may doubt this, and it even needs some
audacity to propound such a question. Such problems can only
present themselves to us within that vague and uncertain limit
which separates the domain of science from that of metaphysics.
Happy are they who, limiting their desires and their hopes, are
content to extract some secrets from the world of phenomena,
patiently analysing its laws and registering its facts, without seeking
* to penetrate the very essence of natural forces, or of the substance
which they put in movement! He, on the contrary, who takes
in the whole world in his ambitious investigations, who will not
accept the convenient duality of mind and matter, who wishes at
least to reconcile their limits, and to fix their point of contact, con¬
demns himself to strange doubts, which scientific certainty cannot
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Problem of Mind propounded to Metaphysics and Science. 177
yet completely dissipate. Yet are there certain minds who cannot
resist the attraction of these problems. Science always leads us
towards man, and man towards philosophy. All optical science is
in our eye—all acoustic science in our ear. The weight which old
age drags, and which youth carries with so facile a grace, is that
which binds the worlds in their orbits. The caloric which animates
our bodies is a portion of the universal heat; the nerves are tele¬
graphs which imprint upon the brain the sensation produced by our
surroundings, and which transmit the dictates of our will to the
senses. All the forces of nature, without exception, have been put
in requisition to create the wondrous composition called man.
Time, space, the world at large, can teach us nothing that we can¬
not study in him, and in him we shall find more than we can ever
discover elsewhere. Man is not only a weight, a combination of
chemical atoms, an aggregate of the most delicate physical instru¬
ments, he is besides all this, a personal force. It is not, there¬
fore, without reason that biology or the study of life has been
the keystone of the scientific edifice. After traversing the nume¬
rous circles of human knowledge, we are forcibly led to this centre,
which on one side metaphysics takes as its point of departure, only
studying the being in itself, without form or exterior support, with¬
out definite action upon that which surrounds it; on the other hand,
science considers it chiefly in its manifestations, and only approaches
by degrees that unknown which lies under the phenomena. These
two methods each present a legitimate operation of the mind. To
proceed from object to subject, or inversely from subject to object,
is it not to clear the same interval, to pass over the same abyss ? To
study the relations of the corporeal substance with the hidden sub¬
stance which regulates its movements, such is the grand problem of
metaphysics; such also is the final aim of science. The former has
more immediate reference to the mind, the latter to the life ; but we
do not know more of the mind than we do of the life, and under these
differing terms is doubtless hidden one and the self-same mystery.
Is the principle of life different from that of the mind ? or, on the
contrary, is it identical? Who are right, the materialists who
identify mind and matter; the vitalists, who interpose life as a bond
between body and mind; the animists, who make the mind the source
and the principle, not only of intellectual phenomena, but also of or¬
ganic functions? Suchare the grave questions which I desire toexamine
with the aid of the most recent labours of metaphysicians and men
of science. The physiological school of Montpellier did not invent
vitality, neither did Stahl discover animism; the germs of these
great doctrines are to be traced in the remotest antiquity. In
reality, one can scarcely apprehend that man exists without demand¬
ing from himself, in terms more or less precise, what relation he
bears to the rest of the world, in what manner he differs from inert
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The Problem, of Mind propounded
matter, if the secret principle which gives him life and thought
must die with him or survive him. But these formidable questions
do not assume the same aspect in the minds of all, and even in
the same individual there are moments when they are rejected as
useless, and other moments when they intrude themselves with
irresistable authority. That which is true of man is true also of
humanity. One of the strongest attractions of the history of philo¬
sophy is to show the successive weaknesses, the victories, and
transports of a great soul which develops itself in time and circum¬
stance. A rapid glance at the modern treatises will show what
numerous solutions the problem of the mind has already received
on the part of the materialists, the animists, and the vitalists, in
France and Germany; we shall endeavour to show in what the
several schools differ, and what sources of enlightenment must be
sought from natural as well as from historical science.
The exact difference between mind and matter was not so distinct
or so complete in past times as it has become in our own day. It
may be said that for ages spiritualism and materialism have been
confounded together, like the commingling of two streams whose
waters unite. With the Greeks, enamoured of beauty of form, we
find an instinctive tendency to substitute matter for mind : Thales
recognised in the mind a force, a principle of activity and movement;
but their notions of the corporeal and of the spiritual essence,
were so indistinct the one from the other, that the same philosopher,
perceiving the attraction of the loadstone for the iron, did not hesi¬
tate to endow it with a soul.
In the Pythagorean school we may observe the first effort
towards what may be called the analysis of mind; it attempts
the classification of functions and of attributes. Pythagoras
distinguished the reasoning and immortal mind, offshoot of the
universal mind, and echo of the universal harmony, from the un¬
reasonable and ephemeral mind. Anaxagoras clearly distinguished
the sensational mind from the reasoning mind, endowing animals
and men alike, only that the reasoning mind united to the body of
an animal was destined to a state of inferiority. In this system it
is the body which perfects the mind, and is the limit of its develop¬
ment. Epicurus attributed even less to mental power, nor did he dis¬
tinguish between the reasoning and the sensational mind; but his
analysis cleared the way for a deeper research into sensational phe¬
nomena. He foresaw the distinction, so well established by modem
physiology, between animal life, properly so called, and the life of
vegetables. Plato unhesitatingly sacrificed matter to mind; com¬
paring the soul to a pilot, of which the ship is the body; he asserted
that their union is a temporary violence, and death a deliverance; a
doctrine at least seductive and ideal. Although Plato discerned in the
mind a principle unique and eternal, he recognised three functions in
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to Metaphysics and Science.
it, namely, sensibility, desire, and reason. The first two are only in
play during the short marriage of mind and matter ; once set free,
the mind ceases to feel and to desire, and immortality is only found
in the reason.
Aristotle did not, like Plato, recognise the entire independence
of mind and body; he did not, as the latter had done, dig a gulf
between the two substances. Above all, he regarded the mind as
a force, a powerful principle of activity: with him, the mind
is not the body, but it cannot exist without the body; as, for
instance, there cannot be weight without a body having weight;
nor light without a luminous body. This doctrine may be inter¬
preted in favour of more than one theory; the ancients and the
stoics chiefly forced it into materialism, the Christian philosophers
endeavoured to reconcile it with spiritualism. But the spiritualism
of the ancient fathers gave a far wider scope to matter than modem
spiritualism allows; to the body was assigned not only sensibility,
but also common sense and memory, a kind of judgment; they only
reserved to the immortal animus the most subtle powers of reason.
Saint Thomas, the angel of the school, had, to use the words of
Pascal, duly recognised the rights of the brute ; he thought it amiss
that Plato, in his sublime scorn, should pretend that the destiny
of the mind was not to be united with the body, but to be definitively
separated from it. He did not, for his part, consider them complete,
the one without the other; he did not place the mind in one defi¬
nite part of the body : it is everywhere, it is a substantial form, it
does not differ from the vital principle. “ The mind,” he writes,
"is so much the reality of the animated body, that it is through it
that the body exists, that it is a bodily organism and a living
faculty.” This doctrine was the general belief of the middle ages.
The mind united to the body enjoyed its complete life, separate from
it, it existed only as a kind of dream; the dogma of the resurrection *
of the body completed that of the immortality of the soul. Thus
Catholicism, whose greatest strength lay in harmonising itself with the
most instinctive and spontaneous wants of human nature, felt the
necessity of making the resurrection of the body the completion
of immortality. The desire of immortality is felt, as much and
as often for the sake of -others as for our own. That which is
repugnant and saddening to us, is the thought that those whom we
love, those whom our hands, our lips, our eyes, have met, those
whose life has been bound to our own with ties so sweet and so strong
that we had thought them indestructible, should disappear, and be
lost in annihilation. We wish them to live again, but our thought can
only clothe them with immortality in the form which has been familiar
to us, and since this has changed with'time and years, our hope fixes it
and clothes it with the features with which we have been most deeply
impressed* The mother bending over the cradle of her newly-born,
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The Problem of Mind propounded
can she see it in heaven otherwise than with the innocent graces of
infancy ? The poets have comprehended this want of our nature;
when Virgil and Dante conduct us to heaven or to the infernal
regions—what do we find there ? The earth. When man will only
listen to his hopes, he strips himself of cold reason, that he may be
dominated by sentiment.
The disunion of mind and matter was never complete among the
disciples of the Aristotelian school, and those philosophical reform¬
ers who aimed at founding independent doctrines yielded this point
to the opinions of their time. Bacon, exclusively physician, recog¬
nised vital and corporeal, as well as invisible mind; Van Helmont
gave a precise form to the doctrine now understood by the name of
Vitalism ; he admitted that the principle which gives us life is dis¬
tinct from the mind. This principle, named by him archeus, serves
to unite the spiritual and corporeal substances. Wherever life exists
there is the archeus: each organ has its own archeus; but in the
living being this is subordinate to a central archeus, which in man
is again under the subjection of the mind.
Descartes tore asunder the ontological tie which united mind and
matter: to the first he attributed thought, to the second extension,
and thus left them face to face, in eternal opposition. Up to his
time all the doctors, whether theologians or philosophers, had given
extension to mind, infinity to the Deity, and a finite nature to angels
and to reasoning beings. This great philosopher revived the science
of metaphysics, divided substance into two parts, without always
explaining the reciprocal action of each one to the other. Where
there is no thought, he saw only material movement; animals were
reduced to the state of simple automata; the mind of man found its
confines in the thought—the secondary need of sensibility was
wholly abandoned to the animal mind. Nothing is more curious
than to observe these great intellectual revolutions which take place
among mankind. While for many ages the attributes of extension
and thought had remained confounded together in all theories, they
suddenly became detached one from the other, and the world found
itself doubled. The incompatibility of extension and thought was
universally accepted, and the Cartesian doctrine has left traces so
profound that even in the present day no philosophical mind is
uninfluenced by it, but, even while protesting against it, shows the
marks of the chain which it has broken.
The founder of vitalism, Van Helmont, endeavoured to reunite
the two substances by an intermediate vital principle. The attempt
which Liebnitz made with the same purpose is well known, being
the original theory of pre-established harmonies. God intervenes
here directly; in His hands He holds the threads which animate
the body and those which move the mind; all the modifications of
the one correspond to the modifications of the other, arranged from
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the very origin of all things. This ingenious system pleases, but it
is so artificial that opinion rejects it, almost without the aid of reason.
A mind which represents essentially the body, a body the essential
instrument of the mind, this mind and body nevertheless strangers
to each other, except that which proceeds from the external will of
the Divinity—such is the system of Liebnitz.
About the same epoch a very different doctrine was promulgated,
which wholly subjected the material substance to the spiritual sub¬
stance ; this is the animism of Stahl, the physiologist of Halle, and
the celebrated author of the ‘ Vraie Theorie Medicale/ Matter was
reconciled with mind by becoming its docile slave, its outward and
spontaneous expression, its perpetual product. In this case the mind
constructs the body, an intelligent force choosing its materials from
the inorganic world assimilating them, impressing upon them a
special form, endowing or clothing them with new properties, com¬
pounding their organs, and grouping them in such a manner as to
co-operate in the development of a living being: the nutrition, the
circulation of the blood, the respiration, are its manifestations, as
well as the thinking powers. None of the acts observed in the
living organism are effected by the body alone, but by the mind, the
principle and cause of life. This it is, according to Stahl, that pre¬
serves the body, that develops it, fits it for its purposes, for the
body is made for and by the mind, rather than the mind made for and
by the body. Here then, it may be said, is a very wise mind! If
it discerns the nature of its organs, why suffer them to be weakened
by disease, without endowing them with the power to preserve health?'
Why permit death to seize them, having the gift of life to bestow ?
She is, therefore, bound by some fatalism in her affinities with the
organism, although the latter be her own immediate workmanship.
Here we trench upon the most delicate portion of the problem of mind.
May this mysterious substance be identified with the ego , or, in
other words, must every operation of mind be accompanied by the
phenomena of conscience and liberty ? or must we rather admit that
min d is not intelligible even to itself, and is free only in certain acts,
and that it can pursue a dull and hidden toil in the domains of
those objects which have direct reference to life, beside and beneath
the operations of thought. The school of Descartes confounded
mind with the ego; the animists only acknowledge the ego to be one
of the expressions of mind, and that it exists even where there is
neither consciousness nor liberty—in sleep, in ecstacy, in madness,
in the instinctive and spontaneous completion of all the organic
functions. Physiology and psychology are thus confounded. At
the lowest degree of animist phenomena commence the functions of
nutritive life, regular as to their principle, fixed by an instinct which
never deceives, perfect in the embryo as in the adult. The functions
of relation hold a higher place; by them the being is in affinity with
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The Problem, of Mind propounded
the external world; the mind is compelled to educate the senses and
to direct the movement of the locomotive organs: all its solicitude
is held in suspense during the period that its movements and its
sensations continue in disorder. In proportion as the acts of this
life of relation fulfil their task more easily, with habitual exactitude,
the mind, less absorbed, little by little loses the consciousness of it;
enters more freely into the world of thought, yet ceases not to act
instinctively in all the phenomena of vitality.
Is such a system materialistic, or is it spiritualistic ? It would
seem that this question cannot be answered with certainty. To
identify the vital principle with the mental principle is, perhaps,
logical; but doubtless it is to approximate the intellectual pheno¬
mena to the vital phenomena, which we are naturally disposed to
regard as phenomena of a purely material order. In the animalism
of Stahl the organic phenomena, it is true, are never referred to the
body, and in this sense Stahl is removed from materialism; but
instead of being joined to the thinking mind, and having consciousness
of its operations, they are joined with the non-thinking mind, acting
without will, without ideas, or at least without the consciousness of
this will and of these ideas. This contrast between the conscious
and unconscious operations of a unique agent has impressed many
minds, and the theory which is named Vitalim, has no other
object than to efface this, and to attribute to distinct agents these
diverse operations. Can they admit the existence of a double force,
to explain, on the one part, that which relates itself to the organiza¬
tion, properly so called, and what, on the contrary, emanates from the
thinking mind ? That would seem so much the more doubtful since
consciousness deserts us, and leaves us at fault, not only in the per¬
formance of certain organic actions, but even in that of thought
itself. It often allures us, dominates us, carries us to new scenes
without our opposition or resistance as conscious individuals. Some¬
thing suddenly arouses us as out of the middle of a dream, and it is
then only by a sudden reaction that we return into the path we have
travelled over, and that our thought manifests itself to the conscious¬
ness. If the mind ceases to be mind in those moments when she
ceases to have consciousness of herself, to what guide shall we then
be given up when we follow the capricious flight of certain ideas our
memory brings together, confusedly and without apparent order?
Who has not yielded to the oppression of a thought that he had
never invoked, starting up perpetually against the rebellious will ?
Who has not experienced presentiments or felt the goad of a thought
wholly unexpected? Who has not in moments of introspection
made acquaintance with thoughts and images, with combinations
and hopes, which a moment after, lit up by consciousness, have
filled him with trouble and sometimes with shame ? There is, there¬
fore, in the mind itself, in its purely ideal operations, something of
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unconsciousness, of fatality, a part abstracted from the law of liberty
and of reason. It is, therefore, wrong to invoke the phenomena of
consciousness in order to divide the internal being into two parts,
and to distinguish the mind from the vital principle.
Nevertheless, this is what all the vitalists have done, from Barthez
down to the present day. Also their theories, are they less interesting
from the proposition of the mind’s affinity with a hypothetical vital
principle, than from the physiological point of view, properly so
called ? The vitalists, for the most part medical men, have nevertheless
demonstrated that the explanation of the phenomena of living being is
incomplete with the intervention only of inorganic forces—light,
heat, gravitation, chemical affinity, electricity. This, it may be
affirmed, is the strong point of the vitalist doctrines; apart from
mechanical, physical, and chemical forces, they admit of special
forces which act primarily as auxiliaries and counterpoises in the
living-being. All vitalists are agreed on this point, they only differ
when proceeding to define the plastic forces which give form to the
living-being. Barthez, the celebrated founder of the physiological
school of Montpellier, recognised one vital force only, the unique
cause of all the vital phenomena of the human body; but the diffi¬
culty which the vitalists met with' in defining the vital principle , to
show how it demonstrates itself simultaneously in the body and
mind, this by degrees compelled them to limit themselves to
discover in each particular phenomenon the particular force which
produced it. They were thus led to reject the unity of the vital
principle, to localise the vital forces in the different organs, the seat
of irritability in the muscles, of sensibility in the nerves, &c. From
this point of view, it becomes easy to look upon matter as suscep¬
tible of self-organization—that is to say, materialism. From thence,
in truth, the vital school of Paris took its rise, the rival of that of
Montpellier. Organidsm is the barbarous name given to the
doctrine which long prevailed in the Academy of Medicine of our
capital. Following the adepts of this theory, force is a special
faculty inherent in organised bodies, a law of life. Yet more, it is
the life itself, the completion of the phenomena which compose it;
vital force is no more a cause, an agent to explain organization; it is
a phenomenon, an effect of this organization itself. M. Cayol, who
long upheld this doctrine in ‘ L’Union M^dicale/ compared vital force
to attraction, stating that it is the law of organized bodies, as
attraction is the law of inorganized bodies. Life thus constituted
becomes an effect only, a mode of existence of the organism, as
attraction is a mode of existence of heavy bodies; the true and only
cause is in God. Thus, on one side we approach materialism, on the
other mysticism; we accord everything to matter, and prudently
shelter ourselves under the name of the Divinity.
Discussions, at first sight confined to the narrow stage on which
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The Problem of Mind propounded
life appears bound up with the mind, and the mind with life, burst
through these limits, and an invincible logic impels certain doctrines
in the direction of pure and simple materialism, the others towards
idealism, properly so called. Characteristic circumspection in our
country usually arrests the mind on these fatal descents; but in
Germany they allow themselves to be carried away without resistance:
theories there assume forms more systematised and original. Beyond
the Rhine, it is no more a question of vitalism; materialism there
boldly asserts itself ; writers and men of science, animated with ardent
zeal and incontestable talent, tear off all the disguises of the ancient
metaphysics, attacking it with the fury of idol-shattering iconoclasts.
Elated by the discoveries of modern sciences, ardent friends of poli¬
tical and social progress, they accuse metaphysics of having too long
sent the mind of their country to sleep by sophisms and chimeras,
rendering it indifferent to liberty, by exhibiting to it all things sub¬
missive to eternal and necessary contradictions. Charles Vogt,
Moleschott, and their followers, use their materialism in the service
of political radicalism. The former, early known to fame, as the
fellow-labourer of Agassiz, and the author of scientific works highly
valued, occupied the extreme left in the parliament of Frankfort in
1848, and there delivered certain Speeches full of eloquence. He is
now proscribed, and fives an exile at Geneva, where he has become
professor of geology, and a member of the council of state.
According to Vogt, the brain secretes thought as the fiver secretes
bile ; the body is only a certain combination of matter subservient to
diverse actions; the mind is but the result of complex forces developed
in the animal organism. These doctrines are set forth in the ‘ Tableaux
de la Vie Animale' of the professor of Geneva, and in his ‘ Lettres
Physiologiques/ “ The development of the intellectual faculties,”
says Vogt, "keeps pace with the development of the brain, with the
improvement of its parts, with the consolidation of its substance, pre¬
cisely in the same manner that in other organs the development of
the function keeps pace with the development of the organ. The
same theory must consequently be admitted for these functions as for
those of the brain, presuming that the functions of sight, of hearing,
of the circulation of the blood, and of respiration, are no more inherent
in the organs, and that they continue after the annihilation of the
organs, in such a manner that sight, hearing, the circulation and
respiration continue even after death, even at the time that the eye,
the ear, the heart, and the lungs have been long since annihilated
and decomposed. The absurdity of avowing such a thing is obvious.
Thus, it will be said, the door is opened to downright materialism !
What! man a mere machine like the other animals, thought the
result of a fixed organization, and, as a result, the freedom of will
destroyed! Every modification of the function infers a material
change in the organ which precedes it, or rather which takes place
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at the same time ! I can only reply by saying :—' In truth, thus it
is, thus it is/ ”
In the foremost ranks of the positive school of Germany, we find
M. Moleschott, professor of physiology at Zurich. In his letters
addressed to the famous chemist Liebig, and collected under the
title, ‘ The Circle of Life/ the doctrine of the soul, of immortality, of
human liberty, the hypothesis of final causes are* attacked with
vigorous eloquence. To M. Moleschott matter, only is immortal,
subject to incessant transformations. Force cannot be conceived to
exist apart from the material substance, and the mind cannot be
thought of as apart from the body. A force without material agency
which supports it, is an image absolutely void of reality, an abstract
idea deprived of sense. “ To uphold the existence of vital force,” he
says, “ we rely upon that which we cannot produce in animal or
plant; but are we then able to create at pleasure every compound
mineral, even when we know its component parts perfectly well ?
And yet who attributes a vital force to the mountain ?” All the
science of life is but an extension of chemical and physical science,
thought reduces itself to a movement of cerebral matter, as sound is
the result of the vibration of the air, and light of aether. We are
plunged into a sea of moving substances, and we are ourselves but a
wave among the waves of this infinite ocean. As to our will, it is
the necessary consequence of all the movements which we produce,
and, as the planet is fixed in its orbit, so is it invincibly bound to a
natural and general law. “ If any statesman,” writes the pitiless
author, “ or more probably some pedant of the study, objects that who¬
ever denies the liberty of the will cannot attain unto liberty, I reply
that he is free who has acquired the consciousness of feeling his own
existence face to face with nature, the evidence of his existence, of his
wants, his desires, his exigencies, the limit and the range of his
activity.”
There are many other names yet to mention besides those of
Vogt and Moleschott, to show the energetic reaction of Germany at
this time against the metaphysical doctrines with which she was, as
it were, intoxicated during the former half of this century. The fun¬
damental doctrine of the new school is, that there is nothing real
without substance, nothing eternal, except substance, except the atom.
Hear M. Dubois-Reymond, the able physiologist of Berlin. “Matter
and force complete one the other, reciprocally suppose each other ;
isolated, they have no existence” he writes in the preface to his great
work upon ‘ Animal Electricity/
M. Hermann Burmeister, professor at Halle, and an eminent
zoologist, affirms, as do Vogt and Moleschott, that the mind is but
the result of forces inherent in the substances united in an ephe¬
meral auimal organism. M. Buchner, professor at Tubingen, in
his works entitled f Force and Matter/ and ‘ Mind and Nature/ has.
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The Problem of Mind propounded
engrafted the modern materialism on the old atomistic theory.
“The atom, or the smallest indivisible and fundamental part of
matter, is the deity to which all life, the lowest as the highest, owes
its existence. Existing from all eternity, the atom participates in an
eternal evolution without truce, to-day in this form, and to-morrow
in another, and it remains identical with itself in the midst of all
these transformations, always the same, immutable. The same atom
which beforetime helped to form the stone, the air, the water, at the
present time forms a part of the body, and perhaps at this moment
participates in the most complicated labour of the intellect, soon
quitting its theatre of activity, returning into the permanent round
of material exchange, and following the most diverse paths. Do
you not here recognise something which is everywhere the condition
and cause of all things, without which neither form, nor thought, nor
body, nor mind, nor in general any existence, could be possible, and
which, as a consequence, in the eternal metamorphosis of all phe¬
nomena, is alone worthy of the name of principle ? This unique thing
is the atom or substance.”
In this concert, in which Germany vaunts the material substance,
discord is always to be found; idealism yet has eloquent and clever advo¬
cates. I desire no better proof of this than the posthumous fame which
attaches to the name and to the works of Schopenhauer. This
eminent philosopher, who through the whole of his life was unable to
break through the circle of indifference and neglect which soured
his genius, now finds passionate admirers. He beguiles by the depth
and originality of his views, by the vigour of his style, and even by
the haughty and bitter melancholy which from idealism conducted to
quietism, and even as far as the nirvana of Buddhism. Schopenhauer
sets out from the absolute scepticism of Kant, and entertains a sus¬
picion of the reality of the exterior world, and of ephemeral appear¬
ances. How did he resolve this doubt? Not after the manner of
Descartes, by saying, “ I think, therefore I am.” It is by making
an appeal to the will: his formulae is:—“ I am, because I will to
be.” The will is the force which is mistress of the world, con¬
scious in men, unconscious in nature; it is the activity which
creates all phenomena, intellectual as well as material. “The
body,” writes Schopenhauer, in his principal work, entitled ‘ The
World as far as Will and Performance*, “is nothing else but the
will interpreting itself visibly, the objective will.** It is by it that
our faith in immortality is explained. If we desired not to live to¬
morrow, we could not five to-day, but wishing to live to-morrow, is
it not to wish to live always ?
As the will is the thing itself, the internal substance, the essence
of the world as of the other part of life, the visible world, the phe¬
nomenon is but the mirror of the will. The German philosopher
infers from it that life accompanies the will as invisibly, as inseparably
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as the shadow follows the body. To live always, it needs but to wish it.
He does not pronounce hesitatingly the famous “ to he or not to be”
he firmly believes that it only depends upon himself to prolong the
union of the will to a form which is its instrument. But what if this
union is not happy, if this immortality is but a chain, if nothing can
break it, not even suicide, for this only shatters the body, what is
left us except to destroy within ourselves the will to live ? All you
who are weary of bitter destiny, of the pitiful labour of daily life,
wounded in your hopes, your desires, seek oblivion in yourselves,
sacrifice your individuality, plunge into the Lethean flood of self-
abnegation. “Thus,” says Schopenhauer, “ in the contemplation of
the life and practise of the saints, we recognise the sombre impression
that nothingness which floats, as the ultimate end, behind all virtue
and all sanctity, and which we fear to dispel, as children fear the dark.
I confess willingly, that which remains after the entire destruction
of the will seems to all those who are yet embued with the desire of
life, a mere nothingness; but, on the other hand, for those with whom
the will is renounced and denied, all this world so real, with its suns
and its milky ways, in its turn is but naught.” Thus this philo¬
sophy, which rests its base upon the will, has likewise for the top-
stone the destruction of the will. The work of Schopenhauer, so rich
in details, of so profound discernment, resembles a palace built upon
the borders of the sea; we admire the sumptuous facades, the long
porticos, one walks through well designed alleys, among clumps of
verdure; but shortly we arrive upon the shore, where ocean opens his
caves and murmurs that monotonous chant which summons thought
to eternal repose.
We have opposed Schopenhauer to the contemporaneous materialists
of Germany; but the animist school numbers other representatives
beyond the Rhine. M. Herman Fichte, the son of the celebrated
philosopher, has attempted to re-animate animalism in his Anthro¬
pology. He attributes to the mind a real and individual existence.
In his system, each particular mind itself organizes the body which
is appropriated to it; this last is not, as in the doctrine of Schopen¬
hauer, an objective will; it is mind manifested in time and space.
The mind, then, may be extended ? Yes, and no; for it is not limited
geometrically by the body, it has yet a definite abode, that which M.
Fichte names—an internal body (innerrer Leib r ) endowed with or¬
ganising power, and passing through successive evolutions from life
to death. This is the new idea of the Anthropology—a strange and
difficult one to comprehend. The internal body, this mystic bond
between body and mind, is it not, under another name, the archeus
of Van Helmont?
Among the German physiologists who support spiritualist doctrines,
we must also mention Cams, the distinguished correspondent of the
Institute of France, who was honoured with the friendship of Goethe.
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The ’Problem of Mind propounded
It is necessary to go back to Plato, in order to find anything ana¬
logous to the doctrine of the learned professor, systematically ex¬
posed in a recent work, ‘Nature and Idea/ As the title indicates,
Carus accepts the body only an objective idea; the soul is the in¬
destructible idea of the body, unconscious of that which relates only
to organic transformations properly so called, conscious in the
domain of thought, but always principle and cause of all the
phenomena of the living being, from that of thought to the act of
nutrition. The mind is not localised, she is not like the spider in the
centre of her web : she has her seat in all the living cells, in each
organized monad, of which each one is in a manner an abstract of
the universe.
II.
9
What impression remains upon the mind after the examination of
so many systems ? At what fixed point can we stop ? One thing is
certain—it is this, that in order to explain life and thought, it is
needful to interpose something more than the qualities known as
that which is commonly called matter. In inorganic bodies, the
combinations result from forces inherent to the very substances
which combine themselves; but in a living compound, the power
which forms and sustains the organisms, does not only reside in the
properties of the elements: there is something else which preserves
the equilibrium between the .chemical affinity and the physical forces.
What may this new agent be? Is it simple or complex? Vitalism
is impotent to define this principle, which it interposes between body
and mind. The animists leave indefinite all the space between intel¬
lectual and organic phenomena, and moreover, do not shew with
sufficient precision all their bonds of union. In the inquiry of the
problem of the mind, they take too limited a view of anthropology.
Let them first ask what is the chief, essential, fundamental difference
between the inorganic and the organic kingdoms, and the reply to
this question will furnish a sure method by which to explore the
general phenomena of the organic world, of which man forms a part,
of which he occupies the highest place, but in which there is more¬
over something else besides.
If one considers the special characteristics of inert matter, and of
that which is organised, one mark of difference (striking from its
universality) is easily laid hold of: the inorganic substance is inde¬
pendent of time, the organic substance is dependent upon it: it is
with it, as the geometricians say, a function; that is to say, the move¬
ment of time develops continual variations in it. The mineral never
changes; it is to-day what it was yesterday, what it was in ages past.
Without doubt, external agencies, chemical and physical, are able to
alter and decompose it; but there does not exist in itself a cause of
change, and in this sense it is never a function of time. This inertia.
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this deficiency of variation removes from objects in the inorganic king¬
dom all characteristics of individuality. A crystal is not an individual:
it possesses the property of special form, but here the limits havfe no¬
thing fixed or determinate. This crystal may be considered as the aggre¬
gate of an infinity of similar small crystals; I can decompose them end¬
lessly, and in each particle discover all the fundamental properties of all.
The organized being, on the contrary, by the very fact that it is
modified during time, possesses a certain individuality which attaches
itself to the aggregate of the organisms, on which time imprints
changes ; each of these molecules is indestructible alone, but their
changing aggregate constitutes a little world, which is the individual.
A variation cannot be understood without the force which produces
it: all the varieties of the organised being must therefore be con¬
nected with correlative forces; but these variations are besides of
one kind. Take man ; if he changes from hour to hour, and from
one instant to another, it is, firstly, because he is organized, but he
has this character in common with all the other animals, and all the
vegetables. There is a certain vegetative life diffused throughout
the world, of which he partakes, and which represents a certain
order of variations in the human body.
By the side of these variations, we observe others. Man is not
fixed to the soil as the plant is ; he has a life of relation, and organs
which are its instruments. The acts of his animal life are not
arbitrary; they are determined by the species to which he belongs.
What is the force which subjects him to the exigencies of his species,
and obliges him to perpetuate its type ? It is instinct. In short,
the circle of free and personal action is supplied by a force which
constitutes individuality, and which is essentially the mind. The
mind of the plant comprises only the force destined to the develop¬
ment of the vegetative life. The mind of the beast contains, besides
that of the plant, forces of a new kind; the mind of man comprises
-at once the mind of the plant, of the beast, and a mind endowed
with higher intellectual faculties. I would not attach more import¬
ance than is necessary to these words, mind of the plant, mind of
the beast, so little capable of being strictly defined. What alone is
important to be well understood is this, that in the forces to which
our being is subjected, there is a prescribed hierarchy. Stahl and
the animists go too far when they place the manifestations of the
min4 which are accompanied by consciousness, upon the same level as
organised force, which manifests itself through a blind necessity. The
first characterise us as individuals, and distinguish us from the rest
of the creation; the second does not belong to us in particular, and
only acts within us as it acts around us. “ Consciousness,” says
Muller, “ is wanting to vegetables from the absence of a nervous
system, and yet there is in them an organic force operating according
to the prototype of each plant.” Consciousness, which does not
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The Problem of Mind propounded
give rise to any organic product, and forms only ideas, is the slow
result of development of itself, and it is bound to an organ upon
which its completeness depends, whilst the first moving power of all
harmonic organization continues to act even upon the monster de¬
prived of an encephalon. The mind, as far as it is only organic force,
manifesting itself after rational laws, must then be carefully distin¬
guished from the mind which creates ideas with conscious intent.
This simple distinction is not enough: psychology will only make
true progress so far as it strives to make a complete analysis of the
mind, as chemists make analysis of matter. It remains to separate
in man the free and conscious portion of the mind from the part
belonging to the species, for we are not only individual agents, we
are part of a vast collection of beings formed upon the same type;
our history intermingles itself with theirs, we inherit the past of
humanity, and we transmit our legacy to the future. Besides the
individual, besides the man, there is in us the animal, the vegetable,
and below all that, the being already freed from physical inertia,
but yet without form, and indeterminate.
Ail analysis of this kind, has something in it to tempt the philosopher,
as much as the physiologist: the forces which hold our being in sus¬
pense are in ceaseless conflict; it is from this point of view that we
must study the strange phenomena of sleep, of madness, of mono¬
mania, of death itself. In each of these phases the equilibrium is
different. In the state of sleep we only live, as it were, a vegetative
life, and perhaps besides this, the life of the species, for certain
instincts of the species do not sleep. Dreams, which have been
sometimes wrongly regarded as the freest flights of the mind, dreams
shun the abstract and the ideal, and principally confine themselves to
concrete images and objects: the thinking mind gives place to that
of sensation. Monomania and madness are in one sense the reverse
of sleep: the life of the species is therein sacrificed, all its wants
are forgotten, sympathy, which in the order of nature attaches it¬
self to the other members of the species, is stifled or at least deadened;
individuality triumphs and seeks by all means to satisfy its fixed
idea, be it furious or docile. The mind in this state of defiance,
headstrong, isolated, becomes occasionally so independent of the or¬
ganizing force, that it voluntarily sacrifices all the instincts, over¬
coming even the natural fear of death. The generality of physicians
no longer doubt that suicide is almost always the effect of mononjania.
Forgetful of all, possessed by an unique idea which becomes all the
world to him, which inexorably bounds the horizon of his thoughts,
so that he discerns everything like the multiplying heads of the
hydra, the wretched man, affected by this gloomy madness, in vain
endeavours to fly from himself, and at last demands from death that
repose he cannot find elsewhere. A too keen wound inflicted on the
instincts of the species, especially on the affective instincts, also
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destroys all the equilibrium of the human being, takes away all
energy of personality, depriving it even of the sad power of formu¬
lating its grief, and plunges the man into that state which is called
melancholy, a tomb in which he is buried alive. In that disease
called reasoning mania certain instincts of the species are in a state
of complete aberration, although the individual preserves all the
faculty of judging and of reasoning. If physicians were philosophers,
or if philosophers were physicians, what valuable observations should
we not possess on all these strange phenomena! The most detailed
analysis with which I am familiar is contained in f Les Maladies de
PAme humaine/ a work of the German physiologist, Schubert, who
was formerly one of the professors of the duchess of Orleans, and
continued afterwards in correspondence with this eminent princess.
He thinks that disease, in interrupting the equilibrium of the
forces which work in unison during health, throws great/ light
upon the relations between body and mind, just as a broken watch
shews more plainly the mechanism which puts it in movement.
Instead of regarding the mind as it were from the centre, one
should approach the consideration of it by degrees and from the cir¬
cumference ; instead of stating man as the immediate subject of philo¬
sophy, let us start from the outer, inert world, at the disposal of
physical and chemical forces: what do we see result? Another
world where the forms individualise themselves, and of which the
continual mobility attests the presence of new agents! Minerals,
plants, animals detach themselves, and appear to us as the steps of
evolutions in nature rising higher and higher. And man! he ap¬
pears at the summit of this vast series, species among the species,
individual in his species. But between the species and the indi¬
vidual is there not yet something ? Between the human type, as it
can be anatomically defined, and this same type such as it manifests
itself in each one of us, as free and isolated agents, is there not a
gap? And this gap is filled by the very history of the human
species; for we pertain to races, to varieties of the human race, and
we all accept the heritage of a long past; we have, if we may be
permitted to employ the expression, a historical mind—we are one of
the links of a long chain; the individual mind gives out a note
more or less sonorous; but this note enters into the harmony of the
concert, and mixes itself with a chant that, without ceasing, swells
and develops itself. The Germans, equally devoted to metaphysics
and to the learned sciences, have always allotted to the latter their
share in their great philosophical systems: they have sought (to em¬
ploy their favorite expressions) the being in its origin, its origin in
the being. There is not one of the great German thinkers of cur
time who is not preoccupied in seizing the development of a rational
idea in the ohanges of history and in the succession of the diverse
civilisations which have successively held the sceptre of human
VOL. viii. 13
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The Problem of Mind propounded
thought upon our earth. Hegel, doubtlessly set out by logic, that
is to say, by metaphysic; but he is immediately occupied in seeking
the application of the laws of his logic, in the world of matter, and
in the world of mind, that is to say, in nature and in history. The
avidity with which in our country the public accepted the works of
this critic, in which history controls philosophy, shews that the Trench
mind is not so rebellious as might be believed to considerations which
one might think it ready to condemn without appeal, when they have
been met with in the region of Germanic reveries. What a change ,
has taken place! In the last century they applauded the witticisms
of Yoltaire upon the Bible; at the present time they study the most
austere works of the exegesis. The Homeric world is better known
to us than it was to the Romans, so much has erudition penetrated
into the depths of the study of the monuments of Greek civilisation.
In going back towards the past, we see opening out on all sides the
avenues that ignorance and religious fanaticism had long closed, but
which lead to the most precious intellectual treasures.
However great may be the discoveries which are yet to be made,
it is an assured principle that humanity has not always been exactly
similar to itself. The ideas which constitute our most precious
patrimony have had their history; civilisations, which are nothing
else than the aggregate of ideas dominant at a certain epoch, and in
certain countries, have not been servile copies one of the other; mental
enlightenment has changed its place, but at the same time it has
increased. This historic mind of which the first impulses and the most
spontaneous testimony remains lost in the darkness of the past, de¬
velops itself from age to age, from nation to nation; never definitely
fixing itself upon one particular religion, aesthetics, or philosophy.
Happy are those who have the power to aid at the flowering
periods of the human mind, during which art, faith, science, all are
renewed; the mind, wafted by a favorable wind, seeks new shores,
and the world seems to be coloured with clearer light. These
periods of glad excitement cannot always continue, but they are never
wasted: nothing is lost, nothing is useless. The impulse then
given diffuses itself elsewhere, extends itself, and never stops.
Newton stands forward in all astronomy. The civilisation of Greece
has not perished; it still fills the civilised world. Who is not pagan
before the Venus of Milo, or the models of noble Greece? Homer
lives again in every one of his readers. Plato is not dead, and will
never die. The sweet and solemn words which in the sermon on the
mount gave consolation to the weak, to the poor in spirit, to the op¬
pressed, re-echo still and will do so through all the ages. Who is
not moved as if he heard them falling from the Sacred lips ?
It may be apprehended that criticism and erudition allot too
large a part in man to the ethnological and historical mind, cur¬
tailing unduly the domain of his individuality. It is, doubtless.
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to Metaphysics and Science.
difficult to find the medium, but this danger should not blind us to
the existence of an element in the mind which represents the
general action of humanity upon each individual, according to the
time, place, and circumstances. Do not deny liberty to man; but
understand that liberty itself is not to be conceived free from strug¬
gle and resistance, and no effort is more meritorious than that
which is exercised under the name of personal liberty against the
tyranny which would impose upon us opinion, tradition, custom,
good sense, which are nothing else than the reason of the historic
mind. Who does not know that these are the hardest forces to
overcome, because they find an auxiliary power in ourselves ? We
wish to breathe the air of liberty, but our lungs are accustomed to
the atmosphere of the age, of the nation, of the family, of a
coterie. A hero worthy of the name is he who listening only to
the voice of truth, stifles in himself all those fawning or irritating
voices which urge him to lie and not to stand aloof from the current
which impels the multitude and leads to easy success. Is, then, the
part of moral greatness lessened by the avowal of the weight and
resistance of those obstacles over which it has to triumph. Man,
without doubt, is free ; but then are there many men free ? The
multitude, does it do anything else than follow the collective mind
which speaks in each of us ? Many even have no desire to listen to this
voice, and, claiming no part of the historic life of humanity, suffer
themselves to live a purely animal life. The most zealous advocates of
human liberty ought not to disregard that force which rivets us to our
contemporaries and to our ancestors by blood, physical ties, moral,
religious, and social influence. Nationality, patriotism, what are they
but the noblest forms of that power which lays hold upon U3 in
the cradle, and so often stifles in us the voice of truth and of reason.
The historic mind is, we may say, pre-eminently the human
mind; animals have no history, the mind of the brute is a mind
purely specific. Its instincts are perpetuated without change;
individuals are only bom for the conservation of a type, and to
occupy one place in the picture. Some species, it is true, have
disappeared after having lived long, but have they on this account
a history ? We can say nothing else of them than that they have
been, and that they are not. Do we not offend our dignity by com¬
paring the monotonous repetition of the phenomena of the animal
kingdom with the drama of history, where races, nations, epochs
express ideas, passions, and aspirations ever new ? The mind which
expresses itself in history is, so to speak, a eea, bearing on it the
free, individual, personal mind—a sea which has its tempests and
its calms, its currents and its rocks. Our liberty consists in
finding our way upon it, in taking for our lighthouse and pole-star
the ideal illumination of the mind. Whether the wave repulses or
favours us, whether we advance or recede, our eye must be fixed
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upon the end and aim; our glory is not in the success, but in
the effort.
The problem of the mind has always been the chief object of
metaphysics; but we see it also confronting science, when, rising
by degrees above the laws which govern the whole world, it
approaches the study of organized beings, and at last that of man,
and of the great human family. The mind passes through a
natural and simple transition from the inorganic to the organized
world, from the stone to the vegetable, from the vegetable to the
animal, from the animal to our own proper species. Metaphysics
and science always apply different methods; the first views the
mind as an indivisible whole, as an ideal entity, which is all
sufficient and independent of the external world; science, on the
contrary, seeks to analyse, considers it under many aspects, studies
it from the outside, and in its connection with the whole of •
creation. There is, so to speak, no branch of human knowledge
which does not furnish some element to this curious analysis; is it
not time that metaphysics should at last draw from the treasures
accumulated by the physical sciences, chemistry, physiology,
zoology, ethnology, and history ? A higher aud universal science
which includes at once the natural sciences and the historical
sciences, might become the solid base of a philosophy whose doctrines
established a posteriori , and not preconceived like those of the old
metaphysics, this would be the resume of all the events, of all the
relations, of all the laws of which this world is at once the perma¬
nent and ephemeral expression, always old and always new.
Doubtless such a science will always remain incomplete; but
what doctrine can satisfy the human mind? To complain that
learning and science afford only imperfect solutions, is a reproach
which is easily made against speculative philosophy. Has it not
already built structures that it has boasted of as immortal, and of
which nothing is left but ruins! Instead of halting unceasingly
between the most opposite systems—from the grossest materialism
to the most intangible idealism—may she honestly become the
ally of science and found human beliefs, not indeed upon absolute i
certainty, but upon relative certainty, resting on a uniformity of laws !
more and more comprehensive. "Recent efforts, such as those of
M. Tissot, a philosopher who seeks the aid of science, and of M.
Carus, a physiologist who attempts to found a metaphysical school,
show that eminent men are prepared to sign this alliance. Both
sides will find it advantageous; science will lose nothing of its
rigour when her researches are made with a high and general aim;
philosophy throws light on the problem of the mind when she asks
of physiology, wherefore the phenomena of life cannot be explained
by the simple play of chemical and physical forces, and of zoology,
what is the nature of instinct; of medicine, what share the body has
ty Google
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to Metaphysics and Science.
in mental disease, or the mind in that of the body; and when
ethnology is interrogated in order to discover what difference exists
between one race and another; history and erudition, to ascertain how
ideas have arisen and developed themselves in the world and in the
succession of time.
The true analysis of the mind, is it not all contained in studies *
such as these? Is there not an immaterial principle in action in the
cosmos, in the plapt, in the brute, in the man ? As the narrowing
circles converge towards a common centre, in the same manner all
the forces that we see playing their part in the world, upon the
earth, in the groups of organized beings, concentrate themselves in
the human mind as in a focus. There are within us many ideas .
which stamp us: one as an organized being; another as an animal;
another as man; these ideas have one unique result, which is none
other than the mind. This is what^the animists clearly understand;
only the mind, as they define it, possesses all these ideas alone—it
creates them, the sotirce of all is in itself. The mind of Stahl builds
even the organs, and defines the bodily form which fixes the genus
and the species. To resolve the question of the mind in these terms
is to sacrifice the general too much to the individual, and to disown
the essence of the ideal principle spread abroad in the world. What¬
ever in the infinite universe is a function of time, whatever has a
history can only be the external development of a law, of a divine
idea; shut out from the infinite in time, whatever assumes form or
a transitory life enters these by thought. The animal species is
ephemeral: it has a beginning and an end; it has its proper laws
in what we call instinct. This collective consciousness is recognised
in man so far as he belongs to a peculiar animal species; but do we
not instinctively feel that this specific force, divided among millions
of individuals, does not exclusively belong to the mind, as the
Stahlians assume ? It is something which imposes itself upon us
and comes from without. How name that other feeling which
animates us in the simple capacity of living beings, belonging to
the organic creation of our planet, a creation which had its begin¬
ning and shall have its end ? Nothing is to be accounted of lightly
in our inner being; if the dull and obscure manifestations of life
do not awake in us the phenomena of consciousness, they are not
the less necessary; they are the base, the foundation, upon which
the unfettered and personal mind erects its daring edifice.
There can be no doubt that the attention of the thinker always
manifests a predilection for that part of ourselves which connects us
directly with the life of humanity, and for that which limits the per¬
sonal will upon the historic mind, and what I shall call the indi¬
vidual mind. Why be astonished at it ? It is in this domain that
our most cherished and most pressing interests are at stake;
curiosity here becomes emotion, doubt becomes inquietude. We seek
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the dread secret of our fate in retracing the wave of history, and in
fathoming the abysses of our own proper thought. We feel that
all our greatness is in reason and liberty. The triumphs of genius—
the noble spectacle of right struggling against force—the upward
aspirations of the religious soul—in a word, the human drama—this it
is which always captivates our mind most forcibly. But in its silence
and its majesty the world has something also to teach us. Beneath
the numberless shows that it reveals to us, we likewise find thought.
That we may thoroughly understand ourselves, we must equally
uuderstand what that is which is outside of us. When we have
recognised, or at least divined the laws, the divine ideas which the
body serves to express, we can look more firmly on our destiny and
on our future. We ought to acknowledge the immortality of our
material substance, as none of the molecules which compose it can
perish ; but we know that these elements now combined in the
human microcosm must disunite and relapse into inorganic inertia.
Immortal in our flesh, we are so equally in our mind, because every
one of the ideas which it receives emanates from the Divine Thought.
The organic creation may disappear from off our planet frozen by
congelation, the species may be destroyed and give way to other
species, nations have perished and left no history, individuals perish
by thousands every day; but a thought develops itself through all
these events—God lives in time, in creation, in history, in man.
That which is divine in us cannot perish ; our individuality only,
that is to say our transient form, must fade away. The vase breaks,
but the perfume which it holds preserves all its strength. We
earnestly desire immortality in our actual shape, because our imagi¬
nation, fettered by the senses, is powerless to conceive it otherwise.
This yearning after infinity is the highest privilege of our nature.
It is, no doubt, useless to seek to fathom the mysteries of futurity :
we shall never know ought of that bourne from whence, as the
English poet says, no traveller returns. Bet us study everything in
the present, let us analyse our mind, let us understand our duty
towards the animated creation, towards our species, our age, our
country, and towards ourselves. Our task accomplished, we have
nothing more (following an expression grand in its simplicity) than to
commit our soul to God.
(From the French of Auguste Langel.)
■ M. A. B.
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The Progress of Psychological Medicine since the time of Dr. Cains;
being the Thurston Speech for 1862. By C. Lockhart
Robertson, M.B. Cantab., &c. &c. &c.
{Read in the Chapel of Gontille and Caius College, Cambridge, on Dr. Wendy's
Commemoration Day, May V&lh, 1862.)
There is no branch of the healing art in which modern medical
science can point to greater results than in that which concerns
itself with the care and treatment of mental disease—none which has
made such progress since the time of our third and greatest founder.
Dr. Caius was in the height of his fame and practice when
Henry VIII, in 1547, granted the revenues of the suppressed priory
of S. Mary of Bethlehem to the City of London, for the reception of
their lunatics, being the first authentic record we possess of the foun¬
dation in England of a hospital specially devoted for the reception of
persons of unsound mind. It is, therefore, in the treatment of the
insane in this and similar asylums that I propose tracing the
progress made, since 1547, in the theory and practice of psychological
medicine.
If I claim for this department of medicine the great advances
which it has made since the days of Dr. Caius, I am also bound to
admit of how recent origin this progress is. Indeed, it is only
within our own generation—I might almost say, since the year 1839,
when Dr. Conolly presented his first report to the Visitors of the
Hanwell Asylum—that the system of non-restraint—on which all
advance, past and future, in the treatment of the insane must be
based—has been recognised as of universal application.
"Nothing, in fact,” says Dr. Conolly, "is more difficult to
account for than the long neglect, in communities calling themselves
civilised, of those afflicted with a malady so much the more dreadful
than other maladies, that, before it destroys life, it may be said to
destroy all that makes life valuable or desirable. No malady effects
such wide destruction, or creates so much and such varied distress.
It extinguishes knowledge, confuses eloquence, or buries it in ever¬
lasting silence; it lays waste all accomplishments; renders beauty
itself painful or fearful to behold; whilst it breaks up domestic
happiness and perverts or annihilates all the habits and affections
which impart comfort, and joy and value to human existence. Yet
nothing is more certain than that this complicated misery, including
every other form of misery and mental suffering, has been not only
the subject of neglect, but of most general abuse and cruelty in all
^8"®% even down to the times in which we live.”
q. thfffos jpital of S. Mary of Bethlehem, which, according to
'■ f J ^^^ted by Strype (little or nothing, save the name, occurs
m % yJ-* editions), stood in Bishopgate Ward without the city
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Progress of Psychological Medicine since the
wall, in what was then open country, was first founded by Simon
FitzMary, one of the sheriffs of London, in the year of our
Lord 1246.
The original deed of gift sets forth a grant of his lands in Bishop-
gate without, to Godfrey, Bishop of Bethelem, and to his successors,
and to the chapter of the Church of Bethelem, “ to make there a
priory, and to ordain a prior and canons, brothers, and also sisters,
when Jesus Christ shall enlarge his grace upon it. And in the same
place the rule and order of the said Church of Bethelem solemnly
professing which shall bear the token of a starre openly in their
copes and mantles of profession, and for to say divine service there
for the soules aforesaid, and all Christian soules and specially to
receive there the Bishop of Bethelem, canons, brothers, and mes¬
sengers of the Church of Bethelem for evermore, as often as they
shall come thither.”
King Henry Till gave this house to the City of London; they
converted it to a house or hospital for the cure of lunatics. “ This
hospital (says Stowe) stood in an obscure and close place, near unto
many common sewers, and also was too little to receive and entertain
the great number of distracted persons, both men and women.” The
site of old Bethlehem is now occupied by Bethlem Court, off Bishop-
gate Street.
In 1675 the second Bethlehem Hospital was built in Moorfields.
Stowe speaks of it as a stately and magnificent structure, “ containing
in length, from east to west, 540 feet, and in breadth 40 feet, besides
the wall which encloseth the gardens before it, which is neatly
ordered with walks of freestone round about, and grass plats in the
middle. And besides this garden there is at each end another for
the lunatic people to walk in for their refreshment when they are a
little well of their distemper; this wall is in length 680 feet, and in
breadth 70 feet, at each end being very high; and that part fronting
the fields hath iron gates in several places of the wall, to the end that
passengers, as they walk in the fields, may look into the garden.
This large fabric is built of brick and freestone; the gate or entrance
all of stone, with two figures of a distracted man and 'woman in
chains (a curious piece of sculpture) over the gate. And in this, as
well as in the building, the architecture is good. It hath a large
cupola with a gilded ball, and a vane at the top of it, and a clock
within, and three fair dials without. And behold, here is a map or
prospect of the building fronting the fields.”
Stowe proceeds to give an account of the general management of
the hospital, from which I would gather, that in' the earlier days of
new Bethlehem— i.e., in the latter part of the seventeenth century—
a more humane system of treatment was pursued there than in the
following century.
Besides the in-door patients, the governors of Bethlehem had out-
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time of Dr. Cains, by De. C. Lockhaet Robinson. 199
door patients or pensioners, who bore upon their arms the licence of
the hospital. It was not until 1675 that this licence was in the
* London Gazette ’ thus formally withdrawn:
“ Whereas several vagrant persons do wander about the City of
London and counties, pretending themselves to be lunaticks under
cure in the Hospital of Bethlehem, commonly called Bedlam, with
brass plates about their arms, and inscriptions thereon. These are
to give notice that there is no such liberty given to any patient kept
in the said hospital for their cure, neither is any such plate, as a
distinction or mark, put upon any lunatick during their time being
there, or when discharged thence. And that the same is a false
pretence to colour their wandering and begging, and to deceive the
people, to the dishonour of the government of that hospital.”
These out-patients, or discharged pensioners of Bethlehem Hos¬
pital, have acquired an undying celebrity through Edgar’s feigned
insanity, to save his life, as a bedlam beggar.
The figure is evidently drawn from life:
“ Whiles I may ’scape
I will preserve myself: and am bethought
• To take the basest and most poorest shape
That ever penury in contempt of men
Brought near to beast: my face I’ll grime with filth,
Blanket my loins; elf all hair in knots
And with presented nakedness out-face
The winds and persecutions of the sky.
The country gives me proof and precedent
Of Bedlam beggars who with roaring voices
Strikfe in their numb’d and mortified bare arms
Pins, wooden pricks, nails, sprigs of rosemary;
And with this horrible object from low farms,
Poor pitting villages, sheep cotes, and mills,
Some time with lunatic bans, some time with prayers,
Enforce their charity.”
D’lsraeli, in his ‘Curiosities of Literature/ devotes a chapter to the
" Tom o’Bedlams,” as these patients were called, and to which I would
refer for farther information.
“ In consequence of the limited resources of the hospital,” he says,
“ the governors relieved the establishment by frequently discharging
patients whose cure might be very equivocal. Harmless lunatics
thrown thus into the world, often without a single friend, wandered
about the country chanting wild ditties, and wearing a fantastical
dress to attract the notice of the charitable, on whose alms they lived,
^ey i 3£ J a kind of costume, which I find described by Handle
otowe, in a curious and extraordinary work (‘The Academy of
-—.* The bedlam has a long'staff, and a cow- or ox-horn by
r 18 sty, his clothing fantastic and ridiculous; for, being a madman,
e is \cLLy decked and dressed all over with ribands, feathers,
cloth, and what not, to make him seem a madman, or
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Progress of Psychological Medicine since the
one distracted, when he is no other than a wandering and dissembling
knave/ This writer here points out one of the grievances resulting
from licensing even harmless lunatics to roam about the country;
for a set of pretended madmen, called Abram men , a cant term for
certain sturdy rogues, concealed themselves in their costume, covered
the country, and pleaded the privileged denomination when detected
in their depredations.”
Steele, in the ‘Tatler/ (June 18,1789,) gives us a glimpse of how
things in his day went at Bethlehem. “ On Tuesday last (he says)
I took three lads who are under my guardianship a rambling in a
hackney coach, to shew them the town; as the lions, the tombs,.
Bedlam, and the other places, which are entertainments to raw minds,
because they strike forcibly on the fancy.” Again, in f The World/
June 7, 1753, there is a paper by Moore, the editor, on the shame¬
ful practice of exhibiting lunatics in Bedlam, from which I make
the following extract:
“ To gratify the curiosity of a country friend, I accompanied him
a few weeks ago to Bedlam. In one cell sat a wretch upon his straw,
looking steadfastly upon the ground in silent despair. In another,
the spirit of ambition flashed from the eyes of an emperor, who
strutted the happy lord of the creation. Here a fearful miser, having
a fancy, converted his rags to gold, sat counting at his wealth, and
trembling at all who saw him. Here the prodigal was hurrying up
and down his ward, and giving fortune to thousands. On one side,
a straw-crowned king was delivering laws to his people, and on the
other, a husband, mad indeed, was dictating to a wife that had un¬
done him. Sudden fits of raving interrupted the solemn walk of the
melancholy musician, and settled despair sat upon the pallied counte¬
nance of the love-sick maid. * * * * I am sorry to say it,
curiosity and wantonness, more than a desire of instruction, carry
the majority of spectators to this dismal place. It was in the Easter
week that I attended my friend there, when, to my great surprise, I
found a hundred people at least, who, having paid their twopence
a-piece, were suffered, unattended, to run rioting up and down the
wards, making sport and diversion of the miserable inhabitants—a,
cruelty which one would think human nature hardly capable of!
Surely if the utmost misery of mankind is to be made a sight of for
gain, those who are the govemours of this hospital should take care
that proper persons are appointed to attend the spectators; and not
suffer indecencies to be committed, which would shock the humanity
of the savage Indians. I saw some of the poor wretches provoked by
the insults of this holyday mob into furies of rage ; and I saw the
poorer wretches, the spectators, in a loud laugh of triumph at the
ravings they had occasioned.”
So also Mr. Pepys enters in his diary, “ Stept into Bedlam, where
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I saw several poor miserable creatures in chains; one of them was
mad with mating verses.”
Hogarth's eighth picture in the "Rake's Progress” (at this
moment in the Great Exhibition) drawn in 1785, and retouched in
1763, is evidently a sketch from the wards of old Bedlam. The
ankle chains are on the rake who is dying in his wife's arms, the
physician leaning over them; in one of the cells is seen a naked
figure on a straw bed, the wrist-chains hanging over the bedstead;
a crowned king sits in another cell; the mad astronomer is in the
centre of the picture, while the cells are only dimly lighted by the
small, unglazed high window, placed near the roof window—just
as they were in the present Bethlehem so recently as in 1852.
“ I have sometimes (says Charles Lamb) entertained myself with
comparing the ‘ Timon of Athens' of Shakespeare, and Hogarth's
1 Rake's Progress' together. The story, the moral in both is nearly
the same. The wild course of riot and extravagance ending in the
one with driving the prodigal from the society of men into the soli¬
tude of the deserts, and in the other with conducting the rake
through his several stages of dissipation into the still more complete
desolations of the madhouse, in the play and in the picture are de¬
scribed with almost equal force and nature. The concluding scene
in the ‘ Rake's Progress,' is perhaps superior to the last scenes of
‘ Timon.' If we seek for something of kindred excellence in poetry,
it must be in the scenes of Lear's beginning madness, where the king
and the fool, and Tom-o-Bedlam, conspire to produce such a medley
of mirth checked by misery, and misery rebuked by mirth—where
the society of those ( strange bed-fellows' which misfortunes have
brought Lear acquainted with, so firmly sets forth the destitute
state of the monarch; while the lunatic bans of the one and the
disjointed sayings, and wild but pregnant allusions of the other, so
wonderfully sympathise with that confusion which they seem to
assist in the production of, in the senses of that ‘ child changed
father.'
"In the scene in Bedlam which terminates the * Rake’s Progress'
we find the same assortment of the ludicrous with the terrible. Here
is desperate madness, the overturning of originally strong thinking
faculties, at which we shudder, as we contemplate the duration and
pressure of affliction which it must have asked to destroy such a
building; and here is the gradual hurtless lapse into idiocy of
faculties, which, at their best of times never having been strong, we
look upon the consummation of their decay with no more of pity than
is consistent with a smile. The mad tailor, the poor driviller that has
gone out of his wits (and truly he appears to have had no great
journey to go to get past their confines) for the love of ‘ Charming
Betty Careless'—these half-laughable, scarce-pitiable objects, take
off from the horror which the principal figure would of itself raise, at
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the same time that they assist the feeling of the scene, by contribut¬
ing to the general notion of its subject:
44 4 Madness, thou chaos of the brain.
What art that pleasure giv’st and pain ?
Tyranny of fancy’s reign!
Mechanic fancy that can build
Vast labyrinths and mazes wild,
With rule disjointed, shapeless measure
Fill’d with horror, fill’d with pleasure!
Shapes of horror that would even
Cast doubt of mercy upon Heaven,
Shapes of pleasure that but seen
Would split the shaking sides of spleen.’
[Lines inscribed under'Jhe Plate'].
“ It is carrying the comparison to excess, to remark that in the poor
kneeling weeping female, who accompanies her seducer in his sad de¬
cay, there is something analogous to Kent or Caius as he delights
rather to be called in Lear—the noblest pattern of virtue which even
Shakespeare has conceived—who follows his royal master in banish¬
ment, who had pronounced his banishment, and, forgetful at once of
his wrongs and dignities, taking on himself the disguise of a menial,
retains his fidelity to the figure, his loyalty to the carcass, the shadow,
the shell, the empty husk of Lear.
“The Rake of Hogarth, when he is the madman in the Bedlam
scenes, is a face winch no one that has seen can easily forget.
There is the stretch of human suffei^ng to the utmost endurance—
severe bodily pain brought on by strong mental agony, the frightful
obstinate laugh of madness—yet all so unforced and natural that
those who never were witness to madness in real life, think they see
nothing but what is familiar to them in this face. Here are no tricks
of distortion, nothing but the natural face of agony. This is high
tragic painting; and we might as well deny to Shakespeare the honours
of a great tragedian, because he has interwoven scenes of mirth with
the serious business of his plays, as refuse to Hogarth the same
praise for the two concluding scenes of the ‘Rake’s Progress/ because
of the comic lunatics he has thrown into the one, or the alchymist
that he has introduced in the other, who is paddling in the coals of
his furnace, keeping alive the flames of vain hope within the very
walls of the prison to which the vanity has conducted him, which
have taught the darker lesson of extinguished hope to the despond¬
ing figure who is the principal person of the scene.”
* The Report and Minutes of Evidence from the Committee appointed
to consider of provision being made for the Better Regulation of
Mad-Houses in England (ordered by the House of Commons to
be printed 11th July, 1815)/ including as it does a full inquiry into
the condition of old Bethlehem, at Moorfields, (new Bethlehem was
just then building), will enable us to follow the history of that metro-
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politan asylum, and thus obtain, doubtless, a fair sample of what
asylums in England, even in 1815, were; and so shall we better be
able to judge of the progress now gained in this department of
medicine.
Mr. Wakefield gives evidence of a visit he made to Bethlehem, on
the 2nd of May, 1814, in company with one of the governors and
Mr. Western, M.P. for Essex. Attended by the steward of the
hospital and a female keeper, he visited the women’s galleries. One
side of the room (he informed the committee) contained about ten
patients each chained by one arm, or by the wall, the chain allowing
them merely to stand up by the bench or form fixed to the wall, or
to sit down on it. The nakedness of each patient was covered by a
blanket-gown only; the blanket-gown being a blanket formed some¬
thing like a dressing-gown with nothing to fasten it with in front;
this constituted the whole covering; the feet even were naked. Many
of the patients at this visit were found locked up in their cells, naked,
and chained on straw, with only one blanket for a covering. One
who was in that state by way of punishment, the keeper described as
the most dissatisfied patient in the house. She talked coherently,
complained of the want of tea and sugar, &c., &c.
In the male wing these visitors found six patients chained close to
the wall, five handcuffed, and one locked to the wall by the right arm
as well as by the right leg; he was very noisy; all were naked, except
as to the blanket-gown, or a small rug on the shoulders, and without
shoes. The nakedness of the patients and the mode of confinement
gave this room (said the witness) the complete appearance of a dog-
kennel. They saw a quiet, civil man, a soldier, a native of Poland,
brutally attacked by another soldier, the keepers informing them that
he always singled out the Pole as an object of resentment, and that
there was no means of separating these men except by locking one up
in solitary confinement. In the men’s wing were about seventy-five
or seventy-six patients, with two keepers and an assistant, and about
the same number of patients on the women’s side; those of the
patients who were not walking about or chained in the side-rooms
were lying “ stark naked ” upon straw on their bedsteads, each in a
separate cell, with a single blanket or rug in which the patient usually
lay huddled up as if impatient of cold, and generally chained to the
bed-place, of the shape of a trough; about one-fifth were in this state
or chained in the side-rooms. It appeared that the weak patients,
and all who were inclined to lie abed, were allowed to do so from
being less troublesome in that state than when up and dressed.
The physician, according to the steward’s evidence, attended but
seldom —" 1 hear he has not been round the house but once these
three months.” The apothecary attended for about half an hour
daily. In certain months of the year particular classes of the patients
were “ physicked, bathed, bled, and vomited at given periods.” The
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patients, said Dr. T. Monro in his evidence, are ordered to be bled
about the latter end of May or the beginning of May, according to the
weather; and after they have been bled they take vomits once a
week for a certain number of weeks; after that they are purged. That
has been the practice invariably for years (3aid Dr. Monro) long be¬
fore my time; it was handed down to me by my father, and I do not
know any better practice.
A male keeper (the apothecary reluctantly witnessed) was ap¬
pointed to the service of the refractory female patients. One female
patient he also admitted had been pregnant twice during the time
she was in the hospital.
The iron-barred windows of the cells, the steward stated, were not
generally glazed, but closed only with a shutter. There was no warm
bath in the asylum, and the one cold bath was so out of the way that
it was rarely used.
The straw in the cells and beds was changed once a week, unless
very wet; the patients in large numbers were locked by the hand to
the bed at night. There was no night-watch in all the asylum.
The offices of religion were apparently unknown in the asylums of
this date.
Verily the insane were then an outcast multitude.
In order vividly to see the progress which medical science has
made since Dr. Cams's time, let us look at one of our English
county asylums of to-day. A very good specimen is the Cambridge
Asylum at Fulbourne, under the able administration of my friend
Dr. Lawrence.
The first great fact observed is the entire absence of all means of
mechanical restraint. Neither belt, strait-jacket, manicle, strong
chair, or any other means whatever for restraining the patient, are to
be found there. All appearance of a prison has also been removed.
The windows have no bars, the doors no bolts, the entrance hall
stands open, and apparently no external distinction is observed
between this and any other large hospital for the treatment of disease.
The whole asylum bears the aspect of some large house of industry.
The female patients, seated at needlework in their day-rooms, or
washing in the laundry, or cooking in the kitchen, or engaged in the
various household arrangements, would hardly by a casual observer
be recognised as persons of unsound mind. So, also, in turning to
the male department. Parties of ten or a dozen working in the
garden, or engaged in the detail of agricultural labour present little
evidence of insanity. In the several workshops of the tailor, the
shoemaker, the carpenter, the smith, the basket-maker, the baker,
the brewer, are patients daily engaged at their respective trades.
Employment and the confidence shown by the implements and tools
intrusted to the patients have evidently replaced the old means of
coercion and restraint. In visiting the several rooms at meal time
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the greatest order and quiet reign. Grace before and after meals is
repeated with all reverence, standing; the food is served on earthen¬
ware plates, the beer in mugs or tumblers, as in any other hospital.
On the tables in the wards inhabited during the day are books and
newspapers, and games—cards, dominoes, bagatelle-boards, &c. The
walls are hung with prints—easy chairs stand before the open fire,
burning brightly without any guard or protection whatever. The
windows apparently open at will (only the opening is so arranged
that no patient can throw himself out of it), and look on a wide
landscape, and, being generally with a south aspect, the house is
filled with the brightness of the morning sun.
One constant, careful, and anxious system of watching pervades all
this apparent freedom. No patient is ever left at any time alone;
the sense of moral control of his attendant is never away from his
mind. By night the wards are hourly visited, and the slightest
noise or restlessness seen and attended to with the prescribed
remedies.
The means of employment are carefully adapted, under the control
of the several officers of the asylum, to the peculiarities of each
individual case.
The nurses who thus tend the insane are of the stamp of the S.
John’s Sisterhood, who now have charge of King’s College Hospital.
They are generally selected young, it being found by experience that
young girls of twenty-three or twenty-four better adapt themselves to
the varying character of their patients than those who commence the
work with more formed mind and opinions.
The sanitary arrangements of these asylums are most carefully
studied. Every ward is supplied with hot and cold water, and a warm-
bath and a hot and cold shower-bath, and a filter to clear the drinking-
water, and water-closets and urinals of the most approved construction.
The infirmaries for the sick are supplied with every requisite treat¬
ment, and medical comforts are administered with a lavish hand.
Every appliance that modem skill can furnish for the relief of
suffering—German spring- and water-beds for the bed-ridden, sofas,
reclining chairs, every variety and contrivance of bath, &c., &c., are
to be found there. The English county asylum of to-day can chal¬
lenge comparison in its healing resources, its quiet and comfort, its
fittings, diet, and domestic arrangements; and, may I add, in the
professional s kill and reputation of its physician? even with the
metropolitan general hospitals; nor will the Cambridge .County
Lunatic Asylum at Eulboume suffer by contrast in these particu¬
lars with Addenbroke’s Hospital.
There is, however, a dark side to this, as to every other picture of
human affairs. There are a large number of hopeless cases of in¬
sanity—the idiot, the confirmed epileptic, the paralysed, the utterly
demented—on whose weary path no remedial agencies can throw any
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light or change, who are also the objects of our care. They are phy¬
sically incapacitated for work; amusement they cannot share in, but
still they can be kept clean and quiet, and carefully nursed and fed,
and so tended while life lasts. They require, indeed, a daily and
hourly care and watching, often of the most varying and harassing
kind, yet of which labour the remedial results can only be seen and
recognised by those familiar with the symptoms and progress of
chronic mental decay.
Again, we have recent and acute cases to treat, and in this task the
resources of modem medicine are most triumphant. I cannot
in this place linger on them, I can only affirm that the most violent
cases of raving madness are all treated in our county asylums,
without any mechanical restraint whatever, and that a week or ten
days active treatment usually suffices to calm the violence and to
remove the urgent symptoms of the disease.
The asylums on the Continent are still, in some places, much as
they were in 1815 in England. Thus Dr. Corrigan, President
of the Irish College of Physicians, so recently as the present year
(' Ten days in Athens, with Notes by the WayLondon, 1862), gives
a description of the asylum at Florence, which would almost apply
to Bethlehem of 1815. “The building,” he says, “is ill-designed
—a horrid array everywhere of iron gratings; the sleeping rooms
with square-barred openings into them, exposing the inmates, male
and female, to the gaze of visitors. One of the first objects that
pained me in my examination, was a weakly-looking young man
under restraint. On his shoulders, and extending some way down
his arms, was a cape of hard, thick leather, which had been let down
over his head ; this, secured below, prevented his raising his shoulders.
Bound his middle was a thick leather strap, secured with an iron
screw; to this were attached handcuffs, in which his wrists were
confined. Attached to the front of the seat of the wooden chair on
which he sat was an inclined plane, in which were holes at intervals,
and through these cotton straps were passed and tied on the under
side of the inclined plane, securing his legs to it, as we see patent
pens and pencils secured in a paste-board for exhibition in a sta¬
tioner’s window. I asked the particulars of his case. He had been
five months ill, and had been for the last two months secured—
confined as I saw him—because he had attempted his own life or
been violent to others. The next patient I saw under restraint, was
a man secured in bed by arm-straps, stretched and tied on his back,
as we sometimes see St. Lawrence represented on a gridiron in a
painting of his martyrdom j but, in addition, there was stretched over
this man, about a foot above his body, a strong web net, firmly
strapped from side to side on the railings of his bed. I saw in the
sick ward a very young man, neither sick nor violent, secured in like
manner as the other, with body-straps not permitting him to turn
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his body, with, strait waistcoat, with legs in like manner secured to
the foot of the bed. I was informed he was epileptic; that he had
once broken his arm in an epileptic fall; that he had an attack the
night before, and that he was thus secured lest he might have
another. In one dav-room I reckoned eleven or twelve of the men
*
under restraint, with leather muffs on their hands, and handcuffs on
their wrists, fastened by iron rings to a leathern belt round the
waist, secured behind by an iron screw, which projected at least half
an inch through an iron plate against the spinal region. I asked to
have the strap loosened, and through all the clothes the skin was
reddened by the working against it of the end of the iron screw.
Lying or sleeping on the back, or even leaning against the back of
a chair, was impossible with such an apparatus, and an accidental
blow or push on the back would drive the projecting point of the
screw against the back, causing pain or more serious injury. In
every day-room there was one or more of the restraint chains, such as
I have already described.”
The old method of treatment, of which I have, in my account of
Old Bethlehem, faintly traced an outline, and which apparently still
lingers in Florence, had for its guiding principle the doctrine that the
insane were dangerous and ill-disposed persons, requiring for their
safe custody the most powerful means of restraint, and for their
guidance the stimulus of fear. Hence, as we have seen, every means
of intimidation were freely resorted to, and cruel physical restraint
was an every day practice. Such was the system of treatment from
Dr. Caras' time down to our own day. So recently, indeed, as in
1859, the Commissioners in Lunacy reported to Parliament, that this
principle of coercive treatment, with its restraints, its neglects,
its filth, was still practised by the Poor Law authorities on the
lunatic inmates of the union houses; while the Royal Scotch Lunacy
Commission, of 1858, exposed the existence of a similar plan of
treatment by the parochial authorities in that country.
The recent progress made in the treatment of mental disease is
based on the recognition of the physical origin of the disease, and
still more on a fuller study of the laws of mental pathology, resulting
in a knowledge of the motives and springs of action which influence
the thoughts and conduct of the insane.
Prejudice and fear of personal injury, together with the general
ignorance of mankind of the relations existing between mind and
body, and of their mutual influence in health and disease, long im¬
peded the application of the principles of rational medicine to the
practice of lunacy. “ The old system,” says Dr. Conolly, “ placed
all violent or troublesome patients in the position of dangerous
animals. The new system regards them as afflicted persons whose
brain and nerves are diseased, and who are to be restored to health,
and comfort, and reason. This simple difference of view it is which
VOL. VIII. 14
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influences every particular in the arrangement of every part of an
asylum for the insane.”
The modern medical treatment of the insane is thus directed to
influence the mutual relations of mind and body; to soothe nervous
irritation ; to relieve congestion of the brain; to remove all cause of
sympathetic irritation or disorder in other organs of the body, which
may influence the mental manifestations; to improve the quality of
the blood, on which, perhaps alone, the disease may depend; and
generally, to apply the principles of rational medicine to the treat¬
ment of the special symptoms of each individual case.
1 quote from a lecture of Dr. Conolly’s read at Hanwell in 1847,
and published in the ‘Lancet/ the following apt illustration, both
of the influence of physical disorder on mental- disease, and of its
treatment in the same case under the old system of coercion, and
then by the recognition of the influence of the existing physical
disorder, on the mental manifestations:
“ It was in the female infirmary at Hanwell, exactly seven years
ago, that I found, among other examples of the forgetfulness of
what was due either to the sick or insane, a young woman lying in
a crib, bound to the middle of it by a strap round the waist, to the
sides of it by the hands, to the foot of it by the ankles, and to the
head of it by the neck; she also had her hands in the hard leather
terminations of canvas sleeves. She could not turn, nor lie on her
side, nor lift her hand to her face, and her appearance was miserable
beyond the-power of words to describe. How long she had been
in this state it is not material to record. That she was almost
always wet and dirty, it is scarcely necessary to say. But the prin¬
cipal point I wish to illustrate by mentioning this case is, that it
was a feeble and sick woman who was thus treated. At that very
time, her whole skin was covered with neglected scabies, and she was
suffering all the torture of a large and deep-seated abscess of the
breast.
“ Let it be considered what must be the effect on the attendants
of having customary recourse to the imposition of restraints, when
such complicated suffering as this became comparatively disregarded
by medical men, in consequence of the spectacle presented to them
being at each visit, not that of a sick person requiring aid, but of a
dangerous lunatic cruelly fastened and bound.
“ But this patient was neither dangerous to herself nor to others.
The excuse alleged for this mode of treatment was, that she would
eat the poultices employed, and^which contained lead, and that she
was very mischievous : that was all. However, she was liberated;
no bad consequences ensued, and, in a few weeks, I saw the poor
creature at the chapel, and even heard her play the organ, which she
had been accustomed to do, in the church of a village in Middlesex,
before her admission. This patient died very recently, having, from
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the time of her liberation from restraints, scarcely ever given any
trouble to the attendants. Perhaps, if I had never seen such a case,
I should have been less earnest to adopt the system which I knew
had been tried at Lincoln, and slower to try to manage the patients
of this great asylum entirely without restraints.
“ Many a case was yet to be managed, in which every ingenious
difficulty was created or encouraged to baffle this attempt ; many
anxieties were to be endured, many misapprehensions to be submitted
to, and much suffered; but all is now passed, and I thank God, with
deep and unfeigned humility, who has permitted this great experi¬
ment to proceed for full seven years without one accident calculated
to discredit it, and with a general result on the asylum best known
to those who knew the asylum befofe, and a general effect on all
other asylums, in almost every region of the globe, which can never
be entirely lost.”
Insanity is, however, a mental as well as a physical disease, and
we are only one step forward in the modern progress of its treat¬
ment, by applying to the relief of the physical symptoms the prin¬
ciples of rational medicine. Another, and I think a more important,
part of the duty of those called to “ minister to the mind diseased,”
consists in the careful study and application, both to the general
conduct and government of the asylum, and to the treatment of each
individual case, of the principles of mental pathology—of the laws
which regulate the manifestations of the mind in disease.
Thus, in illustration of the application of the laws of mental patho¬
logy to the government of an asylum, may be quoted the law, slowly
evolved through careful trials and observation, that insanity does
not necessarily destroy the influence which order and regularity, and
the force of example, exert on conduct, but that, on the contrary, the
most riotous and disorderly patients, after arriving at the asylum
perhaps bound hand and foot, and under strong escort, yet in a few
weeks, often without any treatment, save the influence of the disci¬
pline and order of the house, become, though still as insane as before,
quiet and orderly in their conduct, industrious, and obedient to the
rules which regulate the daily life of those with whom they are
associated. Were this influence not a law of mental pathology, we
should have no alternative but to revert to the old restraint system.
Again, in the treatment of an individual case, the recognition in
mental pathology of the law, that the mind and conduct of the
insane may yet be influenced through the medium of the sympathies,
at once gives us a powerful moral therapeutic agent, with which to
combat insane delusion and conduct. This power of influencing the
morbid sympathies of the insane, and so. winning them to a healthier
frame of mind, through lessons of patience and contentment, is a
gift possessed in very unequal degree by the physicians and attendants
who undertake their care—yet a power on the presence of which
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Progress of Psychological Medicine.
their comparative success materially depends. “ A faculty (says Dr.
Bucknill) of seeing that which is passing in the minds of men is
the first requisite of moral power and discipline, whether in asylums,
schools, parishes, or elsewhere. Add to this a firm will, the faculty of
self-control, a sympathising distress at moral pain, a strong desire to
removeit,andthatfascinatingbiologisingpower is elicited which enables
men to domineer for good purposes over the minds of others. With¬
out these qualities no one can be personally successful in the moral
treatment of the insane. A mere amiable and feeble, or a coarse
and uncontrollable mind, alike fail in this delicate duty; and if the
possessor of such a mental constitution has the wisdom to estimate
this duty at its full value, he must perform it vicariously. That so
much of it may be so well donfe vicariously, by ordinary attendants,
is a most happy circumstance for mental sufferers, and proves that
the possession, at least in a moderate degree, of the qualities indi¬
cated, is consistent with a defective education, and a lowly social
rank.”
So, in the case of a strong delusion, the laws of mental pathology
teach that reason and argument—owing, probably, to the excited or
perverted state of the emotions—have no power in convincing the
patient of his error, and of the unsoundness of his conclusions; but
that, on the other hand, new scenes and active employment, which
call healthy emotions into exercise, gradually lead the way to a cure,
and that the delusion, thus avoided and treated, by degrees fades
from the mind. Such cures of intellectual delusion, by work and
by the moral discipline of an asylum, are of frequent occurrence.
Great thus though the measure of moral and physical liberty is,
which the asylums of 1862 give to the insane, compared with the
cruel bondage of irons, and of fear, which, as we have seen, was their
portion from the time of Dr. Caius, even to our day, the asylums
of the future will, I believe, through the fuller study and application
to practice of the principles of medicine, and of the laws of mental
pathology, extend yet wider the circle of their liberties, until, per¬
haps, the asylum itself become a needless therapeutic agent, and the
treatment of mental disease (in the modified shape it will then as¬
sume) come to be applied, like that of any other malady, in the ward
of a general hospital, and amid the yet healthier influences of home
life.
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Psychological Inquiries (the Second Part). Being a Series of Essays
intended to illustrate some points in the Physical and Moral
History of Man. By Sir Benjamin C. Brodie, Bart., D.C.L.,
E.R.S. Longman, Green, Longman, and Roberts, pp. 247.
Crites, a busy lawyer, and Ergates, a busy surgeon, being wearied
of the din and smoke of the metropolis, gladly avail themselves of
an invitation from their friend Eubulus, to exchange for a time
the “ fumum et opes strepitumque Romae," for the pure and serene
air of his country residence, where, engaged in horticultural pursuits
and in the performance of social duties, he lives that calm and even
life which some suppose to be attended with so little care, and with
so much quiet happiness. Commencing at once with warm praise of
the country, where the “ harmony of rural sounds is so different from
the discords of London streets," Eubulus passes on to a description
of the advantages of the cultivation of the physical sciences, his
friends joining in the discussion, and, as usually happens in books
written in the mode of dialogue, conveniently making the objection
which is so easily put aside, and often perversely missing the exact
objection which they should make. In fact, if this were not pro¬
fessedly a popular work, something might be fairly said against the
adoption of a method of writing, by which an author is enabled to
wander from heaven to earth, from the origin of evil to the origin of
species, from the perfectibility of mankind to the ill consequences of
ennui, and, without logical connection, to join, by the merest accident
or most abrupt transitions of * conversation, subjects that have no
further apparent relation to one another than that man is able to
think about them. The book is not, however, written for the pur¬
pose of communicating any facts not already known, or any con¬
clusions which others may not have arrived at; it consists of the
pleasant garrulity of three old men, and its principle objects are two:
1st. To show that, for the solution of the complicated problem re¬
lating to the condition, character, and capabilities of man, the
observations of the physiologist must be combined with those of the
moral philosopher, either of which alone would be insufficient. 2nd.
To point out of how great practical importance to the individual
such researches are, as enabling him to understand how much he
may contribute to the improvement of his faculties, and to his well¬
being in life. That this unpretending little book more than accom¬
plishes its design in a simple, elegant, and pleasing manner, no one
who reads wisely will for a moment doubt.
When science is so fashionable, and so much esteemed, that it can
easily command on its gala days the willing and a dmir ing services
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212 Psychological Inquiries,
of the beauty aud dignity of the land, it might appear almost un¬
necessary to speak of the benefits which it has conferred on mankind.
The old Norse fable, which relates how the mighty Thor, after trying
to empty the drinking horn of Asgard, after wrestling with the old
woman, and racing against the runner Lok, discovered that he had
been drinking the sea, wrestling with time, and racing with thought,
symbolized in his efforts the helpless contention of man with the
supreme forces of nature. But man is not quite so helpless now as
he wa3 even in those days when there were giants. Tor, although
he cannot drink off the sea, wrestle successfully with time, or win
the race from thought, he has, by patient attention to the physical
laws, succeeded in using the forces of nature most advantageously
for his service; he has, by placing his human force in obedience to
the laws of nature, gained many a glorious victory. He wrestles
very much better with time, and races very valiantly with thought.
It is science which has given him all his success; it is that which
has rendered the intellectual work of the present age so much more
profitable than that of any other age, as to have now become almost
synonymous with civilization. And yet any one who devoted him¬
self to the earnest pursuit of science, in the expectation of reaping
some portion of the reward which such important services might be
expected to obtain from the gratitude of mankind, would meet with
a heavy disappointment. The true man of science does not work
for public admiration; nor does he look to public gratitude as the
reward of his toil; he knows full well the worth of these, knows that,
notwithstanding the enthusiastic applause of the hour, the public
would quite calmly allow him to starve on pure science. It is in the
development of his own intellectual nature, in his own activity, that
he finds his gratification; and while, deriving at all times an even
pleasure from such efforts, he is every now and then above measure
rewarded by displaying some wonderful example of order and design
in nature. But every new discovery reveals more plainly how much
remains to be discovered; and, as it has been aptly expressed, the
higher one rises the more distant is the horizon. The dwarf mounts
on to the shoulders of the giant, only to find how much there is that
the giant cannot see. Nothing, then, can be more puerile than the
complaints sometimes made by certain cultivators of a science, that
it is very difficult to make discoveries now that the soil has been
exhausted, whereas they were so easily made when the ground was
first broken. It is an error begotten by ignorance out of indolence.
The first discovery did not drop upon the expectant idler who, with
placid equanimity, waited for the goods the gods might send, but
was heavily obtained by patient, systematic, and intelligent labour ;
and, beyond all question, the same labour of the same mind which
made the first discoveries in the new science, would now succeed in
making many more, trampled though the field be by the restless
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feet of those unmethodical inquirers who, running to and fro,
anxiously exclaim, “Who will show us any good thing?”
No one who takes a wide and careful survey of the present
position of those sciences which immediately concern themselves
with man's moral and physical state, can fail to conclude that we
stand on the very verge of discoveries of vast importance. The
physiologist is daily approaching nearer and nearer to the mental
philosopher, while the latter has long since found it necessary to
abandon an untenable position, and to accept as the basis of his
fabric the discoveries of the physiologist. Psychology and physiology
are two branches of one science—anthropology ; or, perhaps, it might
be said that physiology, drawing, like the roots of the tree, its sup¬
port from the lower ground of matter, and psychology, like the
branches, spreading out into a higher sphere, unite in a common
trunk, and form therewith a biological unity. The pure metaphysical
philosopher who, disdainful of physical science, cultivates mental
phenomena on the basis of those infallible affirmations of conscious¬
ness which almost every second person does not understand, and
every third person denies; who spins systems of word-philosophy
out of his own mind, as the spider draws its web out of its own belly;
who trammels the unwilling mind with the burdensome logic of the
schools, and in other ways attempts violently to sever man's intimate
relationship with nature, may soon retire to that pleasant suburban
retreat where, with the calm aspect of a lofty philosophical disdain,
he may, in company with the megatherium and other creatures of
the past, look down, in undisturbed repose, on an age which appre¬
ciates him not.
There is some danger at the present time that the physical sciences,
proud of the immense benefits which they have conferred on man,
should assume, not perhaps too prominent a position, but a silent
right, as it* were, to despise a science the products of which are not
of any immediate material utility to mankind. But if the mental
exercise which a man uses in the pursuit of truth is more valuable
to him than the truth, if the acquisition of knowledge is really sub¬
ordinate to the cultivation of our faculties, if the individual is an end
unto himself rather than an instrument for the accomplishment of
something out of him, then, unquestionably, the study of mind has
a better title to be called useful than the “ bread and butter sciences”
(Brodwissenschaften). “Those studies which determine the facul¬
ties to a more vigorous exertion will,” as Sir W. Hamilton says, “in
every liberal sense, be better entitled, absolutely, to the name of use¬
ful, than those which, with a greater complement of more certain
facts, awaken them to less intense and, consequently, less improving
exercise. On this ground I would rest one of the pre-eminent
utilities of mental philosophy.” The opinion of Sir Benjamin Brodie
is scarcely less decided on this matter.
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“ These subjects, which may all be conveniently included under
the name of psychology, constitute a science quite as real as astro¬
nomy, chemistry, or natural liistory; inferior to none of the physical
sciences in interest, and I may add in usefulness. I know of no
better exercise than that which these inquiries afford for the mind
itself, especially as they tend to improve in us the habit of thought
and reflection, as they enable us to form a just estimate of our own
powers and of the nature and limits of human knowledge; thus
rendering us more competent to pursue other inquiries, however
different in their nature, with advantage. Observe that I suppose
the study of mental phenomena to be properly conducted, and
limited to its proper objects, without being adulterated by those wild
speculations in which some have indulged, and which have given
the science rather a bad reputation under' the name of meta¬
physics.” (p. 16.)
And again at p. 18: “ I believe that whoever would form a right
estimate of himself and others; whoever would improve his own cha¬
racter ; whoever aspires to the high office of ameliorating the
condition of society, whether as a statesman, as a religious teacher,
as the promoter of education, or in any humbler capacity, can in no
other way so well qualify himself for his undertaking, whatever it
may be, as by studying the laws which regulate his own mind, dis¬
played as it is in his own perceptions, sentiments, thoughts, and
volitions. This is the only true foundation of that great science
which, for all practical purposes, is more important than anything
besides—the science of human nature.”
More might be justly said, if it were necessary, in favour of the
valuable services of psychology; but it will be sufficient here to
indicate, that it may be of great advantage in pure physiological
investigation. No one can read with care the records of the labours
of such a physiologist as John Hunter, without being forcibly struck
with the great influence which a feeling of the operations of his own
conscious intelligence had in directing his investigations into the
laws of action of that unconscious intelligence which forms and
maintains the organism. Though Hunter himself might not have
distinctly maintained it, yet it is difficult to believe that he did not
feel that there is no more helpful principle in physiological labour
than this—that the human mind follows consciously the same laws
which the so-called vital, plastic, or organic force follows uncon¬
sciously, and, according to the degree of its training and develop¬
ment, reflects more or less clearly the physical laws of organization.
It is plain that such a principle must be very carefully applied, lest
it become the fruitful parent of extravagant hypotheses, and thus
seriously impede knowledge; but it is not so plain that, with proper
care, the cautious recognition of the so-called doctrine of final
causes may not be advantageously combined with the application of
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the inductive philosophy. There is some cause to apprehend that
the world, from its horror of the metaphysical extreme, is rushing
headlong into a materialistic extreme.
This is eminently an utilitarian age, an age which, after the
fashion of Macaulay, "reduces the human intellect to the level of a
saucepan,” which lauds an inductive philosophy that Bacon would
scarce have known, in a way that would have extorted an exclamation
of wondering surprise from Bacon; which appears strongly to
suspect that Plato must have been mad on every point, and Aristotle
mad at least on one point; which detects mysticism in idea, and mad¬
ness in mysticism; which has a sure faith only in the idea when it is
embodied in a steam-engine or in a cotton-machine; and which
labours with a mechanical constancy to root out individuality, and to
reduce men to a dead level of monotonous uniformity. All this may
be right, but it has by no means yet been proved to be so; and
meanwhile there is some reason to believe, that there is truth in
Plato as well as in Bacon, that the words which were the expression
of so powerful an intellect, and which have endured so long, are not
utterly meaningless. And if they have a signification, then the
truth which they contain is reconcileable with the truth which the
investigations of the present age disclose; and if we do not perceive
the relationship, the fault is ours, and the labour to reveal it must
be our duty. It is not, perhaps, to be expected that the multitude,
who feel so vividly the advantages which they derive from the
physical sciences, should exercise moderation in their estimate of
them; but it will be a great evil, as Sir B. Brodie has pointed out,
if the cultivators of science themselves become influenced merely by
utilitarian views. “ The period has arrived when the discoveries of
science, the achievements of former generations, are becoming exten¬
sively applied to the purposes of commerce, of manufactures, and the
ordinary concerns of life. Then the numerous examples which have
presented themselves of late years, of large fortunes rapidly accumu¬
lated, have afforded an additional stimulus (where none was wanted)
to the natural desire of wealth; while the prevailing study of political
economy, with all the great good which it has done, has produced
this evil, that it has encouraged the disposition, in a large portion of
society, to regard the increase of wealth, and the adding to our stock
of luxuries and comforts, as the most important business of life.
From this combination of causes it is, that too many of the public
. are led to measure the advantages arising from the pursuit of know¬
ledge by a lower standard than that by which it has been measured
hitherto; estimating the value of researches in science by their con¬
sequences as affecting the physical well-being of mankind, and
regarding those who apply the discoveries to some practical purpose
as if they were on a level with those with whom the discoveries
originated. The danger to which I allude is, that the cultivators of
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Psychological Inquiries,
science might themselves be led to participate in these utilitarian
views. If it should be so, science must undoubtedly descend
from the high station which it at present occupies. Nor can this
happen without great injury to the cause of knowledge itself.” (pp.
81 , 32 .)
The second dialogue commences with some judicious observations
on the necessity of physical power to intellectual exercise. There
cannot be any doubt that a great deal of evil happens from the
ignorance which men are in with regard to the amount of force
which they have; that many a one foolishly concentrates into a few
years the force which should rightly be diffused over a lifetime, and
suffers through life for his mistake. There is truth as well as error
in the popular opinion, that those who are great at college are little
afterwards. Those who do not fail from the indolence bom of
success, often fail from the exhaustion produced by overwork. And
it admits of serious question, whether the niiddle-class examinations
which have been organised by the universities, are not doing positive
injury to the young vitality of the community. As a matter of fact,
they solicit a great deal of force in intellectual exercise at that very
time when force is most required for physical development; nor does
the forced intellectual development compensate for the physical
degeneration which is undoubtedly sometimes produced. “ In
pueritia senex, in senectute puer,” said Aristarchus the Sophist. It
seems only reasonable to suppose, that a youth should be gaining
force from without, and laying it up, under a system of proper disci¬
pline, as potential for future display, in place of expending it out¬
wardly as he gets it, thereby starving physical development at the
time, and cutting off the supply for future intellectual development.
In the present series, as well as in the first series, of his ‘ Inquiries/
Sir B. Brodie remarks upon the “ ill effect produced by the great
extension of the competitive system, in stimulating many to exertions
beyond their powers, and in promoting the exercise of the faculty of
learning at the expense of the higher qualities of observation and
thought.” No authority in this matter can well carry greater weight
than that of Sir Benjamin Brodie.
A little reflection will render it evident, that the important
principle of the conservation of force must be applicable to human
action, as well as to every other form of activity in nature. The
human body cannot generate force within itself of its own mere
motion, and dispense it outwardly in unlimited quantities ; what is.
given out in any form of motion must be replaced in some way from
without by an equivalent of the motion. And if a man applies his
force in one direction, he has necessarily that much less for use in
another way. Each one, then, may choose for himself how he will
employ the force which he embodies, whether he will exercise the
mind at the expense of the body, or exercise the body at the expense
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by Sir Benjamin C. Brodie, Bart.
of the mind; or whether, as is most just, he will endeavour to
preserve that balance by which the functions of both are best deve¬
loped, and man’s destiny on earth best accomplished. Some may
devote themselves mainly to the propagation of ideas, while others
expend their energies in the propagation of children; and, as Bacon
long ago remarked, those who are good at the one are not generally
good at the other. It has become a common saying, indeed, that
great men have great fools for children; and although a few
exceptions to the rule may be collected, yet the opinion has the
sanction of experience. “ Heroum filii noxse et amentis Hippocratis
ftyii,” said the ancient proverb. It has the sanction also of theory.
For he who has used all available force in intellectual exercise, and
thus displaced it to the admiration of the world in a brilliant inflo¬
rescence, has thereby exhausted the energy of the stock, which there¬
upon rests for awhile, in order to regain power, or decays and actually
dies. So it happens, that stupidity, bodily disease, madness, or
family extinction, not unfrequently follow the eminent man. He
who propagates great intellectual force to his offspring, the true
parent of genius, is the calm self-contained man, who has quietly
done his duty in the world without noise, who, self-denying, self-
reliant, has not dissipated power, but has transmitted it all to his
children. And though it is often said that great men have had
clever mothers, yet it is quite certain that the mother in such case
has not been one who has expended her force in a literary blos¬
soming, or in any other great intellectual achievement, but, on the
contrary, one who has used great powers of mind for womanly pur¬
poses, who, with admirable self-sacrifice, has given her children the
benefit of her advantages, and has thus propagated her influence
through time in that way which nature seems so plainly to have
pointed out as woman’s duty. Does it not happen, for the most part,
that great intellectual display is found to be reserved for the barren and
the unmarried women ? It appears also, that beneath that regulation
of the Catholic Church which enforces the celibacy of priests, there is
true philosophy; for therein is the recognition of the law of conserva¬
tion of force as applicable to the exercise of human force.
In this second chapter. Sir B. Brodie further notices the very re¬
markable circumstance, that on certain occasions a conviction flashes
through us that we have been in precisely the same circumstances
once before; that the identical thing is happening which we felt was
going to happen. We are quite familiar with the feeling; the re¬
cognition is the flash of a moment, and it almost appears as if the
mind had been in advance of consciousness—had, as it were, travelled
, out of us, become familiar with the event, and, then returning,
revealed to consciousness, at the same time, its own private ex¬
perience, and the condition of tilings acquired through the ordinary
channels of the senses. We may suppose that the former expe-
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rience would then appear as the remembrance of a previous existence.
Mr. Oliver Wendell Holmes has noticed the following circumstances
in connexion with this duplicate consciousness. 1. The state which
seems to be the repetition of a former one is often very trivial—one
that might have presented itself many times. 2. The impression is
very evanescent; and it is rarely, if ever, recalled by any voluntary
effort, at least after any time has elapsed. 3. There is a disinclination
to record the circumstances, and a sense of incapacity to reproduce
the state of mind in words. 4. He has often felt that the duplicate
condition had not only occurred once before, but that it was familiar,
and seemed habitual. Lastly. He had had the same conviction in
dreams. All that need be added to these observations is, that the
state which seems to be the duplicate of a former one is not always
such as might have happened before; it is sometimes certainly such
as could not possibly have happened before. For example, even
whilst writing a certain sentence on this page, a conviction flashed
upon the writer that he had been in exactly the same position once
before, which he certainly never could possibly have been. It may
be doubted, too, whether the duplicate condition often is familiar, and
seems habitual, if, indeed, it ever does seem to have happened more
than once before.
Sir Benjamin Brodie gives the following interesting example,
which, he thinks, throws great light upon the subject, by showing
that, on these occasions, there is always an actual revival of some
impression made on the mind formerly, though the events in connexion
with it have escaped from our memory. The account is com¬
municated to him by a “ very intelligent correspondent.”
“ When I was about fifteen years of age, I went, with my father
and mother and other friends, on a tour through Somersetshire j
and having arrived at Wellington, where I had certainly never been
before, we tarried an hour or two at the Squirrel Inn for refresh¬
ments. On entering the room where the rest of the party were
assembled, I found myself suddenly surprised and pursued by a pack
of strange, shadowy, infantile images, too vague to be called recol¬
lections, too distinct and persevering to be dismissed as phantasms.
Whichever way I turned my eyes, faint and imperfect pictures of
persons once familiar to my childhood, apd feeble outlines of events
long passed away, came crowding around me and vanishing again in
rapid and fitful succession. A wild reverie of early childhood, half
illusion, half reality, seized me, for which I could not possibly
account; and when I attempted to fix and examine any one of the
images, it fled like a phantom from my grasp, and was immediately
succeeded by another equally confused and volatile. I felt assured »
that all this was not a mere trick of the imagination. It seemed to
me rather that enfeebled memory was, by some sudden impulse, set
actively at work, endeavouring to recall the forms of past realities.
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by Sie Benjamin C. Brodie, Bart.
long overlaid and almost lost behind the throng of subsequent events.
My uneasiness was noticed by my mother; and when I had described
my sensations, the whole mystery was speedily solved by the dis¬
covery that the pattern of the wall-paper in the room where we were
seated was exactly similar to that of my nursery at Paddington,
which I had never seen since I was between four and five years of
age. I did not immediately remember the paper, but I was soon
satisfied that it was indeed the medium of association through which
all those ill-defined, half-faded forms had travelled up to light;
my nurse and nursery events associated with that paper pattern
being, after all, but very faintly pictured on the field of my remem¬
brance.”
It is obvious, however, that this is not an exact case of the con¬
dition which has been described; but rather an instance of the revival
of certain indistinct infantile impressions through a particular asso¬
ciation of ideas. Still, the explanation which Sir B. Brodie accepts
is one that has been put forward to account for the genuine duplicate
condition of consciousness. It is supposed by those who uphold it,
that the coincidence of circumstances is partial only, and that we
take this partial resemblance for identity, as we sometimes do
resemblances of persons. That may happen in some cases, but in
others it is certain that we have the strongest conviction that the
experience is altogether strange to us, that nothing like it ever has
or could have occurred before to us.
The explanation offered by Dr. Wigan, who had noticed the cir¬
cumstance, was, that the two hemispheres of the brain were not quite
synchronous in action; he supposed, in accordance with his theory of
the duality of the mind, that the results of their action were not
communicated to consciousness exactly at the same moment, so that
the impression of a previous identical experience was produced. It
is an ingenious explanation, but it is not generally accepted.
Still another solution of the difficulty has been offered. Some
imagine, after the manner of Plato, that these flashes are really sudden
recollections of a previous existence; they believe that, in the weary
pilgrimage of life, we every now and then come upon precisely
similar experiences to those of a former existence, the events of which,
with these few exceptions, we have completely forgotten. If this be
so, we are even more miserable than we had any notion of; for, from
' the nature of these remembered experiences, it is plain that our
former life was very much of the same character as this, that sorrow
and labour have been our lot through past ages, as they are through
the present, and may possibly be through the future. We may
possess an immortality on earth like Tithonus, and like Tithonus,
without that which alone would make immortality on earth
desirable.
There seems to be a great probability that the true explanation of
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220 Psychological Inquiries,
the problem will be found in the unconscious action of the mind.
This is a subject which has been studied in Germany with the usual
patient German industry, which has been sketched out by Sir
W. Hamilton with his usual clearness of stvle, and which has been
popularised by Dr. Carpenter under the barbarous designation of
“unconscious cerebration;” it seems also to be included in the
“ reflex action ” of the brain, as described by Dr. Laycock. It is a
subject, however, of far too great importance to be entered upon here,
where all that we need keep in mind is, first, that consciousness of
mental action may exist in every degree down to actual unconscious¬
ness ; and secondly, that the most valuable part of all mental action
is unconscious. If we remember these facts, and reflect also upon
the very great rapidity of the mind's action, it will be conceivable
how it may, in its knowledge of a particular event, anticipate the full
consciousness. The consciousness lagging a little behind, or being
for a moment diverted from following the mental process, will have
communicated to it the result of the automatic action of the mind,
which will then appear familiar, and as a previous experience. It
may be objected to such an explanation that it, after all, assumes a
sort of consciousness of an unconscious mental action. The objection,
however, itself contains the assumption that an act of our own mind
of which we have not consciousness must be quite unfamiliar to us
when brought into consciousness; and it may, at any rate, be dis¬
posed of by maintaining a very partial degree of consciousness in the
automatic act.
In the third dialogue, there is some repetition of what has been
said in the previous two, which, as may well be supposed, in con¬
versational disbussion on such subjects, is not easily avoided. The
mental faculties, although classified for convenience, are not abso¬
lutely distinct. They are really different conditions of one mind
which is now in a state of feeling, now in a state of cognition, and
at another time in a state of will. It is impossible, then, to
discuss one so called faculty, without more or less including others;
and of all undertakings, it is one of the most unprofitable to attempt
to make a precise inventory of the faculties of a mind whose in¬
fluence nations yet unborn may feel. There can be little doubt that
the classification of the mental faculties has been productive of con¬
siderable inconvenience in mental philosophy, on account of the too
great importance which has been attached to it. However carefully
made, it must necessarily be imperfect, and, in so far as it makes
distinctions which do not exist in nature, erroneous. “ For example,”
as Sir B. Brodie observes, “ in a system of logic the imagination is
altogether disregarded; but in practice it is quite otherwise, and even
the pure mathematician would find that he could make but little
progress in the advancement of his science, if he did not call in the
aid of his imagination.”
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Into the question as to necessity and free will. Sir B. Brodie is
not disposed to enter farther than to make the following obser¬
vations. “ First: finding as I do the metaphysical argument to be
entirely on one side, and my irresistible conviction to be entirely on
the other, I am led to suspect that this is one of the subjects to
which Ergates alluded formerly as being beyond the reach of our
limited capacities. Secondly: that, even if we admit the doctrine of
a necessity which rules our thoughts and actions to its full extent,
the practical result is in no way different from what it would have
been if we rejected it altogether. If I am not mistaken, it w^s the
late Baron Alderson who on some occasion addressed a jury to the
following effect, if not in these exact words :—‘ The prisoner is said
to have laboured under an uncontrollable impulse to commit the
crime. The answer to which is, that the law has an equally uncon¬
trollable impulse to punish him/ We may make an allowance for
the external influences which operate on men’s minds; we
may excuse altogether those who labour under the illusions of
actual insanity; but otherwise we cannot get rid of the feeling
of responsibility as regards either ourselves or others; and the
most thorough-going necessarian, when he quits the loftier regions
of Metaphysics to mix in the ordinary affairs of life, thinks and
reasons precisely in the same way as the most unhesitating believer
in free-will/’
It is not impossible that Mr. Baron Alderson was quite right when
he made that observation, that he was right also in laying down, as
he did on the same occasion, the doctrine that, if a man had a delu¬
sion that his head was glass, he would be rightly punished if he
committed murder, and his delusion had not directly' driven him to
do it; but it is quite certain that, when Baron. Alderson expressed
himself so decidedly, he assumed that a man whose relations with
nature were completely perverted by disease, might and could act
exactly as if those relations were undisturbed and harmonious. The
decision seems to have been influenced by the philosophy which par¬
cels out the mind into distinct faculties, and refuses to see that the
whole mind works in every faculty. It is plain that the line drawn
was rather arbitrary, and that there was no sufficient reason why
Baron Alderson might not have further said— “ The prisoner is
said to have laboured under a delusion that he must kill the man.
The answer to that is that the law has an equal delusion that it
must hang him/’ Because an individual has a delusion that he
must kill some one, it does not follow that he is ignorant that he
will be doing wrong, in the world’s opinion, if he does commit
murder; but he does it because he is a law with himself, because,
being mad, he thinks that he is right, and that all the world is wrong.
And when a man has a delusion on one point, when, for example, he
believes that he has a head of glass, he does not merely differ from
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all the world on that matter, and in other things preserve his reponsi-
bility as a rational being; he is altogether mad. A young girl of
only fourteen years of age, who had been mostly good and gentle,
one day suddenly killed her father, opened his chest, and ate his heart.
Some pronounced it to be monomania. But, as Dr. Wendt remarks,
a monomania for what ? Bor eating human flesh ? It was a general
madness, and to call it monomania was to justify the words of the
magistrate, who said that monomanias of that kind should be cured
in the Place de Greve. As disease may be of every degree of
intensity in the mind, so corresponding degrees of responsibility must
exist; and it is obviously impossible justly to place an arbitrary line
between responsibility and irresponsibility. Although, then, it may
be necessary in practice to make the separation, yet it might be as
well even for judges to remember that it is only done at the cost of
some injustice, and that the really just plan would be the seemingly
impracticable one of proportioning the punishment to the degree of
responsibility which actually existed.
It is a common mistake, which even Sir B. Brodie seems to have
fallen into, to suppose that the necessarian doctrine is fatalism. The
true necessarian does not deny the existence of responsibility any
more than the free-will metaphysician. He simply applies the law
of causality to human actions, maintaining that the will, like every¬
thing else in nature, must have a cause. He affirms that he can as
easily conceive creation to have happened without a cause as con¬
ceive volition to be without antecedent. Admitting this, it does
not thence follow that an individual is under a fatal necessity to act
in a certain way; what does really follow is, that given a certain
antecedent state of mind a certain volitional effect will follow, if no
other state of mind meanwhile intervene to counteract it. Very
great confusion has been caused in this matter by the use of the
word necessity—a word which is usually supposed to denote an irre¬
sistible force, a cause which cannot be counteracted; whereas it is
here used only to express an uniformity of sequence. Because it is
possible for A, with an intimate knowledge of the character of his
friend B, and of the particular circumstances in which he is placed,
to predict nearly with certainty how he will act in them, B is none
the less free to act as he likes. The experience of A is, that certain
causes operating in B will produce certain effects, but it is quite
possible that the operation of those causes may be interfered with by
the intervention of other causes which will produce a different effect,
and disappoint the prediction. But it cannot thence be concluded
that the law of causality is not applicable to the human will; all
that can be said is, that A was not acquainted with all the antecedent
conditions. A thief, again, may have so strong a motive to jump
from the top of a house, in the desire to escape from his pursuers, as
to determine his will to the act; or the desire to save his life from
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an apparently certain destruction may intervene, and supply a stronger
motive to^prevent the leap. All that the philosophical necessarian
maintains is, that the first motive determines a certain volitional con¬
sequent, unless a counteracting cause intervene meanwhile and de¬
termine a different result. But the result, whatever it be, has
necessarily its antecedent cause. This, it must be admitted, is a
very different kind of necessity from that which we speak of when
we say that given a certain cause, for example, deprivation of air to a
man, a certain effect, death, must follow, whatever be done to pre¬
vent it.
In all the world, says the necessitarian, there is not a casualty ; for
nowhere in it is there not causality. It must be evident on reflection
what a mighty responsibility this doctrine imposes upon the individual.
Life is seen to be a most important work of art, to be built up under
a recognition of the principle of cause and effect. The individual
sees the way by which he may influence the formation of his own
character and attain to the possession of a strong will by its logical
development through reason. He knows that certain antecedents
must determine certain consequents, and endeavours to operate upon
the antecedents; he fashions in some measure the circumstances which
fashion him. “ All successful men,” says Emerson, “ have agreed in
one thing—they were causationists. They believed that things went
not by luck, but by law; that there was not a weak or cracked link
in the chain that joins the first and last of things. The most valiant
men are the best believers in the tension of the laws.” If the will
determined itself, if it were determined by no antecedents, it is im¬
possible to conceive how a man should have any power over it, any
way o'f influencing it, and, therefore, any responsibility; whereas, in
reality, the education of the will is the highest aim and attainment
of human effort, and a completely fashioned will the last and best
development of nature, the finest flower of all her marvellous works.
“ Sir,” said Hr. Johnson to Boswell, “we know our will is free,
and there’s an end of it.” But the ponderous doctor had rather an
arbitrary way of settling matters, which was sometimes not so satis¬
factory to his hearers as to himself. He fancied that he had de¬
molished Berkeley by demanding triumphantly why the Bishop did
not strike his foot against a stone, and thus convince himself of the
existence of an external world; and he would probably have becom.
exceedingly angry if some one had told him that he had not said
anything whatever to the point, as in truth he had not. Still,
in asserting free-will against fatalism, there cannot be any doubt
that Dr. Johnson was right. It is the fatalist who has done so
much mischief by so completely misunderstanding his own posi¬
tion. He has not seen that the application of the law of
causality throughout every part of nature is not incompatible, with
individual freedom of choice. On psychological grounds, it has been
VOL. vm. 15
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above shown that the volition must have its necessary antecedent;
and on physiological grounds, it may be said that the great principle
of conservation of force demands it. The controversy about free-will
and necessity is now generally acknowledged to be a useless wrangle
about improperly applied words; and while Locke clearly pointed
out how absurd and inappropriate it was to use the word free in
connection with the will, Mr. J. S. Mill has done a like good service
to the equally misused word necessity.
It is time to return to our discursive philosophers. Passing, then,
as abruptly as they do, from subject to subject, it will be interesting
to give Sir B. Brodie's opinion on the use of tobacco and opium.
“First .—It is not simply as a liquor producing absolute intoxication
that alcohol may be injurious. One person may drink a pint of port
wine or an equivalent quantity of some other liquor daily, and that
through a long life, with impunity; while in the case of another,
though never in a state of intoxication, the effect may be to render
him dull in early life, prematurely stupid in his old age, and pro¬
bably shorten his life ultimately.
“ Secondly .—The evils arising from the use of alcohol have been
fearfully aggravated by the invention of distillation. It is under the
influence of gin and brandy, much more than of beer or wine, that
bodily diseases arise, and it is alcohol in these forms especially that
leads to acts of violence and crime.
“ Mututis mutandis , what I have said as to the use of alcohol
may be applied to other articles of the same class, such as opium
and tobacco. The opium-taker is only negatively mischievous to
society; he is dreamy and inactive, but nothing more; and it is
worthy of note that the habitual use of opium does not, like that of
alcohol, seem materially to shorten the duration of life. So as to
tobacco. In the Polytechnic School of Paris it was found that the
habitual tobacco-smokers were far below others in the competitive
examinations. Tobacco-smokers, like opium-takers, become lazy
and stupid, but they have not the vices of gin-drinkers. As to the
effect of tobacco upon the organization generally, I am inclined to
think that it is more deleterious than opium, and more productive
of disease, when the use of it is carried to excess.”
It is rather a bold statement that tobacco-smokers become lazy
and stupid, considering how many of our most active men are great
smokers. And certainly it would be as fair to suppose that those
who were low down in the competitive examination in the Polytechnic
School of Paris were habitual tobacco-smokers because they were
lazy and stupid, as it is to suppose that they were lazy and stupid
because they were habitual tobacco-smokers. Is it not wise for an
individual to create for himself as many gratifications as possible, so
long as he does not injure his health by excess ? Or is it true
philosophy for him to diminish his wants, and, disdaining luxuries.
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to revert to a Spartan simplicity, and to his ancestra sheepskin
apparel ? To Eubulus, who in the fourth dialogue asks, “ What is
happiness ?” Crites replies—“ I consider him to have the greatest
amount of happiness who has the largest proportion of agreeable,
and the smallest proportion of painful feelings, be they either
physical or moral.” While giving this definition, he fears it is
common-place and vulgar; but Eubulus reassures him by pro¬
nouncing it the most philosophical sense in which the word can be
used! Will it not, then, justify a moderate use of tobacco, or the
judicious indulgence of any sensual pleasure ? If a man create for
himself as many artificial wants as possible, so long as he has the
means of gratifying them, he will plainly be increasing his happiness;
besides which, the desire to possess the means of indulgence will
stimulate him to active exertion, which will again be a pleasure.
It is an odd circumstance that the theologians, moralists, and
philosophers, who have undertaken to instruct mankind in the way
to become happy, have almost always confined themselves to the
moral aspect of the question. They do not tell us how to act with
regard to physical enjoyments, nor do they point out how a just and
equable frame of mind may charm away physical pain. And yet,
what profit is it to demonstrate that to be virtuous is to be happy
to an unfortunate creature who is constantly suffering the great
agonies of some painful organic disease ? If a man can find his
happiness in enduring suffering with patient resignation, then he
may ensure to himself a never-failing supply; otherwise, happiness
will be to him, whilst “ confined and pestered in this pinfold here,”
little more than a devout imagination. Judging from appearances,
those who least deserve happiness often seem to get the most of it.
The wicked, on the whole, stands very well in slippery places, and we
may pass many times by his garden and not find it a desolation.
It is very consoling, however, to learn that Sir B. Brodie's long
experience has led him to the conviction that the selfish people who
live only for their own gratification, without regard to the feelings
of others, do not, when they get prosperity, get happiness. He
says:—“ But I have lived long enough to watch the course of some
such persons, and am led to believe that even in this world the day
of retribution rarely fails to come at last. I have seen them, as they
advanced in years, fall into a state of melancholy, amounting to
hypochondriasis, for which even the most firm religious convictions
afforded but an inadequate relief. A philosophical friend of mine
has suggested that remorse is the destined punishment in a future
state of existence. Be that as it may, I am satisfied that many,
who do not own it, even to their nearest friends, are the victims of
remorse even here on earth. Obvious examples of it in one of its
forms are almost constantly presented to us in the daily journals, in
the notices furnished by the Chancellor of the Exchequer of sums of
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money sent to him anonymously for ( unpaid taxes.* Is there any
one, even of the best among us, who does not look back with regret
at some errors which he has committed at a former, and perhaps
distant, period of life ?”
It seems universally admitted, although the practice in this
matter is quite at variance with theory, that whosoever devotes
himself entirely to getting money, who is inspired with that
desire only, commits a certain mistake, and does not get the
happiness which he hopes for. The wealth-passion is plainly a
blighting passion, which always endangers, and often kills, the
moral sense. Nor are its evil effects confined to the individual.
The community is tainted by the subtle and powerful poison; com¬
mercial morality becomes of a different species from true morality,
in reality no morality at all, but immorality under the flimsiest
disguise; and the general plan of estimating an individual by a
money value ignores with a remarkable audacity, yet not with im¬
punity, the genuine worth and native dignity of humanity. Consti¬
tuted as every one is with a moral nature, it is impossible that any
man can cut himself so completely off from his fellows as to live
solely for himself, in utter indifference to their welfare, without
being severely judged of nature; and he who takes that course is
very diligently sowing curses, the fruits of which his posterity will
most likely be compelled to reap. For, though the individual may
forget his relations as a moral being, the universe does not forget.
The wealth which has been hoarded up with such careful toil, not
with any design of using the immense power which it represents for
the good of mankind, but simply for its own sake, or with the
ambitious vanity of founding a family, is often seen to become, after
a little while, nothing more than the gilding of decay. The family
that was to be founded upon it has, by the very means taken to
accumulate it, been tainted with a rottenness at the heart. For the
parent who has systematically repressed the moral element in his
nature and done his best to destroy it, even though he himself
escape the bitter consequences of his error, transmits his acquired
deficiency to his children, who may thus be born with a natural vice
of constitution to which, but for the most favorable circumstances,
they must fall victims. How rare, indeed, is it to find wealth-
founded families endure through two or three generations!
It would scarcely be doing justice to Sir Benjamin Brodie if we did
not here signalise a danger which he fears from the increase in the
population of towns, and the diminution of that of the rural districts.
This also may be attributed to the eagerness after wealth. Our
crowded cities are draining off the stock of vitality that has been
hitherto stored up in the rural districts, and are using it all up in
the eager competition. What, then, is to become of the race when
the supply is exhausted ?
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" Unfortunately, it is shown by the returns under the late census,
that while there is a great increase going on in the population of
the larger towns, the population of the rural districts is diminished
rather than otherwise. I own that I cannot contemplate such facts
as these without some apprehensions as to the future. There may
not be any great difference observable in- the course of a single
generation; Jbut is there not danger that, after a few more genera¬
tions have passed away, the race will degenerate, and that the mass
of the population will no longer be distinguished for those powers
of physical exertion, and that unflinching determination to overcome
difficulties, which have hitherto contributed so much to the power
and welfare of our country ?”
If such apprehensions are ever realised, few will then doubt that
a wealthy conntry may gain its wealth at far too great a cost.
It has, fortunately, happened so far in the world’s history, that
whenever men have come to set up a purely artificial faith, to believe
in shams as realities, some reformer has appeared who, bursting
through formulas, has shattered the spurious conventionalisms, and
has proclaimed with a force that there was uo withstanding the inhe¬
rent dignity of humanity. And when the impassioned eloquence of
earnest conviction utters the simple truth that “ a man’s a man for
a’ that,” it is remarkable how quickly formulas fall to the dust aud
the glitter of false glories fades. There is some reason to hope for a
reformation in the faith of the present age. For there is noticeable
abroad an impatient spirit which rebels against the money-worship
and other idols; on all sides are heard complaints of the evils which
flow from the mad desire for wealth, of the immorality which is being
received without anger into commercial transactions, of the hypocrisy
which is so gladly welcomed in social life, and of the great separation
of the different classes from each other. The separation, says Sir B.
Brodie, “ to such an extent as it exists in this country at the present
day, is a great social evil, while I fear that it may lead to a still
greater evil, perhaps at no very distant period of time.” Seeing, how¬
ever, that the evil is distinctly recognised, and by many strongly
reprobated, there is some hope that the threatened danger may be in
some measure obviated.
If it be the fact, as many suppose, that the separation of the
different classes has not its foundation in any real human superiority
on the part of those who hold the higher position, it is certainly a
fact of grave importance, which cannot but add seriously to the dan¬
ger of such a state of affairs. The upper classes have all the advan¬
tages of a complete and expensive education, but in how few instances,
it is asked, do these excellent opportunities bear good fruit ? With
nothing more to boast of than an outward appearance of refinement,
with no worthy object in life, those who are oom to affluence often,
as Crites observes, “ betake themselves to mean and frivolous, and
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too frequently to degrading and demoralising, pursuits.” Ergates
wishes that he could dispute the correctness of the observation, but
confesses that he cannot. Now, it is very certain that he who wastes
a life in enervating pleasures and in trivial pursuits, who passes away
without the world being any better for his existence, is, whatever
position he may have held in the world's ranks, much less noble a
man than the humblest mechanic who labours honorably in his voca¬
tion. All honest labour is so much added to the wealth of humanity;
while the physical forces of nature might well rejoice, if they were
capable of it, at the miserable drone who allows them to get back,
in so easy a way, that force which has been gained from them, at so
great a cost, by the labour of the thinking and working men. It
scarcely needs a prophet's insight to predict what must be the in¬
evitable result of a condition of things in which superiority really
means inferiority. As Sir B. Brodie justly observes,—If the supe¬
rior classes allow themselves to be distanced in the race, they will
find ere long that they are in danger of losing the position which they
occupy, with all the advantages belonging to it. Money is power,
which is certainly none the less from it being combined with the
prestige of birth and rank; but knowledge and intelligence are a
greater power still, and if the two should unfortunately be placed in
opposition to each other, there can be, as I apprehend, not the
smallest doubt as to which of them must ultimately prevail.”
In the sixth dialogue, our rambling philosophers, after agreeing
that there was a time when neither vegetable nor animal life existed
on the earth, and that the first introduction of life must have been
by some special act of creative power, enter into a short discussion on
the fashionable question of the origin of species. It may, perhaps,
be justly said that it is not an advantage to any scientific question
when it becomes fashionable. There is a danger, then, that our great
philosophers may lose their calm indifference to all but truth, and be
influenced by the passions and prejudices which surge in the vulgar
breast. Unhappily, the pursuit of science is no safeguard against
human weaknesses; and few people seem to have so little of the * milk
of human kindness' as the scientific men. “ There is an avarice of
reputation as there is of money; and the competitors have not
always been so liberal to each other as they might have been well
expected to be.” Injurious, however, as the angry discussions on the
origin of species may in some measure have been, one good thing has
resulted from them—one fact has been added to anatomical science.
The monkey has, without question, a posterior lobe to its brain, and
is nearer to man by the extent of that quantity of nervous substance.
But although it is undoubtedly well that this point has been settled,
yet it must be admitted that the solution of it has not brought us
appreciably nearer to a conclusion on the vexed question of the origin
of species. Sir Benjamin Brodie thus temperately expresses himself
° ! GO. glC MICHIGAN STATE UNIVERSlW
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by Sir Benjamin C. Brodie, Bart.
upon the subject:—“The theory of the gradual development of the
multitudes of living beings from one primitive germ, as first pro¬
pounded by the elder Darwin, and afterwards by Lamarck and the
author of the ‘ Vestiges of the Creation/ has been not unfrequently
viewed with suspicion, as if it had a tendency to atheism. Yet there
can be no greater mistake. Trace back this system to its origin, and
you find that it takes for granted as marvellous an act of creative
power and wisdom as can possibly be conceived. In saying this,
however, you must not suppose that I am advocating the hypothesis
in question; for really, notwithstanding all that has been said on the
subject by the learned and sagacious author of the ‘ Origin of Species/
I find so many difficulties in the way, that 1 aid very far from being
convinced of its truth; and I think there is no one who will not find
a great stretch of the imagination necessary to enable him to conceive
that an oyster, a butterfly, a viper, and an elephant are all derived
from one common stock, and are but different forms of one original
element variously developed."
Though the conception of such a marvellous transformation is
certainly not easily made, it must not be supposed that the difficulty
of conceiving it affords any argument against the possibility of it. It
is obvious that special creative acts are just as little conceivable by
us; and experience has shown that things which at one time were
utterly inconceivable, have become, not only conceivable, but so plain
to comprehension as to make it a matter of wonder that they were
ever doubted. If all the varieties of the human race have had a
common origin, it is evident that considerable modifications have been
effected by time and circumstances even in the most exalted of living
creatures. Sir B. Brodie even supposes it possible that, if two families
of Albinos were placed on an island and left there to intermarry, they
might in time breed a distinct race of Albinos, as there is now of
negroes. That is not very probable, however, seeing that Albinism
is by most authors considered to be a congenital defect of the
organism, and that experience proves that nature does not willingly
propagate such imperfections. As Albinos are generally delicate, and
do not live long; as they have feeble vision, and are partially deaf; and
as they are generally semi-idiotic, there is strong presumption in
favour of the correctness of the statement made by many authors as
to their unfruitfulness. And although one or two examples have
been with great labour collected by Dr. Lucas in which Albinos did
breed, yet the investigations of Dr. Bemiss into the results of mar¬
riages of consanguinity would seem to prove that the most successful
plan of producing Albinos would be that which produces degenera¬
tion of the race, namely, the intermarrying of near relatives.
One very essential and important fact in connexion with his theory
Sir B. Brodie charges Mr. Darwin with having overlooked :—“ Mr.
Darwin has well illustrated the subject by his experiments on pigeons;
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yet lie has overlooked one very essential and important fact. The
transformations to which I have alluded are confined to the external
form, to the limbs, to the skin and its appendages. There are bandy¬
legged sheep; cattle with short horns, or no horns at all; dogs with
long legs and slim bodies, dogs with short legs, big dogs and little
dogs; Albino rabbits and dark-coloured rabbits; and so on. The
Dorking fowl has an additional claw; and in one instance only,
quoted by Mr. Darwin, there was an additional bone in the spine of
the pigeon. But these transformations do not extend to the internal
and more important vital organs, nor to the muscles and nerves, nor
even to the general form of the skeleton. The negro is distinguished
by his woolly hair, by his projecting jaws, the shape of his legs and
heel; yet it matters not to the student of anatomy whether the sub¬
ject of his dissection be a negro or an European. Those organs
which are the special objects of his study, the viscera of the chest
and abdomen, the brain and nerves, and, I may add, the muscles, are
similar in both.” We fear that, in these observations. Sir B. Brodie
has scarcely done Mr. Darwin justice, and has certainly done himself
some injustice. It is undoubtedly a matter of great moment to the
student whether he dissect the brain of a negro or of an European,
if he wishes to gain an accurate knowledge of the important organ.
If he determines to ignore altogether the number and disposition of
the convolutions, and the size and shape of the hemispheres, if he
means deliberately to neglect the investigations of Tiedemann,
Gratiolet, and others, he may contentedly go on with his dissection
on any human brain, and he will find a cerebellum, a corpus striatum,
an optic thalamus, and other such parts, as well in the negro as in
the European brain. He may find all these, too, in the monkey. But
if, impressed with the opinion that co-ordinately with an extension
of the mental faculties, there is an extension and complication of
the brain, he studies the anatomy of the brain with the object of
learning whether the intellectual differences between the negro and
European are attended or not with differences in the extent and
complication of the nervous substance, he will find that they are.
He will see that it is not correct to say, as Sir B. Brodie unwittingly
says, that the “ brain is the same (similar) in both instances; in
fact, the only real difference, and that a comparatively small one, is
in the form of the skeleton, in the skin and its appendages.”
Although information is very much wanted on the extent of varia¬
tion in the brain among the different races of mankind, yet there is
some knowledge to be had upon the subject. “ I am well aware,”
says Huxley, “ that it is the fashion to say that the brains of all
races of mankind are alike; but in this, as in other cases, fashion is
not quite at one with fact.” Tiedemann, who, as the negro's advo¬
cate, makes the least of any differences, says:
“The only similarity between the brain of the negro and that of
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the orang outang is, that the gyri and sulci on both hemispheres are
more symmetrical than in the brain of the European.”
Professor Huxley adds, that the fact must strike every one con¬
versant with the ordinary appearance of an European brain, who
glances at the plate in Tiedemann’s memoir.
Gratiolet has figured and described the brain of the celebrated
“ Hottentot Venus,” and his remarks are as follows:
“The woman, be it premised, was no idiot. Nevertheless, it may
be observed, that the convolutions of her brain are relatively very
little complicated. But what strikes one at once, is the simplicity,
the regular arrangement of the two convolutions which compose the
superior stage of the frontal lobe. These folds, if those of the two
hemispheres be compared, present, as we have already pointed out,
an almost perfect symmetry, such as is never exhibited by normal
brains of the Caucasian race. This regularity, this symmetry, in¬
voluntarily recall the regularity and symmetry of the cerebral con¬
volutions in the lower species of animals. There is, in this respect,
between the brain of a white man and that of this Bosjes-woman
a difference such that it cannot be mistaken; and if it be constant,
as there is every reason to suppose it is, it constitutes one of the most
interesting facts which have yet been noted.”
After mentioning other differences, Gratiolet adds:
“The brain of this Hottentot Venus is, then, in all respects, in¬
ferior to that of white men arrived at the normal term of their
development. It can be compared only with the brain of a white
who is idiotic from an arrest of cerebral development.”
With respect to the shape of the hemispheres, Tiedemann observes
of the negro’s brain: “The anterior part of the hemispheres is
something narrower than is usually the case in Europeans.”
The importance of the subject, and the misstatements made with
regard to it, must be our excuse for one quotation more. Professor
Huxley concludes:
“Thus, the cerebral hemispheres of the Bosjesman (and, to a
certain extent, of the negro), as far as the evidence before us goes,
are different from those of the white man; and the circumstances
in which they differ—viz., the more pointed shape of the cerebral
hemispheres, the greater symmetry of their convolutions, and the
different development of certain of these convolutions—are all of
the same nature as most of those which distinguish the ape’s brain
from that of man. In other words, if we place A, the European
brain, B, the Bosjesman brain, and C, the ourang brain, in a series,
the difference between A and B, so far as they have been ascertained,
are of the same nature as the chief of those between B and C.”
(No. I, * Natural History Review.’)
It is plain, then, that so far as the structure of the most important
internal organ in man is concerned, it is rather in favour of Mr.
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Darwin's theory than otherwise. Even Sir B. Brodie must admit
this, if he wishes to be consistent. For he acknowledges that, “ co-
ordinately with an extension of the mental and intellectual faculties,
there is an extension and greater complication of the nervous system,
especially of that part which we call the brain." He admits, also, the
inferior mental capacity of the negroes and other varieties of mankind.
How then, does, he reconcile these statements with his previous asser¬
tion that the brain is the same in a negro and in an European ? If,
again, as he supposes, the negroes and other inferior raries may, by
the' influence of favorable circumstances through generations, im¬
prove, so as “ even, perhaps, to approach the point which has been
attained by the more civilized communities of the present day," does
it not follow from the previous statements that the brain must under¬
go considerable modification ? The difference which at present really
does exist in favour of the Caucasian brain, will represent the ex¬
tent to which the negro's brain may improve.
It would not, however, be fairly representing Sir B. Brodie, if
the foregoing remarks should produce an impression that he had
come to any conclusion on the subject of the origin of species—
“ You may conclude no more than this: that the thing is so far be¬
yond the limits of my experience, and that, in whatever way I look
at it, I find the question so beset with difficulties, that I cannot
venture to form any opinion on the subject.”
While admitting the co-ordinate development of mind and brain.
Sir B. Brodie refuses distinctly to accept the doctrine that the former
is simply a function of the latter. “ We have no more right," he
observes, “ to say that the brain makes the mind, than that the mind
makes the brain." And to those who may object that we have no
experience of the existence of mind except in combination with
material structures, he gives the answer “ so briefly and clearly given
by the learned author of the * Physical History of Mankind.'" Dr.
Prichard's words are:
“ The whole universe displays the most striking proofs of the
existence and operation of intellect, or mind, in a state separate from
organization, and under conditions which preclude all reference to
organization. There is, therefore, at least one being or substance
of that nature which we call mind separate from organized body,
not only somewhere, but everywhere."
Sir B. Brodie thinks it very remarkable that this argument should
have been “ so much overlooked as it has been both by physiologists
and metaphysicians;" and takes the opportunity to point out the
errors which they have both fallen into in their investigations. The
physiologist's mistake is, that he has studied the brain as he would
any other organ of the body, and has thus tended to reduce the mind
to a mere function of it, as the secretion of bile is a function of the
liver. "We conclude with equal certainty," said Cabanis, "that
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the brain digests in some way its impressions, aDd accomplishes
organically the secretion of thought." The metaphysician has gone
into the other extreme, and has studied mind quite irrespectively of
the corporeal system. Bishop Berkeley is usually said—but the asser¬
tion does not do justice to his philosophy—to have denied altogether
the existence of a material world. “Neither of these, as I appre¬
hend, pursues exactly the right course. The human mind, as it comes
under our observation, is to so great an extent influenced by the con¬
dition of the body, that it cannot be the proper object of study if
the latter be disregarded; while the physiologist is equally wrong
in regarding the mind simply as a function of the brain, over¬
looking the entire want of relationship between the phenomena
which the mind exhibits and those presented by the material world."
It is not exactly apparent, nevertheless, how this last statement of
an “ entire want of relationship between the phenomena which the
mind exhibits and those presented by the material world," is recon-
cileable with the above mentioned “ briefly and clearly given" argu¬
ment of Dr. Prichard.
Sir Benjamin Brodie accepts the logical result of the views which
he has enunciated with regard to mind and brain. He admits that
the mental principle in the lower animals must also be independent
of organization, and believes it not improbable that the future which
man claims for himself will not be denied to them. It is plain that
man has no just reason for claiming “ a sole exclusive heaven," and
when, after a well-spent life, he passes into happier spheres, he may
even expect that “ his faithful dog shall bear him company."
No limits can be put to the extraordinary conceit which man has
of himself. With a remarkable placidity he rests in the belief that
the forces of nature have been at work through countless ages for
the purpose of building him a dwelling-place; that nature has tried
her “’prentice hand" in the construction of numberless organic
forms, in order to attain to the skill of accomplishing the perfection
of his type; and that now, having completed her work and witnessed
the glory of it, nature will rest from her long labours and thankfully
utter a “Nunc dimittis." Por he at last has come for whom there
has been such mighty travail. But is this probable? Is man
really the final blossom of the universe ? As Sir Benjamin Brodie
asks, “ Whatever may be the future destiny of man, is he really so
perfect that he should be regarded as the crowning-piece of the
creation? We have the history of the former inhabitants of our
planet, not handed down by tradition, not written in books, but
recorded in indelible characters in the strata immediately below the
surface of the earth. We learn from these that numerous forms of
animal life existed, in ages which have long since gone by, which
have now become extinct; that the first of these which were called
into existence were of a simpler kind; and that by a gradual, though
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Psychological Inquiries, by Sir B. C. Brodie.
*
by no means regular progression, these have been succeeded by
others of a higher and yet higher order. Is man to be considered as
the last of these productions ? or is it not more probable that he
does but stand in the middle of a long series, ana that in the far
distant future there may be a time when, his mission on earth having
been completed, he too will be replaced by other living beings, far
superior to him in all the higher qualities with which he is endowed,
and holding a still more exalted place in the system of the universe ?”
Such speculations may be vain, but they are the result of a
principle in the human mind which impels it unceasingly to labour
to push back the boundaries of the unknown, and by which it is
made in time to know the limits of its faculties.
In taking leave of these ' Psychological Inquiries/ it may be well
to add that, in books written in the form of dialogue, it is often
difficult to avoid attributing to the author sentiments which may,
after all, not be his, but those of one of his characters. If such an
. injustice has been done to Sir B. Brodie in the present notice, the
blame of it must rest chiefly with himself. Por his “ personae dra¬
matis " are the merest shadows; they have no individuality; Crites
might be‘ Eubulus, and Eubulus might be Ergates, and no one
would find any difference. If one of them had begun at the begin¬
ning of the book, and had talked on to the end of it, while the others
listened, it would be no clearer than it is now that it is Sir B. Brodie
who is talking throughout. Many, perhaps, might have been more
pleased if Eubulus, instead of inviting his friends from town, had
sat down and entered more deeply in some of the rpany interesting
subjects which, as it is, he has only touched upon, being prevented,
whenever he was tempted to do so, by the observations of his friends
that such matters were beyond the reach of human faculties.
He must, however, be a lover of carping criticism who does not
at the end of the book feel grateful to the author for such a clear,
temperate, and careful expression of opinion on subjects that are of
the deepest interest to all mankind.
H. M.
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On the Principles and Method of a Practical Science of Mind, in
Reply to Dr. Thomas Laycock, Professor of Medicine in the
University of Edinburgh. By J. Stevenson Bushnan, M.D.;
Fellow of the Royal College of Physicians of Edinburgh; late
Senior Physician to the Metropolitan Free Hospital; Resident
Proprietor of Laverstock House Asylum, near Salisbury.
The more we study Dr. Laycock's elaborate work, f Mind and
Brain/ and his subsequent relative publications, the more we are
satisfied of the large turn of his mind tor psychological investigation,
of the depth of his attainments in that department, and of the pro¬
fundity of his views; nevertheless, we still retain our opinion that he
has failed to make his works practical in the ordinary sense of that
term. We never said that his views are not susceptible of being
rendered practical. What we insist upon is, that he has not yet
succeeded in what he proclaims on every occasion to be his great
object—namely, to render a study which has been hitherto abstruse
and unintelligible, easily accessible by people of a practical turn of
mind; or at least to make that study more available for practical use
than it was in the hands of the older psychologists.
It appears Dr. Laycock accepts our definition as to what a practical
mental science includes—the following being our words :—“ What
are practical metaphysics ? What but a knowledge of the ordinary
faculties of the mind, of the general laws under which these faculties
operate, and of the modifications which these laws are apt to undergo
in individuals; what but a knowledge of the appetites, desires, bene¬
volent and malevolent’affections of our human nature, of self-love, of
moral judgment and obligation, and of the circumstances under
which these are exalted, confirmed, or subverted P” This definition
Dr. Laycock accepts, with the stipulation that he admits of no limi¬
tations. Let it be so. What we still affirm is, that it is hardly
possible for a student previously unacquainted with psychology, to
obtain from Dr. Laycock's writings the knowledge included in the
above definition, so as to make use of it in his intercourse with the
world.
Dr. Laycock will surely understand when we say this, that we
say it of his book or books, sent into the world without an inter¬
preter to teach the still uninitiated practical psychology. We never
did say, and do not intend to say, that ‘ The Mind and Brain/ used
as a text-book for a course of lectures, while each particular part to
be studied first, next, and so on in succession, is pointed out, while a
commentary on the signification of the several propositions contained
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in each is premised, and a glossary is given of the particular sense in
which such and such words are to be received, will not prove a most
useful work for instruction even in practical psychology. For ex¬
ample, if a student were advised to omit the first 115 pages of the first
volume of ‘ Mind and Brain/ and begm his reading at the second part,
we think, if he had studied psychology, and had endeavoured to under¬
stand some such book on psychology, as ‘ MorelTs Elements' of that
subject, he might really learn some views of surprising interest and
utility from several successive chapters of Dr. Laycock's ‘ Mind and
Brain.' But it may be remarked that, in these chapters, while he is
desirous to show how much he differs from some of the older meta¬
physicians, he finds Sir Wm. Hamilton, avowedly a psychologist of
the old school, continually coinciding with him in his views. Whence
we infer, as we did before, that Dr. Laycock should not contrast his
doctrines with the obsolete doctrines of what, for brevity's sake, we
shall call the psychology of the schools, but compare them only with
the most recent views given in the schools, such as Sir Wm. Hamilton
so copiously supplies. For example, we think he would render his
pupil a great service, in the very beginning of hi« psychological
studies, if, directing him at once to page 116 of volume first, he were
to comment on the words, “ A human being intuitively distinguishes
himself from all other things around him and not of him, which to
him constitute the external world. And just as he intuitively dis¬
tinguishes the external world from himself, so he separates that part
of himself which feels internally, as a subject from that part of himself
which he perceives externally in space—as an object. * * * *
To him, that which sees, touches, and causes motion, is one thing;
that which is seen, touched, and moved, is another. The one is the
agent, the other is the object." The service he would do the pupil
here is the inestimable benefit of saving him from interminable dis¬
cussions as to the insufficiency or validity of .the proofs of the exist¬
ence of an external world. But his immediate quotation from Sir
Wm. Hamilton shows that Dr. Laycock's new system is not singular
in affording this advantage. “ The veracity of consciousness in the
fact of perception [i. e. the accuracy of our intuitive knowledge of
our existence] being unconditionally acknowledged, we have esta¬
blished at once, without hypothesis or demonstration, the reality of
mind and the reality of matter; while no concession is yielded to
the sceptic, through which he may subvert philosophy in manifesting
its self-contradiction."
We said that Dr. Laycock's student must be provided with-a glos¬
sary, showing the particular sense in which he employs words of
common use in psychological discussions. In the passage quoted
above, there is a word which we gave in our last critique as one of those
with which Dr. Laycock confuses his readers. The word we refer
to is “ intuitive." We took occasion to examine at some length our
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Method of a Practical Science of Mind.
author's section, entitled intuitive ideas and necessary truths, infer¬
ring from the frequent use of important words under that head that ‘
his book, as it stands, so far from giving an easy introduction to this
difficult and important inquiry, did nothing but confuse the reader.
Dr. Laycock has complained that we have selected some of the
speculative questions in philosophy, in order to test his system,
instead of choosing our themes from the practical questions which
are largely discussed in his work. "We have bestowed praise on
much of Dr. Laycock’s system; but we have seen great reason to
object to his frequent change of the established signification of words
in general use, and it is this principal fault to which we must still, in
a great measure, confine ourselves. For it so happens that the
change in the use of such words is chiefly to be discovered in the dis¬
cussion of the most speculative questions, though the vitiating
influence of the changes themselves extends even to perverting the
sense of subjects which might seem incapable of being misunder¬
stood. Who could suspect that, in a work designed to render an
abstruse subject familiar to ordinary readers, words so well esta¬
blished in signification as “ intuition and experience” should have been
made use of in a sense totally opposite to that in which they are
universally received ? Nor is this change to be imputed to any haste
or inadvertence; but it is a fixed design, and part of the plan of Dr.
Laycock’s system, as it stands, so to employ these words. He has
not replied to our objections to his section entitled “ Definition of
Instinctive Ideas and Necessary Truths/’ but he has given us a new
discourse, the title of which is “ The Nature and Origin of Experience
practically discussed,” wherein the full extent of his offending against
the legitimate use of psychological language is freely set forth.
Our original objection, which has led to this controversy, was, that
Dr. Laycock had, in a work professing to make psychology easy and
of practical use, changed the signification of such important words
as “ necessary and intuitive,” so as totally to confuse the minds of
his readers. Dr. Laycock does not deny that he has changed the
signification of these two all-important words, the effect of which is to
render every other psychological work a shut volume to those who.
have been initiated in psychology under his auspices. Dr. Laycock’s
system destroys the important distinction between such truths as
that the square of the hypothenuse is equal to the sum of the squares
of the base and perpendicular in a right-angled triangle, and such
truths as that water boils at 212° Fah.; yet the former truth is
universal; the same in the mind of the Creator as at every point of
the universe ; whereas the latter greatly varies, not only on the sur¬
face of every planet, but even at many inhabited spots on the surface
of the earth ; for example, in the South American city of Quito,
where water boils at a much lower temperature than 212° F.
But we doubt if Dr. Laycock has always beeu careful to use the
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Db. Stevjsnson Bushnan, on the Principle* and
words “ intuitive and necessary" in the new sense which he has
affixed to them.
For example, he tells us (at p. 290, vol. i), that" All truths what- .
ever must be truths ©f experience; for consciousness itself is but an
experience of the vital changes within us." Again, in his reply to
our observations (No. XI, January, 1862, p. 510), he says:—“ Now,
the fundamental proposition with me, as to all our knowledge, is that
consciousness itself is experience—an experience of the vital changes
in or by which we feel, think, and know. Here is a plain, distinct
general law, applicable to all modes of feeling, thought, and know¬
ledge." Nobody denies that, in a certain sense, all consciousness is
experience. But is that the established sense of experience, when
contrasted with intuition ? And if it be not. Dr. Laycock has, in
the first place, chosen in his practical work to change the sense of a
word in universal use to denote a different idea—one of the charges
we made against him. But if that be the sense he attaches to ex¬
perience, will he explain to us what idea he affixes to the word in¬
tuitively in the passage before quoted—“ a human being intuitively
distinguishes himself from all other things around him, and not of
him, which to him constitute the external world." Why does Dr.
Laycock here use the word intuitively apparently in the sense appro¬
priated to that word by psychologists in general ? whereas the proper
phrase, according to his system, should be by experience; for in¬
tuitively implies consciousness, and, according to him, all conscious¬
ness is experience.
Again, Dr. Laycock imputes it as a fault to psychologists that
they employ the words intuitive and intuition in the same sense as
intuitive truths and truth; hence, too, it does not follow according to
his view, that man's belief in the external is a truth, unless he here
use the word intuitively in a signification different from that which
he assigns to it.
We entreat Dr. Laycock to reconsider this matter. If he is to
become an authority in psychology, of which we entertain no doubt,
he is, we assure him, introducing one new source of misunderstanding
and confusion into the study of psychology, in addition to the many
such blots by which it is already defaced. We recommend to him
the study of a page or two in Sir William Hamilton's ‘ Lectures'
(vol. iv, 72, 73), under the head “ Intuition," from which we take
the following extract :—“ The only part that might have required an
explanation is the distinction of truth into pure or a priori, and
into empirical or a posteriori. Experience presents us only indi¬
vidual objects, and as these individual objects might, or might not,
have come within our sphere of observation, our whole knowledge
of and from these objects, might or might not exist; it is merely ac¬
cidental or contingent. But, as our knowledge of individual objects
affords the possibility, as supplying the whole contents of our
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Method of a Practical Science of Mind.
generalised or abstracted" notions, our generalised or abstracted
notions are consequently not more necessary to thought, than the
particular observations out of which they are constructed. For
example, every horse I have seen, I might not have seen;,and I
feel no more necessity to think the reality of a horse than the reality
of a hippogriff; I can therefore easily annihilate in thought the
existence of the whole species. I can suppose it not to be—not to
have been. The case is the same with every other notion which is
mediately or immediately the datum of observation. We can think
away each and every part of the knowledge we have derived from
experience; our whole empirical knowledge is therefore a merely ac¬
cidental possession of the mind."
“ But there are notions in the mind of a very different character;
notions which we cannot but think, if we think at all. These, there¬
fore, are notions necessary to the mind; and, as necessary, they
cannot be the product of experience. For example, I perceive some¬
thing to begin to be. I feel no necessity to think that this thing
must be at all, but thinking it existent, I cannot but think that it
has a cause. The notion or rather the judgment of cause and effect
is therefore necessary to the mind. If so, it cannot be derived from
experience."
If Dr. Laycock will apply his mind to this subject, we feel as¬
sured he will discover that the belief in the existence of the external
world is not a truth of experience. Dr. Laycock probably sometimes
dreams that he is still at York; he perhaps thinks himself dining
at some old friend's table with the Minster from the window brought
vividly out in the summer evening's sun. This dream is as much
the experience of a succession of states of consciousness as the reality
it represents would have been. But the dream is beyond doubt a
part of self. There is nothing, therefore, contradictory in the notion
of • the idealists that all the mental phenomena in a man's mind
throughout life are purely internal phenomena, or a part of self, like
those of a dream. How, then, does Dr. Laycock get over this
difficulty, if he regards all truths as truths of experience ? There is
the dilemma. It cannot be got over on his principles. He must
confess that intuitive truth is something more than experience teaches.
If he does not confess that an intuitive truth is a truth felt to be a
truth by the original constitution of the human mind in an act of
experience, it is true, but independently of what that act of ex¬
perience teaches. The appearance of York Minster is equally an
experience of consciousness in Dr. Laycock's waking hours as in his
dreams; but the perception of its being a thing external to his mind
as a truth belongs only to his waking hours. Whence an intuition
is something more than an experience of a particular of conscious¬
ness ; it is an act of experience with a superadded conviction of the
truth of something which stands in relation to the act of experience.
VOL. VIII. 16
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MICHIGAN STATE UNIVERSITY
240 Dr. Stevenson Bushnan, on the Principles and
We continue, therefore, to insist that Dr. Laycock’s system, in so
far as it confuses the pupil by the new or loose use of established
terms, is uufit for teaching practical psychology.
Dr. Jjaycock may possibly have some mode of escaping from our
argument drawn from a dream. Yet there cannot be a doubt that
he teaches a confusing doctrine, when he says, that all truths rest on
experience. Here nothing will satisfy the principles on which our
ideas rest, but the distinct avowal that the evidence of intuition and
the evidence of experience, are wholly separate and distinct. There
may be a debate in psychology whether a particular truth be a truth
of intuition or a truth of experience; but according to the received
principles of human knowledge, there can be no question as to the
evidence of intuition being another thing altogether from the evidence
of experience. What Dr. Lay cock seems to confound is, the ex¬
perience of a state of consciousness with the perception of truth.
Every state of consciousness is undoubtedly an act of experience.
But of what is it an experience ? It is an experience of the exist¬
ence of the being which has the consciousness; it is the experience
of the susceptibility of that being to exist in that particular condi¬
tion of consciousness. Nay, more, if the state of consciousness in
question be the sensation of a red colour, it is the experience of a
red colour external to self; if it be that of a green colour, it is the
experience of a green colour external to self; if it be the remem¬
brance of a red colour, or of a green colour, it is the experience of
a red or green colour, which is a part of self. Yet again, all these
things are truths, and, nevertheless, they are not truths of experi¬
ence—they are intuitive truths. They are experiences of truths, yet
not truths of experience. When a red surface is for the first time
presented to the eyes of a living being, the sensation arises which is
ever after recognised by a particular symbol. The same is the case
with a green surface. In both cases the first sensation is an act of
experience; but has the experience anything to do with the ability
of the living being to recognise the one sensation as distinct from
the other? Not at all. That ability is conferred by the constitution
of the mind:—that is, it is the effect of intuition. So when such a
being regards the experience of the sensation of red as being from,
without, while he determines the experience of the remembrance of
the sensation to be from self, he acts, not by experience, but by the
constitution of his nature, or by intuition. If it be asked what man
learns by the evidence of experience—the answer is, that there are
things winch intuition cannot teach. He learns that wood floats in
water; that stones sink; and yet, after a time, he discovers that
there are some exceptions, as some woods sink, and some stones
float. Man also learns to dance by experience; he learns to skait
by experience; the child learns to avoid the fire by experience, and
will not readily touch the harmless burning delineations made with
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Method of a Practical Science of Mind.
phosphorus. To the determinations of intuition exceptions hardly
occur; two and two always make four; the whole is always greater
than its part. When the proposition that two and two make four
is presented to a matv’s mind, he feels its truth; he has an experience
of its truth; and this is what seems to mislead Dr. Laycock into
the proposition that all truths are truths of experience. In the same
manner—that the whole is greater than its part, is not a truth of
experience, because a man, when the proposition is presented to him,
has an experience of its intuitive character of truth. That such
propositions have not the evidence of experience in their behalf is
readily shown by the counter-propositions, namely: that two and
two make five, or that a part may be equal to the whole. Tor when
these propositions are present to the mind, there is an experience of
consciousness, but not an experience of their truth, but of the contrary.
We, therefore, still ask on behalf of Dr. Lay cock's pupils, what he
means when he says —“ Man instinctively distinguishes himself from
all other things around him, and not of him, which to him constitute
the external world.” (Yol. i, p. 117.) What we ask is: whether,
according to his system, the knowledge of the external is the result
of experience; or is it a piece of knowledge independent of experience,
which only requires experience for its development. His answer is
fundamental as respects his system; and until he makes his election,
his system, as a system of psychology, is full of confusion.
We wish Dr. Laycock to understand that when we said that his
work is in no sense practical, we meant that he has failed in particular
to make his system intelligible to those who seek the knowledge of
practical psychology at an easy price of labour.
Dr. Laycock sets out in his reply to our critique with controvert¬
ing a proposition laid down by us to the effect that “ the way to
practical improvement in almost every department of science and
art., is in the opposite direction to generalisation.”
Dr. Laycock, in attacking this proposition—very unwarrantably if
he had kept the spirit of our observations on his work in his mind—
endeavours to make it appear that we advocate in the above propo¬
sition, one of the following two modes of advancing science. 1st.
“ Either it consists in the exercise of mere practical tact or dexterity,
without a distinct perception or knowledge of general laws or princi¬
ples, commonly known as the rule of thumb, which science en¬
lightens; or 2nd. It is to be found in the deductive or a priori
method by which principles are reached by means of logic instead of
observation and research;” and he conjectures that the latter is the
mode which we prefer. Our readers will bear in mind that Dr.
Laycock throughout his work is unceasingly extolling his own method
as superior to the pyschology of the schools as a means of practical
instruction in psychology. It was then, with a strict reference to
Dr. Laycock’s continual self-glorification in connection with the word
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Dr. Stevenson Bushnan, on the Principles and
“ practical,” while we perceived the vast generalisations exhibited in
his system, on which no slight praise was lavished, that the proposi¬
tion here attacked by him arose in our minds. We felt that the
common systems of psychology were already too much of the nature
of abstract propositions for practical use; and with a system still
more abstract, and embracing still larger generalisations before us,
pretending to be practical, naturally gave utterance to the statement
in question. We trust, however, presently to show to the satisfac¬
tion of our readers, that sentiment to be perfectly true in the sense
in which it was employed. What is the practical? With what
does the practical deal ? Does not the practical deal with individuals,
while the scientific deals with species, genera, orders, classes ? But
does generalisation descend from classes, orders, genera, species to
individuals, or ascend from individuals to species, genera, orders, and
classes? Were we not then entitled to say, that the way to the
practical is usually in the opposite direction to generalisation ? In -
psychology, perception, memory, imagination, judgment, curiosity,
ambition, gratitude, pity, hatred, revenge, self-love and sympathy,
taste, conscience, are all pure abstractions, to employ which in a
practical manner it is necessary to pursue the opposite course from
generalisation, and to regard them as they are exhibited in particular
individuals. A man is a practical psychologist who can readily
catch up the deviations which insanity has produced on the mind of
an individual in respect to the operations -mentioned above, as com¬
pared with their operation in persons of average sound mental con¬
dition. But the training for such a facility of observation is not
obtained by pursuing large generalisations, but after a studied ac¬
quaintance with the prominent features of the generalisations
referred to above, to mingle freely with individual men both in the
large circle of the world and in the narrower circle of asylum life;
or, in short, to seek the practical in the direction opposite to gene¬
ralisation.
"Every great physician is a practical physiologist; but if he be a
clinical lecturer like Dr. Laycock, he does not attempt to teach his
pupils the proper practice of medicine by striving after new generali¬
sations of the known phenomena of physiology, but by descending
to the details of the individual sick before him, while h^ converts
the abstract into the concrete.
Every skilful agriculturist is a practical chemist; but he does not
seek to augment his crops by endeavours after new generalisations of
the known phenomena of chemistry, but by studying to become
more immediately conversant with the individual composition of his
own soils.
Every mineralogist also is a practical chemist; but he does not
seek to improve his knowledge of the forms of natural bodies by new
generalisations of known phenomena, but by applying himself to the
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Method of a Practical Science of Mind.
study of the minute composition and aggregation of the individual
substances that are the subjects of his research, while he has often
found occasion to reverse the process of generalisation, and to pro¬
nounce that to be multiple which was believed to be one.
Dr. Laycock affects to think that we teach that the inductive
method is not the way to advancement in science, and that we deny
generalisation to be a principal mode in which progress is made.
Accordingly he sets about the very unnecessary task of showing that
the generalisations in optics have improved the telescope and mi¬
croscope ; that on the generalisations of Newton the whole modern
science of astromony rests, and so on.
There is not a syllable in either of our two critiques that warrants
Dr. Laycock in making such an assumption. If the word “prac¬
tical" be left out of the proposition which he attacks, it becomes
one of a very different character.
He sets up a man of straw, which he finds it easy to demolish.
Let the reader observe the difference. Here is Dr. Laycock's straw
fabrication. “ The way to improvement in almost every department
is in the opposite direction to generalisation." This proposition is
untrue; it is absurd; it is spurious; it is not ours.
How sorry a figure will Dr. Laycock make if he resorts to such a
defence as that practical improvement depends on scientific improve¬
ment, and if generalisation be the way to scientific improvement it is
therefore the way to practical improvement. Yet this manifestly is the
lesson which he has taught himself in practical psychology by the large
generalisations in which he has indulged. If we Should ever again visit
Edinburgh and having met Dr. Laycock on the street should ask
him the nearest way to the Carlton Hill, and he should point in an
opposite direction, we shall expect him to say in answer to our
reproaches at our next meeting that he pointed in the opposite
direction, because, in that direction, we should have found a guide to
show us the way. We entreat Dr. Laycock to give up such methods
of making himself singular.
There is as little doubt as to generalisation being the usual mode
in which scientific improvement is made, as that deduction, or the
method opposite to generalisation, is the principal means by which
practical improvement is accomplished.
We must deal with the remaining part of Dr. Laycock’s answer to
our objections in a more summary manner.
In his arrangement of our objections the second article is—that
we have represented that the generalisations attempted by him cannot
lead, and have not been capable of application to improvements in
practical metaphysics. We can discover no foundation for this state¬
ment in our observations, except in the following passage, to which
we distinctly adhere. “ Dr. Laycock’s system is in no sense practical.
In its present state it is a purely speculative view. It is on its trial.
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Dr. Stevenson Bushnan, on the Principles and
It cannot be of practical use, in the ordinary sense of that term, until
it be more or less generally adopted; and in order that it may, if
sound, be generally adopted, we are most desirous that it should
receive fair discussion.” He agrees with us in our description of
what practical psychology is :—so far we are at one. We say his
system as regards its great principles is on its trial. We trust it
will turn out largely and usefully applicable even to practical psy¬
chology. But we have felt compelled to point out at length a great
and principal barrier to its immediate success in the number of
instances in which he has confused his readers by employing impor¬
tant words of received and established acceptation in a new significa¬
tion.
In the next page Dr. Laycock, with a wonderful forgetfulness of
the whole spirit in which at once our commendations and animadver¬
sions are written, concludes that we advocate, as the best way to
practical improvements in science the a priori method, or that by
which principles are reached by means of logic, instead of observation
and research. The following passage in our first notice of Dr.
Laycock’s work is probably that which his fertile imagination has
metamorphosed into the above form. “ The great fault charged by
our author against the old method of metaphysicians is that they
limit their inquiries to the subjects of consciousness; and that their
knowledge is confined to what can be acquired by reflection on what
is supplied by consciousness. As respects that part of special meta¬
physics termed psychology, we think that limit should be rigidly
preserved, always with this understanding—that whatever con¬
sciousness may be found to include, shall be admitted, notwith¬
standing that it may be beyond the limits fixed by some of the older
metaphysicians. While psychology limits itself to what conscious¬
ness supplies, it is so far from interfering with the extension of
human knowledge in any possible direction, that the very purpose of
psychology is to render man’s exertions in the pursuit of true know¬
ledge more effective.
“ Our author is not forbidden by psychology to direct his investi¬
gations to any quarter in which he sees reason to expect discovery,
but he is not at liberty to blame psychology for not attempting
studies which he beyond its sphere.”
In the next paragraph the crow Dr. Laycock has to pluck with us
is thus depicted :—“ On my-title page I state that my work contains
the correlations of consciousness and organisation with their appli¬
cations to philosophy, zoology, physiology, mental pathology, and the
practice of medicine. Dr. Bushnan had therefore an abundant choice
of practical departments from which to select test questions; he
limits himself, however, to the department of philosophy, and even
selects the most speculative questions of that department” (p. 498,
January, 1862.)
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Method of a Practical Science of Mind.
In the first place, our debate with Dr. Laycock does not turn on
the point whether he does or does not apply his system to practical
departments, but on the question whether his system, as treated in his
books, is practically applicable to such subjects. Our business
clearly was first to examine his philosophy, and to satisfy ourselves as
to its intrinsic truth; and as to the greater or less facility of appre¬
hending its principles, as set forth in his method of exposition, before
taking up its application to practical subjects.
Dr. Laycock next cavils with us for intimating our belief that
some of the discussions in the psychology of the schools had proved
the most useful exercises ever introduced for the enlargement and
strengthening of the human understanding. Under the same head
he charges us with confounding the study of logic with that of psy¬
chology, and brings to bear against our opinion the recent introduc¬
tion of modem natural sciences by Oxford and Cambridge, into the
range of University studies. We meant what we saidj and we did
not confound logic with psychology; and we are ready still to do
battle for our opinion, even if the two respectable old ladies referred
to should consent to back the Edinburgh professor. We regard it
as undeniable that the highest exercise of human thought is that
which turns on objects which have no sensible representatives. Such
an exercise of thought belongs not merely to psychology, but to all
the subjects which fall within metaphysics. Even in mathematics
this kind of exercise of thought is not obtained; since lines sensibly
represent space. Still less is such an exercise to be gained in the
study of the physical sciences and natural history—nor even in logic,
for all logic may be represented by symbols. We do not dispute
the advantages in the way of culture to be derived from the well-
directed study of any subject of knowledge. But it seems clear that
where sensible objects are concerned, inferior intellects may make
progress, while pure thought is the field for the greatest exertions of
the intellect. But what we most wonder at, is that an acute meta¬
physician, like Dr. Laycock, should suppose that the best school for
teaching the student the rigid use of words is that in which the
sense of those used is incapable of being mistaken. We have heard
of a head cook being sent to learn how to boil a potato, but we
hardly expect the refinements of cookery in one bred in a kitchen
where nothing but potatoes are boiled. It is the very tendency in
metaphysics to ambiguity of language that affords the lesson to the
student; so that, in our mind, Dr. Laycock’s elaborate proof as to
the ambiguity of words in psychology, as an answer to our state¬
ment, is wholly thrown away, as well as his suggestion that, exactness
of phraseology is only to be learned in the physical sciences and
natural history. We repeat, that there is little comparative exercise
in the difficulties of thought and language in the latter studies, as
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contrasted with that called forth by the whole range of metaphysical
pursuits.
Dr. Laycock, in the next page, attacks us for maintaining that
there are different kinds of consciousness, and “ that each of these
has its knowledges and laws as objects of scientific investigation, in
entire independence of the ‘other." We cannot discover where we
have laid ourselves open to this attack; and we deny that the opinion
here raised up for demolition is common to us with the old school of
psychology. We have been accustomed to consider all the states in
which mind can exist as so many states of consciousness; and we
know that this is the view of consciousness most commonly taken of
late by the metaphysicians of the schools. There was a time, no
doubt, when a clear mode of expressing the oneness of consciousness
did not exist; there was a time, after the science of psychology had
made much progress, when a distinct word for consciousness did not
exist in the Greek language; but surely, when Dr. Laycock mounts
his hobby to attack the psychology of the schools, he should have a
greater sense of justice than to ask his opponents to use in their
defence only the rude w eapons of early times, when he comes armed
cap-a-pie with all the advantages of modern mental physiology.
Consciousness is, indeed, one; but there are many very different states
of consciousness. When an oyster in its bed closes its shell on the
approach of danger, there is a consciousness. When Dr. Laycock
draws himself up to repel a blow, there is a consciousness. Here
the consciousness is one—the states are different; the first is ordi¬
nary, the second, we trust, even in the pugnacious city nick-named
the modem Athens, is extraordinary. When Dr. Laycock sees
York Minster before him, there is a consciousness; when he sees it
in a dream, there is a consciousness; the consciousness in both eases
is one—the states are different. The first is ordinary; the second
extraordinary. After this full confession of our creed on the subject
of consciousness, we trust Dr. Laycock will not again throw away so
much ink, if he should ever catch us using so apparently harmless
an expression as “ ordinary faculties of the mind,” out of which it is
plain the whole of this part of his attack has grown.
When our readers are told that on the following passage from our
critique several pages of attack are founded, they will perceive, we
think, that nothing will content Dr. Laycock but an unqualified sub¬
scription to all his views, including all his glorification of the system
he supports, and all the ungenerous abuse he pours on the psychology
of the schools, to the study of which, beyond doubt, he owes his own
power of writing a book like that under consideration. The passage
is as follows: “ It seems manifest, however, that the proper rule in
the old system of psychology, is to take evidence solely from con¬
sciousness in the mature state of the mental faculties, and to regard
at least all inferences from what must have occurred in childhood as
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Method of a Practical Science of Mind.
belonging, not to the metaphysical, but to the physiological side of
the inquiry—that is, the investigation by observation and expe¬
rience.” (p. 375.)
Such a passage as this, instead of being used by Dr. Laycock to
attack our sentiments, should have been viewed by him as a manifest
concession to the kind of inquiry into the functions of the nervous
system, which he advocates. Dr. Laycock’s system is a system of
physiological psychology; that is to say, an inquiry into the functions
of the nervous system on the usual grounds on which physiological
inquiries are prosecuted. We have everywhere admitted, not merely
the usefulness, but the necessity for further progress, of such a
physiological inquiry; and we have not anywhere condemned Dr.
Laycock’s particular mode of conducting such an investigation. Nay
more, we have bestowed much commendation on what is the most
remarkable part of his book and the most special to himself, namely,
the large generalisation “ that mind is the cause of all phenomena,
and therefore the cause of all vital action and of all thought.”
Now the passage above quoted from our critique bears on the face
of it that we are advocates for a physiological investigation of mental
phenomena; yet in spite of 'manifest proofs, everywhere abounding,
of our advocacy of a system of inquiry analogous to his own, he sets
us up to be pelted at, as a figure representing the genius of the old
psychology in its rudest condition.
He continually forgets that it is not the merits of the old psy¬
chology which is the proper subject of debate between us; that is
only an incidental topic, brought up by his unceasing abuse of that
psychology ; and that the real ground of debate is the excellences
or defects of his occasional modes of studying mental phenomena by
a physiological method. The passage above quoted from our second
article, which Dr. Laycock uses most unwarrantably to convict us
“ of being true to the principles of our method, which (according to
him) restricts even the sphere of speculation, while it is confessedly
opposed to induction and generalisation,” occurs in a paragraph
devoted to the consideration of the respective merits of the psy¬
chology of the schools, and what we have termed physiological psy¬
chology. In that paragraph, there is a sentence which shows how
little we are wedded to our mode of cultivating psychology. It is as
follows:—“this (the inquiry into the respective merits of the two
systems) is a very important inquiry, and we profess ourselves ready
to adopt whatever conclusion is best sustained by a review of the
whole facts concerned.” This is not the language of one so blinded
by devotion to an ancient creed as to have become incapable, so Dr.
Laycock represents us, of understanding the uses of the generalisations
of science. This part of our character, to be sure. Dr. Laycock
claims as a discovery of his own, on grounds however which we
think we have shown, a few pages back, to be very fallacious, and the
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assumption of which as true to be an indication that our author is
liable to fall into a reverie of delight with his own speculations, while
the standers by cannot help laughing at the figure he makes. If
further proof were needed that we are not so blindly wedded as
Dr. Laycock represents, it is to be found on the same page, where
we state our belief that in the development of the mental faculties
there are numerous sources of instinctive belief, but that the proof
of this fact is not to be obtained except from the kind of evidence
which belongs to physiological psychology. In short, we defy Dr.
Laycock to point out any passage in either of our two articles that
either condemns the principle on which physiological psychology
rests, or even intimates any decided preference for that of the
old psychology, or the psychology of the schools. Neither have
we condemned the principle on which Dr. Laycock’s peculiar form
of physiological psychology rests. We said in our first article, “we
make Dr. Laycock quite welcome to pursue his own method of in*
quiry, and in common, we are sure, with the philosophic world at
large, we shall feel grateful for whatever benefits the pursuit of that
method may ultimately confer on science.” We are still ready to
acknowledge that these benefits may be, great—if Dr. Laycock him¬
self does not studiously throw obstacles in the way of his system
becoming a standard reference in psychological science. We have
blamed nothing in his two works except such things as we sincerely
believed to stand in that light. We have blamed, for example, his
continual attacks on the olu system of psychology, or, as we have
usually termed it in this article, the psychology of the schools. Now
this we regard as a great fault, because the two systems do not stand
in opposition to each other. It is not necessary for the establish¬
ment of Dr. Laycock’s views, that the psychology of the schools
should be overthrown. The psychology of the schools has risen to
its present height by the successive exertions of many of the greatest
minds which our human nature has produced. It is reared no doubt
on a narrow basis; yet on that basis it stands a monument of the
transcendent powers of the human intellect. It may be that in
point of principle it cannot be carried much beyond its present
bounds. Nevertheless it is a demonstrable error on Dr. Laycock’s
part to think that this old system cannot be made subservient, in the
highest degree, to practical psychology. It is true that when we
desire to convert it into a practical system, we must leave off gene¬
ralities, and descend to particulars. We must study the phenomena
of mind as they appear in individuals. Dr. Laycock is perhaps
simple enough to think that, because the great laws of human
thought in this system are investigated only as objects of conscious¬
ness, it is therefore forbidden to remark the modifications and varia¬
tions of these in individual minds. The application to individual
minds of the great conclusions drawn from reflection on the objects
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Method of a Practical Science of Mind.
of consciousness in the old system, is as open to those who cultivate
it, as is the like application of principles established by the evidence
termed physiological. Dr. Laycock will doubtless find himself mis¬
taken, if refusing to listen to a gentleman, "who" (according to
him) “ looking for the practical in mental science can find no better
tests for it than the insoluble problem of the nature of the Deity,
or the uses of metaphysical logomachy, and the like wearinesses,"
he expects to reach the practical in his psychology by heaping
generalisation upon generalisation, instead of acknowledging “ that
the way to the practical, in almost every department of science and
art, is in the opposite direction to generalisation."
But to recur to Dr. Laycock's continual abuse of the psychology
of the schools: what right has he to heap ridicule on this part of
metaphysics ? Is it that his genius is superior to that of the great
men whose names through long ages adorn th*e paths of psychological
literature—and fit to throw them all into the shade ? Even if his
system were sufficient entirely to overthrow the old psychology, he
would owe his success to nothing else but to the great and rapid
strides of advancement made within a short period in the knowledge
of the economy of living nature, and above all, in the anatomy of
the nervous system throughout the animal kingdom.
We need not fatigue our readers with a recapitulation of faults
besides those which we have pointed out in Dr. Laycock’s book;—
but this we repeat, that none of the faults we have dwelt on are in¬
volved in the leading principles of his system; they are extrinsic and
capable of being removed. And removed they ought to be, for
assuredly they are of a kind to weigh down and sink any system of
psychology however excellent, however otherwise well founded.
Dr. Laycock has not been able successfully to repel any one of
our objections. It is easy to blind a careless reader by raising up
men of straw which can be cut down with a stroke. It is easy to
heap ridicule on us for choosing out of his book questions of a pro¬
found character ; but a plain answer to plain objections would have
been more satisfactory. To a man who sneers at Locke and
Leibnitz as being pretenders, it would have cost nothing to give
our poor objections their quietus with a stroke of his pen.
Laverstock House, Salisbury.
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Foreign Psychology, by Dr. Arlidge.
Psychological Excerpta from Foreign Journals. By Dr. Arlidge.
On the origin of the Swollen Ear. By Dr. Gudden.
(* Allgeraeine Zeitschrift fur Psychiatrie,’ vol. xvii, p. 122.)
In the first volume of the c Asylum Journal/ (p. 45 and p. 107)
we translated a valuable memoir on this subject by Dr. Fischer, pre¬
senting a very complete account of the pathology of sanguineous
tumours of the ear, and a critical inquiry respecting their cause.
With the statements and opinions there made. Dr. Gudden mainly
agrees. At the same time, he considers Dr. Fischer to have mis¬
interpreted several facts he noticed. He' ignores the presumed
existence of a special dyscrasia, pointing out, as we also did, in some
notes on Dr. Fischer’s paper, that these tumours of the ear are not
restricted to the insane, and, furthermore, that they are produced
even in those in perfect health.
With true German patience and minuteness of research. Dr. Gudden
appeals to the literature and statuary of the ancients, which he seems
to have largely inquired into for his purpose, and shows that these
swollen ears are particularly described and named by several Greek
authors, and are moreover sculptured on the heads of several ancient
statues of Mars, Hercules, and Pollux.
Having thus strengthened his assertion, that neither insanity nor
a dyscrasia of the blood and nervous system are necessary antecedents
to the production of sanguineous tumours of the ear, he next shows
that the structural changes remarked by Fischer, and attibuted by
him to inflammation of the cartilage and its perichondrium, may be
produced in the ears of the dead by pressure and rubbing, and that
it is a mistake to suppose such changes precede the effusion and
formation of the swelling. The isolated detachments of the peri¬
chondrium are simple results of force, and the effusion of blood a
consequence of ruptured vessels.
Though a dyscrasia is not essential, it may, notwithstanding,
favour the production of the diseased state; and that this state is
always the result of mechanical injury or force is proved by many
considerations. Thus it is always sudden in its appearance, and from
the firm union between the component tissues of the ear nothing but
violent force could cause their separation. The usual position of
the swelling is the outer or exposed surface of the ear, and never the
meatus or protected portions. The left ear is oftener the seat of the
lesion than the right, indicating that the ear has been struck with
the right hand of a person standing facing the patient. The swelling
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Foreign Psychology, by Dr. Arlidge.
is more common in men, and men are more prone to violence and
more powerful to inflict such an injury, than women. Moreover, the
ears of women are protected by their caps and hair. Paralytics are
more common among the male insane, and are more frequently than
others subject to these swellings of the ear; but this circumstance
is not to be explained by reference to the existence of a special dys-
crasia among them, although it may be admitted that the morbid
state of their blood in general is favorable to effusion, but rather to
other causes, among which their mental condition, as one more
aggravating to attendants, may be reckoned.
Flemming believes the injury may be often self-inflicted, but
Gudden refers it, as an almost universal rule, to violence on the part
of others ; for he argues that where patients fall about and injure
themselves, the ears rarely suffer. But what is more to the point, is
the fact that by holding the attendants responsible for the lesion, he
has found it almost disappear from the asylum. Lastly, the seat of
the lesion is between the cartilaginous laminae, and not between the
cartilage and its perichondrium, in most cases.
On the connection of Osteomalacia with Insanity.
By Dr. Finkelnburg.
( 4 Allgemeine Zeitschrift fur Psychiatric/ vol. xvii, p. 199.)
The author remarks, that though the etiological relation between
rachitic softening in childhood and the development of insanity in
after-life be generally recognised and illustrated by cases in every
asylum, yet that the like connection between osteomalacia in adults
and mental disorder, though equally real, has been let pass unnoticed.
Finkelnberg observes, that though in softening of the bones the
cranium is of all portions of the skeleton the least frequently and the
least seriously affected, yet several specimens of this lesion are pre¬
served in museums, and the author himself met with two. In these
instances the cranial bones acquired throughout the spongy consistence
of the diplbe, and were often thickened; the distinction between the
two tables was lost, and the sutures obliterated. The alteration in
the figure of the cranium occurred chiefly at its base, the sella turcica
being apparently forced upwards, whilst the fossae, in front and
behind, were greatly deepened.
Though some possessors of such crania have, as far as known, not
exhibited mental disorder, and therefore though the deformity and
insanity appear not necessarily connected, yet in the two cases of
osteomalacia winch fell under the writer’s observation, the relation
was distinct. The mental disturbance was that of acute melancholia
with hallucinations of hearing, ending in dementia. The osseous
disease made its appearance after childbirth, and was attended with
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much pain in the head and spine, and with cerebral irritation and
paralysis.
On a form of Acute Mania with inflammatory lesion of the brain,
and on the indications for the administration of Digitalis. By
Professor J. P. H. Albers.
(‘ Zeitschrift fur Psychiatrie,’ Band xvii, p. 305.)
Professor Albers has given much attention to the therapeutical
value of digitalis, and his results on this point are, that—1. It
reduces the pulse in frequency, but at the same time does not disturb
the rate of breathing. Even when the heart is empty and brought
to a stand-still, the regularity of the respiration proceeds. 2. Altera¬
tions in the urinary secretion; an increased quantity of urine in the
healthy, and a still greater augmentation when the drug is given in
inflammatory dropsy accompanied by inflammatory irritation of the
serous membranes of the chest and abdomen. It subdues the
inflamed state of the kidneys and restores them to their normal
functional activity. In mental disturbance dependent on cerebral
inflammation, especially of the serous membrane, digitalis exerts a
remarkably curative effect when given after preliminary abstraction
of blood and the use of antiphlogistics. 3. The solid constituents
of the urine are increased in amount, and particularly the urea, as
shown both by chemical examination and by an increase of specific
gravity. This alteration in the urine becomes manifest, when the
digitalis has reduced the frequency of the pulse and produced a
feeling of lassitude. 4. Reduction of the temperature of the body,
and its equalization. 5. Vertigo, lassitude, debility, and moroseness,
accompany the reduction of the pulse by the drug. The last-named
condition is a remarkable symptom associated with the operation of
digitalis on the system. 6. This medicine is applicable only to those
cases of madness dependent on some inflammatory lesion.
These results, says Albers, are deduced from numerous experiments
and observations on the lower animals as well as on man, both in the
healthy and diseased state.
On the use of Opium in Mental Disorder. By Dr. Ltjdwig Meyer,
(‘ Zeitschrift fiir Psychiatrie,’ Band xvii, p. 453.)
The value of opium and its various preparations in the treatment
of insanity, is most fully recognised in this country, but this is not
the case in many parts of the continent of Europe, and the long essay
by Dr. Meyer, the medical director of the insane division of the
Hamburg General Hospital, is therefore calculated to do good, by
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demonstrating the fact by considerable clinical experience. From a
discursive sketch of the diversity of opinions respecting the use of
opium, and of the virtues ascribed to it in different parts of the world,
he deduces it as a geueral truth, that opium acts as a powerful con¬
servator of vital power, a restorer of expended energy and of pros¬
trated nervous vigour.
He notices some cases of ecstatic mania, arising from debilitating
causes, in which he found opium very beneficial; and he quotes
others, in which he administered it from a priori considerations of
their causes. To quote one of his cases briefly:—It was that of a
woman who, with her husband and family, had been reduced to
extreme poverty and well-nigh starved. The patient lay in bed, with
closed eyes, in a sort of cataleptic condition, speaking and moving
only when excited to it, and suffering from hallucinations of vision;
this condition alternating with excitement. On the third day he gave
her Dover's powder every two hours, containing, in all, three grains
of opium. By this means the agitation was calmed, and she got a
fair amount of sleep in the night. On the following day there was
evident improvement; the opium was repeated in grain doses every
hour, for five hours. Further improvement ensued, and more
nourishment was taken. The opium was subsequently given less
frequently, and latterly only at bed-time, and, after fourteen days,
the mental disturbance was removed. To reinstate her health and
strength she was retained for six weeks, and at the end of that time
was discharged cured. Dr. Meyer records, altogether, seven cases of
the same form of (ecstatic) mania; six of them were females, and of
these, five cases were the result of childbirth and its after-conse¬
quences, and of over-lactation—in other words, of loss of blood and
other debilitating causes. However, he does not consider these as
the sole causes of the mental disturbance, but as conditions concur¬
ring with the insanity itself and coincident with it, and a nervous
lesion of which hysteria is the principal manifestation, and one more
immediately associated with the nervous system and sexual functions
of females. The operation of opium he regards as indicative of this
morbid relation, inasmuch as it is rapid, and doubtless acts primarily
on the abnormal condition of the nervous matter, and, on the con¬
trary, is in no direct way curative of the accompanying anaemia and
debility. Moreover, in many cases of insanity hysterical symptoms
are to be traced in their early history; and this is true, even among
male patients whose nervous system has been greatly prostrated, as
by the practice of self-abuse.
After an examination of the phenomena of hysteria in their relation
with those of the hysterical forms of insanity, he arrives at the con¬
clusion that opiates are especially indicated whenever mi hysterical
condition accompanies mental disorder.
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Frroneous Identification as a symptom of Insanity.
By Dr. Snell, of Hildesheim.
(‘ Zeitschrift fur Psychiatrie,’ Band xvii, p. 545.)
Erroneous identification, or mistaken conceptions of persons, is a
common occurrence among the insane, but on examination will be
found not equally prevalent in all classes of them. Dr. Snell finds
it to be most frequent in mania; in the next degree in dementia fol¬
lowing upon mania and attended with excitement, and in acute
melancholia. It is more rare in the varieties of monomania and in
those of apathic dementia. On tabulating the admissions into the
Hildesheim (Hanover) Asylum, with reference to this form of mental
aberration. Dr. Snell found it to prevail in more than half the total
number; whilst among the older residents in the asylum it was not
seen in more than a third.
The following is a summary of the results arrived at by Dr. Snell:
1. Mistaken personal identification, and also illusory conceptions
of places and objects, are among the most frequent phenomena of
mental disorder, and the most certain and readily observed of its
symptoms. 2. They indicate by their intensity and generality the
degree of mental excitement, and are in general favorable in reference
to prognosis. 8. They are more prevalent the more recent the men¬
tal disorder is. 4. In the transition of the so-called primary forms
of insanity into the secondary, mistaken identification not uncom¬
monly makes its appearance, and is then of bad augury. 5. In the
progress of primary mental disorder towards recovery, the disappear¬
ance of this form of aberration is one of the most certain indications
of approaching convalescence.
On the employment of Tracheotomy in Epilepsy. By Dr. C.Westphal.
(* Annalen des Charite-krankeuhauses/ Band ix, 1860.)
In this paper Dr. "Westphal appears as an opponent to the practice
of tracheotomy as a curative proceeding in epilepsy. He resorted to
it in one case with no other result than that the strength of the fits
was somewhat reduced. The views of Dr. Marshall Hall, and the
three cases recorded by Drs. Anderson, Kane, and Mackenzie, in
illustration of the advantages of tracheotomy in shortening the fits and
preventing their recurrence, he considers quite inconclusive and
fallacious. The theoretical grounds for adopting the operation
advanced by Dr. M. Hall, he regards as scarcely worth discussing.
The notion of what Dr. Hall designated trachelismus rests on mere
assertion and is not proven; and this physician, he continues, reasons
in a circle respecting the dependence of general convulsions on
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closure of the glottis and the utility of tracheotomy. In most epi¬
leptics the signs of trachelismus,—the venous fulness and redness of
the countenance follow upon the convulsions and are secondary to
them, and at the close of the fit there is no sudden pallor of the pre¬
viously suffused countenance. It has certainly not been shown that
general convulsions follow as a rule upon obstruction of the trachea
however caused; on the contrary, Dr. We.stph.al has seen a case of
complete occlusion of the glottis by a wedge-shaped piece of food,
without any convulsions supervening.
Touching the question of the artificial production of trachelismus
by obstruction of the circulation of the head, the writer refers to the
researches of Kussmaul and Tenner, which show that by tying all
the arteries going to the head fits of a truly epileptic character are
produced.
Dr. Westphal concludes his memoir by remarking on the frequent
complication of hysteria with epilepsy, giving rise to the variety called
by Landouzy, “ Hystero-Epilepsy.”
On Parenchymatous Infarction of the Brain in chronic and acute form
of Insanity. By Professor Axbers, of Bonn.
(' Archiv fur Pathologische Anatomie und Physiologie/ von R. Virchow, Band xxiii,
1861, p. 7.)
The primary meaning of infarction was that of plethora, or con¬
gestion of an organ, but of late the term has been applied to the in¬
terstitial effusion of blood or of its elements in a tissue, giving rise to
an expansion, to increased firmness, and frequently to a greater elas¬
ticity of the part involved. Such a stuffing or infarction of tissues
from exudation deposits is the consequence of active hypergemia and
of inflammatory stasis, and happens especially where a constitutional
malady is present, such as scrofula, tuberculosis, or a typhoid state.
In the affected parts the blood-vessels are seen changed, those around
them being expanded, whilst those within are contracted, and the
parenchyma itself deficient in blood, the whole being a condition of
unequal distribution of blood.
Different names have been given to the effused matters, according
to their nature and the constitutional diathesis. Thus we read of
fibrinous, albuminous, purulent, and sanguineous infiltrations, consi¬
dered further under their several relations with scrofula, typhus, and
other general conditions of the system. The elements of the diseased
tissue are disunited by the effused morbid matter, and at the same
time compressed, and hence, in all but the catarrhal variety of infarc¬
tion, there is condensation and induration, and even in that, although
soft, there is an unusual elasticity present.
Infarction is distinguishable according as it is chronic or acute;
VOL. VIII. 17
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the latter variety is the more frequent. When it seriously interferes
with the function of an organ, such as of the liver (in cirrhosis), and
of the lungs (in hepatization), it is fatal sooner or later.
In the brain a fibrinous infarcted matter is often to be met with in
typhus and in cases of insanity, and gives rise to the condition
described as “ cerebral sclerosis.” This lesion has for many years
been observed in patients dying from typhus during epidemics of
that fever. It is shown by an increased volume, and a more compact
and firmer consistence of the brain than normal, and this, too, in
naturally soft parts, such as the soft commissure and the olfactory
nerves. On slicing the brain, the thin laminae are found to be tough,
like white leather, though much more lacerable, and to have an
unusual elasticity under pressure. The colour is often a yellowish or
a dull white, and an unequal distribution of blood is perceptible
throughout. Some capillaries are double or treble in size that of
others normally similar, whilst others are constricted and almost
obliterated. On examining the brain when hardened in chromic
acid, by the microscope, the histological elements are discoverable,
more or less unaltered, and between them a multitude of corpuscles
and granules and a semi-transparent matter, varying directly in
amount with the severity of the lesion. These changes are more
distinct in typhous infarction than in the scrofulous.
The disease may attack every part of the brain, but is most deve¬
loped in the cerebrum, the anterior lobes of which again seem more
prone to it. Moreover, the upper surface is more frequently attacked
by it than the base of the brain. In the brains of the insane, it has,
when found, the same characters as in those of fever patients. The
fever epidemics, in which this lesion has been most prevalent, have
been distinguished by the unusually high delirium present, the rapid
sinking of the vital powers, and the absence or insignificant amount
of alvine derangement.
The same condition of the brain has been met with in patients
dying after acute delirium, aud in imbecile children, in whom irre¬
gular nutrition of the cranium and enclosed brain mass has probably
given rise to a sub-inflammatory state. Professor Albers details a
case of the sort in which the lesion was chronic, the dementia super¬
vening after convulsions in the first year of infancy, with irregularity
in the cranial bones and sutures, and afterwards complicated with
fatal convulsions of a different form. In another case the lesion was
acute, preceded by long-continued headaches, followed by melancholia,
and then maniacal excitement, and death by coma.
Scrofulous parenchymatous infarction often attacks isolated parts,
but more frequently the whole cerebrum. It occurs in children and
young people of.scrofulous habit; and according to its severity and
extent gives rise to different disorders of the cerebral functions, which
usually advance to a certain stage of development and then are
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arrested. During this period the brain is very prone to inflammatory
excitement and to meningitis, and a foundation is laid of mental
disorder of a monomaniacal character, and either with or without a
disposition to mania. An anti-strumous course of treatment has been
found beneficial and even curative in such cases.
Albers is disposed to consider that form of cerebral disease described
as acute hydrocephalus, in which there is hypertrophy of the brain
without vascular congestion, as allied to, if not a variety of, scrofulous
infarction. To the same category he refers another lesion associated
with struma, which commences by an attack of gastric fever of an
intermittent type, followed by convulsions, such as are seen in chronic
hydrocephalus, that become more frequent as a fatal termination
approaches. After death the brain has a rather firm consistence, and
only a very inconsiderable quantity of fluid is present in the ventricles.
Meckel and others record many instances of induration of the brain
found in lunatics, but though there was increased firmness there was
no actual increase in the weight of the brain matter compared with
equal portions of healthy brain, except in a slight degree in one or
two examples. This Albers considers explicable on account of the
absorption and wasting of the cerebral matter following the deposit
of the morbid exudation. As to the symptoms of infarction, he
points to such as have been generally assigned to inflammatory affec¬
tion of the brain, as persistent headache, mental oppression, exalted
irritability, great restlessness, a normally frequent or a slow pulse,
and repeated convulsions. If inflammation be present, local and
peripheral affections of the nerves, squinting, paralysis about the
muscles of the face, or of the limbs, &c., rarely fail to show them¬
selves ; whilst they, on the contrary, are absent in infarction.
Cases of infarction have for a long time been described as instances
of -chronic inflammation in the lungs, liver, and spleen; and in many
such fibrinous exudations have been met with, in the form of new
connective tissue. A similar fibrinous infarction is sometimes met
with in the brain and spinal cord, though not distinctly traceable, it
may be, to antecedent inflammatory action.
An inquiry into the Causes of Melancholia. By Dr. Carlieu.
(‘ Bulletin de l’Academie de Medecine,’ 1861, p. 479.)
This inquiry is long drawn out, and results in little of practical
utility. The author has a wondrous hair-splitting faculty, and
would well-nigh make as many species or forms of melancholia as
there are sufferers from the complaint. He defines melancholia as
a cerebral necrosis, consisting in a partial and lasting aberration of
the intellectual faculties, without fever, and characterised by painful
ideas. He makes two genera:—1. Melancholia, without error of
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judgment, and with consciousness of the condition and cause of
suffering; and 2. Lypomania, with aberration of judgment, and with¬
out consciousness of the mental disturbance. Of the first genus,
he adduces as distinct species: 1. Suicidal melancholia, or as he
names it, antophonomania; 2. Erotic lypomania or Erotomania;
8. Panophobia, or as he prefers to call it. Pantophobia; 4. Nos¬
talgia. The second genus comprises the following species : 1. Noso¬
mania or hypochondria; 2. Lypomania of persecution, or misan-
thropia; 8. Lypomania of legal troubles, or Diceomania; 4.
Demonomania; and 5. Lypomania of poverty, or Panemania.
He examines the causes of melancholia attributed to age, sex,
mode of life, &c., and remarks that infancy is almost entirely exempt
from this disorder, except we refer to it that remarkable sadness
sometimes met with before death in infants. He confirms Esquirol's
statement of the much greater proclivity of females than of males
to melancholia, and points to uterine derangements as the potent
cause. Of the temperaments he places the nervous as the first in
predisposition to the disorder.
Mental disorder, he asserts, increases as civilisation advances; a
conclusion which might make us long for a return to primitive bar¬
barism, but which, if examined accurately, will resolve itself into
the proposition, that the vices of modern society and the transgression
of the laws of health, of morality and of religion, is the root of the
evil and of its increase. This is illustrated, indeed, by the implied
results of civilisation, as detailed by M. Carlieu, as causes of melan¬
cholia ; to wit, over-speculation, excessive application to business;
political revolutions, and exaggeration of material enjoyments.
It would be marvellous for a continental writer on melancholia
to fail to remark on our wonderful proclivity as a nation, to what
our European neighbours will insist on as an English disease, and
will call “the spleen.” We are, to every continental imagination, a
splenetic people, a grim, pleasure-hating nation of the old Covenanter
type, and M. Carlieu, adopting all this as a matter of fact, explains
it by the influence of the east wind, which he seems to presume to
be a constant visitant among us.
Having treated of all conceivable causes, physical and moral,
determining and predisposing, he next aims to establish an exact
diagnosis of each variety of melancholia, with the view of deducing
rules of treatment appropriate to it. Hence he proposes to prefix
an adjective to the term melancholia, expressive of its presumed
cause; thus he speaks of hereditary, of constitutional, of professional,
moral, cerebral, gastric, gastro-intestinal melancholia, and the like.
In short, his research after the causes of melancholia terminates in
a simple enumeration of all the influences and conditions which
may operate on a melancholic patient or be associated with his
mental disturbance.
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259
On the Derivative Circulation. By M. Sucquet.
This is a valuable pamphlet, putting some novel anatomical and
physiological facts before the public. The author shows distinctly
that in the body generally there are two sets of veins, differing in
functional purpose; the one returning the blood, as venee comites of
the arteries, from the nutritive capillaries of parts, the other afford¬
ing direct channels of communication between one part and another,
and not accompanying the arteries. The latter are the veins of the
derivative circulation, and are best exemplified in the arm. To
demonstrate this venous system, M. Sucquet resorted to a black-
coloured pigment for injecting the vessels, and found it the most
useful, as it not only filled up and displayed the larger veins, but
also by its discoloration of the skin showed where the minute
ramifications of these veins were most abundant.
By these means he shows the veins of the hands and fingers seen
coursing by themselves, communicating with the arteries without the
interposition of those minute capillaries present where the blood is
returned from the nutrient arteries of a part into the ordinary venous
system. Prom these special veins of the hands, arise the basilic and
cephalic veins, which take a superficial course, and after many inter¬
communications by cross channels, chiefly about the elbow, pour
their contents into the ordinary system of veins near the root of the
neck. Through these veins a direct course and a rapid transit is
provided for the blood; and through them a coloured injection will
flow, which will not find its way into the venae comites of the arm.
The peculiarity of these veins is shown also by the intermissions-and
variations in their circulating fluid; for in the deep veins the current
is uniform in its flow. All this is well illustrated by the effects of
heat and cold on the limb in their relation to the two sets of veins.
The blood is more arterial in these superficial veins, and flows more
rapidly through them towards the centre of circulation; and when
from any cause the activity of the heart and of the local circulation
is increased, it is seen chiefly in them. Hence they operate as a sort
of safety-valve to an over-active arterial circulation, or, in other
words, they constitute a derivative circulation.
Sucquet pursued his researches in the same way with regard to
the lower extremities, and to the head. The derivative circulation
of the cranium is not so extensive as in the arm, and is principally
illustrated in the angular vein of the face, communicating with the
ophthalmic vein, and by it with the cerebral sinuses, and in the nasal
and mastoid veins. The practical deduction, therefore, seems to be,
that if we want to relieve intra-cranial fulness, the blood should be
drawn from these veins of the derivative circulation of the head.
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On the effects produced in the Encephalon by Obliteration of its
Arteries. By Dr. Ehrmann.
Dr. Ehrmann’s pamphlet would prove valuable were it only for
the resume of cases where one or more of the arteries of the brain
have been tied or otherwise obstructed, but he has in addition pre¬
sented his readers with many original observations. From a priori
grounds, the delicacy of the brain tissue, its evident requirement
of much blood, and the serious results so often seen from even
temporary derangements of its circulation, it might well be supposed
that an obstruction or obliteration of one of its four large arteries
would be of very serious and probably fatal moment. However,
experience teaches us to the contrary even in man, and still more
strikingly in most of the lower animals. Thus, interruption by com¬
pression or by ligature of the two carotids at the same time in
rabbits and dogs, produces beyond a momentary staggering, very
slight cerebral disturbance, or it may happen, none at all. On the
other hand, the experiment is much more serious in its effects when
the horse is its subject.
In the rabbit even the ligature of the two carotids and of one
vertebral artery is not necessarily attended by cerebral disturbance—
convulsion or the like. In the same animal the cutting off arterial
supply from all its four sources was followed by epileptiform con¬
vulsions ; but on the removal of the ligatures the cerebral activity was
renewed.
The ligature of one carotid in the human subject, when sudden,
is often fatal; but in many instances, where the obstruction has
taken place gradually, no symptoms have shown themselves. One
case is on record where the two carotids became obstructed by cal¬
careous deposits, without fatal or very serious disturbance of the
brain functions. Moreover the two carotids have many times been
tied and the brain been uninjured, where the operation has been
performed on each separately and at a considerable interval, as of
from five to twelve days.
Hemiplegia of the side opposite to that on which the ligature is
placed, with or without convulsions, is the most common result of
tying the -carotid artery. The hemiplegia and convulsions appear
sooner or later after the operation, and after continuing for a time
may entirely disappear. Where death has followed the operation,
softening of the brain in the portion more immediately supplied by
the artery, and either of the inflammatory or of the anaemic (white)
kind has been usually found. At times the operation has been attended
by temporary or even by permanent blindness, and more rarely by
loss of power of speech. This last result may be due to the cir-
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cumstance of the recurrent laryngeal nerve having been included
within t&e ligature.
Of forty-nine cases detailed of ligature of one carotid, cerebral
disturbance is noted in 30, and death in 18. Among a larger
number of cases, the accidental and untoward consequences of the
operation were equal to 21 per cent.
Referring to the different effects of ligature of the cerebral arteries
in different animals and in man, it seems deducible as a rule, that the
relative size and capacity of the arterial vessels at the base of the
brain, or the facility and freedom with which an auxiliary or sup¬
plementary circulation can be established, mainly determine the
occurrence or not of injuries and disorders of the encephalon when
its arteries are ligatured.
New Journals of Insanity .—The commencement of the year
1861 witnessed the birth of two new French journals devoted to
the consideration of mental and nervous disorders, and published
monthly. One of these is produced under the able editorship of
M. Baillarger, physician of the Salpetriere, with the co-operation of a
large number of the best-known alienist physicians of France. It is
entitled ‘ Archives Cliniques des Maladies Mentales et Nerveuses,
ou choix d’observations pour servir it l’histoire de ces maladies.
Recueil mensuel/ and is issued at a reduced rate to those who are
subscribers to the e Annales Medico-Psychologiques,’ to which old es¬
tablished journal it may be considered supplementary. The other new
periodical, the ‘ Journal de Medicine Mentale resumant au point de
Vue Medico-Psychologique Hygienique, Therapeutique et Legal,
toutes les questions relatives h la Folie, aux Neuroses convulsives et
aux defectuosit^s intellectuelles et morales/ is published by Dr.
Delasiauve, physician of the Bicetre, &c., with the co-operation of
Casimir Pinel and several other talented physicians. It is presu¬
mable that some rivalry may exist between these two new journals;
but if so, it seems to be of that commendable sort, a rivalry for good,
since M. Delasiauve’s name appears among the ‘ collaborateurs ’ of
M. Baillarger’s paper.
The * Annales Medico-Psychologiques ’ has long held a high cha¬
racter for the excellence and originality of its essays; has well served
the cause and progress of psychological medicine, and not unfre-
quently, like French plays, supplied by its articles the ground-work
and substance of psychological dissertations in an English dress in
our own medico-literary productions. We are therefore glad to find
that these new journals are not to supplant this old favorite, but
that they will take the place of the lighter monthlys as tenders to
the more dignified quarterly, and fulfil their promised purpose of
keeping the medical world more au. courant with the researches in
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Kleptomania.
mental pathology, and with the work effected by those specially
engaged in the treatment of insanity, as well as by other physicians.
M. Delasiauve sets forth as his reasons for producing his small
monthly brochure, that the ‘ Annales Medico- Psychologies' is a
journal too exclusively addressed to specialists, and that consequently
its valuable papers are lost to the bulk of the profession. It is his
object, therefore, to bring together all that relates, directly or in¬
directly, to mental and cerebral disease; to present it in a practical
form, excluding long disquisitions, and to seek the co-operation of
physicians not specially occupied in the treatment of the insane.
In all respects M. Delasiauve's journal has a wider scope than that
published under the direction of M. Baillarger, which is exclusively
a clinical record of cases of insanity communicated by various phy¬
sicians attached to the French asylums. The editor states that its
object is to form such a collection of well-observed cases that in
course of time a much more certain and more accurate knowledge
of the pathology of mental disorder may be arrived at than we at
present possess. Three fourths of the journal will always be occu¬
pied with the detail of original cases, and the remainder with clinical
histories recorded in foreign journals or described in books of
repute.
Thus, though these two new periodicals may compete for public
support, they do so under a different form, and each, we hope, may
succeed in establishing itself in public favour.
Kleptomania.
The injudicious defence of two lady thieves on the plea that they
were subject to that form of mental unsoundness to which Mathey*
and Marc have given the sounding title of kleptomania, has attracted
public attention to this form of mental disease, and has given rise to
a considerable amount of written and spoken nonsense upon the sub¬
ject. Even “ our facetious contemporary ” has had his jests and his
caricatures thereupon, and in the slang of the day a burglar has be¬
come a kleptomaniac, and a prison a kleptomaniac hospital. Alienist
physicians have of course received tneir full share of sarcastic
remarks, as theorisers not over-wise nor over-useful to society, who
would willingly provide for every crime a decent veil, by referring
it to some strange form of mental disease. Now there is such a
thing as theft which is the result of mental disease; and also, let us
boldly avow our conviction, though we write within the precincts
* * Rlcherehes nouvelles sur les maladies de Fesprit/
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Kleptomania.
of a madhouse, that there is such a thing as theft which is simply
a crime, an attack made by the selfishness of one individual upon the
rights of another. Let us even take the broader ground, and avow
our profound conviction that insanity and crime are distinct and
separate entities, wide as the poles asunder in all instances where
their distinctive characters are well marked; although undoubtedly
there are instances which are divided by partitions as thin as those
which Dryden places between wit and madness, or rather instances
in which the qualities of crime and insanity are so intimately com¬
bined that the task of analysing the nature of the act becomes no
easy one either to jurist or physician.
The marks of crime, and not of insanity, were so strongly
impressed upon the instance above referred to, that it is no
wonder the defence of the criminals upon the plea of insanity
converted this question of scientific interest into a public jest.
Two young women belonging to that class of society which is
supposed to entitle them to the designation of ladies, wealthy
and high-born ladies, as the paragraph writers say, were detected
thieving in a remarkably systematic manner. They go to a shop,
examine goods, some of which they pretend to purchase, and order to
be sent to a false address, and in the meanwhile they take the oppor¬
tunity of secreting and stealing other goods. Thefts due to insanity
are not perpetrated in this systematic manner, neither do insane
thieves usually act in combination; and besides the want of com¬
bination, which is a characteristic of the acts of the insane, the
chances would be a million to one against two insane thieves finding
themselves in sufficient proximity to act thus, even if they were
capable of so doing. Such a defence, therefore, in this particular
instance, was simply absurd. Moreover, if this defence had succeeded,
it might in course of law have resulted in sending the lady thieves
to abide release at her Majesty's pleasure in the criminal ward at
Bethlem, or at the new State Asylum at Broadmoor when it is
opened, an alternative to which a temporary seclusion at Cold Bath
Fields might be infinitely preferable. We remember a distinguished
judge once advising an injudicious counsel to withdraw the plea
of insanity for an offence of no great magnitude, on the ground that
he was helping his client out of the frying-pan into the fire. The
counsel took the hint, and if we remember rightly, the accused
man escaped both doctors and gaolers from want of sufficient evi¬
dence. May we not inquire who were the legal advisers of the
shop-lifting ladies, whose offence has pointed so many jests, and
suggested so much nonsense ?
It must be admitted that writers on insanity, and even writers
on the jurisprudence of insanity, have not been very successful in
describing and defining the characteristics of thieving madness;
for they have mixed up in a sad jumble descriptions of the thieving
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Kleptomania.
propensities of persons who are undoubtedly insane, with those of
the monomania of theft in which the propensity is the principal
indication of an unsound mind, and again, with certain rare, but
most curious and interesting cases, the nature of which they have
not taken the pains to investigate, and which we believe to be
neither allied to insanity nor to crime, but to be a kind of mental
and physical tic quite unconnected with any idea of appropriating the
property of others, which is the very essence of theft. We are
inclined to believe that insane thieves are not quite so common as
one would at first be led to suppose from the perusal of works of in¬
sanity, for although we find writer after writer asserting that thieving
is one of the most common symptoms of mental disease, there is a
most suspicious resemblance in the examples which they give to
illustrate the doctrine. Dr. Daniel Tuke gives the most complete
resume of the instances on record, at p. 207 of the f Manual of
Psychological Medicinemany, however, of his instances are taken
from Marc, and Marc we find took most of his instances from Gall.
We shall append to these observations a translation of Gall's cases,
which will perhaps amuse some of those who are best acquainted
with works of insanity, and know how to appreciate the amount of
original information which they contain. Lavater's thieving phy¬
sician has certainly done duty everywhere. In this country he is
generally thought to have been a Bristol practitioner, from the way in
which he has been appropriated by an able writer from that city. Then
there was that funny thief of Vienna, who only stole pots and pans; he
is as ubiquitous as the doctor. It must indeed be admitted, that if
kleptomania be a common form of insanity, we are sadly in want of
new instances to illustrate its phenomena. Yet there ought not to be
much difficulty in obtaining such instances, if we may accept what
the ‘ Times' newspaper said a few years ago (April, 1855), when
another lady thief was prosecuted for stealing cambric handkerchiefs
in a draper’s shop. A prosecution was instituted, against her, which is
said to have been a very bad thing for the man whose goods were stolen.
“ It would be a bad tiling for the coo,” said Stephenson, “ if she got
before the train,” and the draper was no more than a cow standing
before the express train of good society which he affronted by pro¬
secuting the lady thief. The ‘ Times,' on that occasion, delivered
itself on the subject of kleptomania in the following terms. “ It is
an instance of that not very uncommon monomania, which leads
persons, otherwise estimable and well conducted, to pilfer articles of
a trifling value, in obedience to the impulses of a diseased imagination.
The fact is notorious, that many persons of high rank and ample
means have been affected with this strange disorder. Every one who
is acquainted with London society could at once furnish a dozen
names of ladies who have been notorious for abstracting articles of
trifling value from the shops where they habitually dealt. Their
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Kleptomania.
modus operandi was so well known, that on their return from their
drives, their relatives took care to ascertain the nature of their paltry
peculations, inquired from the coachman the houses at which he had
been ordered to stop, and, as a matter of course, reimbursed the
tradesmen to the full value of the pilfered goods. In other cases, a
hint was given to the various shopkeepers at whose houses these
monomaniacs made their purchases, and they were simply forewarned
to, notice what was taken away, and to furnish the bill, which was
paid for as soon as furnished—and as a matter of course, by the
pilferer herself, without any feeling of shame or emotion of any
kind/'
A very common form of insanity, indeed this must be, if this be
true, that any one in society could at once name a dozen lady klepto¬
maniacs; but whatever the truth may be as to the wide-spread
prevalence of shoplifting, we disbelieve the prevalence of the insane
motive. If it be true that attempts at shoplifting in London, by
so-called ladies, are an affair of every-day occurrence, necessitating
the constant employment of vigilance on the part of shopkeepers,
to prevent loss which would in the long run and in the aggregate
be serious, it accords little with our experience of the insane to hear
the motive attributed to mental disease. At the first blush this may
seem a most incredible state of affairs. If, for example, you take a
model English lady, intellectual, refined, sensitive to the slightest
touch of shame, truthful and true, the centre of a home in which
the dearest social affections are nurtured in that modest retirement
from publicity and avoidance of parade which are the characteristics
of the home of such a person; it seems, nay, it is impossible, that
such an one could betray herself to public scorn by per¬
petration of one of the meanest of crimes. But there is another
aspect to this matter. The struggle for existence in the middle, and
even in the upper classes of our complex social system, combined
with the prevailing fashion of an emulative and showy expenditure,
make the sense of want felt keenly in many an English home, where
no traces of vulgar poverty are discernible. The really poor steal
because they want bread; the relatively poor are tempted to steal
because they desire the possession of that which seems, to a mind
trained in a bad school, as essential as bread itself. And how are they
tempted ? How are women, whose education has been one system of
skilful parade, who have been trained to derive a vast proportion of
their daily happiness from that most personal of the aesthetic arts, the
cultivation of dress, how are they tempted .to possess themselves of its
material ? Are they not stimulated t6 covet its possession by every
ingenious device which the mind of man or of woman can devise, by
streets of gorgeous shops, touted in every possible manner by the
most pertinacious inducements, and almost persecutions to buy, buy,
buy; so that it has at last become the custom of the town-bred
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Englishwoman of the present day to spend no inconsiderable portion
of her time in passing from shop to emporium, from haberdashery store
to magazin de mode, in the discharge of that new and peculiar duty of
life called ‘ shopping/ Can we be surprised that when the means fail
to gratify the desires thus stimulated and thus tempted, that in some
few instances the desire of the eye should prove too strong for the
moral sense ? It is painful and humiliating if these things are so,
but it is not wonderful that they should be so; and on the whole jre
can find more pity for the poor woman who purloins a piece of lace,
without which she thinks sne will be absolutely not fit to be seen,
than for the smirking fellow who has caught her in his haberdashery
trap by lying advertisements that he sells for almost next to nothing
the very articles she so covets in her desire to make her person
agreeable and attractive. The fair thieves whom it would be more
true than gallant to consider as an elder kind of children, if pity
does not allow them to go scathless, when they steal the gewgaws in
which their hearts delight, are punished with crushing and ruinous
infamy, to escape from which the imputation of madness has some¬
times been considered a welcome refuge.
But what is true kleptomania ? Monomania du vol ? Dieb-trieb ?
Beal stealing insanity? There is a good deal of scattered in¬
formation on the subject, and yet much remains to be gathered
before we understand it well. We appear yet to have scarcely got
beyond that early stage in a scientific inquiry which gives us a large
generalisation. We have found that some people altogether or
partially insane, are incorrigible thieves, and we have generalised the
fact into the formation of a class of the insane, characterised by
this tendency. But if we carefully examine the cases in the
category thus formed, we find that they differ essentially from each
other, and upon this analytic stage, which is the wider and more im¬
portant part of the inquiry, psychological writers have scarcely entered.
The material for examination is yet scanty, and in this absence of
sufficient data these observations are made rather as suggestions
of the method of inquiry, than as presenting anything like a satis¬
factory explanation. Theft is sometimes one of the earliest symptoms
of mental disease, and if it were to be so decidedly the earliest
symptom that no other indication of insajiity existed, it would, of
course, be extremely difficult to diagnose the character of the theft as
of pathological nature. If it should happen to be the only symptom
with which the physician is acquainted, he must necessarily suspend his
judgment, for it is not by the perception of one attribute that one
thing, even of the most simple character, can be recognised from
another, and in matters of complicated science this is still less
possible. A man may at night see an object which he remarks to
have a round shape, but in the absence of sufficient light he cannot
tell whether it is a disk or a sphere, much less can he tell if it is an
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apple, or an orange, or a ball of iron; and so the simple charac¬
teristic of theft must needs be illustrated by the qualities of the act,
and by the conditions of the actor, before it can be referred to its
category of crime, or of disease. One of the conditions we should
look for in the act as one of disease, is a want of premeditation and
design; the kleptomaniac does not go to the shop or other place
with the intention of committing a theft; some other motive generally
leads him or her into the presence of the temptation. In the good
example given by Pritchard, a man of fortune at Scarborough, saw a
friend and his daughter in a shop, and joined them; in a short time
after, the mercer waited on the father of the lady, and regretted to
state that the lady had taken a silk shawl from the counter; the
gentleman denied the charge, and brought the man to his friend's
residence, in the hall of which he found the great coat his friend
had worn in the morning, and in one of its pockets was the
lost shawl, which was delivered to its owner with the remark,—
it is one of my friend's peculiarities sometimes to take what does not
belong to him—the gentleman died of general paralysis. In this
instance we first observe the want of premeditation in the theft, as
the poor gentleman was undoubtedly induced to enter the shop by the
motive of joining his friends; secondly, the apparent absence of any
intention to appropriate the article stolen; a man of fortune, he
could readily have purchased the article had he really wanted it;
it was moreover an article, though this was an accident in the case,
which was by no means likely to excite his cupidity; he forgot the
act as soon as it was done, leaving the shawl in his pocket; and if
at the time, the progress of the disease had left him in the possession
of sufficient memory to have had the act recalled to him by the
exhibition of the shawl discovered in his coat, he would probably
have shown no symptoms of either shame, or regret, or of appre¬
hension of the consequences. These are the notable qualities of this
particular act; but in addition to these, there would, no doubt, on
investigation, have been found other signs of the diseased state of
mind of which it was the result. The thief s friend in apologising
said, to steal was one of his peculiarities.
An instance in which the difficulties of diagnosis must have been
greater, is recorded by another author. A clerk in a bank was
accused of repeated acts of theft. Nearly all the missing money was
found at his lodgings, carefully concealed in the fining of some old
clothes. When accused, he treated the matter with nonchalance of
so peculiar a character, that suspicion of alienation was expressed
by his employers and Mends; this suspicion would appear to have
been founded upon the manner in which so grave an accusation
against him was received, upon his known habits of integrity, and
upon the absence of motive, his habits of fife being simple, and his
means competent. These facts, combined with the’ important one
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that the money when taken was not expended, but left in conceal¬
ment in the lining of cast-off clothes, were quite sufficient to justify
the humane view taken of the case. It was not, however, until after
the lapse of two years, that the man was found to be decidedly
hallucinated. It would seem probable that if the duty of deciding
on the nature of this case had fallen to the lot of harsh or ignorant
men, this poor fellow would have been consigned to an earlier grave,
through the painful portals of a convict prison. “ En effet,” says
M. Morel, on this very subject, “ soit qu’il s’agisse du diagnostic
d’une maladie mentale, soit qu’il faille apprecier la criminalite d’un
act, nous ne pouvons rester dans une indecision qui compromette le
sort d’un aliene ou les interets sacres de la justice. La science est
assez avancee aujourd’hui pour faire la part de ce qui, dans la
generality des cas, doit etre attribuer au crime ou h la folie.” We
entirely agree with this philosophic writer in the claim which he
advances for psychological science to distinguish the thefts of the
criminal from those of the lunatic in the generality of cases. Some
cases, however, we think there are, in which the certain knowledge
which will alone justify the expression of a positive judgment, can
only be attained by waiting for, and watching the progress of events.
General paralysis is undoubtedly the form of insanity whose incipient
stage is most frequently marked by this tendency to commit theft.
We are not prepared to say whether the tendency ever develops itself
at a period antecedent to the earliest appearance of physical-symptoms.
Probably it does, but it is a point which deserves to be carefully
observed and noted. We have known a general paralytic undergo
a six months’ imprisonment for a theft which he had committed, and
to be discharged from prison without any suspicion having been
excited of the existence of mental disorder. On inquiry, it will, we
think, probably be found that in a certain number of cases the mental
condition which leads to theft, does antedate any degree of muscular
tremor, although it is most common for the state of mind in in¬
cipient paralysis which results in theft, to be accompanied by physical
signs of disease, which a well-instructed alienist will not be liable to
overlook or mistake. The mental condition of general paralytics
which leads to theft is peculiar and characteristic. The patients do
not seem so much to take the things they steal, because they desire to
possess them, as because they believe they belong to them, and because
they at the same time have lost the mental power of discriminating
circumstances. If lunatics of this class do not steal, very often the
first sign of disease which alarms the friends is a reckless expendi¬
ture, manifesting itself beyond their means, and outside of their
wants. They buy all manner of inconsistent and needless things,
paying or running in debt for them, as the case may be. They do
this, or they take the things without the formality of paying or
promising to p&y for them, from the same state of mental exalta-
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tion which leads them to believe that the things do or ought to
belong to them; a state of exaltation, which will, on careful inquiry,
always be found to bfe accompanied by the failing power of judgment
which is the first step towards dementia and fatuity. “ I was once able,”
says the author above quoted, “ to establish the non-responsibility
of a patient of this kind, who had stolen, in a church, the ornaments,
and the most insignificant objects of ceremonial, and who presented
no other symptom of disease than a marked state of congestion,
great self-content, and a silly laugh; the patient had no delusion,
there was only a great intellectual weakness, and the most complete
indifference as to the fate which justice would award ; only three or
four months after his acquittal an attack of acute mania with delirium
of grandeur, trembling of the tongue, and other symptoms of
progressive paralysis justified my prognostic.” Morel, ‘ Traite des
maladies mentales/ p. 410.
Simple progressive dementia is another form of disease, the early
stages of which are apt to be marked by acts of theft, the patients seem¬
ing really to have lost the power to recognise the difference between
meum and tuum, and to steal from stupidity. Hysterical mania, or rather
mania in hysterical women, is another form of mental disease, which
is often marked by propensity to theft even from its earliest stages,
and when other and more decided symptoms of insanity are absent
such a case may present one of the most difficult problems which it
is possible to propose to the medical jurist. Fortunately merely
hysterical people are not very liable to commit crime. With all their
gusty passion, they are cowardly and circumspect; but some modifica¬
tion of responsibility would be fairly permitted to the loss of control
arising from hysteria, although it would not be a less difficult problem
than that arising from hypochondriasis. Both of these diseases are
near neighbours to insanity, and both of them are liable to run into
it. Whether, however, we should call a certain state of mind hysteria
or insanity, would not be the real medico-legal question, but whether
a certain act was the uncontrollable result of disease or not. The
thieving propensities of hysterical maniacs may illustrate and find
illustration from the remarkable fact that women during pregnancy
are sometimes afflicted with a desire to steal. Gall says, that he
knew four such instances in women who had no such propensity at
other times. Perhaps it is difficult for a man to bring the faults of
woman in her most womanly state to the test of cold unsympathising
reason, and on this account the caprices of pregnant women are not
unlikely to be judged with mitigated severity. Casper, however, the
eminent jurist-physician of Berlin, in his work on legal medicine
records the details of a case in which he did not permit himself to be
misled by this view of the responsibilities of the weaker sex. We
refer to his 204th case, “ Theft committed from the pretended caprice
of a pregnant woman.” Madame de X— had committed thefts in
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three goldsmiths’ shops during the last three months of her pregnancy.
The day after her accouchement she was summoned to appear before
the “ procureur royal,” to the astonishment of her husband, who
informed the judge that “ she avowed to me, as if awaking out of a
dream, that she had had during her pregnancy an irresistible desire
to possess shining objects, especially those of new silver. She had in
this manner taken objects from the shops in a state of complete
dementia. Another time, she assured me that she knew nothing
about the matter; and another time, she said, that she had left home
with the intention of restoring the articles, but on her way the con¬
viction had come upon her that they were her own property.”
Madame de X— was said in the depositions to have always been
ridiculously vain and coquettish; although, on the other hand, her
husband said that she was gentle, quiet, and religious. Much evidence
was given to the effect that from the commencement of her pregnancy
a change had taken place in her state of mind ; she had become
absent and careless, and she had manifested the singular desire to
possess shining objects; she used to polish copper objects in her
house, and play with new money, and she had taken a mother-of-
pearl knife and whist markers from the house of one of her relatives,
who observed at the time that she was not right in her head. Medical
opinions as to her state of mind being contradictory, the case was
referred to Casper. He remarked, that although she was said to have
besought her husband not to take her to the houses of her friends
where there were shining objects, she chose to go herself, and without
any necessity, to the shops of the goldsmiths, where she knew that
such objects abounded; and, at these shops, instead of simply taking
shining objects she paid away silver, and then said she wanted
nothing; and she broke up the objects which she stole, in order to
render them unrecognisable. She had each time changed the gold¬
smith’s shop where she went to thieve, and had concealed her conduct
from her husband; and in the interrogations she had made many
contradictory and false statements. Casper concluded that the
diseased propensity of Madame de X— was not irresistible, that she
had not bpen compelled to commit the three thefts in spite of herself,
and that they were criminal actions for which she was responsible.
Madame de X— was found guilty. She was separated from her
husband, and many years after, and when she was not pregnant, she
stole drapery goods from k shop.
In England, or at least in London, Madame de X— would, un¬
doubtedly, have been acquitted, or, more probably, she would not
have been arraigned. It appears to be a generally accepted medical
opinion that pregnant women are subject to quasi diseased states of
mind, which are apt to lead them to commit thefts and other criminal
acts; but it would not be easy to produce reliable data for this opinion.
The exculpatory evidence of a husband in such a case ought to be
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received with grave suspicion; indeed, there are plenty of English
jurymen who would willingly conclude that a husband’s evidence
tending to incriminate a pregnant wife was not worthy to be believed.
The opinion of alienist physicians in these dubious cases is worth
—well, we will not say what we think it worth. It is at least
sometimes heavily paid for. But are we able to produce any definite and
reliable information on these cases, the result of unbiassed observation,
which is worthy to be accepted by judges of the land as real and true
knowledge? Is not our opinion rather the result of the most
vague and general impression, founded upon no data which we can
produce ?
If we attempt to form something like a classification of insane
theft, it will be found convenient, and, on the whole, consistent with
fact, to distinguish between—1st, theft arising from perverted intelli¬
gence, i. e. delusion; 2nd, theft arising from defective intelligence,
i. e. from idiocy, imbecility, and dementia; and, 3rd, theft arising
from perverted emotion, as, for example, the caprice of pregnant
women, and those cases of supposed irresistible propensity which
have been assumed to deserve refuge within the sanctuary limits of
mental disease.
About the nature of theft committed under the instigation of
insane delusion there can be no doubt. If the law held? a man
guilty of crime for taking possession of property which he believed
to be his own, that belief being the result of insanity} the law itself
would be mad.
The nature of thefts of the second category is not always so intelli¬
gible. Abstractedly, the nature of a theft committed by a perfect
idiot, and by a person of merely weak intelligence is the same. The
theft is committed from want of a due appreciation of the character
and consequences of the act. Coleridge said that all rogues were
fools with a circumbendibus. The question in this case will be the
amount of folly. If it is so great as to prevent the thief from
recognising the nature and consequences of the act, he must be held
innocent of crime; but in this class of cases the question of intel¬
ligence, and of consequent responsibility, is one of degree. There must
ever be a border-land between sense and folly, in which it will be
most difficult to arrive at a right and just judgment.
In the category of insane theft from perverted emotion, our know¬
ledge is all at sea. Whatever we may think of the irresistible nature
of thefts by pregnant women, those committed by men and women
who are in no exceptional condition of body, and who manifest no
other symptoms of insanity than that they steal because they cannot
help it, may well be questioned with juridical and scientific severity.
As we have said, a large proportion of the cases of kleptomania,
or, as Mathey first called it, klopetomania, which are found in works
on insanity, have been copied from one another, the original source
VOL. VIII. 18
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being Gall's great work * Sur les Fonctions du Cerveau/ Gall,
indeed, set the first example of quotation, for he has himself quoted
the whole passage in his fourth volume. These are his words, as
they first occur at p. 412 of his first volume.
“ Exaggerated propensity to Theft: destruction of the moral liberty.
"Victor Amadis the first. King of Sardinia, on all occasions appro¬
priated trifling articles. Saurin, pastor of Geneva, although imbued
with the highest powers of reason and of religion, continually suc¬
cumbed to the desire of thieving. Another individual was, from his
earliest years, a prey to this inclination; he entered the army, for
the purpose and with the hope of being restrained by the severity of
its discipline, but continuing to thieve, he was upon the point of
being condemned to be hanged. Always striving to overcome his
desire, he studied theology, and became a Capuchin. His propensity
followed him into the cloister ; but as the things he stole were only
trifles, he indulged it without disquietude. He took scissors, chan¬
deliers, snuffers, cups, and goblets, and carried them into his cell.
A government employe at Vienna had the singular mania of stealing
only household utensils. He hired two rooms wherein to deposit
them; ’he never sold them, nor made any use of them. The wife of
the well-known physician Gaubius had so strong an inclination for
thieving, that tvlien she made purchases she always attempted to take
something away. The Countesses M—, of Wesel, and J—, of
Frankfort, had the same penchant. Madame de N—, had been
educated with especial care. Her powers of mind and talents ensured
to her a distinguished place in society. But neither her education,
nor her rank, exempted her from the irresistible desire to thieve.
Lavater mentions a medical man who never left.the room of his
patient without taking something away, and thought no more about
it. At night his wife searched his pockets; she found in them keys,
scissors, thimbles, knives, spoons, buckles, and needle-cases, and
returned them to the proprietors. Moritz, in his ‘ Traite experi¬
mental sur Fame/ related, with all its details, the history of a thief
who had so strong a propensity for theft, that being nigh unto
death he stole the snuff-box of his confessor. Dr. Bernard,
physician to his Majesty the King of Bavaria, tells us of an Alsatian
of his acquaintance who committed thefts everywhere and at all times,
although he had abundance and was not avaricious. He was edu¬
cated with care, and his vicious propensity had many times brought
its punishment. His father enlisted him as a soldier; this means of
correction was of no avail. He stole to a great extent and was con¬
demned to be hanged. The son of a celebrated savant offers another
memorable example. He was distinguished from his fellow-students
by his talents; but from his tenderest years he stole from his parents.
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Kleptomania.
his sister, his servants, his comrades, and his professors. He
abstracted the most valuable books from his father’s library. All
means were tried for the correction of his fault; he became a soldier,
he oft-times submitted to rigorous chastisement, but all was unavail¬
ing. The conduct of this unhappy young man was in other points
exemplary; he did not justify his thefts; but if he was remonstrated
with on this subject, whether in a friendly tone or in a more demon¬
strative manner, he appeared indifferent, and as one who did not
regard what was said.
“ The almoner of a regiment of Prussian cuirassiers, a man educated
and otherwise endowed with moral qualities, had so decided a propen¬
sity to steal, that often on parade he took away the handkerchiefs of
the officers. His general greatly esteemed him, but as soon as he
appeared every article was put away with the greatest care, for he
had often carried away handkerchiefs, shirts, and even women’s stock¬
ings. Afterwards, when asked for the articles he had taken, he
returned them in good faith. M. Kneisler, director of the prison at
Prague, tells us of the wife of a rich merchant who constantly
thieved from her husband in the most dexterous manner. They were
obliged to confine her in Bridewell. Scarcely was she free when she
again thieved, and was confined a second time. Set at liberty, new
thefts condemned her to a third detention of greater length than the
preceding ones. She even thieved while in the prison. She had
contrived with much cleverness an opening in the stove which heated
the room which contained the money-chest of the establishment. The
repeated thefts she committed on it were observed; for her detection
bells were hung upon the doors and windows, but to no avail, but
she was effectually scared by pistols which went off instantly when
the money-chest was touched, as to give her no time to retreat by
the aperture in the stove. We have seen in the prison of Copenhagen
an incorrigible thief, who sometimes distributed his pilferings among
the poor. In another place, a thief who was in confinement for the
seventh time, assured us, with sorrow, that it seemed impossible for
him to do otherwise than thieve. He demanded peremptorily to be
kept in prison, and that the authorities should supply him with the
means of getting his living.
“ It would be easy to cite thousands of like facts, which also serve
as proof that the desire of thieving is not always the result of bad
education, of laziness, or of poverty, nor the absence of good
qualities, nor even of morality or religion; and this is proved from
the fact that petty larcenies are overlooked by the world when they
are committed by the rich and polished members of society. Absence
of mind is the name given to such thefts. But is not the same
craving found in the poor man ? Does it then change its nature ?
Is it changed by the value of the things stolen ? The result is the
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Kleptomania.
same, and much prudence and experience is needed to decide with
exactitude the different degrees of culpability/’
But for what purpose has this great mental physiologist adduced
these examples of apparently motiveless theft ? Not, certainly, as
examples of mental disease, since he states his opinion with his cus¬
tomary precision, that these exaggerated propensities are not “true
mental alienation, but rather a partial exaltation, a subjection of the
soul, offering an incomprehensible contrast between man and the
animal which he bears within him. Bor the flesh lusteth against
the spirit and the spirit against the flesh; and these are contrary
the one to the other: so that ye cannot do the things that ye would.”
This he observes on the general subject of exaggerated propensity,
but that of theft in particular he appears to have no difficulty in
referring to the innate qualities of man’s nature. “ It is inherent in
our nature,” he says. “ There are very few persons who, with the
hand on the heart, can say that they have never committed a theft,
especially if they go back to their infancy. In the majority of men
it is needful to combat, without ceasing, this propensity to theft, by
powerful motives, by penal laws, by religion,” &c. Between the
propensity as it exists in one man and in another, he observes that
“ The only difference is one of degree: in one man the propensity is
moderated by a happy organization; in another by the influence of
education, by the control of habit, or the fear of punishment; but
in a third, the vicious propensity is occasioned by an organ so energetic
that the same motives which have made honest men of others have
no influence upon him.” Moreover, Gall approves of the legal
institutions by which men punish and endeavour to correct this
propensity (p. 213, vol. iv); and altogether it would seem that one
of the most illogical things which psychological writers have dared
to do, has been to cite the examples which Gall has collected to
illustrate theft as arising from the preponderating action of an organ
in a healthy brain as examples of theft occasioned by mental disease.
With regard to the motiveless nature of some thefts and the
singularly incorrigible character of some thieves, Casper makes some
remarks which appear both new and true: “ The rare cases which
Marc refers to, in which the thief throws away the object stolen, or
spontaneously proposes to pay for it, admit of physiological expla¬
nation. We do not mean by that very common state of perversity
and malignity which may be the cause of some thefts of this kind ;
what we mean is, that so much tact, address, and courage are often need¬
ful to commit a theft without being discovered, that it is so needful
to watch and to seize the right moment, to plan with care and to
execute with promptitude, that one can comprehend the great
pleasure which is experienced in overcoming such difficulties, and
how much so perilous an enterprise, crowned with success, is flattering
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Kleptomania.
to the self-approbation of the thief. I am convinced, also, that in
some individuals a real attraction is felt in this chase after the property
of another. I say chase, for I can compare it to nothing better than
the passionate desire to follow a hare or a fox at the hazard of
life, or to watch for the prey like’ fishermen in England, who
remain whole days on the water patiently watching the least move¬
ment of their game. I am thoroughly convinced that this emotion is
of much force in holding thieves to their mode of life, and it is in this
manner only that we can explain how it is that some of them, after a
long imprisonment, immediately recommence to steal, although they
well know that a second punishment, more severe than the first,
awaits them.”
Theft, indeed, while it is by far the most common of crimes, will
present, to those who seek for it, a philosophy as interesting as it
is important. Let us study it with unprejudiced minds, and not
stultify ourselves by wrong-headedly adhering to a narrow professional
point of view. The doctors are as willing as iEsop's currier to cry
out that there is nothing like leather, and the lawyers are just as bad.
But neither is all crime insanity nor is all insanity crime. Let us
strive, therefore, to distinguish them with all exactness, even though
the effort may make our existing ignorance inconveniently apparent;
and for the question of kleptomania let us at least decide so'far as
at once to decline to make science the handmaiden of crime, by
firmly insisting upon other evidence of the existence of mental
disease than that afforded by the crime itself.
J. C. B.
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NOTICES OF BOOKS, PAMPHLETS, &c.
Asylum Reports.
These annual visitants which so pleasantly in the spring-time
remind one of many a distant friend, contain, it must be confessed,
little which is new, and not much which is instructive. No one who
has not like ourselves examined year after year the whole series of
Asylum Reports, can have any idea of the sameness of their contents.
What is said one year in one report, is said the next year in another,
and so on; the same facts are stated, the same opinions enunciated,
the same entreaties addressed to the local public by one super¬
intendent after another, not from any tendency to imitate or follow
each other, but simply because institutions established under the same
law and for the same purpose, are liable to encounter the same dif¬
ficulties, and to have occasion to make the same complaints and to
address the same entreaties. Thus we find the superintendents of new
asylums complaining to ears, which by old experience we know to be
deaf as adders', that patients are sent to them in a hopeless state of
bodily disease when asylum care can afford no help, and when their
admission can only tend to swell the asylum bills of mortality; and
with equal frequency the complaint is made that few of the cases sent
to the asylum for treatment are sufficiently recent to be curable. It
is discouraging to a superintendent anxious to be widely useful in his
calling, and moved with a noble ambition to effect a good per-centage
of cures, to admit case after case of chronic mania or hopeless
dementia, varied occasionally by an acute case at death’s door from
delayed treatment and exhaustion. We observe, however, that the
old superintendents don’t complain of these matters, having found,
by dire experience, that it is of little use, and that the main reason
after all why patients are sent to the asylum is, that they give
trouble out of it, a fact which We claim to attribute to a beneficent
law of nature; for if, as an esteemed contributor maintains, it is a
law of nature that the insane should be happy and contented under
the influences of treatment which tends to their restoration, surely
we have a right to name it a law of nature that they are troublesome
and dangerous under neglect which tends to their destruction.
This repetition of the same subjects of discussion contained in
Asylum Reports is not only unavoidable, but it is essential to their local
character and purpose. To reproduce this tautology of subject
matter, however, in any attempt to notice the whole series of reports,
would be useless and wearisome; we shall therefore endeavour to
confine our notice to that which is new or unusual, and in doing so
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' Notices of Books, Pamphlets, fyc.
we commence with a report, which, so far as we know, is not published,
except in a local newspaper.
Report of the Gloucester County Asylum.
We observe in the report of the visitors of this asylum to the last
Epiphany Sessions, the statement that, “ the permission for patients to
visit their friends out of the asylum for limited periods, has been ex¬
tended by the superintendent of late, with apparently very good effects.'”
In the report of the Visiting Commissioners of Lunacy this
novelty in asylum treatment is referred to in the following terms.
“The practice of taking the patients beyond the premises for #
exercise and recreation has been continued aud extended, and visits
to their friends and relatives are still permitted and encouraged.
On these occasions the patients are allowed to wear their own
clothes; they also in many instances use them when attending
Divine service in the chapel. All these indulgences have evidently
a most beneficial effect on the inmates, producing a kindly feeling
amongst them, and diminishing the sense of restraint which we find
is often engendered by the opposite mode of treatment.”
When we read this in the Gloucester newspaper, and felt that it was
something new and good, we wrote to our old friend Dr.Williams, who
had instituted the practice, to know more about it, and here is what he
said in reply:—“ Three years ago I commenced the practice of allow¬
ing my patients to go out with their friends, and I have gradually
extended it up to the present time. In only two instances has the
privilege been abused. Last year 400 visits were paid from the esta¬
blishment, and one patient spent a week with his friends in Somerset¬
shire. As a general rule, the expense is defrayed by the friends,
although occasionally I charge it to the institution. I always insist
that the person who takes the patient out, undertakes, in writing,
to bring him back at a certain time. I also keep a book in which I
record every visit, I enclose you one of the leaves.”
It must be observed that this sending out of patients to visit their
friends is altogether different to allowing patients to be absent on
trial under the authority of the visitors, exercised according to the
statute. It is, in fact, an exercise of the power of the physician in
the treatment of his patient without legal warrant, but just similar
to that by which he permits his patients, under proper selection and
care, to walk beyond the bounds of the asylum. The letter of the law
is, that a superintendent who wilfully permits a patient to escape,
is guilty of a misdemeanor; but the spirit of the law is,
that a patient is a patient, and not a prisoner, and that in the
asylum he is placed under the care and treatment and authority of
the superintendent as his physician. In this relation it is evident that
any degree of liberty given by a superintendent to a patient with the
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intention and purpose of conferring benefit and happiness upon the
patient, would come within the scope of the physician's power, so long
as he exercised it with sufficient caution and judgment to protect the
interests of the public and of the patient; and we can conceive few
things better adapted to break any prejudices of the poorer classes
against asylums as places of detention, and thoroughly to reconcile
inmates of asylums with their detention than this new plan of Dr.
Williams. How often may not such a visit to friends be made the
useful preliminary to the legal discharge, leading the mind of the
patient, without needless shock, to view the struggles and trials of
renewed liberty. How often may not the galling doubts of the
• affection of relatives be removed by such a visit ; and above all, in
how many cases will not such visits tend to remove from the mind
of a patient the feeling that he is shut up against his will and against
his interest, and lead him to recognise the benevolent wisdom which
secludes him from the world ? We have ourselves begun to follow
Dr. Williams' excellent example, and we hope and expect to see
much good result from it.
The West Biding of York Asylum.
The report contains a large and well-drawn bird's-eye view map of
the now completed buildings. This map is the work of a patient, and
is an example of what patients can perform under kind and judicious
encouragement. The asylum, which is now one of the largest in the
kingdom, is somewhat too near to the busy and bustling town of
Wakefield, and has a much too limited quantity‘of land, namely, 64*
acres for 1150 patients ; otherwise the asylum arrangements would
now appear to be excellent and complete. A handsome chapel has
been opened during the year, capable of containing 611 persons, and
we are pleased to observe that the character of the services is
varied to suit different tastes. “ The services are about an hour
and a quarter in length. They are made as attractive and as
little monotonous as possible, by the introduction of music. On
the Sunday afternoons there is an excellent choir of about twenty-
four voices from among the officers and servants, kindly assisted by
several leading members of the choirs of churches in the town. Full
choral service, with an anthem, is regularly performed, and the psalms
are chanted, usually to simple single chants. In the morning the
service is, musically, much plainer, the psalms and versicles being
read, and the chants and psalm-tunes being chiefly taken in unison.
One of the objects contemplated by the difference between the musical
character of the morning and afternoon services, is to endeavour to
meet the tastes of those who think chanting the psalms scarcely
devotional, and of the still larger population who are soothed and
devoutly impressed by good church music."
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The Report of the Northampton General Lunatic Asylum,
Contains a statement that women nurses are employed in the men's
infirmaries. Mr. Ley of Oxford, we think, was the first to introduce
female nurses into his men’s wards, though, even before him, we believe
that we ourselves had female night-nurses in the men’s wards. The
practice of introducing female influence on the men’s side seems to be
in every way commendable, though we are inclined to think that women
should not be substituted for men attendants, but be additional helps.
Dr. Wing says, “ Female influence is about to be brought to bear in
another way in the establishment, and in this I am glad to have the
sanction of the Commissioners in Lunacy, women having been en¬
gaged to nurse the very aged, the helpless, and the sick men. Nursing
is the natural province of woman ; her superior delicacy and tact are
universally acknowledged, and in all our civil hospitals and infirmaries,
as well as in many of the military ones also, females are employed to
attend the men. A few lunatic asylums have followed the example,
with which it is a pleasure to number our own.”
Report of the Lunatic Asylum for the North and East Ridings of
Yorkshire.
This is always interesting in a financial point of view, for Mr.
Hill’s reputation as an economist is well known. The accounts, how¬
ever, are not so clear as could be wished; for instance, although the
sum of £693 14?. 9 d. has been received for the maintenance of pri¬
vate patients, and the sum of £1816 13,?. 1 d. has been received for
the maintenance of out county patients, it is nowhere stated how
much has been charged for the maintenance of each of these patients,
and how much in excess of the charge made for paupers chargeable
to parishes in the county.
Whatever this excess may be, it would appear that it has been
appropriated to the reduction of the maintenance rate, so that Mr.
Hill has been able to make so small a charge as 7 s. Id. per week for
the county patients, by appropriating this profit on the private and
out county patients. There appears no other manner of getting at
the cost of each patient in the asylum, except by taking the whole
sum of payments (minus the payments made on behalf of the county
for additions to the asylum) and dividing this sum by the whole
number of patients. The payments were £10,962, and the daily
average number of patients 485, and from these data it would appear
that the weekly cost of maintenance for each patient in the asylum is
8?. 8l«?. We observe that the chairman comments upon the over¬
crowded state of the asylum, and the early necessity which will arise
to apply to quarter session for grants of money to increase the accom¬
modation. Mr. Hill, however, who has private patients in the asylum,
who pay nearly £700 a year, expresses the opinion that fuller and
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freer access ought to be granted by law for the admission of such
patients. He says (though we don't know quite what he means),
“ Seeing then, that the classes of lunatics above pauperism feed the
classes below them, and that this will assuredly go on, so long as
that they are only admitted on sufferance to the advantages of
county establishments; could the wisdom and humanity of counties
also making ample provision for the former be questioned ? so that
.all such, who may choose the care of public institutions, may by
right demand it. In my opinion, nothing could be easier to accom¬
plish, nothing more easy to regulate, and nothing less oppressive to
the rate-payer, who is constrained to pay for his poorer neighbour,
but who in the hour of his own mental affliction incurs the risks and
perils of uncertainty. The law at present is permissive, not com¬
pulsory ; that is, it allows of the reception of others, than paupers,
into county asylums, when there is room."
The Report of the Somerset County Lunatic Asylum.
Dr. Boyd's report is always most interesting and valuable, more so
indeed to medical men than any other report with which we are
acquainted. This, of course, arises from his pathological researches,
and the care with which he communicates the results of them to his
professional brethren through these reports. The following is Dr.
Boyd's resume of his medical treatment:
“ The medical treatment has been the same in most respects as
described in former reports. In epilepsy the tincture of sumbul has
been given in several instances, one female, aged thirty, after taking
this drug in drachm doses seven times diluted with water twice a day
for about three months, had a cessation of the fits, and she was dis¬
charged having been altogether free from fits for six months. In a
second case, that of a male mute, who has also taken the same
drug, there has been a gradual diminution in frequency, and for
the last four months a cessation of the fits. In several other cases,
submitted to the same treatment, a minor degree of relief has
been afforded. It very seldom happens that any objection is made
by the epileptics to taking the sumbul. It has also been given
with decided benefit in three cases of neuralgia and in hysteria, and
in delirium tremens it has been administered in larger doses, and
with good results.
“ Cod-liver oil is another remedy which has been very much used
during the year in cases of marasmus which are so frequently com¬
bined with all forms of insanity. The most remarkable instance in
which almost immediate relief appeared to be derived from this oil
was that of a female with melancholia, transferred from another
.asylum with scrofulous swellings and sores in the neck, who was dis¬
charged recovered at the end of four months. Two cases where pul-
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monary tubercles were suspected have also been benefited by taking
the oil, and one male with general paralysis in an emaciated state has
become greatly improved in condition, although he has nearly lost
the power of utterance. In the latter part of the year there were
more cases under treatment of what has been termed general paralysis
than at any previous period, twelve males and two females, half the
males and both the females in a perfectly helpless state. No treat¬
ment has afforded any permanent relief in this disease. In a few
instances the bodily condition has been for a time improved after
admission by care and attention to diet. The ‘ Liquor Hydrargyri
Bichloridi/ has been given in many cases, and the nape of the neck
and spine blistered. Some instances have occurred in which patients
in a very helpless state, confined to bed, have rallied for a time after
the blistering process has been adopted, combined with rest. It is
only in the last stage of this disease that rest can in general be
obtained, for previous to it, these patients are very restless, and many
of them are not to be kept in bed, but are knocking at the door, and
in the day-time constantly undressing themselves. Perfect rest in
cases of general paralysis, which I have found so often to depend on
inflammation of the spinal cord and membranes, would be most
desirable, if it could be obtained, in the earlier stages of the disease.
Convulsions or fits, in many respects similar to epileptic fits, have
attended some of the cases of general paralysis, especially in the last
stage.
“ The shower bath has always been more or less used in this institu¬
tion in cases of excitement, more frequently in summer, and generally
with immediate benefit. One man subject to frequent and severe
outbreaks of maniacal excitement has it almost daily on those occa¬
sions, and has often said it did him good. Another man with
dementia, subject to periodical fits of restlessness, also finds relief
from it. Two or three of the chronic cases amongst the females also
find benefit from its use, and in acute melancholia it has occasionally
been decidedly beneficial.
“ Packing in the wet sheet has proved of great utility in producing
sleep where opiates, given in as large doses as deemed prudent, had
failed. It has been tried this year for the first time, after the method
witnessed by Dr. Madden, at Boppard on the Rhine. In several
instances the relief was immediate: where excitement, restlessness,
and want of sleep had continued for several days, resisting all ano¬
dynes, they have fallen off in a few minutes in the ‘pack/ and
although the sleep there has not been of very long continuance in
any instance, still the patients afterwards became more manageable
and more disposed to sleep.”
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The Report of the Sussex County Lunatic Asylum.
The report itself contains nothing new beyond a statement of the
fact, which our readers will find enlarged upon elsewhere in these
pages, that the Roman Bath had proved a valuable therapeutic agent,
particularly in cases of melancholia. Forty sailors and marines
have been sent by government from Haslar Hospital to the Sussex.
Asylum. The report contains a full and skilfully-drawn statement of
accounts, and we observe that the omissions noticed in the North
and East Ridings’ Report, do not occur here. The average weekly
expenditure for each patient was 10$. 8 \d .; the weekly charge made
for patients in non-contributing unions was 14#., and for private
patients 16#.; the appropriation of so much of these payments as was
in excess of cost, enabled the patients from contributing unions to
be charged only at the rate of 10#. 3 d. per week. The appropriation
of this extra charge upon out county patients and non-contributing
boroughs, is a question of much importance. It is one of those things
which the statute has left loose; and which has accordingly been
dealt with at the pleasure of the visitors of the different asylums.
In Sussex and in York we see it dealt with to reduce the maintenance
rate, and no doubt this is the usual mode of its appropriation; but in
other counties it has been maintained that this charge is really a rent-
charge for the use of the building, and ought therefore to be appro¬
priated to the maintenance of the building. In this manner it has been
appropriated in the Somerset Asylum, and we are pleased to remark
in the report of that asylum, that the visitors give Dr. Boyd the
credit for having economically increased the accommodation of the
asylum by 50 per cent., mainly through the appropriation of this
charge made upon his patients. In the asylum from which we
write, there are 142 patients from non-contributing Boroughs, each
of whom pays a rent-charge of 3#. 6 d. a week, a payment which
amounts to the important aggregate of £1292 4#. per annum. This
also has been appropriated as a building fund, that is, to pay for the
additions, improvements, and repairs, which would otherwise be paid
for out of the county rate. If, however, it were appropriated to reduce
the payments for maintenance of the 500 patients chargeable to
parishes in the county, the reduction so effected would be at the rate
of about 1#. a week per head.
It is to be regretted that no attempt has been made to regulate
this matter by law, for not only does its present condition prevent
any just comparison being made of the economy of management in
different county asylums, but it is a matter which if left thus loose,
is liable to give rise to contending opinion. Not only has the right
appropriation of this money not been determined, but the persons
have not been indicated who have the right to dispose of it in any
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manner; and the question consequently arises, and has been mooted
from the county whence we write, whether the visitors of the asylum
have any power to use this money in any way, or whether it ought
not to be disposed of by the justices in quarter sessions.
A short time since, moreover, a bill was introduced into parliament
with clauses to compel the visitors of county asylums to provide
accommodation for patients from pon-contributing boroughs for
which, of course, fair payment was to be made. This payment would
be nothing more than the rent-charge of which we are speaking; and
surely if there is any probability that such contracts with boroughs
will be made compulsory upon the visitors of county asylums, the
appropriation of such funds should not be left undetermined, as in
the present rather slovenly omission of the statute.
Upon Dr. Robertson's own report will follow well the Report of the
Provincial Hospital for the Insane at Halifax, Nova Scotia, because
the establishment of this institution has had to be reorganised, and
the superintendent. Dr. De Wolfe, says that the reorganization has
been effected upon the principles laid down by Dr. Robertson in
the pages of this journal.
“ In re-organising, reference was made to the views of Miss Dix, as
propounded to the superintendent, as well as to the mode adopted at
one of the new English asylums, namely, that at Hayward's Heath,
Sussex, opened 25th July, 1859. The superintendent of the
Sussex Asylum, C. Lockhart Robertson, Esq., M.D. Cantab., is
entitled to every consideration, as well from his position as Honorary
Secretary to the Association of Medical Officers of Asylums and
Hospitals for the Insane, as from his experience in the specialty.
“In a descriptive notice of the new Sussex Asylum, in the ‘ Journal
of Mental Science' for April, 1860, the duties and position of the
officers, &c., of the establishment are minutely set forth. These
formed a basis for the plan adopted here, corresponding as they do
with the views of Dr. Conolly and Dr. Kirkbride, than whom no higher
authorities on the subject are to be found in England or America."
Under the head of elopements, escapes as we should say, Dr. De
Wolfe gives an account of the effect produced by one patient upon
many others, which is fortunately a difficulty not often met with in
institutions for the insane.
“ In the autumn a pyromaniac, a young man of highly prepossessing
appearance, was committed, who found the confinement irksome and
intolerable. He not only avowed his intention of making his escape
at all hazards, but preached to others the doctrine that they were not
rightfully confined here, that they ought to be at liberty, and that if
freedom were not granted they ought to take it. In three weeks
he instilled his belief into several other patients, and persuaded them
to elope, himself setting the example.
“ Having no suitable enclosure, no barrier indeed to prevent escapes,
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and but few attendants, it is not to be wondered at that one patient
went as far as Mount Thom, one to Lawrence-town, one to Hammonds
Plains, one to Preston, two to Dartmouth, one to Newport, and
another to Windsor Road. With a single exception, all were over¬
taken and brought back, and the epidemic appears to have subsided.”
It has been pleasant to remark, from the paragraph in the Halifax
report above quoted, that the pages of this journal sometimes carry in¬
struction to remote parts of the world; it is by no means the first time
that we have had the gratification of being assured of this fact. We
indeed receive the strongest assurances from the colonies of the high
estimation in which the governors and superintendents of asylums
hold the information conveyed to them by this journal, and of which,
in their inability to avail themselves of more direct means of informa¬
tion on asylum management, they stand much in need.
Report of the Cheshire County Asylum.
This asylum, containing 365 patients, has been enlarged so as to af¬
ford accommodation for 510 patients, the full amount of which, how¬
ever, the visitors hope will not be wanted for eight or ten years to come.
To employ the unoccupied portion of the building usefully and pro¬
fitably, they are determined to take in private patients at the rate of
fourteen shillings a week. Mr. Brushfield, the medical superin¬
tendent, remarks on the gradual decrease of the curable patients who
are admitted into the asylum, which he attributes to the gradual
increase of aged and broken down cases which are admitted. We
observe that he, as well as several other superintendents, are in
expectation that the clause in the new poor-law removal act, which
imposes the cost of pauper lunatics upon the common fund of unions,
instead of on the parishes where they have settlements, will operate
by inducing the local authorities to send cases of insanity to the asy¬
lum in an early and curable stage of disease. We are inclined to
think that if the clause does operate in this manner it will also have
the effect of inducing the local authorities to press upon asylums many
chronic cases of aged persons who would otherwise receive relief in
union houses, or in their own homes. An octogenarian pauper, in the
second childhood of old age, so long as his condition is looked upon
as the natural result of senile decay, will receive relief from the funds
of his parish; but if the overseers can make out that he is a lunatic, and
obtain his admission into the asylum, they will shift the charge of
maintaining him from their own local rates to the general fund of the
union. Those who are best acquainted with the motives under which
overseers and guardians generally determine to act, will be able to
foretell whether there will now be no tendency to press patients into
the asylum, not for the sake of any benefit they may receive there,
but with the penny-wise motive of saving the parish rates. We by
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no means object to this clause in the poor removal \ct, and, indeed,
we think it a just and good one, and one which, fairly carried into
execution, will work well; but the tendency to work it, in the manner
we have pointed out, will require to be carefully watched.
Report of the Lunatic Asylum for Salop and Montgomery.
Dr. Oliver mentions that in this asylum the power of the visitors
to grant allowances to patients out on trial, under the seventy-ninth
section of the Asylums Act, has been largely resorted to, and with the
best effects. He says that 236 patients have at various times been sent
out on trial, most of whom have been assisted by the allowance
ordered by the visitors. In only forty-one of these cases has the
experiment failed; by which we suppose Dr. Oliver to mean that in
only this number of cases, patients, who have been sent out a month
on trial, have not been able to remain out permanently. A diffi¬
culty has, however, unfortunately arisen which threatens to pre¬
vent the continuance of Dr. Oliver's practice of putting in force the
powers of this seventy-ninth section. He says that the parish autho¬
rities have up to a late period made no objection to the payment of
money for the relief of patients going out of the asylum on trial,
but that recently they have asserted that no money can be legally
advanced for this purpose beyond the first week's instalment) except
an officer of the asylum shall assume the office of relieving officer,
and pay the allowance to the patient or his friends every week during
the period of the patient's experimental absence from the asylum,
which is usually four weeks.
Dr. Oliver does not tell us whether, up to the present time, the
parish authorities have themselves consented to be the medium
through which the payment should be made, and that their objection
would, therefore, mainly apply to the medium, and not to the period
of the payment. We think they would be so far right, and that the
proper person to make the payment is undoubtedly an officer of the
asylum. But there is nothing in the act to say that the payment shall
be made every week or every month. We remember an instance in our
asylum, in which a recovered patient, who had got his livelihood by
teaching, was maintained out of the asylum on trial for three months,
during which he gathered pupils and self-confidence, and has sup¬
ported himself ever since, whereas, if left without aid, he would pro¬
bably by this time have become a chronic lunatic. In his case he
appeared in person, and received his allowance once a month, and we
have no doubt the visitors of an asylum have the full power to make
an advance of this kind for a month, or for any other period which
they may think right; the words of the act being, “ It shall be
lawful for such visitors to make such allowance to such last-men¬
tioned person, not exceeding what would be the charge for such per-
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son if in the asytum, which allowance, and no greater sum, shall be
charged for him, and be payable as if he were actually in the asylum. **
There is nothing about paying the allowance every week here, and
the only responsibility incurred by paying once a month would seem
to be, that if the patient should spend the month’s allowance during
the first week, and become destitute, or if he should die, and his friends
not refund the allowance, the union might decline to pay, and the
asylum have to bear the loss. Of course the words quoted above,
“ shall be charged for him, and be payable as if he were actually in the
asylum,” mean that the sum shall be charged to the parish or union,
and be payable by the parish or union to the treasurer of the asylum;
and we can see no reason why the powers given by the act to enforce
payment when it is refused, would not apply here as much as to the
maintenance of the patient in the asylum, and therefore we cannot
agree with Dr. Oliver in his opinion that the Lunacy Act gives no
power to the visitors to enforce payment of this allowance.
This matter is important under other aspects than the one under
which it is viewed by Dr. Oliver. In the Devon Asylum, for instance,
a certain number of patients are always out on trial, living with cot¬
tagers in the neighbourhood, with a view of affording one means of
relief to the over-crowded asylum. Some of these patients have been
out on trial for several years, the asylum paying all charges, and in
turn charging the parishes for their care and maintenance as if they
were in the asylum. Now and then a parish has objected to the
arrangement, and has requested that the patient may be sent home,
and sometimes the visitors have acceded to the request, and some¬
times have refused, being guided by the opinion they formed as to the
probability of the patient being properly taken care of when at home.
The payments for these patients are made monthly.
Report of the Lancashire Asylum at Rainhill.
The power of making the allowance to patients on .trial appears
also to have been freely used by the visitors of this asylum. Dr.
Rogers says—“The clause in the Act of Parliament by which
patients may be discharged on trial, and an allowance made to them
during their period of probation, has been largely applied during the
past year; and many have been thus discharged much earlier than
it would have been thought prudent to do unconditionally. The
period has, in one or two instances, been extended to a second
month ; and in two cases (both women), reports of their condition -
and conduct when at large not being satisfactory, their final discharge
was withheld, and they still remain under treatment in the asylum.”
It would appear, therefore, that in some asylums this allowance to
patients on trial is freely granted, while in others benevolent funds
have been established to effect the same end; thus in the next report
which we take up, namely, that of—
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The Essex County Asylum.
Dr. Campbell states:—“During the past twelve months, fifty-four
of the patients who were in poor circumstances, on leaving the
asylum received assistance from the Benevolent Fund, established
for the relief of the destitute insane, on their discharge; and I beg
respectfully again to press on the attention of the public the neces¬
sity of a more liberal support to a charity, the benefits of which
cannot be estimated in removing one of the most common occasions
of relapses, namely, the difficulty which such persons, when first
liberated, frequently have in procuring employment, and the anxiety
and hardships to which this difficulty must subject them, and which
must operate with more than usual severity in the then delicately
balanced state of their nervous system.”
There appears to be, and there can be no question that, in a con¬
siderable number of pauper patients convalescing from disease in an
asylum, the cure is confirmed and relapse prevented, by pecuniary
help afforded on the first exit from the asylum; but, as we have
seen, the manner in which this help is given, differs in different
asylums. We shall not attempt to determine which of the- two is
preferable; whether it is better for the visitors to put in force the
powers of the statute, and thus to tax property at large in the county
for the purpose; or whether it is better to establish a voluntary
fund, and in this manner to tax only the liberal and benevolent. As
a rule, perhaps it is better not to resort to individual benevolence to
raise funds for any purpose provided for by the laws of the land. The
fact of its having been so provided for may be taken to intimate that
the benefit contemplated is a general one, and, as there are so many
worthy objects of charity which are not so provided for, it would
seem undesirable to run the risk of diverting contributions from
them for an object for which all the real property of the land is
taxable.
Report of the Royal Edinburgh Asylum for the Insane.
Dr. Skae’s report is enriched by the description of a few in¬
teresting cases, drawn with much vigour. In one of these, a case of
suicidal impulse, associated with persistent watchfulness which defied
narcotics, after describing the ingenious attempts to evade the vigi¬
lance of the attendants and procure some means of self-destruc¬
tion, Dr. Skae says that the patient became tranquil and slept
at night when mechanical restraint was imposed by means of the
“ polka.” What is the polka? “When she saw there was no
chance of effecting her purpose she slept quietly. Again and again
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she was tried without it, hut she never slept when she thus had
•the. slightest opportunity of obeying her morbid impulse. This was
one of the few cases where restraint not only gave additional safety
but was positively beneficial.”
In the table of causes of disease in patients admitted it is worthy
of remark that only eighteen out of three hundred cases are attri¬
buted to intemperance, and Dr. Skae comments upon the diminish¬
ing frequency of this cause in his admissions; this year it being less
than 7 per cent., whereas ten years ago it was the assigned cause in
20 to 25 per cent, of the cases admitted. It is to be hoped that
the reason of this difference is the diminished frequency of intem¬
perance as a cause. Dr. Skae’s remarks on the benefit of extending
the protection of the asylum, for a sufficient period, to convalescent
patients, are so important, that we shall quote them at length. Un¬
fortunately the public asylums are usually so crowded with patients
that convalescent patients have little chance of being retained in them
for the time that is necessary to consolidate their cure.
“ After a residence of ten or twelve months, the prospects of re¬
covery diminish very rapidly; while, on the other hand, of the cases
removed after a very short residence, a considerable number relapse.
One female, who was convalescent from an attack of puerperal mania,
was twice removed prematurely by her husband, and twice brought
back by him, having relapsed almost immediately on returning home
to the associations connected with the first invasion of her malady.
On both occasions she threatened to kill her husband. The great
importance, in a vast number of cases, of change of scene, to avoid
such associations when a recovered patient is removed, cannot be.
over-estimated. In connection with the risks of early removals in
cases of recovery or convalescence, I think it right here to record
my conviction, contrary to a common prejudice, that prolonged
detention of a convalescent patient in an asylum may tend to bring
back the disease, I have never seen any ’case to justify such an
opinion. On the contrary, I think the exercise of self-control, self-
denial, and patience, by a prudent delay, are generally most bene¬
ficial, and tend greatly to confirm the cure. I have had many
occasions to regret, most deeply, the too early removal of convalescent
patients. I do not remember one instance in which I had any
reason to regret the prolonged residence of a convalescent case. On
the contrary, I have in several instances been afterwards thanked by
the patients themselves for having recommended their detention;
and in several other cases I have been told by the patients after-
wards that they were sent away too soon, and that they continued
to labour under their morbid impulses and delusions for some time
after they had left my care, and had succeeded in concealing them
from every one but themselves.”
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Report of the Crichton Royal Institution for Lunatics.
Dr. Gilchrist, referring to some cases in which recovery took place
in contradiction to the probabilities of prognosis, and in which he
attributes the happy result to the skill and assiduity of his medical
assistant, in adapting the moral treatment to the minds of the par¬
ticular case, observes:
"These and other examples tend to confirm our strong faith in
what may be denominated the individualization of moral treatment,
that is, its special adaptation to individual cases, its application being
aided by the exercise of authority and influence. It has been, and
continues to be our firm belief, that this principle lies at the bottom
of all improvement and success in the moral treatment of insanity.
It is a principle, however, entirely ignored in the increased and in¬
creasing tendency to amplify our already overgrown establishments,
where the power of wielding that authority, and exercising that
influence, is reduced to a minimum.” x
Eighteen patients were admitted into the institution in whom the
cause of the insanity was referred to the revival excitements, but of
these only one case was admitted into the private asylum and seven¬
teen into the pauper department; a fact indicating how greatly the
revival movement preponderates in the lower classes of society. Of
these eighteen cases seven were maniacal, ten were melancholic, and
one had acute dementia. In nine of them suicidal impulse was
present. A large proportion of them refused food, and in three
artificial alimentation had to be resorted to for a long time. The
tendency to excitement of the sexual feelings was very marked in a
large proportion of the cases. It was remarkable that only two of
the cases were received from the town of Dumfries, the very focus of
the revival excitement, a fact which Dr. Gilchrist thinks "mainly
due to the care and prudence exercised by the leaders of the move¬
ment.” After all we have heard, it is reassuring to find that care
and prudence can be exercised by leaders of the revival movement.
The results of treatment of these eighteen revival cases were as
follows:—seven were cured, three were removed by friends (of whom
two were improved), of the remainder one is convalescent, one has
passed into chronic dementia, one into persisting mania, and five
continue in a state of melancholia, but in three of these five the
result is still uncertain.
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Report of County Asylums for Monmouth, Her ford, Brecon, Radnor.
Dr. McCullough notices a fact which we also have had occasion
to observe, that the supposed immunity of women from general
paralysis appears to be contradicted by recent experience :
“ The mortality during the past year, though only about an ave¬
rage, was nearly two per cent, greater than in the previous year.
The increase was amongst the females, and the cause was chiefly
general paralysis; the very unusual number of seven having died
from that disease, which is comparatively infrequent in women.”
Are the habits of women approximating more nearly to those of
men, so as to render them more equally liable to this fatal disease ?
Report of the Lincolnshire County Lunatic Asylum.
We are sorry to observe that this model institution is suffering
from the chronic disease of asylums, that is, from the inward ple¬
thora which oppresses the respiration and stagnates the circulation.
The wards are overcrowded, and parts of the asylum are used for
dormitories, for which they were not intended and are ill adapted.
The Commissioners have recommended that a new chapel should be
erected, the present chapel used as a dining-hall, and four rooms
now used as dining rooms be converted into dormitories: a very
good plan for killing three birds with one stone.
Report of the Devon County Lunatic Asylum.
In this the Superintendent comments upon the deaths which
occur in asylums from phthisis, as a kind of health-gauge^or hyg-
ienometer of the institution. He says :
“ The number of patients who die of phthisis is always a source
of peculiar anxiety, inasmuch as the development of this disease may
be regarded as a test of the sanitary conditions of the institution.
Some of the patients who are carried off by it are indeed admitted
with the disease already developed, and sometimes far advanced;
others are admitted with the seeds of the disease in the constitu¬
tion, which the progress of time would under any circumstances
bring to maturity. But, in a certain number of cases, patients long
resident in an asylum pass from a state of good bodily health into
one of tubercular degeneration, from influences which they expe¬
rience, but from which they ought to' be guarded during the time
that they are emphatically placed under medical care and treatment;
of these influences, the bad air of overcrowded dormitories is un¬
questionably the most potent, and although it is one from which the
poor do not escape in their own close and narrow sleeping rooms, it
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is yet an anti-hygienic condition to which the patients in an hospital
ought never to be exposed. An overcrowdea condition of an asy¬
lum, which is an hospital for the insane, is the worst possible con¬
dition in which it can be placed both for the physical and moral
welfare of its inmates. But in addition to this cause of consump¬
tion acting directly upon the body, there is one which may act upon
it through the mind, namely, the influence of a monotonous and
cheerless existence, which a long continued residence within the
walls of an asylum is apt to become to patients of a certain mental
constitution; not only, therefore, are efforts made to relieve the
monotony of a forced detention for the saks of those patients whose
malady admits the reception of curative influences, but also for the
sake of the hopelessly insane, ought proper efforts to be made to
stimulate the flagging interest, and to give colour to a dreary life.”
(To be continued m our next.)
Boll of the Royal College of Physicians of London.
By William Munk, M.D. Longmans.
These two handsome and ably written volumes are, as the learned
author says, an attempt to supply a complete series of the fellows,
licentiates, and extra-licentiates of the college from its foundation, in
the tenth year of Henry the Eighth, to the passing of the Medical
Act, in the twenty-second year of the reign of Victoria. Of course
the series contains the names of many worthy and useful men in
their day, the mute and inglorious record of whose existence now is
only marked by a date; but of more eminent men Dr. Munk gives a
brief biographical sketch, in which the leading incidents of life and
traits of character are drawn with scholarly skill, and gentlemanly
feeling, qualifications which were, indeed, essential to an author who
should be able to draw up a record of our professional predecessors,
in which their frequent and not very dignified quarrels could be pre¬
sented in a manner devoid of all offence to the present standard of
good taste.
The study and treatment of mental disease as a distinct branch of
medicine is of so recent a date, that we cannot expect Dr. Munk's
roll to contain the names of men who would be specially interesting
to us as psychologists. There were, however, some physicians of the
college upon whom the medical care of institutions for the insane
devolved; such was Dr. Thomas Allen, admitted a Fellow of the
College of Physicians in 1671. “Dr. Allen (says the author) was
physician to Bethlem Hospital, and to his credit let it be recorded,
that he refused to accede to a proposition, which had met with general
approbation at the Royal Society, to make the first experiment of the
transfusion of blood in this country, “ upon some mad person in
Bedlam.”
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Dr. Edward Tyson made a fellow of the college in 1683, was also
a physician of Bethlem, and a very able and estimable man. In
Garth's dispensary, however, where he figures under the pseudonom
of Cams, the unscrupulous satirist lashes at his lunatic practice in
the following manner:
“ In his chill veins the sluggish puddle flows,
And loads with lazy fogs his sable brows;
Legions of lunatics about him press,
His province is lost Reason to redress.
So, when perfumes their fragrant scent give o'er,
Nought can their odour like a jakes restore."
In later days we find the eccentric and learned Dr. Battie,
fellow of the college in 1738; he was physician to St. Luke's
Hospital, and proprietor of a large private asylum, and his prac¬
tice, says Dr. Munk, seems to have been limited almost exclusively
to insanity. In his treatise on madness, he censured the prac¬
tice formerly pursued at Bethlem, and was answered and severely
animadverted upon by Dr. John Monro, the son of Dr. James Monro,
who was the first of the Monro's who flourished at Bethlem, and
who accompanied his father to England nearly two hundred years
ago. Dr. Munk gives a quotation from Dr. John Monro's pam¬
phlet in vindication of his father against Dr. Battie, to the effect,
that insanity is a disease the treatment of which can only be empi¬
rical, and cannot be made the subject of lectures; an opinion which
may perhaps confirm the college in its practice of requiring no study
or knowledge of insanity from candidates for its license; although
it is somewhat in opposition to the fact that the College of Phy¬
sicians has itself of late years listened to more than one series of
excellent lectures on this subject. “ He was a man (says Dr. John
Monro, speaking of his father) of admirable discernment, and treated
this disease (insanity) with an address that will not soon be equalled.
He knew very well that the management requisite for it was never to
be learned but by observation; he was honest and sincere; and though
no man was more communicative upon points of real use, he never
thought of reading lectures upon a subject that can be understood no
otherwise than by personal observation."
Our space forbids further reference to the pages of these interesting
volumes, for which not only the College of Physicians, but the medical
profession, are under obligation to Dr. Munk, as a valuable biogra¬
phical record of the members of its most eminent corporation.
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Ties Hallucinations, ou Histoire Raisonnee des Apparitions, des
Visions, des Songes, de I’Extase, des Reves, du Magnetism, et du
Somnambulism. Par A. Brierre de Boismont, M.D., &c., &c., &c.
Troisieme edition. Paris, 1861.
This new edition of the work of our illustrious and learned col¬
league is so greatly enlarged and improved, that it may almost be
considered a new publication. It is a work which ought to be care¬
fully studied by every alienist physician, for those chapters which
relate more particularly to the hallucinations of the insane and which
form the most scientific parts of the work, are invaluable; and although
they may lack some of the interest which attaches itself to other parts
of the volume in which the historical hallucinations of priests and pro¬
phets, or the romantic hallucinations of lovers and poets are recited
with the elegant simplicity of style which is so fascinating in the
writings of this author, still, as he is at least as experienced as he is
learned, and as the knowledge of hallucinations derived from his
experience of mental disease comes to us fresh and first-hand, and is
of positive and unquestioned value to those whose duty it is to observe
and to treat mental disease, we feel that we are justified in placing
a far higher estimate upon the scientific than we do upon what may
be called the historical part of the work.
With regard, indeed, to the historical part of this work, it is difficult
for us to see the facts recorded from quite the same point of view as
that which M. Brierre de Boismont sometimes takes, because he appears
to believe in supernatural phenomena and we do not. This belief in
the supernatural, which is visible in the author's pages, is neither
concealed nor assumed; it is an honest and avowed belief, similar
to that which is entertained by many great men; it is, however, one
in which we cannot for a moment concur. In an early page of his
work the author says of supernaturalism that it is a great belief in
which he emphatically avows his sympathy; but to us superna¬
turalism is an absurdity; if it exists, it exists not for us, as colour
exists not for the blind, nor sound for the deaf. We believe in only
one supernatural existence, namely, in the personal and individual
Power which made nature. We believe in the book of nature, and
in its one Author; in the world, and in God. But as for the super¬
natural, the spirit-world of sights and sounds, the whole tribe of
apparitions, the whole chime of ghostly voices, we believe that they
can, one and all of them, be explained upon the principles of physical
or of metaphysical law. A large number of them are pure and
simple fictions; others, intended only at first as an expression of
imaginative thought, have been mistaken for realities; others again
have been neither more nor less than the expressions of partial
insanity.
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In the mist of forgetfulness and error which disguises from our
eyes any clear and distinct appreciation of the realities of the past, it
has been hut too easy to attribute the conduct of great men which
we cannot explain, either to supernatural agencies or to mental
disease, which if we were able to see it clear and close at hand we
should be able to recognise as merely some imaginative peculiarity
of action or expression. The demon of Socrates, the nymph of
Numa, may have been nothing more than poetical expressions for
modes of thought. We may illustrate what we mean by expres¬
sions which we once heard fall from the lips of the most popular
religious orator of the day. We were listening to a sermon which
Mr. Spurgeon, who was preaching from the text “ Wist ye not that I
must be about my father’s business ?” After having with much force
of language interrogated the different classes of his audience as to
whether they were habitually engaged in their Father's business, he
suddenly turned the interrogatory upon himself, and we heard him
express himself in words to the following effect, which impressed
themselves deeply upon our attention and memory :—“ And I, when
I have been sitting in my study arm-chair of an evening, in my
thoughts elaborating a sermon, and may be elaborating the spirit out
of it, often from the dark side of the room I have seen a hand in
threatening attitude extended towards me, and often from the
obscurity I have heard a voice saying unto me —“ Art thou about thy
Father’s business ?” Now we understood no more from this, and we
do not believe Mr. Spurgeon meant us to understand more from it, than
a rhetorical expression of the conscious feeling that he was not em¬
ploying his time to the best advantage. But how easy it would be,
in fact how inevitable it would be, that such a figure of speech should
be interpreted into the emphatic and public confession that he,
Mr. Spurgeon, was the subject of hallucinations; and how many hallu¬
cinations of men who are in the habit of expressing themselves with
rhetorical vehemence, the stock hallucinations of history, may have
been at the time nothing more than figures of speech, like this of
Mr. Spurgeon’s ? When the devil appeared to Luther, for instance,
and he threw his ink-bottle at him, may it not have been a figurative
expression of the manner in which he rebuked the spirit of evil by the
ink which so copiously flowed from his eloquent pen ? But in addition
to that class of historic hallucinations which are but the lies of false
priests, the hallucinations of the Eleucinian mysteries for example, and
in addition, to the historic hallucinations which are but mistaken con¬
ceptions of figures of speech, there have been no doubt a large number
of partial madmen who have impressed their real hallucinations upon
the history of the world. We cannot agree with M. Brierre de Bois-
mont in the opinion that the hallucinations of the insane are easily to
be distinguished from those which have been experienced by the foun¬
ders of religious systems and creeds, when he says, p. 97, “ As for
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the analogy which some allege to exist between hallucinated persons
and the founders of religious creeds, the distinction is always to
be made ; in the hallucinated man that force of will, that logic
of reason, that fixed purpose are not to be found which belong to
men who have a providential mission, The hallucinated man is
inflamed by certain religious ideas to which he subjects himself, he
can neither lead, nor promote, nor develop them, but allows himself
to be led in tow by them, or rather to be be absorbed by them. The
man of genius masters the idea, directs it; and makes it fructify,
while the insane man has no power over it; it follows him as Ins
shadow and he obeys all its caprices; the one is a king, the other a
slave.” He adds, “ Among the large number of hallucinated persons
whom we have observed for more than twenty years, we have always
found that alongside of the consequential reasoning which appears
the result of the idea, some incoherent word or some extraordinary
act, that is to say, the grain of insanity occurs.” We cannot think
that this line is always to be drawn with such facility as our
author appears to think. Suppose we grant, for the sake of argument,
that Mahomet was a man of genius who made his ideas, which
appeared like hallucination, bear the fruit of success, and that he was
no more hallucinated than Napoleon was when he talked of the
star of Austerlitz. What shall we say of Joe Smith, who has also
been the successful founder of a religious system ? Was he also a man
of sound mind and of commanding genius ? What shall we say of
Edward Irving, the priest and prophet of an enthusiastic sect ?
What, above all, shall we say of Johanna Southcote, the lunatic old
woman, the nature of whose writings the Master of the Eolls has
within these few weeks been called upon to study and to judge? The
great lawyer did not allow the blasphemous nature of Johanna’s
hallucinations to prevent him from deciding that her character was
eminently pious, and her writings obviously intended to promote
religious feeling, and on this ground he refused to disannul the
validity of a will, by which property was bequeathed for the purpose
of extending the circulation of her prophecies.
In our author’s strictly scientific chapters ; that is to say, in those
in which he treats of hallucination as a symptom of, and a part of
insanity, he adopts the excellent method of summing up at the end
of the chapter the conclusions at which he has arrived; thus, in the
fourth chapter on hallucinations of insanity in the state of simplicity,
he sums up the conclusions arrived at as follows :
“ In hallucinations insane of themselves, the actions are almost
always consequent upon morbid sensations, so profound is the con¬
viction of the lunatic in their reality; hallucinations of hearing are
the most common, and may be estimated at two thirds of the
others; enfeeblement or deprivation of the sense of hearing is no
obstacle to their production, this characteristic distinguishing them
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from illusions; most commonly hallucinations of hearing seem to
come from without, but sometimes they have their seat in the
interior of the body; they may be combined with hallucinations of
sight, and less frequently with those of the other senses; to hal¬
lucinations of sight, less numerous than the above, and those which
most attract the attention to them, must be referred the curious fact
of visions; the beholders of visions have always played an important
part in history, these hallucinations being nothing more than the
coloured reflections of habitual thought may be infinitely varied, and
may take as many forms as there are individuals; their production
does not depend upon the integrity of the sense of sight, since blind
men have been affected by them. Hallucinated men believe that they
can see into the interior of their body, a tendency which is observed
also in animal-magnetised persons and in somnambulists. Hal¬
lucinations of sight are often associated with those of hearing, and
their concurrence may result in very remarkable facts. Halluci¬
nations of touch are less easy to recognise than the above, because
they are often confounded with nervous pains and visceral illusions,
well observed facts proving this beyond doubt. Hallucinations of
smell and of taste come after those above mentioned, in order of
frequency; those of smell may be observed at the commencement of
all kinds of insanity, these hallucinations are scarcely ever isolated,
they are combined with the others, and above all with illusions.
Hallucinations without complication are rare, almost always they are
united to one of the forms of insanity.”
On the subject of general hallucinations, in which most frequently,
our author says, it is needful to comprise the union of*hallucinations
and illusions of all the senses, he arrives at the metaphysical con¬
clusion that, general hallucinations will afford a powerful argument
in favour of Berkleyism, if a pathological condition may serve to
establish a psychological principle. On this point we would beg to
observe that the proof of Berkleyism would be of no value unless
the hallucinations were not only general as regards the senses, but
as regards the objects of sense, that they had in fact supplanted all
real perceptions of the real world; a pathological state the existence
of which we have never heard of or read of. We do not understand
how a single hallucination affecting all the senses, how, for instance,
the hallucination of a fire which the patient hears and sees, and smells
and feels, can have any validity in proving that there is no world but
the world of ideas, while in addition to the unreal object of his
hallucination the patient perceives through all his senses the reality
of the material universe.
The frequency of hallucinations and illusions in the different forms
of insanity has been studied by our author in 1146 cases, in 725
of which he found that they existed according to the relative fre¬
quency exhibited in the following table :
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Form of Insanity.
Acute delirium ....
Mania.
Monomania of fear (Lypemania) ..
Hypochondriacal monomania .
Simple melancholia .
Stupor.
Monomania of sadness with stupor .
Monomania.
Dementia .
Genera] paralysis .
Weakness of mind, imbecility, idiocy ....
Alcoholic insanity .
Hysterical insanity.
Epileptic insanity .
Puerperal insanity .
Alternating insanity (folie a double form)
Moral insanty.
Insanity ......
1146 725
We regret that the limited space at our command forbids our
analysing the able chapters of the work in which the psychological
and the physiological aspects of the subject are exhausted. These,
and the chapter on the etiology, and that on the medico-legal
relations of hallucination, are written with the fulness of informa¬
tion and breadth of view which characterise the experienced and
philosophical author. The work is in every way an admirable
production.
The Statistics of Insanity.
The Commissioners in Lunacy frequently give to their very able
reports some distinguishing feature, and in their last report this
feature was statistical. The appendix contains a continuation of the
statistical tables given in the eighth report, and comprises the sta¬
tistics of England and Wales for five years, ending with 1858. The
tables show a vast increase of pauper patients in asylums, namely,
7222 in the ten years ending January 1st, 1861, and this is accom¬
panied by the remarkable fact that there has not been any increase
in the number of registered private patients during the same period.
There has, indeed, been an increase of private patients in the hospitals
for the insane to the extent of about 207 in the ten years, but this
increase has been counterbalanced by a corresponding decrease in the
private patients of licensed houses, so that the result is the stationary
position of the number of private patients throughout the country.
The first important deduction from their tables upon which the Com¬
missioners remark, is one which adds a new and valuable illustration of
the well-known importance of early treatment in insanity. In direct
Number in whch
Number of Gases Hallucinations
observed.
and Illusions
were present.
... 32 ...
. 25
... 229 . .
. 178
... 303 ...
. 248
... 63 ...
. 43
1
. 0
... 6 ...
. 2
... 7 ...
. 3
... 34 ...
. 29
.... 82 ...
. 41
.... 147 ...
. 37
... 53 ...
.. 17
.... 73 ...
. 49
.... 14 ...
. 9
.... 28 ...
.. 9
.... 23 ...
. 18
.... 27 ...
. 14
5
. 1
.... 19 ...
. 12
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proportion as patients are submitted to early treatment, they are sus¬
ceptible of cure; and in direct proportion as they are withheld from
early treatment, they are liable to become incurable and irreclaimable
burdens upon the resources of the community. Of 1000 patients
admitted into asylums the duration of whose disease did not exceed
one month, at the end of three years 509 in 1000 had been discharged
recovered, 155 had been discharged relieved or not improved, 178
had died, and 158 were remaining in the asylums. Contrast with these
figures the results of treatment of 1000 patients admitted into asylums
after they had been insane six years and upwards, of these only 50
recovered, 173 died, and 633 were remaining in the asylums, the
other 124 we presume were discharged, not recovered. The com¬
missioners found this result of experience upon what may be called
a statistical law. “ The recoveries decrease with the increase of the
duration of the attack at the time of coming under treatment,” and
the operation of this law, coupled with the fact stated by the Commis¬
sioners that comparatively few recent cases are admitted into asylums,
has resulted in the ever-increasing accumulation of chronic and incura¬
ble cases.
Looking at this question of the curability or incurability of patients
solely as an affair of the pocket, the statement cannot be too often
repeated to the guardians of the poor, who are practically the persons
in authority over the insane poor, that if they send cases to the
asylum on the first outbreak of the malady, at the end of three years
only 158 per 1000 will remain as a charge upon the poor’s rate,
whereas if they defer to send patients to the asylum until six years
have intervened after the outbreak of the malady before the resort to
asylum care and treatment is made, 633 per 1000 will remain a
weighty and burdensome argument against the impolicy of delay.
The Commisssioners, we think very properly, lay but little stress
upon the fact that there has been no augmentation of private patients
in asylums. The number of private patients in asylums bears so inde¬
finite and unknown a proportion to the number of insane persons in
the rank of life from which private patients are drawn, that it would
be rash to found any argument relating to the increase or decrease of
insanity upon such imperfect and fallacious data. Our own personal
observations and enquiries have led us to the conviction that not a
moiety of the insane of the upper or middle classess of society are
registered in the books of the commissioners, either as private patients
in asylums, or as single patients kept for profit ; and it is a subject
of grave importance in these enquiries to ascertain the extent to which,
in a still lower rank of the community, the custom of detaining the
insane at their own homes, tends to vitiate our statistics of the insane
in questions relating to the increase or decrease of the malady. How
is it that so few recent cases are admitted into our public asylums,
that, as the Commissioners point out, the increased duration of life of in-
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curable cases due to good treatment in detaining patients from the grave,
so completely outweighs the influence of improved methods of treat¬
ment in effecting the discharge of patients by cure, as continually to
silt up our largest institutions ? Something of this must no douot be
attributed to the short-sighted parsimony of the guardians of the poor,
who have been but too willing to defer as long as possible the evil
day when an insane pauper will cost the parish eight or nine shillings a
week in hard money; something also must be set down in many coun¬
ties to the difficulties of procuring asylum care and treatment where
the asylum accommodation is inadequate to the demand made upon it;
but a still larger share of this lamentable result must, we are sure,
be attributed to a great fact hitherto overlooked in the statistics of the
pauper insane, namely, that the admission of a pauper into an asylum
is in a very large class of instances not the direct result of his
insanity, but the result of his poverty. He has been maintained out
of the asylum, and beyond the reach of the Commissioners' registration,
either upon his own means or upon those of his friends, until under
the impoverishing influence of his malady these means have become
exhausted, when he is admitted into the county asylum, and for the
first time comes under official cognizance an old-established and in¬
curable case of lunacy. This is, without doubt, the most potent
cause of the lamentable fact that comparatively few recent cases are
admitted into our county asylums; and it is the consideration of cir¬
cumstances constantlybringing this cause under our notice, which makes
us hesitate to give full credence to the public statistics of the insane
in this country, as sufficient data whereon to found any reliable con¬
clusions respecting the proportion of the insane to the population.
In view of the general bearing of their statistics the Commissioners
arrive at two wide conclusions of a satisfactory and comforting nature.
The first is, that they believe them to afford “ abundant reason for
discrediting the statements which foreign authors have founded on
our returns, to the effect that the inhabitants of this country are more
liable to insanity than those of any other civilized state." The second
is, “ that we have not found any reasons supporting the opinion gene¬
rally entertained, that the community are more subject than formerly
to attacks of insanity." With regard to the first of these conclusions,
the Commissioners evidently go on strong grounds, inasmuch as they
demonstrate that a very large proportion of registered lunatics is due
to the operation of the law intrusted to their administration, whereby
the existence of lunacy, at least in the pauper class of the community,
is accurately registered.
In countries where there is no constituted authority, or a very
limited one, over the insane members of the community, they
cannot even be counted, much less protected; and it is clear that
no comparison can be drawn between the proportion of lunatics to
the population in countries placed in altogether different circum-
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stances for facility of registration. But it must be remembered that
there are some civilized countries in which the registration of lunatics
is as perfect as it is in our own. This is certainly the case in Holland
and we are inclined to think that it is also so in France. The statistics
of the insane of the latter country published once in nine years, are a
perfect model of careful and scientific arrangement. In these sta¬
tistics it is to be remarked that the number of the large class
of unregistered lunatics who escape the computation of our Com¬
missioners is by some means or other obtained, and forms a most
important element in the result. In the enumeration of the insane
in France in 1851, there were altogether 44’970, or one in 796 of
the population of the country ; of these 20’537, or 45’68 per cent, of
the whole number were in asylums for the insane or general hospi¬
tals, waiting for their transference to an asylum, and 24433 lunatics,
or 54’23 per cent, were living at home (a domicile') a number which
the reporters think would be still further increased but for the lamen¬
table prejudice so injurious to the insane, which leads families to
conceal the existence of their insane members.
The reporters remark on this fact that there are a greater number
of insane living at home than in asylums, “ although it is probable
that the larger proportion of the insane living at home belong to the
class of harmless lunatics, yet in relation to public health and safety
a considerable amount of clanger exists in such a state of things.”
The reporters give tables showing the number of the insane who
are living at home in twenty of the departments, and the proportion
which tins number bears to the population. At the head of this
table i$ the department of Vosges, containing 516 lunatics living at
home, or 121 in 100,000 of the population. At the foot of the
table is the department of the Seine, containing 169 lunatics living
at home, or 12 in 100,000 of the population. As might have been
expected, the six departments which contain the largest number of
the insane living at home are devoid of asylum accommodation;
while out of the ten departments containing the smallest amount of
insane living at home, eight have the advantage of possessing an
asylum. This result, that the departments without asylum accom¬
modation (oh il n’existe aucun etablissement consacre au traitement
de Talienation mentale) are those in which there are the greatest
number of insane living at home, is more completely proved by the
following table, which shows at a glance the position of the insane in
this respect in all the departments of France :
Population in Lunatics living
18ol. at home. Population.
In the 25 departments without asy¬
lums . 8,908,923 7,225 73’24
In the 61 departments which have
asylums . 26,874,226 17,208 64-03
Total . 35,783,170 24,433 68-28
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. The reporters inquire whether the figures of this table “ do not
prove that the real cause of the continued increase of persons
admitted into asylums is to be found less in the progress of the
disease, than in the creation of the asylums themselves, which, in
receiving each year an increasing number of patients, have the effect
of gradually diminishing the relative number of the insane who were
before time taken care of in their families."
The Commisioners in Lunacy for Scotland, in their third report,
also take cognizance of the insane living at home, or as they put it,
living in private houses. Thus it appears that there are in Scotland
8084 lunatics, of whom 2632 are in public asylums 852 are in
private asylums, 866 are in poor-houses, and 3734 are in private
houses. Of this number of patients who are in private houses 1877
are private patients, and 1847 are pauper patients. In Scotland
as in England the number of private patients has diminished
while the number of pauper patients has increased and the
Scotch commissioners point to a very obvious cause for this.
“ This result is probably in great measure due to the transfer of a
number of the indigent insane from the class of private patients to
that of paupers." We do not observe any reference in the English
report to this explanation of the fact that the establishment of a
system of public asylums is accompanied by this transference of
patients to the pauper class j yet every county asylum in England
contains no inconsiderable number of patients who in the olden times
would have been found as private patients in the large low-class
asylums which were formerly the substitutes for public institutions;
and many of these patients, even at the present time, although nomi¬
nally paupers, are in reality private patients, inasmuch as the cost
of their maintenance, sometimes the whole of it, though more often
in part only is defrayed by their friends through the intervention of
private arrangements made with parochial officers.
The Commissioners' report gives the number of pauper patients
in private houses as 5980, of whom 785 were in lodgings or
boarded put, and 5195 were living with relations. The corre¬
sponding number of private patients, however, who are on the books
of the Commissioners as living in private houses, being those only
who are returned as single patients kept for profit, is 118. The dis¬
crepancy of this number for the whole of England and Wales when
compared with the number of private patients known to live in private
houses in Scotland, namely, 1887, shews how essential it will be to
institute an enquiry on a larger base, as a test of the prevalence of
insanity in the population. We should expect to find a much smaller
proportion of the insane of the middle classes living at their own
homes in Scotland than in England, because the former country has
in its excellent middle-class asylums long been in the possession of
asylum accommodation for the insane of small means, of which this
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country is loudly proclaimed to be greatly in need. But notwith¬
standing the existence of the middle-class asylums of Scotland we
still find 1887 private patients who are known to reside out of
asylums. Now if we take the population of England and Wales as
about seven times greater than that of Scotland, there ought to be
13,209 insane persons not paupers living out of asylums in this
country, instead of the 118 recorded as doing so in the books of
the Commissioners in Lunacy ; an enormous mass of unrecorded
insanity which must vitiate any general statistical conclusions founded
on the numbers of the insane who are registered and counted as the
inmates of asylums. These unrecorded cases will explain the much
greater proportion of insanity in Scotland to that which is known to
exist in this country, since the 8084 lunatics in Scotland would, on
the above estimate of the relative populations of the two countries,
correspond to 56,588 in England and Wales. It is indeed a subject
of regret that effort was not made through the instrumentality of
the census to gain some knowledge of the amount of insanity in the
country. In referring, however to the elaborately accurate report of
the Massachusets commision, we find that even a house to house
visitation of census officers, may be ineffectual to obtain this
knowledge. The Massachusets commision obtained, by means
of the medical profession, the accurate information that in 1852
there were in the State 3719 idiots and lunatics. Six years
before this enumeration was taken, a State commission had
been issued for the same purpose, which commission made its
enquiries through the muncipal authorities. This inquiry resulted
in the enumeration of only 1512 insane persons, of whom 1156 were
paupers, and only 291 able to furnish the means for their own
support. This enumeration was tolerably correct respecting the
number and condition of the pauper insane of whom the municipal
authorities could have direct information, but it was evidently most
incomplete in the enumeration of the insane who were living at home
and supported on their own property or by their friends. Again,
only two years before Dr. Jervis's commission the officers of the
national census were by law directed to ascertain the number of the
insane by house to house visitation, and they discovered only 2471
insane and idiots. “ It is probable" says Dr. Jervis “ that many of
the families refused or neglected to report to these officers the insane
that were within their households." The large proportion of inde¬
pendent lunatics enumerated by Dr. Jervis's own commission shows
to what an extent such a refusal would vitiate the correctness of
these statistical returns, for of 1110 lunatics having property no
fewer than 716 were found to be residing at home.
The success of the commission worked by Dr. Jervis, in obtaining
a full and accurate account of all the insane persons in the State,
was gained, as we have said, mainly through the instrumentality of
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the medical practitioners. Country clergymen, overseers of the poor,
superintendents of asylums, &c., gave their quota of information, but
the mass of it was obtained by the medical men who worked
willingly and systematically, comparing notes with each other so as
neither to omit nor to repeat the enumeration of any case ; and so
unanimous were they in the work, that of 1319 physicians in the
State all except four made reports to the commissioners.
The second conclusion which the Commissioners have drawn from
their statistics is that reasons are wanting for the support of the opinion
that insanity is on the increase; and this conclusion appears mainly
to be founded on the satisfactory reasons they have been enabled to
afford for the great increase of pauper lunatics, namely:
“ 1st. The large number of cases previously unreported and only
recently brought under observation.
“ 2nd. The increased number of lunatics sent to asylums.
“ 3rd. The prolongation of their life when thus brought under care.”
The manner in which the operation of the county asylum system •
brings to light the existence of the insane among the poor, is singu-
arly illustrated by a comparison of the proportion of the insane
paupers to the amount of the pauper population in those districts, which
do, and those which do not, possess asylums. " Thus in two contiguous
districts in South Wales, nearly equal in population, the one (with¬
out an asylum) which has a large excess of paupers receiving relief,
has at the same time a considerably smaller number of paupers under
care.” The boroughs of Maidstone and Canterbury afford a similar
instance; Maidstone, which has asylum accommodation, has nearly
double the number of insane paupers to Canterbury, which has no
asylum accommodation. This result is partly no doubt owing to
the rapidity with which neglected pauper lunatics disembarrass the
poor's rate by dying off, but by far the greater part of the difference
is owing to the lunatic poor of the unprovided districts not being
counted as lunatics. There are no doubt just as many persons who
become insane in these districts as in the others, but about half of
them are not recognised as insane, or they do not receive relief as
such. The special relief wanted, that of the asylum, cannot be
obtained, and therefore no relief is demanded.
It would be a strong argument in favour of the opinion that
insanity is not increasing with what is called civilization, if it could
be established that the number of the insane in the upper classes of
the community has not increased. As we have said, the returns of
the Commissioners show that their number in asylums has not
increased, but this certainly does not conclusively tend to prove that
the increase in the number of the pauper patients cannot be attri¬
buted to social or other causes which would operate with even
greater force upon the upper classes; since the number of the
upper classes who are in asylums is no test of the number
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of these classes who are insane. But must we then believe
that the great increase of the pauper insane is fully explained by
their more complete registration, and by their increased duration
of life? Pauperism has decreased during the last ten years, by 20
per cent., and moreover, as the Commissioners remark, “ We are
unable to discover any material changes in the social condition of the
labouring population rendering them more prone to mental disease/*
On the contrary, we may say that the changes in the condition of the
labouring population tends quite the other way; the people are better
fed, better clothed, and better housed; there is less drunkenness,
there is less moral excitement; no epidemic incendiarism, no wide¬
spread discontent, no reform-bill agitation, no corn-law agitation;
political faniticism defunct; religious fanaticism in a rapid decline;
and yet, in ten years, here is an increase of pauper lunatics from
fourteen to twenty-two thousand. We must acknowledge that we have
much difficulty in repressing the belief that insanity in the community
• at large is on the increase. The sthenic diseases which struck down
our hardy fathers have disappeared; the lancet rusts in its case,
and the free-handed use of opium and brandy has replaced the
tartar-emetic and the calomel of our youth. Such an atonic consti¬
tution of disease, accompanied by an increased liability to nervous
excitement and depression, would be an amply sufficient cause of
the increased prevalence of insanity. What is the cause of the
cause, or what is the mode of influence of the habits of civilisation
in the production of this atonic and nervous constitution of disease,
is a subject worthy of most diligent inquiry. We cannot believe
that this is an age in which “ wealth accumulates and men decay/*
but we do firmly believe that men are not constitutionally what
they were before the time of the cholera and influenza epidemics, when
Christendom was not only muscular, but vascular.
The Fourth Annual Report of the Commissioners for Scotland
contains a statement, supported by a statistical table, which opens up
a new view of the occurrence and existence of insanity :—“ But
it would appear, from the following table, that the occurrence of
lunacy is considerably more frequent in urban than in rural districts.
We here use the term occurrence in contradistinction to that of
existence. Tor it by no means follows that the number of lunatics
should be greatest where most cases of lunacy occur. It may happen,
for instance, that in a district in which comparatively few cases occur,
a greater number of lunatics will remain at the end of a fixed period
than in another district in which lunacy is of much more frequent
occurrence; and the explanation of this fact will probably be found
in the greater proportion of recoveries and deaths which takes place
among the patients of the latter district. With the view of elucidating
this point, we have contrasted the number of pauper lunatics inti¬
mated from town and rural districts, and we find that in the
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former the occurrence of pauper lunacy, as compared witli its
occurrence in the latter, is as 100 to 54, whereas the proportion
of existing pauper lunatics at 1st January, 1861, in the corresponding
districts, was as 100 to 106. We have regarded as urban those
parishes containing towns, or parts of towns, having more than
20,000 inhabitants, and as rural all other parishes.” (p. xxxiii.)
The Commissioners think that some portion of the remarkable fact,
that the occurrence of insanity in the town population of Scotland is
nearly as two to one to its occurrence in the rural districts, is to be
explained by the officers of town parishes admitting the insane into
the lunatic wards of workhouses, discharging them therefrom, and
admitting the same cases again, with a facility which does not occur
in asylums supplied by rural districts. After deducting somewhat,
however, for this influence on the accuracy of the town returns, a
a large part of the difference must still remain. That with so great a
difference as to the occurrence of insanity, the existing amount of
insanity between the two kinds of population should be so nearly
equalised, is a remarkable and suggestive fact, suggesting, as the
Commissioners indicate, that mental disease in the town is more fatal
or more curable than in the country. The impressions left upon us
by our own experience of these two classes of the insane would
entirely concur with this view; the inquiry, however, deserves to be
carefully and thoroughly pursued as to the prevalence of different
causes and different forms of insanity, and its different results in
town and country; and it is quite possible that such an inquiry
may throw light upon the apparent increase of insanity in the com¬
munity in connection with one of the most remarkable tendencies of
society in this country and in this our age, as indicated by census
returns; namely, that the increase of the population of the country at
large has taken place in the towns, and that the rural population is
stationary. The true value of statistics as a branch of science is to
give us the means of foreseeing events, so that we may resist the
tendencies to evil, and promote the good; and it is just possible that
in the course of time the skeleton forms of the statistics of insanity
which we now possess may be so filled up that we may be truly able
to estimate the force of the influences which tend to the production
of this dread scourge of our race. As an instance of the deeper
foundations of statistics, take the influence of the Earl of Shaftesbury,
who has signed the report which has served as a test for these
remarks. In the discharge of his duties as the Chairman of the
Commission in Lunacy, he has undoubtedly done more than any
one else to leave his mark upon the statistics of the insane, both by
promoting the influences tending to their cure and diminishing
those tending to their injury, and by establishing an accurate
record of all official facts bearing upon the movement of their
numbers; but a more profound statistic than we at present possess
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might, and very probably would, demonstrate that something else
which his lordship has done has had far more influence than all
the above upon the statistics of the insane. The Act of Parliament
in which the voice of humanity made itself heard as law, forbidding
that the youthful promise of our town populations should be ruined
in health in that greed of gain which would use up the springs
of life of factory children with as little remorse as fuel is supplied
to the untiring machine which animates the mill; this must have had a
profound effect in preventing the causation of insanity, to estimate
which we must be in the possession of quite another kind of statistics
to any which we now have. Our readers will not mistake us to mean
that any large number of factory children would be likely to become
insane from the simple effect of fatigue. But the secondary effect
of the exhaustion of the vital powers at a time when children are
growing into men and women, the secondary effect upon the causation
of insanity resulting from an enfeebled stock of men and women,
whose nervous system had been strained to the utmost in early youth
and subjected to unnatural stimulus that it might hear the strain,
must have been fearful. When we think of the physiological effects
of men and women so used up in youth becoming the parents of a
race, we get an idea of the manner in which an insane population
might be produced. All our knowledge tends to convince us that
the seeds of insanity are sterile unless they fall in fruitful ground,
and that the immediate causes are unimportant compared with those
wider influences which we call primary. Take a healthy boy and
girl, of healthy parents, and supposing such a devilish experiment
possible, you would find that you could scarcely succeed in inflicting
insanity upon them by any amount of vice, misery, or wretchedness.
But after the experiment, let these children breed, and you will
produce a crop of madmen and idiots. We must look for the most
potent causes of insanity a generation at least beforehand. v
. The Social Science Review.
Numbers 1 and 2.—We welcome this new paper, for which
there is undoubtedly a place in the thick crowd of periodical lite¬
rature, if only it is so conducted as to fill the want which is felt
for some organ to bind together the disjecta membra of what is
called social science. The contents of the two numbers which
have been issued are valuable and interesting, although we fear
that the method proposed of dealing with the subject-matter of
social science in articles which are never to exceed three columns
in length, and which are always to be complete in themselves,
that is, to admit of no continuation in future numbers, that such
a plan, however well adapted it may be to store the bricks and
mortar of information will leave no scope for the design of any
temple of science, no, not even for a portico. The promoters of the
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‘Social Science Review/ appear to have imitated the method of
the Social Science Association, which, in limiting the papers to be
read at their meetings to a delivery of twenty minutes, have
adopted the surest means of providing themselves with an inter¬
minable supply of- shallow talk on every possible variety of subject
which can be supposed to influence the welfare of the human indi¬
vidual. Now, society reduced to its most elementary condition can¬
not be less than the society of man and woman, or that of man, woman,
and offspring; and any question not involving the relations of human
beings towards each other in some state of society, which may be thus
narrow, maybe a question of science,butitcannot be a question of social
science. Social science, as it was understood by Auguste Compte, who
first investigated its laws and who gave it a name, was meant to be
the comprehensive survey of all other sciences as they affect society.
His scheme for the new science was grand and vast, though
it was vague and obscure; but we may well doubt whether since
he has left us, any progress has been made in the development of his
idea. His thought, which was a noble generalisation, which it
might take ages to work into the definite formulae of knowledge, has
been succeeded by the day of small things, in which three columns
of a newspaper, or twenty minutes of an address, are thought to
suffice for subjects embracing the most intricate problems which can
be propounded to man’s intellect. Social science, as we take it, is, iu
the first place, the investigation of the laws of nature as they relate
to man, in his relation to his fellow-men; in illustration we would
say, that the causation and treatment of disease is not a. question of
social science unless the disease is capable of being occasioned by
one human being’s influence upon another. In the second place we
would say, that social science exists only in the relation of other
sciences to each other; thus, we would say that neither the science
of jurisprudence nor that of medicine, nor any other penfold of know¬
ledge taken separately, deserves the name of social science; and going
further even than these artificial divisions in our knowledge of the laws
of nature, it would perhaps even be true to say that neither the phy¬
sical sciences nor the moral sciences can alone be considered to con¬
stitute social science. It is the mixed and interchanging action of all
law as it affects human society which can alone be considered the
science of society, and it is this broad generalisation of all science
as it affects society which appears to have been so strangely over¬
looked in the promoters of the so-called social science of our day.
We trust that the able men who have commenced the ‘ Social
Science Review ’ will keep themselves free from the service of the rag
and bone collectors of social science; or if they do take these rags
of science under their notice, that they will reduce them into pulp
and expand them into paper, and write upon them the great and noble
generalisations of true philosophy.
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The Scotch Lunacy Bill.
The Lord Advocate having withdrawn the objectionable clauses in
this bill, by which the present able and distinguished Commissioners
of Lunacy for Scotland would have been reduced to the position of
inspectors of asylums, under the control of a board of lawyer com¬
missioners, there is little now remaining in the bill to comment
upon, unless it is that the constitution of the board of commissioners
for only two years very needlessly imposes a limit of duration which
will tend greatly to weaken the power und authority of the board.
When the condition of the lunatic poor in Scotland first became
known to the public, it might be wise, in the surprise and novelty of
the situation, to pass an Act constituting a Scotch Board of Lunacy for
a limited time. This mode of legislating, however, has been attended
with evil effects of a grave nature, inasmuch as the persons upon
whom the duty fell of erecting pauper lunatic asylums in certain parts
of the country knew that if they could postpone the discharge of this
duty for a certain time it could not be imposed upon them until a
new Act of Parliament had been passed; and these persons unwilling
to raise the funds for the erection of asylums for pauper lunatics,
instead of discharging their own plain and simple duties, have in fact
thought fit to raise an agitation against a new lease of power being
granted to those who have authority over them in the matter. The
English Board of Lunacy is constituted with no limit in point of time,
and no such encouragement is offered to agitate against its authority,
which would, undoubtedly, be given if it were the creation of • a
biennial Act of Parliament.
In passing through committee of the House of Commons, Mr.
Blackburn unsuccessfully divided the house on the sixth clause, which
appears to have been expressly framed to check-mate the procras¬
tinating tendencies of the gentlemen who are appointed to build
asylums, and who don’t like to do it. The cause, enacts that when
a district board fails to provide the requisite asylum accommodation,
the Secretary of State may authorise the commissioners to apply to
the Court of Session to appoint a person to perform the duties of
the district board relative to the provision of such accommodation.
Mr. Blackburn thought it was unfair to override all the counties by
this clause, because a few of them had neglected their duty; not
permitting himself to perceive that it would only apply to such
counties as did neglect their duty.
J. C. B.
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THE JOURNAL OF MENTAL SCIENCE.
No. 43. OCTOBER, 1862. Vol. VIII.
OFFICIAL REPORT.
ASSOCIATION OF MEDICAL OFFICERS OF ASYLUMS
AND HOSPITALS FOR THE INSANE.
AGENDA FOR THE ANNUAL MEETING
HELD AT
The Royal College op Physicians, Pall Mall East,
On Thursday, the 3rd of July, 1862.
At 12 noon. The Committee of Management meet at the Royal
College of Physicians.
At 1 p.m. Annual General Meeting of the Association at the
Royal College of Physicians.
1. Dr. Lalor will resign the chair to Dr. Kirkman, the President-
Elect.
2. Dr. Kirkman's address from the chair.
3. Receive the report of the Treasurer.
4. Election of President (and place of meeting) for 1863.
5. Annual election of officers, viz.. Treasurer, Editor of the
Journal, General Secretary, Secretaries for Scotland and Ireland, two
Auditors.
6. Election of new members.
7. The following communications will be read :—
a . “ On the Cottage Asylum System,” By Dr. Mundy, of Moravia.
b. "On Middle-class Hospitals for the Insane,” by Dr. Maudsley.
c. "On Modes of Death among the Insane,” by Dr. Bucknill.
d. "On the Special Utilization of Asylum Sewage,” by Dr.
vol. vm. - 21
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810 Annual Meeting of the Association.
Robertson (with a ground plan of eighteen acres of meadow land thus
irrigated at the Sussex Lunatic Asylum). i
8. Mr. John Warwick’s resolution. J
9. Dr. Flynn’s resolutions. ,
10. Dr. Burnett, on The Red Hill Asylum. ?|
REPORT OF PROCEEDINGS ,
At the Annual Meeting held at the Royal College of Physicians,
on Thursday, July 3rd, 1862. I
Dn. Kirk man, M.S., Suffolk County Asylum, President.
There was the largest attendance of members that has ever met. <
The following ( among others whose names were not left with the Sec¬
retary) were present. Dr. Kirkman, President; Professor Czermak,
of Prague, the originator of the laryngoscope, Dr. Hera, Assistant-
Surgeon to the Imperial Hospital in Vienna, Dr. Alex. Lumniczer,
Chief Surgeon of St. Rochus’ Hospital in Pesth, Hungary, Dr. Mar- (
kusovszki, from Pesth, Editor of the ‘ Medical Weekly Journal of
Hungary,’ Dr. BuckmU, Dr. Caleb Williams, Dr. Paul, Dr. Har- \
rington Tuke, Dr. Wood, Dr. Monro, Dr. D. Mackintosh, Dr. S.
Newington, Dr. Ross, Dr. T. B. Christie, Dr. Andrew Wynter, Dr.
Gustavus Symes, Dr. Campbell, John Warwick, Esq., Dr. Davey, Dr.
R. H. H. Sankey, Dr. Fayrer, Dr. Sibbald, Dr. Mundy, (Moravia),
H. H. Stewart, Esq., Dr. Corsellis, Dr. Wing, Dr. Sheppard,' Dr.
Brushfield, Dr. Gilchrist, Dr. Rorie, Dr. Lowry, Dr. Boyd, Dr.
Burnett, E. Toller, Esq., Dr. Maudsley, Dr. Eastwood, H. Jacobs,
Esq., Dr. Robertson, W. M. Hollis, Esq., J. P., Dr. Webster,
Dr. Salmon (Maleno Asylum, Sweden), Dr. Brown, Bloomingdale J
Asylum, New York, Dr. Edward Hart Viven, Dr. Llewellyn*
Williams, Mr. King, C. E. (142 High Holbom), James Hewart,
Esq., Belfast; Dr. Clouston, G. G. Gardiner, Esq., &c. &c.
Dr. Robertson , the Secretary, read the following letter from Dr.
Lalor resigning the chair to Dr. Kirkman:
Richmond District Lunatic Asylum, *4
Dublin ; June 26, 1862.
My dear Dr. Robertson, —A question regarding increased \
hospital accommodation for the insane in this district, which is of the
deepest importance to the institution, has just arisen, for considera¬
tion in different quarters here, which will require my constant ,
presence at home for some time, so that I find my hopes of being at
your meeting on the 3rd July, disappointed, just at the last moment.
It is indeed a deep disappointment to me that I cannot personally
have the pleasure of repeating the expression of my heartfelt thanks
to the members of the association, for the high and unmerited honour
to which they raised me, at the same time that I resigned that
honour into the worthier hands of my successor. Dr. Kirkman.
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It would have been also a source of great gratification to me to
have had an opportunity of personally expressing at the meeting, the
obligation which in common with the other Irisn Resident Medical
Superintendents, I owe to the association, and to our Irish Chief
Secretary, Sir Robert Peel for the improvement which has been in¬
augurated in our position, by the new rules for the Management of
District Lunatic Asylums in Ireland. This improvement in our
position, for which we are so largely indebted to the kind support of
Sir Robert Peel, and of the association, is valued by us, as we
believe, it was recommended to him, and to the association, for no
other reason more highly than for the opportunity it affords us of
bettering the condition of the institutions in our charge, an oppor¬
tunity of which I trust, we will temperately, judiciously, and
perseveringly avail ourselves. Thus, as I am convinced, can we best
prove to Sir Robert Peel and to the association, the sincerity and the
extent of our gratitude.
With sincere and warm thanks, with many earnest wishes for the
continued prosperity of the association, and with fond hopes of
meeting the members at many future meetings (and at no distant
period again in Ireland), I now beg through you to resign the
Presidential chair which I shall ever feel it a source of pnde and
honour to have held.
Your very much obliged,
Joseph Lalor, M.D., &c.
To D. C. L. Robertson, M.D.,
Hayward’s Heath Asylum, Sussex.
PRESIDENT’S ADDRESS.
Dr. Kirbnan then took the chair and read the following address :
Gentlemen, —Your kindness has placed me upon a very giddy
height, and it is to the continuance of that kindness that I must
look to uphold me lest I fall. When I call to mind the previous
occupants of this chair—men honoured in science, and the very echo
of whose names still ennobles that branch which we cultivate, and for
whose prosperity we devote every energy and effort, I may well
solicit your indulgence as I ask for your support. If any depart¬
ment wherein medical science and art are blended, can claim the
high privilege of proposing to itself, the great end of humanity and
the search after those means by which God permits this end to be
approached, it is the delicate investigation of Psychology, and if those
who engage in it, do so, in the spirit of my talented predecessors in
this chair, they will be led to acknowledge the true theory of life,
as tenanting this temporary structure, that mode in which God him¬
self manifests his wisdom.
It may be observed with submission, that even in the sacred science
of theology, assertion and dogmatism are too often substituted for
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investigation and proof. But we would not have it so in psycholo¬
gical inquiry, we would remember one universal law of organization
and life, that the more refined the more exquisite the organization
the higher the faculties are; and, consequently, the greater our
responsibilities. We would not attempt in the slightest degree to
sever this peculiar branch of the practice of medicine from the full
exercise of the higher morality. Psychological science forms a.
broader portion of the foundation of ethics, than some may be dis¬
posed to admit, or than has ever yet been duly acknowledged by the
moralist; but in proof of it, it will be enough for me to point to the
honoured authorities I have already referred to, some of whom we
are permitted to claim as adorning our own ranks; professors of
bright intellect illuminating whatever truths or facts they have been
illuminated by; but concentrating all upon the cause of a class long
unnoticed and almost unknown, and are still identifying themselves
with sufferings not their own, and devotiDg a toilsome and an anxious
life to the benefit, the health, the restoration, and the happiness, of
the insane generally, and especially of the insane poor.
I am old enough, gentlemen, to remember the origin of this asso¬
ciation, existing at first only in a small volunteer band, urged on by
the energetic labours of Dr. Hitch. I can revert in pleasing recol¬
lection to its more organized arrangements, and its augmented
numbers from our meeting at Oxford (with the liberal encourage¬
ment of Mr. Ley); and in marking its progressive growth, from the
days of its peripatetic youth, widening its area, before it deepened
its roots into “ a local habitation and a name." I cannot but con¬
gratulate every officer and every member on the influence that the
association now exerts, and the rank that it holds among the nations.
Our bands are now strengthened by increasing numbers of foreign %
associates, and we esteem the presence of these gentlemen among us,
and appreciate their value, while we assure them that our houses are
free for their inspection, and with our hands and from our hearts we
shall cordially welcome them.
As the vast concurrence of all peoples and tongues, rational and
irrational, causes us to meet once again in London, I cannot but
be reminded of our earliest visits, as an associate body, to Hanwell,
at the time of its mighty strides in ameliorating the treatment of the
insane, when the feebler sporadic efforts in the counties were forti¬
fied by electrical connection with the great centre of commendation
and of praise. Nor can I resist a reference to Bethlehem Hospital,
with its present philanthropic revolutionist, without pausing for a
moment aptly to solicit the attention to those splendid memorials
graven on stone, by the father of. Colley Cibber, of mistaken views
and practice, which stand in the hall, and as he looks upon the
fettered limbs of the maniac, and the petrified melancholia of Crom¬
well’s servant, without dwelling unpleasantly on the comparisons
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between 1662 and 1862, just to trace his own contrast between
“ Now and then.” Here is indeed a bicentenary worth celebrating,
now the old chains of ignorance and cruelty are melted for ever in
the fires of knowledge and of love. The false theory and practice
of the past are carved in stone, because they belong no longer to
the flesh; the sculpture of the present is on the living tablet of the
brain itself.
"Ring out old shapes of foul disease,
Ring out a slowly dying cause,
And ancient forms of party strife;
Ring in the nobler modes of life,
With sweeter manners, purer laws.”
While we meet, then, in order to focus the teachings of prolonged
experience, and the light of psychological science, and to take a pro¬
spective view of the many important steps yet before us, we cannot
forget those honoured members who have ceased to instruct and to
cheer us. Each year deplores the loss of living thinkers, although it
is enriched with the legacies of their thought. It is because of those
who are gone, and have left their records with us, that we are able
to repeat as to one science, what Lord Bacon said of all, “ Now is
the true antiquity." But especially ours is no region where the wave
of deep grief has not travelled for the loss of the Prince Consort.
Having laid the first stone of the Medical Benevolent College on the
foundation of his own name, and given promise of far more varied
assistance in the future, our mournful tribute to his memory is not to
be estimated by or dissolved into quantity of utterance, but fixed in
intense regret that a thousand chains, and our own not the least, have-
lost their integrity by this one royal link which has been snapped.
Though the past and the present give full confidence in the future,
the shadows of that future are not altogether free from unsightly
appearances. The uncertain state of our lunacy laws still calls for
the closest attention of every member of the association, but we may
confidently look to those of our body who are anxiously watching
the course of events, with the assurance that they will not }et slip
any valuable propositions, or fail to condemn whatever may present
itself of a perplexing, or an antagonistic character. It seems as if
legal opponents were resolved to take arms against medical authority,
and to suppress if not altogether to reject medical evidence on medi¬
cal cases alone. Our law courts, in some of their strange vagaries,
seem disposed to deal with lunacy as a purely legal idea, and even
the Lord Chancellor's bill appears to be based upon the principle
that lunacy is not a medical question, but irrespectively of the
physiological fact, a question of equity or law. We may well take up
the distinction which somewhat ludicrous declares that law is not
equity, and equity is not law, but while neither disputing upon legal
technicalities, or attempting to decide upon legal questions, we lay ex-
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Annual Meeting of the Association.
elusive claims to the ability of answering our own. We earnestly, zea¬
lously, and conscientiously protest against that “ hazy legislation,” as
expressed by Dr. Mayo, winch would hazardously interfere in purely
medical questions and encroach upon the full prerogative of medical
men to judge of mental sanity. Such legislation must be as an
instrument edged with evil, and it cannot by any legal dexterity be
tempered into good. At the late Social Science Congress, Mr. Palmer,
the secretary of the Law Amendment Society, is reported to have
said that no less than eight acts of parliament must now be studied
to understand the law as applicable to the courts presided over by
Sir Cresswell Cresswell, ana he asks whether anything could more
clearly show the empiricism of our legislative proceedings. I thank
that gentleman for the term, because I am sure that we can show
sbmething that does evidence empiricism more clearly when we
point to men who would decide upon medical questions without
having received a medical education. This is really empiricism, and
it strikes at the very root of every correct, of every safe decision.
The empiric taking it on this authority as a medico-legal term, may
gain sometimes, we admit, very great public confidence, and an acci¬
dental result will strike the public mind as forcibly and often more
so, than one arrived at by the true principles of induction from facts
and premises adequately estimated, even where nothing but those prin¬
ciples could avail. It is the more needful to remember this, because
some men, whose services have raised them high in public esteem,
have not thought it beneath them to endeavour to lower and meta¬
morphose the psychologist into the mad doctor, and to treat his
devotedness with sarcasm and contempt. Such ridicule is both
undeserved and misapplied, and if the delusion went no farther one
might be content to bear it; but when we are met with the prepos¬
terous supposition that lawyers, who are ignorant of anatomy and
physiology, and more particularly of the symptomatology of disease,
and of those abnormal changes which are constantly taking place
within the cranium, long before there is any outward evidence of
insanity or intellectual aberration, are to be the judges whether a
patient is of sound mind or not, we must reject their assumption
altogether. Is it possible (we would ask) for any other than medical
men to trace the course of the “ sly treacherous miner working in
the dark,” to recognise the tremor of the upper lip, the hesitation of
speech, the inability to pronounce the consonants, the tripping of
the foot, and the irritable temper as incipient symptoms of general
paralysis? Whereas the psychological physician would have his
suspicions aroused at the appearance of the first symptom, however
slignt, and his diagnosis and prognosis pronounced long before the
appearance of any delusion, long before that which is the great and
sole guide of non-professional opinion. As far as all human know¬
ledge extends at present, it is generally supposed, that whatever the case
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815
may be morally, intellectually at any rate tbe mind cannot be sick.
If diseased mind cannot exist apart from diseased matter, how can
those attempt to give an opinion upon the former, who are ignorant
of the changes which characterise the latter. If the high legal
authorities should go back, and take part with the ancient Greek
empirics, who contended that an investigation of obscure causes and
natural actions was fruitless, because nature was incomprehensible,
we can only say in reply, with old Celsus, “that as pains and various
kinds of diseases arise in internal parts, no one can apply remedies to
these who are ignorant of them." Let us still trust, however, that the
legislature will not sanction such anomalies as these, and that we
may look with confidence to the anticipative appointment of the
Chancery Commissioners as correctors of much that we feel to be
almost intolerable in the examination of medical witnesses. The
physician should be called, not as the advocate or the witness for any
particular party, but be as unfettered and unbiassed in his opinion as
the members of the jury. He should be allowed to question wit¬
nesses, and give his opinion upon the evidence before him. This
would tend to check many of those unguarded expressions which
keep up a morbid feeling in the public mind. At the late monster
case, whose records “frightened the whole isle from its propriety"
for four-and-thirty days, the stain of insanity was a term in fre¬
quent use; an epithet which stained the phraseology of those who
ought to know better.
This leads me to observe generally that the functions of the
psychological physician are becoming every year more widely diffused,
and more intimately interwoven with social life. While, conse¬
quently, the sphere of our labour, so also that of our convictions, is
less limited by the radius of an asylum, more especially as the cases
to be decided by court or jury in which the verdict of insane is con¬
tingent, rapidly increase, it is a question for us to echo forth from
hence, what party is competent to pass such a verdict. Is any
court, judge, or jury, without special evidence to justify it ? Could
a physician pronounce finally on the ambiguous tortuosity of a will ?
Can a lawyer or a jury be justified in returning that verdict which is
now so common, so easy, and so cheap, of insane in a case of suicide,
where in all probability the first act of insanity was the act of suicide
itself? Is it not equally immoral as authoritatively relaxing the bonds
of responsibility and guilt, and confused as announcing a conclusion
without premises ? Is it more irrational than our other hackneyed
verdict, given with all thoughtless flippancy, “ Died by the visitation
of God," whenever there is no palpable cause of death assignable from
subsequent investigation.
I fear we must acknowledge the increase of insanity both at home
and abroad. I quote from the ‘ Times' (June 12th), which states
that there were in workhouses “5160 women and girls, imbecile,
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Annual Meeting of the Association.
idiotic, or weak-minded." I quote from the ‘ Lancet/ which says
that there are fifty-eight lunatic asylums in Prussia, besides thirty-
two which are only preparatory or provisional, and that the number
of patients in these has been progressively on the increase, there
having been in 1853, only 4054, and in the successive years to
1860, 4094, 4074, 4278, and 4882. The ‘ American Medical
Times/ as quoted in the ‘ British Medical Association Journal/
writes of New York—“in this State there are upwards of two thou¬
sand insane persons confined in almshouses, penitentiaries, and gaols.”
It is a question whether that clause in the new Poor Laws Re¬
moval Act, which throws the charge of the patient from off the
parish to which he belongs, and on to the common fund of the
union, will not tend to increase the number of imbeciles and idiots
in the county asylums. If so, it is useless to expect the reception
of recent cases, and our efforts must be in great measure neu¬
tralised against both prevention and cure. Those noble institutions,
asylums for idiots, have a claim upon the public which should
be liberally responded to, and it is matter of no small gratulation
that they are under the fostering care of one of the ablest and most
philanthropic men of our day, and that we can point to their
great supporter. Dr. Conolly, as a valued member of our own body.
I fear that the pressure for admission into these valuable institutions
is very great, and that many are retained in the county asylums to
the discomfort of their more legitimate inhabitants. I know an
asylum where there are two congenital idiots. One, nine years of
age, the other four and a half, and yet the house will not hold half
the patients demanding admission, and it is in contemplation to
enlarge. It has now 96 per cent, of probably incurable inmates.
The difficulties which beset the questions of distribution and pro¬
vision for such increasing numbers is very great; but the subject of
prevention is more difficult still. Who can stop that fertile source of
both insanity and idiotcy, scrofulous marriages ? Who can check the
course of the dypsomaniac ?
“ Though mortal mind may fail
To tell how the most trivial circumstance
May operate in the mass of combinations,
The fine deep moving processes of life,”
still there is a fearful seal which stamps the lineage of patients
inheriting a strumous diathesis. There is a want of vitality in the
brain, it is too large, or too small; soft and pulpy, heavy in its
functions, and liable to effusion from vascular debility. The practical
difficulties from this source of evil are immense, and whatever the
class among whom the attempt may be made, they each and all defy
classification. The difficulty of engaging in this preventive service
is not from any position in society alone, but it arises from the
feelings and from the ages of those with whom we have to deal.
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They are the young, who, if they have forgotten the literal translation
of Cffisar’s ‘ Commentary/ or if they never heard it, they still adopt
the self-satisfying one, “ I came, I saw, I married,” and however
unpalatable the assertion may be, T fear the result of such rapid
evolution is too often a cripple, a maniac, or a fool.
One of those main channels into which our investigations must
continually flow, and to which all special 'streams of observation and
discovery must be tributary, is the correlation of brain disease and
mental aberration. It is most satisfactory to have to record the con¬
tinuous patient research, the amount of thought, and the studious
microscopic scrutiny which have been devoted to this subject. Upon
the very threshold, as it is, of the unsolvable mystery of the con¬
nection between mind and matter, the darkness of that central
mystery must necessarily hang over this subordinate portion of the
problem. To a philosophic mind, not charmed away from the
severe path of induction by attractive theorising, nor chilled by the
delay in assuring themselves of those laws which are mighty in their
simplicity, our present state and our future duty are equally clear.
In our present state we cannot be said yet to have arrived at any
ceri-ain law of relation between distinct phases of insanity, and distinct
forms of cerebral disease. Our duty is to continue increasing the
number wherein the form of insanity as known in life, and the con¬
dition of the brain as observed after death, are registered together.
The problem, as a matter of scientific discovery, and as a means of
practically advancing the treatment of disease, is of very different
dimensions. In the former case it is very great, in the latter it is
probably very small. Our therapeutic power must always be far
greater than our physiological knowledge. And for this simple
reason, that we have two available avenues towards the converging
point of their union, which is shrouded from our understanding.
The structure of the brain is to be acted upon in both cases indirectly
through the body and through the mind. We are, perhaps, guilty
of a paradox in our phraseology, having enthroned the term psycho¬
logy on the level of the inductive sciences, while more accurately
and practically we are craniologists. Strictly speaking, craniology is
the science of the disease as seated in the brain. Psychology of its
symptoms and manifestations. As to the physical treatment of brain
structure, through diet, medicines, exercise, and asylum retirement,
nothing need now be said. As to the mental or psychological treat¬
ment, without running over the old strings whose tones are familiar
to us all, I would keep to those points more particularly when we
come in contact with those of other professions. We have not, I
fear, hitherto been duly attentive to the process of introducing
thoughts into the mind which at once would begin to operate upon
the physical structure. A fit thought, introduced ah extra , can create
tendency to healthy circulation, and normal condition of the brain
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Annual Meeting of the Association.
matter, as a poisonous one can disturb the machinery, and fix that
disturbance in the form of cerebral disease. The wise administration
of religious consolation is perhaps our most powerful agent. Where
that consolation is withheld from diffidence or fear, the approach is
close upon—
“ that path of old, Spinosa trod.
To man a coward, and a brave to God.”
But the agent is a “ sharp sword,” by its own designation, and
the higher it is tempered, the keener that the edge is ground, and
the more morbidly sensitive the surface it has to touch, the greater
is the danger from its injudicious use. While I can register many
thoughts and passages from the Bible, simply and strictly among the
most powerful agents in the Pharmacopoeia, while I oan recall happy,
faithful death-beds, after prolonged residence in the asylum, and
mark the peculiar phenomenon of the candle just flickering up anew
before going out in the short period of positive sanity previous to death,
I would still guard our asylum chaplains, lest by an unwise adminis¬
tration they change a remedy to a poison. The power of fanatical dis¬
tortions of the gospel to produce insanity has been only too fearfully
illustrated of late, and plentifully treated in many of our periodicals.
In the other direction is the power of simple presentation of certain
truths, actually to give the first impetus towards cure. Nothing can
be more striking than the undeniable fact that the very definition and
essence of insanity seem lost, while the insane can be healthily reci¬
pient of the highest thoughts upon which the most rational can
reflect. It is thus with moral delinquency, and it is thus with
mental distortion; and by careful investigation of each case, the
phase of insanity, and the individual character which must be the
substratum of it, may be acted upon on the first principles of all the
therapeutic art.
A man's moral character and his spiritual character, his amiability
or his moroseness, his purity or impurity, his hypocrisy or abandon¬
ment, are clearly to be distinguished after some intercourse, through
all the clouds of insanity. And it is practically understood, too, with¬
out any of the subtle niceties, or endless confusions of legal ques¬
tionings, and categorical distinctions, how far insanity merges moral
responsibility. It is understood by the physician, and it is irresistibly
felt by the patient himself; so easy is it for us to perceive the dif¬
ference between -the sufferings of insanity, and the moral madness of
sin, and to retain analyses of those two, which are but contingently
united. All this can only be done by the discriminating eye, and
the mind of the physician.
It is a vital principle at length acknowledged, now that the legis¬
lature, by requiring every asylum superintendent to be a specially
educated medical man, has, at least indirectly, condemned the paradox
of the old system of visiting physicians; accompanied, as it must be.
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with interference, and fraught with injury and discomfort. The dis¬
interested withdrawal from the Metropolitan Asylum of him who held
the highest position in this respect, must warn back the assumption
of all others, and prove that their introduction, must be merely
nominal.
In approaching, gentlemen, as I feel now that I must, the con¬
fines of very tender ground, I desire, before I take one step upon it,
to speak with all deference and respect of the Commissioners in
Lunacy; to express regret at the loss of Mr. Procter, and pleasure
at the appointment of Mr. Poster. Por myself, I should gladly hail
an increase in that body, and when I look, as I now do, upon those
who would adorn that commission, and augment its vitality and
strength, I would gladly render that anticipative respect which a
master mind must always command from a mind of mediocrity.
Whether there should be undivided authority in this official body is
a question upon which some difference of opinion may exist. But
perhaps you will pardon our personal intrusion here, as I assure you
that, through the long course of thirty-one years, 1 have never known
one hour’s discomfort from the visitors of the Suffolk Asylum. All,
however, have not been so favoured as I have been, and some of
those conflicts well known to us, and to which it is not necessary
particularly to refer, only serve to establish the conviction that there
should be undivided authority somewhere. Conflicting opinions must
harass the superintendent In his duty, and impose upon him needless
distractions. He has enough upon his mind, without being thwarted
in his efforts by one party, or teased with immaterial suggestions from
another. He who is honest in his endeavours, may be pardoned if
he couples his honesty with some little jealousy of intrusion upon
unimportant points. The conjunction of these feelings is the great
preventive against the perpetuity of error. The asylum superinten¬
dent can take no subordinate position. He must act from an infinitely
higher motive than the aim after official commendation, and hold
himself altogether free from the fear of official censure.
The valued proprietors of our private asylums are equally interested
with public officers in these questions. How many honoured names
have been rudely taken in vain ? how many has the boldness of igno¬
rance exposed to annoyance, from the hasty and injudicious urgency
for the removal of patients only partially restored? Some alleged
lunatic’s friends, as they called themselves, obtained the removal of
a patient from a house of high respectability and name, contrary to
the opinion of the resident physician, and in opposition to his own
expressed desire; and that gentleman was seen by a late friend of
my own, only a few weeks afterwards, painfully exposed to the dis¬
reputable frequenters of the Strand. “ Every encouragement,” said
Marshall Hall, “ should be given to the devoted investigator, every
obstacle, every source of annoyance and distrust, should be entirely
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Annual Meeting of the Association.
taken away. The physician makes great sacrifices; he exposes him¬
self, it may be, to misrepresentation; his path requires cheering; it
should not, and it ought not to be, unnecessarily interfered with, or
beset with thorns.”
I can cordially echo these sentiments of the late Marshall Hall,
and I would conjure my colleagues by “ the rights of our fellowship”
(I wish I could add by “ the consonancy of our youth,”) to take care,
while their minds are on the stretch, lest the progress of improvement
should sink into collapse; to guard their own health, by joining some
fighter recreations to their heavier weights. I wish every one of ns
had a hobby. Eosinante is essential for recruiting the spirits as well
as for the main purposes of chivalry. “ It is all very well,” says the
philosophic author of the ‘ Caxton Papers/ “ to trace the symptoms
and prescribe repose. But repose is not always possible. A brain
habitually active will not be ordered to rest. It is not like the inani¬
mate glebe of a farm, which when exhausted you restore by the
simple process, ‘ Let it fie fallow/ A mind once cultivated will
not lie fallow for half an hour. If a patient habituated to reflection
has nothing else to meditate, his intellect and fancy will muse exclu¬
sively over his own ailments, muse over a finger ache, and engender
a gangrene. And what is to be done ? Change the occupation,
vary the climate, call new organs into play, restore the equili¬
brium deranged in overweighting one scale, by weight thrown
into another.” The conscientious superintendent of an asylum
is alarmingly exposed to that condition of mind caused by the
persistent tension of the brain, called by Dr. Ordronaux mental
hyperaesthesia. “The mind though greatly fatigued is not dis¬
posed to quiescence, but it continues to oscillate under the reflex
influence of its original stimulus.” Many sad results from such
a condition are known to us, and we think that the Commissioners
in Lunacy, from their conviction of this fact, have done themselves
honour in urging a limitation to fifteen years instead of twenty,
for the grant of pensions to medical officers. Gentlemen, we thank
them, but we ask for compulsory enactment for this grant. We
deserve what we solicit before we ask for it. We do not make the
request as an inducement for future exertions, though it is of the
greatest moment that all pensions should be made positive in this
latter point of view. In order to support any stretch of mind, and
keep up the vigour of any science, it must be permitted to hold out
some permanent encouragement for men of talent and research to
devote themselves to it. If we are met with the objection that the
demand is made by interested parties, I for one most candidly allow
it, but I contend that the interested parties are the insane poor of
England. Only lower the honorable reward which is the ladder to
“all high designs,” and “ that which should accompany old age,” and
see if the loss will not injuriously weaken the pulse of self-sacrifice
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821
The President's Address.
t,
and life-long energy, which now throbs with regularity and health.
It is this which makes us feel that we should be entirely independent
upon the decisions in amount even of a liberal magistracy, and free
from the financial observations of sessional meetings or sectional
boards. There may be every desire to acknowledge the claims of
long and faithful service; the public may estimate individual exer¬
tions made in the cause and for the welfare of its afflicted population,
but we look to the legislature, for what we think the legislature
should not withhold, decided security against any disappointment,
and reward of the servitude of fifteen years' residence in an asylum,
with a positive and permanent pension.
I can now, gentlemen, only look back with humility on this feeble
effort to conduct you a few steps upon the beaten path without
attempting to open up new avenues on it. Though I have traversed
that path longer, you have traversed it more philosophically than I;
but that you have done so with more hearty desire for the good of
the insane wanderer, for the steady advance of the sure inductive
science of psychology, and for the general philanthropy of all; I
hardly can allow. While we yield then, together, to the entertainment
and instruction which swarms around us in this marvellous era, let
us never be distracted from the enthusiastic and philosophic view of
every asylum as a great exhibition, with its unnumbered manifesta¬
tions of mind, reflecting all the colours of the opal, and promising
more discovery than the utmost to which we have hitherto attained.
Dr. Bucknill: Mr. President, I beg to thank you in the name of
the large body of members here present, for your able address.
It is a privilege, sir, to hear such large and humane views on
so many important questions so admirably expressed; and what¬
ever opinions we individually may have entertained upon them, I
am sure we are all truly obliged for the instruction you have
afforded us.
Dr. Munro: Will you allow me, sir, to second that, as I think—in
the position in which I stand, being one of the censors of the college
just now, I am the person who should second it. I feel that I have
not myself taken the interest in the working of this association which
I ought to have taken; therefore, I do not feel that I am at all an
important member; but, as. being connected with the College of
Physicians, I desire to second this vote of thanks to you. I unfor¬
tunately happen to be a visiting physician of an hospital, and there¬
fore I am afraid I am not at this moment in very good odour here.
I hope, however, that though I am a visiting physician, I shall do
the best I can as long as visiting physicians continue. (Hear, hear.)
The President: I am very much obliged to you, gentlemen, and I
can only regret that what I have had to say has not been more
worthy of your attention. Our first business now is to receive the
treasurer’s report.
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322
Annual Meeting of the Association.
TREASURER’S REPORT.
Dr. Robertson , in the absence of the treasurer, read the annual
financial statement.
On the motion of Dr. Robertson, seconded by Dr. Williams, the
report was received.
Dr. Robertson: With reference to the treasurer’s report, I have now
an unpleasant part of my duty to perform. We have seven heavy
defaulters. A resolution was passed at a general meeting some years
ago, that any gentleman being two years in arrears in the payment
of his subscription, payment having been demanded for three months
by the secretary, should be struck off the list. I have always been
unwilling to do that, and the names have remained, but I hope you
will not come down on me for the arrears. (Laughter.) The
heaviest defaulter is * * * * * *. I understood from Mr.
Lee, when I took the office of secretary seven years ago, that there
was a small outstanding claim of Dr. * * * * against the asso¬
ciation.
Dr. Williams: Is it needful to go over the names ? I should
think that could hardly be necessary.
Dr. Robertson: I do not like to take the responsibility upon
myself.
Dr. Wood: Have you written to these gentlemen annually ?
Dr. Robertson: I have written to them repeatedly during each
year. >
Mr. Warwick: I think I have not paid for five years. I did not
receive any communication till a week or two ago, having been tra¬
velling about. I think it would be desirable to write to the gen¬
tlemen who are defaulters. It may be only an act of neglect on their
part.
Dr. Robertson: I had not your address, and I knew that your
money was safe. I have written to these gentlemen whose names
are before me, dozens of times, but I do not like to strike them off
the list without some authority.
Dr. Campbell: I would propose that their names should.be struck
out of the list. It is useless mincing matters. We had better act
according to our rules.
Dr. Williams: It is a matter for the committee, I think.
Dr. Robertson: The committee discussed it, and referred it to the
general meeting.
Dr. Williams: I think we should request them to manage a matter
of that kind, and not bring any names of defaulters before this
general meeting.
Dr. Wood: It is certainly a delicate question to bring before the
public meeting j and, aftqr all, the offence is not so very great. I
ty Google
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Copy of Balance Sheet of 1861-2.
William Ley, Treasurer of the Association of Medical Officers of Asylums and Hospitals for the Insane.
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MICHIGAN STATE UNIVERSITY
324
Annual Meeting of the Association.
would suggest that the matter might be submitted to the President.
Their names could be struck out by his authority, and that would be
an official act.
Dr. Bucknill: You might mention, in general terms, that so
many members are in arrear, and not having answered to the appli¬
cations for payment, their names will be struck off the list.
Dr. Campbell: I was present some years ago when a rule was
passed on the subject. What in the world is the use of framing
rules, and having them printed, if we are not to act up to them out
of feelings of delicacy in mentioning names ? We may as well do
away with our rules altogether. The rule that I refer to was passed
unanimously bythe association, and if these gentlemen have brought
themselves into it they must take the consequences, and I say,
decidedly, that they should be struck off the list. I call it playing
with the association. If the rule is there, it had better be carried
out ; if not, I do not see the use of rules at all. Either stick to
them, or do away with them. I beg to second the motion that these
gentlemen be struck off the list.
The President: In the Eastern branch of the British Association
we take a preparatory step; we read over the names of the defaulters
at a general meeting, and then, if there is no notice taken of the
matter, their names are struck off. It seems a little milder course
to adopt to read their names over before you send them adrift.
Dr. Munro: Would you strike them off in the first or the second
year?
Dr. Robertson : In three years.
Dr. Munro: I was a defaulter four or five years. I thought I
would run on till the amount came to £5.
Dr. Wood: I would suggest that this matter of defaulters is one
that need not occupy our time. It can be safely left in the hands
of the committee. It is not desirable that our time should be
wasted in a matter of this sort. As, however, there is a distinct
motion on the subject, I would say that I hesitate lending my name
to any such harsh measure. I can quite understand that the
omission to pay has arisen in many cases from inadvertence or care¬
lessness, or want of business habits, and without any intention of
shirking the responsibility of membership. Before taking such an
extreme step as tur ning these gentlemen out,' I think we ought to
give them one more opportunity. Let another letter be sent to them,
stating that in the event of their not paying before a certain day
their names shall be struck off. The proceeding at present proposed
seems to me somewhat harsh. It is true there is a rule on the
subject, but that rule has not been acted upon.
Dr. Campbell: I should be glad if Dr. Robertson would read the
rule on the subject.
Dr. Robertson: The rule is, “ that any member in arrear of his
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325
Treasurer's Report.
subscription over twelve months of the expiration of a year, and
more than three months after application, shall cease to be considered
a member of the Association, provided no reason satisfactory to the
annual meeting be assigned for the non-payment of such arrears."
The question, therefore, is distinctly referred to the annual meeting;
" if no satisfactory reason for the non-payment is brought forward,"
it is for the annual meeting to strike these gentlemen off the list. I
am strictly within the rule in calling upon the general meeting to
perform this unpleasant duty.
The President: If any gentleman has a satisfactory reason to
assign, perhaps he will now do so.
Dr. Wood: Before we carry out the rule now, I think we ought
to consider how often it has been disregarded. At present, I believe
we should come within that rule. I believe it has been my custom
to pay my subscription every two years, because I have not been able
generally to attend the provincial meetings, and I have usually paid
in that way. It might have happened that a special engagement
might have prevented me from being here to-day, and I might have
gone on for a third year. At any rate I come at present within the
provisions of the rule, and if it were strictly enforced, I am no longer
a member of the Association. I dare say there are many other
gentlemen in the same position, and I would put it to the meeting
whether it is fair, seeing that the rule has been a dead-letter so long,
that it should now be put into practice so fiercely as is at present
proposed. I would propose, as an amendment, “ That before the
names of members whose subscriptions are in arrear are removed
from the list of members, a final notice of one month from this date
be given them."
Dr. Munro: I beg to second that amendment.
Dr. Bucknill: I should not object to an arrangement that after
such notice has expired, if these gentlemen do not pay, the Secretary
should have power to strike them off the list. I think no one will
object to such notice being given. I think it is a pity to disturb the
law, and yet the Association would regret not to adopt the course
recommended by Dr. Wood. I would suggest that the motion and
amendment be withdrawn, and that it be left to the Secretary to act
upon the suggestion that he should write again to these gentlemen,
and then put the law in force. I think it would be a pity to dis¬
turb the rule.
Dr. Davey: Any other course than that suggested by Dr. Bucknill
is out of order. It is not in harmony with the rules of this Society,
at least that is my impression.
Dr. Bucknill: My recommendation is that both the motion and
the amendment be withdrawn, and thus to leave the Secretary to
act according to the rule, with the understanding that the plan
recommended by Dr. Wood, will in this way be adopted.
vol. viii. 22
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326
Annual Meeting oj the Association.
Dr. Wood: I do not object to withdraw my resolution, but I
think we should have some specific rule, and act in accordance
with it. There are many gentlemen, perhaps, in arrear one or two
or three years, but after application has been made, I think the
subscription ought to be paid. If you alter one rule you must alter
them all. I have no desire to act harshly towards any member of
the Society. At the same time if you have rules you ought to
adhere to them.
The motion and the amendment were then withdrawn.
Dr. Robertson: Allow me to mention here that I have received
several letters of apology for not attending this meeting, which I
ought to have named before, from Dr. Browne, Commissioner in
Lunacy, Scotland; Dr. Manley, Dr. Flynn, Wm. Ley, Esq., Dr.
Thurnam, F. W. Casson, Esq., Dr. Stewart (Belfast), Dr. Tyerman.
ELECTION OF PRESIDENT FOR 1863.
The President: The next business is the election of a President
for the ensuing year, and the place of meeting. I have not yet
heard any recommendation brought forward on the subject.
Dr. Robertson: The Committee at their meeting this morning
determined to propose the names of two gentlemen to the general
meeting for election to the office of President for the ensuing year.
The first name they bring forward is that of Dr. Skae, Superintendent
of the Royal Edinburgh Asylum at Momingside, and the other name
is that of Dr. Harrington Tuke, as a representative of a very
important section of the Association, the proprietors and physicians of
private asylums; and the Committee further propose, in the event of
either of those gentlemen being elected, that the place of meeting
next year be in London. We find, as we see to-day, that London
is the place where we can get a good meeting. We go into the
country, to Liverpool for instance, and get seven members. There is
an extreme difficulty in getting a provincial meeting, whereas every¬
body comes to London. The names proposed by us for President
are. Dr. Skae and Dr. Harrington Tuke, with equal recommendation
on the part of the Committee. At the same time it is. open to any
member in this room to propose any other gentleman he pleases for
the office of President. The Committee have no wish to press either
of their two candidates.
The President: Perhaps we had better decide the place of meeting
first.
Dr. W. P. KirJcman: I beg to propose that the place of meeting
be London.
Dr. Munro: I beg to second the motion.
[The motion was unanimously adopted.]
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327
Election of Treasurer, Editor of Journal, fyc.
Dr. Munro: With regard to the place of meeting, if I can be of
any assistance in endeavouring to get you the College of Physicians
next year, I shall be very glad to do so. (Hear, hear.)
Dr. Robertson : The way in which we have been received here this
morning will certainly induce us to return if we are able.
Dr. Munro: I think the College would be glad again to offer this
room to the Association, as far as I can understand the feelings of
the authorities in the matter.
The Rresident: If no gentleman has any other name to propose as
President, I will take a show of hands on the names of the two
gentlemen proposed by the Committee.
Dr. Davey: This is rather a delicate matter to decide by open
voting and I think it will be better that the voting should be by
ballot.
Dr. Tuke: Proud as I am of the distinction of being nominated,
there is one circumstance I ought to mention. The Committee very
kindly suggested that I should put myself in nomination, but I
objected, on the principle that we carried this rather too far. I
should myself, if voting papers were handed round; vote for Dr. Skae,
who is a most eminent and deserving man. At the same time, if
elected by the suffrages of this distinguished meeting, I should strive
to do honour to their choice. It would not be in the least dis¬
tressing to me to fail with Dr. Skae for a competitor. I am certain,
if Dr. Skae is not elected, the only reason will be that he is not
present. I believe the proposition of Dr. Davey to be the wiser
course, and I should be glad to see it adopted.
The use of the ballot was agreed to.
ELECTION OP TREASURER, EDITOR OP JOURNAL, &c.
Dr. Robertson: The next business, to which we can proceed while
the ballot is being taken, is the appointment of Treasurer. Mr. Ley
has served the Association for twelve years, and I do not think that
we can improve upon our old servant. I beg to move that he be
re-elected.
Dr. Bucknill seconded the motion, which was unanimously
adopted.
Dr. Williams: I beg to propose that Dr. Bucknill be re-elected
Editor of the Journal.
Dr. Burnett: I beg to second the motion.
The motion was carried unanimously.
Dr. Bucknill: In thanking you for your continued confidence,
I wish to say that it is my intention to carry out a resolution of
a previous meeting, that the surplus funds should be devoted to
payment for assistance in my editorial work. This has as yet been
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328 Annual Meeting of the Association.
done to a very moderate extent, and the Treasurer's balance has
been accumulating in consequence. I propose now to engage the
regular services of a sub-editor ; and I am sure I shall have the
approval of the meeting in so doing. (Hear, hear.) I do not ask
for any formal approval now, because it was given two years ago.
The President: The next business is the election of our General
Secretary. I presume that we shall all desire to re-elect Dr.
Robertson.
Several gentlemen rose to second the motion, which was unani¬
mously adopted.
The President: The next business is the election of a Secretary for
Scotland.
Dr. Robertson: In thanking you for my re-election to my
honorary office here, I beg to propose that Dr. Rorie be re-elected
as Secretary for Scotland. He has taken great interest in the Asso¬
ciation, and exerted himself in making our objects known throughout
Scotland. I beg also to propose that Dr. Stewart be re-elected
Secretary for Ireland.
The motion having been seconded, was unanimously adopted.
ELECTION OE NEW MEMBERS.
The following new members were then elected :
Dr. Mundy (Moravia), 14, Old Cavendish Street.
Dr. T. S. Clouston, Royal Asylum, Edinburgh.
Dr. Yellowlees, Royal Asylum, Edinburgh.
H. Jacobs, Esq., Hoxton House.
Dr. Eastwood, Eairford Retreat, Gloucestershire.
Duckworth Williams, Esq., General Lunatic Asylum, North¬
ampton.
G. W. Mould, Esq., M. S., Manchester Royal Lunatic Hos¬
pital, Cheadle.
Dr. Harper, Chester County Asylum.
Dr. J. Crichton Browne, Derby County Asylum.
Dr. J. E. Duncan, Earnham House, Dublin.
Dr. E. Schofield, Camberwell House, London.
Dr. Henry Stilwell, Moorcroft House, Uxbridge.
Dr. Macreight, The Bungalow, Torquay.
G. G. Gardener, Esq., Brook House, Clapton.
Dr. De Wolf, M. S,, Hospital for Insane, Halifax, Nova Scotia.
Election of President {continued').
The report of the ballot for the election of President for the
ensuing year, was as follows:
Eor Dr. Skae . . . . .19 votes.
„ Dr. Tuke.13 „
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Original Communications. 329
The President declared Dr. Skae to be duly elected.
Dr. Take: While I congratulate Dr. Skae on his election, I
hope the meeting will perfectly understand that I entered on this
matter with a perfect certainty of the result. In the Committee we
were anxious that the system of a clique electing a particular man
should be abolished; and I hope the meeting will do me the credit
to believe that in coming forward in the way I did, I was not in the
least degree opposing Dr. Skae, but merely opposing the system
which has been hitherto adopted. As it is, I congratulate the
meeting on the election it has made.
Dr. Davy: I beg to give notice that it is my intention next year
to submit a resolution to this Association, having for its object a
new mode of election of President year by year; the object being to
take the election from the few, and place that duty in the hands of
the many. Let me say, in anticipation, that I think I shall be well
supported by you all in my endeavour to carry out this innovation.
This happens to be an innovation which is a decided improvement,
and I trust that I shall be well supported.
ORIGINAL COMMUNICATIONS.
The following paper was then read by
Dr. Mundy on the Cottage Asylum System :—
Gentlemen, — I must first apologise to you for venturing to
address you in your own language, but the indulgence which you
generally and generously grant to foreigners, induces me to hope,
you will also extend to me.
I embrace the opportunity which you have kindly given me to
address you on a new system of our science, which although it
appears to you under various names and denominations, is, in reality,
but one and the same thing, and has raised itself by its importance
into a question of the day. ,
I cannot but admit, that many look upon this question a, priori,
as Utopian: others, on the other hand, consider it a question settled
by previous debate, call it impracticable, and have given it up alto¬
gether. There are indeed but few left who have at once the courage
and perseverance to appear as its champions and promoters. If I
therefore endeavour to examine the principles of those who look upon
reform as “ given up,” I think I shall be able to discuss with advan¬
tage the question, and to do justice to the three different parties.
And here let me now ask you, gentlemen, whether it is right to con¬
sider a question given up and settled, which has never been debated
on its own intrinsic merits, but merely on unsatisfactory examples.
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Annual Meeting of the Association.
and results which have scarcely given material for gossip or for the
pen ? And I can truly say such has been the fact with regard to
“ Gheel,” a name which I really venture to mention before you with
great reluctance, and assure you I will not repeat again. But it
is not only this Belgian town, gentlemen, which I could quote to
you as an example for the possibility of a practical solution of this
question; I have other proofs to show that the new system and its
application is successful and practical. It must be known to you
that the brothers Labitte, of Clairmont (Oise), in France, situated
twenty miles from Paris, have become millionnaires in less than ten
years by a colonization of the insane.
In Germany, only Hanover has commenced with a small asylum
of this kind, and in my own country the inhabitants of the island of
“ Cepel,” which is situated four miles fromPesth, in Hungary, have
adopted the same humane practice. In Scotland the attempt has
also been made; and in England, in the Devonshire Asylum, you may
trace single but splendid example of the* same system, which has
been introduced and fostered by a gentleman of high reputation both
in England and on the Continent, but particularly valued and ad¬
mired by yourselves, his fellow-labourers, including myself; I mean
of course our distinguished colleague, Doctor Bucknill.
You may therefore term this system good or bad, practical or the
contrary, it remains yet with all the pros and cons , a fact, an undis-
putable fact, that this system shows a possibility of application, and
when we consider the examples I have mentioned, it shows a possi¬
bility of application in all countries in the world.
Can you, gentlemen, then doubt that an improvement on the ex¬
amples quoted, however limited their sphere may be, to be impossible?
It is certainly a great pity that that improvement has not been
attempted by newer establishments of a similar kind;—indeed not
only has this not been done, but even the principle of reform in the
treatment of the insane, has been treated with harsh refusal! May
I trust that you will act differently, and bestow some attention upon
this serious question; for it is in your mighty and noble country,
where that ever youthful aged man, whom I am happy and proud
to see in your presence, has become the benefactor of all countries
and peoples, and his name will be entered in the great book of history
with golden letters —“ Exegit sibi Doctor Conolly monumentum aere
perennis !”
England’s unfortunate insane, over 50,000 in number, live with¬
out restraint, through his wise and indefatigable exertions. I have
mentioned this great fact, gentlemen, as historic, but your scientific
minds as well as your humane feelings will wonder, when I tell you
in opposition to this pleasing fact, that neither France, Italy, Ger¬
many, nor the rest of Europe, consider a no-restraint system pos¬
sible. They doubt its application altogether, and treat the insane.
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Original Communication*. 331
in opposition to reason, justice, and established principles, in the
contrary way to this reform!
It requires but a momentary glance to see the great abyss which
separates the countries I have just mentioned from the much more
powerful step in advance to abolish “ the sequestration system” of the
insane. It will, indeed, be long before they will perceive their bar¬
barity of treatment, and unless legislative power should determine it
otherwise, they will certainly be in no hurry to adopt the “ family
system ” in which every member can move without restraint, and in
which the insane will be nursed and cured in the same manner in
which every other patient is treated and cured.
That such is possible we know already; that we can improve upon
what has been already done we certainly believe; let us then consider,
gentlemen, whether this improvement be necessary, and if so, whether
the new system be better than our present practice. If, gentlemen,
you cast a glance from England towards Europe and America, you
will at once perceive that the gigantic asylums of our day are scarcely
sufficient after five or ten years to take in the increase of the insane
population, and that more and more large institutions become an
urgent necessity for every country, and at enormous cost.
It cannot be suffered—thus remark the “ initiated ”—that these
asylums which swallow up millions, shall only be built for ten years,
and that new taxes must continually be paid by the community to
defray the enormous outlays which new asylums require, and that this
tax is continually to increase for the ever-growing demand of further
asylums. Others again say, that it cannot be endured any longer to
permit asylums to be built like fortresses and prisons, and for accom¬
modating thousands of patients " pell-mell.” By such centraliza¬
tions the medical influence becomes a mere illusion, and these costly
institutions, therefore, offer no scope for therapeutics, but are mere
places for the keeping, housing, and custody of the insane.
Lastly, there are a few who condemn the sequestration—which
is still looked upon as the rule—as useless, without aim or profit
to the patient's welfare. These few recommend "free air,” the
family life, work, or in one word, the family colonization, or cottage
treatment system! The few followers of thi3 new doctrine, maintain
that by such arrangements science is alone able to extend its bless¬
ings to the insane, and to obtain for therapeutics its chief aim and
object, “to cure the curable” expeditiously, and to offer to the
incurable at any rate the most agreeable lot under circumstances
large for utility, so sad.
Already the wonderful practical results obtained by means so
insufficient, offer to the adherents of the system the best guarantees
for its success if these ideas are carried out on a scale sufficiently
and with a scientific basis.
If I have succeeded, gentlemen, in showing you clearly the neces-
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Annual Meeting of the Association.
sity of such reforms, it would also now be necessary to examine
whether such reforms be sensible, practical, scientific, and capable
of furthering our science ?
On these questions I invite you, gentlemen, to debate at a future
time, and I beg leave to place before you for that purpose the
following theses, which your experience and your wisdom will solve:
1st.—What are the principles of the new system, generally termed
the colonization of the insane—theoretically, and scientifically in¬
vestigated and -determined ?
2ndly.—What practical benefits might result in reference to the
examples already furnished for— (a), the therapeutics of the insane—
(b), the management of the patients ?
Srdly.—Is it possible that these theoretical principles can be prac¬
tically adopted in England and other countries of the world ?
4thly.—What is the relation between the advantages and disad¬
vantages of the new system to the advantages and disadvantages of
the present system ?
5thly.—What can be done to break with the old system radically,
and to promote and adopt the new one as the rule of action ?
6thly.—Is this new system applicable to the rich and poor, or to
both, and under what modifications ?
7thly.—And what system ought to be adopted if the colonization
system be not found practicable ?
These seven questions, gentlemen, were indeed the objects to which
I wanted respectfully to draw your attention.
The very short time which you kindly grant me, altogether pre¬
vents my doing more than laying these questions before you, and
recommending them to your consideration, if you should consider
the subject worthy of your deliberations.—Whether the “ block-
system ” will be chosen, towards which England seems already to
lean, or you adhere to the stagnation of our present time—at all events
it would be of the highest interest for our science to hear from so
potent an authority as yourselves—from men of your practical expe¬
rience and independent judgment, practising the no-restraint system
now upwards of twenty years; the pros and cons on the principle which
is of 30 much importance to humanity, and which is yet so little appre¬
ciated and known, and consequently so ill judged.
I hope, gentlemen, you will not consider me presumptuous if I
propose to you the discussion of those questions mentioned by me,
and if you would appoint from your society a committee for the pur¬
pose of examining the same, and to let their report be placed before
you at your meeting next year for further debate.
At the moment I speak to you here, the insane of Aversa rehearse
Alfieri’s “ Brutus,” in order to repeat and represent the same in the
evening at the “ Teatro Fondo,” at Naples. A great number of
your own unfortunate inmates of asylums visit at the present time
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“ the great International Exhibition,” in which the progress of
humanity is strikingly illustrated by the remarkable quantity of guns
from all parts of the world! Might such extremes not tend to
encourage me to hope that you, gentlemen, will resolve to debate on
a new system, when you perceive that the old one is indeed
tottering!
Dr. Robertson : I am sure we are much indebted to Dr. Mundy
for his paper, which is the first that we have had from any of our
foreign friends. I had a long and interesting conversation at
Hayward's Heath with Dr. Mundy, with regard to this question of
lunatic colonization; and I must say that he made a convert of me;
and if I could only get the land, I should be glad to try the ex¬
periment. Land in Sussex is dear; but if I were in the Highlands,
I think I should set too at once. We spoke to several of our at¬
tendants, and went into the question of their receiving the patients
in their houses. In fact we went into the question of imitating what
I saw carried out by Dr. Bucknill, at Exminster, five or six years ago,
which is a beginning of the system that Dr. Mundy is in England
to advocate. The questions raised by Dr. Mundy in this paper are of
such importance that at this meeting we can hardly go into them;
but I think we might adopt Dr. Mundy's recommendation, and
appoint a small sub-committee, to draw up a report on the subject,
instead of undertaking the journey to Gheel. I do not know any of
our members who would be disposed to go there, except Dr. Browne,
and we should not like to send him alone. If a committee were ap¬
pointed to bring up a report on the subject at the next meeting, the
question would then be fairly and properly dealt with.
[The names of Dr. Tuke, Dr. Davy, and Dr. Mundy were suggested.]
Dr. Tuke: I must decline to serve on such a committee, par¬
ticularly after the speech of Dr. Bobertson; for I have a strong
feeling that the scheme is perfectly Utopian and absurd. Therefore,
with this strong prejudice existing in my mind, I think I ought not
to be appointed a member of the committee. I could not, without
going to the place, upon mere hearsay, or written evidence, come to
any conclusion on the subject. Dr. Kobertson has spoken strongly
in favour of the Gheel system : I could speak as strongly against it.
I noticed the other day a statement that was made with regard to
the tendency of hereditary succession of insanity; and it was remarked
that children born of insane patients at Gheel were not generally
insane. I do not know whether that struck any visitor at Gheel,
but it was an extraordinary statement; because it would imply that
the female patients at Gheel were living in that charming state that
they were in the habit of increasing the population, and doing so
very satisfactorily. That is one strong objection I have.
Dr. Williams: I think the subject is of very great importance. It
will be obvious to almost every one conversant with the subject, that
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Annual Meeting of the Association.
our very large asylums are very large evils. This mode takes us to the
very antipodes of our large asylums; and I think there must be some
middle course in which true wisdom will be found. I quite concur
in the idea that a committee should be appointed; but I think that
that committee should visit Gheel before bringing up a report.
Dr. Bobertson: I think you would not get the members to go.
Dr. Williams: If any gentleman would take the trouble to go on
his own account, I imagine a committee would go. Last year I went,
if I may so say, on my own hook, to Gheel; and I have no doubt
other gentlemen will be found who would do the same.
Dr. Christie: I have also been to Gheel, and seen the system in
operation. There was an able report on the subject, in our Journal,
some little time since, in which the system was thoroughly discussed.
I think we need only refer back to our own Journal to see how the
Gheel system has answered; for the subject is there very impartially
discussed.
Dr. Sibbold: I think the Association is fortunate in not having
sent a committee to Gheel this year. I was there about a month
ago, for the second time. The asylum, which it is necessary should
be in working order before the system can be properly judged, now
only contains three or four patients, so that it would be impossible
for any committee this year to have made a satisfactory report.
Dr. W. P. Kirbnan: It is the cottage system that we want a
- report upon, not the new asylum. I think that the appointment of
a committee to report on the subject without going to Gheel would
be attended with great benefit. Knowledge is power, and we should
have the aggregate knowledge of the members of the committee to
find out the truth.
Dr. Mundy: Allow me to say that I have not said one word about
Gheel. I have simply spoken of the principle, which has never before
been fully discussed. Gheel is a great example; but I have not
brought it forward. I was there for six months, and know it per¬
fectly Well; but my object has been to discuss the principle of
colonization.
Dr. Bucknill: One objection to the appointment of a committee
seems to be that many of our associates have already made up their
minds one way or the other. Dr. Mundy has certainly made up his
mind that seclusion in our asylums is an unmitigated evil; and
that the residence of the insane in the cottages of the poor would
be an immense improvement. Dr. Tuke, on the other hand, thinks
that Dr. Mundy’s proposal to place the insane in the cottages of the
poor, is an absurd and Utopian scheme. Now, I think it would
scarcely be wise to name a small committee with Dr. Mundy and
Dr. Tuke upon it. (Laughter). For my own part, I have given
some attention to this subject for some years. I have had patients
living in cottages for five or six years; and I still continue that
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method. I have about a dozen female patients living in cottages; and
there are also ten men living in one cottage which I have taken for
them, where they go and sleep like ordinary persons. But then, you
must remember that I have 650 patients to choose from. From all
I can see, I should say that the system of placing the insane poor to
live in cottages may be a slight help to the asylum accommodation;
but that you could not go very far in carrying out that system ;
that you would soon be brought up by the characteristics of the
patients—their unsuitability for the system—or by the difficulty of
finding suitable people to take care of them. That is the result of my
experience. It is a most interesting and important question; and it
is one which bears also upon the best plan of building asylums.
There is an asylum now about to be built in a neighbouring county
—a second asylum in Surrey, for 600 patients; and some influential
persons in that county are so convinced that the concentrated system
of asylum building is not the best, that they propose to entirely
constitute the new building of separate blocks. I think it is within
our province to go into all these questions; but whether we should
do so by independent investigations, or by committees, I do not know.
I must own that I see some difficulty with the committee proposed.
Dr. Munro : Allow me to ask what is meant by the cottage system ?
Some gentlemen seem to include in it associated villages for the
insane, while others speak as if they only meant private lodgings for
individuals scattered over the country. I hardly think that we have
a clear notion of what is meant by the cottage system. There is a
great deal to be said in favour of one of those systems, which cannot
be said in favour of the other.
Dr. Mundy: This question was discussed, as Dr. Bucknill knows,
about two months ago, in the Psychological Society of Prance. It
was also discussed at two meetings in Germany, and will be discussed
at another meeting in September. It will be most remarkable if men
of your experience should refuse a discussion of this principle, and
that in England, where, alone, the system of no-restraint is adopted.
Dr. Kirkman: With regard to the question that has been put by
Dr. Munro, I think the general idea of psychologists is, that the
cottage system includes a cottage holding from one patient to twenty.
I have had the honour of being officially connected with Dr. Bucknill
at the Devon Asylum, and I have seen the system there carried out
satisfactorily, up to the number of forty-two. As it appears distasteful
to some members to have a committee appointed to report upon the
subject, would it not be better that those who feel inclined to give
the matter their consideration should supply Dr. Bucknill with papers
on it for the journal. In that way the matter can be brought before
the members who will be able to give it the attention it deserves.
Dr. Tube: If that is the cottage system, I think there cannot be
a better. The number of patients being from one to twenty, which
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Annual Meeting of the Association.
is precisely the number under my own care at the present moment,
I regard that as the ne plus ultra of perfection.
The President: I am sure the meeting will desire to return the
cordial thanks of the Association to Dr. Mundy for his interesting
and valuable paper.
Dr. Bucknill then addressed the meeting as follows:
On certain modes of Death prevalent among the Insane.
Mr. President and Gentlemen, —If it were needful to adduce
any reason for calling your attention to the peculiar manner in which
a large number of our patients cease to be our patients, through
the intervention of that benevolent agency which to the helpless and
the hopeless comes as the “Tod als Freund” of the German artist,
a sufficient reason would I think be afforded by any effort made to
tabulate the results of mortality in asylums as they are recorded in
our annual reports. The character of fatal disease is no doubt much
the same in our various county asylums, and yet the manner in
which the results are recorded in our reports is so different as to
render it impossible to make a satisfactory summary of the mortality
in our asylums collectively.
I hold in my hand the obituary tables of a few asylum reports taken
as they come to hand. The first is that of my friend and neighbour.
Dr. Boyd, which differs from all the others not less in the fulness of
detail with which it is made up, than it does in the peculiarity of the
assigned causes of death. In Dr. Boyd’s report, the interpretation of
pathological appearances, expressed by such terms as arachnitis, cere-
britis, meningitis, myelitis, &c., takes the place of the generalizations
which we meet with in other obituaries. If Dr. Boyd is right in his
views respecting the inflammatory nature of general paralysis and other
forms of brain-disease causing insanity, it must be admitted that his
manner of describing the causes of death is accurate and scientific,
and worthy to be adopted by us as a model for our obituary tables.
But if, as I think, the thickened membranes and the softened substance
of brain and spinal marrow which we so often find in our asylum
necroscopies, cannot be shown to be the results of inflammation, and
can only as yet be recognised as the results of processes of diseased
nutrition, the real nature of which it remains our task to investigate;
then I think it will, for the present, be better to use the generalizations
of the causes of death which we find in most obituary tables. It is,
however, most important that we should not use these generalizations
more largely than we are compelled to do by the present state of
our knowledge, and if our associate to whose obituary table we have
referred, has employed a greater degree of pathological exactness than
we can imitate, it is not, on the other hand, needful that we should
generalize every form of death not readily accounted for by local
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disease under terms having such wide and indefinite application, as to
he almost without meaning.
I have here the report of an able asylum physician, who in an
obituary table of forty-five cases, attributes fourteen, or 30 per cent, of
them, simply to “exhaustion.” Here is that of another who attributes
eleven out of thirty-four to the same indefinite cause. In another
report I find a number of deaths attributed to “ prostration,” which
is perhaps a synonyme for exhaustion; while in other reports the
terms “ gradual decay,” or “ general decay,” appear often to be used
to express the same facts; so that an examination of these obituary
tables leads to the belief than one of the largest classes of which they
are made up is entered in the various reports under very different
headings, and that the death of a patient under identical circumstances
might in the obituary of one asylum be attributed to “ cerebritis,” or
“myelitis ” and in another simply to “disease of the brain,” in another
to “gradual decay,” in another to “ exhaustion,” and in a fourth to
“ prostration.” The fact at the bottom of all this confusion is, that the
insane die largely of forms of disease which are not tabulated in any ex¬
isting systems of nosology. Even when a person suffering from mental
disease dies from some recognised form of bodily disease, from phthisis
for instance, the most frequent form, it is found that the symptoms
of the bodily disease are greatly modified, and its aspect often wonder¬
fully changed; for insanity is not confined to the brain, and, when it
is confirmed, a man becomes a lunatic to his finger ends; literally so, for
scabies will often abound on an idiotic or demental patient without
seeming to touch the blunted sensibility, just as phthisis often ravages
the lungs of the insane without producing cough. The most ordinary
diseases of the insane, therefore, require special knowledge of their
peculiarities, although we have yet to endure to be told that physicians
skilled in the treatment of the insane require the assistance of phy¬
sicians who are not skilled in the treatment of the insane, whenever
they suffer from ordinary disease. With regard to the peculiar forms
of disease here referred to, from which so large a proportion of the
inmates of asylums die, we find that they are for the most part different
varieties of the gradual loss of power of the nervous system, more or
less chronic, in their course; and to which our associates apply the
terms exhaustion and decay in rather a promiscuous and undeter¬
mined manner.
In some of the obituaries both of these terms are to be found, in
others only one of them j thus, in Dr. Robertson’s report, fourteen
patients are said to have died of exhaustion, but not one death is
attributed to any form of decay; in Dr. Wing’s report eleven deaths
out of thirty-four are attributed to exhaustion, and one to old age,
but none to decay. On the other hand, in Mr. Hill’s report, ten cases
are attributed to gradual decay, and five to old age, while only four
are attributed to exhaustion. And in Mr. Cleaton’s report, thirteen
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338 Annual Meeting of the Association.
deaths are attributed to senile decay, while only five are attributed
to exhaustion after mania and melancholia. I cannot, in examining
the tables, find that any discrimination has been used in these terms
exhaustion and decay, though probably the former is more fre¬
quently intended to designate that failure of the powers of life which
rapidly supervenes upon acute symptoms, and the term decay is
used to indicate the more chronic processes of degradation through
which the nervous system passes in several forms of insanity. If the
use of these words is to be continued, no doubt this distinction in
their employment ought to be preserved; but I am strongly of opinion
that one of these terms ought to be disused, and that the other ought
always to be characterised so as to bear a more definite meaning.
The term of which I advocate the total disuse is “ exhaustion,” to
whose indefinite influence we have seen that in some large obituaries
as many as one third of the whole number of deaths is attributed.
Now the manner in which patients suffering from acute mania, die
from exhaustion, is very similar to the manner in which cases of
typhus, or cases of delirium tremens die from exhaustion. There
are the same influences tending to death in both these diseases, and
especially so in delirium tremens ; the same loss of sleep whereby the
nervous system is deprived of the opportunity of rest and repair, the
same deterioration of the nutrient qualities of the blood, and the
same death by syncope, due for the most part to asthenia arising
from exhaustion of nervous energy, but often greatly assisted by
poverty of blood. The mode of death, therefore, both in acute mania
and melancholia, and also in delirium tremens, and in a large number
of cases of typhus, is death beginning at the heart; that is, death by
syncope, the largest factor of which is asthenia. Such is the mode
of death, more precisely expressed than by the vague word exhaus¬
tion. But in obituaries we do not endeavour so much to indicate
the mode of death as to name the remoter cause of death, namely,
the disease which leads to the portals of the dark house. We do not
say that a patient dying of delirium tremens, or of typhus, died of
exhaustion, or even of asthenic syncopy, but we name the disease
which led to this cause of death; and in like manner I urge it upon
the members of our Association to recognise in their obituary
tables, the undoubted fact, that acute mania and acute melancholia,
with persistent delirium exhausting the powers of life, with insomnia
and refusal of food preventing repair, are in themselves bodily
diseases as fatal as typhus or delirium tremens. Let us therefore, in
assigning the cause of death, always give the name of the disease,
though we may choose in addition to it, also to specify the mode of
death. For example, let us say in an instance where the powers of
life have been worn down by the uncontrollable course of acute
mania, that the patient died of acute mania, though we may add that
the mode of death was asthenic syncope; and in those acute cases
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where food has been refused, either from delusion or from the
diseased condition of the gastric membranes, let us say that the
patient died of acute mania, or acute melancholia, adding, if we think
fit, that the mode of death was anaemic syncope from refusal of food.
In support of my recommendation that we should disuse this
vague word “ exhaustion" as a cause of death, I am glad to be able
to cite the authority of the Registrar-General, who always objects to
accept exhaustion as a cause of death, unless the disease which
caused the exhaustion is also specified.
The term “ decay," which is also so much in use in our obituary
tables, cannot in many instances be replaced by any other term,
because it expresses not so much the mode of death as the cause
of death, in the absence of any definite disease to which death can
be attributed. But while I object to the term “ gradual decay "
as the needless employment of an attribute, since all decay must be
gradual, I wish earnestly to solicit the attention of the Association
to the necessity which exists of defining more accurately the various
kinds of decay under which our patients succumb. The only kind of
decay which is usually defined in our tables is that of old age; and
•although this may be taken as the type of all other forms of decay,
it will be obvious from an examination of our tables, that this term
is used to indicate the form of death in a large number of persons of
middle life. By fatal decay, I understand that gradual failure of all
the organic functions which, without the aid of active disease, results
in death which neither begins exclusively at the heart, nor yet in the
brain, but is at once the result of degradation of the cerebral,
spinal, and ganglionic nervous systems, of impaired assimilation and
diminished nutrition; so that watching the advances of death it is
difficult to say whether it invades most through the heart or the
brain. The nature of senile decay, which is the simplest and typical
form of decay, is by no means so well understood that we can con¬
fidently take it to illustrate the various other forms of decay to which
it bears analogy. I myself think that a marked declension of the
function of the nervous system throughout the body is the ultimate
fact in the history of our decline in old age to which all others must be
traced; for although as Dr. Symons points out in his able article on
Age, in the ‘ Encyclopaedia of Anatomy and Physiology/ this defection
of the nervous function is partly the result of diminished force of cir¬
culation and diminished energy of assimilation and nutrition; it must
be borne in mind that these latter functions are themselves dependent
upon the integrity of the nervous function. In the decay of old age
it may be impossible justly to apportion that which is effected by the
lost energy of the nervous function, and by the declension of the
functions of circulation, respiration, and secretion, through thick¬
ening of the capillary walls, or collapse of the cells. All the functions
are so inter-dependent that it is impossible to say where death com-
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Annual Meeting of the Association.
mences to break the circle of life; but the decay of earlier age is
often directly traceable to degradation of the nervous system. Either
that system is congenitally imperfect as in idiots, and prematurely re¬
fuses to discharge its functions; or through the influence of recurring
disease like epilepsy, or through the shock of disease whose active
processes have ceased, as that of past inflammation, the state of
nutrition of the nervous system becomes altered in some manner in
which we can only recognise the gross changes of the bulk and
appearance of the organs. "We see the brain and spinal marrow
diminished in bulk and consistence, and changed in colour; and
we perceive that all its functions fail. All the other organs of
the body may, so far as we know, be healthy; but yet a train of
symptoms commences which very closely resembles those attending
the decline of life from extreme age, and these are the forms of decay
which I wish to recommend our associates to specify more distinctly
in their obituary tables; and I think at least we may distinguish—
i, the decay of idiocy; 2 , the decay of epilepsy; 3 , the decay following
apoplexy; 4 , the decay of dementia; and 5 , the decay of old age.
The decay of idiots is very remarkable. Some of these imperfect
beings appear to arrive at real old age at a time when man scarcely
attains maturity. They become feeble, decrepit, and all their functions
decline, and thus they pass out of existence without any symptom of
positive disease. In connection with this early decay of their stinted
life, a very interesting fact may be mentioned, that in some idiots a
premature maturity may be observed. Idiot children under nine
years of age sometimes exhibit all the signs of puberty, a fact which
may bear some analogy to the premature ripeness of fruit, the growth
of which has been arrested by the tooth of the worm. The idiot child
whose development is arrested by the inability of its defective nervous
system to continue the processes of growth, undergoes those changes
which in healthy children take place when their growth ceases in the
normal manner; these changes, by which the nutritive fluids are
directed into new channels, are those of puberty.
The decay of epilepsy closely resembles that of idiocy, and is often
combined with it. An epileptic may die in various ways; he may die
from coma and asphyxia following a fit, or rather a succession of
fits; he may die from syncope, after a severe fit which has so para¬
lysed the nervous energies that the heart ceases to beat from asthenia;
and he may die from what I venture to call epileptic decay, in which
the fits have no immediate influence in the causation of death. In
these cases the fits, in some manner to us unknown, change the
nutrition of the whole nervous system, the functions of which decline,
and the patient dies deprived of sense and sensibility, in what I
venture to call the decay of epilepsy.
By the decay of apoplexy I wish to indicate those cases in which”the
patient, after having recovered from one or more apoplectic attacks.
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gradually loses first the mental, and then the other functions of the
nervous centres, at a considerable period after the incursion of the dis¬
ease to which these results are primarily to be attributed. Some, but
by no means all of these cases have more or less local paralysis, but
they are all distinguished by that gradual failure of the powers of inner¬
vation, circulation, and respiration, which characterise other forms of
decay. These symptoms are also observed in no inconsiderable number
of cases of chronic insanity in which profound dementia is either the
primary or the secondary form of mental disease; and these deaths
should, I think, be assigned to decay from chronic insanity.
With regard to the decay of old age, I have only further to ob¬
serve that some care is needful to prevent cases being attributed to
it which it has not caused; for it is not uncommon to see patients
in extreme old age, die from an attack of mania or melancholia;
and in such cases it is scarcely needful to observe that the cause of
death is not the decay of old age, namely, the gradual failure of all
the functions, without the interference of active disease.
I have been tempted to add to the above forms of decay that
which is due to general paralysis, but as this disease, whatever its
nature may be, is the actual and efficient cause of death, I think the
gradual failure of all the functions by which such death is brought
about, is more conveniently and properly attributed simply to the
general paralysis itself. The modes of death in this disease are
remarkable and instructive, making for our observation, as they do,
physiological experiments as to the effect of the gradual denervation
or abstraction of nervous influence upon the various functions of the
organism. One of these effects I have not anywhere seen alluded to,
although it produces a most remarkable moae of death. In some
cases, which indeed are rare, but which I have observed several times,
the molecular death of all that we can see of the body appears almost
to precede the systemic death. While the heart still regularly beats>
and the lungs expand, the whole surface of the skin takes the ap¬
pearance of a body so far decomposed that the cuticle peels off at the
sb'ghtest touch, as if from putrefaction. There is no reason why the
whole of the cuticular surface should not die while life still maintains
itself for a brief period in the fortresses of the organism; but these
rare cases of general paralysis are the only instances in which I have
ever observed phenomena which could bear this explanation. That
an amount of mischief to external parts from disease or physical
injury which would be fatal to a healthy organism may be endured
by an organism in which the nervous bonds of sympathy have been
abolished by the pathological changes of general paralysis, is a re¬
markable fact, of which evidence is not wanting in the frightful mor¬
tifications which sometimes occur in general paralytics, without pro¬
ducing any of those secondary symptoms which would undoubtedly
arise with fatal readiness if such an amount of injury were inflicted
vol. viii. 23
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842 Annual Meeting of the Association.
upon the soft tissues of a healthy subject. It is well known that in
the lower classes of the animal kingdom in which the nervous system
is little developed, an amount of mechanical injury to the limbs and
soft parts which would inevitably be fatal to the higher classes, will
be endured without producing much constitutional effect. Some
reptiles, for instance, will bear injuries with apparent immunity, which
would quickly destroy birds or mammals. Now general paralysis,
which gradually deprives a man of the benefit of a nervous system,
seems to place him for a time in the position of those animals which
have nervous systems of a simpler nature, and to grant him for a
time their immunities from the painful, and often, destructive im¬
pressions which can only be inflicted when the nervous system is in
its perfect state of sensitive sympathy.
The President: I am sure we are much obliged to Dr. fiucknill
for his interesting address. I confess that when he was turning his
statistical returns over, and complaining abont the frequency of the
term “ exhaustion," I was very much afraid he was about to refer
to my own returns ; for I confess I have very frequently assigned
that as the cause of death.
j Dr. WiUiams ; I wish to make one remark with regard to disease
of the brain, not always connected with insanity, but which is con¬
nected with it in many cases* Andral made the observation long
ftgo, that the patient does not die of disease of the brain; mid you
will find that the person dies from extensive sloughing, and from
Jesuits of the original disease, not from the disease itself. I have
a patient at this monlent who has sores as large as two or three
hands, in different parts of the body, and he is dying from the irri¬
tation occasioned by these sores, not, I believe, from the disease of
his brain. The remark which Andral made with regard to common
diseases of the brain, is, I believe, applicable also to those connected
with insanity.
Dr. Davey: It occurs to me, from the remarks which Dr. Bucknill
has made, that there remains much for us to do if we would be
exact in the employment of terms intended to convey the cause of
the death of our patients. I think that the matter is not so easy as
Dr. Bucknill, from some remarks that he has made, would have us
believe. It is not always in our power to reach the diseased struc¬
tures. Patients will die after a long course of illness. You examine
the brain and the internal viscera very attentively, but you find no
pathological appearances to account for death. The prominent
Symptoms may have been the general exhaustion of the vital
powers, and you naturally put down “ exhaustion" as the cause of
death. Having for a number of years kept the particulars of the
deaths of patients at the Hanwell and Colney Hatch Asylums, where
the deaths were very numerous, I was obliged from necessity to put
down “exhaustion" or "general debility," as most expressive of the
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Original Communications. 343
cause of death, and a reference to the reports of these large esta¬
blishments will show that to be the case. Taking the hint conveyed
in Dr. BucknilTs remarks, I think it would be well if the causes of
death in our reports were divided into proximate and remote. Some
such arrangement as that might bridge over the difficulty which has
been brought to our attention, and render our accounts of death
more accurate than they now are.
The President: I have now to call upon Dr. Mauddey, for his
paper On Asylums foe the Insane among the Middle Classes.
Dr. Maudsley said there would be hardly time for two papers,
and he desired to withdraw the one he had prepared, in order to
afford Dr. Robertson an opportunity of bringing forward the subject
of Utilisation of Asylum Sewage, in which the members would
be more generally interested.
Dr. Robertson : I do not propose to trouble the meeting with a
paper on this subject, nor have I prepared one, but I have brought
with me a ground plan showing the method by which this system of
sewage irrigation has been employed at Hayward's Heath. I have
also asked the engineer, Mr. King, who was introduced to me by
Mr. Mechi, to attend here, that he may answer any questions members
may desire to put to him on the subject.
Last spring, one of our visitors called my attention to the im¬
portance of making use of our sewage, if I could find out any
mode of doing it. I wrote to Mr. Alderman Mechi, who kindly
sent me his book upon the subject, and did me the greater favour of
introducing me to Mr. King, with whom I put myself in communi¬
cation. Mr. King went over our grounds, and made us a tender
at a very low rate, viz., £3 an acre (including every expenditure), for
which he was to apply the sewage, and we were not to pay him
unless we were satisfied with the work. Mr. King has now applied
the sewage to eighteen acres of grass land. Of course, the asylum
sewage offers many advantages. In the first instance, it is properly
diluted, and it is not of that powerful nature which town sewage is,
because we use more water, and are cleaner than people in towns.
Another advantage is, that there is no unpleasant smell from asylum
sewage. (Laughter.) If gentlemen would walk over our fields,
they would hardly know that it was not clean water going over the
ground. By receiving the sewage, which comes down in a limited
quantity, into an open tank, and making use of nature's own deodo¬
riser, earth, and putting vegetable matter and other refuse from the
garden into the tank, the smell is entirely removed. There it is
with all its fertilising qualities, phosphates in solution, and ammonia
in combinations, ready to flow across the land free from all smell.
Mr. King's principle of applying it to meadow land, assuming that
he has a reasonable fall, is to divide the land into so many chains.
The sewage is introduced at the top of the field, and by a very slight
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344 Annual Meeting of the Association.
manipulation it is made to run over one square chain, and then
over another, as shown in the ground-plan which I hand round. Any
man, with a few hours' instruction from a person who understands
the work, can easily undertake this irrigation. We have an old man
who does it for us for 2s. 6d. a week. He takes one square chain
of grass, and then another, and so lets the sewage gradually, bit by
bit, fall over the whole surface. The sewage is conveyed in two
divisions, one from the male and the other from the female side of
the establishment, the latter being the better sewage of the two, in
consequence of the products of the laundry including the soap
and other materials. We have one pipe going into a field of four
acres, and another to a field of eight acres; it is on the former that
our operations have been principally conducted this year. The
sewage has been flowing on the field since March, and the result is
that, since the 30 th of April, when we first began to cut the grass, we
have fed fifteen cows solely from it. In the five subsequent weeks
to the 30th of April, these fifteen cows, thus fed from the cuttings of
these four acres sewage meadow, yielded £80 worth of milk,
valuing the milk at 1*. per gallon.
The field was formerly in a very miserable state, the whole farm
being little better than moor land; a heavy clay soil, very much
neglected, having no manure, and no drainage of any kind. The
result of our first six months' experience of this sewage irrigation
is, that we have all the summer been feeding our fifteen cows off
these four acres of irrigated meadow land.
Dr. Campbell: What is the return per acre? .
Dr. Robertson: I do not know the tonnage per acre, we have cut
it as we went along.
Dr. Davey: How much milk have you obtained from the cows ?
Dr. Robertson: Fifty gallons a day, and £80 worth in the first
five weeks. We have been found fault with for overstating the quan¬
tity of milk, but I can say that the first week our butter rose from
fifty to seventy pounds. The first day the cows would not eat the
grass, and the only way we could get them to eat it was to put them
on a*night's fasting. The next morning they began, and have since
eaten it very steadily. Our crop of hay was so heavy that the
mowers would not face it, and instead of paying 4 s. 6 d. for our
mowing, which is the ordinary price of mowing in our county, we
have had to pay Is. 6d.
Dr. Bucknill: With regard to the quantity of grass cut under the
system of sewage irrigation, I may say that I have sold grass at £1
per ton, and I received £14 per acre for it; that was the first week
in May, and I had a good crop of hay afterwards.
Dr. Robertson : I omitted to mention that the sewage water, after
passing over the field, is so beautifully filtered, that I am sure you
would drink it for spring water if it were put on your table. In the
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Original Communications. 345
Essex Asylum, on the other hand, the magistrates put up a large
filter to stop the solid part of the sewage, and let the water pass
through, acting upon what Mr. Mechi considers quite a wrong prin¬
ciple; and at the Worcester Asylum I saw a similar contrivance.
The result is that they have nothing to show in the way of improve¬
ment of grass-land. I do not know whether Dr. Campbell can give
us any account of that said filter.
Dr. Campbell: I must be allowed to dissent from Dr. Robertson.
Unfortunately, we are not all provided with such admirable falling
slopes as Dr. Robertson. I am perfectly aware that in the Sussex
Asylum, all the farm falls from the house, aud consequently there is
very little expense incurred in throwing the sewage over the farm;
but if you make the sewage flow on flat land, where you have no
such fall, I am afraid the results would be very different. I think
I see an asylum superintendent here who is one of our most practical
farmers, and I believe he will tell you, what I can tell you, that
where the whole machinery has been purchased by farmers for the
purpose of using the fluid manure, they have converted that machi¬
nery afterwards to other purposes. With regard to Mr. Mechi's
system, I think any one who reads the return that appeared in the
‘ Times 1 newspaper, will say that the scheme can never pay a farmer
who has to pay rent. It is very well for Mr. Mechi, who makes
thousands of pounds a year by other means, to experiment in that
way, but he has never shown us any satisfactory result on Tiptree
Earm. I should like to hear the experience of the Superintendent
of the Derby Asylum upon this system of fluid manure, because I
have more confidence in his judgment, as a practical farmer, than
that of all the superintendents of asylums in England.
Dr. Hitchman: If I felt reluctant before to address the meeting,
I feel still greater reluctance after the eulogy which has been passed
upon me by Dr. Campbell, in reference to my knowledge as a practical
farmer. I can, however, endorse, as far as my own experience goes,
all that he has said in reference to the value of liquid manure upon all
ordinary farms, unless there is something special in the slope, by
which you can keep the irrigation at a constant flow, and then with
certain kinds of grass, especially the Italian rye grass, you may get
something like the profits which have been stated. I do not think
that any ordinary grass would flourish for a long time upon that
kind of sewage. The Italian rye grass will for three years produce
large quantities, realising immense profits, and enabling you to feed a
large number of cows; but unless you can keep up a continuous and
rapid flow, the result would be disappointment. As far as regards
the liquid sewage of the Derby County Asylum, I wish from my
heart that I could make Dr. Robertson a present of it.
Mr. Sanlcey: At the Oxford County Asylum, the whole of the
land, amounting to about twenty-four or twenty-five acres, has been
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846
Annual Meeting of the Association.
treated in this way. The land is excessively uneven, and all the
sewage has been turned on by the patients, with one or two skilled
persons to look after them. The ground has been altered in its level,
and the whole of the sewage from the asylum, containing 500 patients,
is used on the land. There are several different levels and flats,
and when the sewage cannot be used upon higher grounds, it is
allowed to run into cesspools, where it is mixed with the refuse
ashes and clay, for we are obliged to mix clay with the ashes on
account of the soil being very light and sandy, then it is allowed to
run down upon the lower level, and in that way we can run it upon
the grass-land, but it requires a considerable amount of filtration
before that is accomplished. After filtration it is very valuable, and
we have had some very fine crops.
Dr. W. P. Kirlcman : As Dr. Robertson has stated that the cows
would not eat the grass, I should like to know whether he took the
trouble to ascertain the chemical composition of the milk, as that is
a matter of great importance.
Dr. Robertson: I can only say that I have used the milk freely
myself.
Dr. W. P. Kirlcman : I should also like to ask whether ammo-
niacal gas liquor has been used, as I have been told that this pro¬
duct from the gas-works is a good manure for pasturage when largely
diluted, and produces very large crops. I have 103 acres to experi¬
ment upon, and I think, in addition to carrying out Dr. Robertson’s
suggestions, I shall try the gas liquor.
Mr. Sankey: With regard to the cattle not eating the grass, I
think it has arisen from the grass having grown a little too rank, and
the liquid manure supplied to it being too strong. I have found
that to be the case in several instances. It has been only when the
liquid manure has been supplied in too concentrated a form that the
animals would not take it.
MR. WARWICK’S MOTION.
The President: I have now to call upon Mr. Warwick to bring
forward a motion of which he has given notice.
Mr. Warwick: I find myself placed in a situation of some diffi¬
culty, because, in the first place, the motion which I have to propose
is in some degree a personal matter, and in the next place it will
Seem like throwing the apple of discord into what has hitherto been
a very agreeable and pleasant meeting. My motion is :—“ That a
sub-committee of this Association be appointed to inquire into the
proceedings of the Commissioners in Lunacy with regard to the
licensing of private asylums in the metropolitan district.’’ I appre¬
hend that this Association takes cognisance of all matters that
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Me. Warwick's Motion.
347
relate to asylums, and to the status, and position, and interest of
medical men concerned in the treatment of the insane. I cannot for
a moment imagine that because a large number of members here are
connected with public asylums, therefore they will look with indif¬
ference or coolness upon the interests of those members who have the
misfortune in some cases to be connected with private establishments.
(Hear, hear.) The members present are probably aware of the slight
difference that exists in the mode of licensing private asylums
throughout the country generally, and asylums in the metropolitan
district; you are aware that the application is the same in both cases.
You send in your plans, with a list of your patients, and so on. In
the case of the county asylums, that is read before the magistrates in
quarter or general session, in public open court j you are at liberty
to have your counsel present if you like, and if any objection is made
to your license it is generally made publicly; at any rate, if your
license is refused, you know the reason why. In the metropolitan
district no such rule holds good; you send in your application in .
the same way, but it is considered in secret, debated in secret, and
you have no opportunity of being represented; any kind of accusation
may be made against you; the decision is secret, and it is irrevo¬
cable. It seem3 to me that that is a state of the law which requires
some amendment. Why should not proprietors of private asylums
in the metropolitan district enjoy the same advantages that pro¬
prietors enjoy in counties generally ? Perhaps an example will tell
more than a very long story, and although I am the subject of the
example which I am about to relate, I must beg your kind attention
and indulgence; because if I adduce it, it is not that I wish the
Association to take up any personal quarrel of mine, it is simply
that I can speak truly on the matter, being thoroughly conversant
with the circumstances to which I am about to refer. Two years
ago I was looking out for a small asylum in the metropolitan
district. In March, a gentleman who had a small asylum came to
me j he had incurred the censure of the commissioners for a purely
private and domestic matter, in no way relating to his patients, of
whom he had but two, a middle aged lady, and an elderly gentleman.
For that private matter, the commissioners took away his license,
and not content with that, they wrote to the friends of the patients,
advising their immediate removal before the time of the license had
expired. That gentleman asked me to take his asylum off his hands.
Seeing that his patients were then under compulsory removal, any¬
thing like goodwill or purchase-money was out of the question, he
asked nothing, nor should I have given anything j he merely asked
me to take the lease off his hands, and to buy his furniture and
fixtures at a valuation, and to repay some little expenses he had been
at in fitting up the house. There was no question, therefore, of
purchasing the asylum as such. Before I entered into negociations
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348 Annual Meeting of the Association.
I applied to the Commissioners in Lunacy to know whether, in the
event of my taking the asylum, they would grant me a license; in
return, I had an order to attend the meeting of the board. I went,
and was asked many questions relating to this gentleman who wished
to part with the asylum, but none respecting myself. They did not
inquire into the matter of the intended purchase, but asked me many
irrelevant questions, all connected with the gentleman leaving the
place, not as to myself about to take it. They then told me they
would send me an answer; some few days afterwards I received an
answer from them, in which they said that they should feel it their
duty to decline granting me a license to that establishment. Now,
when I made the application, I had had seventeen years’ experience in
lunacy practice connected with a large public establishment, and ten
years of that had been under the jurisdiction of the Commissioners
in Lunacy. During the whole of that time I am not aware that any
kind of complaint was made against me; I know I never incurred
any kind of censure or reprimand; I uniformly received favorable
and sometimes laudatory reports, and I cannot charge my memory
with having one single dispute with the commissioners. Yet sud¬
denly they, without assigning any cause, refused my license to an
already existing establishment, which I was anxious to take. I have
applied to them from time to time for an explanation of their conduct,
and sought some reason for their refusal, but, up to the present time,
I have been unable to obtain any kind of satisfaction whatever; they
replied that it is not their custom to state the reasons of their de¬
cisions, and that is all the answer, and all the satisfaction I can
obtain; so that I find myself, at the end cf nineteen years’ expe¬
rience in lunacy, during which time I have never incurred any blame
or censure, suddenly compelled to give up my practice in the metro¬
politan district, and to refuse many patients who, from previous
acquaintance, would have been placed under my care. I am actually
excluded from my profession—it virtually amounts to that, so far as
the metropolis is concerned, and that without any kind of reason or
statement being made in explanation. Now, surely, this is some¬
thing like tyranny; it seems very hard, after many years’ practice,
that a man should be virtually shut out of his profession merely
because a secret tribunal, giving no reasons for their conduct, choose
to say that he shall not practise. I really have not in any way
over-stated or exaggerated the case. I have been told that the
commissioners are anxious to reduce the number of private asy¬
lums in the metropolitan district, thinking there are too many of
them; that may be, or it may not; it would lighten their labours
to have fewer, but that has nothing to do with the question;
the public have a right to choose their own medical attendants,
and if insanity be a disease, surely A, B, or C, the friends of the
insane person have a right to select any medical man they wish to
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MICHIGAN STATE UNIVERSITY
Mr. Warwick’s Motion .
349
attend their own relative. If a man is duly qualified, and there is
no objection to him in character or status, it is a harsh proceeding
on the part of the commissioners to exclude that man from practice.
I really do not know any reason for the course they have adopted,
unless it be that the Commissioners in Lunacy are strongly opposed to
what may be called the Metropolitan Cottage System—that is, the
system whereby the patients are placed in private houses in the neigh¬
bourhood of the metropolis. Lord Shaftesbury, in conversation with
me some three years ago, expressed the strongest abhorrence of the
system, and he told me that if any relatives of his became insane, he
would rather place them in any common lunatic asylum than in any
one of these pretty metropolitan villas, scattered round London,
attended by eminent medical men. It is certain that thi& refusal to
license is only perpetuating that system. The anomaly is this, that
although you cannot have two persons in one house without a license,
you may have fifty detached in separate houses. So that by refusing
to license a properly qualified person, the commissioners are only
increasing what has been stated to be a very great evil. I am,
therefore, utterly at a loss to account for their conduct in any way.
I know no private, and I can see no public reason for their pro¬
ceedings. But you will ask me what remedy do I propose? I
propose that a sub-committee be appointed to consider the circum¬
stances, and, if expedient, to draw up a petition, which might be
presented to parliament, in the event of the bill—the Amended
Lunacy Act—being brought before the legislature. I apprehend
another session will not pass without something of the sort being
done; and I think a petition from this Association would have
weight. I only go to this extent, that the commissioners should
license in the metropolis in the same way as is done by the county
justices; that the application should be made in open court; that
counsel should be allowed to attend; and that if the commissioners
refuse, they should state their reasons. This does not seem to be
an exorbitant demand; and it is only placing proprietors in the
metropolitan districts on the same footing as those in the provinces.
I beg you will excuse me for having taken up so much of your
time. So anxious am I that this subject should be considered on
grounds of merit only, and not as a personal matter, that I have
abstained from seeking a seconder to this motion, and trust to the
generosity of this meeting to find me one, if they should think this
is a matter worthy of their consideration. I cannot but think that a
temperate agitation of this subject, and the presentation of a petition
to parliament, might relieve us from what seems to me to be a very
harsh method of jurisdiction.
The President: Before I ask whether any gentleman seconds this
motion, I may be allowed to make one remark. I am quite sure
that the medical officers of county asylums have no invidious feeling
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350
* Annual Meeting of the Association.
towards private proprietors; indeed they consider their interests
identical. (Hear, hear.) This, however, is a delicate question,
which may require careful attention.
The motion not being seconded, fell to the ground.
Dr. Campbell: As Mr. Warwick has brought this subject before
the meeting, it is only due to him to say, after the statement he has
made, that we quite enter into his feelings; but we should be placed
in a very awkward position as medical men connected with asylums,
if we took upon ourselves what he proposes, and were to address our
views to the Commissioners of Lunacy.
Mr. Warwick: Not to the commissioners, but to parliament.
Dr. Campbell : I think it would be even more indelicate to go to
parliament with any complaint from us, reflecting upon the com¬
missioners.
Mr. Warwick: It does not reflect upon them. It is a simple
request that the proprietors in the metropolis, as regards licenses,
shall be placed on the same footing as proprietors in the provinces.
Dr. Campbell •* I only felt it right to state why we declined to
enter into the subject. I think we cannot do it, out of respect to
the Commissioners of Lunacy; that we should be exceeding our
position in addressing them, or addressing parliament regarding a
matter of which we have only heard from Mr. Warwick, and in
which we are in total ignorance as to all the facts.
Dr. Davy: I agree with Dr. Campbell in his remarks with refer¬
ence to this resolution. I do not think that we, as an Association,
are in a position to inquire into the proceedings of the Commissioners
of Lunacy in this matter. It is not our place, and certainly it will
not be to our profit to do so. What is left to be done by us as a
body is just to bear in mind the facts which have been placed before
us by Mr. Warwick, which are very important; and let us hope that
an opportunity will one day offer, when this revised law is brought
into operation, to go through it carefully, and, at a subsequent period,
enter our protest against this, that, or the other, taking care, so far as
we are concerned, that some clause shall be inserted that would meet
the difficulty which has been explained to U3. We might, as indivi¬
duals, or as a corporate body, bear the evil in mind, and work
through the difficulty, but at present, I think, we cannot undertake
the responsibility which has been suggested to us.
DR. FLYNN'S RESOLUTIONS.
The President: The next business is the resolution to be pro¬
posed by Dr. Flynn.
Dr. Robertson : Unfortunately, all our Irish members are absent,
as the asylums in Ireland hold their monthly meetings on the first
Thursday in the month. Dr. Flynn has entrusted to me a series of
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351
Dr. Burnett's Observations on the Idiot Asylum.
suggestive resolutions. He does not Wish to tie the Association to
his words, but his object is that some public acknowledgment should
be made to Sir Robert Peel for the great firmness with which he
dealt with and settled the question of the position of the resident
physicians in Irish asylums. He simply wishes that the Association
winch addressed Sir Robert Peel last year on the subject, should now
make some acknowledgment of its thanks. I would, therefore, as
Dr. Flynn's mouthpiece, propose that the Secretary of the Associa¬
tion be desired to express to Sir Robert Peel their sense of the
courteous consideration he has given to the communication which
was made to him by a deputation of the Association last year at
their meeting in Dublin, and their extreme gratification, generally,
with the rules which he has promulgated for the government of the
Irish asylums, and which have been assimilated, as far as circum¬
stances would permit, to those of England; which was what we
asked him to do. What the Association asked Sir Robert Peel to
do has, in fact, been done by him; and I have no doubt that the
deputation who waited upon him was the cause of the new reso¬
lutions that have been adopted. Sir Robert Peel, I am told, has
done all this in the face of considerable opposition on the part of
the privy council in Ireland.
Dr. Stewart: I beg to second the motion. I am quite aware
that Sir Robert Peel has carried his measures after very great oppo¬
sition ; and if he had not been very energetic and anxious about the
matter, he would not have succeeded.
DR. BURNETT'S OBSERVATIONS ON THE IDIOT
ASYLUM.
Dr. Burnett: I do not know that I have a right to detain the
meeting, as I have not given formal notice of the observations I
desire to make. But I asked the favour of being allowed to say a
word or two, if there should be time at the end of the meeting.
The subject is one which really involves the interests of the private
proprietors of asylums in this country, and I think it will eventually
involve even more than it does at this time. One or two cases have
occurred to my mind since I have been here, bearing upon the point
which I wish to bring forward. I will not propose any formal
resolution, but merely ventilate the subject, so as to ascertain the
opinion of the meeting.
I was consulted about nine months ago about a case that
was to be committed to my care by some private connections
of my own. The case was that of a child who had become idiotic
in consequence of a slow scrofulous inflammation of the mem¬
branes. It was agreed that the child was to be admitted into my
establishment, and every arrangement was made for the purpose. I
had even engaged a nurse, and done everything that I thought was
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352
Annual Meeting of the Associationr
necessary. I afterwards received a letter from her father, telling
me that he had been to Brighton, and had there met with some person
who had recommended him to place his child in the Earlswood
Asylum. I said nothing more about the matter ; I did not want
to enter upon any discussion, and I did not condescend to make any
reply to the father, beyond telling him that I had no doubt the
resolution he had come to was the result of his own careful delibe¬
ration. But afterwards I thought—for thoughts will cross one’s
mind on these occasions—upon the time when the asylum was first
established. Amongst the number of persons applied to when they
wanted to get up the public interest in so philanthropic a cause, I
was one, and I received a letter from the late Dr. Bead, requesting
that I would go and advocate the cause of the idiot. 1 did so ;
and also gave my subscription. I continued to do the same for
some years, until I found that the institution was sufficiently esta¬
blished, and, after that, I, of course, withdrew my subscription. This
asylum has been erected by the public purse. It is, in fact, an
eleemosynary establishment, founded by the agency of men like the late
Dr. Bead, who have held public meetings and obtained subscriptions
for the purpose. The asylum is built; and the public have an idea
that it is erected solely and entirely for helpless idiots—a class of
persons that are pressing round our asylums ; for if we had an idiot
asylum for every comity, we should not be out of our proper ratio
compared with the number of the population; because there are a
thousand idiots in a population which is exceeded by that of most
of our counties. Under these circumstances, what room can there
be in an isolated idiot asylum for the reception of persons who are
quite capable of keeping patients in a very different position, for
these were people of property ? I ask whether it is just that patients
under these circumstances should be admitted, or that any terms
should be made to receive them into such an asylum ? It may be a
difficult thing to determine: at the same time, I think, if we look at
the justice of the matter, it is not right to draw subscriptions from
the public under the impression that they are supporting the poor and
helpless idiot, when, in fact, they are only furnishing good apartments
for the education of rich people. I think some steps ought to be taken
in the matter, or, at any rate, that publicity should be given to it.
I do not want to make any stir. I do not wish my name to appear
in the matter in the journals of the day, but I certainly think that
the opinion of so large a meeting of our brethren as this is, should
be taken as to whether that is a right course to pursue, or a wrong one.
The President: I believe the subject you have brought forward
has been under discussion in other counties. I have myself heard
it discussed in Essex, and in Suffolk, but only in the way of ordi¬
nary conversation. No doubt there are abuses; but whether we
can take cognizance of them here is another matter.
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Vote of Thanks to the President (Dr. Kirkman).
353
VOTE OF THANKS TO THE PRESIDENT AND FELLOWS
OF THE COLLEGE OF PHYSICIANS.
Dr. Bucknill: I am sure that we all have one feeling with regard
to the courtesy and liberality of the College of Physicians in
grantingus the use of their noble rooms on the present occasion. I
am happy to have observed. Sir, so large an assemblage of our
members, not only to grace your presence in that chair, which you
so admirably fill; but also to grace this building, which I felt it
was rather an ambitious thing even to think of coming to. That we
have been permitted by the first of British medical institutions to
occupy the greatest and most famous of the Collegiate buildings
connected with the profession, is a subject of congratulation; and
calls for an expression of our best thanks. I beg to propose that
the best thanks of this Association be conveyed to the College of
Physicians for the use of the College rooms, for this meeting; and
that Dr. Munro be requested kindly to convey the same. In asking
Dr. Munro to convey our thanks, instead of allowing them to go
through the ordinary channel of our Secretary, I do so because of the
very distinguished position which he holds in the Corporation whose
house we occupy; and because we feel proud in having so eminent a
member of the College of Physicians among our associates.
The motion having been seconded, was unanimously adopted.
Dr. Munro •• I feel exceedingly obliged by this vote of thanks, which
has been paid to the College of Physicians; and in some measure
directed off towards myself, because of the happiness I enjoy at the
present moment of occupying a post amongst the physicians of the
College. All I can say is, that I shall do my best to get these
premises offered to you again next year; and I believe I shall be
successful. I would take the opportunity of saying that I feel I have
not hitherto sufficiently appreciated the importance of this association.
I hope in the future, if I am spared, that I shall not be a mere silent
member; but be more active in it than I have hitherto been. The
Association has my most cordial regard, and wishes for its success;
and I hope I may be the means of assisting it in a humble way; and
if one means of aiding it is the exercise of that little influence which
circumstances have at the present moment given to me, I shall be
truly pleased.
VOTE OF THANKS TO THE PRESIDENT (Dr. Kirkman).
Dr. Bucknill: We cannot allow you. Sir, to leave that chair,
without giving you the best thanks of the Association for the ad¬
mirable manner in which you have filled it.
Dr. Burnett •• I beg to second this vote of thanks to our President.
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854
Annual Meeting of the Association.
It gives me great pleasure to see my old friend. Dr. Kirkman, in the
chair; for, I believe that honour has fallen upon one who really
deserves it. One who has spent his life in this cause; and who now,
in the days of his honoured age, comes to us, to guide us by his
counsel, and give us the benefit of his wisdom; a wisdom which, I
feel confident, far transcends that of many whom we are too apt to
follow.
The vote of thanks was carried by acclamation.
The President: I can but very imperfectly return you my thanks.
My great regret is that I have not been able to fill the chair more
ably than I have done.
DINNER.
The annual dinner took place at the Star and Garter, Richmond.
The dinner was everything that could be desired. Dr. Paul acted as
steward of the feast. The party numbered thirty-five. Among the
guests were: Dr. Pitman, Registrar of the Royal College of Physicians;
Dr. Tweedie, Dr. Markham, John Churchill, Esq., Dr. Llewellyn
Williams, Dr. Edward Hart Yinen, Dr. Salomon (Sweden), Dr.
Brown (New York), &c. &c. The following members were also
present: Dr. Kirkman, President; Rev. J. Kirkman, Dr. William
Kirkman, Dr. Mundy, Dr. Sibbold, Dr. Eayrer, Dr. Bucknill, Dr.
Paul (steward of the dinner), Dr. Wood, Dr. Christie, Dr. R. H. H.
Sankey, Dr. Campbell, Dr. H. Tuke, Dr. Robertson, Dr. H. Stevens,
Dr. Wing, E. Toller, Esq., Dr. Davey, H. Jacobs, Esq., Dr. Boyd,
J. Warwick, Esq., Dr. Rorie, Dr. Stilwell, Dr. Burnett, Dr. Lowry,
Dr. Maudsley, Dr. Eastwood.
Dr. Watson, President of the Royal College of Physicians, was
prevented from accepting the invitation of the Association.
Dr. Robertson has received the following communications relating
to the business of the meeting.
Rotal Edinburgh Asylum for thk Insane ;
July 9, 1862.
Mv dear Dr. Robertson, — I beg to acknowledge your favour
of the 7th, informing me of the very unexpected and very gratifying
honour conferred upon me by the Association of Medical Officers of
Asylums in electing me President for next year. My clinical class
has heretofore prevented me attending the meetings or entering into
the business of the Association with that interest which I feel. I
had, therefore, not the remotest reason to anticipate such an honour
as being your President; and hope, therefore, that I may now be in¬
cited to use all my energies to make up for my past deficiencies by
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Letters on Irish District Asylums. 355
renewed efforts for the future in supporting the objects of the Asso¬
ciation.
I am.
My dear Doctor,
Yours very truly.
Dr. Skae.
Dr. Ci L. Robertson.
Dublin Castle ; July 25, 1862.
Snt,—I have to acknowledge the receipt of your letter of the
23rd instant, with its accompanying resolution passed at the annual
meeting of the Association of Medical Officers of Asylums for the
Insane, relative to the recent rules promulgated for the government
of the Irish District Asylums.
I am. Sir,
Your obedient servant,
William Lawson.
C. L. Robertson, Esq.,
Sussex Lunatic Asylum, Hayward’s Heath.
Whitehall ; August 5,1862.
Sir, —I am in the receipt of your letter of the 2nd, and am obliged
to you for the opportunity you have afforded me of giving expression,
in less formal terms than can be conveyed in a dry official acknowledg¬
ment, to my warm appreciation of the unanimous approval by the
superintendents of asylums in this country of the rules recently pro¬
mulgated by the Irish government for the better management of the
District Lunatic Asylums in Ireland; and I rejoice to find that our
views on this subject have been endorsed by so practical and influential
a body as the Association which you have the honour to represent.
I am. Sir,
Yours very faithfully,
Robert Peel.
C. L. Robertson, Esq.,
Hon. Sec Association of Medical Officers of
Asylums for the Insane.
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356
Middle-Class Hospitals for the Insane.
Middle-Class Hospitals for the Insane.
By Henry Matjdsley, M.D.
A little more than a year ago a public meeting was announced as
having taken place in this metropolis for the purpose of establishing
a “ Benevolent Asylum for the Middle Classes." Though many were
without doubt pleased with the project of so useful an undertaking,
it appears that the vast majority of the public regarded it with great
indifference. Bor, from time to time, an advertisement in the papers
—a doleful and undignified document—has complained of the want
of support, begged for further aid, and reminded lately the public
that the amount subscribed for the Hartley Colliery Fund over and
above what was wanted, would have been more than sufficient
to have started the benevolent asylum. The public indifference
must be the result of public ignorance ; for we well know that when
the heart of the country is touched, its sympathy and help are given
in a profuse and practical manner. * To elicit such aid, however,
there must be a reasonable and well understood end in view; and
the question is, whether the promoters of this proposed asylum have
given a clear idea of what they want, of what they propose to do,
and of the way they propose to do it.
As the commissioners have the power of obtaining information
from any lunatic hospital or asylum, they would be doing a
service by supplying us with a concise and faithful account of the
various asylums which have been founded and are conducted on the
benevolent principle. Thereby they might succeed in dissipating the
doubts of the sceptical, in interesting the indifferent, and in fortifying
the faith of friends.
It seems to admit of no question, amongst those who have a
knowledge of the matter, that some provision is yet needed for those
insane who are poor, but not poor enough to be paupers. Many
cannot pretend to pay what would be necessary for their admission
into a private asylum; and others, who by the utmost shifts contrive
to do so, do it at a sacrifice which cannot be justified, save by its
necessity. In the latter case it often happens that those who are
growing, and have to take their places in life, are deprived of
important advantages for the sake of one who is perhaps for ever
dead to the world. Now it is plainly bad philosophy to expend
power on a dead past, and to starve the future of power, and, there¬
fore, bad policy on the part of society to put any man in the posi¬
tion of being obliged to do it.
The resource which is afforded by the few county asylums which
do admit these unfortunately placed insane on payment of the usual
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857
hr/ Dr. Henry Maudsley.
charge for maintenance, is but a partial, uncertain, and ineffectual
remedy; nor is it by any means certain that even when there is
room in the county asylum, it is advisable to admit private
E atients. Passing by other grounds of objection which might well
e urged against such a course, it may be maintained on just
principles of treatment, no less than on amiable grounds of benevo¬
lence, that it is not well to place any one who has become insane in
very different social conditions from those of his or her former life.
If it be most dangerous, as it certainly is, to the mental health of a
sane person to be placed in entirely changed external conditions,
without his inner lue having been gradually adapted thereto, how
much greater must the danger be to the unsound mind which has
lost that very controlling force of reason whereby it might adapt
itself to the unwelcome change. To demand such an adaptation
from the diseased mind is to put a strain on the cracked links of
reason which they will scarce bear when quite sound. And that is
really to begin treatment on the homoeopathic principle of doing
that which would be most likely to produce the disease in a sound
person. County asylums have been built with a certain design, and
the accomplishment of that design must be their duty. However
valuable, then, their assistance may be as a temporary expedient, they
cannot be considered as affording a permanent provision for the poor
insane who are not paupers. It would scarcely be just, as it would
certainly be unfeeling, to insist on every family making provision for
the contingency of this most expensive of diseases. We must
remember that many of those who become insane never recover, and
of those who do recover, many sooner or later relapse. Moreover,
the patient cannot be kept at home as in other diseases, but must be
sent away to be treated at a great expense. Society insisting on
this for its own protection, must rightly accept the responsibility
which accompanies such an exercise of power ; and, without question,
he who bylosing his reason,is forced to relinquish his rights as an active
being, claims his human rights as a suffering being, and if the affliction
cannot be grasped in the arms of family benevolence, it must be em¬
braced bvthelargerarmsof humanity. With greater power comes greater
responsibility ; and the correlative of those higher faculties by which
man surpasses other animals is the moral duty to do, in the struggle
for existence, exactly the opposite of what the animals do ; in place
of crushing out its weakest members it is the bounden duty of the
human kind to take care of them. When, therefore, the friends of
the insane cannot send them to a private asylum, and these cannot
be admitted into the county asylum, and are not fit to be at large,
the public must do one of two thongs—either subscribe money
enough to keep such cases in a private asylum, or build a suitable
public asylum for them.
Of the two expedients it will evidently be better to adopt the last,
vol. vm. 24
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358
Middle-Class Hospitals for the Insane ,
because, amongst other things, if rightly carried out, it affords a
means of throwing the burden of the poor insane to some extent
upon the rich insane. The proprietor of a private asylum cannot be
expected to receive any patient at a price which will not be profitable
to him; and he can scarcely, therefore, admit at a lower rate than
£1 1$. a week. Now and then, perhaps, when there are a few
vacancies, he may admit one or two even at 15$. a week, and thus
let charity go hand in hand with interest; but, as a regular thing, a
charge of less than £1 1#. a week seems incompatible with the just
demands of insanity, and the reasonable profit of the proprietor.
To make even a guinea a week fairly profitable, it will be necessary
to suppose either that there are a great many in the asylum, some of
whom pay more, or that there are many paupers out of whom a profit
may be made, or that the proprietor has inherited the establishment
in good working order, and has no rent to pay, and no large outlay
to make.
Compare for a moment the charge in the county asylum. The
charge for maintenance is eight, nine, or ten shillings a week; in
four county asylums it is over ten, and in one over eleven shillings,
while the repairs of the building are paid out of a county rate. There
are from 500 to 1000 inmates. There is a farm belonging to the
asylum, the work of which is mostly done by patients; and the
patients being paupers may be fed comparatively cheaply. With
all these advantages, the county asylum finds it necessary to make a
maintenance charge of nine or ten shillings a week. How, then, it
may be asked, can the proprietor of a lunatic asylum containing
twenty, fifty, or a hundred inmates, who has rent to pay, who has
no farm, who cannot employ his patients for his own advantage,
afford to maintain private patients for fifteen shillings a week, pay¬
ing for the repairs of the building, and the general wear and tear
out of that sum.
Look, again, at some of the public hospitals for private patients.
The average weekly cost of each patient for the year 1860, was,
exclusive of repairs or rent:
At Coton Hill
Nottingham
Manchester
Warneford
Retreat.
^ ^ Average number
** Sa ' resident .
1 1 10* 105
1 4 11 38
1 0 10 74
0 19 1} 56
0 18 9* 116
So that the average maintenance cost of five public hospitals is
£1 Is. 1 d. weekly for each patient. These figures are from the report
of the commissioners, notwithstanding which we must not put too great
faith in them. We know that there are certain doubtful expenses
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MICHIGAN STATE UNIVERSITY
359
by Dr. Henry Maudsley.
which may be put under the account for maintenance, or the account
for repairs, and the most satisfactory plan would be to call for the
total expenditure during the year, and to estimate the average
weekly cost upon that. In the Manchester Hospital the total, and,
therefore real, weekly cost of each patient for that year was £1 5<y.
It is true that there were extraordinary expenses that year; and the
average total weekly cost was £1. 4s. for ordinary years. In a
private asylum there will no doubt be more economical management,
on account of a greater quantity of action and a livelier responsibility,
and the cost of the same comforts would, therefore, be a little less;
but if we allow three shillings a week per head for better manage¬
ment, saying nothing of rent, or £624 for the year on eighty patients,
the cost is still £ 1 1#. per week. For those who cannot justly afford
to pay that sum, who cannot, in fact, pay as much as they cost,
public hospitals are needed. And as there are many who are in that
position, it is evident that public hospitals must be the inevitable
result of the extreme care and comforts now demanded for the
insane, and of the supervision of a central authority.
We must look forward also to an increase in the cost of treating
insanity, and not to any diminution, for the system is not yet so per¬
fect but that it admits of improvement. One very desirable change
urgently demanded, according to my experience in asylums, but
especially in those which receive private patients, is certainly a change
in the rate of payment of attendants. The work which is required
of these officers is of the most trying kind, such as few people, who
can find anything better to do, will willingly undertake, and such as
it requires a mind unimpressible through the gifts of nature or the
acquirements of art, to undergo without injury. Kindness, under the
most severe irritation; patience with the wilfullest perversity; self-
control, under the most offensive insolence; a cheerful life in the midst
of the most melancholy horrors; these are the qualifications required
at a cost of from £20 to £30 a year for men, and from £12 to £20
a year for women. If such valuable qualities are to be had so
cheaply, all that can be said is, that the principle which asserts the
price to be influenced by the demand and supply is a false one.
But, in truth, they are not so to be had; and it must be confessed
that an attendant is not unfrequently one who has been unsuccessful
in his own business, or has otherwise missed his way in life, and
who brings with him for his great responsibilities the recommenda¬
tion of previous failure. To fill rooms and galleries, then, with
creeping plants and showy objects, whilst the price paid is not such
as can possibly secure the best material for attendants, on whom the
substantial comfort of the patient depends, is really but a poor way
of concealing a fundamental defect.
The admission of desirable and costly changes in the treatment
of insanity, makes the necessity of public asylums more urgent.
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MICHIGAN STATE UNIVERSITY
860 Middle-Class Hospitals for the Insane ,
Clearly there must be a large outburst of public benevolence to start
them. For the erection of a good building, capable of containing
100 or 120 patients, and for the complete furnishing of it, with the
purchase of a suitable quantity of land, nearly £20,000 will be
required. One of the existing hospitals cost a little more than
£30,000 for building, land, and furniture; and though that was an
extravagant sum, we must admire the excellent spirit and great
energy which enabled one town to raise such a sum for such a pur¬
pose. But if the thing is to be done, it is much better that it
should be done well at once, than that the building should be in¬
complete, unsuitable, or half furnished. It should be able to offer
at its commencement, before its reputation is established, the best
accommodation, so that patients who can afford to pay well may be
induced to come to it by the advantages which it offers. Some of
the present hospitals have suffered from not being able to do that.
There has been no money for completely furnishing and for properly
laying out the grounds; and good patients have been invited to
come to a place which had a bare, rough, unfinished, and comfortless
look. Perhaps there was no carriage, or other luxury to which
wealth is accustomed; or if there was a carriage, it was the used up
relic of some coach proprietor, which daily creaked its rickety
astonishment that it held together at all. Wealthy patients would
not pay for such miserable equivalents, and so the hospital suffered,
not only in not getting profits which it should have done, but in
losing what might have been an excellent connection, and in having
its reputation damaged at that very time when it could least
afford it.
To those who say that it is not the real design of these public
establishments to admit the wealthy and to make money, but rather
to admit the poor and needy and to exercise charity, this question
may be put. If out of six or eight wealthy patients the hospital
makes a clear profit of £1000 a year and uses it in charity, is it not
much better than to be obliged to appeal to the public year by year
for that sum ? Once fairly established, the promoters of these hos¬
pitals have a right to demand that they be made self-supporting.
There is a large capital of benevolence funded in the building, and
on that it ought not only to exist, but to pay a fair interest in
charitable work. There is all the difference in the world between a
rational and an emotional charity. The former, clearly recognising
the great moral principle that it is the duty of the strong to help the
weak, establishes a machinery for applying it to the insane world; it
builds a hospital, offers to the wealthy lunatic excellent accommoda¬
tion, makes its fair profit out of him, and then in place of using its
profit in any selfish way, applies it, in accordance with its funda¬
mental principle, for charitable purposes. Such charity is sound,
efficient, and likely to last, whereas the emotional or spasmodic and
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361
by Dr. Henry Matjdsley.
impulsive kind usually wastes half its force for want of method, and
may cease at any moment.
These observations may be illustrated and confirmed by a few
figures. In the year from July, 1858, to July, 1859, the income of
the hospital of which I was superintendent, was £4652 15a. 5 d., and
the expenditure was £4589 4$. 3d.; so that there was a surplus of
£63 10$. lid. From 1859-1860 the income was £4977 15$. Id.,
and the expenditure £5021 19$. 9 d.; so that there was a deficit of
£44 4$. 3d. Now both these years, for reasons which it is not
necessary to give here, were very bad years; the income was very
low in the former, and though better in the latter, it was yet far
below the average. However, on the two years there was. a surplus
of £19 6$. 3d. This was sailing very near the wind, but the just
principle of squaring the expenditure to the income was not broken.
From July, 1860, to July, 1861, the income was £5660 14$., and
the expenditure £5223 16$. Id.; so that there was a surplus of
£456 4$. 2d. The accounts for 1861-1862 are not yet made up,
but from an approximate estimate, which will not be far from
the truth, the income may be stated at £6000, and the expendi¬
ture at a little over £5400, say £5500. There will be a surplus of
£500; so that for the last two years there will be a gain of
£936 17$. 11 <7. And yet these two years were exceptional; for in
them extraordinary expenses were incurred, which amounted to
about £1000. Now as these will not occur again, but have now
really become an addition to the capital, a surplus of from £800 to
£1000 may be calculated upon every year.
Meanwhile a considerable amount of charity is exercised, as the
following analysis will show. The average number of patients for
the last year is 80, and the average weekly income, without including
physicians’ fees and extras, may be called £100, although, in reality,
it is a little more. So these 80 patients have to pay £100 a week.
Of these 4 pay £4 4$. a week each, and 5 pay £3 3$. a week each;
or 9 patients pay £32 11$. a week towards the £100. There are 71
patients left to make £67 9$. Of these, 7 pay £2 2$. a week each,
or altogether £14 14$., leaving £52 15$. for 64 patients to pay.
8 more will pay £111$. 3d. a week each, or together £12 12$., and
there are left 56 patients, who have to make £40 3$. Suppose 30
of these to pay £1 1$. a week each, although more than 30 will do
that, and we have £31 10$. towards the £40 3$. There is left
£8 13$. for 26 patients to pay, or 6$. 7 id. a week each. The dif¬
ference between 6$. 7 id. and £2 4$., represents the amount of charity
per week to each of these 26 patients.
Of course, however, it is not desirable that these hospitals should
strive for a large surplus. It must be spent in diminishing the
charges for those who are ill able to pay; or another way of using it
may be suggested. In a large hospital there are many disadvan-
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362 Middle-Class Hospitals for the Insane,
§
tage3; there is the accumulation of all kinds of cases under one roof
and the consequent affliction, notwithstanding the best classification,
of those who are slightly suffering, by the sight and noise of those
who are far gone. This is a very great and painful evil. Then,
again, there are the dreary monotony of confinement, the locked
doors, the fixed regulations, and all that machinery of system, which
is so necessary in a large establishment, but which is not necessary
for some who are in it. For it admits of no question that in all large
asylums there are some cases which would do very well iu a private
house under moderate supervision. These cannot, however, be kept
at home, because they are worse there than anywhere else, and very
completely destroy the comfort of the whole family. Strangers, too,
who would care about having them in their houses are not usually
those who care about doing their duty by them. For such cases the
establishment of the cottage system in connection with the hospital
would be an excellent resource, as it would also for some of those
patients who were convalescent, and for others whose special circum¬
stances might render it desirable. There should be built on the
land several cottages or detached houses, each with its own garden,
and the various comforts of a private house; and the central build¬
ing remaining as a depot for those who require great care, for the
demented cases who are so miserable to look at, but who will be as
happy there as anywhere else, for the violent cases, for recent acute
cases, and for those who cannot be trusted at all. In place of, as
under the Gheel system, making the colony the rule, and having a
central asylum for exceptional cases, the central building should be
their main place and the cottages offshoots from it. They would
be, as it were, private rooms removed from it for the sake of quietness,
and if put down in the fields—still be on hospital ground and under
hospital discipline. We thus start on what appears the just general
principle, that insanity should be shut up, and then, as we are able,
make exceptions on the nature of the particular case; instead of
beginning with what seems the false principle, that insanity should
not be shut up, and thus being obliged to make continual excep¬
tions. It is to the establishment of a cottage system, under which
some patients might have liberty without license, and might be
under control without undue restraint, that the surplus made by
any lunatic hospital as at present constituted might well be devoted.
This cannot be done, however, until an important obstacle is
removed. By an act of parliament charitable institutions are pre¬
vented from possessing more than thirty acres of land; any quantity
which they may have above that is forfeitable to the crown. Recently
it was very desirable in the case of one public lunatic hospital to
buy some land which lay very near to the building, and which would
have been of great advantage to the hospital; but the land already
owned was thirty acres, and so the purchase could not be made. It
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MICHIGAN STATE UNIVERSITY
by Dr. Henry Maudsley. 863
is evident that a central hospital with its gardens, and a cottage
system, will require more than thirty acres of ground.
If, then, in conclusion, the foregoing observations are founded on
just principles, it must be obvious that it is not advisable to com¬
mence a benevolent asylum on anything like £3000, as the promoters
of the Metropolitan Asylum contemplate doing. The result must be
a painful struggle for existence on the part of a 'meritorious object
under most unfavorable circumstances. Would it not be better
to ask for £20,000, and to declare that the asylum will be con¬
structed on the best possible principles, and will embrace the cautious
application of the cottage system; that, furthermore, excellent accom¬
modation will be afforded to those who can pay well; that the best
medical skill will be obtained; that no one will have any selfish
interest in the establishment, but that all profits will be spent upon
the patients ? Will not such a definite programme, and so just an
appeal, draw forth a satisfactory response from the public ? A pro¬
vincial town raised £30,000 for the benevolent object; London and
its neighbourhood will surely not refuse £20,000. It will not, how¬
ever, do it in consequence of feeble, querulous advertisements,
which breathe indecision and want of heart. Instead of the weak¬
ness of complaint, there must be definite aim in the purpose, system
in the plans, and energy in the action; and then, assuredly, there
will be reacting force elicited which will carry the project to the top¬
most heights of success.
On the treatment of Hallucination by Electrization.
By James Rorie, M.D., Royal Lunatic Asylum, Dundee.
So much difficulty is experienced in producing the slightest alle¬
viation of the sufferings of those affected with that form of de¬
rangement of the nervous centres which gives rise to what has
been termed a hallucination , that the suggestion of any means by
which this disease can be directly attacked, must be regarded as a
decided advance in the treatment of this affection. Such a sug¬
gestion has recently been made by M. Baillarger, of Paris, in the
recommendation of electrization.
As this mode of treatment is, however, still in its infancy, in¬
stead of discussing it at length, and entering upon its supposed
mode of action, I will here at present confine myself to the de¬
scription of the following case, in which I have found it prove
successful:
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364
Dr. James Rorie, on the Treatment
W. T—, set. 50.—Melancholia. Admitted 15th January, 1850.
History. —Married, and the father of a family; a mechanic. He
is of the Presbyterian religion; common education, and nervous
temperament. Originally of a cheerful disposition, sober and in¬
dustrious habits, and average intelligence. The disease is of three
months' standing.
Symptoms on admission .—He is reserved, melancholy, complains
of being ill, and that he feels an impediment about his jaws when
he speaks, and also at the root of his tongue. He has told his
friends that he has felt both suicidal and homicidal promptings.
He does not stand firmly upon his legs, and says that they are occa¬
sionally cramped. His lips are slightly tremulous, and he has an
ulcer upon anterior aspect of left leg. The cause of his mental
condition cannot be traced proximately. His father, however,
suffered from melancholia. Tongue slightly loaded. Pulse 96;
skin natural. Was treated with mercurial purges, &c., but with
little benefit.
On October 16th, 1852, his symptoms were as follows: "Still
suffering intensely from melancholia. He is tormented by the delu¬
sion that he is one of the monsters of iniquity alluded to in the
Revelations, and that he is to be the means of bringing awful
calamities upon the world. He can find no comfort, no consolation
in anything, and wishes that he was out of existence. He says,
however, that he cannot destroy himself. He seems to have under¬
gone little or no change since admission. He refuses all kinds of
aid, whether in the form of medicine or advice, and becomes very
ill-natured if these be pressed upon him.”
From this date to the 25th May, 1860, his malady appears to
have undergone not the slightest change. His symptoms then were
as follows: “ very excited and miserable; says he is cursing God, and
cannot help it.”
June 7th.—Has been much excited for last three days. Is very
melancholy, exclaiming, “ Oh, God ! what will I do !”
Has not as yet shown suicidal tendency. About this date he
began to suffer much from hearing voices and noise in his ears*
His sight was also considerably affected.
On the 29th October, 1860, he began to suffer from slight epi¬
leptic fits, which threatening to become more severe, he was put on
a course of belladonna and quinine, which not only had the effect
of removing his tendency to epilepsy, but also of greatly improving
his general health. He continued, however, to suffer much from
noise in his ears, hearing voices, &c., especially at night. As these
symptoms gave him much uneasiness, and frequently prevented him
sleeping at night, I resolved to try the effect of galvanism, and,
accordingly, on the 28th May, 1861, I applied the wires to his
ears, continuing a pretty strong current for about five minutes.
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365
of Hallucination by Electrization.
The effect during the application was greatly to increase the noise,
the patient stating that it appeared to come from a corner of the
roof.
On the 29th, the patient stated that after the operation he was
free from noise in his head for about nine or ten hours, and that it
recurred on his going to bed. The operation was again repeated
for about seven minutes with a similar result, namely, total cessa¬
tion of noise for a period of ten or twelve hours. The galvanism
was accordingly continued for about ten minutes, daily, for a fort¬
night, the noise remaining away for a gradually longer and longer
period, till it ceased returning altogether. Relieved from these dis¬
tressing symptoms, the patient soon began to occupy himself indus¬
trially, and is now quite convalescent, having to a great extent
recovered his former cheerfulness, to which he has been a stranger
for eleven years and a half.
On the Pathological Elements of General Paresis or Paresifying
Mental Disease (Paralysie generate). By Dr. E. Salomon.
Translated from the original Swedish, by William Daniel
Moore, M.D. T.C.D., M.R.I.A., Honorary Member of the
Swedish Society of Physicians and of the Norwegian Medical
Society, Corresponding Member of the Royal Medical Society of
Copenhagen.
INTRODUCTION.
General paresis , paresifying mental Disease , or in Latin paresis
generalis, that is, paresis of mind and body, insania paresans, are
terms applied to the form of mental disease generally known uuder
the French denomination of paralysie generate.*
The synonyms of this disease are particularly numerous. Among
the most important names in use with authors I may enumerate the
following :—dementia paralytica; paralysia generalis progressiva;
paralysis progressiva; anoia paralytica; (1) dementia paralysans. (2)
The French have called it, alienation ambitieuse avec paralysie incom¬
plete (Bayle); demence paralytique; folie paralytique (Parchappe);
paralysie generale incomplete (Calmeil); paralysie generale pro¬
gressive ; &c. The Germans term it Geisteskrankheit mit Paralyse;
allgemeine progressive Gehimlahmung; paralytischer Blodsinn; &c.
* u Paralysie generale ” is a singularly inappropriate term ; for he who is gene¬
rally paralysed is certainly dead, and not liviug.
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The English call it simply general paralysis. (3) General paresis *
occupies a prominent place among affections of the mind, by reason
of the great interest presented by this form of mental disease in a
pathological point of view.
The knowledge we at present possess of this singularly constant
morbid process, and its essential nature, may be regarded as a vantage
ground, whence scientific investigation - may advance in the still
uncertain field of mental diseases.
Calmeil says :—“ Le diagnostic anatomique des lesions, qu'on doit
s'attendre h rencontrer dans les cavites cr&niennes des individus
affectes de periencephalite chronique peut prendre rang parmi les
verites les mieux etablies de la pathologie humaine.” (4)
Even if this statement cannot be taken literally, it shows that the
assiduous labour which has been bestowed upon the investigation of
the pathological anatomy of this disease has not been without result.
In order at the present day to obtain the recognition of an affection
as an independent form of disease, it is not sufficient to exhibit a
certain group of symptoms; we must at the same time be able to
show that these symptoms spring from one and the same source.
The pathology of every distinct disease must therefore consist of
two parts: the symptomatic (or physiological), and the anatomical.
I shall make this division the basis of my essay and shall therefore
commence with the symptomatic pathology, to which is appended a
chapter on the differential diagnosis of the disease. I shall then pass
on to the anatomical pathology, and shall conclude with an investiga¬
tion of the essential nature of the disease.
I, SYMPTOMATIC PATHOLOGY.
I. SKETCH OP THE DISEASE.
In the very commencement of the cerebral morbid process which
constitutes the subject of the following essay, the mind appears
injured in the conditions fundamentally necessary to the normal dis¬
charge of its functions; it is diseased in its very root.
The degenerative process which takes place in the cortical substance
of the brain, (5) prevents the normal reproduction and association
of ideas; so that all combination, or any adequate comprehension of
circumstances, the apprehension and conception of the most ordinary
phenomena, are rendered impossible.
On this depends the peculiar change in the patient's behaviour:
the astounded, vacant look, with which he glances around;
the difficulty, or absolute impossibility of performing the simplest
mental operations. The patient has scarcely swallowed the last
morsel of a copious meal, when he demands more, assigning as a
* 7rape<r(£,=paralysia incompleta, imperfecta.
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reason that he has got no food during the entire day; he wishes to
go to bed in the middle of a bright day, because it is evening, &c.
This stamp of devastated intelligence general paresis maintains
during its whole course, whatever form of other mental disease it
may assume. There is scarcely any form of mental disease under
whose colours general paresis may not advance. Oftentimes it pre¬
sents itself to observation as an eccentric, multiform, alternating
ambition, with or without maniacal exaltation; very frequently it
occurs with a melancholic state of mind manifest in the patients'
outward demeanour. False ideas of external greatness are also to be
discovered, although the patient does not spontaneously give utter¬
ance to them. The disease may likewise run on with an unmeaning
loquacity, without nny definite or typically marked delirium, and
with alternating fits of exaltation and comparative calmness of mind.
Some cases have been observed under the form of a more apathetic
mental torpor, with intercurrent, rapidly transient ebullition of feeling
and hallucinations of various kinds.
Notwithstanding that from the first commencement there is a
decided diminution of intelligence and of the power of judgment,
the frequently recurring states of exaltation, the constantly varying
false ideas, hallucinations, and illusions, often present a remarkable
variety in the disease on its first appearance. Even if we leave out
of view the motor disturbance constantly attending the affection,
{ jaresifying insanity is thus distinguished from every other form of
unacy.
Accordingly as the cerebral disorganization advances, the active
alternation of phenomena gradually diminishes, while the manifesta¬
tions of the cerebral lesion become the most striking. The functions
of sight and hearing do not in ordinary cases, when the disease is not
very far advanced, exhibit any very remarkable change. But towards
the close of the third stage, the power of hearing usually diminishes.
In the rare instances in which the patient lives to the fourth stage
sight and hearing become finally annihilated. Hallucinations (endo¬
genous sensations) are not unfrequently met with in these senses.
Smell and taste are often altered, so that the patient without re¬
pugnance submits to their operation the most loathsome things.
Hypersesthesia of the skin may possibly sometimes be observed, but
it does not belong essentially to the disease. The sensibility of the
skin often continues perfectly normal, even in the third stage; but
in most cases it is blunted in some degree proportionately to the
advance of the motor disturbance. This blunting, however (except
in the fourth stage), never amounts to complete insensibility.*
The motor disturbances exhibit a vast number of changes and
varieties. Even in the first stage, we observe more or less of transient
* The occasional suspension of perception must be distinguished from loss of
sensibility.
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convulsive movements (involuntary spasms) in the muscles of the
face, especially in those of the upper lip. Sometimes the setting in
of the disease is marked by sudden fits of vertigo or transitory attacks
of an apoplectic character. Again, there is a more interrupted, invo¬
luntary, as it were, jerking movement in the lips; creeping sensations
in the tongue (fibrillar convulsions in the muscles of the organ),
when it is protruded; the patient betrays a certain amount of diffi¬
culty in expressing himself, evidenced by a laboured and catching
mode of delivery, and a difficulty and occasional complete inability
to pronounce words abounding in consonants, which require a more
combined action of the muscles engaged in articulation. The patient
still walks quickly, but sooner or later he experiences uncertainty in
his gait also. It becomes insecure and staggering, causing him to
walk with a feeble step and straddling stride (sailor’s walk). This
is more apparent when he is suddenly called and attempts to turn;
the lower extremities now begin to give way under the weight of the
body; the power of combination for its movements is interrupted.
If the patient has advanced somewhat into the third stage, it happens
that when he attempts to get out of bed his knees sink together, and
he is for a time paralysed, but again recovers. After such attacks
the power of motion in the lower extremities gradually diminishes,
so that if he reaches the fourth stage he can no longer leave his bed.
A similar condition occurs, in the progress of the disease, in the
muscles of the upper extremities. In the last stage the muscles
connected with the expulsion of the excreta and with deglutition no
longer perform their office.
The vegetative functions usually continue rather long undisturbed.
But with the gradual diminution of nervous influence nutrition also
declines, and emaciation attains a high degree. In many instances
an atrophied state of all the parenchymatous organs is met with on
post-mortem examination. Of the diseases which interrupt the
paresis, and cause death before the disease has reached the fourth
stage, pyaemia, pneumonia, and colliquative diarrhoea, are the most
frequent. Gangrenous destruction of the parts of the body exposed
to more considerable pressure (the sacral region) is an almost con¬
stant phenomenon.*
The course of the disease may extend from some months to three
years. In rarer cases it may reach to five years, but scarcely ever
exceeds that time.
The disease belongs especially to full manhood, and in normal
cases is not developed before the age of thirty years.
It may in general be stated that it occurs in persons who have
lived too fast, and have fallen victims to enervating excesses. It
presents a ready picture of premature old age (senium 1. marasmus
prsecox).
# Cf. Joffe, in * Zeitschrift Wien. /Ertzte > 1857 ; 1, 2, 3, 5—1860.
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General Paresis, or Paresifying Mental Disease.
France is the peculiar focus of the disease. The insatiable thirst
after “ la gloire ” (outward distinction), which there more commonly
than in other lands distinguishes the struggling young man, causes
him to bend the bow too tight, and thus to be suddenly interrupted
in his career. Paris is the head-quarters of the disease.
II. FORMS OF THE DISEASE.
We usually distinguish two separate forms or types, under which
paresifying insanity occurs, namely, the expansive and the depressed
form; of which the former has four varieties, the latter two. (6).
(a) The expansive form (l'affaiblissement masque), generally occurs
in men, and is distinguished by—
1. The delusion of riches and greatness , which gives the delirium
a peculiar stamp. The false ideas are persistent, predominating, and
of a progressive nature.
2. Over estimation of one's own personality; contentment and
self-satisfaction; occasionally a rapidly transient expression of false
ideas of riches and outward greatness.
3. The notion of riches and greatness, but with long intervals.
The attacks supervene and disappear sometimes with the rapidity of
lightning.
4. A mixed expansive and depressed form, with false ideas of
riches and power.
(b) The depressed form, usually occurs among women and weak
men.
1. Melancholic type. —The patient goes about with a depressed
and sorrowful exterior, and when asked how he is, always answers,
“I am exceedingly well.” “ First rate.” Alternating delirium.
2. Anaesthesia psychica, characterised by a progressive decline of
intelligence (stupidity) .*
Under whichever of the above-mentioned forms the general paresis
may occur, it is always and constantly attended with motor dis¬
turbances.
' III.-STAGES OF THE DISEASE.
We recognise paresifying insanity under four stages of develop¬
ment :
1. Thestage of Mental Alteration.
2. The stage of Mental Alienation.
3. The stage of Dementia.
4. The stage of Amentia, the character of which is paralysis of
the mind=Dementia completa.
* To this belongs the seventh series of cases of paralysie generate incomplete in
Calmeil—for example, No. 67. This is a very rare, and not generally recognised
form.
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370 Dr. E. Salomon, on the Pathological Elements of
1. The stage of Mental Alteration.
(a) Mental symptoms. —The mind in this stage undergoes a
change, the patient's conduct differing from what characterised him
before his illness. The change affects especially the patient’s temper,
character, energy, and intelligence.
1. The temper is so changed that, from being comparatively lively,
equable, gay, and steady, it becomes— a, irritable and impetuous;
b, morbid, dull, and careless about everything relating to the patient’s
self and those about him; c, sorrowful; d, childish and rash. (7)
In the patient’s mode of life the change described under a mani¬
fests itself by his becoming troublesome to those about him, causing
them often to experience the outbreak of a certain choleric irritability
( (< manie congestionnairef Guislain). His morbid apathy prevents the
patient engaging in any regular occupation. He neglects his duty.*
His sorrowful humour gives rise to a retired and shy behaviour. His
childish want of thought makes him constantly fall into extravagance,
and leads him into undertakings and affairs which threaten, and too
often actually cause, both his own and his family’s ruin. The
patient’s actions are characterised by leniter in re , sed fortiter in
modo.
2. The character (moral faculties) is so altered, that it becomes
degenerated (moral insanity). The patient, even though he be a
highly cultivated man, with fixed and settled character, becomes
uncertain, dissolute, and dishonorable. He continues in the exer¬
cise of the duties of social life, but his surprised relatives mourn in
silence over his indelicate acts, his dishonesty and debauchery. An
honest man suddenly commits an open theft (8); so that he soon
renders himself unfit for social life.
3. The patient’s energy is changed, exhibiting a marked falling
off*. The power of deciding for himself diminishes; his acts are
determined by external accidents; his conduct is so changed that
from being steady it becomes extravagant.f
4. His intelligence is so altered that his power of criticism (judging
of things in general) is diminished in comparison with its strength
before his illness.
5. Momentary absence of mind. —The patient stops in the middle
of a conversation, sometimes in the middle of a word, but continues,
after some moments, the conversation from the point where the
interruption occurred. He suffers, moreover, from a certain unusual
dissipation of thought, and incapacity to collect his ideas.
6. Forgetfulness (=oblivion of what has just occurred).—This is a
constant and important symptom.
* The representations of relatives against his irregular and whimsical mode of
life have not the slightest effect (“ Fapatliie raisonnee”).
t See the foregoing note.
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7. Morbid mobility and disquiet in the patient’s whole conduct,
occasioned by the mental change.
8. Indifference in general to the subject for which in health the
patient entertained a lively interest.
(b) Paretic symptoms .*—The patient’s capability of executing
detailed movements diminishes. Movements en masse are performed
with full power. Tailing precision and diminished power of combi¬
nation in muscular movements set in early.
1. Speech .—Alterations of speech are the first pathognomonic
symptom of paralysis. The articulation becomes thick, loses in dis¬
tinctness and precision, and suffers from a certain inaccuracy. Diffi¬
culty in plainly pronouncing some more complicated words, abound¬
ing in consonants, sets in.
2. The patient’s gait becomes uncertain and tottering. He walks
with a feeble step.
3. The handwriting is changed, the usual rounding being wanting.
It becomes streaky and scratchy. The patient can no longer with
his hands exercise any movements of a more complicated nature and
which require much precision.f
During this stage the patient experiences involuntary spasms in the
muscles of the face, particularly around the angles of the mouth and
eyelids and in the upper lip. Eapidly transient attacks of vertigo.
The pupils exhibit a constant contraction, not yielding even to dimi¬
nished access of light (pin-point pupils). During the transition to the
second stage maniacal seizures supervene (= (< manie congestionnavre,”
Guislain), which, however, quickly pass off. In these attacks the
patient is able to deal violent blows, &c., showing that in the strict
sense of the word muscular power is not wanting, and that the
muscles are not in themselves affected. Meyer has shown that in the
attacks of mania occurring towards the close of the first stage the
temperature of the vertical region is exalted. (9) Usually it is not
until maniacal attacks have set in that the patient is considered to
be insane. He is now admitted into an asylum, and is in the stage
of mental alienation.
2. Stage of Mental Alienation.
(a) Mental symptoms .—The distinguishing characteristic of this
stage is the confusion which, in consequence of abrogated power of
judgment, the patient makes between his ideas and his desires, or his
desires and ideas; he can no longer distinguish between them; they
are for him quite the same.
* The paretic symptoms in the first stage are only a bodily expression of the
incipient paralysis of mind. The energy of the patient’s movements is relaxed. The
cause is central. Cf. Gehirnlahmung.
f All these signs are of importance, only by comparison with the practice in the
use of his muscles which the patient had before his illness.
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Dr. E. Salomon, on the Pathological Elements of
1. The stamp of decline and weakness in his psychical activity
becomes more evident.
2. Mania, frequently under the form of the delusion of riches
and greatness {=monomanie des grandeurs).
3. More or less frequent maniacal attacks.
(b) Paretic symptoms. — The speech is not merely thick and
stammering, but laboured, and occasionally completely interrupted j
the same syllable is repeated several times before the patient can
articulate it. He stops short in the middle of a word, endeavours to
pronounce it, but finds difficulty in doing so. He then becomes
vehement, but the greater effort he makes to complete the enunciation
of the word or sentence, the more impossible it seems to be. The
movements of the tongue which, in the former stage, were unaffected,
are now somewhat impeded; fibrillar spasms in the tongue are also
observed.
2. The patient's gait is much more uncertain than in the former
stage. He walks with yielding knees and a wide step, but does not
on this account the less frequently knock his knees together. He
is glad to use a stick, or endeavours to lay hold of something which
may serve him as a guide. He never walks in the middle of a flight
of steps.
3. The movements of his hands are more limited. He finds it hard
at the first attempt to lay hold of what he wishes to seize. If he has
succeeded in getting it, he retains it for a time, but soon relaxes his
hold.
4. The patient's figure collapses and often becomes at the same
time crooked.
During this stage the pupils are constantly unequally dilated. Sen¬
sibility is somewhat blunted.
The delusion of greatness (=monomanie des grandeurs) has by French
writers been looked upon as a pathognomonic sign of developed
general paralysis. This I consider not to be the case, for although
the ambitious form of mental alienation is the most frequent, it does
not constitute anything essentially fundamental in the morbid process
itself. It is not this formal point of mental alienation which deter¬
mines the disease, but it is the progressive diminution of mental
energy, and the simultaneously diminished power possessed by the
patient in the employment of his motor organs.
I consider the confounding of ideas and desires to be the charac¬
teristic element in the stage of mental alienation. The patient
accidentally sees a well-known face. The sight has directed his
thoughts to this person; thought and wish are the same. If he is
confined, he endeavours forcibly to get out, for he wishes* to meet
the person in question. His unbridled fancy leads him to wish him¬
self a millionaire, a king, &c.; the wish and thought are for him
the same. He fancies he has millions and a royal crown. As reality
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General Paresis, or Paresifying Mental Disease. 373
is for the patient of subordinate, or rather, of no importance, lie
soon finds himself in fact* a millionaire, a king, &c.
A persistent delirium belongs to this stage. That which it is of
importance to bear prominently in mind is the gradual development
of the false ideas until they have attained their culminating point.
If the patient be a king, he becomes God, supreme God, &c.
Another progresses from baron to count, king, emperor, &c. A
poor person begins by suddenly finding that he is possessor of fifty
or a hundred thousand rix-dollars; he soon acquires million upon
million, &c. When the progression of the delirium has ceased, and
the patient can no longer produce anything new, but lives exclusively
upon the old stock of false ideas, he has arrived at the third stage.
In the transition to the next stage, apoplectic attacks occur as
accessory phenomena, after which the patient’s condition always
declines considerably.
3. Stage of Dementia.
(a) Mental symptoms. —The characteristic of this stage is the
patient’s incapacity to produce new ideas. The delirium has from
being more acute passed over to the chronic form.
1. The mind becomes gradually weaker, with a tendency to fully-
developed dementia.
2 Incoherent repetition of reminiscences from the false ideas of
the preceding stage. It is, as it were, a mechanical repetition of
isolated words or short sentences, as for example, “ million; ” “ I
am king.”
3. Tailing memory of the patient’s past life.
(b) Paretic symptoms. — 1. The power of speech is extremely
limited. Towards the close it consists only in the muttering of
thick, indistinctly articulated noises (10). The expression of the
face is vacant. Now and then a silly leer plays over the patient’s *
otherwise motionless features. There is difficulty in putting out the
tongue.
2. The patient’s gait is slow and dragging; his course is zigzag;
in walking he turns in all directions. Towards the close he chiefly
lies in bed, and, for the most part, on the back.
3. The relaxation of his hands has so increased that the patient
cannot retain anything in them.
4. Involuntary discharges set in towards the close.
5. Hearing, and subsequently sight, diminish considerably.
Nutrition, which had hitherto continued undisturbed, rapidly
diminishes, notwithstanding that the appetite is still voracious.
* For the paretic with mental alienation a fact = the object of their fancy.
VOL. VIII. 25
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Bed-sores form on the sacrum and hips. The sensibility is consider¬
ably blunted.
As accessory phenomena epileptic seizures (convulsions accom¬
panied with loss of consciousness) occur during and towards the
close of the stage (11.) The patient usually succumbs in the course of
this stage.
In some rare instances it happens, when the patient has been
nursed with exemplary care, that he survives to the fourth stage of
the disease.
4. Stage of Amentia.
This stage represents the highest possible degree of human
degeneration. The man dies while still alive, for it is only the
animal which breathes and assimilates. The patient has attained the
stage of brutalisation.
(a) Mental symptoms .—The senses have in this last stage of the
disease ceased to discharge their functions; the patient can therefore
no longer have any sensations. Psychical symptoms are consequently
absent.
(b) Paretic symptoms .—These have attained their culminating
point. The patient no longer possesses the power of speech. He is
unable to walk, nor can he move from his bed. At last he cannot even
change his position but lies motionless upon his back. He can take
nothing in his hands. The masticating muscles are paralysed. The
food has to be thrust down to the commencement of the oesophagus.
The muscles of the trunk are paralysed, so that respiration becomes
extremely slow. The movements of the thorax are scarcely percep¬
tible. The impulse of the heart is feeble, and is observable only on
accurate examination. The food often gets into the trachea, and
suffocates the patient; or, in consequence of paralysis of the pharyn¬
geal muscles, a larger or smaller bit becomes impacted behind the
root of the tongue and compresses the epiglottis. The temperature
of the skin is low. The bed-sores spread deeply, and often reach the
subjacent bony parts.
A coloured drawing of this stage would form a horrible picture.
The wreck of the unhappy man lies dumb and immoveable as a sack
of flesh.* The man is in the fullest sense of the word “ out of his
senses.”
Soon, however, death puts a long-wished for close to this extreme
limit of human misery, as the patient is only a burden, a mass of
foetid lumber here upon earth (12).
* “ Corome une masse inerte.”—Guislain.
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II. DIFFERENTIAL DIAGNOSIS.
We must, in the first place, distinguish paresifying insanity from
other forms of mental disease; afterwards from other non-mental
diseases in which paralytic symptoms occur.
1. Paresifying Insanity compared with other forms of Mental
Disease.
If the pathognomonic paralytic symptoms have been recognised,
there can be no confusion ; supposing that these have not been duly
apprehended, the question remains, how far the disease may b&
diagnosed from the psychical symptoms alone. This can undoubtedly
to a certain extent be done. I shall endeavour to describe the most
important elements in the diagnosis.
I do not consider that in the first stage the psychical symptoms
present any reliable resting-ground. In the second stage the
delirium is not specific with respect to its form; for ambitious
delirium occurs not unfrequently in diseases in general. But in this
form of delirium, in other mental diseases, the false ideas are fixed
and unchanging (Conf. T. Fixerwahn). In paresifying insanity,
the delirium is distinguished by an uninterrupted progress upwards
to higher and more gigantic erroneous conceptions—in a word, it
is a progressive delirium which is not met with in other cases.
The character of confusion, or unity between ideas and desires,
which I have stated as distinguishing the second stage, is peculiar
to paresifying insanity. Mania paretica wants the character other¬
wise belonging to mania, of perfect intermissions. From the ordinary
form of chronic dementia (= “ demence franche v ) it is distinguished
by the fact, that in the latter the patients are perfectly silent, while
paretics, on the contrary, rave incessantly. In other respects, the
dissimilar courses of the diseases present a striking distinction be¬
tween them.
2. Paresifying Insanity compared with other non-psychical diseases
in which paralytic symptoms exist.
Under this head I shall speak only of apoplexy, chronic alcoholismus
and paralysis from muscular atrophy.
1. Apoplexy .—In a slighter attack of apoplexy, where the paralysis
affects the tongue, it is exclusively or predominatingly unilateral, on
which account the tongue turns to one side when it is protruded.
Hemiplegia, paraplegia, &c., present not the slightest similarity to
general paresis, for m such cases the paralysis is complete in the
parts of the body affected, and moreover is partial and not general.
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Da. E. Salomon, on the Pathological Elements of
2. Jlcoholismus chronicus. —General paralysis has almost invariably
been confounded with this toxical disease. Even in the present day
French writers especially confound these diseases in consequence of
insufficient acquaintance with chronic alcoholismus. (13)
The group of symptoms included under the denomination dementia
paralytica belongs essentially to paresifying insanity, but it may also
be met with in chronic alcoholismus, when the latter has attained a
higher degree of development. A man may arrive at dementia in
many ways; dementia with bodily paralysis he may reach especially
through general paresis or chronic alcoholism. When the patient
has already reached the goal, it may often be difficult to say imme¬
diately, from the existing symptoms, in what way he has attained
to it; but when information is afforded as to the course of the
disease, the decision is as easy as it is certain.
The principal feature of the differential diagnosis is to be found in
the dissimilar starting-points of the diseases. General paresis pro¬
ceeds from a morbid process in the fine membranes of the brain;
chronic alcoholism from a general intoxication. In the former case
the psychical symptoms occupy the first place : the degeneration of
the mind tends to produce that of the body. In the latter, the
paralytic symptoms are the first: the general intoxication of the
body tends to the degeneration of the mind. The dissimilar etio¬
logical source of the diseases differentiates them in a decided manner.
A person who has indulged in an excessive use of brandy at length
becomes poisoned, and in consequence thereof, becomes the subject
of chronic alcoholism, but never of paresifying insanity. If he has
at the same time indulged in enervating excesses, particularly in
those of a sexual character (14), he may, in addition to his chronic
alcoholism, acquire general paresis.
3. Paralysis from muscular atrophy. —This disease has been con¬
founded with paresifying insanity. If this mistake is still made, it
is attributable to deficient scientific knowledge in the physician.
The diseases have this in common, that in both progressive paralytic
symptoms proceeding from the muscular system (occur paralysie pro¬
gressive.) In other respects they are wholly dissimilar. In the one
the seat of the disease is in the brain; in the other it is in the muscles.
Paretic patients may, under the influence of delirium, employ their
muscles in a very violent manner; such a patient may dash in
pieces the door of the room in which he is confined. A person
suffering from paralysis from muscular atrophy does not rave, and, in
consequence of the degenerated state of his muscles, cannot be
violent.
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General Paresis , or Paresifying Mental Disease . 377
III. PATHOLOGICAL ANATOMY.
I shall include the description of the pathological anatomy of the
disease under four divisions, each being referable to a corresponding
symptomatic stage;
1. Leptomeningitis chronica { 16) (= the stage of mental alteration).
2. Periencephalitis chronica diffusa (= the stage of mental aliena¬
tion).
3. Degeneratio substantia corticalis cerebri (or marasmus sub¬
stantiae corticalis = the stage of dementia).
4. Atrophia vera substantia corticalis cerebri (= the stage of
amentia).
That the disease commences with leptomeningitis of a chronic
nature is proved by the fact, that in the cases where the patient dies
in the stage of mental alienation, signs of a still persistent or recently
terminated inflammatory process are met with in the pia mater
(= lepto-periencephalitis*). If the patient dies in the third or in
the beginning of the fjpurth stage, we constantly observe a change in
the pia mater, the result of a preceding leptomeningitis. The
process indicated under 2, is recognisable by the increased volume
(“ triibe Schwellung ”) of the cortical substance of the brain. The
degeneration referred to under 3 has been demonstrated by Roki¬
tansky. The atrophy mentioned under 4 is discoverable principally
by the circumstance, that when the patient has lived to the commence¬
ment of the fourth stage, the most superficial portion of the cortical
substance, corresponding to the lamina nervea in the healthy condi¬
tion, is changed into cicatricial tissue, giving the sensation, on feeling
with the point of the finger the now nearly obliterated surface of the
convolutions, of a firm brain, and of a certain fluctuation of the
subjacent dissolved cortical portion.
The honour of having demonstrated the anatomical changes in
paralysis with mental alienation belongs to the Vienna school (Wedl,
Rokitansky).
K. Wedlf has in every case of general paresis demonstrated an
hypertrophy of connective tissue in the small arteries and veins in the
pia mater and cortical portion of the brain. On the outer wall of
the vessel is a hyaline, imperfect layer of connective tissue studded
with partly scattered, partly grouped oblong or rounded nuclei.
This layer of connective tissue, projecting over a greater or
less extent of the vessel, undergoes, with the nuclei occurring
in it, in the direction from without inwards (from the peri-
* A contraction of lepto-meningo-periencepbalitis.
f * Beitrage zur Pathologie der Blutgefasse.’ Wien, 1859.
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phery of the vessel towards its centre) a fibrillar change. The
veins of capillary structure cannot resist the pressure, hut are also
drawn into this process, and are completely obliterated, and changed
to corresponding bundles of fibres. The abnormal layer of connective
tissue not unfrequently serves as a seat of deposit for finely divided
olein and amorphous calcareous salts, while in other places calcareous
depositions take place in the inner elastic and muscular layer. The
small and slender cerebral vessels thus calcified can, on section, be
observed in the cortical substance as a number of needle points.
Wedl endeavours to explain the adhesion of the superficial layer of
the cortical substance to the pia mater by the penetration of the
grouped nuclei in the adventitious membrane of the pia mater to a
certain depth into the cortical substance. When the pia mater is
separated, a layer of the softened cortical substance often accom¬
panies it, corresponding to the depth to which the nuclei have
penetrated.
The complete obliteration of the calibre of the small veins caused
by this degenerative process, demonstrated by Wedl, must give rise to
a considerable obstruction to the circulation, both in the pia mater,
and subsequently in the cortical substance of the brain, with con¬
sequent ischaemia ;* to stasis, pressure, irritation, and inflammation.
All this produces a progressive aggravation of the cerebral symptoms,
and disturbs the nutrition of the cortical substance.
Kokitanskyt has, in all genuine cases of paresifying insanity,
demonstrated a considerable increase of the connective tissue enve¬
loping the cortical elements. The pathologically augmented con¬
nective tissue is at first of a tough and viscid nature, and imparts
to the cortical substance a somewhat looser consistence than exists in
the normal state. The connective tissue subsequently, in the course
of the disease, assumes a harder and more fibrous form. This ex¬
cessive formation of connective tissue causes the breaking-up of the
nerve-tubes. Those are first attacked which constitute the lamina
nervea covering the cortical substance of the brain; afterwards
those which horizontally traverse the same and separate the several
layers of cortical substance; lastly, the degeneration attacks also
the nerve-tubes, passing singly through the grey substance. The
nerve-tubes broken up by the pathological process, are changed into
colloid or amyloid granules (granular cells, granular bodies), which
are met with in variable quantity in the extending connective tissue.
The ganglionic cells of the cortical substance are often found dis¬
solved, and in a state of colloid degeneration. See the subjoined
woodcut (after Rokitansky) :
* Virchow— l<rx<*>=to check.
f ‘Ueber Bindegewebeswucherung im Nervensysteme.’ Wien, 1857.
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General Paresis, or Paresifying Mental Disease.
379
Colloid (and amyloid) metamorphosis of the cortical substance in a person affected with
paresifying insanity. The pia mater is represented as separated with loss of a portion of
the cortical substance. In the cortical substance, the superior white filamentous layer (lamina
nervea) is replaced by a layer of colloid corpuscles of various sizes ; under this separate colloid
granules lie in a mass studded with numerous granular nuclei. Lower down are ganglionic cells
Bwollen or changed to colloid bodies.
The cortical substance has split asunder, and (in the third stage)
yields to the least touch. In the transition to the fourth stage,
the superior layer (corresponding to the lamina nervea in the healthy
state) is in a firm and tough condition. The inferior layers still
retain their pappy and soft state. The convolutions are now nearly
obliterated, and the mass of the cortical substance is diminished in
volume.
In consequence of this pathological process, set in action by
ischaemia, determination of blood, hyperaemia, or inflammation, the
grey cerebral cells become destroyed, and changed to an inert mass.
The constant changes met with in every well-marked case of fully
developed insania paresans, are:
1. In the arachnoid, results of previous inflammation in the
form of condensation, diminished transparency, &c.
2. In the pia mater, results of previous inflammation appearing
as opacity and condensation of the vascular membrane.
3. In the cortical substance, the consistence is looser than is
normally the case. It is often pappy and soft.*
In addition we frequently have:
4. In the dura mater, results of previous pachymeningitis ex¬
hibiting themselves in adhesion of the membrane to the inside of the
calvarium, thickening, &c.
5. In the calvarium, thickening and hyperaemia.
6. In the sac of the arachnoid, effusion of variable nature.
* When the patient has died in the beginning of the fourth stage, the cortical
substance may appear resistant, and normal to the touch. The most superficial
layer must in that case be removed, before the dissolved state of the subjacent
tissue can be observed (17).
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7. Pia mater, often intimately connected with the cortical sub¬
stance.
8. In the ventricles, more or less abundant serous effusion. If
the changes enumerated under 1, 2, or 3, are not met with, the
patient has had some other disease than insania paresans (18).
4. Essential Nature of the Disease.
The disease, whose pathological elements I have above described,
is a mental disease, and has all the characters pertaining thereto
(insania). It is an independent form of mental disease, for it has
signs, both symptomatic and anatomico-pathological, belonging ex¬
clusively to itself. These are principally mental and paralytic
symptoms, going hand in hand, and being progressively developed,
with a dissolved state of the cortical substance.
Mental disease, whose expression is a disturbance in the action of
the human mind, cannot exist without a morbid change in the organ
of mental activity, viz., the brain. In this change science must seek
the cause and essential nature of the disease in an anatomico-patho¬
logical point of view.
Two views have been entertained with respect to the essential
nature of the disease, namely, the French and the German.
1. The French view regards paresifying insanity as an inflam¬
matory disease, arising as the result of irritation produced by
repeated congestions, and causing a disorganizing inflammation.
The anatomico-pathological names given by French writers to the
disease refer exclusively to this theory; as for example, Bayle calls
it meningitis chronica ; Calmeil makes it a peri-encephalo-meningitis
chronica diffusa; Belhomme calls it meningo-cerebritis; while
Parchappe has proposed to term it, cerebritis corticalis generalis.
2. The German view declares the disease to depend, as is shown
by demonstrated facts, upon obstructions produced in the vascular
walls (in the pia mater and.cortical substance) by degeneration
(hypertrophy); with their results, ischaemia and inflammation. The
primary cause, therefore, is degeneration of the vascular walls.
Hence proceeds derangement of the circulation, with its consequent
disturbed nutrition. The secondary cause is a spreading and
destructive excessive formation of connective tissue in the cortical
substance, leading to the destruction of nerve-tubes and nerve-cells.
As long-continued cerebral hyperaemia may exist, without being
attended with degeneration in the vessels of the pia mater, and ex¬
cessive formation of connective tissue, it is clear that something more
must also be present. This additional element is supposed to con¬
stitute the peculiarity of the disease, and to be of a degenerative
nature (19).
The diffuse periencephalitis (general paresis) presents incontestably
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General Paresis, or Paresifying Mental Disease.
a striking analogy to diffuse nephritis (= morbus Brightii). The
former is anatomically characterised by a degeneration in the tissue
of the cortical substance of the brain, destroying the nerve-tubes and
nerve-cells. Clinically, it is characterised by a profound alteration
in tkf.e function of the cortical substance of the brain. The latter is
anatomically characterised by a degeneration of the tissue of the
kidney, and by alteration in the urinary canals and Malpighian
bodies. Clinically, it is characterised by a profound change in the
function of the kidneys. In both diseases we observe stages of hy-
peraemia, increase of volume, degeneration (softening) and atrophy.
In the present state of science we must lay it down that the
disease we have been considering consists essentially in a degenerative
process in the adventitious membrane of the vessels of the pia mater,
and in the tissue connecting the elements of the cortical substance of
the brain (neuro-glia*), which degenerative process, in its development,
causes the change of the grey cerebral cells into an inert mass.
When the disease has attained its climax, the use of the animal
muscles is completely abolished, and the vital process is deprived of
mind—anima—(20).
APPENDIX AND REFERENCES.
1. The disease is thus called in the Asylum for the Insane at
Prague. See Fischer, ‘ Pathol. Anatom. Befunde in Leichen v.
Geisteskranken.' Lucern, 1854. This essay contains a review of
the pathological changes in 318 bodies of insane patients who died
in the asylum between the 18th of April, 1849, and the 30th of
June, 1852. The post-mortem examinations were made under
Professor Engel's superintendence. The results at which the author
arrived are not very decisive.
2. This denomination has been proposed by Dr. Rjellberg, in his
‘ Clinical Lectures on Diseases of the Mind/ delivered at the Central
Hospital, at Upsal, in spring term, 1861.
3. French medical literature of late years abounds in works upon
general paralysis. In English there is only one separate work upon
the subject, namely, Austin ‘ On General Paralysis / London, 1859.
In addition, we have papers by Dr. Conolly, in the * Lancet' for
October, 1849; Dr. Skae, in the f Edinburgh Medical Journal' for
April, 1860; and Dr. Harrington Tuke, in the ‘ Asylum Journal'
for October, 1859. Of German authors Dr. Joffe has written best
on the subject.
4. Calmeil, * Traits des Maladies inflammatoires du Cerveau/
tome i, p. 484. Paris, 1859.
5. This term is borrowed from Florman. See his ‘ Systema
Cerebro-Spinale/ p. 71. Lund, 1830.
* y\ia= glue.
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382 Dr. E. Salomon, on the Pathological Elements of
6. The following classification is chiefly after Brierre-de-Boismont.
Compare his paper read before the Academie des Sciences on 24th
September, 1860, and reported in the ' Annales Med. Psychol/
1861, p. 89.
7. “ Childish manners contrasting with the habits of the subject.
The normal man disappears; it is the child who exhibits himself.”
(Guislain, ‘ Lemons Orales/ i, p. 339.)
8. "Every physician who has devoted himself to the study of
mental affections has confirmed the fact of the existence of this ten¬
dency to theft in individuals labouring under general paralysis. But
I have thought it useful to endeavour to make it as publicly known
as possible, inasmuch as in courts of justice the presence of general
paralysis is often overlooked, not only in its commencement, but
even at an advanced period of its development, when there is not
merely evident weakness of the intellectual faculties, but even thick¬
ness of speech and great difficulty in the articulation of words.”
(Dr. Sauze, " Observations de Paralytiques condamnes pour vol.”
‘ Annales Med. Psychol/ p. 54. 1861.)
9. See ‘ General Progressive Cerebral Paralysis, a Chronic Menin¬
gitis'—( f Die Allgemeine progressive Gehirnlahmung, eine chronische
meningitis')—A clinical essay, by Ludwig Meyer. Berlin, 1858.
10. Last autumn I saw in the Asylum for the Insane at Aarhus,
a patient at the termination of the third stage of paralytic insanity
lying in his bed, and mechanically muttering the following sounds :—
"Hjoonn,” " Khoonn,” forming a bad substitute for the words,
million, king (Konge).
11. “ Almost invariably the last moments of the life of paralytic
patients are attended with convulsions.” (Esquirol, ‘ Maladies men-
tales/ ii, 264. Paris, 1838.)
12. The fourth stage calls to mind the description of extreme old
age given by the Swedish poet Stjernhjelm, in his “ Hercules.”
13. Morel, in his ‘Traits des degenerescences del'espece humaine(l)
(Paris, 1857), says, in reference to this point, that since Huss's
description of alcoholism, there ought to be no confusion between the
latter and general paralysis.—“ When medical observation has suc¬
ceeded in elucidating as happily as the learned Swede has done, one
of the departments of science, it is perfectly useless to question the
results of works so conscientious.It is no longer pos¬
sible for us in the present day to confound chronic alcoholism with
other idiopathic affections of the brain and spinal cord. The general
progressive paralysis of the insane, when it has reached its ultimate
limits, is, perhaps, the only affection, the differential diagnosis of
which presents some difficulty” (pp. 79, 94). The knowledge of
chronic alcoholism has of late years begun to spread among French
physicians, but is still far from being so general as would be desi¬
rable and necessary. Conf. “ L'alcoolisme consideree h Charenton”
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General Paresis, or Paresifying Mental Disease.
Annales Med. Psychol./ p. 565,1859); andThomeuf, ‘ De la Folie
alcoolique, Paris, 1859. Erlenmeyer —* The Cerebral Atrophy of
Adults' ('Die GehirnatrophiederErwachsenen;' Dritte Aufl., Neuwied,
1857)—says in his introduction:—"A condition which might
sometimes be confounded with it is chronic alcoholism, of which
Huss has given so masterly a description.” The differential dia¬
gnosis between paresifying insanity and chronic alcoholism presents
such a great abundance of interesting and, in a purely pathological
aspect, important points, that it well deserved to be made the subject
of a separate essay. The French writer on paresifying insanity who,
in my opinion, is clearest on the difference between the latter and
chronic alcoholism is Jules Falret. But he too has “ run over the
numerous cases contained in the work of Dr. Huss” (Jules Falret,
* Becherches sur la Folie paralytique/ Paris, 1858. Section on
“ Paralysies alcooliques,” pp. 107 , et seq.)
14. " Sexual excesses have an especial tendency to terminate in
general paralysis.” (Guislain,' Le<;ons Orales/ ii, p. 64.)
15. In Haulier's book, ‘ Recherches sur la Paralysie generate pro¬
gressive,' Paris, 1849, most of the cases are either muscular atrophy
with paralysis, or chronic alcoholism. Only exceptionally has the
author met with a pure case of parseifying insanity.
16. This expression is employed by Lebert (' Praktische Medi-
cin,' ii, p. 440 )—Xstttoc = thin, fine, delicate.
17. In every post-mortem examination of paresifying insanity, I
consider it to be indispensably necessary that the cortical substance
of the brain should in the first place be the object of a special and
careful macroscopic investigation. At the same time microscopic
examination ought not to be neglected. Parchappe says on this
subject:
“ Several times, if I had trusted to simple appearances, and if I
had confined myself to the ordinary modes of examination, I might
have overlooked the existence of the characteristic alteration. The
meninges were healthy; they separated from the surface of the brain
without producing that decortication which usually reveals, on the
slightest traction, the state of softening of the cortieal layer.: The sur¬
face of the brain was not altered in colour, its consistence appeared to
be even increased. The brain,cut into slices, appeared perfectly healthy;
but a more accurate examination, and the adoption of a more effica¬
cious mechanical proceeding enabled me, in these cases, to establish
positively the softening of the cortical layer in its middle part. The
handle of a scalpel, gently insinuated into half the thickness of the
layer, succeeded, on cautiously raising the external portion of this
layer, in detaching it through an extent greater than that in which
the action of the instrument took place, and in this manner I obtained
the decortication so easily effected, in the great majority of cases, by
simple traction of the membranes.
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“ The efficacy of this manoeuvre in demonstrating the reality of the
existence of softening, is exhibited also in ordinary cases where decor¬
tication is produced by simple traction of the membranes. It is oh
a level with the free margin of the convolutions that this result is
obtained. But it would be a great mistake to admit in these cases
that softening exists only where decortication is produced by traction.
Softening of the cortical layer exists also very decidedly in many
points of the parts of the convolutions corresponding to the anfrac-
tuosities, and of the free margin of the convolutions, whence the
membranes are detached without causing decortication. In all these
points it is by raising with the handle of the scalpel the external
portion of the cortical layer that we can establish on the fullest
evidence the existence of softening.
“ I believe that the instances of perfect integrity of the cortical
layer of the brain in paralytic insanity, which have been adduced,
are to be explained either by an error of diagnosis during life, or by
the inadequacy of the modes of investigation after death.”
The same writer further observes :—“ As to the appeal which has
been made to the microscope, as the only means of satisfying science
upon the question of the seat of the general paralysis of the insane,
I believe I may affirm, that for the solution of this question its
employment is not indispensable. Doubtless, we may expect from
microscopic observations much information and many advantages. I
am convinced that microscopy will confirm, and it seems it has
already confirmed, the inflammatory nature of the alterations of the
cortical layer in the general paralysis of the insane.” (Parchappe,
‘De la Folie paralytique/ pp. 17, 18. Paris, 1859.) In the
estimate of the importance of the microscope with reference to our
knowledge of paresifying insanity put forward by the author I cannot
participate. The microscope has already proved the necessity for its
intervention; without it, science had still remained ignorant of the
change in the vessels of the pia mater. Without the microscope
nothing would have been known of the excessive formation of the
connective tissue of the cortical substance.
18. In this section only the substance of the subject matter has
been put forth; all which is not plain matter of demonstrated anato¬
mico-pathological fact is excluded.
19. Delasiauve has anticipated the degenerative nature of the
disease; he assumes “ un germe det^riorant it Evolution fatidique”
Conf., r Annal. Med. Psychol., p. 480, 1860. Wedl has demon¬
strated the degeneration. Calmeil considers that the disease is not
of a degenerative nature.
20. I have in this essay employed the word mind (sinne = anima;
sensus intimus) in the same sense as French writers employ the
expression “ sens intime.” Conf. the title to LordaPs book ' De
rins6n6scence du sens intime” (=on the perpetual youth of the mind).
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General Paresis, or Paresifying Mental Disease.
Animus signifies spirit, soul in the higher sense; Ger. Geist. Animus
is a spiritual and not a carnal idea. Of disease of the animus or soul
we cannot speak in a medical or scientific sense. The circumstances
which surround the soul fall within the range of speculative science,
and belong not to medicine in the scientific signification of the word.
Personal Identity, and its Morbid Modifications. By J. Crichton
Browne, M.D., Edin., L.R.C.S.E., Ext. Mem., late Senior
President Royal Medical Society, Edinburgh; Assistant-Physician,
Derby County Asylum.*
The answer to Shakespeare’s question, “ What’s in a name ?” as
conveyed in Juliet’s subsequent remarks, is, at least in some points of
view, unsatisfactory; for placing aside all regard to beauty or euphony
of sound, there is yet much either of good or evil connected with
every name that rises to our lips or is silently repeated in our minds.
There is, to a sensitive being, a pleasure or a pain connected with
it, in which memory, experience, and association have wrapped it
round. True, the pleasure or the pain may be of infinite and almost
imperceptible minuteness, but it is nevertheless an atom in our
emotional existence, and is added to the sum of our mental expe¬
riences. This is the case with the words used to designate the
objects which surround us, but is more obvious with those applied
to places which we have visited or known, and to persons whom we
have encountered, or with whom we have been familiar. But the
importance and significance of a name are most clearly appreciated
and understood, when viewed with reference to the articulate sound
by which we ourselves are called by our fellow men. This we will
find, upon reflection, to be a very important part of ourselves, to be
intimately united to our “ dear perfection,” and to adhere to us with
wonderful tenacity, so that it is difficult to throw it aside. At the
same time it is well known that a man may be legally stripped of his
name, that on a sufficient payment, he may be permitted to denude
himself of a beggarly appellation and to clothe himself in one of
aristrocratic splendour. Yet even after this has been formally
accomplished, the savour of his rags will still, we opine, hang about
him. The memory of his discarded title will still, ever and anon,
come back upon him like vestiges of a state of former existence, and
* I owe an expression of gratitude to Dr. Hitchman for permission to avail
myself of the cases in the Derby County Asylum, as illustrations for this paper.
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Personal Identity , and its Morbid Modification^
will probably produce a mental confusion bordering upon double
consciousness. Nor does it seem wonderful that a man's name
should stick very closely to him and be difficult of divorce, when it is
remembered how intimately it has been connected with all his
conscious states from his very baptism, and how he has come to
associate it almost indissolubly with the first person singular, the
Ego, simple and concrete. Firmly grafted, as a man's name is upon
his belief in his own personal identity, and being almost the sole
expression of personal identity, as it certainly is, to many of the
uneducated masses of mankind; it is not wonderful that it should
be a permanent and persistent fact, difficult to be got rid of. For
amongst the most fundamental principles of mind, is the conviction,
out of which all names have arisen, that a man continues to be
always himself; that he is at any given moment the same person
that he was the moment before, and that he has always been, since
he came into existence. This belief is, in fact, the very essence of
mind, and arises necessarily out of the succession of momentary
conscious states; just as corporeal identity springs out of a suc¬
cession of material atoms endowed with certain vital functions.
There is such a thing as corporeal identity, notwithstanding the reve¬
lations of physiology and chemistry. It may be perfectly correct that
our friend A. B.'s body is in no particle the same with that which he
wore ten years ago. That may have been formed of the dust of Julius
Caesar, this may be framed of guano; and yet they are to all intents
and purposes one and identical. We have an intuition to that effect,
and who shall contradict it ? Besides, is there not positive evidence ?
Are not the two bodies marvellously alike in general appearance and
in minute detail ? Do they not assume the same attitudes, do they
not bear the same marks, moles, and nsevi ? Are they not liable to the
same diseases ? But still, there are no two particles the same; so
that corporeal identity cannot be material in its nature, and must
therefore consist in those forces determining the succession of atoms,
regulating the nutrition and buildihg up of the economy, and endow¬
ing each new particle with functions similar to those of its prede¬
cessor. When the influence of the nervous system in these
particulars is considered, corooreal and mental identity are found to
be very closely approximated to each other. The former, taken as
distinct, must be extended to the vegetable kingdom; for plants have
an identity of their own, which again is identical with life in all its
manifestations, as in the animal kingdom also, but in plants of
course, corporeal identity cannot be reflected in consciousness.
In addition to the corporeal identity of the individual which is, as
it were, a variation, there is the corporeal identity of the species, for
men do not gather grapes of thorns nor figs of thistles. In virtue of
specific identity, the lilies of the field are arranged as in the days of
Solomon, and the heliotrope turns as in the time of Homer. *
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by Dr. J. Crichton Browne.
But with corporeal identity in its various aspects, per se, we have
at present little concern, the object of this paper being merely to -
point out a few of the errors of personal or mental identity, and to
offer one or two suggestions regarding these. The consideration of
such a topic may at first sight appear only a matter of speculative
curiosity, and unlikely to lead to any profitable results, but on being
more thoroughly examined, the subject will assume an importance of
much greater magnitude. Not only are errors of identity matters of
high interest to the psychologist, but, like all other delusions or
mental perversions, they exercise a powerful sway over the sane or
insane who are subject to them. They are sources of happiness or
misery; they may oppose or facilitate treatment, and they complicate
the operations of the physician, by demanding a special and consistent
course in each case; a course so devised as to destroy the error,
without impairing confidence, exciting suspicion, or inflicting pain.
A consideration of them may also ultimately contribute to an eluci¬
dation of the mystery of mind, and may, I believe, in each case in
which they occur, be made to aid somewhat alike in diagnosis, pro¬
gnosis and treatment.
The personal identity, the affections of which are to be referred to,
has been long a dark spot in mental philosophy, and may still be
regarded as such. Various opinions have been entertained as to its
nature and characters, and these have been evolved in erudite and
protracted discussions. In modern times it has been usually looked
upon as an intuition or an innate truth, but for my own part I am
inclined to regard it, with a great physiological metaphysician of the
present day, as a “ fundamental belief,” and consequently, in accord¬
ance with his theory and phraseology, a truth of experience. Apply¬
ing the fundamental law of cognition to an explication of this
question, we are forced to conclude that in an enlarged sense, not
merely this single necessary truth of personal identity, nor even one
or two others, but all truths are the result of experience. Conscious¬
ness itself is only an experience of the vital actions and changes
perpetually taking place within us. We cannot be assured of our
own existence as one out of relation to something else which we have
experienced. The most elementary stage of conscious existence is,
the division of the unity existence into the me and the not me, whilst
the immediately succeeding stage is the subdivision of the me into
mind and body. Sir William Hamilton says, “ We think one thing
only as we think two things mutually at once,” and hence personal
identity “ is the consciousness of existing continuously, as one
derived from the continuous operations of the vital forces which
constitute the living body into one.”* But the teleorganic
changes upon which the fundamental belief of continuous personal
* * Mind and Brain,' by Professor Laycock, vol. i, p. 210.
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MICHIGAN STATE UNIVERSITY
888 Personal Identity, and its Morbid Modifications,
identity depends are reflected in the consciousness as verities, as
for the time being they have the character of necessity. The element
of so-called necessity, however, is not confined to conscious conditions,
but is coextensive with existence; for a man cannot will to alter his
stature or to possess additional limbs. The belief in personal identity,
then, may be regarded as one of a series of fundamental and necessary
ideas, with which the faculties must be invariably occupied in all
actual states of consciousness, and which are the necessary casual
elements of all thoughts and actions. It is the result of the tele-
organic changes in the encephalon as a whole, and is correlated with
the past and the future. In consequence of its origin from tele-
organic changes it must have this correlation. Tor every action or
change of this description has an antecedent or cause which repre¬
sents the past, and an object or design which implies the future.
Thus it is that the fundamental belief in personal identity unites the
links in the chain of consciousness, or, to speak more correctly, is
itself formed out of this union. It is accordingly an absolute identity
in the strictest sense of the term, consistent, at the same time, with
innumerable diversities. In the progress of life, from the cradle to
the grave, the same being exhibits innumerable and diverse mental
manifestations. He slumbers in listless apathy, and is stirred by
mighty and restless energies. He is fired by enthusiasm, softened
by benevolence, or debased by malice and vice; and yet, through
all these infinite changes, one thread of harmony prevails, which is
often not lost, even when the “sweet bells” are “jangled out of
tune,” and which tells of unity and sameness in diversity. Yet
there are times when even this is lost or altered, when the mind
passes into another alotropic form, just as the diamond, which
retains what may be called its identity, in its rough and polished
state, as it flashes in a coronet or lie3 hidden in a mine, loses it
when it is converted into amorphous carbon. This change in per¬
sonal identity takes place when the corrigent sequence of teleorganic
changes is interrupted, or when there is an interference with that
play of external impressions which is required to evolve an intuition
into a derivative truth. When this play of affinitive impressions
from without is cut off, by what is termed functional or structural
disease of any portion of the encephalon or of other organs, so that
it cannot influence the intuitive substrata, then the changes that
take place are not correlative with true belief. The aberrant change
of one moment is not corrected, under these circumstances, by the
change of the succeeding moment. Thus, false convictions, of the
most extraordinary nature, take ^possession of the mind. Personal
identity has been already declared to be in relation to the changes in
the encephalon as a whole, and it is, therefore, subject to modifica¬
tions, in accordance with healthy or morbid encephalic conditions.
There are, therefore, morbid modifications of personal identity, but
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ly Dr. J. Crichton Browne.
these are not, perhaps, so frequent as some have declared. It
becomes important to point out those other states with which they
have been confounded.
Now, it has long been the practice to enumerate as modifications
of personal-identity, a number of erroneous convictions which, upon
examination, will be found to have quite a different nature. The
vagaries of the hypochondriac and the delusions of the monomaniac
have been thus regarded, and individuals who have declared them¬
selves to be teapots, animals, emperors, or angels, have been classed
by eminent psychologists with those affected with morbid changes in
the feeling of personal identity. This feeling, however, seems to be
scarcely at all involved in such delusions, and is, indeed, as has been
already said, much more rarely abrogated or destroyed than would,
at first, be imagined. A patient who believes himself transmuted
into some brute or inanimate object, does not lose the consciousness
of continuous self-existence, does not confound, as a general rule,
his former history with his present convictions, or cease to believe
that he ever was something that he is not now. Where rank, wealth,
and power are arrogated most pertinaciously, the patient carries with
him into his new condition, usually at least, all his antecedents, his
loves, his hatreds, his mental peculiarities. He is found explaining
and defending the incongruities and inconsistencies which his pre¬
tensions involve, or industriously removing difficulties which obstruct
his own belief, even where that is strongest, or where it would
have been attested and maintained in former and darker ages, on
the scaffold or at the stake. It is remarkable, too, that there is no
repudiation or forgetfulness of prior experiences, but that there is
rather the impression of a progression, of a change, of an interven¬
tion of divine or diabolical power in bringing about a transformation.
That there is no interruption in the train of thought constituting a
patient, entertaining such fixed delusions, the same person that he
was before the change took place, was well illustrated in the case of
a gentleman whom I have examined. He was a well-educated per¬
son, but cherished the inexpugnable delusion that he was the Almighty
and the Son of God. He pointed out his apostles, correctly adduced
his own genealogy as a proof of the accuracy of his statements,
directed attention to a cicatrix in his side as the work of the spear; to
scars on his brow, produced by his own fingers, as the wounds of
the thorns, and, in writing to his wife and relations, whom he
properly addressed as such, subscribed himself God. Here was a
strange admixture of reality and fiction, exhibiting unmistakeably the
unbroken continuance of the patient's intellectual life, and the trans¬
ference of the feelings and cognitions of his healthy into his diseased
condition. This gentleman, too, though signing himself “ God,”
politely replied when addressed by his proper surname, and habit¬
ually deported himself in a manner inconsistent with a change in
personal identity corresponding to the belief which he professed.
vol. vni. 26
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890
Personal Identity , and its Morbid Modifications,
Thus it is also with the majority of persons similarly affected. They
do not act as they assuredly would act if they had altogether thrown
aside their former selves and put on a new personality It is no
uncommon thing in an asylum to see an emperor of Russia brushing
shoes, or a queen with vast dominions scrubbing a floor—branches
of industry not likely to be followed by those feeling within them
the assurances of royalty. The emperor, too, if led into conversation,
will speedily let you know that he has not lost all remembrance of
his former character, or of the surroundings among which he lived
before assuming the imperial purple, while the queen will probably
fail to understand that there is any incongruity between her preten¬
sions and her occupations. I have seen patients who have held that
they have been deprived of their souls and transmuted into the
mould of the grave-yard, complacently partaking of dinner, per¬
forming all the functions of life, and conversing about incidents
which occurred previous to their supposed extinction.
There are, no doubt, cases of insanity in which the insane notion
is so prominent as to obliterate all recollection of the healthy period
prior to its incursion, in which the sufferer will deny that he ever
was anything else than what he now maintains himself to be. A
person thus afflicted may refuse to recognise his relations or to
answer to his own name. He may deny all knowledge of the true
circumstances of his past career, and describe other circumstances
in harmony with his dominant delusion, as having characterised it.
But ever here there need be no involvement of personal identity.
The delusion has no other foundation than an error of intellect and
memory, internal assurance being rarely urged in its defence. The
acquirements of the previous life are still made use of, the habits of
thought and action continue unaltered, the occurrences of the past
are still sometimes unwittingly referred to, and the man himself
does not allege that his identity has been interfered with. The as¬
sumption, however, of such a form by a delusion, I would be inclined
to regard as of unfavorable omen, and as indicative of the progress of
the physical lesion. I have more than once observed that in general
paralysis the advance of the disease is marked by the gradually ^
increasing repudiation of a man's real circumstances. A patient in
whom the delusions are not of a very varying character, in the
first stage of general paralysis may call himself, John Smith, or
Thomas Jones, as the case may be—Prime Minister of England; while
in the second stage he may introduce himself as Lord Palmerston,
Prime Minister of England, at the same time admitting that he was
once John Smith or Thomas Jones. Later again in his illness, he
may still call himself Lord Palmerston, but will scorn the idea that
he ever bore a cognomen less known to fame. I have noted several
cases in which the delusions of the general paralytic underwent
changes analogous to those described, and in all of them the disease
proceeded rapidly and steadily to a fatal issue.
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391
by Da. J. Crichton Browne.
Lately I have had under observation in the Derby County Asylum
two cases which I may allude to, as illustrations. In one of
these the affection had just developed itself, and the man repre¬
sented himself as S. P— (using his own name). Proprietor of
England. In the other, the morbid state had existed for above
a year, and the man spoke of himself as George IY, proprietor
of England. In imitation of Leurefs experiment with the two
patients under his care, calling themselves the Holy Ghost, I
confronted these two men, and pointed out to each of them how
absurd it was to suppose that there could be two proprietors of
England. The result of their interview merely was, that the man
in whom the disease was more advanced, spoke of the other as “ a
poor beg-gar,” and continued to assert his -own proprietorship,
whilst the other, in turn, pronounced him a madman, deplored his
insanity, expressed a hope that he would get better in the next
world, as he certainly never would improve in this, and informed me
a few days afterwards, that he had discovered by a mathematical
calculation, that the “ poor madman would recover in 133 years, the
period of the resurrection."
In some instances of so-called brute madness, there is, as I shall
hereafter endeavour to show, a modification of personal identity, but
this form of alienation ought not to be characterised as a whole, as
a perversion of that belief. Many cases of it are subject to the ex¬
planations which have already been given, with reference to delusions
in general, and others are liable to misinterpretation.
A girl recently under treatment, was supposed to have a change
in personal identity, and to fancy herself a brute, because regularly
during the night she emulated the cries and attitudes of animals,
such as dogs, Hons, and cats. Since her recovery, she has explained
that she never entertained such a notion, but that she conceived
herself attacked by vermin and dangerous animals, and that she
therefore imitated the creatures that prey upon these, in order to
keep them at a distance.
Altogether, then, it would appear that errors of identity in the
ordinary forms of mental disease are rarer than some psychologists
have supposed. This fact was appreciated by the philosopher Brown,
who, when speaking of the distinguishing marks of a behef in our
continued identity, says, that it is “ so universal that even the very
maniac, who conceives that he was yesterday emperor of the moon,
believes that he is to-day the very person who had yesterday that
empire.”* It may also derive confirmatory evidence from the ex¬
perience of each one of us in dream-Hfe. Dreams are in many
respects the analogues of insane delusions. They Hft up the veil, as
it were, which would otherwise obscure the mental condition of the
madman from the man of sound mind. They enable us, so far, to
* Brown's 'Lectures on the Philosophy of the Human Mind,' Edin., 1828,
lect. xiv, p. 83.
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392 Personal Identity , and its Morbid Modifications,
comprehend the nature of delusions. In them the senses being in¬
active, impressions from without are not received, and cannot there¬
fore exercise a regulative influence over the vital changes in the
encephalon, which cannot therefore correspond in law of sequence to
external phenomena. As the result of this, the relations of the in¬
dividual in time and space are lost, and all checks upon the action
of the brain being removed, it follows its own devices. The dreamer
has presented to him the most wild and incongruous processions
of persons, things, and events. To him space is as nothing, and
time is no more; so that centuries, may be crowded into moments,
and a belt put round the world in less than forty seconds. Yet
how seldom is it that the dreamer experiences any impairment of
personal identity. He may be parched in the Sahara, frozen on
polar icebergs, elevated to the seventh heaven or sunk into a demon-
peopled abyss of darkness; but he is still himself. Several nightly
dreamers, who have grown gray dreaming, assure me that they never
remember to have experienced any loss or change of personal identity
in dreams. The fact is, that the dreamer rarely indulges in any
kind of self analysis. There are a thousand objective for one sub¬
jective dream. If, then, such cases are thus infrequent in dreams, we
have a sort of presumptive ground for concluding that they are
equally infrequent in the common types of insanity.
Where then, and under what circumstances, it may be demanded,
do errors of mental identity arise ? How are they to be recognised,
and when recognised, treated ? In replying to these questions, it
may be first remarked that errors of identity are of three kinds, or
at least may be artificially divided into three groups. First, errors
in which there is an abolition; second errors in which there is a per¬
version; and third, errors in which there is an exaltation of the
feeling in question. As we are now only occupied with morbid
modifications, it would be out of our course to inquire whether, as
some have alleged, there is an abolition or rather a suspension of
personal identity in ordinary profound sleep. This inquiry would
lead us into the consideration of a subject still warmly contested;
the unbroken perpetuity or intermittence of consciousness; the
decision upon which would at the same time decide the query as to
personal identity. But without examining the condition of personal
identity in sleep, it is necessary for us to refer to a temporary
abolition of it which frequently occurs in the condition between
sleeping and waking. This most generally occurs when sleep is
suddenly broken in upon, and is undoubtedly abnormal in its nature.
The sleeper starts up, and is perfectly conscious, for he looks round
him and sees every neighbouring object with ordinary correctness,
but though perhaps in his own chamber, and looking upon a familiar
scene, he cannot conceive where he is, neither can he conceive who
or what he is. Every sense is awake and active, but the mind can¬
not grasp its relations. In many who experience it, this state is
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393
by Dr. J. Crichton Browne.
accompanied by a vague sense of apprehension and alarm, by pal¬
pitation, and by a restless movement of the hands, which are passed
to and fro as if in an effort to lay hold of something tangible. This
state rarely lasts for more than a few seconds, recovery from it being
sometimes accomplished per saltern; the sufferer springing, as it
were, at once from oblivion into intelligent being, in a way defying
all explanation. In other instances, again, the restoration to nor¬
mality is more slow and gradual. Some particular object is fixed
upon; its particular relations are at length apprehended, and the
truth then dawns upon the mind. A gentleman at one time, very
subject to them, has told me that he found in his own case the
speediest way to free himself from those terrors which were very dis¬
agreeable to him, was to have his own name printed in large letters,
and hung up at the foot of his bed. Whenever his eye fell upon
this, he was at once recalled to himself. It would be very difficult
to say upon what physical condition such states depend. They may
be due to a change in the cerebral circulation, but then why should
not perception be also in some way involved? They may also
be accounted for by supposing the brain, or a portion of it, to be
labouring under a certain form of shock produced by a sudden dis¬
charge of accumulated vis nervosa. Whatever be their physical
cause, they most commonly attack the nervous and excitable, those
prone to every psychical ailment.
Another affection of personal identity, closely allied to that just
described, has been noticed in a youth whose case has been long
watched with peculiar interest. He is of the neuro-arthritic diathesis,
and several years ago, when he was about fourteen years of age, began
to experience sudden and painful attacks, which were chiefly charac¬
terised by a loss of personal identity. According to his own descrip¬
tion these attacks came upon him always unexpectedly, principally when
he was alone, after some intense mental exercise, or the day after some
great excitement. There were no premonitory symptoms, the loss of
personal identity being the first indication of illness. The patient
declared that he felt his identity passing from him, that he lost him¬
self, was unable to remember his own name, or the position which
lie occupied in the world, that there was a slight dimness of vision,
and intense and uncontrollable fear least he should not “ get into
himself again,” and that this was followed by very violent palpitation.
Whenever the attack came on, he was impelled to rapid movement,
and went as quickly as possible into the presence of other persons,
as he generally became well at once when addressed by any of his
friends. When I say got well, I mean only so far as his mental
symptoms were concerned, for palpitation and feelings of uneasiness
continued for a considerable period after each attack. The attacks,
which were at very irregular intervals, most usually occurred in the
evening, though they occasionally happened in the morning, and at
other hours. At first it was thought by the physicians who attended
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894 Personal Identity , by Du. J. Crichton Browne.
the case that the attacks were connected with the period of puberty,
but as this passed, and the illness continued unaltered, various
courses of treatment were tried, but without any decided effect. At
length, after the patient had attained his eighteenth year, preserving
tolerably good bodily health, the attacks began to diminish in
number, and are now of the very rarest occurrence. One enlightened
physician who watched the case, and who knew the constitution of
the patient, expressed his belief that the attacks were connected with
irregularity of the heart's action. The patient's pulse had intermitted
more or less since birth, and the physician thought that immediately
prior to each attack there was an intermission so considerable as to
affect materially the cerebral circulation, and the changes dependent
upon it, and that thus the mental symptoms, the loss of identity, and
the fear, had their origin, whilst these again reacting upon the heart
excited it into violent action, and thus produced the subsequent
symptoms. It is worthy of remark, that as the attacks became less
frequent, so did the heart's action become more regular.
There are in every asylum patients who are so entirely “ lost" in
appearance, who have such a vacant expression of face, who move
about so restlessly, and who give so few indications of the possession
of identity, or of any comprehension of their worldly position, as at
least to justify the suspicion that they are permanently in the condi¬
tion which I have just referred to as a fleeting and transient attack.
What the real mental state of such patients who are commonly called
dements, is, we have no grounds for judging, any more than we have
data for deciding as to the conscious conditions of individuals in
trances or in cataleptic seizures, should they be conscious at all.
These modifications of personal identity, which have been briefly
touched upon as errors by impairment, consist in the negation of
vital properties in contradistinction to those which remain to be
considered, which arise out of an excess or alteration of the same
vital properties. The former bear the same relation to the latter,
that anaesthesia and paralysis bear to spasm and convulsions. The
distinction, however, in the present case, is not so broad and palpable,
for all the modifications auuded to, may be said to depend upon
morbid changes in the nutritive and interstitial processes in organs
whose function it is to perform the vital acts of which under ordi¬
nary circumstances, personal identity is the expression. The dis¬
tinction is artificial, and is simply a matter of convenience, for it is
probable that the nutrition changes, which in health produce
personal identity, as the vital effect, reflected in consciousness, occa¬
sion both negative and positive abnormal conditions of the same,
when augmented in degree, according to the intensity of such
augmentation.
Betaining, however, the distinction for convenience sake, and
turning to the other divisions of the modifications of personal
identity, we are encountered at once by a deeply interesting condition
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MICHIGAN STATE UNIVERSITY
Bxcerpta from Foreign Journals , by Da. Arlidge. 395
which invites, but has hitherto defied, the investigations of the
psychologist. In it personal identity is altered, for the individual is
separated into two distinct beings. He feels the promptings of two'
different natures; he remembers two different trains of thought,
and conceives that he is two persons at the same time, or at different
times. Or, which is more rarely the case, but more immediately
connected with this inquiry, all remembrance of the one state is lost
when the mind passes into the other, and the two periods of existence
are in no way bound together by consciousness or memory. One
of these states may be healthy, characterised by the exercise of sound
sense and generous affections; the other may be diseased, disfigured
by folly or passion ; or both may be diseased, but distinguished from
each other.
The further consideration, however, of this most instructive duality
of mind, together with the consideration of the other modifications
of personal identity, must be deferred until I have next the oppor¬
tunity of saying a few words on the subject in the ‘ Journal of Mental
Science/
(To be continued'.)
Bxcerpta from Foreign Journals. By Da. Arlidge.
In our last abstract from German and French works, we noticed
the appearance of two new French journals devoted to psychological
medicine, and made some general observations upon the character
and purpose of each as set forth by their respective editors. We
have now collected the numbers for the whole of the.past year, and
will attempt to cull from them what appears likely to interest our
readers ; and as the subject matter before us is on the present occasion
to a large extent of a clinical character, our excerpta must largely
partake of the same, a circumstance which we trust will not render
them the less interesting.
The f Archives Cliniques des Maladies Mentales et Nerveuses/
edited by M. Baillarger, is, as its title imports, restricted to the
recording of clinical observations. The monthly numbers collected
together for the past year form a volume of 575 pages, and contain
numerous well narrated cases of great interest. And with this
collection before us, proceeding from the industry and research of
the asylum physicians of France, we cannot avoid lamenting that no
similar attempt to give the results of observation and experience has
been yet made by the superintendents of our asylums in Great
Britain, although they have this journal to serve as a most appro-
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MICHIGAN STATE UNIVERSITY
896 Excerpta from Foreign Journals,
priate medium, a field of observation quite as extensive as their
French brethren, and institutions in which they take pride as un¬
surpassed in the civilized world. If psychological medicine is to
make progress, and to keep pace with general medicine; if its obscure
pathology is ever to be cleared up, and its therapeutics to be placed
on a more rational and efficient footing; it must, as a science of
observation, attain these advantages by the combined labours of its
disciples in observing and in recording the fruit of their observations.
Even these comparatively few reports furnished by our fellow-
workers in the asylums of Erance, affprd opportunities for the com¬
parison of cases presenting similar pathological phenomena, for
collecting hints as to the psychological changes attending them, and
for supplying suggestions in the matter of their medical and moral
treatment. What might not be effected in the ample sphere for
observation existing in our own asylums, were their medical officers to
take up the study of selected cases under their charge, and to detail
the result of their labours for the benefit of others ? certainly, some
such thing is done by a few superintendents, who publish short
notices of interesting cases in their reports; but this work is of a
casual and incidental nature, for it is rarely that cases are recorded
on any pre-arranged plan, or to illustrate any presumed hypothesis
or fact. Moreover, the cases, however valuable or curious, so
printed, are virtually lost, for the pamphlet-like report is a privately
circulated document, it falls into the hands of a few only, and in
its mongrel character of a report on the building projects of the year,
the medical transactions, the religious history, and the financial and
domestic returns, it rarely so far finds favour with its recipient as to
secure its perpetuation and careful deposition in book-covers on his
library shelves.
These remarks are a digression from the business we have in hand,
though suggested by the journal under notice, yet we feel that every
well-wisher for the progress of English psychological medicine will
pardon this, and unite with us in the desire to see more concerted
action among English asylum superintendents in its clinical study,
and in the collection of facts from the vast field of observation at
their command.
Hypochondriasis as premonitory of general paralysis.
Asylum superintendents have for years past noticed the occasional
association of melancholia with general paralysis, either during a part
or the whole of its course, hut M. Baillarger goes much farther in
endeavouring to show that a form of hypochondriasis is a frequent
prelude to its first appearance, and symptomatic of it. A brief paper
in support of this hypothesis was contained in the ‘ Annales Medico-
Psychologiques' for 1860 (p. 509), and several illustrative cases are
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MICHIGAN STATE UNIVERSITY
397
by Dr. Arlidge.
reported in the ‘ Archives Cliniques* for 1861, by M. Baillarger and
other physicians. M. Baillarger asserts that the connnection of
hypochondriacal delirium with paralysis is close, and may serve as a
diagnostic of the precursory stage of the latter malady. At the
same time, he adverts to this association not as constant but as
frequent. Such hypochrondriacs usually agree in the character of
their delusions, which refer to partial or entire changes in their
bodily structure, to destruction of organs and functions. Some
assert they cannot swallow because the oesophagus is closed; others
that their bodies are in a state of decomposition wholly or in part;
others that they have lost the faculty of vision, or of some other
sense, or the power of locomotion, whilst some will maintain that
they are actually dead. Moreover, a distinction is attempted between
this and the ordinary type of hypochondriasis, and also between it
and the delirium of melancholy not uncommonly seen among
paralytics. Such hypochondriacal symptoms in paralytics are un¬
favorable as to prognosis; the disease advances more rapidly, is
more speedily fatal, and complicated with a greater tendency to
gangrene of the tissues.
In these views M. Baillarger has received the support of M.
Legrand du Saulle, who carried on a discussion with M. Linas re¬
specting them in the ‘Annales Medico-Psychologiques * for 1861.
S. Casimir Pinelin the ‘ Journal de Medecine Mentale’ (1861, p. 15)
disputes their correctness, and considers the existence of a special
hypochondriacal delirium, separate from ordinary hypochondriasis
and from melancholia, not established. On the contrary, he believes
that a delirium marked by mental depression, assumes at one time a
hypochondriacal, at another a melancholic form, and that at other times
the two forms occur simultaneously, and further, that this mental
state, may alternate with the expansive delirium, and precede, ac¬
company, or follow general paralysis, without furnishing any positive
ground of diagnosis.
In reading over the cases of general paralysis recorded in the
‘Archives Cliniques/ we find twelve in which hypochondriacal or
melancholic symptoms were associated with it. Of these, four pre¬
sented at their outbreak symptoms of melancholia or of hypo¬
chondriasis. The first of these was that of a man, set. 35, who, after
a short period marked by numberless extravagances and follies, fell
into a state of mental prostration (torpor), with melancholia, re¬
markable especially by the complete absence of the power of the will,
and by hypochondriasis, with the delusion that he) was dead, or
dying, or was deprived of his limbs. Dirty habits, a suicidal ten¬
dency, and refusal of food followed, dht after six months his reason
and health were so far restored that he was discharged recovered, and
resumed his occupation. Five months afterwards he was readmitted,
but at this time, the mind was in a highly excited condition, and
his delusions were of an ambitious character, and the symptoms of
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398 Excerpia from Foreign Journals,
general paralysis became more and more pronounced. In this state
he lived a year, melancholic delusions from time to time intervening,
until dementia became frilly developed.
A second case occurred also in a man thirty-five years old. Long
immersion in water at first induced an attack of aberration, marked
by distressing delusions and a suicidal impulse. After three months
he was so far improved that his friends removed him from the asylum,
and he entered again on his occupation. However, instead of mani¬
festing a coldness and dulness of character as heretofore before his
illness, he was unusually gay and loquacious, and pursued his
avocations with excessive ardour and at the cost of great bodily
fatigue. A fall from his horse, attended with a great fright, about
a month after his discharge, produced a state of unconsciousness
with general convulsions; and from that time epileptic fits con¬
tinued to recur. His conduct now became dangerous to others,
and very shortly the physical signs of general paralysis made their
appearance, without, indeed, the ambitious delirium generally ac¬
companying that disease.
In the third case, the existence of general paralysis was not
positive. The patient was twenty-seven years of age, and attacked
suddenly with acute melancholia and a tendency to suicide. From
this state he recovered after the lapse of three months, when again,
nine months afterwards, he was seized with a maniacal attack; was
noisy and incoherent, and in his ravings talked of the immense
wealth he possessed, of his high dignities and magnificent projects.
His speech became rather embarrassed, but the question arose whether
this was not attributable rather to the overflow of ideas crowding his
mind, and the inability of his organs of speech to utter them fast
enough. Yet the course of the disease was in many respects ab¬
normal, and the pupils were unequal. In about four months after
his admission the maniacal excitement abated, he gained flesh, and
the physical symptoms of paralysis decreased, although the ambitious
delirium persisted. Three months afterwards there was a sudden
improvement, which having continued, he was discharged recovered
from his mania and the paralytic symptoms.
The fourth case is narrated by M. Baillarger himself. It was
that of a woman aged forty, who for eight months before her admission
into the Salpetriere suffered very marked hypochondriasis. When
admitted, there was great mental excitement, and in a day or two the
symptoms of general paralysis were observed in the hesitation of
speech, unequal pupils, and obtuse sensibility. The same fancies
about her health persisted as before for a time, but before the end
of the first month of her residence in the hospital, she became more
calm, and very shortly afterwards she went out recovered. She sub¬
sequently presented herself to the authorities as quite well, with her
mind clear and her speech unaffected.
On looking over the narrative of these four cases, the hypochon-
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driacal delirium insisted on by M. Baillarger as a precursory dia¬
gnostic of general paralysis, can be predicated of two only of them;
viz., in the first and last. In both these, recovery took place to
a greater or less extent after a short time, followed in the former by a
speedy relapse, when general paralysis for the first time manifested
itself. In the last case the restoration to health continued at the
date of its report, but it may fairly be questioned whether it was at
any time a case of general paralysis. The woman had absurd fears
about her health, and acted extravagantly wildly in consequence of
them, but such were not symptomatic of paralysis. The hesitating,
difficult, and jerking speech, unequal pupils, and diminished sen¬
sibility, might or might not be symptoms of the .disease; and in
deciding this point, it is necessary to notice that she was guilty of
self-abuse, and that there were daily intermittent attacks of agitation
in the afternoon, a circumstance most probably dependent on the
former, as well as, we are disposed to think, much of the impediment
of speech and diminished sensibility. On this point we may quote
a remark by M. Baillarger himself ( f Ann. Medico-Psychologiques,’
1862, p. 5), namely, that “ we must be on our guard in concluding
that general paralysis exists on account of embarrassment of speech ;
and that in all cases it is necessary to have the lesions of intelligence
distinctly manifested/’
In the eight other cases, where hypochondriasis or melancholia
was associated with general paralysis, it was an after event, and when
the disease was fully established, after having been ushered in by
maniacal excitement, or at least by extravagant conduct and notions.
In two of the instances narrated, the early history was not known,
the patient coming under the narrator’s observation when dementia
and paralysis were manifest. In neither of these, therefore, can a
precursory hypochondriacal delirium be predicated. In another,
ambitious delirium alternated with melancholic delusion; in another,
again, recovery ensued after a maniacal attack, and then followed
melancholia and paralysis. Two other cases in which maniacal
excitement attended the development of the paralysis, and melan¬
cholia afterwards supervened, are worth a particular notice, inasmuch
as they occurred in two brothers, nearly at the same time; the suc¬
cession to an inheritance being the apparent exciting cause. The
course of the disease was similar in the two, but more violent and
more quickly fatal in the younger brother.
It seems to us, then, that so far as the experience recorded in
the ‘ Archives Cliniques ’ can be quoted, it affords no support to M.
Baillarger’s notion of the association of a particular variety of hypo¬
chondriacal delirium with general paralysis, as a precursory symptom
available in diagnosis. We might add, moreover, that of several other
cases of paralysis recorded, an antecedent or an intercurrent melan¬
cholia or hypochondriasis is mentioned in none, and, on the other
hand, that several instances of hypochondriasis are noted without
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any coexisting or subsequent paralysis; and, as Dr. Casimir Pinel
remarks, most practitioners can adduce examples of hypochondriacs,
having* precisely that particular class of delusions respecting them¬
selves, to which M. Baillarger would attribute a special significance,
in whom no paralysis was ever manifested.
The Water Cure in the treatment of Insanity.
The employment of water, in the form of baths and douches, has
always been much more extensively resorted to on the Continent
than in this country. The use of prolonged baths, though sanc¬
tioned and advocated everywhere else in Europe, has never been
adopted in this country, though doubtless valuable and active as a
means of treatment. Douche baths are very much more frequently
resorted to by foreign physicians, and their place largely supplied
among ourselves by the shower bath, and, at the present time.
Dr. Lockhart Robertson is most vigorously at work in testing and
recommending from experience, the use of the Roman, or as they are
better known, the Turkish baths. And doubtless much more may
be done with baths and other modes of applying hot and cold water
to the body than most of us are disposed to believe. Every year
hypochondriacal, morbidly affected, and half-crazy men aud women,
find their way in multitudes to water-cure and bathing establishments
at home and abroad, and, as every one’s experience can testify, are
for the most part improved, if not cured, by their excursion, dippings,
and washings. And we find.that some of the asylum physicians of
Prance have thought so favorably of the water cure, as to try it with
some of their patients. Pour instances of its employment are reported
in the ' Archives Cliniques ’ for 1861.
The first one, at Charenton, was that of an officer, who entered the
army at nineteen; was drafted immediately to Africa (in 1832), and
there exposed to all the dangers of the field, and the excitement of a
soldier’s life. In 1844, he had symptoms of tapeworm, and did not
get rid of it until 1851; he was afterwards run over by a carriage,
had a slight attack of cholera, and after that a sun stroke, and in
1856 began to exhibit symptoms, which eventuated in general
paralysis, of which he died in 1858. It was not until the beginning
of 1858 that the water treatment was commenced, and when paralytic
dementia was far advanced; and it is, therefore, not surprising that
this means should fail to benefit. This case, therefore, cannot be
cited for or against the advantages of the water cure, for it was one
beyond the power of remedies of any sort.
The second case was one of recovery, and occurred at the Asylum
of Quatre-Mares, under M. Dumesnil. It was that of a young man,
eighteen years old, a victim to masturbation, and predisposed by
maternal descent to insanity. He fell into a state of melancholia
with stupor (melancholia attonita), and was admitted into the asylum
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in March, 1860. He rather got worse than better, and fell into
almost a typhoid state, when, on June 15 th, he was tightly enveloped
in a wet sheet, and over it three or four blankets. Reaction ensued
in an hour and a half, and he was replaced in bed. On the 17 th a
seton was inserted in the neck, and the wet sheet repeated daily,
an improvement manifesting itself after its application, but it was
not until the 24th of the month that this was maintained; after which
date it became progressive. With the hope of accelerating recovery,
electricity was tried on the 12th of July, but as it seemed to do no
good, this was omitted on the 24th. And on the 1st of August the
seton, which had almost ceased to discharge, was withdrawn. The
wet sheet seemed to promote his recovery, and was continued until
the 11th of October. A month afterwards he returned home quite
well.
Another case is referred to by the same reporter, where the mental
and physical symptoms were the same, and where also the same
mode of treatment was employed with equal success. This patient,
after his recovery, stated that he was sensible of amendment after the
use of the wet sheet was begun, and the seton introduced in his
neck. The measures previously employed, electricity, baths, coffee,
and stimulants of all sorts, were of no efficacy at all.
The third instance of the employment of so-called “ hydropathy,”
was in an unmarried woman, aged forty, whose habits had changed,
and who had become morose, indifferent, and torpid, averse to
movement and occupation of all sort. On her admission into the
asylum at Mareville, she appeared to suffer with melancholia with
stupor, and notwithstanding the treatment adopted, the stupor
advanced until she became completely cataleptic, and might be placed
in any attitude without resistance and without change. Stimulants
and antispasmodics, particularly ether, purgatives, derivatives, and
affusions, and afterwards tonics and stimulants together, were
employed without advantage. At length the water treatment and
electricity were tried, and very soon effected an improvement, and
ultimately a cure. The wet sheet was used, and besides thi3 friction
with snow. M. Auzony attributes the recovery equally to the
hydro-therapeutic treatment and to the electricity.
The fourth case was also one of melancholia with stupor, and
occurred under M. Auzony's care, at Mareville. It was that of a
young man, aged twenty-six, admitted in the spring of 1859, in a
state of most complete moral and physical torpor, yielding auto¬
matically in his movements to others, and quite taciturn. Stimulants
were at first resorted to, of every sort; then affusions, the douche,
blistering the head, purgatives, and urtication. Moreover, a trial
was several times made of etherization, carried only so far as the
stimulating stage, but without durable effect. Electricity was now
tried, and with so much success that he began to take some gymnastic
exercise in the gymnasium attached to the asylum. In the autumn
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he was sensibly improved, and then vapour baths were superadded,
and seemed to afford relief by the free transpiration induced. This
suggested the employment of the water cure, which was carried out
by vigorous rubbing with snow, followed by wrapping in the wet
sheet, and enveloping him then in blankets. The abundant sweating
produced by this means had a most favorable effect, and the patient
became much more sensible to the electricity (faradization). In
February, 1860, gymnastics and faradization were alone continued
to hasten the patient's convalescence, which had distinctly set in
since the adoption of the cold water cure.
Insanity by imitation.
A remarkable case of insanity by imitation dr simulated insanity,
in two sisters, is recorded by M. Combes, from the Asylum of
St. Gemmes. They were two country girls, and admitted at the same
time after all the legal formalities of medical certificate, proces-verbal,
or inquest before a magistrate, and order of admission, had been
complied with. The elder sister was thirty-eight years old and
unmarried, and had been disappointed of marriage. The disease
showed itself by eroto-mania, then by destructiveness and wandering,
but though she often was threatening in manner and language she
did no harm to any one. She dragged about with her, her younger
sister, who appeared as crazy as herself, and partook in all her
irregularities. On admission, the two sisters were separated, but the
elder made no inquiries after the younger. She was treated prin¬
cipally by prolonged baths, and after a time recovered. The
younger sister was also single, and thirty-five years old. The only
abnormal condition discoverable was a certain degree of mental weak¬
ness, although to establish her insanity it was affirmed that, instead of
being an industrious woman as previously, she had suddenly laid aside
all labour without appreciable motive, had not opposed the destruction
of their furniture by her sister, and had followed her sister in her
vagabondage and irregular life. She was also accused of having
similar delusions as her sister with regard to impossible marriage
schemes, and of lewdness, and was stated to have said that, “ as for
me, I have no need of so many husbands, I shall be quite content
with my sister’s." Lastly, there was no question that when at
length taken in charge, she was as completely naked as her
sister.
When questioned relative to these circumstances, and her pre¬
vious life, she answered quite rationally; but remarked that she was
not strong in the head, that she loved her sister so much that she
voluntarily associated herself with her in all her caprices, although
conscious of their insanity, and chose to imitate her and to be
accounted a lunatic. The circumstance of being found naked she
explained was that she and her sister being imprisoned in a room at
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the Mairie, all their clothes were removed to prevent an attempt to es¬
cape, but that they did escape from a window nevertheless; an explan¬
ation which was confirmed. She acknowledged she was much to blame,
and, unlike her sister, when first seen exhibited no signs of sexual
excitement and libidinous expression, but a sense of shame when in¬
terrogated respecting her joining her sister in her irregular and im¬
moral conduct. During her stay in the asylum she showed no
signs of mental disturbance, conducted herself with propriety, and
always manifested the greatest interest in her sister’s health and
progress.
At page 29 of the * Archives Cliniques/ M. Dagron, of the Asylum
of Napoleon-Vendee, reports another interesting case of two sisters
affected with similar monomaniacal delusions, and placed in con¬
finement at the same time. The unmarried elder sister, thirty-
eight years of age, played the most prominent part and her history
only is detailed. Her sister had been married, and was thirty-six
years old. Both lived with an aged father, and for some years were
the source of great trouble to him on account of their eccentricities;
these at length became unbearable and dangerous. The elder unmar¬
ried sister was under the delusion that she had been violated during
sleep, and insensibility induced by a noxious drug, and that her father
was privy to it. After seeking interviews with her supposed seducer,
and being disappointed, she manifested^ a desire to revenge herself
on him, and at one time sought to decoy him into a house, where
she and her sister were prepared, armed with pistols, to murder him.
Moreover, she never walked out without arms, and used the greatest
precaution to safely lock herself in when at home, to save, as she
said, herself and her sister from those who had designs upon their
virtue. A brother she accused of exercising the art of magic and of
allowing her no repose. At length M. Dagron was called upon to
arrange for the removal of these two afflicted ladies to the asylum,
and he naively relates the difficulties and danger he had to encounter
in effecting this object, and of the subsequent annoyances he had to
undergo at their hands, when by his skill their mental state had been
improved.
In this last-quoted case there was no question as to the insanity
of both sisters ; the principal point to be noted is the concurrence of
the two in the same delusions, a circumstance of only occasional
occurrence among the insane and therefore deserving to be recorded.
The simultaneous occurrence of similar aberration and eventual
general paralysis in two brothers, has already been noted above.
Recovery as a sequel to incidental disease.
It is a well recognised fact that insanity, even when of an unfa¬
vorable type, is every now and then seen to disappear, or to be
greatly ameliorated, after the attack of some grave Dodily disorder.
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We have ourselves witnessed this occurrence after smallpox, erysipelas,
and pneumonia. In the first volume of the ‘ Archives Cliniques,'
several examples are recorded. Tor instance, in a man, aged forty-
four, admittted into the Blois Asylum with ambitious delirium,
muscular tremor, and stuttering, hesitating speech, or, in short, with
the symptoms of general paralysis, recovery which lasted four years
appeared to supervene upon an abundant suppuration from sloughs
on the two elbows. A second instance occurred at the same asylum,
where a man, thirty-one years old, was seized with suicidal melan¬
cholia, and severely bruised and cut his scalp by beating his head
against the wall. From these injuries a large formation of pus re¬
sulted, and incisions were required involving some loss of blood, which
with the suppuration reduced him to a state of excessive feeble¬
ness, with symptomatic fever. On the occurrence of free suppura¬
tion an improvement at once showed itself, and in eleven weeks
from the date of his admission, the patient went out well.
M. Dumesnil reports a case of melancholia cured after an attack
of scarlatina intentionally contracted. The patient, a farmer, was
seized with suicidal melancholia, when thirty-eight years of age, and
was transferred to Charenton, where his case was viewed unfavorably
on account of a strong hereditary predisposition to it. After seven
months' treatment no marked improvement was effected, and he then
came under M. Dumesnil's notice. After a time he somewhat im¬
proved, but then again relapsed, and was transferred to the infirmary
just at a time when two cases of scarlatina had made their appear¬
ance. After three or four days' residence in the infirmary the idea
occurred to M. Dumesnil that possibly an attack of scarlatina
might bring on a crisis in the patient's malady, and as the disease
was mild and uncomplicated, he, with the sanction of his colleague,
determined to let him remain exposed to the contagion of the fever.
The patient took the fever, and even before the characteristic erup¬
tion was well out, he announced to his physician that his morbid
depressing ideas has left him as if by enchantment, and from this time
his mental state underwent an entire change; he passed through the
fever without untoward event, and in six weeks from his febrile
attack returned home well, and has continued so for the three years
which have since transpired.
Dysentery proved critical in two cases. The first was that of a mar¬
ried man, aged forty-two, who became suddenly maniacal upon hearing
of the loss of 3000 francs, and was excessively violent, destructive, and
incoherent. Two days after the outbreak he was admitted into the
Asylum of Rodez, and on the following day was seized with dysentery,
which was then prevailing in the institution. During the course of
this malady the delirium and agitation gradually decreased; he
seemed to insensibly awake from a state of dreaming, and by the
first of September was cured of the dysentery and restored to reason.
It should be mentioned that besides the dysentery the patient suffered
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from various cuts and bruises about his body, and especially with a
deep gash, self inflicted, across the back of the neck. M. Renault
du Motey, who reports the case, attributes the recovery in some
degree to this large suppurating wound, as well as to the
dysentery.
The second instance in which an attack of dysentery appeared
to be curative, was that of a lady admitted into Maryville Asylum
February 4th, 1861, aged forty-nine. She was predisposed to in¬
sanity, her mother having been insane, and her mind gave way on
the occasion of a judicial search being made in her house respecting
some stolen property. She fell into a state of melancholia, with
aversion to her husband and partial stupor was superadded, to this
disorder some short time after her admission into the asylum, fol¬
lowed by refusal of food, and much excitement and destructiveness,
against which the camisole was employed. In May her condition
had become worse, and a seton in the neck, previously applied, was
removed. In the middle of June she got an attack of dysentery with
frequent vomiting, but this was relieved in about ten days, and a
marked improvement occurred in her whole condition. She became
quieter, slept well, took food readily, and requested employment.
Contemporaneously with all this it was observed that she had pro¬
fuse sweats regularly every morning; these however, produced no ex¬
haustion. On the 8th of July she was alarmed at the escape of an epi¬
leptic female in a state of nudity, and the reaction of this on her mind
completed its restoration to health. The morning sweats continued,
and it was now discovered that the catamenia had left her six months
before her admission into the asylum and two months only before
the outbreak of her insanity, and that she had suffered on their dis¬
appearance from fulness of head, faintness and vertigo. On the 28th
of August she was discharged cured.
Dysentery, followed by acute rheumatism, was apparently the
cause of recovery in a woman, attacked with monomania in her
thirty-eighth year, and after four years' persistence of the disorder.
There was no appreciable cause of the attack, which commenced with
sadness, and the delusion of persecutions and conspiracies. After
cherishing her project for some time, she murdered one child and
would have killed a second if not prevented, by dashing out their
brains against the ground; her desire being that she should be executed
for the murder. Being acquitted on the ground of insanity she was
transferred to the Asylum of Napoleon'Vendee, and there about a week
after admission, almost succeeded in committing suicide by cutting
her throat. If not perpetually watched she attempted self injury
in every conceivable manner, and was a cause of the greatest anxiety
in the asylum. Prolonged baths, hot and cold, according to the
season, continued irrigations on the head, douches, opiates, deriva¬
tives, &c., &c., were successively employed during more than three
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years, without benefit, when in October, 1858, she was seized with
dysentery, then prevailing in the asylum. After some days’ refusal of
the means of treatment prescribed, she at last willingly submitted
to them, and from this time convalescence set in, but was interrupted
by an attack of rheumatism, which was got the better of in October,
1859, when she appeared quite recovered in mind, though still de¬
tained in the asylum.
Another case is recorded by M. Berthier, from the Asylum of
Bourg, where recovery ensued three years after an attack of religious
monomania, with melancholy and stupor, in a woman thirty-nine years
of age. About three years after admission she eluded her nurse and
precipitated herself from a window, causing, among other injuries, a
comminuted fracture of the elbow. No improvement in her mental
state followed, whilst her bodily condition became deteriorated by
haemoptysis, intense fever, and then signs of purulent absorption and
an apparently dying state. However, she revived, took nourish¬
ment, and although an attack of dysentery supervened in the following
year, and ended in chronic diarrhoea, she slowly acquired strength.
After a time the diarrhoea ceased, and an evident mental improvement
occurred; her sleep returned, she took food well, and employed
herself. Her delusions of being lost, and of unpardonable wicked¬
ness, were elicited only by interrogation; she desired to see her hus¬
band, and in a short time more her mind appeared recovered and
she returned to her home. Nine months afterwards she remained
quite well. In this case, the attempt at suicide happened in March,
1858, but it was not until the autumn of 1859 that improvement
showed itself, when the vigour of the body had been all but anni¬
hilated.
Profuse intestinal haemorrhage ushered in recovery in a case of
painful hallucination of vision consequent upon an injury from a
railway accident. The report is by M. Baillarger. The patient was
fifty-two years old, and met with an accident on the railway near
Nancy, which rendered her insensible at the time and delirious for
several days afterwards. She was twice bled after the accident, and
when consciousness returned was haunted at short intervals by the
appearance of a train about to crush her, and the hallucination in¬
duced general tremor, with a sensation of fright, lasting several
minutes. She sought to go to Paris, but would not again venture on
the railway and determined to walk there. However, her strength was
unequal to the task, another attack of delirium seized her, and she was
found wandering in a wood and exhausted. She was brought on to
Paris, and was then found a prey to the same hallucination, followed
by universal trembling and a sort of convulsive motion. Apart from
this, her reason seemed to be sound, and she was able to go on
with her employment in the market. Nevertheless her hallucination
exposed her to great dangers, for she was prompted by it to throw
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herself before carriages and many times scarcely escaped being crushed
to death. Very soon delirium was again superadded, and then she
became haunted by other painful hallucinations, as of reptiles and
all sorts of animals tormenting her, and of objects being overturned,
cut in two, or enormously enlarged. The mental disorder became
general, she tore her clothes, and acted so wildly that she was taken
to the Salpetriere. Here on admission her attention could for a
time be fixed, but when left to herself she was incoherent. Under
improved regimen, repose and quinine, a speedy amelioration of her
condition ensued, excepting in respect to her hallucinations. She
continued the same until October 29th, when a copious haemorrhage
from the bowels took place, with immediate mitigation of her hallu¬
cinations. A few days later, however, these recurred as vividly as ever,
when, on the 19 th of November, they were replaced by a vision of
a collision and a conflagration, followed by strong emotion, vomiting,
and a cutaneous eruption. On the next day, there was pain in the
liver, which was evidently enlarged, and a jaundiced hue of the skin
and conjunctiva. Twenty leeches were applied over the liver, and
soon after a second attack of intestinal haemorrhage came on. From
this moment the hallucinations decreased in frequency and vivid¬
ness, and after five or six days' repose in bed, they disappeared
altgether.
Derivative Treatment by Blistering in Melancholia .
The above-quoted cases of incidental disease and injury followed
by recovery are examples of what is hypothetically called derivative
action; the one following is another instance of the same action,
obtained purposely, and attended by an equally favorable result. The
patient, aged thirty-six, unmarried, a governess, was under the care of
M. Petit, at the Nantes Asylum. After living fifteen years gover¬
ness in a family, her services were no longer required, and although
a home was still offered to her in the family, she declined it, and
went to live with some friends. In a very short time her manner
began to change; she became dull, susceptible, and scrupulous, and
at length entertained fears for her personal safety, and brusquely
quitted the house to go to her brother’s. Here the same sombre
disposition was manifested; her scruples went on multiplying, and
her mind, preoccupied with the delusion that she was lost for ever,
was the cause of all the evils which had befallen her family, and
that she ought to die. Her next act was to endeavour to
poison herself with laudanum, after which she was removed to the
asylum. Baths were ordered, and other treatment resorted to, but
her condition grew worse; she required constant watching, as she
sought to destroy herself; she refused food, and had to be fed at
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length with the oesophageal tube. Baths, douches, and affusions with
hot and cold water failed to benefit her, and the coldness of the
season rendered their employment less expedient. Recourse was then
had to the derivative treatment, not, as M. Petit remarks, from a
belief in its influence on the cerebral disease, but as a means of
fixing the attention of the patient, who necessarily desires to be
released from a painful or uncomfortable mode of treatment. It was
accordingly impressed upon her that, as her brain was diseased, a
rigorous but also a very efficacious means of removing irritation
must be adopted. A blister, about four inches in diameter, was
accordingly applied to the calf of one leg, and she was told that if
this did not serve the purpose another would be placed on the other
leg on the following day; she complained much of her blister, which
pained her, and prevented her walking. However, as she did not
yield in any way, a second blister was ordered. The next day she
made loud complaints, sat quietly on account of the pain, and took
some food without the oesophageal tube, and she was told her blisters
should be diminished in size if she did well. On the subsequent day
she was better, and only one blister was continued; this in another
week was omitted, the improvement having steadily advanced, and in
another month she was discharged cured. Five years afterwards, at
the date of the report to the Journal, she continued well.
On the Sequestration of the Insane.
Dr. Casimir Pinel has published in the ‘ Journal de Medecine
Mentale/ a series of papers on the “ Sequestration of the Insane," and
on the modes in which it may be most advantageously effected in
respect to the different classes of such sufferers. He reviews and
discusses the advantages and disadvantages of home treatment, of
surveillance in private houses, of confinement in asylums, public and
private, anckof travel. He commences by showing that mental differ
so materially from other disorders, that treatment at home under
the usual conditions is almost always impracticable and mischievous.
Even treatment apart by isolation of the patient in his own house,
where this is practicable, is rarely desirable. Still this rule has
exceptions, and, by way of trial, home treatment is permissible when
the attack is recent, and presents no grave features; as when there is
only slight maniacal excitement, monomania or melancholia, or certain
hallucinations and delirious conceptions not relating to the family, or
a state of hypochondriasis, or of dementia devoid of agitation. If,
under such circumstances the attention of relatives is duly appre¬
ciated, thankfully received, and ardently desired, then the removal of
the patient is not only not necessary, but also cruel; for naturally
none can and will do so much for his comfort and well being as his
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by Dr. Arlidge.
relatives. Where entire restriction to his own apartment is required,
some trustworthy attendants, strangers to the patient are needed,
and the visits of friends and of persons of the opposite sex inter¬
dicted. The exclusion of the wife or of the husband, as the case
may be, is often absolutely necessary, to avoid sexual excitement; and
under the most favorable circumstances, numberless inconveniences
and annoyances will attend the detention of a patient in his own
house. These are well pointed out by M. Pinel, but neither
they nor the circumstances which should induce the abandonment
of the attempt at home treatment, need be repeated in these
pages.
The next plan of treatment considered is that in private houses, -
where the necessary means are provided. It is more available than
home treatment for the insane, but from its cost, is necessarily so
only for the richer classes. The house should be in the country, and
be detached and surrounded by a good garden or pleasure-ground.
It should not be the property of the patient; it should be secure,
and provided with all appliances for treatment, such as baths; con¬
stant surveillance by trustworthy attendants should be provided; if
possible a medical man should reside with the patient; but if not so,
a neighbouring practitioner should daily, or at least frequently, visit
him. Another essential condition is, that none of his family should
reside in the same house, unless under some exceptional circumstances
by permission of the physician in attendance, to whom the whole
direction and control must be confided. Provided these conditions
be complied with, this plan may, under certain circumstances, be
(says M. Pinel) equally advantageous with those supplied by an
asylum. In fact, such a house is a small asylum, but exempt from
those impressions attaching to an asylum, and excluding all fear of
contact or of the moral influence of other lunatics; matters, by the
way, concerning which the public makes a great outcry, though
really rather favorable than otherwise to most insane patients.
A private house organized to meet all the legitimate requirements
of the case, at whatever expense, yet involves the patient in complete
isolation, and deprives him of the influence of a multitude of condi¬
tions, which together concur to render the moral and physical regime
more perfect, and more successful in practice. And moreover, a
thousand incidents are perpetually occurring of an irritating and
wearying character for the medical attendant, and perpetual annoy¬
ances from attendants and from the relatives of the patient, with
whom there is almost always a division of opinion relative to the
mode of treatment adopted. These drawbacks to the plan of
sequestration in a private house are graphically and truthfully detailed
by the writer.
"When patients have been unsuccessfully treated, and have become
calm and inoffensive, or are demented and paralytic, and therefore
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require only general attention to hygiene, their care in a private house
is available; and except where hereditary predisposition exists,
separation from their family at large is not required. Nevertheless,
it is prudent not to subject children, especially young girls, to the
moral contagion of intercourse with their afflicted relative. On the
other hand, this sort of provision cannot be entertained where there
is violent mania, melancholia, suicidal tendencies, epilepsy, or homi¬
cidal or instinctive monomania; for with the best intentions, the
measures necessary for the safety and treatment of such cases cannot
be resorted to without detriment to the patient. Other disad¬
vantages are pointed out, and M. Pinel concludes that treatment in
a private house is only exceptionally preferable, but that the majority,
including necessarily all those of moderate means and the poor, are
best cared for in asylums. He discusses at large the objections
made against asylums, shows how worthless they are in almost every
point, how largely asylum treatment has improved, and to what
perfection it is brought, and what care has been taken by the State
to guard against improper detention and improper treatment. He
examines the relative advantages of private and of public asylums
for those classes of patients competent to pay for their maintenance,
and decides on the superiority of private establishments, defending
them and their proprietors from popular calumnies so frequently
current with the public. He inquires, lastly, why asylums do not
effect more good, and by way of conclusion remarks, that " in the
interest of the insane, of families and of society, both from a medical
and a philanthropic point of view, a more prompt resort to treatment
than is usually the case should be insisted on; that delay in the
sequestration of lunatics is a cause of incurability in a multitude of
instances, and an occasion of accidents, and that it is right that the
law should insist in some cases on the confinement of insane persons
in asylums.”
The utility of travel to insane patients is well discussed by M. Pinel,
who whilst recognising the many difficulties which surround the plan,
and its mistaken adoption in many cases, agrees with Esquirol and
others on the great benefits which ensue from it in properly selected
cases. The circumstances which are favorable to the trial of tra¬
velling as a means of treatment in insane cases, are thus set forth:—
“ In threatened but not developed delirium, the result of excessive
intellectual work, of abuses of any sort, of violent griefs, of disap¬
pointed love, or of any other vehement passion or emotion. In such
the removal from the scene of excitement or toil, and the brusque
interruption of fatal habits by travel may turn aside the threatening
attack. 2. In melancholia, without incoherence of ideas. 8. In the
lucid intervals of certain intermittent mental disorders, to prevent the
recurrence of the paroxysm. 4. During convalescence, to confirm
the recovery, and especially to avoid the too speedy resumption of
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labour, or return home. 5. Lastly, in intellectual derangements of
an inoffensive character, and which have resisted the course of treat¬
ment in an asylum for a long time.”
Epithelial Granulations of the Arachnoid .
Dr. Ludwig Meyer has presented a complete history of these gra¬
nulations in Virchow's f Archiv/ Band xvii. These granulations,
noticed on the arachnoid in the brains of many insane, occur in large
numbers" are small, and look, when viewed obliquely under a direct
light, like so many opaque elevations. When seen by a magnifying
glass, many of these granulations are found to be connected together
by flat processes, whilst in other places they appear to form various
intersecting lines. They are, as a rule, found on the convex surface
of the cerebral hemispheres, but occasionally occur at their base, and
also on the cerebellum. The arachnoid, when so affected, is always
opaque, and thickened at parts, and frequently the well-known
granulations of the spondyma of the lateral ventricles are also met
with in connection with the meningeal granulations of the cerebral
surface. No such growths were met with on the arachnoid in indi¬
viduals who had died from typhus and tuberculosis. A microscopical
examination showed that these granulations are composed of large,
dark-outlined, opaque, or granular cells, which burst on the appli¬
cation of acetic acid, and allow their granular contents to escape.
No actual connection can be found between them and the connective
tissue of the arachnoid itself. Their granules are disposed concen¬
trically, or in longitudinal lines, or at times in heaps, and their form
does not admit of their being confounded with the granules of the
connective tissue. Meyer's conclusion, therefore, is that these
granulations originate from a sort of hypertrophy of the epithelium of
the arachnoid.
In many specimens the cells were found to be undergoing meta¬
morphosis, and presented in their interior collections of fat-cells or
of calcareous matter in the form of granules, or more frequently, of
concentric spherules. The last-named were noticed as first appearing
at the apex of the granulation. Meyer, moreover, found in the
normal condition of the arachnoid a collection of small, uniformly
rounded cells, under its epithelial layer, which he looked upon as the
analogue of the rete Malpighii.
The granulations of the arachnoid are met with in cases where
delirium tremens, chronic epilepsy, or progressive general paralysis
have existed, and have brought about also other considerable changes
in the brain and its membranes. Similar granulations were, moreover,
observed in the epithelial layer of the dura mater.
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Case of the presence of Cysticercus cellulosus in the Brain.
This case is reported by Dr. Snell, of Hildesheim ( f Zeitschrift fur
Psychiatrie/ Band xviii, p. 66, 1861). It occurred in a young man,
aged twenty-four, a linen-weaver, who also in the winter was partially
occupied in slaughtering pigs. In April, 1857, he had an attack of
intermittent fever, with great congestion about the head and chest.
Strong doses of quinine removed the paroxysms for a time, but at
intervals, longer or shorter, they recurred, and he did not completely
recover his health. In the summer of 1857, the patient suffered
from frequent and periodic severe pains of the head, especially of the
occiput, with weakness of vision, dilatation of the pupils, noises in
the ears, vomiting, anxiety, a feeling of weakness, and of loss of
power in the extremities. The mental state was also very often con¬
fused ; and sometimes the patient had to keep his bed, at others,
engaged in some light work. About the end of September he was
suddenly seized with a maniacal attack, and had to be restrained
from violence. He had hallucinations of balls of fire falling around
him, which he endeavoured to catch and to extinguish. He next
thought himself pursued by monstrous forms, which endeavoured to
seize upon and chain him in fetters, scattered around in every
direction. More cheerful hallucinations were exchanged for those
terrible ones; he imagined himself in company, and travelling spor¬
tively over hill and dale. After this state of excitement had lasted
three days and nights without any sleep, he fell into a deep sleep for
twenty-four hours, and then awoke quite conscious, having, however,
no distinct remembrance of the excitement and mental disturbance
he had passed through. He now again suffered from headache, with
a feeling of a ring tightened round the head, noises in the ear, indis¬
tinct vision, and more or less paralysis of the voluntary muscles.
The excitement recurred during the next two months several times,
B through the same course as before. In November and
ier the mental disturbance became more continuous, and
the paralysis, with mental stupor, augmented. Appetite and nutri¬
tion, however, remained normal.
At the end of December he was taken to the asylum. His gait
was then faltering; the pupils unvarying and dilated, and the left
one rather larger than the right, and he was getting blind fast.
Pulse 96. Severe frontal headache complained of. Anaesthesia of
the skin was not discoverable. He could comprehend and answer
questions directly addressed to him only when they related to objects
and circumstances immediately under his notice. All the bodily func¬
tions of nutrition and circulation appeared healthy. He slept well on
the first night, and appeared rather better next day; but at night
the paralysis became so much worse that he could neither stand nor
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by Dr. Arlidge.
move his arms. After a tranquil night he was better on the 29th.
He walked across the room, moved his arms quite freely, and gave
intelligent answers; at the same time the rigidity of the pupils and
blindness persisted. Towards evening the paralysis increased, and at
10 o'clock was very restless. He got out of bed and groped for the
■walls of the room, telling the attendants he must get away out of
the churchyard. After three hours this excitement passed away and
coma followed, which ended in death three hours afterwards.
Autopsy .—Body well nourished. Brain weighed fifty-four ounces.
Throughout the brain numerous cysts were discovered, which proved,
under the microscope, those of cysticercus cellulosus. Five of these
cysticerci were affixed by pedicles to the inner surface of the dura
mater; all the rest occurred in the gray matter alone, and in this
wherever it existed, whether on the surface of the convolutions, or
in the ganglions, or in the commissures. By far the largest number
existed in the gray lamina of the hemispheres, and here and there
were collected in dense groups. The gray substance of the optic
thalami, and corpora striata, was closely beset with them. In the
cerebellum only four were met with, whilst in the medulla oblongata
they were entirely absent. They were not seen anywhere within the
white substance, although at some points where very numerous in
the gray lamina they had penetrated it.
The entire number of cysticerci encountered was 200. They were
for the most part fully developed, and contained watery fluid;
however, there were some in process of degeneration, containing
opaque, yellowish, or purulent matter. In size they were mostly
about that of a small pea, but some were not larger than millet seed,
whilst the largest did not exceed the dimensions of a full-grown pea.
The brain was otherwise firm, and quite normal in appearance;
nothing like inflammatory action showed itself in the neighbourhood
of the cyst, or, indeed, any other change. The arachnoid and pia
mater were normal.
Excepting in the brain, no cysticerci were discoverable in any
part or tissue of the body elsewhere, and no pathological change of
any sort; wherefore all the morbid symptoms and the cause of death
can be attributed to nothing else than the presence and pressure of
these parasites in the brain substance. It is well to observe the
entire absence of spasm in the history of this case; and another
very remarkable circumstance were the variations, not only in the
psychical symptoms, but also in the degree of paralysis; the fluc¬
tuation in the latter condition being most distinct in the last stages
of the disease. The cysticerci presented, when detached, placed in
lukewarm water, much more active movements than they generally
have credit for, particularly in their capacity of contraction. Could
such movements stand in any immediate relation with the fluctuations
in the symptoms ? Stich inclines to this opinion. In his meritorious
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Excerpta from Foreign Journals,
essay on cysticercus (in the ‘ Annalen des Charite-krankenhause/
Berlin, 1854), he has collected the history of fourteen cases of this
parasitic growth in the brains of man. Some of the descriptions he
makes use of, from various writers, are in parts very defective; but
he deduces the usual indications of the presence of cysticerci to be
mental disorder, convulsions, and paralysis. In four cases, epileptic
convulsions were noted. Twice intermittence in the symptoms was
noticed, as in the preceding case, which began as intermittent fever.
In some few cases, where the number of cysticerci was small, no
morbid results were connected with their presence.
The Temperature of the External Surf ace of the Head in the Insane.
By Professor J. P. H. Albebs.
Professor Albers, taking as his starting point the thermometrical
observations of John Hunter on the comparative temperature of the
body in health and disease, and the admitted elevation of the tempe¬
rature of the external surface in some fevers, in pneumonia, and
other diseases, proceeded with a series of original researches on the
temperature of the head among the insane, the internal disordered
action of the brain being in some cases, at least, referable to
altered circulation, to congestion, if not to inflammatory action.
Admitting an abnormal circulation to prevail within the cranial
cavity, he argues from analogy with other inclosed organs, that
this disturbance must be manifested externally on the surface of the
investing structure.
But before he could carry out his plan with reference to the
temperature of the head in insanity, it was necessary to know what
might be the usual temperature of that region in healthy people ;
a piece of information he could nowhere discover in books. Ac¬
cordingly he was compelled to commence ad initio, and to collect
data with respect to the sane to serve as a standard of reference
for his enquiries relative to the insane. In order to secure as much
correctness as possible with such data, in was necessary in exploring
the temperature of the head and other regions to discover the
differences, if any, dependent on age, sex, the surrounding tempe¬
rature, the variations of warmth attendant upon clothing, the time
of day, the state of health and constitution, the state of repletion or
of fasting, the quality of the food, or the medicinal agents taken, &c.
On these particulars he does not go into detail, and the leading
results narrated are as follows: Of all the external parts of the
body the highest temperature is met with in the axilla and in the
triangular space on the front of the neck inclosed between the two
stemo-mastoid muscles. In this region the temperature was 29° B.,
more rarely 28 J or 28.° Taking the parts of the head, the heat in
the temporal region varied from 24° to 25° E., and behind the
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by Dr. Arlidge.
ear from 27° to 28°. These are the usual ranges of temperature in
adults of from twenty-two to thirty-five years of age, and calculated
from between 800 and 400 observations. As general facts it may be
stated that the degree of warmth immediately over muscles exceeds
that in spaces adjoining them, and, what is remarkable, that the
right is appreciably warmer than the left side of the body. This
latter holds as an almost universal rule, the exceptions being so few.
These facts hold good of the human subject both in health and in
disease.
Professor Albers, after establishing these general data, proceeds to
give a daily record of observations made in a case of religious
melancholy attended with great restlessness. The patient was twenty- -
four years of age, and had been ill five months. The irritation was
accompanied with plethora and with haemorrhoids. The tempera¬
ture of the room was kept at the time of observation, which was
between half-past nine and half-past ten in the morning, an hour
and a half after breakfast, at a uniform temperature of 15° R.; and
the patient out of bed and dressed. The thermometer was applied
to the temples, behind the ear, on the fore part of the neck, and to
the hands. The figures representing the temperature of each of these
regions are daily recorded, together with the mental condition of the
patient, the amount of sleep he took, and the medicine administered;
these particulars we cannot here reproduce, and it must suffice to
notice Professor Albers' conclusions from them.
The heat of the temporal region is normally 24° or 25°, but in the
young man in question it was rather higher, viz., 26°. In a young
officer of sound mind, in the temporal region the thermometer stood
on the left side at 26° R., and on the right at 27°; the mastoid
region showed 27° on the left, and 28° on the right side; while the
temperature of the neck reached 29°. The heat of the temporal
region is less than that of the mastoid, and still less than that of the
front of the neck; the variation equalling two degrees between each
region.
Other series of observations were carried on in two cases of
chronic dementia, and in one case of hysterical insanity, and the
same general results were arrived at, together with the following:
that maniacal excitement in any form 6r degree is accompanied by
an elevation of temperature in the frontal region, and in a lesser
degree in the temples, and under and behind the ears. The fact
that the sufferers from dementia present as high a temperature of
the head as the non-demented insane is one of much interest, par¬
ticularly as from the less active and complete nutrition of the brain
in the former it has been generally supposed that there must be a
diminution of cutaneous warmth. The increase of temperature con¬
sequent on mental excitement, if dependent on an augmented supply
of blood, implies that such excitement is attended by an increased
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determination of blood to the head. 2. That the increase of tem¬
perature is greatest in the temporal region. For the differential
amount of heat, about two degrees, between that and the mastoid
region, is decreased when any amount of excitement occurs, a circum¬
stance equivalent to a positive rise in the cranial temperature.
3. The figures denoting the heat of the head and of the neck respec¬
tively, are, 24 or 25 in the former, and 28£ or 29 in the latter.
But if there be an accession of heat in the temporal mastoid region,
the augmentation in the neck is not proportionately great, the tempe¬
rature rarely exceeding 29°. The normal difference, therefore, between
the head and neck is diminished, and the more so as the frontal
heat is greater; and the conclusion may be drawn that the tempe¬
rature of the head is abnormal when there is a difference between
it and that of the neck of less than three degrees. 4. With refe¬
rence to the difference of temperature between the two sides of the
head, of from £ to li under slight emotion, this becomes inappreci¬
able under strong excitement.
Two other sets of facts occurr^l to Professor Albers from these
researches on animal heat; one bearing upon the rapidity with which
an elevation of temperature is accomplished, and the other on the
inequality in the radiation or diffusion of the warmth. On
measuring the heat of the head in sudden paroxysms of passion,
when the countenance, the head and neck had momentarily red¬
dened, he found the temperature rise from one to two degrees. Such
results are best and most witnessed in the sudden outbursts of rage
in the insane, and, though in a less pronounced manner, in that
passing irritability attended with redness and heat of face, noticed
in women at about their climacteric period. And it is instructive
to notice both that insanity is liable then to occur, and that when
it does happen, it follows the psychical type of that period, when
the mind is imbued with distrust, is irritable, morose and enfeebled,
and disposed to despondency.
The other phenomenon noticed was the unequal length of time
which transpired before the thermoifieter marked its highest point.
On some days, under precisely the same conditions of surrounding
media, of the time of day and of thermometrical reading, the
maximum heat of the part Was not indicated until after the lapse
of three or four minutes, whilst on others this was accomplished in a
minute or a minute and a half. This circumstance is explicable
only on the supposition of an unequal rate of radiation of heat from
the body on some days than on others, for the moisture or softness
of the skin did not exhibit any modifying effects in this phenomenon.
It moreover appears from the many measurements made upon
patients, that the radiation of heat from the body varies at different
parts of the day, and under various conditions of health. Whilst
putting forth these facts as well worth attention. Professor Albers
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confesses that similar observations need be repeated, and the varia¬
tions caused by food, sleep, motion, external temperature, baro¬
metrical pressure, the evacuation of the bladder and rectum, and
other conceivable disturbing causes, allowed for and duly appreciated.
As to the effects of different diseases, as far as observed, no
difference obtains in melancholia and in dementia; except when
there was much torpor, when the rise of the mercury took place
more slowly. This fact suggests the question as to the difference
of radiation of paralysed and of non-paralysed parts. The variation
in radiation at different parts of the day, and on different days,
suggests this inference—that the needof clothing and of warmth must
likewise vary even where external atmospheric conditions are un¬
changed as to temperature. Indeed, it is a well recognised fact,
that we may feel warmer on one day, when the temperature is even
lower, than on another in which the heat has been greater.
Sixteenth Report of the Commissioners in Lunacy to the Lord Chan¬
cellor. 1862, pp. 225.
Fourth Annual Report of the General Board of Commissioners in
Lunacy for Scotland. 1862, pp. 248.
Eleventh Report on the District, Criminal, and Private Lunatic
Asylums in Ireland, with Appendices. 1862, pp. 60.
"Reserving for another occasion an analysis of the general
contents of the official Reports which head this article, we shall at
f uesent restrict ourselves to a sketch of the comparative statistics of
unacy in the three divisions of this kingdom.
According to the returns of the English Commissioners in Lunacy,
there were 24,845 lunatics in asylums, hospitals, and licensed houses
on January 1st, 1861, and 26,200 on January 1st, 1862, showing
an increase of 1355 in the course of the year. Of this increase 128
occurred among private, and 1227 among pauper lunatics.
The Scotch Commissioners’ returns are upwards of a year old, and
unlike those of the English Board present the statistics of 1860.
However, on the 1st of January, 1861, there were in public and
district asylums, and in private asylums and licensed houses to¬
gether, 2619 lunatics, being an increase of 80 in public, and of 55
in private institutions, and together of 135 in the course of the
year 1860.
ty Google
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Lunacy Reports.
The Irish Report, again, comprises the history of lunacy in Ireland
for only nine months;'viz., from the 81st of March to the 81st of
December, 1861, and thus increases the difficulty of a survey of the
state of luuacy in the entire realm. Keeping in view only those
insane who are inmates of public or private asylums, we find that
there were on December 31st, 1861, 5114 such lunatics in Ireland,
of whom only 515 were resident in private establishments. Instead
of 4599 in public asylums, there were on March 31st, 1861, 4502
lunatics, showing an increase of only 97 in nine months, whilst in
the case of inmates of private asylums only two were added in that
period, their numbers being 511) instead of 513.
The addition to our lunatic population in asylums in the three
divisions of the country in the periods to which the reports refer, was
1589, and of this increase England alone contributed 1355, a circum¬
stance which, if it represented the relative prevalence of insanity in
this portion of the empire, might well give rise to alarming appre¬
hension of a mental degeneracy of its inhabitants. However, such
figures very remotely indicate the prevalence of mental disorder
either in England or in other portions of this realm. The English
Commissioners in their Reports deal exclusively, except by way of an
occasional appendix, with the insane in licensed institutions, public
and private, and inasmuch as its population is so much larger, and
the development of such establishments has proceeded in England
to a much larger extent than in the sister kingdoms, it follows that
both the number of their inmates is proportionately larger, and the
figures representing their movements,—the admissions, discharges,
and deaths, assume a greater magnitude. This explanation must
be admitted, so far as it goes, to be correct, still it cannot be
sufficient and satisfactory in the face of such an enormous annual
addition to the number of the insane in England as compared with
what has taken place in the course of a year in Scotland. Doubt¬
less this wide divergence of results in the two kingdoms admits of
some other explanations, without assuming it to be a fact that the
insane in England are multiplying at a fearful rate, an appre¬
hension which the last report of the Commissioners in Lunacy was
calculated to dispel.
We should be pleased to see a tabular statement annually put
forth by the English Commissioners representing the whole state of
lunacy in the country as far as discoverable; for surely, as a great
social question, it is important to know what is the entire number of
lunatics, whether found in recognised institutions for their deten¬
tion, or in workhouses, prisons, or private houses. This information
is presented in the Scotch Reports as far as it is attainable, and in the
Irish returns there is a precise statement of the number in poor-
houses and in prisons, and an approximate estimate, made through
the instrumentality of the police, of all other lunatics in the country
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hot under the supervision of the Commissioners. On the other hand,
the authorities in Ireland have not proceeded so far as those in
England in their endeavour to discover and bring within their juris¬
diction the numerous cases of single patients detained in private
houses, and of which, from time to time, the English commissioners
hav6 attempted to give an approximative return.
Commencing with the more complete details furnished by the
Scottish Board, we will extract the tabular summary published of the
whole estimated number of the insane, and of their distribution:
Mode of Distribution.
M.
F.
Total
Private.
Pauper,
M.
r.
Total.
M.
F.
Total.
In Public Asylums
Private „
Poorhouses
Private bouses.
1353
378
343
1840
1359
529
500
1834
2712
907
843
3674
391
88
1041
375
136
2
846
766
224
2
1887
902
290
343
799
984
393
498
988
1946
683
841
1787
Total
3914
4222
8136
1520
1359
2879
2394
2863
5257
These figures represent the actual number of lunatics in Scotland,
ascertained officially, except in the case of those living in private
houses, of whom the number given is only approximative. Of these
the Commissioners remark that, during their first inspection, they
“ acquired knowledge of the existence of 1887 private single patients,
—1041 males and 846 females; but in later inspections we have
forborne to make any searching inquiries respecting such patients, as,
for the most part, they are living with their families, and, conse¬
quently, are not subject to statutory visitation. As it is probable,
however, that the decrease in their numbers, by removal to asylums,
recovery and death, is at least compensated by the occurrence of new
cases, and by the transference home of unrecovered patients from
asylums, we continue to adopt the numbers formerly ascertained as
still sufficiently .accurate to be adopted in a general estimate of the
number of the insane in Scotland.”
Of those detained in public and private asylums we found the
number augmented during the year 1860, by 135; but from this
increase must be deducted 23, representing a decrease in the lunatic
wards of workhouses, and also 60, the number of pauper lunatics
placed as single patients less than that of the preceding year (1859),
making, together, a diminution of 83. Therefore the whole actual
addition to the insane population of Scotland in the year 1860 was
135 less 83, that is, 52, a remarkably small increment, contrasting
strongly with the returns for England, and also much beneath those
for Ireland, as we shall now show.
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Lunacy Reports.
The following summary occurs in the Eleventh Report.
Lunatics.
Idiots.
Epileptics.
General Total.
M.
F.
Total.
M.
F.
Total.
M.
F.
Total
M.
F.
Total.
In District asylums .
1966
1968
3934
76
62
138
174
142
316
22162172
1388
Poorhouses .
227
441
668!
470
547
1017
311
596
907
10081584
2592
Gaols
207
118
325
—
—
—
—
—
—
213
126
339
Private asylums
244
231
475
13
15
28
8
4
12
265
250
515
Central asylum
Lucan Spa asylum^
(House of Industry !
patients) . . J
87
38
125
2
2
4
1
1
2
90
41
131
18
62
80
—
—
18
62
80
Convict prisons
10
—
10
—
—
—
—
—
—
10
_
10
Total
2759
2858
5617
561
i
626 1187
494
743
1237
38204235
i
8055
"Besides the above (add the reporters), from returns we obtained
at the close of 1860, from every police district in Ireland, and in
which the particulars as regards name, age, residence, &c., were
given, there appeared to be an aggregate of 8991 human beings of
all grades more or less mentally affected, of whom 1651 were
lunatics properly so called, 5469 were imbeciles, and 4871 affected
with epilepsy. We need scarcely observe that these returns, from the
mode through which they were obtained, although, as stated in our
last Report, every care was taken in their compilation, can only be
regarded as simply approximative/’
In the above-quoted table, a discrepancy appears with respect to
those enumerated as detained in gaols, for under the heading of
lunatics 325 occur, whilst in the column of totals 339 are set down.
To explain this we refer to p. 27 of the Report, where we find it stated
that "321 lunatics committed as dangerous were still in custody/’
whilst again, in the tables at p. 53, this same number 321 recurs in
the one setting forth those who were confined in gaols as " dan¬
gerous lunaticsin another, 11 are accounted for as persons in
custody, " acquitted of offences on the ground of insanity,” and in a
third, 7 are returned as remaining in gaol, " who were found to be
insane on arraignment, and incapable of pleading.” On adding
together these numbers, the total 339 given in the table, will be
found correct, the error having crept in somewhere in the columns
representing the form of mental disturbance.
Comparing the totals in this table with those returned nine months
previously, an increase is seen of 58 in workhouse inmates, of 99 in
the district asylums, of 2 in private asylums, and of 57 in gaols ;—a
total of 216. But from this must be deducted a decrease of 2 at
Dundrum (central asylum), leaving 214 as the total increase in the
period specified. In this estimate no account is taken of lunatics
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421
Lunacy Statistics.
resident in private houses or at large, who were, as already noted,
approximative^ numbered at 8991 by the police authorities at the
beginning of 1860, and respecting whose increase or decrease during
the succeeding year no data are furnished.
The English commissioners publish, as before remarked, no such
complete summary of the numbers and mode of distribution of the
insane in England and Wales as we are favoured with by the Scotch
and Irish boards. In the absence of such a summary, we will, by
the aid of the returns published by the Poor Law Board, supplement
the summary of the English commissioners by an enumeration of
lunatic paupers detained in workhouses or in lodgings or resident
with their relatives, and by such means produce a table so far alike
that its results may be compared with the statistics presented by the
Irish and Scotch authorities, except with regard to private single
patients, of whose numbers in England no estimate has been formed
by the authorities.
A most elaborate return of the pauper lunatics, including idiots,
in all the unions and single parishes in England and Wales, on
January 1st, 1861, showing their number and place of maintenance
in each, was prepared by Mr. Purdy, the principal of the statistical
department of the board, and printed as a parliamentary paper in
1861; and a subsequent return of pauperism on January 1st, 1862,
furnishes us with the numbers of pauper lunatics at this latter date.
With the data so derived we have constructed the following tabular
synopsis of lunacy in England and Wales'on the 1st of January, 1861,
but have been compelled, however, for reasons before stated, to omit
the item of private patients living in private houses.
Mode of distribution.
M.
F.
Total.
Private.
Pauper.
M.
F.
Total.
M.
F.
Total.
In Public asylums
Private „
Workhouses
Private houses
9579
2095
20,742
4,103
8,543
6,115
1183
1648
921
1370
i
2104
3018
~\
1
8396
447
10,242
638
18,638
1,085 |_i
8,543 \ £
6,115 f w
9 J 00
Total .
—
—
39,503
2831
2291
5122
—
—
34,381
The n um ber of lunatic paupers of each sex in workhouses and
private houses is not shown, but, taking the gross numbers, we find
that the two sexes stand so related, that for seven lunatic pauper males
there are nine lunatic females.
In compiling a table such as the foregoing, a considerable discre¬
pancy appears between the returns made by the Poor Law Board and
those by the Lunacy Commissioners with regard to the number of
paupers maintained in asylums, public and private, and in hospitals
Vol. vni. ~ 28
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422 Lunacy Statistics.
for the insane. Thus, on January 1st, 1861, the Poor Law Board
makes a return of 18,262 pauper lunatics in such establishments, and
the Commissioners in Lunacy report an aggregate of 19,723, an excess
of 1461 individuals over and above the former number. This
difference is explicable, at least in a great measure, by the circum¬
stance that there are various unions and parishes in the country which
make no returns to the Poor Law Board, though they together com¬
prise a population of 247,741 persons; also that county patients and
many criminal lunatics not chargeable to the poor-rates are omitted
from the estimate made by the board.
Bearing these facts in mind, and allowing for these unnumbered
lunatics in the Poor Law Board returns, we will construct a table
for the year ending January 1st, 1862, similar to that above given
for the previous twelvemonth ending January 1st, 1861. However,
as unfortunately the special lunacy return by the Poor Law Board is
not yet published, we have only the total of chargeable lunatic pau¬
pers not in asylums, and no further division of them according to
their place of maintenance.
Mode of distribution.
M.
F.
Total.
Private.
Pauper.
M.
F.
Total.
M.
F.
Total.
In Public asylums ,
Private „
Workhouses and y
private houses)
10,136
2,225
11,671
2,168
21,807
4,393
14,800
1251
1704
906
1389
2157
3093
8885
521
10,765
779
19,650
1,300
14,800
Total.
—
—
41,000
2955
2295
5250
—
—
35,750
The amount, 14,800 paupers in workhouses, lodgings, and resident
with their relatives, is, as above intimated, approximate, owing to the
absence of precise offi cial information; nevertheless it is, we are
persuaded, not far wrong, and, at all events, is within the actual
number.
Comparing, now, the two tables for 1860 and 1861, a considerable
increase in the number of the insane is manifest under every head¬
ing, and a total increment of 1500 in the latter year, of which
the greater proportion by far (viz., 1065) has taken place, in the
public asylums and hospitals for the insane. Moreover, if we
further examine these tables, we notice that there has been a positive
decrease in the number of private patients in asylums, a circumstance
which renders the increase of pauper lunacy still more alarming.
This increase may be attributed to accumulation of chronic insanity,
but however this may be, it progresses year by year in this king¬
dom, and inevitably entails an increased expenditure. Public
asylums are ever multiplying and being enlarged, but all this
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423
Lunacy Statistics.
increased accommodation does not prevent a constant rise in the
number of pauper lunatics, both in private asylums, in workhouses,
and in the private dwellings of the poor. This state of things is
most unsatisfactory and painful, considering the great endeavours
made and the enormous expenditure undergone to provide for the
treatment of the insane, and the impression will force itself on most
minds that the plans adopted hitherto must be in some measure at
least ineffectual, and that our method of providing for the insane
must undergo a material change.
Adding the totals in each of the three divisions of this country,
we find that at the commencement of 1861 (January 1st) there
were 55,430 lunatics and idiots known to the legally constituted
authorities of the realm, leaving out of sight several thousands of
private cases not recognised by those authorities, and which we have
seen in Ireland alone approximatively estimated at 9000, a number
slightly larger than that of the whole number in institutions mider
the supervision of the commissioners for that kingdom. During
the course of the year 1861 this large total of 55,430 appears to
have been augmented by an addition of 1800 other lunatics,
elevating the insane population of the whole empire to upwards of
57,000, without reckoning single private cases in England and
Ireland.
Taking the population of England, according to the census of 1861,
at 20,061,725, and the number of lunatics as estimated at 41,000,
the per-centage of the latter to the whole population is 0*204, or
rather more than one fifth per cent., so that among about every 450
people in this kingdom, men, women, and children, there is one
insane individual ; or, taking the accepted estimate of the adult popu¬
lation twenty years old and upwards at 9,816,597, and allowing
6000 of the 41,000 for idiots and others mentally disordered under
twenty years of age, the per-centage of adult lunacy is 0*36; or,
in round numbers, there is one adult lunatic in every 300 grown¬
up individuals. YYe have not at hand the means of ascertaining the
number of persons of unsound mind under twenty years of age, but
we believe we much over-estimate them at 6000, for in 1862 the
Poor Law Board returned only 674 as under sixteen years old out
of the large number of 34,215 pauper lunatics chargeable to unions
and parishes. Therefore the general deduction ventured upon, that
there is one individual insane known to the authorities in every 300
.adults, is within the mark. These computations refer only to the
proportion of officially recognised insanity in the community, and
could they be so extended as to comprise all the lunacy existing,
or, in other words, could we add to the official numerical returns
the number of the insane not accounted for in them, we should
discover the ratio of insanity to the population to be considerably
higher. Among these officially recognised insane are those lunatic
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424
Lunacy Statistic.
paupers belonging to parishes which make no returns to the Poor
Law Board, and who are detained in workhouses or resident in
lodgings or with their own relatives, also the large number of private
patients, including a certain portion of Chancery lunatics not enume¬
rated by the commissioners, living in their own houses or boarded
out, together with the lunatics to be found in the Government
convict prisons and reformatories, as well as in the county gaols;
vagrant lunatics, and those of the army and navy not found in
Haslar Hospital or any of the private asylums visited by the Com¬
missioners in Lunacy.
By far the largest proportion of such unenumerated lunatics con¬
sists of private patients, living in private houses, who, if the esti¬
mate given by the Scotch board of such patients, after minute
inquiry respecting their numbers, can be used as a standard in
forming an opinion of the numbers probably existing in England,
will constitute a large addition to the above calculated sum of the
insane. Eor, as we have recorded, such cases are set down by the
commissioners for Scotland at 1887, and there is a population of
3,061,251. Now, the population of England and Wales is
20,061,725, or rather more than four and a naif times greater than
that of Scotland; consequently, if the private single cases of insanity
stand in the same ratio to the entire population as they do in Scot¬
land, these cases will amount in England, in round numbers, to
12,000. And judging from the statistics of lunacy in the two king¬
doms, we have good reason for surmising that this class of the
insane may be even more numerous in England than in Scotland.
As to the other classes of lunatics unrecognised in the official
tables, it will be a moderate estimate to put them together at 1000 ;
this, with the sum of 12,000 just arrived at, gives a total of 13,000
to be added to the 41,000 insane officially enumerated, and the grand
total representing the numbers of the insane in England and Wales
will therefore be 54,000. This sum represents a per-centage of 0*26 on
the entire population of England, and O’55 per cent, on the entire
population of the country, or one adult insane individual in every
200 who are twenty years old or upwards.
On making similar calculations for Scotland, we lind that in a
population of 3,061,251 there are 1,136 lunatics, and therefore that
the latter constitute 0*26 of the entire population; or, in round
numbers, there is one insane person in every 400. Assuming, as
is usually done, that of the entire population one half is twenty
years of age and upwards, then the ratio of lunatics to the adult
population will be double that just calculated, or 0‘53 per cent., a
proportion almost precisely the same as just now determined in
England. Some slight reduction, however, in this proportion is
demanded, inasmuch as among the 8136 lunatics there is a certain
number under twenty years of age; what this may be we are not in-
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Lunacy Statistics. 425
formed, as none of the tabular statements given in the Scotch report
set forth the ages of the patients.
Not having the results of the last Irish census at hand, we are
unable to extend these calculations respecting the number of the
insane to Ireland.
Another point is the ratio of pauper lunacy to pauperism, and
here we have, with regard to England, the precise statement from the
Poor Law Board returns, that “ 3*69 per cent, of pauperism, on
the 1st of January last, is ascribable to insanity, the lunatics being
2*64 per cent, and the idiots 1-05 per cent.” So, again, with respect
to Scotland, we have the calculation made by the Lunacy Board
that paupers are in the proportion of 25 253 per 1000 of the entire
population, and pauper lunatics in that of 1*717 ; whilst the latter
are to the paupers as 68*002 in every thousand, a ratio not much
less than double that ascertained in England. In the Irish report
we discover no data for similar calculations.
The following instructive tables and comments we copy from the
last (fourth) report of the commissioners for Scotland :
Years.
Numbers placed in Asylums.
General total.
Pauper.
Private.
Male.
Female.
Total.
Male.
Female.
Total.
Male.
Female.
Total.
1858.
436
606
1042
193
213
4m
629
819
144#
1859.
476
555
1031
201
190
391
677
745
1422
1860.
488
573
1061
166
215
381
654
788
1442
1861.
475
686
1061
220
215
435
695
801
149ff
Average..
468-7
580-0
10487
1950
208*2
403*2
663-7
788-2
14520
Years.
Number of Pauper
Lunatics on Jan. 1st.
Increase.
1858
4737
1859
4980
243
1860
5226
246
1861
5257
31
As the number of pauper lunatics estimated in 1858 and 1859,
i. e. just after the appointment of the commission, was probably
considerably above the average, owing to an accumulation of old
cases then first brought to light by the commissioners, the first-
quoted table will more correctly indicate the progress of lunacy in
the last three years named. And on examining that table it will be
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426
Lunacy Statistics.
seen to show “ a remarkable steadiness in the annual production of
lunacy, so far as this can be estimated from the necessity for asylum
treatment, in its relative occurrence among the pauper and non¬
pauper classes of the community, and in the relative susceptibility of
males and females.” ... It “likewise throws light on the
causes of the supposed increase of insanity. Judging from the
evidence it affords, this increase is almost entirely due to the accu¬
mulation of the numbers of the insane, and certainly not in any
marked degree to a greater disposition in modern times to mental
disease, for while, in the years 1858, 1859, 1860, and 1861, the
admissions into asylums scarcely varied in number, the patients
resident in such establishments showed every year a large and steady
increase. Thus, on January 1st, 1858, their number amounted to
3965; on January 1st, 1859, to 4114; on January 1st, 1860, to
4350; and on January 1st, 1861, to 4462. It thus appears that
the admissions are on an average about 230 in excess of the removals
and deaths. This annual increase of the population of asylums,
which, it should be noted, is confined to paupers, must add about
£5000 a year to the expenditure for this class of the insane. On
January 1st, 1858, the number of private patients in establishments
was 1012; on January 1st, 1861, it was 992, or 20 less (the pro¬
portion of private patients admitted into asylums is to that of
paupers as nearly 1 to 3). This constant growth of pauper lunacy
and stationary condition of private lunacy deserve most serious
consideration, and, as was pointed out in our last report, indicate
either that a larger number of private patients are improperly
removed from asylums or that a large number of pauper patients
are unnecessarily detained in such establishments.”
The preceding statements in general apply to the histojy of lunacy
in England, as the following table we have constructed for the
purpose sufficiently demonstrates, although, from the absence of
official information, we cannot show the relative number of admissions
of private and of pauper patients. On this matter, however, the
previous table of the existing state of lunacy in England (p. 422)
- will throw some light by means of the columns indicating the
relative proportion of pauper and of private patients remaining on
January 1st, 1862.
Years.
Admissions.
Remaining January 1st.
Increase.
Male.
Female.
Total.
Male.
Female.
Total.
On each
preced¬
ing year.
Total at
end of 5
years.
1858
1859
1860
1861
1862
4042
4528
4505
4460
4104
4576
4735
4495
8146
9104
9240
8955
10,493
10,827
11,216
11,673
12,361
11,817
12,084
12,501
13,161
13,839
1
22,310
22,911
23,717
24,834
26,200
1966
601
806
1117
1366
i
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427
Lunacy Statistics.
This table shows that in the period of the last five years the
addition to the insane in asylums, by accumulation and increase
together, has been 3890, and at the rate of 778 per annum. This
amount comprises both pauper and private patients; but from the
following table, which we compile, the separate and comparative
increase of both classes may be computed.
Remaining
January 1st.
Private.
Pauper.
Male.
Female.
Total.
Male.
Female.
Total.
1858
2508
2230
4738
7985
9,587
17,572
1859
2658
2231
4889
8169
9,853
18,022
1860
2696
2231
4927
8520
10,270
18,790
1861
2829
2287
5116
8844
10,874
19,718
1862
2955
2295
5250
9406
11,544
20,950
Increase \
in 5 yrs. j
447
65
512
1421
1957
3878
Thus, whilst private patients have accumulated in five years at the
rate of 102*4 per annum, pauper lunatics have done so at the rate
of 675*6 per annum.
The relative proportion of the two sexes among the private and
pauper occupants of asylums is well deserving consideration, but
we have not opportunity at present to work out this question, and
unfortunately the commissioners, in their annual summary of ad¬
missions, do not distinguish private from pauper patients. At the
same time, we would call attention to the larger proportion of males
to females of the class of private patients, and to the contrary
relation in the case of lunatics of the pauper class.
The ratio of recoveries to admissions in the public and private
asylums, and in the licensed wards of poor-houses in Scotland, we
find to be throughout 40*54 per cent.; for males 38*51, and for
females 42*25. The ratio is stated by the commissioners for each
description of establishment separately, as follows:—In public
asylums the recoveries equal 40*52 percent.; for males 39*87, for
females 41*16. In private establishments they are at the rate of
32*14; for males 26*78, for females 87*60. In the wards of
poor-houses they reach 46*24 per cent.; 42*76 for males, and 49*73
for females. The occurrence of a maximum of recoveries among
lunatics in the wards of workhouses will be somewhat startling to
most readers. But it is explicable without resort to the suppo¬
sition of their excellence as places of treatment. These establish¬
ments have “ high mortality, and a high proportion of admissions
in comparison with the average number of residents. This last
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428
Lunacy Statistics.
feature is more particularly observable in those poor-houses in which
patients are received for curative treatment, and depends, in a great
measure, on the facilities which such establishments offer for dis¬
posing of patients suffering under temporary excitement from
drinking or other causes, and who, without such facilities, would
scarcely have been subjected to asylum treatment." Besides thus
receiving a much greater proportion of slightly marked cases than
do asylums, " the apparent number of recoveries in poor-houses is
likewise occasionally increased by the discharge of patients from the
lunatic wards, and their removal to the ordinary wards before
recovery has been completely confirmed. Their condition is not
such as to warrant unconditional discharge; but they are, never¬
theless, removed from the roll of pauper lunatics, and are reckoned
as recoveries.” ..." Table II, of Appendix D, affords strong
evidence of the transient nature of the insanity of many of the
patients admitted into the lunatic wards of poor-houses. During
1861, 1021 patients were admitted into public asylums, and 341
into lunatic wards of poor-houses; but the discharges of recovered
patients during the first month amounted to only 19 from asylums
against 39 from poor-houses. Under equal conditions, the dis¬
charges from asylums should have been 117." In the public Irish
asylums, on 921 admissions there were 450 recoveries, or 49 per
cent .; " and on the daily average (4348) under treatment," they
amounted to 13*8 per cent. In England we find that in the public
asylums, and hospitals for the insane the recoveries during 1861
were at the rate of 36*32 per cent, on the admissions, whilst in
private asylums they only reach 29*85 per cent.
As to the ratio of deaths, not having returns furnished respecting
the average numbers under treatment in the English asylums, hos¬
pitals, and licensed houses, we are unable to reckon its per-centage,
but in the district asylums of Ireland the commissioners tell us that,
"assuming it to be represented by 100, the mortality in them would
be at the annual rate of 32 on the daily averages, and 70 on the
total under treatment." To understand this rather enigmatical way
of stating a per-centage, we turn to the statistical tables, and in
Appendix B find that the total number of patients under treatment
during the nine months (to which period the returns are limited) was
5210, and that in that time there were 221 deaths; consequently, the
I ier-centage of the latter upon the former is 4*24. In the private
icensed houses the deaths were 24, and the whole number under
treatment 670; hence the per-centage of deaths was 3*58, and less
even than that in the public asylums, where it must be admitted to
be marvellously small. Lastly, in Scotland the deaths in the public
asylums were at the rate of 7*96 per cent.; 8*733 for males, and 7*204
for females. In private asylums th$y. equalled 7*32 percent.; 7*207
for males, and 7*44 for females. In poor-houses the proportion
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STATE UNIVERSITY
Group of Family Idiots . 429
ranged higher, being 12*50 per cent.; or 15*929 for males, and 9*09
for females.
In the foregoing remarks we have endeavoured to bring together
a collection of facts respecting the prevalence of insanity in Great
Britain and Ireland calculated to enlist the attention of every student
of social science; for the care of the insane has grown to such
dimensions as to become a subject in the internal polity of the king¬
dom of vast importance, and by the very rapidity of its growth one
just now of great perplexity and difficulty. The question forces itself
upon the mind, are we proceeding in the right way with respect to
our mode of provision for the insane ? or, as it has been curtly put,
“What are we to with our lunatics ?” The feeling has got abroad
that the present system of providing accommodation for them has
failed. To discover how far this sentiment is based in truth,
and if found true, to devise a remedy, such statistical researches as
we have briefly and imperfectly sketched, and many others bearing
upon the increase and the accumulation of the insane, on the results
oi treatment in asylums and elsewhere, and on the curability and
mortality of insanity, in its different stages, need be perseveringly
prosecuted. The length to which this paper has extended forbids
our attempting to enter further into such questions for the present.
J. T. Aulidge.
Group of seven Idiots, brothers and sisters, from a Photograph.
Contributed by Dr. T. W. A. Beowne, Commissioner of Lunacy
for Scotland.
In passing through an asylum I saw five odd and apparently
aged men, seated together around a table and apart from the other
patients. They smiled; spoke a few words; gabbled or jargonised.
My companion said, “ They like to dine together.” On com- -
plimenting him for his attention to their wishes, he answered, “ Oh,
they are all brothers.” On going to the department for females, I
observed two quiet, elderly women, indulged in the same way.
“These,” said my guide, “are sisters, and sisters of the five
brothers. They were the children of poor but industrious and self-
supporting parents, who were somewhat eccentric, and believed to
be cousins, or related. They are all, in different degrees, imbecile,
ineducable, irresponsible, and incapable of guiding or maintaining
themselves. They had, besides, a brother who disappeared, and was
supposed to have been drowned in a quarry; another imbecile
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MICHIGAN STATE UNIVERSITY
430 Group of "Family Idiots.
sister still alive ; and two brothers and one sister, who were
healthy.”
I. Agnes W—, set. 71, affectionate, especially to Thomas;
quiet; inoffensive; industrious; speaks indistinctly. First row,
first on right.
II. James W—, set. 69, affectionate; childish; confused; ex¬
citable ; does nothing. Behind Agnes.
III. Helen W—, set. 65, affectionate and attentive to brothers
and sisters; tractable; willing and useful as a worker in scullery;
neat in dress; speaks intelligibly. First row, second on left.
IV. David W—, set. 56, indifferent to brothers and sisters; pas¬
sionately fond of washing stockings and coarse articles, and of
assisting the female servants; will not work in garden. First row,
second on right.
V. William W—, set. 53, affectionate to brothers and sisters;
will work in garden, under guidance, but will not wash; cannot
speak intelligibly. Behind David and Helen.
VI. Thomas W—, set. 51, affectionate to sisters, indifferent to
brothers; quarrels with James; occasionally violent; displays much
interest in changes in establishment, and worked in garden until he
lost the use of right hand. First row, first on left.
VII. Mungo W—, set. 47, indifferent to brothers and sisters;
sometimes speaks to James; solitary ; taciturn; works laboriously in
garden. Behind Thomas.
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431
The Lunacy Amendment Act, 1862.
This new Act appears to ns, on the whole, a wise and judicious
measure of legislation. It must undoubtedly be accepted as the
result of the agitation against the lunacy law, and of the inquiry of
the special committee of the House of Commons, which ensued upon
it about three years ago; and if we consider all the vices which
were then charged against the Lunacy Law and its administration,
and the large and sweeping measures of change which were proposed,
we must accept this Act as a measure of amendment characterised
by moderation, and a wise adhesion to existing forms.
It might indeed be called, an Act to extend the powers of the
Commissioners in Lunacy; but the members of our Association will not
forget the strong opinions which they expressed against the delegation
of any part of the power of the commissioners to new officials; when
it was proposed, first that an independent physician living in the im¬
mediate neighbourhood of every licensed house, should be the inde¬
pendent visitor and reporter on every individual patient; and sub¬
sequently that England should be divided into small districts under
the supervision of a staff of sub-inspectors of lunacy. Their earnestly
expressed wish that if any change took place, it should be an extension
of the powers of the commissioners will induce our members to recog¬
nise in this Act the fructification of their own desires and opinions.
Moreover, the extension of these powers is kept within moderate
limits, and consists for the most part in the increase of visitation.
It imposes two additional visits in each year to be made by the com¬
missioners to each licensed house within their district, and by the
visitors to each licensed house not in the metropolitan district; so
that now each licensed house in the metropolitan district will be
visited six times in each year, and each house in the provinces will
be visited eight times in each year, namely, six times by the visitors,
and twice by the commissioners. This is the amount of visitation
which is imperative, but in addition to this, one or more of the com¬
missioners have now power to visit any asylum or hospital for the
insane, or licensed house, at any time and as often as they may
think fit, and at such visits they will have the same powers as they
enjoy at the regular visits. This provision is certainly more in
accordance with common sense than the law as it stood before, which
only enabled the commissioners to make the prescribed number of statu-
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The Lunacy Amendment Act.
tory visits, whether the house was under the best or the worst manage¬
ment. Their time will be too fully occupied for them to be able to
throw away superfluous visits upon any establishment where they may
not think their visits are needful ; and an amendment Act which did
not give them full powers to visit whenever and wherever their
presence may be thought needful, would indeed have been a lame
and futile measure.
By section 31 two of the commissioners may order the removal
of any lunatic from a workhouse, and direct him to be received
into an asylum; an appeal, however, being granted the guardians
to the Secretary of State. This power, needful as it is, even
under present conditions, is likely to become more so, if the powers
of the 3th section should be largely carried out, by which chronic
lunatics selected by the superintendents, may, with the approval
of the commissioners and the Poor Law Board, be removed
from the asylum and accommodated in the workhouse. The 32nd
section gives power to two of the commissioners to visit any
pauper lunatic who is not in a workhouse, to call in the assist¬
ance of any medical man, and under his certificate to order the
removal of the patient to an asylum. The 31st, 32nd, and 33rd
sections, in fact, give the same power to two commissioners in
sending pauper patients to asylums, as that already possessed and
exercised by one justice; a very reasonable extension of their powers,
which cannot be expected to work otherwise than beneficially, since
it is not likely to be exercised except in instances where their know¬
ledge and experience, and disinterestedness, are opposed to other
qualities in local authorities.
The general purport of the most important clauses which we have
not already commented upon, is as follows :—The 4th clause refers
to a dispute about plans for an asylum for an union of counties, in
which the courts of session, or committee of justices of one county,
disapprove of the plans; under such circumstances the decision
is placed in the hands of the secretary of state. The 5th section
provides that plans for building or enlarging county asylums shall
be accompanied by estimates of cost.
The 6th clause permits the visitors of an asylum to apply such
sums of money received from non-contributing counties or boroughs
as may be in excess of the ordinary maintenance rate, to the forma¬
tion of a fund by which the asylum may be altered, repaired, or
improved. Perhaps it would have been still better if the clause
had gone somewhat further, and had directed the visitors of every
asylum to apply these moneys in this manner; since there can be no
doubt that the money is derived as a rent-charge on the buildings,
and that therefore it ought to be applied to the maintenance of the
buildings. In the majority of asylums it is still applied to diminish
the maintenance rate; a mode of appropriation which not only
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433
The Lunacy Amendment Act.
appears unjust in itself, but which renders it exceedingly difficult to
institute any exact comparison between the finances of the different
county asylums.
The 7th section enables the justices of a county or borough under
contract for reception of their lunatic paupers into an asylum, to
defray out of the county or borough rates so much of the weekly
charge as shall represent the sum due to the asylum; that is, the
sum paid as a rent-charge for the buildings, and which by the pre¬
ceding section the visitors are empowered to appropriate as a building
fund. This sum, however, which may be raised on the county or
borough rates, must not exceed one fourth of the weekly charge—
a limitation which seems to be too narrow, for in most of the asylums
which receive borough patients under contract, the sum fairly charged
for rent is considerably more than one fourth of the total for rent
and maintenance.
In connection with this subject of contracts, it is worth noting
that the original bill contained a clause to compel the justices of
counties to admit boroughs into unions for providing asylum accom¬
modation. As might have been expected, this clause was strenuously
opposed; for whatever feelings of humanity the county magnates
might entertain for the condition of poor borough lunatics, it was not
probable that they would readily grant powers to the Secretary of
State to throw open all their board-rooms to the tradesmen-magis-
trates living in the borough towns.
If Sir George Grey had ascertained in what manner the borough
and county of Oxford ploughed together under the same yoke,
before the time when Berkshire was added to the county element
of the board, he would have been able to foresee the objec¬
tions which have been raised to compulsory unions of counties and
boroughs. But if the county men have been permitted to have their
way in objecting to legislation which would render such unions im¬
perative upon them, they have, we think, no right to object to any
other feasible method, by which the pauper lunatics of boroughs of
moderate size may be provided with accommodation in the neigh¬
bouring county asylum; and we do think that in withdrawing this
clause, which under certain circumstances would have rendered
unions of boroughs and county asylums imperative. Sir George Grey
might fairly have stipulated that contracts upon equitable terms for
the admission of borough patients into county asylums should be
compulsory upon the counties under order from the secretary of state.
Sir George Grey might in effect have said,—We will not, gentlemen
of the counties, compel you to commingle in joint boards of manage¬
ment with gentlemen of the boroughs, but we will not permit your
opinions and feelings to throw any impediment in the way of the
proper care and treatment of a class of unhappy people very much
dependent upon legislative protection. A proper asylum for the
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484
'Hie Lunacy Amendment Act.
reatment of pauper lunatics, is a large and complicated institution,
and a borough with only forty or fifty lunatics chargeable on its
rates, cannot be expected to provide such an institution for itself. We
must therefore urge, and if needful compel you to admit them, on
such just and equitable terms as will repay you for past expenditure,
and guarantee you from future loss. Some legislative measure must,
indeed, sooner or later be passed, unless the justices of counties and
the visitors of their asylums generally and voluntarily act in this
direction. There is a subsidiary point, however, which deserves the
attention of the members of our Association, namely, the remuneration
of officers for the care and treatment of patients admitted into
asylums under new contracts. The superintendent of an asylum, for
instance, has been engaged to take charge of the asylum provided
for the care and treatment of the patients of a certain county ; if, after
a time, the size of his asylum should be increased, and his own re¬
sponsibilities and cares doubled, perhaps, by the admission of a num¬
ber of troublesome borough patients, it does seem reasonable that he
should be paid for work which has thus been thrust upon him. We
have been informed that the objections of superintendents have some¬
times proved the greatest impediment to contracts for the admission
of borough patients into our asylums; and it may well be supposed that
the experience of other superintendents who have made no such
objections, but who have had their labour and their pains for thanks
and reward for the care and treatment of borough patients, may not
have been without influence upon the minds of their professional
brethren.
We hardly know what to think of the 8th clause, or to foresee in
what way it will work. It enables the visitors of an asylum, and the
guardians of an union, with the approval of the commissioners and
the president of the Poor Law Board, to make arrangements in the
workhouse for the accommodation of a limited number of chronic
lunatics, “ to be selected by the superintendent of the asylum, and
certified by him to be fit and proper so to be removed.” A limited
number must mean, either a small number or a specified number, the
number being fixed in the scheme to which the commissioners give
their approval. The real responsibility, it will be observed, is made to
rest upon the shoulders of the superintendent of the asylum who has
to select the patients and to certify their quality, so that whatever
goes wrong with the lunatics in the workhouse is likely to be attri¬
buted to the error of his selection. If it were possible he ought to
see the manner in which his selected patients are accommodated and
treated. Pew superintendents, however, would have the leisure to visit
union-houses; yet it seems probable that if this clause should be
acted upon to any large extent, the visiting commissioners will desire
to provide themselves with some local assistance in discharging this
particular duty; and if the clause should be actively worked.
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The Lunacy Amendment Act. 485
the next lunacy amendment act will probably provide such
assistance.
The 11th section repeals a restriction in the old Lunacy Act, that
visitors of asylums must not lease lands for less than sixty years, the
absurdity of which was pointed out in these pages long ago. The
visitors may now hire or take on lease for a year or any term of
years; which indeed they have already done, though contrary to the
law, for a law without a penalty is often found to be no very great
impediment where men are doing a good thing with right intentions.
The J 2th section will prove a great disappointment to the officers
of asylums, since it refers to their superannuation, and since the
latter part of it contains a provision which more than neutralizes
the good intentions of the clause as it originally stood. The clause
as it stood, for which the officers of asylums were indebted to Lord
Shaftesbury, reduced the term of service for which a pension could
be granted to them from twenty years to fifteen years, and provided
that in calculating the amount of superannuation regard may be had
to the lodgings, rations, or other allowances enjoyed. In com¬
mittee the following rider was attached, under, which we have no
hesitation in saying, that no superintendent will ever enjoy a super¬
annuation until he has a foot and a half in the grave, or unless he
has had the good fortune to serve in some small homogeneous county
in which the visitors completely rule the courts of session, and we
fear we may also add, in which he has been more studious to make
friends than to do his duty. The rider runs thus : “ Provided that
no annuity by way of superannuation granted by the visitors of any
asylum under the provisions of this Act, or of the Lunacy Act,
chapter 97, shall be chargeable on, or payable out of, the rates of
any county, until such annuity shall have been confirmed by a reso¬
lution of the justices of such county in general or quarter sessions,
assembled.”
The 13th section provides for the superannuation of a matron
whose husband is already superannuated, said to be inserted for the
benefit of one particular matron; if this be so, we can only say, that
the interests of an individual may be better cared for in the legislation
of the country than those of an important class.
The 14th and 15th clauses require that justices, on application
being made to them for a licence, or for consent to additions to a
licensed house, should take into consideration the report and opinion
of the commissioners before such licence or such consent be granted.
Perhaps it would have been well to have said, before such licence be
refused, since wrong is quite as likely to be done by justices refusing
a licence to a building in every way suited to the welfare of lunatic
inmates, because it is near to some influential person who dislikes
the proximity of mad ^people, as by granting a licence to some
dilapidated building in some lone and sequestered spot, which, in
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436
The Lunacy Amendment Act .
the 'opinion of nine justices out of ten, would be the very locality
in which people out of society should be shut up.
The 16th clause provides that the medical men residing in or
visiting licensed houses of which the proprietors are non-resident,
should be approved of by the commissioners if the house is metro¬
politan, and by the justices if it is in the provinces.
The 17 th section imposes a penalty not exceeding fifty pounds for
each patient received into a licensed house beyond the number
specified in the licence; and the 18th section allows two of the
commissioners to permit a person who has been under certificates as
a lunatic for five years, to be received as a boarder in a licensed
house, with his own assent; a clause which probably goes quite far
enough in providing for that voluntary seclusion in asylums which
has of late years been so much advocated.
The 19th clause very properly relieves relieving officers from the
responsibility of expressing an opinion as to whether “ a lunatic is a
proper person to be sent to an asylum.” The 20th clause, on the
other hand, imposes upon medical officers of unions the responsi¬
bility of declaring whether a lunatic in a workhouse is a proper
person to be kept in a workhouse; and the 21st clause imposes a
new form of return of the pauper lunatics in workhouses to be used
by medical officers.
The 22nd section abolishes the necessity of medical certificates for
placing in an asylum a person found lunatic by iuquisition, the
order of the committee and copy of the office order appointing the
committee being substituted. Hitherto when a person has been
found lunatic under the full and careful investigations of an in¬
quisition, he could not be placed in an asylum without the, in
his case, superfluous authority of two medical men certifying, de
novo, to his insanity. Persons found lunatic under inquisition are
also removed from the operation of the law of medical visitation
which applies to other lunatics living as single patients.
By the 23rd section persons signing orders for the reception of
a private patient into asylums, &c., must have seen the patient
within one month prior to the date of the order, and must make a
statement when the patient was so seen, in the order. This clause
will necessitate an alteration in. the form of order.
The 24th section proliibits any medical man from signing cer¬
tificates for the reception of private patients in asylums, &c., who has
either received a per-centage on the payments of private patients, or
who is a medical attendant as defined by the Lunacy Act, chapter 100;
that is, every medical man who shall either keep any licensed house,
or shall attend in his medical capacity any licensed house, asylum,
hospital, or other place where any lunatic shall be confined. As
medical men may very fairly be divided into those who know some¬
thing about insanity and those who know nothing about it, and as
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437
The Lunacy Amendment Act.
the former class will almost entirely come under the denomination of
medical attendants, it follows that the 24-th section of this Act
imposes the duty and responsibility of signing certificates of insanity
upon that class of medical men who know nothing about the matter.
The 25th section very properly directs that notice of the death of
any patient in an asylum, &c., should be sent to a relative; and
section 26th enacts that the original papers shall authorise the deten¬
tion of a private or pauper patient, although his status as private or-
pauper may be changed.
The 27th section gives the commissioners power to order the
discharge of any patient from any asylum, &c., either of whose cer¬
tificates being incorrect or defective, are not amended to the satis¬
faction of the commissioners within fourteen days. It would, we
think, have been well if the commissioners had also been empowered
to order new examinations and certificates to be made of the patient
without discharging him from the asylum, &c., since it might well
happen that a patient discharged on account of informal certificates
during an attack of acute insanity, might thereby suffer the terrible
mischief of losing his chance of cure, and all through the ignorance
or obstinacy of the certifying medical man.
The 28th section requires that notice of the admission of any
private patient should be sent to the commissioners within one clear
day of the admission; the statement of the patient's condition
being sent as before after two, and before the expiration of seven
days. The next sections have been already referred to.
The 34th section enjoins upon the superintendent of every
asylum to send each half year to the guardians of each union a
statement of the condition of every pauper lunatic chargeable to
the union. We trust that the commissioners will prescribe some
form in which this shall be done; for if the superintendents should
have to make a statement in such detail as to supersede the neces¬
sity of correspondence with the guardians as to the] condition of
individual patients, that, indeed, would be rather a heavy half-yearly
task in asylums containing from five or six hundr’ed up to a thousand
patients.
The 38th section empowers the proprietor or superintendent of a
licensed house or hospital, with the consent of the commissioners or
visitors, according to the jurisdiction, to permit any patient to be
out on trial for such period as he may think fit; and the 39th
section imposes a penalty, not exceeding £20, upon any officer or
servant who permits or connives at the escape of any patient from
any licensed house. These two clauses do but assimilate hospitals
and licensed houses to asylums, to which similar clauses have long
applied. The next clause, however, the 40th, applies only to private
patients, whether in asylums, or elsewhere. It enacts that letters
addressed by patients to the commissioners, or to the committee, or to
vol. vm. 29
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438
The Lunacy Amendment Act.
visitors, shall be forwarded unopened, and that if addressed to any
other person, such letters shall also be forwarded ; unless, in the
latter case, the person in charge of the patient prohibit it by endorse¬
ment, in which case the letters shall be produced to the authorities
at their next visit. We have nothing to say against this clause as
it stands in the Act ; we have long given up all attempts to inter¬
fere with or control the correspondence of our own patients, and if the
legal injunction that such correspondence shall be unfettered affords
any assurance to the public that the inmates of asylums are fairly dealt
with, such assurance will be cheaply given at the expense of embar¬
rassing the commissioners with a large amount of waste paper. With
regard to letters addressed to other persons than the commissioners and
other authorities, there can be no doubt that the power of prohibition
has been most wisely placed in the hands of the persons in charge.
If this were not the case, the most mischievous results would ensue.
Take the instance of a professional or commercial man, struck
down with an attack of curable insanity, during which his great
delight is to write to all his friends and acquaintance letters of which
the unprincipled might take ruinous advantage, and which, at the
very best, would be a publication of his state of mind as mischievous
as an advertisement to that effect in the second column of the
‘Times/ This clause, as it stood in the original bill, contained
the extraordinary provision that letters addressed to other persons,
should be forwarded unopened, unless by endorsement, &c., but
luckily this was changed in committee.
Of the concluding clauses, which are useful amendments of an
administrative kind, none requires notice except the 44th, which
enacts that the superintendent of an asylum, or a person in charge
of a single patient, shall transmit notice to the coroner of the death
of a patient, and in default be guilty of a misdemeanour. This clause,
which bring patients in asylums and single patients under the same
law as patients in hospitals and licensed houses, will relieve superin¬
tendents of an irksome responsibility. Heretofore it rested with the
superintendent whether he should send to the coroner or not, and in
many cases it was by no means easy to determine the proper occasion
to do so. If he sent for the coroner to see an epileptic who died with
his face on the pillow, he might experience a rebuff for giving need¬
less trouble, and the next time he might omit to send for him when
an investigation would have elicited events which ought not to be
concealed.
On the whole, this Act, although like all amendment acts it is
neither systematic nor complete, is, we think, except in the few points
we have indicated, a wise and judicious and satisfactory measure,
and one which we trust will prevent the necessity for any meddling
with lunacy law for some time to come.
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The Statistics of Insanity .
439
Statistics of Insanity, embracing a Report of Bethlem Hospital, from
1846 to I860, inclusive. By W. Charles Hood, M.D.,
Resident-Physician of Bethlem Hospital, &c. &c.
Dr. Hood has a second time enriched our knowledge of mental
disease, as it is founded upon numbers and the reflections they
suggest. His present valuable contribution to the statistics of the
insane is one of a series which we hope to see emanating from the
officers of our large institutions, and we entirely echo Dr. Hood's
earnestly expressed hope, that the Commissioners in Lunacy will
recommend an uniform plan of statistical inquiry to be adopted in
our county asylums, by which the present vague and unsatisfactory
information contained in their reports may be compressed into form,
so as eventually to become the basis of certain knowledge upon
which the diagnosis and prognosis and treatment of the insane,
may be conducted with some greater degree of confidence than we at
present possess.
The admissions into Bethlem Hospital are dependent upon a
selection of patients, conducted according to regulations, “which
render ineligible all applicants who have been insane for more than
twelve months, all who are afflicted with paralysis, epilepsy, or any
other form of convulsive disease, all who have been discharged un¬
cured from other hospitals, and all aged and weak persons and preg¬
nant women; in addition to which those who are not recovered after
the expiration of a year are dismissed." Such a selection must
necessarily to a certain extent render any conclusions drawn from
the statistics of Bethlem inapplicable to the general numbers of the
insane; they are, in fact, the statistics of recent and uncomplicated
cases of insanity, and as such are of themselves of great and special
importance. The value of enumerated facts often entirely depends
upon the discrimination of a limited class of subjects to which they
apply. . If the statistics of insanity were consulted, for instance, for
the purposes of determining the probability of cure within a limited
time of a recent and uncomplicated case cf insanity, Dr. Hood's tables
might be appealed to with confidence for a trustworthy answer; while
from the tables of any county asylum in which a-large proportion of
the inmates are fatuous from age, or idiotic, or epileptic, and the
S rtion of curable cases resident is perhaps not ten per cent., no
gable information upon the point could be obtained. We are
inclined to think that no trustworthy comparison can be made
between the results of treatment of such institutions as Bethlem and
St. Luke's and those of county asylums, Hanwell and Colney Hatch,
for instance ; the character of the conditions of disease subjected to
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440
The Statistics of Insanity,
treatment being so entirely and irremediably different, that the
results can afford no test of the excellence of that treatment.
The per-centage of cures of insanity effected in workhouse wards is
greater than that effected in any of our best institutions ; but who
would compare the modes of treatment, or think it worth while to
dwell upon the bare fact, after receiving the explanation that the
cure of insanity in workhouse wards means the cure of drunken
excitement ?
Dr. Hood thinks, and brings good reason from Esquirol, Prichard,
and others, to show that the selection of proposed curable cases
admitted into Bethlem is counterbalanced to a large extent by the
limitation of residence permitted to cases. By comparison with the
experience derived in the Salpetrere, 281 of the 643 cases calculated in
the Bethlem report would have been cured if they had remained longer
in the hospital, and that only 362 of the whole number would not
have been cured: “ a proportion,” he says, “which still shows that the
number of recoveries in Bethlem is somewhat increased by the present
rules of the institution; for the 281 recoveries, which were not effected
for want of sufficient time, must be considered as more than counter¬
balanced by the 385 incurable cases which were rejected. It is very
doubtful, however, whether this conclusion is perfectly accurate, and
there is some reason to believe that Bethlem Hospital may in reality
be not so much the gainer in the matter of recoveries. There is
ground for this supposition, inasmuch as the recoveries after the first
year appear to be underrated rather than overrated. This may be
gathered from the experience of the Betreat at York, which is, that
nearly 50 per cent, of the entire number of recoveries occur after
the first year of residence.”
The following tables show, in detail, the movement of patients in
Bethlem during the period embraced by the author's studies, and
also during the last century:—
ty Google
Original from
MICHIGAN STATE UNIVERSITY
by Dit. W. Charles Hood.
Patients admitted as Curable .
From 1816 to 1860 inclusive.
441
Admitted.
Discharged.
Cured.
Uncured.
Died.
M.
F.
Total.
M.
F.
Total
Per cent.
M.
F.
T.
Per cent.
M.
F.
T.
Per cent.
1816
125
1G8
293
66
95
161
54-95
_
_
3
7
10
311
1817
124
190
311
68
107
175
55-73
_
_
_
_
3
9
12
3-82
1818
118
188
306
74
82
156
5098
_
_ _
_
_
2
9
11
3-59
1819
121
192
316
66
106
172
54-43
_
_
_
_
6
12
18
5-69
1850
135
209
311
74
123
197
57-26
_
_
-
-
20
11
31
9-01
1851
112
174
286
51
69
120
42- 3
_
_
_
_
9
17
26
9*09
1852
101
167
268
49
91
143
53-35
_
_
_
_
15
12
27
10-07
1853
72
128
200
38
75
113
56- 5
_
_
_
_
9
7
16
8-00
185 1
77
110
187
40
70
110
59*35
_
—
_
_
4
7
11
5-87
1855
78
137
215
48
84
132
61-68
_
—
_
_
5
7
12
5 60
1856
61
110
171
41
70
111
64-91
31
47
78
45-61
3
3
6
3-50
1857
82
127
209
46
69
115
55"02
22
38
60
28-70
4
6
10
4-78
1858
68
112
210
33
79
112
53-33
16!
42
58
27-61
7
5
12
571
1859
58
100
158
38
60
98
62-02
27i
55
82
51-08
7
3
10
6-32 ;
I860
75
116
191
41
62
103
5202
2 o[
32
52
26-72
5
5
10
5 05 [
1110
2258
3668
773 I 121 . 5 '
1 1
2018
55-01
116214
1
330
3514
102
120
l
222
6-05 !
Aggregate of the 100 years ending 31st December, 1860.
Admitted.
Cured.
Per cent.
Died.
Per cent.
19-619
8-539
43-45
1-481
7-53
The largely increased per-ccntage of cures, and the decreased mor¬
tality as shown in these two tables, are sufficiently satisfactory,
though we do not doubt that the results of the present treatment at
Betlilem, in comparison with the past, are but feebly represented there.
The present system of treatment and management in Betlilem is well
known to be everything which can be desired, and the past is well
known to have included everything which could not be desired, and
among other things, an absence of reliable records; and, as is well
known, in loose records men rarely err on the side of giving them¬
selves too little credit, we should be inclined to discount the per¬
centage o£ cures effected at Betlilem in the olden time, small as it
is compared with the present, and to accept those which did occur
as cures which would occur notwithstanding treatment rather than
in consequence of it.
“The experience of Betlilem Hospital,” says Dr. Hood, “is, in
many respects, very interesting. On the authority of Stowe, who
derived his information from Dr. Tyson, the physician to the hospital
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44a
The Statistics of Insanity,
at that time, 1294 patients were admitted between the years 1684
and 1703; and of these, 890, or about 2 in 3, were cured; but be¬
tween the years 1784 and 1794, when 1664 patients were admitted,
the number of recoveries was 574, or only a little more than one in
3. We next learn from a report which Dr. Prichard obtained from
Mr. Lawrence ( f A Treatise on Insanity/ 1835, p. 141), that the
number of recoveries increased after the hospital was removed to its
present site. This record extends from 1819 to 1833. During this
period 2445 patients were admitted; and 1124, or one in a little
more than 2, were discharged cured.”
We have always thought that Bethlem, with its princely revenue,
ought to be the great middle-class asylum in the country—an opinion
in which, we believe, its accomplished physician fully concurs. In
the present pages his mind on the subject may be seen in the fol¬
lowing paragraph on the education of the patients admitted:—“ It
appears certain that a very large proportion of educated persons are
admitted into Bethlem: a fact which shows that little alteration
would be necessary, so far as the patients are concerned, if it were
thought desirable, to send the uneducated poor to the asylums which
are provided for them on the most princely scale in every county,
and to reserve Bethlem Hospital for the reception of the poor though
educated insane of the middle class.” The degree of education was
found to be as follows:—Superior, 272; good, 865; moderate,
2152 ; indifferent, 293; none, 86. Total, 3668.
The extent to which Bethlem is still used for the treatment of
patients for whom the county asylum would be more suitable, we do
not learn from any of our author's tables. The tables in the fourth
chapter, showing the social condition of the patients, certainly
indicate what may be called a middle-class position. The upper and
the lower crust of the Bethlem society may be taken to be repre¬
sented by the members of the learned professions and by the
servants and labourers. Of the former, among the male patients
there were only 23, namely, 10 clergymen, 4 lawyers, and 9 medical
men; of the latter, there were 12 labourers and 11 domestic servants.
There were also 2 soldiers, 2 sailors, 4 policemen, 1 shepherd, 1
flvman, and some other unit instances of the classes scarcely
above that of the labourer. The great bulk of the patients were of
the artizan and tradesman class. It is remarkable that 115 female
servants are enumerated to only 11 male servants—a nude difference,
of which we cannot guess the cause. On the liability of different
callings to insanity indicated by this table, Dr. Hood remarks —“ It
is to be noticed that the medical men are nearly twice as numerous
as the lawyers; and this, perhaps, is what might be expected, when we
consider the mental and bodily fatigue to which a large majority of
the medical profession are exposed, for if it is sufficient to shorten
the average duration of their lives appreciably, it must also affcet
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by Da,. W. Charles Hood.
very seriously their mental health. Nor is it surprising that the
number of schoolmasters and musicians should be so high. Under
the head of schoolmasters are included a large number of tutors,
which, no doubt, is a sufficient reason why schoolmasters, as a class,
so considerably increase the list, for the unsatisfactory social position
in which such gentlemen are too often placed, tends necessarily to
fret and irritate their minds. Musicians, on the contrary, more
excitable than the majority of the population, may be in danger, by
being too much flattered in that society where they are constantly
welcomed. The number of clerks is high, though not higher,
perhaps, than the extent of this class would lead us to expect. Com¬
paring the number of those engaged in sedentary mechanical in-door
pursuits, with those engaged in non-sedentary mechanical in-door
pursuits, we find a marked difference, the preponderance being with
the latter. Among the former the tailors are most numerous, and
then the compositors: among the latter, are first the carpenters and
then the plumbers.”
The seventh chapter treats on the residence of the patients admit¬
ted. From 1846 to I860, 1609 patients were admitted from London
and its immediate neighbourhood, and 2059 from the provinces;
while from 1856 to 1860, 593 patients were admitted from London
and its vicinity, and 346 only from the provinces. It would appear
therefore, that between 1846 and 1856, 1609 were admitted from
London, and 2059 from the provinces; but that in the subsequent
period these proportions were reversed, and 593 were admitted from
London, and 346 from the provinces. It speaks well for an insti¬
tution that it is most used bv the district in which it is best known,
since any important change in the reputation of Bethlem as a hospital
for the insane, would be much more fully and speedily known in
London than in the provinces; but the above figures, which so
unmistakeably prove that this great institution, which belongs to the
country at large, confers the greater portion of its benefits within
the bounded area of the metropolis, ought, if more known, to make
the inhabitants of the provinces more alert to claim their share.
There is no disposition, we believe, on the part of the authorities at
Bethlem to give any preference to the Londoners, but want of in¬
formation in the provinces, the difficulty of travelling to any distance
with a lunatic patient, and the uncertainty of his being found a fit and
proper subject for the hospital on his arrival, all tend to make this
great charity less used by the inhabitants of the country than by
those of the more well-to-do town population, among whom its
enefits are certainly not more needed.
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OFFICIAL REPORT.
association of medical officers of asylums
AND HOSPITALS FOR THE INSANE.
A Special General Meeting of the Association was held at the
Freemasons’ Tavern, Great Queen Street, on Wednesday, the 17th of
September, at 3 o’clock. The meeting was called, to receive Dr.
Bucknill’s resignation of the editorship of the Journal, and to make
arrangements for its future management; and also to elect Drs.
Bucknill and Hood to be honorary members of the Association. The
following members were present. Dr. Conolly, Baron Mundy, Dr.
Sankey, Dr. J. S. Bushnan, Dr. W. Tuke, Dr. Paul, Dr. Ross, Dr.
R. II. Burnett, Dr. Manley, Dr. Christie, Dr. Millar, Dr. Hitchman,
Dr. Duncan, Dr. J. F. Duncan, Dr. Henry II. Stewart, Dr. J. Strange
Biggs, Dr. McCullough, Dr. T. Thurnam, Dr. Robert Stewart, Belfast;
Dr. C. H. Fox, Mr. Ley, Dr. Robertson.
Dr. Kirkman, the president, occupied the chair.
The President. —Gentlemen, this is a very important meeting of
the Association; and without further preface, as we shall have
plenty to do, I will call upon Dr. Robertson to read the notice con¬
vening the meeting.
Dr. Robertson, having read the notice, said—This meeting is
called in accordance with precedent established by Dr. Conolly, who,
when president, held two general meetings to consider the new
lunacy laws, which, in the year 1859, were before the House of
Commons. Dr. Kirkman, in consultation with the committee, deter¬
mined that, under present circumstances, he would call a general
meeting to deal with this important question of the editorship of the
Journal until the next annual meeting of the Association.
The President .—If you will allow me, I will now read a letter
which I have received from Dr. Bucknill, containing his resignation.
I must say I do so with mingled feelings of regret and pleasure—
regret that we have lost Dr. Bucknill as the editor of the Journal,
and pleasure that we shall not lose him as an associate and friend.
I am sure that in everything connected with the interests of the Asso¬
ciation he will always be active and energetic.
The President then read the following letter: ■
“ Devon County Asylum ; Sept. 16,1862.
“ Dear Mr. President,—The Lord Chancellor having conferred
upon me the appointment of Chancery Visitor, it has become necessary
that I should resign into the hands of the members of the Association
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Special General Meeting of the Association. 445
the office of Editor of their Journal, with which they entrusted me
nine years ago.
“ I have much pleasure in looking back upon these years of
editorial labour, which I have incurred at the bidding of the Asso¬
ciation, as time which has not been ill spent in advancing the know¬
ledge of our specialty, and in aiding and directing well-intentioned
efforts to promote the interests of that most afflicted portion of our
fellow-creatures whose remnant of comfort and happiness in this life
is so intimately dependent upon our knowledge and our humanity.
“ I have to offer my heartiest congratulations to my fellow labour¬
ers in this work, and to assure them of my continued interest in its
advancement. I think I shall not be out of order if I show this
interest at the present time by addressing a few words to you on the
choice of my successor. I earnestly hope that you will be enabled
to entrust the responsibilities, which I have had the honour to bear,
on a gentleman who will discharge them with discretion and temper,
and who, taking a comprehensive view of all matters bearing upon
the welfare of all classes of the insane, and upon that of all those
whose real interests are bound up therewith, will conduct the Journal
in that spirit of impartiality which will give weight to its opinions,
and reflect honour upon the Association.
“ It affords me much pleasure in being able to express my own
conviction, that the Association would find such an editor in my
friend Dr. Robertson, to whom we are already under so much obliga¬
tion for the long and zealous discharge of the duties of General
Secretary. My new office prevents my acting as a member of the
Association, or I should have attended to-morrow to have proposed
and voted for Dr. Robertson. I feel myself, however, still at liberty
to express my opinion, and I do so with the full assurance that the
members of the Association, who for so many years have kindly
placed some value upon it, will give it their best consideration. I do
not see where the Association will be able to find a fitter man to be
the editor of their Journal than Dr. Robertson, who has so zealously
done the work of the Association for the last seven years, who has
been one of my ablest coadjutors in the Journal, who has devoted
himself to the study of psychological medicine during the whole of his
professional life, and who. is well known to many of the members of
the Association as a gentleman and a man of honour, against whom
no shadow of suspicion can attach that he might be capable of making
the'Journal serve indirect or personal ends.
“ Allow me, before I conclude, to say a few words on another
subject. An attempt has recently been made to persuade you that
your Journal ought to be largely devoted to the exposition of your
grievances. If anything could more readily than another bring your
Journal into contempt, it would be an undignified system of queru¬
lous complaint. But when a real and general grievance exists, not
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440
Special General Meeting of the Association.
only ought the Journal to declare it plainly, as it has done in several
instances, but the Association itself ought to take action if any useful
mode of action should be open to it. Such a grievance does appear
to me to have been inflicted upon many of the members by the
amended form of the 12th section of the Lunacy Acts Amendment
Act. This 12th section was introduced with the intention of con¬
ferring a large benefit upon the officers of asylums by reducing the
term of service under which a pension could be granted from twenty
to fifteen years, and by allowing the amount of the pension to be
calculated upon the value of lodgings and allowances in addition to
the salary. This good intention has been defeated, and the officers
of asylums left in worse case than before, by a rider appended to the
original clause, by which ‘ rider* it has been enacted, that no such
superannuation shall be chargeable on or payable out of the rates of
any county until it shall have been confirmed by the justices in
quarter sessions. In all counties this provision will be a great im¬
pediment, while in some it will amount to a prohibition of all super¬
annuations. The first superintendent to whom I pointed the clause
out said, ‘In my case it would entail the concurrence of the
sessions of two counties and of three boroughs, which would be
impossible.*
" You are not unaware of the interest I have long taken in the
efforts made to obtain just provisions for superannuation, and
on the ground of this long continued interest I would beg to
suggest that, at your meeting to-morrow, you should appoint a
committee, not with any vague and impossible mission of general
interference with legislative measures, but with the definite object of
obtaining a reversal of the latter portion of the 12th clause of the
recent Act, and to press for legislative sanction to satisfactory super¬
annuation arrangements. I would beg to suggest that, in such
arrangements, a distinction ought to be drawn between those asylum
officers and attendants upon whom falls the heat and burthen of
responsibility in the treatment of the patients, and those who are
engaged in less arduous duties. At present the superannuation of
asylum chaplains and stewards stands on exactly the same ground as
that of the medical officers of asylums; and it is worthy of remark
that the new Act contains a clause (sect. 13) providing for the super¬
annuation of matrons who are the wives of officers already pensioned.
After yourself, my dear sir, the Nestor of superintendents, I have
been the longest in office as the superintendent of any county asylum.
It is now eighteen years and a half (18J) since I was elected to the
office of medical superintendent to the Devon County Asylum, and
although in resigning that office I lay aside all personal interest in
this question of superannuation of the officers of asylums, I beg you
to believe that I am incapable of becoming indifferent to the general
interests of my old Mends and associates.
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Special General Meeting of the Association. 447
“ Allow me, dear Mr. President, to tender to you and the
Association the expression of my sincere regard, and to remain
"Very faithfully yours,
"Dr. Kirkman, " J. C. Bucknill.
" President of the Association of Medical Officers
of Asylums, Sfc. fyc”
Dr. Conolly: Mr. President and gentlemen, I suppose it will be
the wish of the members present, that they should express to Dr.
Bucknill their thanks for his services, and should give a cordial
reception to his letter, and the sentiments expressed in itr. I have
not had the advantage of knowing what the subject of the
letter was, but it confirms, I think, what I have endeavoured to
express in a short resolution, which I beg leave to submit to the
consideration of the meeting. That—
“ The members of the Association, sincerely congratulating Dr.
Bucknill on his appointment to the important office of Visitor ito the
Chancery Lunatics, have to express their regret that the responsible
duties now devolving upon him are incompatible with his continued
superintendence of the ‘ Journal of Mental Science / and on re¬
ceiving his resignation of its editorship, beg to offer him a grateful
and cordial expression of their appreciation of his valuable services
during a period of nine years. They feel assured that Dr. Bucknill
will not cease to take an interest in whatever relates to psychological
science and its application to medical treatment, and they trust that
he may long enjoy his increased opportunities of promoting the welfare
and the protection of the insane, and the real interests of the medical
profession in relation to insanity, and which they believe to be in¬
separably connected with the real advantages of the community.”
I beg merely to submit this to the meeting, not to be at all the
interpreter of their sentiments. This resolution of course contains
my own views, and I beg leave to propose it in that form, or in
some similar form, so that the feelings of the meeting be expressed to
Dr. Bucknill.
Dr. Hitchman: As one who has long admired the transcendent
ability of Dr. Bucknill, the unwearied energy, the great zeal and
high moral courage he has shown in conducting the Journal, I beg
to second the proposition that has been proposed by Dr. Conolly.
The President put the resolution, and it was carried unanimously.
Dr. Robertson: The next subject which we have to bring before
the meeting to day is the election of Drs. Bucknill and Hood as
honorary members of the Association. It has always been our prac¬
tice, as in the case of Dr. Gaskill, and in the case of Mr. Wilks, and
also in the case of Dr. Browne, when he was elected Commissioner
in Scotland, to offer the honorary membership to gentlemen who
have been promoted to official positions, the business of which pre-
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448
Special General Meeting of the Association.
vents their coming and taking part in the proceedings of the Asso¬
ciation. I am sure the Association will feel that we do well to make
this offer to Drs. Bucknill and Hood. The other night I was
reading one of Shakespeare’s plays, and I met with a passage which
seemed to me so appropriate to the present occasion that with these
lines I shall leave my proposal in your hands:—
“ Who shall go about
To cozen fortune and be honourable
Without the stamp of merit ?
Let none presume to wear undeserved dignity.
Oh, that estates, degrees, and offices,
« Were not derived corruptly !
And that clear honour were
Purchased by the merit of the wearer.”
I am sure no clearer honour was ever purchased by the merit of the
wearer than in the case of both Dr. Bucknill and Dr. Hood in their
recent advancement to the offices which they hold, and wliich 1 hope
they may long continue to fill. I beg to move that Drs. Bucknill and
Hood be elected honorary members of this Association.
Dr. Mandsley: I have great pleasure in seconding the resolution,
which must commend itself to the unanimous approbation of every
member of the Association. I am sure that we are all heartily
glad that the Lord Chancellor has made two such excellent appoint¬
ments, and we shall be equally glad to see the names of two such
distinguished men among our honorary members.
The President put the resolution, and it was carried unanimously.
The President: I have now to read to you another letter of resig¬
nation which I have received from Dr. Robertson.
“ Hayward's Heath ; Sept . 17.
“ Dear Dr. Kirkman,—I beg to place in your hands the resigna¬
tion of the office of General Secretary to the Association, which I have
now held for seven years. In so doing I would desire to express to the
Association my thanks for the consideration with which they have
on all occasions received my poor efforts in their service—a service
which to me has thus always been a labour of love.
"Believe me,
“ Sincerely yours,
" C. L. Robertson.”
The President also read a letter from Mr. Ley, resigning the
office of Treasurer.
v Dr. Tliurnam: With reference to the last letter, I beg to suggest
to the meeting that we ought not hastily to receive the resignation
of Mr. Ley, for really this is not the ordinary occasion for ap¬
pointing the officers of the Association. We are summoned to-day
for the special purpose of filling offices rendered vacant by the resig¬
nation of Dr. Bucknill. I hope we are not going to be called upon
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449
Special General Meeting of the Association.
to receive the resignations of all our officers, for I fear if we accept
the resignation of the Editor, the Secretary, and Treasurer, the next
resignation will be your own as President, and we shall be an un¬
officered Association. I really hope that Mr. Ley will not press his
resignation. I do not see that his case is at all mixed up, or
in any way hangs upon, the vacancy which unhappily in many
respects we may say is now before us.
The President: I have received six or seven letters from Mr.
Ley, some of which I have in my pocket, and he wishes distinctly
to have his resignation brought forward to day. We are now only
making appointments pro tem.; they must be confirmed at the
Annual General Meeting. Whatever appointments are made to day
will be subject to the confirmation of the Annual Meeting.
Dr. Thurnam : I hope it will not be inconvenient to Mr. Ley to
hold his office until our Annual Meeting. The letter which has
been read does not imply more than a wish to be relieved.
Dr. Robertson : It is one of a series of letters which he has been
writing ever since Dr. Bucknill resigned. He says his work was
bound up with Dr. Bucknill's, and he does not wish to continue his
duties under a new editor.
Dr. Thurnam: We are hardly in a position to accept his resigna¬
tion at the present time. The meeting is called for a special purpose,
and special duties will only be transacted to-day.
Dr. Robertson: I do not suppose Mr. Ley will press his resig¬
nation. I shall be willing to be the interpreter of the feeling of the
meeting to Mr. Ley.
Dr. Stewart: I think, Mr. President,it will be altogether out of rule,
as my friend Dr. Thurnam has remarked, to accept Mr. Ley's resigna¬
tion. We are assembled here for the special purpose of appointing
those officers who must be appointed, owing to certain changes which
have taken place by the promotion of others; but on the present occa¬
sion to act upon that letter of Mr. Ley would, I think, with very
great respect to him, be entirely going outside our duties; in fact, we
have no power to accept it. This meeting is called for a specific
purpose, and we certainly have no right to go beyond that object.
It would be quite irregular, and independently of that I should be
sorry that we should lose the services of Mr. Ley, who has so long
held the responsible office of Treasurer, and so satisfactorily discharged
his duties. Under any circumstances, I think he might, as Dr.
Thurnam has suggested, retain the position in wliich he has given
so much satisfaction, until the regular Annual Meeting of the
Association.
Dr. Robertson: I shall be very happy to convey that expression
of feeling to Mr. Ley, and I have no doubt he will be satisfied.
Dr. Thurnam: Mr. Chairman, I have been requested, since I came
into this room, to propose a gentleman to fill the office of Editor of
the Journal for the nine months which remain, until our Annual
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450 Special General Meeting of the Association.
Meeting in July next. In doing so, I would make very few obser¬
vations. It appears to me, as it has been suggested in the letter
which you have read, that it is a very important function which this
meeting is called upon to perform—the appointment of a successor
to Dr. Bucknill, a gentleman who for more than nine years has
filled the office of editor with great ability, and to the general
satisfaction of the members. I am not here to defend every sentence
which has appeared from his editorial pen in that Journal. On
many occasions, I could not subscribe to many sentiments which
have there appeared; but in the main I am prepared to say that
the Journal has been edited with great skill, and very much to the
advantage of the members of the Association. Therefore, I am ex¬
tremely anxious that for the future we should have an equally able and
equally discreet editor. Sir, I looked at the rules of the Association
yseterday, for I was not able to do so before, having been absent
from home for two or three weeks, and it appears to me that this
meeting, summoned under your authority, is not competent to elect
an officer of this description, who shall be the permanent editor of
the Journal. We can only fill up temporarily the office of editor,
and finding that Dr. Lockhart Robertson, who for so long a period
has filled the office of secretary, is willing to take upon himself the
new functions of editor of the Journal, I very much rejoice at it, and
I have great pleasure in proposing, that until the next Annual
Meeting in July, Dr. Lockhart Robertson be elected editor of ‘ The
Journal of Mental Science/ In electing him, I believe we shall
have every guarantee that the functions of editor will be dis¬
charged with advantage to the Association.
Dr. Burnett: Mr. President, before the resolution is seconded,
allow me to make a remark. I think I have a right to be heard
now. Am I correct, sir ?
The President; No; the resolution has not been seconded.
Dr. Burnett: But before it is seconded.
The President: No; I think it should be seconded.
Dr. Campbell; Mr. President, I have much pleasure in seconding
the nomination of Dr. Robertson. So far as I know that gentleman,
I think we cannot do better than appoint him during the next nine
months to conduct this Journal, which has been so ably edited before
by Dr. Bucknill. I am fully aware of the difficulty of recom¬
mending a gentleman to fill Dr. Bucknill's place, but I believe we
shall find in Dr. Robertson a gentleman who is thoroughly qualified
to discharge the duties of the office with credit to himself, and with
advantage to the Association.
Dr. Burnett: Mr. President and gentlemen, I have attended this
meeting for the purpose of hearing a discussion upon the election of
the new Editor of the Journal, and I hope the subject will be dis¬
cussed before we separate this afternoon. It is quite unnecessary
that I should tell you that the editorship of this Journal, situated
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Special General Meeting of the Association.
as the editor is in relation to the Society which he undertakes to
represent, is one of no trifling importance. I am sure I do not speak
invidiously when I tell you that there are very diverse interests
represented in this Association. 1 do not think it is at all an
unusual thing, where the interests are so wide apart, to have two or
three descriptions of editors—that is to say editors not all selected
from one particular class as representing the Association. lean instance
an example of that by alluding to the appointment of the Bishop of
Jerusalem, which you know is taken alternately by this country and
by the kingdom of Prussia. And also in many of our ecclesiastical
appointments, the appointment rests sometimes with the Crown, and
sometimes with the See. In this case, I think it is a very important
thing that the editor of the Journal should be a man not holding
exactly the 3ame position with the Association as the editor that went
before. About nine years ago, 1 think it was, when Dr. Bucknill
was appointed editor, I made the proposition that he should be the
Editor of the Journal,* and I did so because I thought the interests
of psychological medicine were going rather too much in one direction,
and I thought I should like to see a little restoration of the balance.
Now we have had Dr. Bucknill nine years, he has advocated the
cause of the Association with much credit to himself, and with great
satisfaction to all the members of the Association, but at the same
time I do hold that a society like this ought not to be fettered, and
that we ought to have a free representation of the interests of all.
Without saying anything more, I beg, therefore, to propose that
the editor should be elected from one of the proprietors of private
asylums; that instead of electing a man who represents the superin¬
tendents of county asylums, we should this time elect the pro¬
prietor of a private asylum.
Dr. Take: It seems to me that Dr. Burnett's proposition is
monstrous, that we should select a man from a special class. Our
object should be to get the best man in the right place. Therefore,
I do not see that we are in any way called upon, or that we ought in
any way to commit ourselves to say that the editor of the Journal
should be a public man or a private man. Let us get the best man
we can in the place. Therefore, I think we ought to negative Dr.
Burnett's proposition.
The President: Dr. Burnett, have you any one that you would
wish to propose as editor ?
Dr. Burnett: I do not wish particularly to propose any one
member; I did not come here with the design of proposing any
particular member, but I did come intending to support that prin-
* [On referring to the minute-book of the Association, we find that at the
meeting at Oxford, in 1862, when the establishment-of a journal and the election
of an Editor were determined upon, Dr. Burnett was not present. Dr. Bucknill’s
appointment as Editor was proposed by Mr. Ley and seconded by Dr. Thurnam.—
Ed.]
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452 Special General Meeting of the Association.
ciple which I have now stated, because I believe it to be a sound
one. If you recollect, before Dr. Bucknill was appointed, we were
very much dependent upon the editor of f The Psychological
Journal/ who was the proprietor of a private asylum, therefore, you
see the principle has been acknowledged before. We have acted
upon it, and it was in order that it should not be carried all in one
direction that I supported Dr. Bucknill, and it was by my resolution
that he was elected editor of the Journal. Now, I say we have
had a physician of a county asylum as editor, and the time has again
recurred when we should select the editor from one of the private
asylums. I really do not wish to dictate who should be the editor,
but if you ask me to name a member on the spur of the moment,
it has occurred to me, in consequence of receiving Dr. Bushnan's
circular, that he is a man qualified for the office. He is calculated
to advocate the cause of psychological medicine, he is a man who
has been accustomed for many years to edit public journals, he has
seen and had a good deal of experience in literary matters, and I
t hink he is quite as calculated to uphold the integrity of our society
as Dr. Lockhart Robertson himself. I do not see why he should
not be elected, nor why he has not, in fact, a higher claim, on
account of his previous experience. I should say he is a much
superior man to Dr. Robertson, because Dr. Robertson has not had
any experience as the editor of a journal.
Dr. Harrington Tuke: Will you allow me to point out to Dr.
Burnett that we have already got his beau ideal. We have already
a gentleman at the head of a journal who is connected with a private
asylum, therefore, if there is any question which Dr. Burnett thinks
could be properly canvassed in that journal, he could at once apply to
that gentleman. I think it is very undesirable, indeed, that we
should divide our meeting upon the question of public and private
asylums. We ought to avoid as much as possible the question ever
arising. "We meet here as physicians on the footing of perfect
equality, and I would deprecate exceedingly any resolution that would
divide us on that point. For myself, I shall Vote for Dr. Robertson.
I am perfectly sure that that gentleman will deal justly with every
member of the profession, whether engaged in the private, as it has
been called, or the public practice of it.
Dr. Burnett: I may, perhaps, be permitted to make one remark
before anything further is said. I have not divided the meeting,
because the principle was acted upon nine years ago. We changed
from a proprietor of a private asylum to a physician of a public
asylum, therefore it is no division of the meeting. But there is
another reason why I should oppose Dr. Robertson's election. It is
simply this: I will state it to the whole meeting, and I am quite
certain the great body of the meeting will go with me upon it. I
do not think it is right for one who has resigned his appointment to
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dictate to the meeting who shall be his successor, nor do I think it
is a matter for the Council to take into consideration, because we
should come here under such circumstances to receive the dictation
of the council; we should not be a public body. Under those cir¬
cumstances I do say everybody has a right to be heard. I do not
want to have any personal remarks. With regard to proprietors of
asylums, many of them, I believe, to be the greatest men I am ac¬
quainted with; at the same time, I do not think it is right that I
should be looked upon as wishing to divide the meeting, simply
because I wish to ventilate the question, which is of great importance
to the whole profession.
Dr. Thurnam: May I be allowed to make one observation ? I
think some misconception must have arisen on the part of Dr.
Burnett. I have been connected with this Association from its
earliest institution, some twenty years ago, and I am not aware of any
journal or periodical emanating from thi3 Association edited by a
gentleman holding office in a private asylum. I do not recollect
any such circumstance.
Dr. Burnett: I say we had no journal at all, therefore our
interests were advocated by f The Psychological Journal/
Dr. Thurnam: You said a change had been made some nine years
ago, when Dr. Bucknill was elected, and now was the time to revert
to the former precedent. I may have misunderstood Dr. Burnett.
Dr. Burnett: So far it was a change, that instead of our interests
being advocated by ‘The Psychological Journal/ from that time forth
our interests were advocated by our own editor.
Dr. Thurnam: As an Association we were entirely independent of
that journal, and had no connection whatsoever with it. It was
entirely a private speculation, with which we had no concern. It
was in existence then, and is in existence still. I would venture to
say, in reference to what Dr. Burnett has said, it appears to me,
Mr. Chairman, with submission to you, that it is perfectly com¬
petent for any gentleman here to propose any gentleman whatsoever
as editor of the Journal. There is not the least feeling in the matter.
I am sure I would not have ventured to submit this resolution to
you had I supposed I was coming here with the object of dictating
to the meeting who should be the editor of the Journal. This
meeting is entirely open; but we, as a committee, I imagine, were
not out of order in coming prepared with our views on the subject,
and in submitting them to the meeting; but that does not at all
prevent any other gentleman rising in his place, and proposing any
gentleman whatever to fill this office.
The President: It strikes me that it is not simply the editor of
the Journal you are so much considering, or the interests of the
Association aloue, but you are considering an appointment which is
connected with the interests, not of the insane of England only, but
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Special General Meeting of the Association.
of the insane of the civilized world, for I do believe, with reference
to our Journal, if I may make use of a quotation, “ There is not a
speech or language where its voice has not been heard;” and when I
remember that Dr. Robertson has been very much associated with
our foreign members, I do think he has a powerful claim upon us.
• I should be sorry to state anything from the vantage-ground of this
chair, but I most cordially echo the opinion that Dr. Tukc has
advanced, and also Dr. Thumam.
Dr. Burnett: I beg, as an amendment, to move that Dr. Bushnan
be the new editor. If anybody will second that proposition it will
set the matter at rest.
The President: It is proposed that Dr. Bushnan be the future
editor of the Journal; does any gentleman second that resolution?
Dr. Wood: Perhaps I may be a little out of order in saying any¬
thing before this is seconded, but I should like to suggest to Dr.
Burnett the expediency of withdrawing his motion before it is
seconded. I feel strongly that it is desirable we should have no
division here. All our interests are in common, and they will cease
to be in common if there is division in the camp. I repudiate the
notion of attempting to appoint a man because he belongs to this or
that branch of the profession. I think as our friend here. Dr. Tuke,
has very well said, we want the best man, come from where he
may. I do not think we are quite in a position at the present
moment fairly to balance the claims of rival candidates. Therefore I
think it is much better, as it is only a provisional appointment, that
we should be unanimous in it. "We should have the opportunity in
the spring, first of seeing what the new editor can do, and then in a
more satisfactory manner than I think we can do now, of making a
final appointment. The only way in which I think we can meet the
difficulty, for I feel it is a difficulty, is, that we should consent to
this provisional appointment. We presume it has been proposed by
the committee to appoint Dr. Lockhart Robertson provisionally for
the next nine months. As that time approaches, we should be able
to determine whether Dr. Robertson or doctor anybody else would
be the proper person to be put forward. Then I would suggest that
the form of election should be something different from canvassing
a man's merits before his face. I think by that time we may all
become acquainted with the claims of the respective candidates, and
let each man who proposes to be a candidate, send a circular round,
so that each member of the Association may have the opportunity of
forming his own opinion, and then let the voting be by ballot.
Dr. Tuke: I rise to order on this matter. Dr. Wood has risen,
and has asked permission to suggest that Dr. Burnett should with¬
draw his resolution, and now he is making a speech about how we
shall conduct the election next year. I am entirely in the hands of
the meeting.
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Special General Meeting of the Association.
Dr. Wood: So am I. I am going to ask Dr. Burnett to with¬
draw his motion, and I am only saying what I do now as a reason
why I think it would be desirable to do so. If my friend thinks I
am, out of order, as perhaps I may be, I am quite willing to sit down.
I have very little more to say, except this,—that I do feel very strongly
it is of the greatest possible importance that we should have no
division; therefore, on that ground especially, I would ask Dr.
Burnett to withdraw his motion.
Dr. Burnett: I should be very sorry, indeed, to be the cause of
dividing this meeting, and I only lament that you allowed Dr. Wood
to put it upon that ground, because I commenced my observations
by saying, “fe are all a brotherhoodand it is to prevent anything
open to suspicion—which I am certain has been pretty freely sug¬
gested, because it could not have reached my ear unless it had been
so—it was to prevent anything of that kind that I proposed to
restore the balance, that there should be no cause for division; but,
depend upon it, if you persist in always electing an editor from the
county asylums, the Society will not always be as united as it is now.
I am certain it will not be. It is all very well for men to say at
these meetings they hope this and feel that; but, after all, it is acts
and not words that we wish to be guided by, and therefore I am
very anxious that an understanding should take place at once. I
I have no ill feeling towards any man; I have no wish to show any
ill feeling. Here, especially, I feel I am amongst my brothers, and
therefore I should be very sorry to do anything to divide the meeting.
I do not think, because I do not withdraw the resolution, that I
ought to be represented as standing here to divide the meeting; I
do not think that is right. It is a perfectly free and unfettered
meeting; and I think the resolution I have proposed ought to be put.
The President: Does any gentleman second Dr. Burnett's re¬
solution ?
The resolution was not seconded, and it consequently fell to the
ground.
Dr. Conolly: Gentlemen, I am going to take the liberty of
making a few observations upon the general bearing of this matter,
and in doing so I rather appeal to you as a very old member of the
profession, one gradually retiring from all the active duties of it, and
with no ambition and no personal object whatever in what I say. I
very deeply regret that there should be even the appearance of
division in an assembly of gentlemen, all of whom we know to be
engaged in such honorable service, and most of whom we have the
happiness of knowing also as men who have shown that they possess
high attainments, both intellectually and morally. I trust that if
there is any little feeling of this kind, it will be allowed to die away,
for you must remember, gentlemen, that there is no section of society,
I really believe there is no section of society which labours under more
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Special General Meeting of the Association.
misapprehension and greater disadvantage than our section—the
speciality of attending to the interests of the insane. We really may
be said to be people who have no friends (hear, hear). The public
are entirely ignorant of all our highest duties, and have no appre¬
ciation of them at all. The tendency of almost every legislative
movement is to confer some new disadvantage upon uS, or to throw
some insult or affront upon medical men who are engaged in this
department of practice. As for the public in general, we know that
they have not any sensible notions upon the subject, and that every¬
thing depends upon the exertions of medical men who are connected
with it, and upon their temperate representations at all times, or, if I
may use the word, their instruction of the public in matters that
relate to us. There is one point to which, as there are so many
superintendents present, I would take the liberty of alluding. I have
often alluded to it before as the great want of our profession, and a
great impediment to any progress in it; and that is, a want of schools
for clinical instruction in the nature and treatment of mental mala¬
dies. Until you have those schools, you will never be able to
command men to take positions of great importance—not such as
you would sometimes wish could be found. Nor will you give to the
study of mental disorders its proper value till you place it in that rank
which it ought to take among other departments of medical science.
At present it has no place whatever. It is recognised in none of the.
schools, it i3 scarcely taught in any of the schools. That is one great
and general disadvantage we labour under. I hope, gentlemen, that
proper attention will be given to this and other subjects, and among
the rest to a much larger intercourse with our foreign brethren, a
more intimate knowledge of what is doing by the great minds that
are scattered over the different countries of Europe as well as our
own, so that we shall have a more general comparison, as it were,
of ideas between them, and that many points that are subjects of
dispute and prejudice, will be more clearly understood. These and
many other important points which I shall not take the liberty of
mentioning to you at present, seem to me materially connected with
the conduct of our Journal. I think whoever is editor, the Journal
must always be considered as the organ of this Association, and I am
most anxious that it should be so conducted as to fulfil all these con¬
ditions. I therefore do hope that if there is any little feeling of the kind,
it will be allowed to subside, and that, at all events for the present,
we should concur in the resolution which has been proposed to you.
The President: It remains for me to put the resolution proposed
by Dr. Thurnam, seconded by Dr. Campbell, “ That Dr. Lockhart
Kobertson be elected editor of the Journal until the next Anuual
Meeting.”
The resolution was put, and carried nem. con.
Dr. Robertson: Mr. President and gentlemen, I shall willingly
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Special General Meeting of the Association.
accept the charge of the Journal, as you have proposed, until July.
In doing so, however, you will perhaps allow me to slightly refer to
some remarks which have been made. Neither the committee, nor
Dr. Bucknill, nor myself, put me forward. On the contrary, I most
carefully avoided putting myself forward. I intended. leaving the
question of editor entirely in the hands of this meeting; but it was in
consequence of a printed circular sent round to every member that I
was forced into action. In that circular one of the members offered
himself as editor, and I felt that to remain longer silent would certainly
be to forego my just claims upon the appointment. Therefore I wrote
to several of my friends. I wrote first to Dr. Bucknill, then to
Dr. Wood, Dr. Munro, Dr. Campbell, and Mr. Marshall; and I
wrote to Dr. Thurnam and others, stating that I also was desirous
to have my claims considered by this meeting. It was in consequence
of the appeal that I made to Dr. Bucknill that he wrote this letter
to the President. I should have been very unwilling to sit down,
leaving the meeting under any false impression that Dr. Bucknill
wished to dictate who should be his successor. I am sure that
nothing could be farther from his mind. There were many letters
exchanged between Dr. Bucknill, Dr. Kirkman, and myself. Our
whole wish was to call a general meeting, so that the committee
should not appear to interfere in the matter of the Journal. I
resigned the secretaryship, because, considering myself a candidate, I
thought it was fair that the Association should meet me as one of
the members, and not as an office-bearer. I shall very willingly
conduct the Journal until July, on the distinct and clear under¬
standing that I have no more claim on the editorship in July than
any other member of the Association. I am particularly fortunate
in having received from Dr. Maudesley—a name that I am quite sure
every gentleman who reads the Journal will appreciate—the promise
of his co-operation during this period. The editorship shall remain
open till July. I shall edit it, and I have the promise of Dr.
Maudesley's assistance until then. I hope that Dr. Wood will so
far approve of our efforts as to continue his support to us until that
meeting. That, however, is a question for the future to determine.
I beg to thank you for this, and for the many other acts of kindness
I have always received from the Association.
Dr. Wood Mr. President, I am sure that what Dr. Bucknill
did, in recommending Dr. Robertson as his successor, he did in the
interests of the Association; and the very straightforward and manly,
way in which Dr. Robertson has proposed to act, during the forth¬
coming nine months, quite removes any doubts in the minds of
anybody as to his being the proper person to take' charge of the
Journal until that time.
The President: Gentlemen, Dr. Robertson's editorship of the
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Lunacy Acts Amendment Act.
Journal entails another appointment which you must make to-day.
You must have a Secretary.
Dr. llitckman: Mr. President and gentlemen, I have very great .
pleasure in moving that Dr. Harrington Tuke be solicited to take
the office of Secretary of this Association. He is a gentleman whose
courtesy and ability are well known to us all. He has taken a
most active and lively interest in the success and prosperity of this
Association from the very earliest time of its establishment; and I
am sure his appointment would be satisfactory to us all.
Dr. Manley: 1 have very great pleasure in seconding that reso¬
lution. It would be a graceful act to Dr. Tuke, as he lost the
presidentship a short time ago.
The resolution was put, and carried unanimously.
Dr. Tuke: Mr. President and gentlemen, I very sincerely thank
you for the honour you have done me. I would almost rather be
secretary than president. I think the office of secretary is one in
which a man may be of great use, who has at heart social inter¬
course and kind feeling between the members. I shall be very
happy, as Secretary, to promote that in every possible way. I sin¬
cerely trust that as a society we shall all be bound together, and that
we shall never on future occasions have amongst us any distinction
between “ public” or " private” asylums. I sincerely trust that
that may be the case, and that when I meet you next year I may be
re-elected Secretary.
Dr. Robertson : I believe, gentlemen, the only business remaining
to do is to propose a vote of thanks to our Chairman. He has
taken very great trouble about this meeting, and had a great deal of
anxiety and thought about how we should conduct it. He has
come a long journey to attend it; and I beg to propose a vote of
thanks to him for his conduct in the chair.
Dr. Millar: I beg to second that proposal.
The motion was carried with acclamation.
The Lunacy Acts Amendment Act, 1862; Taper of Instructions by
the Commissioners in Lunacy (September 1st, 1862).
Private Patients.
Sec. 23.—The order must be dated within one month prior to the reception;
the person signing the order must himself have seen the patient within one
month prior to its date; and a statement of the time and place when the patient
was so seen, must be appended to the order. A form of order is subjoined.
[c. 96, s. 4. c. 97, s. 74.]
Sec. 25.—Where possible, every order must contain the name and address of
one or more relations of the lunatic, to whom notice of the death of the lunatic
must be sent.
Sec. 24.—Besides the persons hitherto prohibited from signing certificates
and orders, the following also are now disqualified:
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Lunacy Acts Amendment Act.
Any person receiving any per-centage on or otherwise interested in the pay¬
ments for patients.
The meaical attendant, as defined in the Lunacy Act, chapter 100.
[c. 96, s. 12. c. 97, s. 76.J
Sec. 26.—Where a patient received as a pauper is made a private patient, no
fresh order or certificate is required, and vice versa.
n .b. —Notice of any transfer under this section should he given to the Commis¬
sioners.
Sec. 28.—With the exception of the statement by the medical officer as to a
patient’s mental and bodily condition, all the documents heretofore required to
be sent to the Commissioners after two and before seven clear days from the
reception of the patient, must in future be sent within one clear day from such
reception. The medical officer’s statement is, as heretofore, not to be sent
until after two and before seven clear days.
[c. 100, ss. 52 and 90. c. 97, s. 89.]
Sec. 40.—Without special directions to the contrary, letters addressed to the
Commissioners, Committees of Visitors, Committees of a Hospital, and the
Visitors of Licensed Houses, must be forwarded unopened.
Other letters must also be forwarded unless, by an endorsement thereon, the
superintendent or other person having charge of patients should prohibit their
transmission.
Letters so endorsed to be laid before Commissioners, Committees, or Visitors
at next visit.
Sec. 38.—Absence on trial may be permitted to patients in the same way as
leave of absence for the benefit of health is permitted under the 86th section,
chap. 100.
Sec. 43.—In the absence of any person qualified to discharge under ss. 72,73,
chap. 100, a discharge or removal may be ordered by the Commissioners.
Pauper Patients.
Sec. 25.—The order must contain the name and address of one or more rela¬
tions of the lunatic, and notice of the death of the lunatic must sent to such
relation. [c. 96, s. 7. c. 97, ss. 67, 68, and 73.]
Sec. 26.—Where a person received as a private patient is retained as a
pauper, no fresh order or certificate is required, and vice versa.
n.b. —Notice of any transfer under this section should he given to the Commis¬
sioners.
Sec. 38.—A pauper permitted to be absent on trial from a licensed house or
hospital, may have such an allowance made to him by order of the Commis¬
sioners, Visitors, or Committee as would be charged for him were he in the
house or hospital.
Licensed Houses and Hospitals.
Sec. 14,15.—No fresh licence can be granted by Justices without inspec¬
tion and report by Commissioners. Notice of alterations in houses licensed
by Justices must be given to Commissioners. Their report upon the premises
proposed to be licensed, and on any proposed alterations, must be submitted to
the Justices and considered by them, before the licence is granted or the altera¬
tions are consented to.
Sec. 16.—The physician, surgeon, or apothecary, not being a licensee, where
any such is by law required to reside in or visit a licensed house, must in the
metropolitan district be approved of by the Commissioners, and in the pro¬
vincial district by the Visiting Justices.
[c. 96, s. 2.]
Sec. 17.—A penalty is imposed on any person infringing the terms of Ins
licence as to numbers, sex, or class.
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460 Appointments.
Sec. 18.—-With the consent of two of the Commissioners, or in the case of
the provincial licensed houses of two of the Visitors, a person who may have
been a patient within five years immediately preceding may be received as a
boarder into a licensed house.
[Extension of c. 96, s. 6.]
Sec. 29.—Licensed houses may be visited at any time by one or more Com¬
missioners or Visitors, but in the metropolitan district they must be so visited
twice in the year in addition to the present visits by two Commissioners, and
in the provincial districts similarly by Visitors. Commissioners and Visitors
visiting singly have substantially the same powers of inspection and inquiry as
when visiting together, but only the 63rd, 64th, 65th, 66th, and 67th sections
of the old Act are applicable to the additional visits to be made by Visitors, to
which the 62nd section of that Act does not apply.
[c. 100, s. 61.]
Sec. 39.—A penalty is now imposed on any officer or servant conniving at an
escape.
Sec. 43.—In the absence of any person qualified under sec. 72, 73, chap. 100,
the Commissioners may order the discharge or removal of a patient.
Sec. 35.—The inquiries now authorized to be made by Visiting Commis¬
sioners and Justices, will in future include inquiries as to monies paid to the
superintendent or proprietor.
[c. 100. ss. 64 and 92.]
Sec. 36.—Copies of entries made by the Commissioners in all houses not in
the metropolitan district must in future be sent to the clerk to the Visitors.
[c. 100, s. 67.]
Sec. 38.—Absence on trial may be permitted to patients in the same way as
leave of absence for the benefit of health is permitt ed under the 86th section,
chap. 100.
Medical Certificates.
Sec. 27.—Where medical certificates have been returned with a written
direction of the Commissioners for amendments, and such amendments shall
not have been made within 14 days, the Commissioners may order the patient’s
discharge. [c. 96, s. 11. c. 97, s. 87.]
Sec. 22.—Lunatics so found by inquisition may be received without certi¬
ficates on an order of the Committee, accompanied by an office copy of the
order appointing such committee.
APPOINTMENTS.
Dr. Wm. Wood, M.R.C.P., to be Visiting Physician to St.
Luke's Hospital.
G. W. Saunders, M.D. Lond., late Assistant Medical Officer to
the Devon County Asylum, to be Medical Superintendent of the
same Asylum.
The pressure on our pages caused by the report of the special meeting
compels us to defer some papers and notices which were in type on the condition
of the great Australian Asylum, Dr. Gairdner’s excellent work on clinical
medicine, &c.
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NOTE BY DR. ROBERTSON.
It is with no small diffidence that, in accordance with the
unanimous vote of the Association, Dr. Robertson now
assumes the conduct of this Journal.
It will he his anxious endeavour, in the performance of
the task now entrusted to him, to maintain the Journal in
the position of honour which it has hitherto held, by following
the example of independent, straightforward action set to
him by his distinguished predecessor. He trusts that during
his editorship the pages of the Journal will continue, as
heretofore, unsullied by unseemly disputes and personal dis¬
cussions unworthy of the members of a learned profession,
against which Dr. Bucknill has firmly closed Ins pages.
He deems it right to take this first opportunity of explicitly
stating his rule of action on this important point, and no
fear of offence to individual members of the Association will
induce him to depart therefrom.
Nine years have elapsed since the first number of the
Journal appeared; it may be not uninteresting on the
present occasion to look back on the work which during these
years this Journal has accomplished. The year 1852 found
the Association few in numbers, of limited funds, and less
influence. The Annual Meetings had almost fallen into
abeyance, and the objects of the Association in the improve¬
ment of asylum management, the diffusion of the knowledge
of the treatment of mental disease, and the promotion of free
communication on these subjects between its members, were
alike unfulfilled; the Association was but a dim name, and
of its existence even many members of the department,
including the present writer, were ignorant.
The Vbth of November, 1853, the first number of t J, e
Asylum Journal appeared. Some of the readers of this
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Note by Dr. Robertson.
note will remember its unpretending bi-quarterly form. In
October , 1855, it assumed its quarterly form, and in Aprils
1861, it was transferred from the provincial printer to an
excellent London establishment. Forty-two numbers in all
have been published. Dr. Robertson ventures to say that
the thought and tone of the articles contributed in this period
have materially raised the position of the English psycho¬
logical medicine both at home and abroad. The Journal
now circulates in our most distant colonies, and it was only
this summer that Dr. Robertson learnt from a distinguished
foreign visitor that no less than seven copies circulated in
Sweden.
With the issue of the Journal the Association rose into
new life. With one or two exceptions, whose absence Dr.
Robertson personally regrets , as that of men whose work
he has learnt to know and value, all the medical officers of
the public asylums in England, Ireland, or Scotland, have
joined our ranks , which have had further added to them
every physician of any character or pretensions engaged in
the private practice of this department in medicine. More¬
over, men of European fame, as Sir Benjamin Brodie, Sir
Henry Holland ; of high official position, as Mr. Gaskell,
Dr. Nairnk, Mr. Wilkes, Dr. Browne, Dr. Coxe, Dr.
Nugent, 8fc., have mllingly consented to enrol their names
in the list of our honorary members. It is superfluous to
point out the increased influence which such an extension
of our members has given to the Association.
The contents of the ‘ Journal of Mental Science’ may be
divided into —
I. Original Contributions and Lectures.
II. Reviews.
III. English and Foreign Quarterly Psycho¬
logical Retrospect.
IV. Correspondence and News.
V. Medico-legal Cases.
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Note by Dr. Robertson.
463
I. Original Contributions and Lectures.
Dr. Robertson knows hoio able the members of the Asso¬
ciation are to supply such articles. Few pleasures in this
vain world are more real than the satisfaction which flows
from successful intellectual effort. It is, moreover, a duty
which each owes to his calling , to make known, as undely as
opportunity may offer, the results of his thought and labour.
The French physicians herein set us an example which we
would do well to imitate. Our asylum case-books , to quote
Dr. Conolly’s emphatic words, contain treasures hitherto
hidden.
II. Reviews.
It will be the desire of the Editor, and of those associated
with him in the conduct of the Journal, fairly and without
favour to pass in review all recent works bearing on prac¬
tical psychology and its kindred subjects.
III. English and Foreign Quarterly Psychological
Retrospect.
In this section of the Journal will be given a quarterly
summary of the progress of medical science at home and
abroad in all that relates to subjects embraced in the
* Journal of Mental Science.* The Editor ventures to add
that the experience which he acquired when associated with
Dr. Ranking, as a writer in the * Half-yearly Abstract of
the Medical Scienceswill enable him to conduct this im¬
portant department of the Journal to the satisfaction of the
Association.
IV. Correspondence and News.
In the earlier numbers of the Journal some very inte¬
resting letters are to be found relating to everyday asylum
life. “ A class of articles (writes the Editor in the number
for November, 1854), to which we attach much importance,
and which we hope to see developed , is one for which it is
difficult to find a name. We mean the multifarious little
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MICHIGAN STATE UNIVERSITY
464
Note by Dr. Robertson.
matters of practical utility, ranging from pins and needles
upwards—the utiliaria by which the ship is kept neat and
cleanly or comfortable. Little matters, but of great impor¬
tance to the ivell-being and economy of a large institution,
and not unfrequently also to the health and the safety of the
patients.”
V. Medico-legal Cases.
• The increasing attention which the public press as well as
the medical and legal professions pay to trials in lunacy,
renders it desirable that a record of these cases be preserved
in the pages of the * Journal of Mental Science.’ The
Editor has promises of help in this section of his ivork, such
as will enable him fairly to deal with this difficult depart¬
ment of medical jurisprudence.
In thus surveying the work before him, Dr. Robertson
candidly admits that he feels unequal, single-handed, to
undertake it. It is only the promised aid and co-operation
of so competent a writer as Dr. Henry Matjdsley that
now emboldens him to embark on his editorial duties. It
was a matter of much regret to Dr. Robertson’s supporters,
as well as to himself, that the rules of the Association pre¬
vented the election, at the late Special Meeting, of more
than one Editor, and that consequently they ivere prevented
from formally associating Dr. Maudsley’s name with Di*.
Robertson, as joint Editor of the Journal. Moreover,
Dr. Robertson was overruled by a special vote at the.
conclusion of the meeting in his wish to leave the public
announcement of the names of the conductors of the Journal
open till the next Annual Meeting. Under these circum¬
stances he adopted the only course left open to him, of giving
the notice to the Secretary, required by Buie 18, of his
intention, at the Annual Meeting of 1863, to move that Dr.
Maudsley be associated with him (i in the event of his
re-election) as joint Editor of the Journal, as until that date
he will be in its management.
September 18^7j, 1862.
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MICHIGAN STATE UNIVERSITY
ASSOCIATION OF MEDICAL OFFICERS OF ASYLUMS AND
HOSPITALS FOR THE INSANE.
Office Bearers and Committee of Management , 1862-3.
President — Dr. Kirkman, M.S. Co. Asy., Suffolk.
President Elect — Dr. Skae, M.S. Royal Edinburgh, Asylum.
Ex-President — Dr. Lalor, M.S. Richmond Dis. Asy., Dublin.
Treasurer — Wm. Ley, Esq., M.S. Co. Asy., Oxfordshire.
Auditors —Dr.W. P. Kirkman, M.S. Co. Asy., Carlisle; Dr. Millar, Bethnal Green Asy.
Hon. Sec. (General )—Dr. H. Tuke, Manor House, Chiswick.
Hon. Secretary for Ireland —Dr. Stewart, M.S. District Asy., Belfast.
Hon. Secretary for Scotland —Dr. Rorie, M.S. Roy. Asy., Dundee.
Editor of Journal— Dr. Robertson, M.S. Co. Asy., Sussex (Hayward’s Heath).
Other Members of Committee.
Dr. Burton, M.S. Dis. Asy.,Maryborough.
Dr. Dayey, Northwoods, Bristol.
Dr. Gilchrist, M.S. Chrichton Instit.,
Dumfries.
Other Members of the Association.
Dr. Paul, Camberwell Ho., London.
Dr. Conolly, Hanwell.
Dr. Hitchman, M.S. Co. Asv., Derby.
Di; Du
Adams, Richard, Esq., M.S. Cornwall
Co. Asy., Bodmin.
Aitkin, Dr., M.S.*Co. Asy., Inverness.
Allen, Thos., Esq., M.S. Warneford Asy.,
Oxford.
Arlidge, Dr., Etruria, Stafford.
Armstrong, Dr., Peckham Ho., London.
Bakewell, Dr., Church Stretton, Salop.
Berkeley, Dr., M.S. Distr. Asy., Mullingar.
Biggs, Dr., Co. Asy., Wandsworth.
Btrkett, G., Esq., Northumberland Ho.,
Stoke Newington.
Blandford, Dr., Blacklands, Chelsea.
Blotjnt, Dr., Bagshot, Surrey.
Boisragon, Dr., Duddeston Hall, Bir¬
mingham.
Boyd, Dr., M.S. Co. Asy., Somerset.
Browne, Dr. J. Crichton, Derby County
Asylum. [Heath.
Browne, Dr., Sussex Co. Asy., Hayward’s
Browne, H., Esq., Hayes.
Brushfield, Dr., M.S. Co. Asy., Chester.
Bryan, Dr. E., Brighton.
Buck, J., Esq., M.S. Co. Asy., Leicester.
Bull, Dr., Cork.
Burnet, Dr., Westbroke Ho., Alton, Hants.
Bush, J., Esq., Clapham Retreat, London.
BusHNAN,Dr.S., Laverstock Ho.,Salisbury.
Campbell, Dr., M.S. Co. Asy., Brentwood.
Casson, F. W., Esq., M.S. Hull Boro’ Asy..
Chevallier, Dr., The Grove, Ipswich.
Chawner, Dr., V. P. Lincoln Hospital
for the Insane.
Christie, Dr., Pembroke Ho., Hackney.
Cleaton, J., Esq., M.S. Co. Asy., Wakefield.
Clouston, Dr. T. S., Roy. Asy., Edinburgh.
Corbet, Dr., M.S. State Asy., Dundrum.
Cornwall, J.,Esq., FairfordjGlo’stershire.
Corsellis, Dr., Benson, Oxon. [Arden.
Dartnell, Dr., Arden House, Henley-in-
Delany, Dr., M.S. Dist. Asy., Kilkenny.
De Wolf, Dr., M.S., Hospital for Insane,
Halifax, Nova Scotia.
Diamond, Dr.W. H., Effra Hall, Brixton.
Dickson, Dr., Wye House, Buxton.
Dixon, Dr. F. B., Hoxton House, N.
Down, Dr. Langdon, Idiot Asy., Red Hill.
Duffy, Dr., Finglass, Dublin.
Duke, Dr., Dublin.
Duncan, Dr. Nugent,
Du
ncan, Dr. Nugent, I
IKSd&tTe J
Farnham House,
Dublin.
Duncan, Dr., Colchester. [tershire.
Eastwood, Dr., Fairford Retreat, Glouces-
Eaton, Dr., District Asy., Ballinasloe.
Eustace, Dr. John, jun., Glasnevin, co.
Dublin.
Fairless, Dr., Asy., Montrose.
Fayrer, Dr., Henley-in-Arden.
Flynn, Dr., M.S. District Asy., Clonmel.
Foote, Dr., Constantinople.
Fox, Dr. Francis, 1 0 . ,. . TT
TW nr I Brislington House,
'
Bristol.
Fox, Dr. Charles,
Fox, Dr. C. H.,
Garbutt, J. M., Esq., Dunston Lodge,
Gateshead.
Gardener, G. G., Brook House, Clapton.
Green, Thomas, Esq., M.S. Boro. Asy.
Birmingham. -
Hammond, F., Esq., Co. Asy., Hants.
Harper, Dr., Chester County Asylum.
Hastings, Sir Charles, D.C.L., Wor¬
cester.
Helps, Dr., Royal Bethlem Hospital.
Hewson, Dr., M. S. Coton Hill Asy.,
Stafford. [Stamford.
Hill, R. G., Esq., Shillingthorpe Hall,
Hills, Dr.W.C., M.S. Co. Asy., Norfolk.
Hitch, Dr., Sandywell Park, Glo’stershire.
Hitchcock, C., Esq., Market Lavington,
Wilts.
Hobart, Dr. S., V. Surg., District Asy.,
Cork.
Humphry, J., Esq., M.S. Bucks Co. Asy.,
Aylesbury.
Hunt, Dr., Co. Asylum, Worcester.
Iles, A., Esq., Cirencester, Glo’stershire.
Jacobs, H., Esq., Hoxton House, N.
Jamieson, Dr., Roy. Asy., Aberdeen.
Jepson, Dr. Octavius, Co. Asy., Hanwell.
Jones, G. T., Esq., M.S. Co. Asy., Den¬
bigh, North Wales.
Kitching, Dr., M.S. Retreat, York.
Knight, Dr., V.P. Co. Asy., Stafford.
Law, Dr. R., V.P. Central Asy., Dublin.
Lawlor, Dr., M.S. Killarney Distr. Asy.
Lawrence, Dr., M.S. Co. Asylum, Cam¬
bridge.
Lewis, H., Esq., 54, Paradise St., Lambeth.
Lindsay, Dr. J. M., Royal Asylum, Perth.
Lorimer, Dr., Crumpsall New Workhouse,
Manchester.
Lowe, Dr., Saughton Hall, Edinburgh.
Lowry, Dr., W est Mail ing, R ent. ^ ^ ^ ^ ^ ^ yy
List of Members — continued\
Lynch, Dr., Drumcondra, Dublin, [lington.
Mackintosh, Dr., Dimsdale Park, Dar-
Mackintosh, Dr., M.S. R. Asy., Glasgow.
Mackintosh, Dr. W. C., Royal Asylum,
Perth.
Macmunn, Dr., Dist. Asy., Sligo.
Macreight, Dr., The Bungalow, Torquay.
Madden, Dr., Asy., Somerset.
Manley, Dr., M.S. Co. Asy., Hants.
Marshall, W. G., Esq., M.S. Co. Asy.,
Colney Hatch.
Maudsley, Dr., 6, Crescent Place, Morn-
ington Crescent [gavenny.
McCullough, Dr., M.S., Co. Asy., Aber-
McKinstry, Dr., Armagh Dis. Hos.
Meyer, Dr., M.S. Surrey Co. Asy., Wands¬
worth.
Miller, Dr., V.P. St. Thomas Hos., Exeter.
Monro, Dr. H., Cavendish Square, V.P.
St. Luke’s Hospital.
Morison, Sir Alexander, M.D., Pem-
bridge Gardens, Notting Hill.
Moss, Dr. W. C., Longwood Ho., Bristol.
Mould, G. W., Esq., M.S. Manchester
Roy. Lunatic Hospital, Cheadle.
Muirhead, Dr., Longdales Asy., Bothwell.
Mundy, Dr., 14, Old Cavendish Street.
Needham, P., Esq., Lunatic Hos., York.
Newington, Dr. Charles Hayes, Tice-
hurst, Sussex.
Newington, Dr. Samuel, Ridgway, Tice-
hurst, Sussex.
Niven, Dr., H.E.I.C.S. Med. Depart.,
Bombay, late Co. Asy., Essex.
NobleT Dr., Manchester.
Oliver, Dr., M.S. Co. Asy., Shropshire.
Palmer, Dr., M.S. Co. Asy., Lincolnshire.
Paley, Dr. E., 39, Arlington Street,
Mornington Crescent.
Parsey, Dr., M.S. Co. Asv., Warwickshire.
Phillips, E. P., Esq., M.S. Co. Asy.,
Haverford West.
Philp, Dr., late V.P. St. Luke’s.
Power, Dr., M.S. District Asy., Cork.
Prichard, Dr., Abington Abbey, North¬
ampton.
Rae, Dr., Naval Asy., Haslar.
Robinson, Dr., Newcastle-on-Tyne.
Rogan, Dr., M.S. Londonderry Dist. Asy.
Rogers, Dr., M.S. Co. Asy., Rainhill.
Ross, Dr. A., Waterloo, near Portsmouth.
Sankey, H., Esq., Co. Asy., Oxford.
Sankey, Dr., M.S. Co. Asy., Hanwell.
Saunders, J., Esq., Co. Asy., Devon.
Schofield, Dr. F., Camberwell Ho., S.
Sheppard, Dr. E., M.S. Co. Asy., Colney
Hatch.
Sherlock, Dr., M.S. Co. Asy., Worcester.
Sibbald, Dr., M.S. Co. Asy., Lochgilphead,
Argyll.
Smith, Dr. F. M., Hadham Palace, Herts.
Smith, Dr. G. P., Mount Stead, Ilkley.
Smith, Dr. R., M.S. Co. Asy., Durham.
Smith, Dr. Jno., 20, Charlotte Square,
Edinburgh.
Stanley, Dr., Rathfarnham, co. Dublin.
Stevens, Dr. H., Grosvenor St., London.
Stephens, Dr. H. O., Borough Asy., Sta¬
pleton, Bristol.
Stewart, Dr. H. H., M.S. Govt. Asy.,
Lucan, co. Dublin.
Stiff, Dr., M.S. Co. Asy., Nottingham.
Stilwell, Dr. H. S., \ Moorcroft House,
Stilwell, Dr., J # Uxbridge.
Sutherland, Dr., Richmond Terrace,
Whitehall, C.P. St. Luke’s Hospital.
Symbs, J. P., Esq., Co. Asy., Devizes, Wilts.
Symes, J. G., Esq., M.S. Co. Asy., Dorset.
Tate, Dr., Lunatic Hospital, Nottingham.
Terry, J., Esq., Bailbrook House, Bath,
Thurnam, Dr., M.S. Co. Asy., Wilts.
Toller, E., Esq., M.S. St. Luke’s Hospital.
Tukb, Dr. Daniel H., Falmouth.
Tyerman, F. D., Esq., Colville Ho., Low¬
estoft.
Walsh, F. D., Esq., M.S. Hospital for the
Insane, Lincoln. [wich.
Watson, J. F., Esq., Heigham Hall, Nor-
Warwick, J., Esq., Hyde Hall, Saw-
bridgeworth, Herts.
West, Dr., M.S. District Asy., Omagh.
Willett, Dr., Wvke House, Brentford.
Williams, Dr. Caleb, York.
Williams, Dr., M.S. Co. Asy., Gloucester.
Williams, Duckworth, Esq., General
Lunatic Asylum, Northampton.
Wilson, R., Esq., M.S. Northumberland
Co. Asylum, Morpeth.
Wilton, F., Esq., Co. Asy., Gloucester.
Wing, Dr., M.S. Gen. Lun. Hos., North¬
ampton.
Wood, Dr., Harley Street, Cavendish
Square, V.P. St. Luke's HospitaL
Wood, Dr. A., Barnwood Ho. Asy., near
Gloucester.
Wynter, Dr. Andrew, Coleherne Court,
Old Brompton.
Yellowlees, Dr., Roy. Asy., Edinburgh.
Honorary Members.
Baillarger, Dr., La Salpetriere, Paris.
Battel, M., Paris.
Boismont, Dr. Brierre de, Paris.
Browne, Dr., Com. in Lun. for Scotland.
Brodie, Sir Benjamin Collins, Bart.,
D.C.L.
Bucknill, Dr., Chancery Visitor.
Calmril, Dr., Charenton, Paris.
Coxe, Dr., Commissioner in Lunacy for
Scotland.
Falrkt, Dr., La Salpetriere, Paris.
T * lemming, Dr., Editor of the 1 Zeitschrift
der Psychiatries
ff !&iJ(!qmmic <ir in I.nn _
Hatchell, Dr., Inspector of Asy., Ireland.
Hood, Dr., ChanceryVisitor.
Howe, Dr., Boston, U.S.
Holland, Sir Henry, Bart., M.D.
Jarvis, Dr., Boston, U.S.
Laycock, Professor, Edinburgh.
Morel, Dr., St. Yon, Rouen.
Nairne, Dr., Commissioned n Lunacy.
Nugent, Dr., Inspector of Asy., Ireland.
Peach, Dr., Langley Hall, Derby.
Ray, Dr., Providence, Rhode Island, U.S.
Stanley, Hans Sloane, Esq., Chairman
of Visiting Magistrates, Hants Co. Asy.
THE JOURNAL OF MENTAL SCIENCE.
No. 44. JANUARY, 1868. Vol. YIII.
PART I.—ORIGINAL ARTICLES.
On the want of a Middle Class Asylum in Sussex, with Suggestions
how it may be established. By C. L. Robertson, M.B. Cantab.
{Read before the Brighton and Sussex Medico-Chirurgical Society ,
December 4, 1862.)
“ I must own, that the more I reflect on the subject [public asylums for the
middle classes], the more it grows upon me, and the more am I inclined to wonder
that this idea, which has been contemplated so long by great and good men, has not
been embodied into a reality. Should it ever exist, and should good results spring
from it, it will only be another instance of how continually we are on the verge of
finding a treasure, and pass it by unconsciously—“ Public Asylums for the Middle
Classes ” by Henry Monro, M.B. Oxon, • Journal of Psychological Medicine/
October, 1851.
The subject which I am permitted to-night to bring before this
Society is one I have long had at heart, and one which the daily
experience of my practice at Hayward’s Heath prevents my passing
by merely on account of the difficulties which evidently attend the
realisation of my hopes, should such an issue be granted to them. I
refer to the want in our county of an asylum for the care and treatment
of the insane of the middle class—a class with which, while sepa¬
rated by education and calling, we, in our profession, are, on the
other hand, too often linked by the common bond of narrow means
and pressing daily cares.
Hardly a week passes over without bringing me letters from the
medical attendants of patients of the middle class, or from their rela¬
tives, asking if they can be admitted at Hayward’s Heath as private
patients; and if not, what steps I can advise to meet their urgent
requirement of good asylum accommodation, at such cost as their
limi ted means will permit them to defray. My reply is a statement
of the painful truth that I cannot help them, and it is thus week by
week pressed home to me that I must not allow so grave a social
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466
Dr. C. L. Robertson, on the Want
want to continue unredressed in my daily path without making an
effort to supply the same.
And in looking around to see whence help was herein to come to
those thus afflicted, and whom I am obliged to leave unaided in their
distress, I have felt that to none should I with more hope of help
bring my case than to my professional brethren in the county, and
more especially to you practising in this influential and wealthy town
of Brighton. With this view I spoke to your late President, Mr.
Hollis, who, from his official position at Haywards Heath, is familiar
with the want of which I am speaking, and he kindly arranged that
this evening should be given up by the Brighton and Sussex Medico-
Chirurgical Society to the discussion of the want of an asylum in
Sussex for the middle class, and of the means by which, perchance,
it may be provided.
You all know how liberally the county of Sussex and this town of
Brighton have provided at Hayward's Heath for the care and treat¬
ment of their insane poor. Were I myself, in the wise providence of
the Most High, afflicted with so terrible a trial as mental disease, I
should desire no better home than that Asylum affords. A wise
liberality has there provided all that science has hitherto devised as
tending to the cure of insanity and of the relief of its sufferings.
When, in 1859, the asylum there was opened, the Visitors, acting
on my advice, determined to admit patients of the middle class to the
benefits of the asylum on a weekly payment of 16$., the Lunacy Act
permitting such an arrangement so long as spare beds are in the
asylum, not required by the pauper patients of the county. This
permission is, however, granted only, and most wisely, on the fur¬
ther condition that they be treated exactly as the parish paupers,
and this in order that in such a hospital for the cure of mental
disease the classification and other elements of moral treatment con¬
tinue to be based solely on the mental condition of the patients, and
remain uninfluenced by social restrictions.
When I so advised the Visitors, I was fully aware of the trouble
which this restriction would bring to me from the complaints and dis¬
satisfaction of the friends of private patients, nor was I deceived in
my reckoning. Rather the contrary. Indeed, it was matter of
much personal comfort to me when, in the spring of this year, the
crowded condition of the wards obliged the Visitors to close the
doors against the admission of private patients, and to require the
removal of those already there.
I can hardly spare time, and perhaps it is as well unsaid, to tell
you of the practical difficulties, not to speak of the personal worry,
attending the mixing in one house and under one system of treatment
of pauper and private lunatics. Dr. Campbell records a similar
experience when the trial was made in the early history of the Essex
Asylum. " The admission," says the visitors in their report of 1860,
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467
of a Middle Clast Asylum in Sussex.
“of private patients into the Essex Asylum was inconvenient and
inconsistent with the quiet and the good management of the great
body of pauper lunatics.”
As, however, the asylum at Hayward's Heath is closed against the
admission of private patients of the middle class, and as there is,
from the increasing demand on the part of the unions, for beds there,
no prospect of its ever again being opened for their reception, we
may here dismiss the further consideration of the county asylum as
a place for the treatment of the insane of the middle class in Sussex
and Brighton.
Lord Shaftesbury, in his evidence before the select committee of
1859, and which I shall have occasion again to quote, recognises
the evil of this mixing of private and pauper patients in county
asylums. “ The receiving of private patients in some of the county
asylums is,” he says, “ a very bad thing; it is not right, for they are
classed with the paupers. And yet,” he justly adds, “ to recognise a
distinction would be the very worst thing that could be done. There
we have found that the combination of differing classes has always
been the cause of the greatest jealousy; the paupers have thought
that they were pushed into nooks and comers, and that their in¬
terests were made subservient to the interests of others.”
So likewise Dr. Bucknill, in his evidence before the same com¬
mittee, condemns the mixing in the same asylum of pauper and
private patients, and refers to the experience at Gloucester, where
the two classes have been separated, and a middle class asylum for
the county instituted.
The daily want felt in Sussex of a house for the care and treatment
of the insane of the middle class is one which thus has been felt, and
which has engaged much attention in different parts of England. In
1857 the Earl of Shaftesbury, the chairman of the Lunacy Board,
made, in a published letter, the following observations on this
subject:
“It is of real importance to the happiness and comfort of persons
and families in a superior condition of life , but with small fortunes ,
that they should have the means , in case of mental visitation , to
obtain for themselves or their relatives the best treatment at a mode¬
rate cost.
“ Nothing worthy of the name of treatment or accommodation can
now be obtained , except at a cost which is ruinous to clerks , trades¬
people , and hard labourers in various professions.
“ The misery that follows inflictions of this kind in families such
as I have mentioned is indescribable.”
In 1851 Dr. Henry Monro published, in Dr. Eorbes Winslow’s
* Journal, ' a paper on “ Public Asylums for the Middle Classes,” in
which a strong sense of the same want is expressed. “ What,” he
says, u can the father of a family, the possessor of an income ave-
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468
Dr. C. L. Robertson, on the Want
raging £150 or £200 do when one son out of five becomes insane?
or what can the children do for that father? What can the clergy¬
man, the medical man, the man of small business—I may say the
great majority of the middle classes—do ?.Dor the
wealthy all conveniences are open, whether private asylums, lodgings
with medical men, or their own houses, and it is the fault of their
friends more than their circumstances if all is not done for them
which can be done. Tor the poor or labouring classes the county
lunatic asylum, the hospitals of Bethlehem and St. Luke's, afford
great and suitable accommodation. But what is there for persons
of habits as refined as their richer neighbours, and education
often superior? They cannot afford the former alternative, and
are too often compelled to accept the latter, and this at a cost
which none but those who witness their sufferings can at all ap¬
preciate."
Mr. Gaskell, one of the Commissioners in Lunacy, whose know¬
ledge (to quote Dr. Bucknill's words) on the whole subject of
lunacy is unsurpassed, in a paper which he contributed to the
‘ Journal of Mental Science' for April, 1860, bears similar testimony
to the urgent want of asylum accommodation for the insane of the
middle class. “Bor the pauper," he says, “attacked by insanity,
asylums are required by law to be opened in every district, and on
behalf of this class little further is needed, except a more satisfactory
recognition of the intention of the legislature, the abolition of certain
restrictions attributable to an incomplete abandonment of obsolete
views and practices. But for those not included in the list of
paupers there is a lamentable want of proper means of treatment
and care in this portion of the United Kingdom. Benevolent indi¬
viduals have, indeed, from time to time endeavoured to supply the
deficiency; nevertheless, the few charitable institutions scattered over
the country are quite inadequate, the amount of hospital accommo¬
dation for mental affections being far below the demands made for
accommodation and relief, presenting, as it does, a striking con¬
trast to the abundant provisions made for bodily ailments in every
district.
“The question naturally arises, how are the unfortunate individuals
who belong to the labouring and middle classes accommodated and
treated? It is too notorious that many are detained at home,
causing sad disasters, confirmation of the malady, and reduction of
the family to pauperism by the expense incurred; others, again, are
sent to private asylums, where, the cost of maintenance being neces¬
sarily great, a like pauperising result ensues, and in numerous
instances admission is obtained into the county asylum, which, being
strictly instituted for the reception of paupers, involves an evasion or
infraction of the law."
Again, Dr. Maudsley, in a paper in the current number of the
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MICHIGAN STATE UNIVERSITY
469
of a Middle Class Asylum in Sussex.
‘ Journal of Mental Science/ “On Middle Class Asylums/* makes the
following observation:
“ It seems to admit of no question, amongst those who hare a
knowledge of the matter, that some provision is yet needed for those
insane who are poor, but not poor enough to be paupers. Many
cannot pretend to pay what would be necessary for their admission
into a private asylum; and others, who by the utmost shifts contrive
to do so, do it at a sacrifice which cannot be justified, save by its
necessity. In the latter case it often happens that those who are
growing, and have to take their places in life, are deprived of impor¬
tant advantages for the sake of one who is, perhaps, for ever dead to
the world. Now, it is plainly bad philosophy to expend power on a
dead past and to starve the future of power, and, therefore, bad
policy on the part of society to put any man in the position of being
obliged to do it.
“ The resource which is afforded by the few county asylums which
do admit these unfortunately placed insane, on payment of the usual
charge for maintenance, is but a partial, uncertain, and ineffectual
remedy; nor is it by any means certain that even when there is
room in the county asylum it is advisable to admit private patients.
Passing by other grounds of objection which might well be urged
against such a course, it may be maintained, on just principles,
of treatment, no less than on amiable grounds of benevolence, that
it is not well to place any one who has become insane in very
different social conditions from those of his or her former life. If it
be most dangerous, as it certainly is, to the mental health of a sane
person to be placed in entirely changed external conditions, without
his inner life having been gradually adapted thereto, how much
greater must the danger be to the unsound mind which has lost that
very controlling force of reason whereby it might adapt itself to the
unwelcome change. To demand such an adaptation from the
diseased mind is to put a strain on the cracked links of reason which
they will scarce bear when quite sound. And that is really to
begin treatment on the homoeopathic principle of doing that which
would be most likely to produce the disease in a sound person.
County asylums have been built with a certain design, and the accom¬
plishment of that design must be their duty. However valuable,
then, their assistance may be as a temporary expedient, they cannot
be considered as affording a permanent provision for the poor insane
who are not paupers/*
In a paper read before the Association for the Promotion of Social
Science in 1859, my revered friend. Dr. Conolly, makes the following
remark on the difficulties in which persons of the middle class
afflicted with mental disease are, from the want of asylums suited to
their means and requirements, now placed:
“Their situation/* he there says, “if their resources are very
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470
Dr. C. L. Robertson, on the Want
limited, is indeed pitiable. The public asylums (of England), with a
few happy exceptions (Bethlehem Hospital, St. Luke's, the Hospital
for the Insane near Northampton, and the Coton Hill Asylum, near
Stafford), and the private asylums where the terms are not more than
can be afforded, do not offer the advantages enjoyed in the county
asylums by the more fortunate pauper. Institutions adapted to the
insane of the poorer of the middle and educated classes areyet unhap¬
pily wanted ." And repeatedly, in conversation with me, has Dr.
Conolly lamented this great want in the provision in England for
the care of those mentally afflicted. I say in England, for in
Scotland the want is not felt, owing to the admirable provision
made for this class of patients in the seven chartered asylums built
by private benevolence, and since their erection self-supporting.
In 1859 the Earl of Shaftesbury, in his evidence before a select
committee of the House of Commons, points to these chartered
asylums of Scotland as the type on which provision for the insane
of the middle class in England should be formed. "I now
speak," he says, “ with reference to that large class of society which
begins just above pauperism, and goes on to the highest in the
land. All the difficulties in legislation arise out of that particular
class.If you had establishments of that kind, asylums
or public hospitals, I should like to say chartered asylums, you
would find that they would be precisely the reverse of those I have
mentioned. First of all, there would be a total absence of that
motive which constitutes the vicious principle of the present licensed
houses, there would be no desire or view to profit of any sort.
I have no doubt that a certain number of those licensed houses
would continue, and I dare say that persons, from peculiar notions
of their own, would resort to such asylums. I would allow them
to continue, and I would also have, as you have public asylums for
paupers, houses on a public footing for persons in a better condition
of life.
“ The example which I principally should follow would be the
example of Scotland. In Scotland the chartered asylums have
existed for a certain number of years, and they have been productive
of the very greatest benefit. We have a certain number of insti¬
tutions similar to them in England, and they are called hospitals.
Hospitals in England are founded upon private funds. The chartered
asylums in Scotland are also founded upon private funds."
Eleven such institutions already exist, affording accommodation to
about 500 persons of the middle class. Some, like the Friends'
Retreat near York—and a blessed, calm retreat for the weary and
troubled in mind it has indeed proved—have now been in operation
for many years.
In the ninth report of the Commissioners in Lunacy (1855) will
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MICHIGAN STATE UNIVERSITY
471
of a .Middle date Asylum in Sussex.
be found in Appendix B a detailed history of these middle class
asylums, some of which are in possession of considerable funded
property. The following is a list of these hospitals, with the mean
population (average number of patients resident) during the year
1861:
Name of Middle Class Asylum.
Year in which
founded.
llean population.
1861.
1. St. Thomas's, Exeter •
1801
59
2* Barnwood House, Gloucester
. 1860
15
3. Liverpool Lunatic Hospital .
1792
55
4. Cheadle, near Manchester
. 1849
79
5* Lincoln Lunatic Hospital
. 1820
75
6. Northampton „
. 1838
96
7. The Coppice, Nottingham
1859
45
8. Warneford Asylum,. Oxford .
. ■ 1826
56
9. Colon Hill, Stafford
1854
122
10. York Lunatic Hospital .
1777
146
11. Friends' Retreat, York .
1796
122
These middle class asylums are all situated far away from Sussex;
indeed, there is not one in the home counties. The wants of the
most populous part of England for middle class asylum accommo¬
dation have yet to be met.
The expense of erection of these eleven middle class asylums has,
in most instances, been the result of long years’ accumulation of
funds the gift of private benevolence. It must, however, be borne
in mind that these offerings were made previous to the Lunatic
Asylum Act, which compelled counties to erect asylums for the care
of their pauper patients, and that appeals to the benevolent for such
funds were responded to before ratepayers became practically ac¬
quainted with the lunatic asylum rate, which now permanently
figures as an additional charge of the county rate.
I have thought long and carefully over this question, and I have
endeavoured to view it in its several bearings. While daily more
convinced of the urgent want of a middle class asylum for Sussex—
an opinion shared, I know, by several of the visiting justices of the
county asylum at Hayward’s Heath—I have also arrived at the con¬
clusion that it would be fruitless to endeavour to raise the necessary
sum (£20,000) by any appeal to the charity of the county. That
charity has already, as regards the insane, been wisely' and liberally
exercised in the construction of the county lunatic asylum; and in
my opinion, no further claim could herein be with justice raised.
"The voluntary principle,” said Lord Shaftesbury in 1859, "has
its limits, and I think that the voluntary principle on this head has
reached its utmost limits in England. It has founded eleven hos¬
pitals that have worked well, but the voluntary principle has. not
gone any further, and 1 do not think it is likely that any more will
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MICHIGAN STATE UNIVERSITY
472
Dr. G. L. Robertson, on the Want
be founded. I believe you will get nothing done by relying my mote
upon the voluntary principle. . . .
“ In the year 1845, when there was great sympathy excited with
respect to lunacy, we held a large public meeting, and we got all
the best names in the medical profession to assist us. We had a
long debate, and the greatest sympathy was expressed; there was
not a human being who did not admit that it was a crying evil, and
I never received more expressions of congratulation in all my life,
but I was obliged at last to say that a little less praise and a little
more support would have been more acceptable, for, notwithstanding
all the sympathy that was expressed, the voluntary principle was so
dead that we only succeeded, after a great deal of trouble and anxiety,
in raising £1200. That £1200 we kept for a long time, hoping
that it would increase, but nobody seemed inclined to assist us, and
we were obliged, after two or three years, to give it back to the sub¬
scribers, a break at the whole thing."
Moreover, the middle class of England neither require nor desire
alms. What they want in this and many other similar instances is
organized co-operation. The law of the land has already supplied
the insane poor of Sussex liberally and amply with all that they
require; the law of demand and supply has furnished the insane
of Sussex of the wealthier class with an asylum unequalled in the
land for the quiet, comfort, privacy, and luxury, which it offers. But
the ready supply of its every want which wealth always has com¬
manded comes more coyly to those of humbler, estate. It is only
in our own day that the many are learning the power of numbers
and co-operation to supply the advantages of wealth. Our fathers
could not dine as we do at our clubs, with all the luxury and state
of a peer, for half-a-crown, and this not from any charitable con¬
tributions of the wealthy to increase our comforts, but simply by
the power of co-operation. The history of the model lodging-houses
is a similar illustration. I believe that herein will be found the
means of supplying the want, which we all acknowledge, of a middle
class asylum for the county of Sussex.
Lord Shaftesbury, in his evidence before the select committee to
which I have already referred, thus states the remedy which he re¬
commends for these evils, viz., legal encouragement for the endow¬
ment of hospitals for lunatics. These hospitals “ to be founded in
two ways, either, as in Scotland and in some parts of England, by
private contributions—and we have eleven hospitals in England also
so founded—or, as in England, in respect to borough and county
asylums, upon the public rates.I would give in the
bill a permissive clause to counties for the purpose of founding
these asylums entirely for the reception of the middle class patients.
. . ... It would not require that the county should do more
than give the guarantee of its rates; it would not be necessary that
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473
of a Middle Class Asylum in Sussex.
the county should expend a farthing; in fact, it would incur no hazard
of its own whatever. But then it should have power to erect an
asylum of that description; I would leave the governing power, the
initiating power, just the same as with regard to the county asylums,
with the magistrates in quarter sessions, or it might be vested in
the visiting justices of the present county asylums, who, having
considered all matters, might, with the consent of the magistrates in
quarter sessions, if they thought it desirable to institute such an
asylum, merely take the guarantee of the rates to raise the sum of
money at per cent., the whole interest and principal being thus
paid off in thirty years. The thing would be self-supporting, and
the moment the asylum was opened it would be filled with patients,
some of a higher class and some of an inferior class, who would pay
the whole expense; their payments would cover not only the
per cent., but the whole expense of carrying on the institution, the
care and maintenance of the inmates, ana all the salaries and every¬
thing else.”
Every word of this I believe would have come true; and had such
powers been given in this county to the justices, I feel certain that a
well-ordered middle class asylum might be erected, which would
return 10 per cent, on the capital invested, and so, after the repay¬
ment of the loan, form a fund for the reduction of the rate of charge
in deserving cases.
Unfortunately this wise suggestion has not been adopted in sub¬
sequent lunacy legislation, although similar permissive powers have,
without entailing any loss on the ratepayer, erected in London, and
many of our large towns, baths and wash-houses of which rich and
poor alike reap the benefit. Through the guarantee of the rates of
the London parish in which I formerly resided (St. George's,
Hanover Square), I had, without any loss to the ratepayers, and at a
remunerative price to the undertaking, a morning plunge-bath for
4 d. or 6d., and a tepid swimming bath better than Brills' for 6d.,
while as yet private enterprise alone leaves the cost of a cold bath in
Brighton at 2 s. and a swimming bath at Is. 6 d. If I mistake not, I
paid 3s. at the Bedford Hotel for a tepid bath in no way better than
I got for 6rf. at the St. George's Baths and Wash-houses.
Had the application of this principle of the permissive guarantee
of the rates, at the discretion of the justices, for the erection of middle
class asylums, been sanctioned by the legislature as Lord Shaftesbury
desired, the want which we all feel of an asylum in Sussex to which
to send our patients, who neither require the luxury nor are able
to meet the cost at Ticehurst, would already have been provided,
and would in thirty years have repaid interest and capital, leaving
subsequent profits to form a fund for the reduction of the cost of
maintenance in individual cases requiring such aid. Tailing such
legislative aid, the obligation to help ourselves becomes the greater.
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MICHIGAN STATE UNIVERSITY
474 Dr. C. L. Robertson, on the Want
The success of recent joint-stock hotels, under the security of the
Limited Liability Act, points the way to the solving of the question
of how an asylum for the middle class in Sussex may best be pro¬
vided.
The effort of getting such an undertaking afloat, if only heartily
taken up by the members of this Society whom I have now the
honour to address, would not be great, while the benefit it would
confer on their patients, if afflicted with mental disease, and hence on
the whole community, would be incalculable.
At present, except in the case of a rich man who can afford his
two to three hundred a year for care and treatment at Ticehurst,
there is no place in the county where an insane patient can be sent,
an attendant procured in cases of emergency, or the wants of the
profession in the treatment of mental disease in any way met. The
consequence of this is, as I have before said, weekly appeals to me
to admit private patients into the county asylum, and which I am
obliged to refuse; and subsequent subterfuges between the patient's
friends and the parochial authorities to evade the law, by certifying
and sending as pauper patients to Hayward's Heath persons who are
not paupers, and who, while repaying the parish the charge made there
for their maintenance, would infinitely rather pay the cost of a middle
class asylum, were such open to them. I am violating no official
confidence—the question already having been before the late West
Sussex Sessions—in referring to these subterfuges to evade the law,
and to the practice of thus getting private patients admitted at
Hayward's Heath. I may also say that the Visitors entertain
a strong feeling of the legal obligation that rests on them to pre¬
vent the admission of such cases into a house built exclusively for
parish paupers, and for the right use of which they are responsible
to the ratepayers. I may, therefore, confidently state that the in¬
creasing demand for beds at Hayward's Heath made by the union
authorities of the county will render it more and more difficult for
patients of the middle class—wives of Brighton tradesmen and such
like—to be, by a good-natured evasion of the law, admitted as patients
there. And while, for the sake of those afflicted and of their sor¬
rowing relatives, who know not where else to turn in their distress,
I regret this state of things, we must, powerless as we are to alter
the existing law or to increase the responsibilities of the ratepayers,
yet admit its force, its unanswerable force, as an argument for the
necessity of that middle class asylum for Sussex whose establishment
I am to-night here to advocate. If the Visitors enforce, as they are
determined to do, the strict requirement of the statute—that each
patient admitted at Hayward's Heath should bond fide be a pauper,
maintained at the cost of the union sending him—then the facilities
which, for the past three years, by the admission of private patients
and of others surreptitiously added to the union lists, have come to an
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475
(fa Middle Claes Asylum in Sussex.
end, and it is for the public, advised as they will herein be by the
profession, to take steps for the establishment of a middle class
asylum, of whose sheltering care no one can say how soon the object
of his dearest love may not stand in need. Like pale death, and yet
more to be feared in its visitation, mental disease—
“ JEquo pul sat pede pauperum tabemas
Regumque tufTes.”
This question of a middle class asylum for the insane is really a
personal matter, coming home to every household of the great
middle class in the county, and needs not that I further weary you
by urging its, alas ! too obvious necessity.
I would rather pass on to the second part of my subject—to a
brief sketch of how and at what cost I would propose, in the esta¬
blishment of the middle class asylum I am advocating, to supply
this pressing social want.
1. I would suggest that the Sussex Middle Class Asylum begin with
offering accommodation for 100 patients, fifty male and fifty female.
It is much better in every way to begin with such arrangements as
will at once place the institution on a self-supporting and profitable
basis. Most probably, within twelve months of the opening of the
asylum these 100 beds will be filled. It will then be an easy matter
to extend the accommodation as the demand arises.
2. Form of construction .—It is beyond question, I think, that a
house such as we propose should be devoid of all architectural pre¬
tensions whatever. There are, it is true, two or three architects in
England who can build palaces where ornament and use meet, and
where the stately structure is furnished well without and within.*
. # Architecture as distinguished from Building .—“ Architecture/' gays Mr, Ruskin,
“ is the art which so disposes and adorns the edifices raised by man, for whatsoever
uses, that the sight of them may contribute to his mental health, power, and plea¬
sure. It is very necessary to distinguish carefully between architecture and build¬
ing. To build—literally to confirm—is, by common understanding, to put together
and adjust the several pieces of any edifice or receptacle of considerable size. Thus,
we have church-building, house-building, ship-building, and coach-building. That
one edifice stands, another floats, and another is suspended on iron springs, makes
no difference in the nature of the art, if so it may be called, of building or edification.
The persons who profess this art are severally builders, ecclesiastical, naval, or of
whatever other name their work may justify; but building does not become archi¬
tecture merely by the stability of what it erects, and it is no more architecture
which raises a church, or which fits it to receive and contain with comfort a required
number of persons occupied in certain religious offices, than it is architecture which
makes a carriage commodious or a ship swift..
Let us, therefore, at once confine the name (of architecture) to that art which, taking
up and admitting as conditions of its working the necessities and common use of
the building, impresses on its form certain characters, venerable or beautiful, but
otherwise unnecessary. Thus, I suppose, no one would call the laws architectural,
which determine the height of a breastwork or the position of a bastion. But if to
the stone facing of that bastion be added an unnecessary feature, as a cable moulding,
that is architecture. It would be similarly unreasonable to call battlements or
machicolations architectural features, so long as they consist only of an advanced
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MICHIGAN STATE UNIVERSITY
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Da. C. L. Robertson, on the Want
Such men, however, do not in our day build our lunatic asylums
or other Houses of Mercy. These are too often, I might say
always, built by second-class architects, who may be at once recog¬
nised by their unanimous sacrifice of comfort and use to debased
external ornament. We need not travel twenty miles from Brighton
to view an imposing illustration of such architectural skill (so called).
County gaols built in miserable imitation of a baronial keep, the
handiwork of these second-rate artists, are also to be found in every
county town.
I disclaim the wish to have the Sussex Middle Class Asylum built
by such architects as these. The cost is, moreover, beyond the
subject, and would, indeed, be misplaced. Such a house of refuge
from sorrow and disease cannot be too quiet and unpretending in its
externals. A staring structure of gaudy pseudo-Gothic or Lombardo-
Yenetian is a painful burlesque on the pain and suffering within its
walls, and on the care fretting those whom business brings to its
The old skill that built our colleges at Oxford and Cambridge,
and such hospitals as St. Cross at Winchester and other of our
ancient almshouses, has fled the land. We can afford no experi¬
mental trials at its recall, and must therefore content ourselves, and
shall best do so, with a plain, square, three-story building, devoid
of all architecture, and built of the bricks made in the locality.
I think the quiet effect of the Friends' Retreat at York, thus
simply built and adapted to its required use, decides, for our pur-
E ose, the question of any attempt at modern, architecture in our
uilding.
Next, as to arrangement. The block system offers for such an asylum
the greatest facility, both of management and subsequent extension.
Thus, in the first instance, one central block, containing the kitchen,
general mess-room, offices, stores, &c., of a size sufficient to meet the
gallery, supported on projecting masses, with open intervals beneath for offence.
But if these projecting masses be carved beneath into rounded courses, which are
useless, and if the headings of the intervals be arched and trefoiled, which is useless,
that is architecture. It may not be always easy to draw the line so sharply and
simply, because there are few buildings which have not some pretence or colour of
being architectural; neither can there be any architecture which is not based on
good building; but it is perfectly easy and very necessary to keep the ideas distinct,
and to understand fully that architecture concerns itself only with those characters
of an edifice which are above and beyond its common use/' —The Seven Lamps of
Architecture.
My meaning thus is to build the Sussex Middle Class Asylum , but not to try
any architecture on it, and this for the simple reason that, in the present tran¬
sition stage of English art , there are few men who deserve the name of architect,
and thaty moreover, these few are so engaged on buildings, public and private, that
they do not undertake to build lunatic asylums. And as for the men who do so, I
repeat that 1 personally would prefer the workmanship of the village builder, in its
native absence of beauty , to their pretensions designs—designs which, contrary to
all true art , sacrifice internal comfort and use to debased attempts at external
effect. I could unfortunately write pages in practical illustration of this assertion.
i
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MICHIGAN STATE UNIVERSITY
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of a Middle Clast Asylum in Sussex.
ultimate requirements of the asylum is a work once done and re¬
quiring no further enlargement or expenditure. Then a second
block with day and sleeping accommodation for the fifty male
patients, and a third for that of the fifty female make the necessary
beginning of the asylum. A detached laundry follows, and to which
a genend bath-house would be attached. Should subsequent ex¬
perience, as I believe it will, render it desirable to extend the accom¬
modation, the cottage asylum system, now so much debated, is
exactly the means at our hand for doing so. A few simple cottages
for two or three patients, built on the grounds, yet drawing their
supplies from the central stores, is a suitable and economical means
of extending both our accommodation and classification.
Of the central block, I need say little. Kitchens, dining-rooms,
stores, and offices, are much alike everywhere. Only a word as to
the general mess-room. I would have all the patients andbfficers of
the house to take their meals there. The separation of sitting-rooms
and the solitary meals, too common in private asylums, urged as this
plan is by the unwise kindness of friends, are serious impediments
to the cure of mental disease, and too often lead to depraved habits
and practices. The society of other patients is an important element
in the curative process, paradoxical though it may appear. The
patient who has the least chance of recovery is the one for whom
the expensive private lodging, under the auspices of some London
physician of high fame, away from all sympathy and social relations,
is hired by his ill-advised friends.*
Except in cases of illness, I would have all the meals of the
establishment—not of course at the same hours—both prepared and
served in this central block.
In the detached blocks for male and female patients I would
observe the same simple style of building and arrangement. I pro¬
pose that the patients of each sex be divided into two classes, the first
consisting of twenty patients, and the second of thirty patients, at a
charge, the first of £2 2 s. and the second of £1 Is. a week.
The ground floor of the block on each side would thus be devoted
to the second class, the first floor to the first class, while the third
story would afford the additional sleeping-rooms required. The fur¬
niture and fittings in the second class I would have as simple as
those at Hayward’s Heath. In the first class, additional furniture
and ornament would be introduced, so as to assimilate the apartments
to those of a private family. Each floor would also have a bath-room,
* Lord Shaftesbury, in his evidence before the select committee (1859), which
I have already had occasion to quote, says, 44 In a vast proportion of cases, I should
say, in every possible respect, both with a hope of cure and with a view to the
security and comfort and general happiness and enjoyment of existence, that the
best way is to send the patient to some good private asylum ; because we find now,
and all our experience goes to show, that association is one of the best means of
curing lunacy ; a well-managed association is one of the best modes possible”
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Dr. C. L. Robertson, on the Wartt
water-closet, scullery, and attendants’ room. The day-rooms in the
male block would include a library, billiard-room, and smoking-room
on each floor (fitted according to the class of patients), and in the
female block a sitting-room, music-room, and needle-room, would
occupy the same space. There would thus on each side be three day-
rooms for the twenty first-class patients, giving thus as much privacy
as one gets in a large country house. The thirty second-class
patients would in the same space have ample room for the necessary
classification and employment. There would also on each first and
second floor be a six-bedded dormitory for the infirm and sick, with
an attendants’ room adjoining.
The third story in both blocks would consist of associated dormi¬
tories, with three and six beds each, and single rooms. These dormi¬
tories I would fit and furnish in the most simple way. Cleanliness
and quiet would be my chief study. The attendants would sleep in
the dormitories.
3. Cost of fabric .—I have spoken with our excellent county
surveyor, Mr. Card, of Lewes, of this plan, and I am satisfied that
such a series of block buildings for 100 patients as T now sketch
could be built for £75 per head, while another £75 would furnish
all the necessary fittings and furniture. I am willing to pledge my
professional reputation on the building and furnishing, to the entire
approval of the Commissioners in Lunacy, such an asylum for 100
patients at £150 per head = £15,000, this sum to include an ample
margin for the laundry and bath-room and all the necessary domestic
offices.
4. Site .—Then as to the site. Of course such a house ought to
be in the country. About twenty to thirty acres of land to be laid
out in grass and shrubberies, and flower and kitchen garden would be
desirable. The purchase of this may be put at £70 an acre, the price
we paid at Hayward’s Heath. I would not, however, think it wise
at once to purchase the land; a lease of twenty-one years, with power
to purchase during the period, would be a better arrangement. I
have a dream that, if such a site could be got near the county
asylum, an arrangement to the advantage of both parties, in the
supply of water and gas, and in the work of the land and of the
laundry, and of the produce of the county asylum workshops, might
readily be made—an arrangement which would reduce the prelimi¬
nary outlay on the building by the cost of a well and engine and
laundry, and the subsequent working expenses by the supply of
water, of gas, of laundry and farm labour and artisan’s work, at a
moderate price, and at the same time benefit the county asylum by
extending the means of employment for the patients there, and
lessening the cost of water and gas, &c., by this increased consump¬
tion. The Artesian well at Hayward’s Heath is equal to the
supply of all Brighton, not to mention a small middle class asylum.
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of a Middle Claes Asylum in Sussex.
Such an arrangement would reduce the total working expenses of
the new asylum by twenty per cent, at least, and yield also a profit
to the county of the same amount.
5. Total cost. —Placing, then, the cost of the asylum building and
fitting at £15,000, and of the land, if purchased, at £1500, and the
preliminary expenses at other £1500, a sum of £18,000 would be
required to fit the house for the reception of 100 patients. In
addition to this, other £2000 would probably be necessary to meet
the preliminary expenses of the first year, as, of course, a staff of
officers and servants must be engaged to meet the first patient, and a
few months would elapse before the house begins to fill. This gives
a total of £20,000 as the first instalment of capital required to open
such a middle class asylum as I have now sketched.
6. Average weekly cost of maintenance. —The charge for board,
lodging, and medical care, I have proposed to fix at the relative rates
of £1 1*. and £2 2 s. per week; this charge to include all extras
except clothing, which the friends of private patients usually prefer
finding themselves. I calculate that the expenditure on such an
establishment would average 24 s. per week per patient, including
repairs and wear and tear, and would thus leave a certain profit of 5s.
a week per patient, making every allowance for the necessary repairs
and refurnishing. I make this calculation, not on any theories of
my own of the necessary expenditure, but on the authority of
Dr. Maudsley, late medical superintendent of the Manchester
middle class asylum at Cheadle, who, in a paper to which reference
has already been made, in the * Journal of Mental Science' for the
current quarter (October, 1862), enters very fully into the financial
arrangements of the existing middle class asylums the list of which
I have already given. The average weekly cost (he says) of each
patient for the year 1860 was, exclusive of repairs or rent--
At Coton Hill (Stafford)
Nottingham .
Manchester .
Warneford (Oxford)
Retreat (York)
£ s. d.
Average number
resident.
1 1 10* 105
1 4 11 58
1 0 10 74
0 19 1} 56
0 18 9* 116
So that the average maintenance cost of five public hospitals (middle
class asylums) is £1 1$. Id. weekly for each patient. These figures
are from the report of the commissioners, notwithstanding which we
must not put too great faith in them. We know that there are cer¬
tain doubtful expenses which may be put under the account for
maintenance or the account for repairs, and the most satisfactory
plan would be to call for the total expenditure during the year, and
to estimate the average weekly cost upon that. In the Manchester
Hospital the total, and, therefore real, weekly cost of each patient for
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Dk. C. L. Robertson, on the Want
that year was £1 5 s. It is true that there were extraordinary
expenses that year , and the average total weekly cost was £1 4*. for
ordinary years.
I accept Dr. Maudsley’s figures, and estimate the cost per patient
in the Sussex Middle Class Asylum at 24 s. per week, although,
according to my views of the requirements of such patients, I do not
think that the cost ought to be so high, and that the total expendi¬
ture per week might be reduced in time to £1 Is. a head. However,
it is better to have too high an estimate than the contrary, and I am
content to form my calculations on Dr. Maudsley's figures.
. A calculation made on this wide margin leaves for a dividend £25
a week, or £1300 a year, or 6*5 per cent, on the total capital of
£20,000. Moreover it is self evident that this dividend would, by a
further increase of numbers, soon most legitimately be raised. And
to show you that this is no visionary scheme, allow me to quote
from Dr. Maudsle/s paper the following facts :
“ In the year from July, 1858, to Judy, 1859, the income of the
Manchester Middle Class Asylum of which I was superintendent, was
£4652 15#. 5 d., and the expenditure was £4589 4 s. 6 d.; so that
there was a surplus of £63 10#. llrf. For 1859-1860 the income
was £4977 15#. Id., and the expenditure £5021 19#. 9d.; so that
there was a deficit of £44 4#. 8 d. Now, both these years, for reasons
which it is not necessary to give here, were very bad years; the
income was very low in the former, and though better in the latter,
it was yet far below the average. However, on the two years there
was a surplus of £19 6#. 3 d. This was sailing very near the wind,
but the just principle of squaring the expenditure to the income was
not broken. From July, 1860, to July, 1861, the income was
£5660 14#., and the expenditure £5223 16#. Id.; so that there
was a surplus of £456 4#. 2d. The accounts for 1861-1862 are
not yet made up; but from an approximate estimate, which will not
be far from the truth, the income may be stated at £6000, and the
expenditure at a little over £5400, say £5500. There will be a
surplus of £500; so that for the last two years there will be a gain
of £936 17#. 11 d. And yet these two years were exceptional, for
in them extraordinary expenses were incurred, which amounted to
about £1000. Now, as these will not occur again, but have now
really become an addition to the capital, a surplus of from £800 to
£1000 may be calculated upon every year.”
An asylum thus arranged and planned would be essentially a
public asylum, with all those guarantees for good and liberal manage¬
ment which such an institution affords. The profit of the share¬
holders being fixed within a certain limit, there would be little or no
inducement to augment these profits by unjust economy. The
feeling rather would be, I hope, to found here in Sussex a middle
class asylum, of which the reputation and the cures effected and
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of a Middle Class Asylum in Sussex.
the misery relieved would greatly enhance the fixed value of this
dividend even to those so blessed in God's mercy as not for one of
their own family circle to need its care.
7. How this capital of & 20,000 is to he raised. —The means by
which I propose that this capital of £20,000 be raised is in shares
under the provisions of the Limited Liability Act. From what I
have just said, I believe such an undertaking would return about
£7 per cent., on the lowest calculation ; while, should its operation be
successful, and further numbers seek admission, an extension of the
plan by the erection of detached cottage-asylums would readily and
legitimately raise the dividend to £10 or, it may be, £20 per cent. I
should, however, be extremely unwilling to see such a plan become
a mere means of profitable investment, and I certainly should take
no part in bringing such a speculation forward. It is of the essence
of my suggestion (and hence I address myself in the first instance to
this society, and not to the Stock Exchange) that the undertaking
should not be a mere pecuniary speculation. I believe, as I have
just said, that, if well worked, a middle class asylum thus established
in this county would ultimately yield a return of £10 to £20 per cent.
My proposal is, that the interest on the shares he limited to 7 per
cent., and that any subsequent dividend he applied to forming a fund,
to which further charitable contributions and legacies he invited, for
the reduction of the cost of maintenance in deserving cases. It is my
firm belief that in the course of years a large sum would thus from
these two sources accumulate, and so a fountain of charity to the
most needy and sorely afflicted of men be opened up. I should
indeed feel thankful were I permitted, with your support and co¬
operation, to begin this work in the county of Sussex.
In so limiting the profits of the shareholders to a fixed dividend,
I am only following the practice recognised in most proprietary
insurance offices, where the proprietors and the insured mutually
share the profits. In this instance I think it better to divest the
undertaking of everything of a speculative character, and to leave
the rate, of dividend on the capital sunk at a fixed per-centage.
Farther, as an inducement to take the shares, it may be added that,
as this capital must be sunk in freehold land, in buildings, and fur¬
niture, .there is thus a tangible security for a large proportion of the
funds, even should failure attend the undertaking.
I have strictly confined my remarks to-night to the wants and re¬
quirements of our own county, and with which my practice at Hay¬
ward's Heath has made me familiar. I am not in a position to deal
with the whole question of asylum accommodation for the middle
class in England, nor have I to-night attempted to do so. I find
that in Sussex there is no asylum in which our patients above the
class of paupers can be received and healed, except the very high-
class house at Ticehurst, adapted only for persons of rank and wealth,
vol. vm. 32
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MICHIGAN STATE UNIVERSITY
482 Considerations with regard to Hereditary Influence,
a nd which, for such patients, is the best asylum of the kind I have
seen. But for the large body of the middle class I find there exists in
Sussex—and this remark applies equally to the neighbouring counties
of Kent and Hants—no asylum accommodation whatever. I have,
therefore, come here to-night to ask you, as the most influential
body of medical men in Sussex, to consider with me the means
whereby this daily want in our practice may best be supplied. I
have stated my regret that the remedy which I conceive best fitted
to supply the same—a legal power to mortgage the security of the
rates for the repayment in thirty years of the building, as suggested
to the select committee of 1859 by Lord Shaftesbury—has not been
sanctioned by the legislature. I have farther stated my doubt of
the wisdom of applying to the voluntary system for aid, as also (which
is, perhaps, more to the point) my certainty as to the failure of such an
appeal. Lastly, I have suggested a plan rendered practicable by
the Limited Liability Act, by which I believe that this acknowledged
want of a middle class asylum in Sussex may be supplied, and at the
same time a good dividend on the capital thus raised secured ; and
should my statements have carried conviction with them, I can
hardly doubt that in this wealthy town of Brighton a large share of
the capital required will soon be forthcoming, nor that the members
of the Brighton and Sussex Medico-Chirurgical Society will be
backward in aiding the work by their counsel and support.
Considerations with regard to Hereditary Influence. By Henry
Maudsley, M.D. Lond.
“ The fathers have eaten sour grapes, and the children’s teeth are set on edge.”—
A Proverb in Israel .
“ Fortes creantur fortibus et bonis
Est in juvencis, est in equis pat rum
Yirtus, nec imbellem feroces
Progeuerant aquilae columbam.”— Horace .
“ T6 tt)q ’AvayKTjg for’ aSrjpirov oOsvog." — ASschylus.
Although the axiom ex nihilo nihil fit may unquestionably in
strict logic be pronounced to be a pure assumption, forasmuch as it
is not impossible that an enlarged experience may sometime furnish
us with an instantia contradictoria , yet it is plainly necessary within
the compass of human knowledge to consider it an established truth.
"Within human ken there is, indeed, no beginning, no end; the past
is developed in the present, and the present in the prediction of the
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by Dr. Henry Maudsley.
future; cause produces effect, and effect in its turn becomes cause.
Dust is man, and to dust he returns; the individual passes away, but
that out of which he is created does not pass away. The decom¬
position of one compound is the production of another, and death is
an entrance into a new being. This is no new truth, although
modern science is now for the first time making good use of it; the
earlier Grecian philosophers distinctly recognised it, and it has many
times been plainly enunciated since their time. “ All things,” said
Empedocles, “ are but a mingling and a separation of the mingled,
which are called birth and death by ignorant mortals.” Plato
expressed himself in like manner; and the plain statement of the
truth was one of the heresies of the unfortunate Giordano Bruno.
The imagination of Shakspeare, faithful to the scientific fact, traces
the noble dust of Alexander till it is found stopping a bung-hole, and
follows imperious Caesar till he patches a hole to keep the wind away.
The immortality of matter and of force is an evident necessity of
human thought.
The doctrine of the conservation of force, which is the modern ex¬
pression of the old truth—the doctrine which maintains that whatever
disappears on one side must reappear on some other side, or, as it has
been fancifully stated, that not a breath of air moves, not a wave
splashes on the shore, without the movement palpitating through the
universe—is now accepted as strictly applicable in physiological
science, and is continually receiving new confirmation in the dis¬
coveries thereof. When Lavoisier proved that the products of com¬
bustion are heavier than the body which is burned, he commenced
that exact method which, by means of well-devised instruments and
careful experiments, has now resulted in the application, with so great
advantage, of exact numerical determination to the phenomena of the
animal body. Physiologists are now striving to demonstrate, from
the data of observation and experiment, the equivalence of the quan¬
tity of force given off by the animal body, as heat and motion, to the
quantity supplied in the nutrient material; and although complete
success has not yet attended their efforts, they are justly confident of
ultimate triumph.* As it seems to be an irresistible impulse of the
human mind to make a system, it is not surprising that the more im¬
pulsive minds of the physiological school in Germany have rushed
forward, and have plainly declared mental phenomena to be subject to
the same method of investigation as other phenomena of the living
organism. It will readily, however, be understood that they have
done no more than proclaim the supposed fact—that they have not
* In confirmation of which it is only necessary to refer to the labours of Dulong
and Despretz, Barral, Helmholtz, our own countryman Dr. E. Smith, and to the
work of A. Fick, entitled 4 Temperaturtopographie der Thiere.’
Most important of all, as signs of the times, are the recent investigations of
Graham on the crystalioidal and colloidal conditions of matter. — 4 Philosoph.
' Transact./ 1861.
-y
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484 Considerations with regard to Hereditary Influence ,
hitherto been able to do anything whatever towards demonstrating it.
Their opinions cannot, therefore, be of any moment in an examination
which is not concerned at all with the essential nature of mind, but
only with such phenomena as are universally acknowledged to be
determined by physiological causes. Though humbler and less Ambi¬
tious, it is certainly more profitable to deal with phenomena, than it
is to aid in the construction of any metaphysical or material Tower of
Babel for scaling inaccessible heights.
As new it is well understood that by how much an organism, from
its commencement as a germ, grows and developes, by so much does
that which is not organism diminish, as in fact material is but trans¬
formed in nature and force re-embodied, and nothing new created, it
is philosophically necessary, in the cognizable phenomena of any indi¬
vidual existence, to look for certain inevitable antecedents and certain
subsequent conditions. There is required, as is well known, in all
the higher spheres of animal life, the conjunction of two organisms
to generate an organic individual ; and in those cases in which the
being is produced without the conjunction of parents, it almost
invariably proceeds from a single parent of a like kind.* Every
living creature has its living antecedent, from which it inherits its
plan of being ; for, whatever may have happened in primeval times,
we have no sufficient evidence that transformation of species now
takes place.f
Every little mortal, then, who enters the world, even if it be only
the world of a workhouse ward, has necessarily an inheritance. In
any case, under any circumstances, it inherits a destiny. It first
of all receives and brings with it the plan of being according to which
it is to develope; it, in fact, inherits its species. Our most careful
observations do not furnish us with anything by which we can distin¬
guish the ovum of a human being from that of a quadruped, and yet
there manifestly exists some condition of the human ovum whereby
it developes into all the glory and excellency of the human form, and
into no other form. It follows a certain aim, and the aim is in
itself. The plan is in the substance, as the quality is in the element ;
it is the law of its nature, according to which it must develope, and
no plan exists objectively in nature apart from the particular case in
which it is manifested. Plan apart from the particular is a sub¬
jective creation of the human mind. Much of the energy which has
been wasted in the discussions about transformation of species, might
perhaps have been spared if such consideration had been duly
weighed; and certainly some physiologists, if they had kept it in
* We say “almost invariably,” because in the remarkable case of “alternate gene-
ration ” the offspring is completely different from its parents, and yet itself pro¬
duces offspring which returns to their type.
t The experiments of Pasteur are generally believed to have disproved the
notion of “ spontaneous generation.” Professor Wyman, of America, has not,
however, obtained quite such decisive results from similar experiments.
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by Dr. Henry Maudsley.
mind, would have avoided on certain occasions their extravagant
expressions of admiration at the excellent accomplishment of some
supposed design in organic nature. The design, as far as it existed,
has been in their minds; and they might have done well to have
avoided the mistake of transferring the crude, imperfect design of
their imagination to the incomprehensible design of creation. The
ovum of any individual, being an actual definite production of it, will
contain the plan in the matter; for there is no substance conceivable
without properties, as there is no property conceivable without sub¬
stance. We are utterly unable to explain how it is that a certain
combination of matter, which we call ovum, has the property of
developing according to a certain definite plan, just as we are unable
to explain how it is that one element has certain properties, or that
any particular law of nature is as it is; hut it would certainly be, if
possible, less explicable and much more wonderful, if the descendant
followed a different plan of development from the parent. The real
matter of wonder is the introduction of the plan, the origin of the
particular species. Given that, wofider must rightly cease and inves¬
tigation begin, the problem being the analytical investigation of the
complex processes which are connoted in the words, inheritance of
species.
If it is certain that a new being derives its plan from its parents^
and so far imitates them, it is none the less certain, also, that it
deviates from them, and displays variety within the type. Nature
not only repeats, but invents; and each succeeding individuality
is a proclamation of her fertility in invention. We have every
reason to suppose that each new individual is different in something
from any individual who has previously existed or now exists—that
two beings exactly alike never have lived upon the earth; and if
this be so, it is plain that nature is even more fertile in realisations
of individuality than the most ingenious and active mind can be in
conceptions thereof: And yet the individuality is the result of a
combination of parental elements, and must, therefore, contain—latent
or more or less manifest—the influence of its physiological causes;
it is under the tyranny of the natural law of evolution of the ante¬
cedents of which it is the immediate consequent. Parental pecu¬
liarities may be very evidently and largely repeated in the offspring,
or they may be but indistinctly traceable, or they may not be de¬
tectable at all; but even in this last case we cannot but suppose
them to have exercised their influence ; and, therefore, in some way
to be contained in the new individuality. A chemical compound, as
sulphuric acid, does not resemble in properties its constituent ele¬
ments ; and, although there can be no exact comparison between the
complex vital production of a new individuality, and the compara¬
tively simple formation of a chemical compound, yet it is evident
that vital combinations must rather resemble chemical than me-
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MICHIGAN STATE UNIVERSITY
486 Considerations with regard to Hereditary Influence,
chanical compounds. And an example from a science which is lower
in the order of complexity, may serve to assist the conception of
something, if it prove nothing, in the more complex science. When
we find, accordingly, that in chemistry we are utterly unable to
predict the properties of a compound from the known properties of
its constituents, it is no wonder that in the infinitely more complex
process of vital production, we sometimes fail altogether to perceive
the evidence of parental characters in the result. As the ovum or germ
contains in some obscure manner the plan of the species, or, more justly,
the plan of the individual of the species from whom it proceeds,
the offspring into which it develops must inherit that which really
constitutes the nature of the particular germ. Furthermore, as it
is certain in our experience that out of nothing nothing comes, it is
certain also that something cannot become nothing; and, accord-
ingly, whether we can detect them or not, the necessities of our
thought compel us to assume the existence of the parental elements
of individuality in the offspring.
It seems to have been more or less generally assumed that here¬
ditary influence was to be recognised only in visible manifestations
of parental characters in the offspring; that the effect in a vital
production was, as in a mechanical compound of causes, the sum
of the acting forces. But such a supposition, if it exist, is mani¬
festly very false. When we cannot discover any imitation of the
parents in the new being, there is none the less a necessity to ac¬
knowledge the variety or invention to be determined by some mys¬
terious combination of the parental elements. Suppose that a
certam inherent evil of a particular kind taints the character of one
or both parents, and that, nevertheless, there exists no evidence of
any such evil in the child, are we therefore to say that the parental
evil has had no effect upon the child—has been, as regards it, as good
as non-existent ? Are we not rather bound to suppose that the evil
m ? D r j anises been Uppity modified, counteracted, or
neutralised by the influence of other causes co-operating in the for¬
mation of the embryo, or by the force of circumstances affecting
its development after birth ? And if this be so, the happy elimina-
lon of the evil is the result of so much force expended in counter¬
acting a positive viciousness, and really testifies to the influence of
the antecedent condition upon the result. On some such supposi-
tmnonly is it possible to explain the phenomenon of Atavism, in
which some bodily peculiarity or disease is seen to skip one genera¬
tion and to reappear in the next. The peculiarity or disease must
have been somehow latent in the generation in which it did not
appear As the compound in chemistry is formed by the combina¬
tion of certain definite proportions of the elements which unite to
lorm it; as, therefore, not a single atom of these elements but is of
essential consequence to the definite result ; so, in the much more
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by Dr. Henry Maudsley.
complex compound, which a new individuality is, the combining
elements cannot be conceived to' unite capriciously and under no
definite laws. Every effect or defect in the parent must be subject
to the fixed laws of individual production, whatever they are;
and, in considering the nature of any defect or effect in the
offspring, we may accept with certainty the proposition of Polonius,
that “the effect defective comes by cause !” “ How shall a man,”
asks Emerson, “escape from his ancestors, or draw off from his
veins the black drop which he drew from his father’s or his mother’s
lifer
It is a conclusion which, in a purely physiological sense, can scarce
be avoided, that the embryo is indebted to its progenitors for all that
is contained in its corporeal nature; it is the necessary organic con¬
sequent of certain organic antecedents. The parental peculiarity
winch it may seem to want, and the individual peculiarity which
seems an entirely new production, are explicable on the same
supposition of an obscure and complex combination of elements for
the formation of a new product, which does not resemble its consti¬
tuents in properties, which is not the reproduction of them in a
mixture, but the new distribution or development of them in a com¬
pound. Though parents thus enjoy a sort of immortality in their
offspring, it is, as with all earthly immortality, under a new com¬
bination of matter and a correlative metamorphosis of force. The
parental forces are combined, ere their dissipation through decay and
death, into a new individuality, and thus the human past is continued
into the future. The law of causality is true of organic as of inor¬
ganic existence. “ Though his father die,” says the son of Sirach,
“ yet he is as though he were not dead; for he hath left one behind
him that is like himself. "While he lived he saw and rejoiced in him;
and when he died he was not sorrowful. He left behind him an
avenger against his enemies, and one that shall requite kindness to
his friends.”
Having so far pointed out how the necessities of human thought
seem to demand the recognition of a large play of hereditary influ¬
ence in human development, it may be added, that men have,
as might be supposed, in all ages more or less distinctly ac¬
knowledged it. The belief has affected in an important manner
systems of religion and philosophy; but nowhere, perhaps, has it
been more plainly enunciated than in the ancient books of the
Hindoos. To it the institution of caste unquestionably owes its
origin; and the feeling of a destiny made for a man by his ancestors,
inspired the philosophy of that sect of the Hindoos which taught
the perpetual rebirth of mortals, and the development in this exist¬
ence of the deeds done by them in a former state of being. “ The
antecedent life of a being,” it was said, “ is his destiny.” Where
castes existed, the hereditary descenf of professions was obligatory;
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MICHIGAN STATE UNIVERSITY
488 Considerations with regard to Hereditary Influence,
but this prevailed also in Greece, where it was not obligatory. Plato
openly maintains that the wicked owe their wickedness to their
organization and to a vicious education, so that their fathers and
instructors ought really to be blamed. The Levitical code pro¬
hibits marriage within certain kinship ; and Solomon deems it one
of the merits of a good man that he leaves an inheritance to his
children’s children. On the other hand, the sins of the wicked are
visited upon the children unto the third and fourth generations;
and it was not a matter of wonder that those whose fathers stoned
the prophets should reject Him who was sent unto them—"Ye
are the children of those who stoned the prophets.” Though an
institution of castes is not recognised in England, something very
like it, nevertheless, does exist. What but the belief in the hereditary
influence upholds the esteem for ancestral blood, and dictates the
common saying, which is the generalisation of common experience,
that it takes three generations to make a gentleman? "Bless not
thyself only,” says the author of the ‘Religio Medici/ "that thou
wert born in Athens; but, among thy multiplied acknowledgments,
lift up one hand to heaven, that thou wert born of honest parents,
that modesty, humility, patience and veracity lay in the same egg,
and came into the world with thee. Erom such foundations thou
may’st be happy in a virtuous precocity, and make an early and long
walk in goodness j so may’st thou more naturally feel the contrariety
of vice unto nature, and resist some by the antidote of thy temper.”
In almost every nation which possesses a history, families might
be selected that have been remarkable for special characteristics.
The Claudian genus was noted at Borne for its pride, cruelty, and
ferocity. Of it came the morose and cruel Tiberius, and so also
Claudius, Caligula, and Nero, in whom this mighty curse of hu¬
manity ended. " The Apii,” says Voltaire, " were always haughty
and inflexible, the Catos always severe!” The Guises were as spe¬
cially remarkable in France as the Napiers have been in England.
The Jews and the Gipsies have both preserved their mental and
bodily characteristics in a notable manner.
It has been the custom in some countries to expose to certain
death, or at once to destroy, weakly and deformed children, lest
their infirmities should descend through generations and deteriorate
the race. And measures even still more energetic have been adopted
to prevent the injurious operation of hereditary influence. '" Here¬
tofore, in Scotland,” says Hector Boethius, " if men were visited
with the falling sickness, madness, gout, leprosy, or any such
dangerous disease, which was likely to be propagated from the
father to the son, he was instantly gelded; a woman kept from all
company of men ; and if, by chance, having some such disease she
was found to be with child, sh$ with her brood were buried alive.”
The astrologer, conscious of a fate in human life, gazed curiously
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ly Dr. Henry Mauds ley.
into the heavens, and deemed that by a knowledge of the stars in
the ascendant at the time of a mortal's birth, he might predict a
mortal's destiny. But the astrologer failed to find in the heavens
the cause of a fact which he had not failed to perceive; his predic¬
tions were not verified by results ; and one fact, which has refuted
the extreme advocate of hereditary influence, might have sufficed to
refute him—it is the fact of different moral dispositions in double
monsters. The celebrated twins, Rita and Christina, were so fused
together that they had only two legs between them; they had two
legs, four arms, and two heads; and yet they were quite different in
disposition. Two twin sisters in Hungary, who ) were united by
the bottom of the back, lived twenty-two years. They were,
says Barthez, of extremely different! temperament, and yet their
blood was the same; for, after death, the blood-vessels were found to
communicate by an extremely large opening. Other such cases are
on record; and they plainly prove that hereditary influence is not a
mere matter of repetition or imitation, but that it operates, in accord¬
ance with unknown laws of vital combination, in producing new
compounds or inventions.
That dread inexorable destiny, which plays so great and grand
a part in Grecian tragedy, and which Grecian heroes with a praise¬
worthy inconsistency so often struggled against, while they believed
in it, was seemingly a generalisation from that feeling which every
reflecting individual has, of the inevitable dependence of the present
self on its antecedents in the past. Strive as diligently and in¬
geniously as philosophy may, to demonstrate the dignity of the
human will, man feels at the end of all that, whether strong-willed
or weak-willed, free or a slave, he is inevitably what he is. It is
the law of causality manifesting itself in human consciousness.
“ There is," says Schelling, “in every man a certain feeling that he
has been what he is from all eternity, and by no means became such
in time." We feel instinctively the line of causation which runs
through existence, the claim of necessity “ wherewith we're darkly
bound." And the persevering way in which we uphold our power
of self-determination, as Laiis of old resisted the oracle which all
the while he believed, is a scarce less decisive proof of this feeling of
dependence than a direct acknowledgment would be. As authors
often write against the imperfections which they feel in themselves,
so humanity struggles against the necessity within which it moves,
and constructs out of its frailty a helpful philosophy. Surely it is
meritorious thus to strive upwards, if we regard ourselves only as
beings with present duties to do; but it is much more so if we regard
ourselves as causes occupied in making a future. So far, unhappily,
it is only in.the highest human art that we find human aspirations
realised; for hitherto mankind has not been able to live its art.
It is much easier, indeed, like Romeo, heartily to wish to “ hang up"
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490 Considerations with regard to Hereditary Influence,
philosophy than to live it, when the great afflictions of life demand
it and supply the exact conditions of its applicability.
Friar. ** I’ll give thee armour to keep off that word.
Adversity’s sweet milk, philosophy,
To comfort thee, though thou art banished.
Romeo. “ Yet banished 1 Hang up philosophy;
Unless philosophy can make a Juliet,
Displant a town, reverse a prince’s doom:
It helps not, it prevails not: talk no more.”
Even when our greatest teachers utter with placid decision maxima
which should inspire humanity to great efforts in self-development,
it is but too evident that they are speaking from the philosophical
platform; and a backward look into their lives, or the observation
of unguarded moments, and of that which, in the moments of great
affliction, is the genuine utterance of their nature, reveals very
clearly the difference which there is between man making art and
man making life. Goethe, for example, in one part of his writings,
compares a man entering on life to a sculptor who is placed with
chisel and mallet before a block of marble; he may make what
figure he pleases; and in like manner man should determine cir¬
cumstances and make his own destiny. It is excellent philosophy;
but let us not forget what comfort Goethe on one occasion is obliged
to take to himself when recalling in age the bitter recollection of a
gloomy period in youth when he cruelly forsook one, who in her
great love had very great claims upon him. A man, he thinks,
must declare once for all that that is right for him which is conformable
to his nature, to the law of his existence : a much more comforting
philosophy for poor, erring human nature! There is, indeed, no
help for it; no mortal can transcend his natureand his present
nature is by no means a present production; it has descended from
the past through regular laws of development. And while much is
unquestionably done in individual formation by means of education
and circumstance, the foundation on which all rests is not acquired
but inherited. The destiny of an individual is innate in him.
Not only, then, does the recognition of hereditary influence, when
closely considered, seem to be a necessity of human thought, but it
is found to be more or less distinctly manifest in all the records of
human thought. Moreover, the actual condition of mankind on the
different parts of the earth's surface testifies to the existence of a
law of hereditary transmission.
Whether it be true that maukind have spread over the earth from
a common centre, or, as some ethnologists would maintain, from a
few centres, the fact must in either case be accepted as evidence of
the hereditary transmission of qualities. To place an inhabitant of
the tropical regions in the extreme north would be to ensure him a
speedy death; and the inhabitants of the north who pass to hot
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by Da. Henry Maudsley.
climates, decay and die out in a few generations. And yet men do
live in the torrid climes of the tropics, and in the frozen regions of
the north. The diffusion of mankind over the earth must then have
been accomplished in a very gradual way, in ever-widening circles,
which followed one another after intervals of generations. Thus
the race which had left its old country for adjacent lands, having
adapted itself to the different conditions of the new climate, would
transmit to the next generation an innate adaptability thereto;
and some from this generation again or from its successor, wandering
still farther away to a climate that differed perhaps but little from
that which they had just left, although considerably from that which
their forefathers left, go through a similar process of naturalisation,
and similarly transmit their acquired nature. And so, like the
widening undulations on the surface of water, mankind have spread
from the centre, until the uttermost parts of the earth have been
reached, and the dark places thereof peopled. It is on this power
which organisms have of accommodating themselves to changed cir¬
cumstances by respondent nutritive changes, which are then inherited
by the offspring as natural endowments, that two important argu¬
ments rest—the argument for the unity of origin of mankind, and
the argument for the transformation of species.
The cause of the hereditary character of our social and political
regulations has been sought for in hereditary influence as a natural
fact. “ It is from the vital fact,” says Dr. Lucas, that the social
fact proceeds.” And as the latter is universal, it must be founded
in nature, “ for the generating principle of any convention that is
universal and permanent is nature.”* A man transmits to his children
an inheritance of organic qualities by a law over which he has no
control; but he consciously imitates nature in that over which he
has control, and leaves by testament his acquired property to his
children. And should he fail to make such provision, the law or¬
dains that his children shall inherit. The social fact is the ex¬
pression in human consciousness of the natural fact.
The organic adaptation to a change in external circumstances,
which has taken place amongst mankind, is continually taking place
also amongst the lower animals. The peculiarities of conformation
by which domesticated animals are distinguished from wild ones of
the same species, and the instincts which they have acquired, have
all been gradually developed in them, and have arrived at their
present condition by the action of hereditary influence through many
generations. They are the harmonious adaptations of organic nature
to new circumstances—a phrase of that correlation between organic
life and external nature by reason of which organic life is possible.
* 4 Traits Philosophique et Physiologique dc FHeredite naturelle/ par le Dr.
Prosper Lucas, vols. ii:—Full of information; for it contains almost everything that
has ever been written on the subject.
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And if the favorable conditions of domestication are removed, the
same influence gradually undoes the work which it had done.
Pritchard observes that when a flock of sheep is neglected, and no
attention paid to the breed in selecting rams and ewes of the finest
breed for propagation, the fine wool gives place to much coarser
growth intermixed with strong hairs. “ The breed seems gradually
to degenerate towards the character of the Argali or wild sheep of
Siberia, which has generally been supposed to be the original stock
whence all the varieties of domesticated sheep are derived.”* It has
been observed, also, that when horses return to the savage state,
modifications are after a time produced in the capacity of the cranium,
and that the head becomes stronger and much more irregular.
Blumenbach had remarked similar differences between the wild and
the domestic hog; and Dr. Roulin confirmed his observations on
hogs that had become savage in the new world. It is to be pre¬
sumed that if the Bosjesman, the Chinaman, the native Australian
and the European were placed under exactly the same conditions of
existence, they would in the end assimilate to a common type. Thus
hereditary influence may continue onwards the development of a
race or may continue the degeneration of it; indifferent to con¬
sequences, it helps to make a variety or to eradicate it. But which¬
ever part it play, it is plainly a law of the utmost importance in the
economy of nature.
It may probably seem strange, after the foregoing remarks, that any
one should deny positively the reality of hereditary influence. And yet,
strangest of all, that has been done by a learned and thoughtful writer,
who was engaged, when overtaken by an untimely death at Damascus,
in writing the ‘ History of Civilization/ With a remarkable incon¬
sistency, the author of a ‘ History of Civilization’ denied the reality
of that by which alone civilization seems to be possible; for it is a
question that may very well be asked, as to whether there would
have been any civilization if there had not been hereditary influence.
And whatever may be the answer to the general question, it may be
very distinctly acknowledged, from the results of experience, that
there is no hope of cultivation for the native Australian or the Bos-
jesman save from the operation of hereditary influence through
many generations. Certainly it appears but a very small and un¬
certain hope, when we reflect that another law may intervene to
prevent the beneficial action of hereditary influence—the law by
which, in the struggle for existence, the stronger variety ever
crushes out the weaker.
On a cursory reflection, it might appear to be anything but
creditable to physiological science that what has been so long and
* 4 Physicnl History of Mankind/ vol. i, p. 363. It may be well to state here,
that in this general paper, devoted mainly to the statement of the difficulties of the
subject, no attempt will be made to give every reference.
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so generally acknowledged should still be so little understood.
History cannot direct us to any nation in which the reality of here¬
ditary influence has not been accepted; and yet there is not a single
law of its action known at the present day. But can this justly be
made a reproach to physiology? It is unquestionably true, as
Comte observes, that ‘ the discovery of gravitation—the first great
acquisition of positive physics—was contemporaneous with the dis¬
covery of the circulation of the blood—the first fact which rendered
positive biology possible ; and that there has been an immense in¬
equality in the progress of the two sciences since that timeit is
true that the astronomer can predict the events of heaven and foretel
the existence of unseen worlds, while the physiologist can predict
little more than his error if he ventures to predict ; it is true even
that physics is a science, while biology is yet very far from justifying
its name; but when all has been said that can be said in praise
of one and to the discredit of the other, the matter stands ^exactly as
it should do, as it inevitably must do. Physiology must, from its
nature, wait for the development of the other sciences; for it can be
rightly built up only on a knowledge of the laws which prevail and
of the forces which are at work in every other part of nature. The
forces which are concerned with molecules, the attraction of cohesion
and the repulsion of'heat, the forces which produce undulations
whether of sound or of light, the forces of polarity, electric and
magnetic, the chemical forces, and perhaps even, what is still a
matter of dispute, other special forces, are supposed by and engaged
in the living organism; so that the sciences of material bodies
(physics) and of chemical bodies (chemistry) are presupposed by
biology or the science of living bodies. The order of development
of the sciences must correspond with the order of development of
the natural objects wherewith they deal; and as man is the com¬
pendium of nature, a full knowledge of his organism necessarily
supposes an inductive advance through nature.
. There is really no fair comparison between the discovery of the law
of gravitation and the discovery of the circulation of the blood; for
while the former may be justly called the starting point of positive
physics, the latter occupies no such position in physiology. The
law in physiology which will correspond to the law of gravitation in
physics, but which has not yet been discovered, is the law of life.
And when the chemist or physiologist has succeeded in analysing the
relations of the complex combination of physical and chemical forces
out of which it is now the fashion to suppose life to result, and syn¬
thetically combining them again so as to produce life, it may then be
confidently expected that there will quickly be as rapid an advance
in physiology as there has been in physics since the discovery of the
law of gravitation.
It requires, then, but little consideration to see that it lies mainly
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494 Consideration* with regard to Hereditary Influence,
in the nature of the subject, as involving a knowledge of life, that
little or nothing should be known of the laws of hereditary in¬
fluence. When the simplest manifestation of life presents an
insoluble problem to the investigator, the more complex vital pheno¬
mena will certainly not admit of explanation. There are, moreover,
great difficulties in the way of observation of those facts of hereditary
influence which do lie within the sphere of human cognition. The
observations, to be of real service, should be patiently continued and
carefully recorded through many generations; and men are for the
most part far too careful about the present, far too anxious about
the fame which comes to the successful generaliser, far too little alive
to the humble purpose of individual life, diligently and con¬
scientiously to gather facts from which they receive no honour,
laboriously to plant that which shall not bear fruit for many gene¬
rations, if it ever bear fruit at all. And even in these observations
that are made it is impossible to discriminate between the many cir¬
cumstances, and to assign to each its due weight of influence in
determining the way of hereditary action. Accordingly, we con¬
stantly find that imperfect observation misleads to false conclusions;
so that no sooner is a theory set up by one investigator, than another
eagerly hastens to repudiate and refute it. Linnaeus, for example,
held that in hybrid plants the interior, or the organs of fruc¬
tification, resembled those of the female; the exterior, or organs of
vegetation, those of the male; notwithstanding which, De Candolle
maintained the opposite, and facts upset both theories. Similarly
opposed theories have been upheld with regard to animal hybrids,
and with a similarly unsatisfactory result. Dr. Pritchard endea¬
voured to develope this law as regards man—that all original or
connate bodily peculiarities tend to become hereditary, while changes
in the organic structure of the individual from external causes during
life, end with him and do not affect the offspring—which, however, so
far from being, as Sir Henry Holland supposed, a general law which
“ may be deemed highly probable if not proved,” is in direct con¬
tradiction to daily observation, was denied positively by Muller,
Burdach, G. St. Hilaire, and Flourens, and was ultimately abandoned
by Pritchard himself. It results, in truth, from the manifold
opposing theories which have prevailed, and still prevail, that an
account of hereditary influence must be for the most part a statement
of the difficulties inherent in the subject, and a discussion of the cir¬
cumstances and conditions which there is reaspn to believe are more
or less operative, and interfere with the acquisition of exact know¬
ledge thereupon.
It will not be without interest to detail some of the circumstances
which are connoted in the comprehensive term, hereditary influence.
And, in the first place, it is evident that there are manifold causes in
the condition of the parents, previous to the act of procreation, which
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by Da. Heney Maudsley.
must greatly affect the destiny of the progeny. The complete history
of an individual should begin with what has happened, not only before
he was bom, but even before he was begotten.
It is observed in the production of hybrids, that there is a greater
potency in one species than there is in the other; and that, in
accordance therewith, the offspring has more of the characters of the
more potent species. The “ potency of the species" is, therefore,
recognised as a fact in hereditary influence under such circumstances.
But a similar difference has been observed in the potency of different
varieties of the human race. According to Bush, the Danes, inter¬
marrying with women of the East, produce children of a European
type, whilst the converse does not ' take place when Danish women
intermarry with men of the East.* The Dane, then, has the greater
potency in this case. There is, furthermore, a difference between the
organic force, or potency, of individuals belonging to the same
variety of the human race; there is, in fact, a “ potency of the indi¬
vidual." It is evident, then, that, under the condition of perfect
health in both parents, the nature of the offspring will be in greater
degree determined by the more potent of the individuals concerned
in its production. But while this takes place as a natural fact, it is
further evident that the organic force or potency of the individual
will itself be greatly modified by different conditions of age and
health, and by the temporary circumstances, psychological and phy¬
siological, accompanying any particular act of procreation. As
regards age, for example, Giron de Buzareingues concluded, as the
result of his numerous observations and experiments upon animals,
that the offspring of an old male and a young female resembled the
father less than the mother, in proportion as the mother was more
vigorous, and the father more decrepit; the reverse was true of an
old female and a young male. He also found that, by putting very
young rams to vigorous females, he obtained a preponderance of
female lambs, while he could obtain a preponderance of male lambs
by putting strong and vigorous rams to the ewes. The best result
is said to be produced in the human kind when the male is a few years
older than the female.
The state of health at the time will evidently influence to an
important degree the individual potency. Where there is great phy¬
sical exhaustion in one or both parents from disease, from licentious
sensuality, or from any other cause, the organic product in an act of
such intense vitality, must suffer seriously from want of force. There
may, indeed, exist every degree of deficiency in procreative power
down to actual impotence or sterility. When conception has taken
place, abortion may terminate embryonic life at an early period, or
* Quoted by Burdach, in his * Physiology/ also by Lucas. Indeed, the few facts
which are known, may be found repeated in every book which treats upon the
subject.
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496 Consideration* with regard to Hereditary Influence,
miscarriage may do so at a later period ; or again, the foetus may with
care arrive at birth, and then, by reason of its inherent deficiency,
sooner or later perish in convulsions or otherwise ; or, last and worst
of all, the child fives on, visited with its father’s or mother’s sins,
when its nature inherits their acquired infirmity, and perpetuates
through time the effect of their vices. " My son,” says the son of
Sirach, "keep the flower of thine age sound, and give not thy
strength to strangers. When thou hast gotten a fruitful possession
through all the field, sow it with thine own seed, trusting in the
goodness of thy stock. So thy race which thou leavest shall be
magnified, having the confidence of their good descent.”
Other causes, it is plain, besides physical disease and immoderate
sensuality, may so diminish organic force as to interfere with the due
accomplishment of the propagative function. As an individual only
embodies so much force, and by no means has an unlimited supply
thereof, it seems an unavoidable conclusion, that what he spends in
one way, he is so much the loser by in another. So that, just as
those who are given over to immoderate sensuality are notably inca¬
pacitated for great intellectual exercise, so those who use all available
force in intellectual work will be deficient in or destitute of the
force necessary for due procreation. It is a common observation,
and it always has been so, that the intellectually great have very in¬
different sons, for which Cardan assigned this reason, " Quoniam
spiritus sapientium ob studium resolvuntur et in cerebrum feruntur
& corde;” and Lemnius agrees, "Quod persolvant debitum languide et
oscitanter, unde foetus h parentum generositate desciscit.” Whether
the explanation be correct or not, it admits of no dispute, that great
mental exercise, like great bodily exercise, diminishes sexual desire
and lessens sexual power. The giants in mind, like the giants in
body, appear to be often incapable of procreation. Moses inter¬
dicted sexual union during a time of war; and Bacon observes, that
the greatest achievements in the world have been mostly effected by
childless and unmarried men. Such is the compensation in nature,
that what these great men gain in one direction they lose in another;
and it appears as if nature were exceeding jealous of allowing to
any individual an immortality both in his works and in his
progeny.
Burdach came to the conclusion that great men have generally
proceeded from simple parents, and have belonged to common, poor
and unknown families; and Nehusius has shown by an account of
the genealogy of the most celebrated persons of ancient times, how
greatly the sons of the great have degenerated from their father’s
excellence. By what singular hap, he asks, could there proceed
from the wise Pericles two brutes like Paralus and Xanthippus, a
madman like Clinias ? from the just Aristides an infamous Lysi-
machus? from the grave Thucydides a foolish Milesias, a stupid
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by Dr. HenryMaubsley.
Stephanus; from the temperate Phocion a dissolute Phocus; from
Sophocles, Aristarchus ami Aristippus; from Themistocles and
Socrates the vilest sons ? The son of Cato was infamous for cowar¬
dice and immorality, the son of Cicero was a drunkard and a de¬
bauchee ; Caligula was the son of Germanicus, Domitian the son of
Vespasian, Commodus the son of Marcus Antoninus. It might
yerily seem, as Lucas says, that there is a fatality which prevents
the sons of eminent men from being worthy, by their intelligence
. and virtue, of their fathers. The fatality, if it really exist, must be
the fatality of natural law.
If, however, it is the common opinion that great men have
foolish sons, the opinion also commonly prevails that great men
have had clever mothers. The proposition is of extremely doubtful
worth, and rests rather on the popular wish to have it so, and on the
evidence of a few notable cases, than on the careful observation of
well-considered instances; but even if it be true, it does not diminish
the value of what has been before said. The maternal cleverness in
such case will be found to have been of that quiet, self-contained,
self-denying kind, which was concerned mainly in promoting the
welfare of the family, and not of that description which bursts out
into literary inflorescence or any other such demonstrative dissipation
of force. When great power is thus restrained within a definite ap¬
plication, the children receive the benefit of it; but when it is dis¬
sipated abroad, the universe may have the benefit of it, but the
children have not. It is surely only reasonable to suppose that,
whilst a new life is beiug formed and developed within her life,
a woman needs all her force at home, and has none to spare for
philanthropic enlightenment of humanity. Are not our intellectual
women commonly unmarried or barren? And is not the mother
of genius the self-sacrificing woman, whose best energies have been
absorbed in her family ? It is probable that an attentive observation
of the families in which a great man has appeared might not un-
frequently show also that there was a really great, if not famous,
father or grandfather, in whom there was a vast amount of undis¬
played force. But though undisplayed to the world, not on that
account inoperative. The flowering progeny has received the benefit
of it, and expends it. Still, for his brilliant display he owes a large
debt of gratitude to that silent, self-reliant, self-contained, self-denying
father or grandfather, who has quietly done his duty without thought
of the world's applause, and fashioned the vigorous stock which now
blossoms, in so goodly a manner, to the admiration of the world.
It is not, if the foregoing remarks are correct, an argument
against the reality of hereditary influence because the son of an.
eminent man is a notable fool. The eminent man has given all the
best of himself to the world, and his son has inherited what was
left; he has been a friend of humanity, and humanity must now
VOL. viii. 88
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498 Considerations with regard to Hereditary Influence ,
befriend his son. Perhaps he might have been actually as great,
though not so eminent and prominent, a man, if he had not made
his existence known to the world; but in him the time of blossoming
of the family tree arrived, either in due natural course or accelerated
by the forcing influence of opportunity ; and he blossomed ac¬
cordingly and bore fruit, whicn has been taken up by nature, and
will follow its course there. But the family, after such a display;
must test through a long obscurity, if it does not become extinct.
A French writer, Benoiston de Ch&teauneuf, who has studied the
subject, professes himself astonished at the rapidity with which
illustrious families die out.* Scarcely any of them survive the third
generation, and yet “ as short a time as they last, almost all survive
the glory of their name.” The family of Boileau hardly lasted two
hundred years, notwithstanding thirteen male children; that of
Racine did not continue beyond three generations; Moli&e died
without leaving any children; Corneille was never married; Bailly,
Lavoisier, Condorcet, left only daughters behind them. And where,
it may be asked, are the families of Shakespeare, of Milton, and of
Cromwell ? There was no child to perpetuate the title of Baron
Verulam, and Newton was never married. When a family can
trace its genealogy up to the time of William the Conqueror, it is
presumptive evidence that it has never produced a true man of
genius.
If we consider the fundamental relations of the instinct for pro¬
pagation, we may, perhaps, more clearly perceive the antagonistic
relation which must exist between the exercise of the function and
great intellectual exercise. It is customary to say that there is im¬
planted in the organism an instinct or impulse for self-conservation,
by virtue of which it appropriates material and grows, and, after it
is full-grown, maintains its state. Whether there be any such
instinct or not, the term happily describes a series of actual phe¬
nomena. Now, at that period when the organism has nearly attained
to its full growth, and when, therefore, there is a superabundance of
force which is not required for the purposes of the individual, another
instinct or impulse appears, the aim of which is not the conservation
of the individual already provided for, but the conservation of the
species. Its mission accordingly is, not to appropriate material and
force, but to dissipate them, to give back to nature in definite form
something of that which has been withdrawn from it. It is the
instinct of propagation, by the prompting of which the individual is
moved to act for the continuation of his kind, which is in a certain
sense the propagation of himself, through time. Obviously this
instinct might be logically resolved into a special mode of manifes¬
tation of the self-conservative instinct; for it is certain that a man
* ‘ Annsles d’Hygiene pultlique et de M6d. L6g.,’ “ Memoire sar la dur£e des
families nobles en France.”
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does not proceed to the sexual act with the design of begetting
children, but simply with the object of gratifying himself. Never¬
theless it is convenient, on account of the speciality of its phenomena,
to consider the propagative impulse separately. In man, then, both
these instincts must necessarily appear in consciousness, and display
themselves there in their highest developments. The instinct of
self-conservation, in consciousness or out of consciousness, prompts
the acquisition of that which is pleasing and the avoidance of that
which is painful; it is, in fact, that self-feeling which lies at the
root of all our emotions, and, indeed, of our conscious individuality.
It necessarily goes on alone for some time, acquiring power and
laying up stores in development, inasmuch as the propagative or
distributive instinct does not make its appearance until growth is
nearly completed. The youth gains knowledge, strives for what is
pleasing to himself, avoids what is disagreeable, is markedly selfish,
and, indeed, acts consciously, as the self-conservative force of his
organism does unconsciously. But in due time the propagative
impulse manifests itself in the organism, and it must necessarily
appear about the same time in consciousness. Accordingly, new
ideas and feelings appear in the mind with the development of the
sexual system; there is, as Goethe aptly expresses it, “ an awakening
of sensual impulses which clothe themselves in mental forms, of
mental necessities which clothe themselves in sensual images.” This
new budding forth of beautiful ideas, like the expansion of the
flower which foretells fructification, marks the appearance of the
propagative instinct in consciousness; and the youth, in all likelihood,
begins sepretly to write poetry, or in other indefinite ways to satisfy
his mental longings, being moved to communicate himself by an
impulse which he cannot explain. It is certain that the instinct
to communicate their ideas is, in those who have any, as natural as
the instinct to continue their kind; and as the latter effects the
conservation of the species, so the former, by preventing knowledge
from dying with the individual, perpetuates the mental gains of the
species. If, then, the individual organism is capable only of de¬
veloping a definite quantity of force, which it acquires in accordance
with the self-conservative law of its existence, there exists a sufficient
reason why those who, in accordance with the distributive law of
propagation, are displaying excessive force in intellectual exercise,
should lack procreative power; and, on the other hand, why those
who are sensually abandoned to the gratification of the sexual desire
should be incapable of mental exercise, and even fail in mental
S ower. An instinct is not inexhaustible, and if the force of it is
rawn off in one direction it is not available for use in another.
So far, certain causes have been specified which seem likely to be
of influence in diminishing procreative force; but there are other
causes which may seemingly produce qualitative modifications in it
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500 Considerations with regard to Hereditary Influence,
or in the specific material which is its necessary substratum.*
Mental conditions exercise an effect upon the seminal secretion as
plainly as on any other secretion of the organism. Indeed, if it be
allowable in these days of positive science to speak of its vitality, it
may be described as more vital than any other secretion, and as having
the closest connections with that which is the culmination of vitality,
namely, mind. Certain ideas Of a lascivious character largely in¬
crease its quantity, and probably modify its quality; and an ap¬
pearance of new ideas and feelings in the mind corresponds with
the appearance of spermatozoa in the testicles. But if we suppose,
as physiologists now generally desire, that its physiological functions
stand in the most intimate causative relation to its chemical consti¬
tution, it is necessary to add that its chemical constitution is of so
complex a character that, often as it has been investigated, very
little is known with certainty thereupon. A very interesting disco-:
very of Kolliker is that the semen contains a substance resembling
a brain fat, the so-called “ myelin,” of Yirchow; it is not yet quite
certain, however, that myelin is a simple fat. It will be of no less
importance if a statement by Gobley be confirmed, that the semen
of fishes contains a compound of glycerine and phosphoric acid,
which may also be obtained from brain. Such results of positive
investigation irresistibly call to mind the expression of Alcmaeon,
an ancient writer upon medical subjects, who, on account of its
vast importance, called a drop of semen a drop of brain. What is
plainly certain with regard to it is that it has a very complex che¬
mical constitution, as its physiological functions would lead us to
expect; that it is, so to speak, of the highest chemical dignity.
While some secretions are produced only to be excreted, and have
been examined with considerable precision as to their chemical
nature, as, for example, the urine; and while others are secreted for
chemical use in nutrition, and have also been satisfactorily investi¬
gated ; the spermatic fluid has a constitution which is at present in¬
scrutable, and a function which appears almost miraculous. But
the very complexity of its composition, in connection with what we
know of its close relation with mental phenomena, justifies us in
assuming that it will be more affected in quality by disturbing
mental causes than a secretion which is more simple in composition
and less important in function.
Becent experiments in physiology, especially those of Ludwig and
Bernard, have proved that the nerves exercise a direct power over
* In using the term 44 procreative force 99 it is obviously not intended to designate
a single distinct force; it is but a general term used provisionally to denote the
many conditions which are concerned in generation. Science will some time be
able to say whether these conditions are physical chemical, or vital, or result from
a combination of the three; but until that time comes, we need some term to
express them.
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secretion, independent of any charge which they may produce in the
calibre of the vessels supplying the glandular organ. These direct
observations have so far reference chiefly to the quantity of the
secretion, but it admits of little doubt that the quality may
be affected also. It is now acknowledged, on sufficient evidence,
that nervous action may directly influence nutrition; and Bernard
some time since discovered that injury to the floor of the fourth
cerebral ventricle caused the immediate appearance of sugar in,
the urine. Popular opinion has always accepted the influence
of mental states on the secretions. Emotion causes the tears to
flow; fear diminishes the flow of saliva, so that the tongue cleaves
to the roof of the mouth ; and anger is said sometimes to vitiate
it so that it becomes poisonous, like as it does under certain
circumstances in the mad dog. Emotion is usually credited
with an influence upon the biliary secretion, and instances are
related in which maternal passion has so affected the milk that the
infant has been instantly poisoned thereby. The very powerful
effect of emotion on all the processes of organic life is amply
attested by common observation; and Bichat’s location of the
passions in the organs of organic life, though not tenable as a theory,
does no more than justice to the close relation which unquestionably,
exists between them. Having, then, such positive general evidence of
the effect of nerve force on secretion and nutrition, is it not an in-,
ference which is almost unavoidable, that so highly endowed a
product as the spermatic fluid cannot escape the influence of the
mental conditions under which it is secreted ? It carries in some
mysterious manner the moral qualities of the parent into the off¬
spring; a single spermatozoon may contain the potentiality of a
Socrates or of an idiot, and it may well, therefore, contain also some
effect of the mental state which existed during the time of its secre¬
tion. Temporary mental conditions of the parent will thus obtain a
realisation m its nature, and, through it, in the nature of the new
being which it may generate. Here, as everywhere else in nature*
we are taught the eternity-of action of any kind—that nothing
perishes absolutely in the universe, not even a gust of. passion.
What has been said of the sexual product of the male may he
applied to that of the female. The ovum is in the female that which
the spermatozoon is in the male; and, although it might at first
sight appear that the former is a nutritive product, while the latter
is a secretion, it must be remembered that secretion and nutrition
are so closely allied that what can be shown of one may be confi¬
dently assumed of the other. The ovum might even be called the
sexual secretion of the female, for it is produced in a Graafian
vesicle, which is the homologue of the seminiferous tubule in which
the spermatozoon is generated, and, when not impregnated, it is
discharged as a useless excretion. With the first discharge of the
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ovum, as with the production of the spermatozoon, Very important
changes take place in physical and mental development; and mental
disturbances interfere in a marked manner with the regular system
according to which the ovum is matured and discharged in health.
The connection between disturbed ovarian action and disturbed
mental action is a most frequent observation in the pathology of in¬
sanity. If we accept the physiological proposition, that the functions
of the structure are determined by its physical and chemical quali¬
ties, a very complex chemical constitution may be predicted for the
ovum. Very little, indeed, is known with certainty as to its com¬
position, except that it is very complex. It is known, however, that,
like the semen, it contains a substance which, on decomposition,
gives rise to the compound of glycerine and phosphoric acid. And
it is necessary to assume of it, as of the spermatozoon, that the
specific differences in the results of its development must be de¬
pendent on differences, quantitative or qualitative, in its constitution,
although such are not at all detectable by our present means of in¬
vestigation. It is by their results only that we recognise them.
And it is furthermore a necessary conclusion, in view of the notable
influence which mental emotions have upon the destiny of the ovum,
that its constitution and, therefore, the character of that into which
it may develop, must be influenced in some degree by the existing
mental state of the individual during the time of its production.
The foregoing observations render it evident that, even if a par¬
ticular spermatozoon and a particular ovum were given, and the
problem were to determine the results of their vital combination
under the simplest possible conditions, it would be completely in¬
soluble. For, in the first place, we are ignorant of any single law
of so-called vital combination; and, in the second place, we are
utterly ignorant in the present case of the elements in the combining
substances. There are, however, y*et other causes which appear to
have an effect upon fertilisation, and which further complicate the
matter.
A cause of considerable power, in its interference with any simple
law of evolution of the parental characters in the offspring, is
sometimes met with in the strange effect which one conception
may have on all succeeding conceptions. It is a remarkable and
at present altogether inexplicable fact, that the influence of the
male upon the female in one fruitful copulation may be such
that, though he never come near her again, one or all her future
conceptions by other males bear more or less plainly his stamp. A
white woman who has borne a child to a negro, and is afterwards
married to a white, may have children with more or less of the
negro in them. The mare that was once covered by the qnagga ever
afterwards produced foals with the quagga marks upon them. So
much alive are breeders to this fact, that an inferior horse is not
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permitted to cover a good brood mare, lest she be thereby spoiled for
breeding; and so likewise is it with other well-bred animals. It
appears wonderful that one small spermatozoon should contain the
character of the creature producing it, but the wonder is greatly
increased when we reflect that, though this minute body penetrates
the ovum and disappears in the development of an embryo, which in
time leaves the female body, its effect has nevertheless been such
that the female has been more or less strongly impregnated with its
character, and may henceforth communicate its influence to all the
ova which she produces.* Strange, however, as the fact certainly
seems, it is not, when we reflect, singular in its mystery. The
marvellous effect which is produced upon the whole body by the
introduction into it of an inappreciable quantity of a certain virus,
as, for example, that of smallpox or syphilis, is not less inexplicable.
As the virus of either of these diseases affects the whole body and
determines certain special eruptions, so the spermatozoon seems
similarly to affect the whole body and determines a special product.
And one fact is as great a mystery to us as the other. It may
readily be imagined, however, what a disturbing element such a
mysterious action must be in any attempt to trace the ^ay of heredi¬
tary influence. Children born to a second husband may have
physical and mental traits of a first who is mouldering in his grave.
And, in truth, such a disturbing cause has yet wider relations. The
mental and physical condition of a male during the procreation of a
first child may actually be supposed to affect the character of one or
more of his children subsequently begotten] and as a certain in¬
fluence {nay be thus left behind on the female body by every pro¬
creation, there is a sufficient reason for many varieties in the characters
of children from the same parents, and no discernible limit to the
possible complications of hereditary action.
It does not appear, and it is not likely, that any influence is re¬
ceived by the male from the female in an act of fruitful copulation
which affects the children subsequently begotten by him. The cir¬
cumstances, as regards him, are manifestly different; and although
we may not accept the philosophy of the Hindoo code, it must be
confessed that the part of the male appears to be an influence
exercised mid a force imparted, while that of the female is an in¬
fluence received. The ancient code of the Hindoos regards the
woman as the field and the male as the seed, and consequently
assigns a much greater power to the action of the latter in propa¬
gation ; for, it observes, whatever species of grain is cast into the
prepared field at the suitable season, a plant of that species is always
produced. But whatever be the relative influence of the two agents
* Some, it is true, have explained the fact by supposing that the imagination of
the mother was dwelling, at the time of conception, on the former husband; but
how could this improbable explanation apply to animals P
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504 Considerations with regard to Hereditary Influence,
in generation, and there are contradictory theories ttpon the subject,
it is plain that in the subsequent organic connection of the foetus
with the mother there is a reason why she should be alfected by its
nature which does not exist in the father's case. Close, however, as
is the connection between a mother and her foetus, it by no means
affords an indisputable explanation of its influence upon her, or
entitles us to assume such an influence in every case; for how does
it happen that, notwithstanding the intimate connection between
them, the foetus may have the smallpox and the mother be free from
it?' Acquiescence in ignorance is the most praiseworthy course
where, from a great deficiency of facts, all attempt at explanation
must end in unfruitful hypothesis.
Having specified in the preceding observations certain conditions
which are of consequence to an individual before the act of his
generation is accomplished; having pointed out, in fact, how that
his fate is in some degree being fashioned for him before he is
fashioned, it now remains to indicate the circumstance in the sexual
act itself which may appear to affect the result. The existing state
of body and the existing state of mind in the individuals concerned
will plainly be of some importance; but as the mental cause must
operate indirectly by the induction of material conditions, it will not
be desirable to attempt to consider them separately. Assuming the
body, then, to be in a fair state of health ana of natural development,
what accidental circumstances, may interfere with the due discharge
of its function? "The advice which I am about to give,” says
Plutarch, “ is, indeed, no other than what hath been given by those
who have undertaken this aVgument before me. You will ask me
what is that ? It is this, that no man keep company with his wife
for issue sake but when he is sober, as not having before either
drunk any wine, or, at least, not to such a quantity as to distemper
him, for they usually prove wine-bibbers and drunkards whose
parents begot them when they were drunk; wherefore Diogenes
said to a stripling somewhat crack-brained and half-witted, * Surely,
young man, thy father begot thee when he was drunk V ” Therein
has Plutarch signalised a cause of unsuccessful procreation, which,
as he says, was known and treated of before his time, and which has
been largely exemplified since. Instances are related in which a
father who, while in the habit of going to bed drunk, has begotten
children idiotic or otherwise afflicted, has, after throwing off his
evil habits, had very healthy children; and it is said that a temperate
man with many sound children has had one idiotic child, the plainly
traceable effect of a single act of drunkenness during which it was
begotten. In his excellent report on the * Causes of Idiocy/ Dr.
Howe declares that out of 359 congenital idiots no less than 99
were the children of habitual drunkards. No doubt, in some of the
numerous cases which are recorded as examples of the effect of the
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by Dr. Henry Maudsley.
vice, the evidence is not quite conclusive; but the important fact of
the ill effect of drunkenness on offspring begotten during its existence
issues with certainty from experience, and is indisputable. An act
which is of a very intense nature, which makes a hill demand upon
the best energies of the organism, and which has most important
consequences in determining the destiny of that which is to come,
requires undisturbed and healthy bodily function. It was an opinion
of Goethe that the custom of rejoicing and making festivity on the
occasion of a marriage is not commendable, inasmuch as an im¬
portant and uncertain journey is then about to be commenced, which
should rightly be entered upon, as an uncertain voyage in life would
be, with sober, earnest, and serious consideration. Joy and festivity
should follow success ; and those who have well and helpfully borne
tiie burden of existence together may, in the eventide of life, ere they
lie down to rest, justly then rejoice with a sober gladness over the
happily accomplished journey. The opinion may be an unwelcome
one, but it has, perhaps, a stronger support even than the reason as¬
signed for it. Those who enter on marriage are simply sealing their
right to initiate the destinies of certain human beings, and to any
but the most thoughtless of mortals it must surely be a fearful
responsibility to be the means of introducing a single soul into this
sin-laden earth. Marriage is plainly not a mere selfish affair of
the present happiness of two individuals, but a solemn matter that
concerns the future welfare of several individuals—a matter, there¬
fore, for quiet accomplishment rather than for noisy demonstration.
For it is a simple scientific truth that the nature of the offspring is
in some degree influenced by the bodily condition of its parents at
the time of its procreation.
The ill effect which alcohol is acknowledged to have on the pro¬
duct of the sexual act may be more or less plainly produced by other
substances, such as opium and tobacco, which disturb the natural
functions of the organism, and injuriously affect an act so exacting
in its demands on the whole energy thereof. There is, indeed,
reason to believe that any circumstance which causes a temporary
or lasting degeneration of the individual will, to the extent of its
evil, be injurious to the offspring. The fructification of plants is
notably determinable to a certain extent by external conditions; and
that of animals cannot possibly escape the influence of the conditions
under which it takes place. The degeneration of a race means the
degeneration of the individuals forming it, and the degeneration
of individuals is gradually accomplished by virtue of the law through
which the acquired infirmities of the parent become the natural
infirmities of the offspring. Though we may not accept in full the
doctrine of Cardan when he says that if a man is over-full, dull,
fearful, or perplexed in mind, his children will be much subject to
madness and melancholy, we must, nevertheless, acknowledge a
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506 Consideration* with regard to Hereditary Influence,
substratum of truth beneath it, and respect the recognition of
eausality in the reason which he gives:—“ For if the spirits of the
brain be fuzzled or misaffected by any such means at such a time,
their children will be fuzzled in the brain; they will be dull, heavy,
timorous, discontented all their lives."
It has been before said that it is not possible to discriminate
between the influence of mental conditions and that of bodily con¬
ditions on the product of the sexual act. In a legitimately accom¬
plished sexual conjunction, where there is a deep, sincere, and
virtuous affection between the agents, where love blends the minds
as passion blends the bodies, there is a more complete unity of
individual mind and body, a greater oneness of the organism, than
exists at any other time. There is a great tension of the whole force
of the organism, mental and physical, and in the discharge of the
force a new individual is spiritnally as well as physically begotten.
But where there is dislike or aversion between tne agents, where
there is passionate sensuality on one side and indifference on the
other, or where any other disturbing cause prevents the due co¬
operation of the mind, the act is reduced to an animal level, and it
cannot justly be a cause of wonder if something little above an
animal is generated. Kind produces its kind; animals generate
animals; idiots are impotent, or incapable of procreation; lunatics
beget idiots, as drunkards are liable to do; and the being who makes
himself a temporary animal, idiot, or lunatic, cannot rightly expect
to escape the law of their propagation. He will produce his kind.
It is not sufficient that man be physically generated, he must be
spiritually generated also. And whosoever, therefore, abandons
him self in dininken excitement to propagation as an act of sensual
gratification commits an unpardonable sin against the dignity
of human nature, and generates consequences which no repentance
can ever undo, and no remorse ever atone for.
An opinion is entertained by many that bastards are often
remarkable for great ability, and many examples might be adduced
to show that some of the greatest achievements in the world have
been the work of those who were illegitimate. It is naturally
assumed that the explanation of the fact is to be found in the
passionate circumstances of the sexual act. Shakespeare, who gives
his bastards great ability, gives that reason for it, for he makes
Edmund thus speak t
" Why brand they us
With base ? with baseness ? bastardy ? base, base ?
Who ip the lusty stealth of nature take
More composition and fierce quality
Than doth within a dull, stale, tired bed,
Go to the creating a whole tribe of fops V*
Cardan, Yanini, and other writers, have held a similar opinion; and
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by Dr. Henry Maudslry.
Valuni even goes so far as to exclaim thus: “ O utinam! O utinam 1
extra legitimum ac connubialem thorum essem procreatus : ita enim
progenitores mei in venerem incaluissent ardentius ac cnmulatim
affatimque generosa semina contulissent e quibus ego formse
blanditiem et elegantiam, robustas corporis vires, mentemque innu-
bilem consecutus !"* On the other hand, Burdach thinks that the
cause of the frequent vicious character of bastards lies in that which
so greatly moves Vanini's enthusiasm. If it be admitted, however,
that the great erotic tension in an illegitimate sexual act is likely to
originate an energetic and stormy nature, it may be supposed that
the circumstances in which he is afterwards placed will have much to
do in determining whether the world shall have cause to applaud or
to curse him. So that, if it be true, as Burdach assumes, that
bastards are commonly vicious, a sufficient reason for the fact may
exist in the unhappy circumstances in which they are generally
placed, without appealing to the vice of the act in which they were
unlawfully begotten. The world is not their friend, nor the world's
laws; and when, like Edmund, they feel that their K dimensions are
as well compact," their minds us generous, and their “ shapes as
true as honest madam's issue," it is not unnatural for them to rebel
against customs which are established and laws which are made for
the fortunate. When they are vicious and criminal, they are not
generally feebly so; they are strikingly vicious and notable cri¬
minals.
It has been said, again, that the illegitimate become insane in
greater numbers than the legitimate. It is easily conceivable; for
when the mind is possessed with feelings which spring from the
external circumstances, there cannot be that fulness of unity of it
and the organism which has been declared to be necessary to the
best propagation. Although the result may be genius when there
is a complete self-abandonment and passionate union of the agents,
it is possible that when there is not that complete forgetfulness of
circumstances the result may be instability and madness. The fact,
however, which comes forth, whatever the theories may be, is that
genius, madness, and vice, are all three attributed in greater propor¬
tion to the illegitimate than to the legitimate. Now, it is a common
observation that genius cannot at times be distinguished from mad¬
ness, and that madness runs imperceptibly into vice, or vice into
madness; that there is not, in point of fact, a single link wanting in
the chain which binds the extreme of one with the extreme of another;
and whilst it is still only conjecture that the cause of the greater
frequency of their occurrence amongst those illegitimately bom lies
* The reason for his wish he gives thus:—“ Cujus raihi ratio ea videtur esse,
quod omnia large et effuse ex paternis lumbis ac visceribus sunt consecuti, nec in
furtivo illo ac clandestino concubitu parc&, jejune, tenuiter, sed affluenter naturae
nuraera illis infusa est. Cum enim uterque avide,” &c.
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608 Considerations with regard to Hereditary Influence.,
in the character of the sexual act, it would plainly be the vainest of
all attempts to endeavour to point out those conditions in the act of
combination which might be supposed to determine the different
degrees of instability of the resulting compound.
Another observation which has been made is that there is a greater
number of female than of male children amongst illegitimate births.
Is the explanation of this also to be sought for in the circumstances
of the act of generation ? The much-discussed, but yet obscure,
question, of the causes which determine the sex of the offspring,
seems to have arrived at the probability that the sex is determined
at the same time as life. Burdach has accumulated proof of this
proposition, and his proofs may be shortly summed up under three
divisions.—1. The time of the appearance of the sexual , organs is, as
Meckel, Rathke, and Muller have shown, nearer the time of fecunda¬
tion, the higher the being is in the scale of organization. In
vegetables the sexual organs do not appear till the plant is fully
developed; in the invertebrata and in fishes only after the hatching
of the egg; in birds they appear early, in the chicken, for example,
at the fifteenth day; and in man they are seen at the end of the
fifteenth week. 2. There are manifestations of sexual character
independently of sexual organs. According to Soemmering, the sexes
in the human embryo have visibly different forms, and the genital
organs are, as it were, the local expression of the sexual character
which is determined with life. 3. The facts of hereditary in¬
fluence certainly favour the supposition. How, then, is the sex deter¬
mined in the act of generation ?
As one kind of being produces offspring of the same kind, and
every kind reproduces its kind throughout nature, so there is a ten¬
dency on the part of every individual to produce himself; the
male tendency will be to form a male, and the female tendency to
form a female. There is, then, a sort of conflict in generation as to
which element is to prevail, and the result of the struggle will be
here, as everywhere else, to the strongest. The sex of the offspring
will be determined by the greater energy of the sexual element in
one of the germs by the combination of which it is formed. Thus
the preponderance of female births amongst primiparse is by some
attributed to the great sexual force of the female which enters into
the first conception; and Burdach thinks that a like preponderance
of female births amongst polygamists is to be explained by the
rareness of sexual conjunction with the female. Both these causes
will serve to explain the preponderance of girls amongst natural
children; they are mostly first births, and it is probable that con¬
nection has rarely taken place. Obviously, however, there may in
such cases be another reason for the preponderating sexual force of
the female, when the great erotic tension drives her to break through
all conventional restraints and to rush passionately on an amorous
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fate. On the other hand, the children of an old man and a vigorous
woman are usually female, because age has diminished his sexual
force, however great it might have been at one time. For it is
evident that the sexual force of individuals will not only differ as a
natural endowment, but that it will be subject to the variations pro¬
duced by conditions of age and health, as well as to temporary exal¬
tations and depressions from psychological and physiological causes.
With the law by which the sex of the offspring is determined, it
seems probable that the law of the relative degree of transmission
of the parental qualities to the offspring must be closely connected.
The theories which asserted that the offspring received a certain
part of its system from one parent, and a certain other part from
the other parent, have been proved worthless. It is certain that
every character, physical and moral, may be communicated at one
time by the father and at another time by the mother, and may pass
from mother to son, *and from father to daughter. Moreover, there is
not anv certain connection between the inheritance of a character¬
istic of one parent and the inheritance of another characteristic of
the same parent. Sir H. Holland, indeed, supposes that there is a
general ratio between the resemblance of external features and that
of internal parts of structure, but the supposition is not borne out
by facts. A child may resemble its father m form and features, and
not resemble him in internal structure and moral disposition ; and
the well-known instance of the cross between the dog and the wolf,
in which one of the progeny resembled in disposition that one of the
parents which it did not resemble in form, affords a striking example
of the anomalies which may be met with in hereditary action. That
which happens in the matter of colour when a European and a
negro procreate may happen with any other characteristic, internal
or external, and may be serviceable here as a helpful illustration.
The usual result of the intercourse between a negro and a European
is a mulatto, a being in whom the colours, so to speak, have been
combined so as to produce an intermediate shade. But it sometimes
happens that a child appears who is black with a white patch, or
white with a black patch—pieballed, and the colours might then be
said to be mixed, and not be combined. In one case, again, a
negress had twins by a European; one was perfectly black, with
short, woolly, curled hair; the other was light, with long hair.
Here there was not even a mixture of the colours, but a simple repe¬
tition of them. In like manner it may be with any other parental
characters. They may be simply repeated, so as to be plainly recog¬
nisable ; or they may appear in a mixed form, so as to be partly recog¬
nisable ; or they may be combined, so as not to be recognisable at
all. But how it is that they are transmitted in such different ways,
no man can say. That it is not the male or female nature which deter¬
mines the character of the relative action of the father and mother
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510 Consideration* with regard to RerediUury Influence,
upon the offspring is at any rate certain. It may be, as some sup¬
pose, that the result is dependent upon the individual organic force
of each parent, upon the relative potentiality of the germs, apart
from the sexual character.* The proposition, which at first appears
so vague as to be valueless, may, perhaps, merit some consideration
when we call to mind another proposition, which is this, that an
individual is a unity formed of the association of an infinite number
of individualities, and the so-called individual force of the whole
organism the sum of a multitude of individual forces, to each of
which the first proposition, if true, must be applicable. Clearly,
however, when we have thus descended to the individual cells, very
little is at present to be gained by the motion.
Every consideration, however, which can be justly entertained mi
a very obscure matter tends to prove the great importance of the
act of fecundation itself. [Nature proclaims the time of its advent
with all the beauty of her colouring and all the harmony of her
sounds; the flowers are the dress of love, and the spring melodies of
birds are love songs. There is a transport throughout the living
kingdoms of nature ; the temperature of the plant is increased, and
it is arrayed in all its glory; the plumage of the bird becomes
gayer, and its joyous excitement thrills forth in lively melody ; the
animal functions everywhere reach a certain state of exaltation, an
ecstasy of love. A dose of arsenic which would kill a frog at any
other time appears to be without effect upon it when it is copulating.
And so much is the vital force exalted during the rut, that a stag
which has been very seriously wounded is then capable of efforts
which it would have been quite unequal to at another time after
such injury. Some animals may be greatly mutilated during copu¬
lation without seemingly feeling the injury. The snail is then,
according to Haller, insensible; and if the frog be then mutilated,
it still holds to the female ; nay, if its paws be cut off, seizes her
again with its bloody stumps. This erotic transport does not exist
only where there is a consciousness of it and all the joys and gains
which flow from such consciousness, but it pervades the organism;
there is a love-tension throughout. The experiments of Pfliiger
show that, when the connection between the brain and spinal cord
is severed in the male frog during copulation, it still clings to the
female, and even seizes her again after its leg has been dragged
away from her. It is manifestly an attraction as natural and in¬
voluntary as that of one chemical element for another, or of posi¬
tive for negative electricity.
Of what use, it has been asked, would the state of heat in the
animal be if reproduction were complete without it ? Of what use
the erotic transport if it were no wise essential to proper fecunda-
* Dr. Lucas has most largely discussed this question, but his results in the
way of definite knowledge, it will almost be needless to add, are nil.
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by Du. Henry Maudsley.
tion ? That it is essential may be inferred from the rareness of
fecundation where coition does not take place under these circum¬
stances. It is true that conception may take place during sleep,
drunkenness, somnambulism, and syncope; but it is undoubtedly
rare where there is not mutual self-abandonment. A forced copula¬
tion may be fertile amongst animals, but is by uo means as certainly
so as a voluntary (me; and Parent-Duchatelet found only twenty-
one infants bom yearly out of 1000 prostitutes in Paris, the erotic
transport being exceptional among them. Then, again, the degree
of influence of the relative amount of the erotic orgasm of father
and mother upon the offspring, which was admitted by Empedocles,
Hippocrates, and Aristotle, and has been accepted by Hufeland,
Spurzheim, Girou, Burdach, Lucas, and others, is decisive evidence
as to its importance in successful generation. An absorption of the
whole force of the organism in the act, amounting to an insensibility
to surrounding objects, is evidently the normal state of the creature
during fecundation.
Now, the intensity of the erotic orgasm, and the excellence, there¬
fore, of the product thereof, will depend in a great degree on the
mutual attraction which there is between the individuals concerned.
Amongst animals, the female prefers the strongest male, for she
looks quietly on until the battle for the possession of her person is
ended, and then contentedly yields herself up to the victor. In that
way the principle of natural selection takes effect, and the most
vigorous procreation of the species is secured. It is said that a
male which is deprived of its finest ornaments—a yellow-hammer, for
example, with its tail-feathers pulled out—is rejected by the females;
and Hunter observed that a bull would not copulate .with a herma¬
phrodite cow although copulation was as practicable as with an
ordinary cow. Nature seems to have opposed herself, again, to pro¬
creation between greatly different ages, by the aversion which there
is to it among mankind, and by the difference of the time of rut
at different ages amongst some animals. The rut of old stags, for
example, is in the second half of September, while that of the
middle-aged is in the first half of October and that of young stags
towards the end of October. So it is effectually ordained that only
those of nearly the same age can copulate. A similar difference in
the time of heat has been observed in certain birds, as pheasants,
and even in the time of spawning among certain fishes.* In man,
however, other forces arise and overcome the aversion which nature
has implanted in him to the copulation of haggard age and blooming
youth. But the natural fact is not altered thereby—remains a reality,
notwithstanding all the artificial motives which spring up in society
to induce a neglect of it.
* Bloch, cited both by Burdach and Lucas. '
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512 Considerations with regard to Hereditary Influence.
When interest in place of affection makes a marriage, and when :
indifference or repulsion prevails instead of attraction, there is not
that harmonious co-operation of all the circumstances which is essen¬
tial to the best propagation. Accordingly, as good an author as
Burdach maintains that the beauty and ugliness of children are not
so much dependent on the beauty and ugliness of their parents as
upon the love and aversion which these have for one another. And
to this opinion Lucas heartily subscribes. Where interest and not
love makes matches, as too often happens in civilisation, bad results,
he says, ensue on the health, soul, and beauty of the offspring—
those gifts of heaven and of life, which engender love, and are
bom of it. Instead of that beautiful attraction, that elective affinity,
by which two beings are drawn together, and combine in marriage
like two elements in nature, the passions engendered by civilisation
supply other forces for binding together those who cannot be com¬
bined. Thus, the wealth passion binds withering age to vigorous
youth, joyous health to pining disease, delicate refinement to
sensual grossness; and this ugly, unhallowed union of antipa¬
thies, which all appliances of wealthy civilisation cannot render
grateful to human feeling, cannot but have consequences in the
inexorable logic of natural law.
Nature, it is evident, in the propagation of life, puts forth all her
beauty, and provides the utmost gratification for all the senses with
which man has been endowed for communion with her. To the
eye she appeals in a magnificence of floral beauty which Solomon
in all his glory could not equal; the sense of smell is gratified with
the richest perfumes of her. countless varieties of flowers; the ear
is delighted with the multitudinous melodies with which heaven’s
vault is then filled; and the touch is intensified and exalted into a
state in which individuality is lost, and conscious man for a moment
blends with unconscious nature. As if tense with life, nature bursts
forth in generation into all her beauties, and declares the joy of birth
in all her most glorious manifestations. But man, unhappily, is
ever striving to sever himself from nature, and to destroy the great
unity of the whole. It was an Oriental idea, which Plato has alle¬
gorically expressed, that a complete being had in primeval times been
divided into two halves, which were seeking to join together and to
reconstitute the divided unity. The desire and pursuit of this unity
is love; it is accomplished in the union of the sexes, and realised
in the individual which results therefrom. Is it not manifestly of
the greatest importance that the natural attraction of love should
unite the right halves ? Then that which is beautiful in nature will
be beautiful also among mankind.
{To he continued ’.)
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Practicable Mental Science. A scientific comparison of established
views and recent developments in Psychology. By Kenneth
McLeod, A.M., M.D. Edin., Certified Student in Medical
Psychology and Mental Diseases of the University of Edin¬
burgh, and Assistant Medical Officer of the Durham County
Asylum, Sedgefield.
Two recent numbers of the ‘ Journal of Mental Science ’ contain
two communications, respectively entitled—
1. On the Principles and Method of a practical Science of Mind.
By Dr. Thomas Laycock. (Journal, January, 1862.)
2. On the practical use of Mental Science. By Dr. J. Stephenson
Bdshnan. (Journal, April, 1862.)
These papers represent the deliberate and matured deliverance, in a
more or less systematic form, of two scientific gentlemen, physicians
and practical psychologists, upon a subject undoubtedly the most
important that can occupy the minds of men.
The communications are in especial interesting to the Association,
which has established the Journal for the very purpose of discussing
such subjects, and whose members look to it for instruction and
guidance in those matters which form the principal concern of their
fives.
It is, then, a matter not only of intense interest, but of singular
importance, to examine these papers severally and comparatively,
and thus to ascertain if they coincide either in general principles or
special details, what they express in common, and if they differ,
which is most in accordance with reason and experience, and most
worthy of acceptance as a guide and rule. Most of the readers of the
Association Journal—and these include the most, and most assiduous
and earnest and enlightened of British psychologists, and not a few
continental alienists of note, all of whom take a most lively concern
in this and allied topics—will have come to some decision upon the
matter already, will have judged each and both according to acquired
information and experience, and opinions formed thereon, and con¬
cluded as to their merit or demerit, their truth and trustworthiness as
a guide, or the reverse. Still a systematic comparison of the papers
of Drs. Laycock and Bushnan, of what in them is peculiar to the
writers or representative of a psychological school, cannot fail to
produce benefit and lead to the development of truthful principles.
vol. viii. 34
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It has fallen to our lot, as an educational sequence in this depart¬
ment of knowledge—(1) to have obtained a thorough training in the
Scotch school of philosophy and psychology, the school of Reid,
Stewart and Hamilton, and to have eagerly imbibed and implicitly
believed their tenets. (2) As the result of metaphysical thought
upon a physiological subject, to have elaborated a teleological system,
having in it many features in common with that of Dr. Laycock,
before we became acquainted with his philosophy.* (3) To have
learnt, as Dr. Laycock's class-assistant, from personal intercourse,
from his lectures, his clinical instructions, and his books, the leading
principles and practical application of his system. (4) To have,
during the last twelve months, served in a county asylum where the
practice has been active and experience considerable. We trust,
therefore, that that amount of knowledge has been acquired, and
that degree of mental and scientific discipline attained, which will
warrant us in attempting an examination and comparison of the
papers cited.
In pursuance of our design, we shall, after passing Dr. Laycock's
and Dr. Bushnan’s papers in review generally, come to close
quarters with them, and, in as fair and accurate a way as possible,
obtain from each an answer to the vital questions—
I. What is the object and design of each? What, in the ex¬
pressed opinion of each, constitutes, or ought to constitute, “ a prac¬
tical science of mind” ? What, according to each, have we to know,
and seek to know, and where ?
II. What is the method of each ? What the principles, suggestions,
instructions, which are intended to direct, assist, and control us in
the attainment of a practical science of mind? jHow are we to
know and seek to know—investigate—in order for practice or per¬
formance ?
III. What remits are exhibited by each of the practicability of
their doctrines ? Or how, when they are fairly and fully applied,
brought face to face with nature and fact, do they stand the test,
assist, or produce ?
On looking generally at the papers under review, we find Dr.
Laycock in the position of a defendant. His system of psychology,
as set forth in his published works, a system containing in many
essentials what is opposed to the established faith, and very much in
addition to it, had been assailed by Dr. Bushnan, who, as the ad¬
vocate of the philosophy of the schools, attempted to repel objections
stated or implied to former belief and method, breaches of psycho¬
logical canon, and to cripple the facts investigated and conclusions
established according to the new method, thus acting at once the
part of conservation and destruction—conservation of existing views
* An unpublished graduation thesis, entitled ‘ On the Homologies of Limbs.”
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and beliefs, and unsparing destruction of aught not in conformity
with these. Although Dr. Laycock's paper is defensive and contro¬
versial, rebutting the arguments and assaults of his opponent,
still in it we have a concise and compact statement of his doctrines,
set out more summarily and practically than in his book, and ad¬
mirably available for instructing any one previously unacquainted
with his peculiarities, forming, as it does, a digest of or index to his
work, on which it rests, and with which it altogether coincides.
The expositional predominates over the controversial, and the com¬
munication is divided into distinct sections, devoted to the inculcating
and illustrating of particular doctrines. Dr. Bushnan’s paper is al¬
together expositional, and the controversial does not at all appear in
it. Still it stands in the controversy series, and seems to be a
studied exposition and protest—an exposition after the prevailing
fashion of practical writing, attempting to exhibit the practicability
of dogmas and doctrines already in vogue, those which he was taught,
and whose truth has been, until recently, unquestioned; a protest
against the folly and futility of attempting anything different or in
addition to what is already known ana believed. Such a production
is valuable, whether true or false. If true, then it does establish a
strong presumption of the futility of anything besides or beyond;
and if false, affords a most excellent ground for comparative exami¬
nation such as we attempt.
The other papers of the series, those more purely controversial,
will throw light upon doubtful assertions, especially the last.
(Journal, July, 1862.) Before plunging in medias res we will first
examine and compare the titles and general style and nomenclature
of the papers.
I. The titles are as follows :
“ The practical use of mental science.”
“ The principles and method of a practical science of mind.”
1. Dr. Bushnan's mode of entitling his communication represents a
delusion as to the complete distinction between “ the practical ” and
<( the scientific,” which appears very prominently in all his papers,
and forms the subject of some of his hardest controversial hits.
Further on in the same paper he speaks of “ practical psychology,
as superadded to scientific psychology” (p. 133). Still more ex¬
plicitly he says, at p. 242, Journal, July, 1862, “ What is the prac¬
tical ? With what does the practical deal ? Does not the practical deal
with individuals, while the scientific deals with species, genera, order,
classes ?”—as if species, &c., were not an expression of individuals,
and could exist in generalisation or notion without or apart from
individuals, unless we are to understand the passage as stating a new
and fictitious realism. We have here a most complete differentiation
of “ the practical ” and “ the scientific; ” a positive statement that
“ the -practical ” concerns one thing, and “ the scientific ” another.
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Stranger still, Dr. Bushnan asserts that his two artificially differen¬
tiated and unified departments of knowledge have a different mode
and principle of knowing, and a different means of investigation. We
axe, “ in short, to seek ‘ the practical * in a direction opposite to
generalisation” (p. 242). And, again, “ Dr. Laycock affects to think
that we teach that the inductive method is not the way to advance¬
ment in science” (p. 243), therefore that it is so in practice, which is
distinct and different, and opposed in sphere, object and method—an
accusation which he scouts. Then comes a climax :—“ How sorry a
figure will Dr. Laycock make if he resorts to such a defence as that
practical improvement depends on scientific improvement; and if
generalisation be the way to scientific improvement, therefore it is
the way to practical improvement.”
Finally—“ There is as little doubt as to generalisation being the
usual mode in which scientific improvement is made, as that de¬
duction, or the method opposite to generalisation, is the principal
means by which practical improvement is accomplished.” Dr.
Laycock has already, in a paragraph specially devoted to the subject,
vindicated pointedly and unmistakeably the truth, which is a ne¬
cessary axiom in all science whatever, and in the assertion of which
“he makes such a sorry figure.” Dr. Bushnan cannot resist its
concise reality, although he disposes of it in two lines, but attempts
to get out of his position by modifying the assertion which Dr.
Laycock criticises, after quoting it correctly.
As Dr. Bushnan, whose statements avowedly represent ideas, not
things, appears to us to misapprehend the real import of what
science and practice are, and to be ignorant of their mutual depen¬
dencies and relations, we shall try, in all humility, to show what
these are. He appears to entertain a mystic, misty notion of the one,
and a rough, granitic conception of the other. Science, according to
him, is a system of “ pure abstractions;” practice, or “the practical,”
a rude contact with individuals. We will not, however, permit
Dr. Bushnan the merit of singularity in this matter.
Aristole says, “Science is conversant with things unalterable,
necessary, and eternal; incapable of being generated, exempt from
corruption; the knowledge of which admits not of degrees between
total ignorance and absolute certainty.” ( f Ethics/ lib. vi, cap. 3.)
Sir William Hamilton calls science “ a complement of cognitions,
having in point of form the character of logical perfection, and in
point of matter the character of real truth.” I might cite many
other psychologists of the old school who define science similarly,
and limit the term to the expression of what Terrier denominates
“the unchangeable (or permanent), necessary (or essential), uni¬
versal (or common or general), in cognition.” ( f Institutes/ p. 153.)
Metaphysical or ontological truth of the most general and abstract
character.
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Karslake puts the point most clearly. He says, "In science,
sciamus ut sciamus (‘ the scientific’); in art, sciamus ul producamus
(‘the practical’). And therefore science and art may be said to
be investigations of truth; but one—science—inquires for the sake
of knowledge; the other—art—for the sake of production. And
hence science is most concerned with the higher truths and art with
the lower; and science never is engaged, as art is, in productive appli¬
cation. And the most perfect state of science, therefore, will be the
most high and accurate inquiry; the perfection of art, the most apt
and efficient system of rules; art always throwing itself into the form
of rules.” (‘Aids to Logic,’ b. i, p. 24.) This is exactly Dr. Bushnan’s
creed, though tamely expressed; for Dr. Bushnan does not admit '
the sciamus in " the practical,” but " deduces” from the sciamus of
“ the scientific”—of higher truths—how and with what result we
shall see.
Now, what is science? Simply knowledge—cognition—im¬
pression—presentation. It is the incidence in man’s reflex exist¬
ence. It is the experience of every vital change within us, in or by
which we feel, think, or know (Laycock, ‘ Mind and Brain,’ vol. ii,
p. 81, § 447.) It includes every sensation, perception, act of atten¬
tion, memory, reflection, conation, every state of consciousness of the
„ individual during his whole existence, and the united experience of
the race. Such is science, the entrance of which may be involuntary,
systematised after its acquisition, or the result of a designed conemur,
that we may systematically know. It is one and indivisible, and
implies all the knowledge that man or mankind can obtain of him¬
self or the external—all cognition.
It may, of course, be logically and truly divided according to its
subject matter; and such the instinct and sense of man has led him
to do. Thus, we have the science of abstract ontological truths—
metaphysical ideas presented as intuitions in consciousness by the
working brain; and fre may establish these as a category, and call the
collection and system necessary, intuitive, absolute, actual, &c. &c.;
and the science of more special and particular modes of existence,
which we categorise as contingent, accidental, variable, &c. &c.; and
we may still further subdivide—and it is done to a very great extent
—and single out as many sciences or ologies as there are attained or
attainable facts of nature and creation. But the notion of calling
ontological (metaphysical) truths—whether obtained by abstraction
or generalisation from any fact or facts, or revealed in the con¬
sciousness of man as intuition—science, and that only, and asserting
that the method of attaining such knowledge, and such only, is
generalisation, is preposterous; while we are at the same time actually
told that our knowledge of individuals—beings or things, we suppose,
not actions—is not a part of science and ‘‘the scientific,” the very name
and perception of any individual being a generalisation, and though
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Practicable Menial Science,
an instinctive one, as truly one as the most abstract ontological
truth. It is true enough that, before we arrive at any metaphysical
or ontological fact, we must generalise, or accept as a fact our cog¬
nition in consciousness of a generalisation, physiologically accomplished
in and by the working brain, in virtue of its organization and action
(intuitions). Thus our principles of action and truths of existence
(and we can know nought beyond facts of mode of existence) may
be derived cognitionally by generalisation from one object by suc¬
cessive abstractions, or from many by abstraction of what is common
to all; or intuitionally attained, by the experience of the general
principles (noetic, teleiotic ideas) of the organization and action of
the working brain. But this we assert, as the foundation of all phi¬
losophy whatever—as that truth without which philosophy is a
delusion and a falsity—that science is one, and its mode is one—
observation, cognition, experience, incidence, presentation, and
generalisation; that truths otherwise attainable by inductive com¬
parison may in all degrees of abstraction become objects of cognition
as intuitions, and in that degree of generality, and may be generalised
to a higher degree; but that no truth of greater particularity can
be obtained from the more general in any way whatever, but must be
arrived at by direct cognition or generalisation from what is lower
still. And we protest, in behalf of Bacon and his system, in behalf
of science, its servants and votaries, against the fatal notion that
“ deduction (syllogistic logic), or the method opposite to gene¬
ralisation, is the principal means by which practical improvement is
accomplished.” Its use, at best, is speculative, designed, and sys¬
tematic conation to science, but a process merely tentatively pre¬
paratory to the exercise of observation and generalisation, the only
modes of attaining any knowledge whatever.
Dr. Lay cock states, as the only other modes of knowing or pre¬
tending to know other than by observation and generalisation—1, mere
practical tact or dexterity, without a distinct perception or know¬
ledge of general laws and principles, commonlyknown as the “ rule of
thumb,” which science enlightens ; and 2, the deductive or a priori
method, by which principles are reached by logic instead of observa¬
tion and research.
The first of these modes is an instructive, incomplete, and unsys¬
tematic observation and generalisation, such as must of necessity
obtain in “ the practical,” if scientific induction is elimina ted as a
mode of inquiry; and the second is that which Dr. Bushnan con¬
fessedly advocates, as the “ principal means by which practical im¬
provement is accomplished.”
Let us next ask what is practice, or “ the practical ?” It is nothing
else than action —representation—expression—the excidence of the
unit man. It stands in this relation to science, that it is consciously
or Unconsciously doing, and science consciously or unconsciously
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knowing ; that the more and better (more systematically and truly) we
know, the better we do* and that in doing we come to know, that is,
learn by experience. That whereas knowledge may be instinctive
or intuitive, so may practice or action; and that both in knowing
and doing the general principles of knowing and doing are invari¬
ably instinctive and intuitive.
Now, whereas observation, comparison, abstraction, and generali¬
sation, are the modes, and only modes of knowing; so design, force,
and action, are the only modes of doing. Designing stands to doing
in exactly the same relation as generalisation to knowing They are
homologues, principles of knowing and acting; the correlatives in
cognition and representation of each other and of the teleiotic
ideas , cosmic, biotic, and noetic, which they represent. Thus, in
truth and reality, the scientific (knowing) and practical (doing) are
not only different, but opposite; the one the incidence, the other the
excidence, of the reflex action of conscious or unconscious man,
who observes and generalises quoad the one, designs and acts quoad
the other. This is the foremost and fundamental truth in the teleo¬
logical psychology of the present day, which affirms intuitive or meta¬
physical ideas, not only in existence or cognition, but also in action.
But this is not Dr. Bushnan's belief or statement. If “ practical
use” and “ mental science” were meant and applied in the way we
have developed and stated, then the expressions would not only be
correct, but excellent ; but, as we shall see in examining the papers
more minutely, “ menial science?’ means with him a system of onto¬
logical laws, and obtained by empirical intuition, and “practical
use?’ either a rule of thumb induction or the logical deduction of
these laws. Dr. Bucknill, who is, we presume, a psychologist of
the old school, represents our convictions on this subject very clearly
when he says, “ But while we admit that metaphysics may be called
one department of mental science, we maintain that mental physio¬
logy and mental pathology are also mental science under a
different aspect. While metaphysics may be called speculative
mental science (speculative science ?), mental physiology and patho¬
logy, with their vast range of inquiry (induction) into insanity,
education, crime, and all things which tend to preserve mental
health or to produce mental disease, are not less questions of mental
science in its practical, that is, in its sociological, point of view.”
(Journal, April, 1861, p. 138.) Our only objection to this sentence
is that it does not, as Dr. Laycock does, recognise all science,
metaphysical and practical, as available for practical as well as
sociological use. A striking and true corollary to this proposition
is, that any so-called scientific fact or system of facts, not available
for practical and sociological use, is no science at all.
Dr. BucknilTs view and definition is a transition to another view,
which is entertained by many men of eminence, viz., that meta-
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Practicable Mental Science ,
physics is one thing and science another; that science ought, as a
definitive term, only to concern and express facts gained by induc¬
tion—objective perception; and that metaphysics, as a more or less
speculative system, is truly not science. This view is perfectly
correct if metaphysics include and express facts of the universal and
absolute in existence, as different from the universal and absolute in
cognition. The former may be the latter, but it may not; and this pre¬
sumption of contingency of our universal gives pro tanto a presumption
of inaccuracy of facts of our universal when raised into the universal,
unless it can be proved that the two coincide, which it cannot.
2. Dr. Lay cock’s title is logically more correct and certainly more
promising of something useful to come. Practical is adjectively
connected with science, without .qualification or limit, implying,
among other things—(a) That knowledge is logically necessary for
performance, consciously, just as impression or incidence is necessary
for expression or exidence. (b) That generalised systematic know¬
ledge is necessary for any adapted performance. These two propo¬
sitions involve the corresponding corollaries—that the more and
more minutely we know, the more efficiently we perform; and that
the more complete our system of generalisation, the more safe and
certain our performances, (c) That all science is one, and that its
principles in cognition are the principles and causes of practical
manifestation, adapted representation, production, construction,
designed and adapted art, whether voluntary or involuntary, con¬
sciously adapted or reflex, (d) That not only is the science of the
contingent and variable of the individual and its description, whe¬
ther being, thing, or action, and the systematic knowledge of these
by generalisation, necessary for practice, and the more minute and
particular the knowledge (obtained, however, by induction, not logic)
the more certain and excellent and useful the practice; but that
ontological and metaphysical facts which are repeated in conscious¬
ness as intuitional cognitions are the causal ideas in adapted mani¬
festation, whether conscious or unconscious, voluntary or involun-
tary.
We have thus, in the expression which entitles this communica¬
tion, an exposition of what a science, to practise, is and ought to be.
What the paper professes to indicate is the principles and methods
upon which the attainment of such a practical science rest.
II. The style and nomenclature of the productions under review
are matter of interest and comment only in respect of the general
law that the mode of arrangement and expression is a fair index,
of the philosophy (mode of thought) of the writer, and the reality
and truth of the substance of the paper. Dr. Bushnan’s paper is
diffuse, immethodical, and does not exhibit an approach to logical
arrangement or systematic inclusion. The production of a man
well read in metaphysical and metaphysico-psychological ‘writing, and
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521
frequently exercised in thought upon such subjects, it has a show
of learning, reads tolerably well, and has a specious but fallacious
aspect of truth of assertion and grasp of subject; but on careful
sifting, it is as barren, as a revelation of new fact^-or elaboration of
new principles—as such an amount of writing upon an important
subject well could be.
The nomenclature is equally as metaphorical, mystical, beguiling,
and impracticable. The word “ man” occurs only about twelve times
in this paper, which purports to concern his most intimate and im¬
portant interests. Ignorance, defect, error, disease, insanity, crime,
are hinted at or casually alluded to, or discussed in such a way as to
mystify and confuse. Even life and its phenomena are sparingly
touched on, and, instead of the beihg, his existence and its modes, his
circumstances and their effect, his condition,errors, crimes, disease, &c..
We have “ the mind,” a t£tm which occurs upwards of fifty times,
unified as a substance and ,a principle, consciousness spoken of as a
condition coexistent with sensation, &c. (p. 137)—a faculty to all
intents and purposes—“ states of mind,” “ states of consciousness,”
“ outpourings, rushing in mad career,” and “ currents of thought,”
and—tell it not in Gath —“ links in prevailing currents.”
On turning to Dr. Laycock’s paper we find a logical division,
subdivision,' and inclusion; no meandering beyond or out of the
design of each particular paragraph, no intermixing or confusion.
We are brought in contact with things, not ideas, and our under¬
standing and senses, and both these as systematised in science, are
constantly appealed to. There may be new doctrines hard to under¬
stand, but they are elucidated and illustrated. There may be new
words difficult to comprehend, but we find them precise and definite,
point to things, not ideas; and there may be new applications of old
words, but we find these changes necessary to meet the requirements
of wider generalisation and more systematic and established science.
Mind is no more merely used to express the collective phenomena
of consciousness as a unit, but is generalised into a force of the
whole universe, wherever designed and adapted action exists, and is
manifested by phenomena whose relation and correlation in time and
space indicate a causal adaptiveness. It is thus made a subject of
scientific investigation as a fact of mode of existence which was not
before, besides being brought into correlation with all other coexist¬
ing phenomena. “ Necessary,” and its cognition in consciousness as
intuition, are no longer merely properties of those cognitions which,
as it were, fill the mind, and leave no r6om for contingency, but
“ necessary” is generalised, into all existence, as an invariable expres¬
sion of causal ideas and creative adaptiveness; and by intuitive
truth is meant the cognition of a necessary idea, of such a general
ontological fact that, as a law, it governs all occurrence in our
universal and, therefore, must govern the physiological activity of
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Practicable Mental Science,
the brain. But not only does it exist as a dominant law of brain
action, but of every other action as well, so that the same necessary
truth which, as a necessary noetic idea is revealed (experienced) intui¬
tively, in consciousness is also capable of being investigated and scien¬
tifically observed and stated in every other manifestation or pheno¬
menon whatever. Now, with Dr. Bushnan, necessary and intuitive
have the same significance as “ the scientific,” and he includes all
these in his differentiated unity, “ the mind,” not recognising nor ad¬
mitting the fact that “ the mind,” as manifestations or phenomena,
must express or represent ontological and biological facts, in common
with the rest of existence whose attribute is being or living, This
is an excellent example of the truth of error, showing that Dr.
Bushnan'e brain works according to teleiotic, noetic ideas, ontolo¬
gical and biological law, unifies ; but that his cognitions are both
imperfect and inaccurate, and exhibits practically and concretely to
all observers the nature and origin, physiology and causation of
error. These prefatory remarks will render our comparison much more
intelligible and useful, and now we shall take evidence upon the
first question raised, and judge accordingly.
I. What is the object, ultimate aim, and design of each ? What,
in the expressed opinion of each, constitutes, or ought to constitute, a
practical science of mind, &c. ?
We shall first hear Dr. Bushnan in reply, and produce the
following paragraphs from his paper in evidence.
1. “In the practical application of mental science, it is with in¬
dividual character that we are for the most part engaged”
(p. 132).
2. “In short, the chief practical use of mental science is to enable
us to deal with and influence individual minds” (p. 133).
3. “ Practical psychology might be described as the exercise of
converting the general laws of suggestion laid down by meta¬
physicians into particular instances” (p. 134).
4. “ It belongs to practical psychology to make an approach, at
least, to anticipating such a train of thought as that just cited, when
the prevailing turn of the individual mind has been indicated”
(p. 135).
5. “To gain insight into the links of suggestion which are
customary in individual minds” (p. 135).
6. “This particular department, the peculiarities of mind in in¬
dividuals, is, in short, the practical part in psychology.”
7. “The laws of suggestion, taken as a whole, carry us into the
pith and marrow of practical psychology” (p. 139).
8. “ It seems evident, from these and similar considerations, that
what was termed above physiological psychology bears most on a
practical psychology” (p. 152).
(“Physiological psychology is the knowledge of the functions of
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the animal kingdom, obtained through whatever channel may appear
worthy of confidence”—p. 150.)
9. “It will be seen from the general tenor of the observations
which I have offered in this paper that I regard a practical psychology
as essentially the psychology of individual minds” (p. 152).
10. “ Man, in short, is bom endowed with certain susceptibilities,
destined to be called forth under corresponding conditions; when
these conditions arise, the predetermined result follows” (p. 151).
Here aTe ten paragraphs carefully extracted out of Dr. Bushnan's
paper, all of which purport to answer our question, of what he
intends to tell us and in what he means to instruct and guide us.
The first fact in their comparison which strikes us is their diversity;
not only are they not expressions somewhat similar of the same thing ,
but they vary in the extent of what they include, and actually refer to
things really and logically different.
It is cunous also to observe that as the desultory discussion ad¬
vances, mind and consciousness, subjective phenomena, and their
kindred metaphysical phantoms, vanish; life, and its laws, pecu¬
liarities, and manifestations, are dimly seen through a misty clouding
of metaphysical terms, and at last a single paragraph (No. 10 in
our enumeration) coming immediately after the discussion of intuitive
belief in personal identity and the existence of an external, solemnly
in a tone of melancholy sadness, proclaims the essence of a teleo¬
logical system of psychology, concedes the truth of all Dr. Lay cock's
doctrines, and is logically sufficient to overthrow every principle as¬
serted in the rest of the paper. This transition is both interesting
and instructive.
1. Phenomena of consciousness, peculiarities of mind, individual
characters, &c.
2. Physiological states of living body, outrageous trains of thought,
the result of material impulse on the nervous apparatus, &c.
3. Latent cerebration (i. e. mental action without consciousness,
which attends upon every sensation, feeling, thought, emotion, passion,
volition; in short, every state in which the mind can exist) con¬
fessedly abolishing consciousness and logically abolishing the mind
as factors in cerebral activity; reflex cerebration, going further in
the same direction.
4. Man. —Bom, endowed, conditions, predetermined results.
We have thus, in the wandering discourse of a man well informed
as to the present and past aspects of psychological science, an epitome
of the stages of progress of that science, from the pure phenomenal
psychology of the ancients down to the most recent development in
mental philosophy, namely. Dr. Laycock's teleological system.
No designed or systematic treatise could have done more simply
or conclusively what Dr. Bushnan does involuntarily, namely, es¬
tablished the practical worth of the teleological mode of studying
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524 Practicable Mental Science,
mental phenomena. It is a most valuable tribute to Dr. Laycock,
though unwarily rendered, and yields in one short sentence, standing
singly and alone, all the recently controverted questions in favour of
Dr. Laycock, his doctrines and gathering school, inasmuch as it
not only concedes but affirms the fundamental truth of his system.
But the very next paragraph leads us back to No. 8, and that
immediately succeeding conveys us to our impracticable starting-
point—the author’s professed belief and statement of the scope of a
practical science of mind ; consciousness studied singly in individuals
and comparatively in the race, or, rather, the generalities and pecu¬
liarities of the mind as evidenced in consciousness. Dr. Bushnan
here exhibits the essence of error, excessive or absolute unification.
He unifies “ the min d ” as a special object of investigation, and con¬
sciousness as a special mode of investigating; and not only is his
unification excessive, but it is absolute. The mind is unified out of
relation with all known or knowable phenomena whatever, and con¬
sciousness is singled out as a mode of obtaining knowledge, different
and distinct from all other modes whatever. We have a speciality
in its grossest form, and its logical consequence is apparent in the
necessary statement of “ the mind” as a principle and substance, and
the proclamation of a duality professedly material and immaterial,
but really and truly, in nomenclature, expression, and logical signifi¬
cance, doubly material. Restrained within these limits even if
induction, observation and generalisation were Dr. Bushnan’s in¬
strument of knowing in this matter, he must necessarily restrict
himself to consciousness, according to his definition of it, admit all
the evidence which it affords, and exclude all that consciousness does
not and cannot reveal; for mental activity, according to his principles,
can only be evidenced by consciousness, and any phenomenon what¬
ever not so attested cannot be a phenomenon of “ the mind.” Without
arguing the matter further, we strongly state 1 —1. That what Dr. Bush-
nan proposes for investigation is not an existence, viz., “the mind,”
which even with the more enlightened of old psychologists, is “the con¬
sciousness.” Both are an evidence, are one and the same thing, may
coexist with the activity of every fragment of man’s nervous system
or may not, and at best evidence effects without giving the slightest
information of causes, or causes without being able to register effects.
Thus, Dr. Bushnan proposes to make an entity of an evidence, to
take evidence of the states of the entity by the fictitious entity itself
under another name. This cannot fail to end in confusion and error.
2. That if Dr. Bushnan energises at all in the way. of scientific
discovery, or for the sake of practical science, he must totally and
entirely throw aside his principles, and in act adopt others which we
shall immediately note. This we shall find Dr. Bushnan constantly
and invariably doing. Par be it from us to depreciate the value of
the information which we obtain concerning what happens wi thin us
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in all relations and conditions and states of our body, when such can
be obtained (for in many active conditions and states it cannot ); but
we assert its nature and functions as experience or cognition, and
its unity as an informant of vital states, whatever they are, and how¬
ever caused. Consciousness cannot become an object of scientific
inquiry. We can only say of it that it exists as a unity, correlative
with the unity man. It is only the contenta of consciousness as
particular acts that we can know and compare, and these, as they are
real existences—changes—are known and believed as facts, in what
way whatever the changes arise. In consciousness, we may thus
have facts, cosmic, biotic, or noetic existences or actions, and if it is
the facts of consciousness thus defined and generalised that are to
constitute science, then there can be no disputing that absolutely
nothing remains to be desired; but we are limited to the cognisance
of noetic facts, experiences of cerebration, the modes of association,
combination, sequence, &c., of cognitions, of cosmic and biotic facts.
Taken, as it truly is, as a cognition of brain action, whether
normal or the reverse, how, in the name of reason and common sense,
not to say philosophy and science, can we hence derive facts as to
the circumstances under which normal cerebration takes place, or
which exalt, confirm, or subvert the mental operations ?
If Dr. Bushnan asserts that consciousness only reveals states of
"the mind ,” and that in psychological investigation these states
and their succession and relation are the only facts which can con¬
stitute the science, or can avail for practical use, then we say, as we
trust we have shown, that he labours under a fundamental fallacy,
and that the more he systematises and writes on such a foundation
the deeper he plunges into confusion and error, and the further he
departs from what is feasible and practicable.
If Dr. Bushnan concedes that thought cannot take place apart from
brain, and grants us that, practically, the knowledge of its conditions
and of the vital changes which take place in it, in association with
particular “ states of mind," is all important in order to influence
individual minds, in whatever state, ana more especially in a state of
disease, how can he, in consciousness, as concerning and containing
a particular and different kind and order of facts, and that only,
attain^ to the knowledge of the causes which affect the brain, the
state of the brain itself, facts which in order precede the facts to
whose cognisance he limits us ? Indeed, in consciousness, as he
defines it, we could not obtain a knowledge of the existence of a
brain at all.
Finally, if Dr. Bushnan yields us that, not only the state of the
brain, but the condition of the living body, its nutrition, its vital
energy, and the right performance of the functions of the various
organs, and, as a matter of course, the conditions which cause the
condition of the body, as not only coinciding with but causing
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certain felt and manifested states of mind and temper, how, in the
knowledge of the laws of suggestion, and “ the peculiarities of in¬
dividual minds," are we to know anything at all of cause, proximate
or remote, of normal or diseased action; and if we know nothing of
the causes, how can we prevent or modify their action and occurrence,
so as to influence individual minds or masses of individual “ minds."
A practical science of mind must include not only a knowledge of
“ particular states of mind of individuals," but a knowledge of every
state of brain, body, or nature generally, coincident with, or every
action and occurrence of each and all causal of, any experienced or
manifested “ state of mindand even then the “ state of mind" is
but the cognition of a certain mode of existence teleologically con¬
ditioned and caused.
Let us now turn to Dr. Laycock’s paper. He tells us at the out¬
set that his object is “ to determine how far a mental science, in the
true meaning of the term science, is possible and capable of practical
application to mental pathology, therapeutic, and hygiene, and the
needs of society in general." We are here at once introduced to
something actual and existing; man’s mental imperfections, his
diseases, errors, crimes, and tendencies thereto, are made the subject
of investigation, and the means which prevent their occurrence,
obviate the tendency, or correct the morbid manifestations. “ Living
man," as he exists on earth, is made the subject of scientific in¬
vestigation, and not even as a separate unity, but as existing and
acting in subjection to the general laws and conditions of the universe
and the particular conditions of his existence; and the nervous system
and brain of man is investigated as organized and active under these
laws, and under the physiological laws of the organism, possessing
thus the general properties of all substance, the special properties of
living substance, and the still more special endowments of co-ordinating
(physiologically abstracting and generalising) nervous substance.
Consciousness is considered as a unity, correlative with man’s
existence in space and time, is taken as a fact of man’s existence, as
a being perfectly incapable of being defined, so that the question
what is consciousness or what is the mind cannot become a scientific
concern.
Now, as all these conditions—cosmic, biotic—are causes in the
development, organization, and vital activity of the human being, it
follows that no science of him can be complete without a knowledge
of these, nor of any vital state of any part of him, nor of any coin¬
cident state of consciousness.
And as his normal state demands an amount of knowing so at
once minute and comprehensive, h fortiori his abnormal states, which
can only be remedied when these conditions and causes have been
thoroughly explored. “ In short, the science must be complete in its
scope,” must involve everything out of man that has a relation to him.
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and everything in man that has a relation to his brain, can influence
its state, and consequently modify the state of consciousness.
To bring the matter to an issue. Dr. Bushnan limits our in¬
vestigations to “ states of consciousness," “ peculiarities of mind,"
and unifies this field of research into absolute peculiarity in existence
in every possible respect.
Dr. Laycock declares for an unlimited scope, a complete science,
which must be etiological if it is to be of the slightest practical
value whatever. The crowning merit of his system is that it puts
mental phenomena in exactly the same conditions for etiological in¬
vestigation as any and every other science, unifying all science as
the correlative of existence, and cognition as the correlative of both;
stating the profound truth that man is cognisant of himself scien¬
tifically in exactly the same way that he is cognisant of every other
created thing; extracting mind and ontological facts out of con¬
sciousness and cognition, and asserting for both their existence in
the universe of action.
II. Dr. Laycock and Dr. Bushnan’s notion of what a practical
science ought to be, where the facts which constitute it are to be
obtained, being so diverse, it devolves upon us next to examine how
each proceeds to develop a practical science. Dr. Bushnan, true to
his fundamental notion, asks, “ How, then, are we to proceed to gain
insight into the links of suggestion which are customary in in¬
dividual minds ?” (p. 135); postulates a previous acquaintance with
all that “ scientific psychology teaches us concerning the nature of
human feelings, thoughts, emotions, and passions and proceeds to
enumerate, as the most obvious means of penetrating into the
“ recesses of thought," as follows :
1. A careful scrutiny of the characters of others.
2. The study of systems of scientific psychology which generalise
mental facts metaphysically.
3. The influence of physiological conditions of the human body
in modifying trains of thought.
4. The study of the products of mental activity, man’s writing
and acts, and imaginative or real records of what man has done and
said.
We shall, without reserve, concede to Dr. Bushnan that facts
of the kind thus classified are all more or less important as mani¬
festations of mental activity; but we submit—
1. That they are not all admissible on his principles.
2. That after they are attained, they are of no use whatever, ac¬
cording to his method. Even when read and interpreted according
to the broad philosophy which demands an etiological science upon
teleological principles for practical use, they fall short of such a
completeness as to render them available for practice; but when
cramped in the fictitious unity which Dr. Bushnan creates for them.
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Practicable Mental Science,
they are utterly delusive as a science and void of use for practice.
The only division which at all savours of the feasible is the third,
which appears to be rather a concession to present scientific develop¬
ments than a segment of the legitimate science of psychology according
to the author. Let us, however, in order to test his system more
minutely, take his divisions into consideration seriatim.
1. His first division concerns the careful scrutiny of character.
This, even in ordinary parlance, means a considerable amount of in¬
formation beyond what Dr. Bushnan postulates in a hypothetical
impossibility, which would, on his principles, make his science com¬
plete. It means a knowledge of the man, not only what may be
called his mental generalities and peculiarities, his modes of thought,
as manifested in speech, action, writing, behaviour, &c., but his
morphological peculiarities, his size, height, temperament, phy¬
siognomy, &c., and his physiological peculiarities, rate and kind of
motion, gesture, talk. The manifestations of what are purely
physical and physiological are as much part of the estimated
character as the modes in which thoughts are “ accustomed to array
themselves.” This much the common sense and instinct of mankind
have led him to; but when systematised in science, the “ character” of
a man means an exact and well-taken statement of the peculiarities
of his body, its action, as well as the peculiarities of his mental
manifestations. A careful register of. every such particular con¬
stitutes the “ case” of an individual ; and each well-observed “ case”
constitutes an instance of the coincidence of certain conditions, mor¬
phological, physiological, and psychological, an induction for the
sake of comparison with other similar inductions, and generalisation
therefrom, generals of all degrees bring deducible from everyone,
either physiological or ontological, or from the comparison of
several and all. Now, this or such as this is, in our humble appre¬
hension, what constitutes one of the modes of attaining to a science
for practice; and as this is om belief, so it is our practice. Every
“ case,” therefore, which it becomes our duty to record is made the
subject of induction, according to a fixed mode; coincident facts,
morphological, physiological, pathological, and psychological, being
stated in as clear and orderly a manner as possible. Any “ case”
not possessing all the information possibly attainable is in that
degree imperfect, and it is a complete and systematic knowledge of
coincident phenomena, the preceding and succeeding sequences, the
causation and results, and only that, that can enable us to diagnose or
prognose, as it is, a complete and thorough knowledge of agencies
causing other sequences and coincidences of phenomena in such and
such circumstances, and that only that can enable us to treat. Such
is the familiar mode of amassing a science for practice, and the
results of induction, more or less elaborate, conducted in this way;
and according to the care of the conducting and the comprehensive-
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by De. Kenneth McLeod.
ness and minuteness of the induction, the results are more valuable,
appear from time to time in our records, and such, we have no doubt,
is Dr. Bushnan's own invariable habit. Still, in his efforts to reconcile
a delusive and false philosophy with actual occurrence and the needs
of mankind, what absurdities does he fall into and enunciate ! As
the beau ideal of knowledge of character, as the utmost possible
amount of psychological attainment, he asks for a minute of all the
operation of a man's “ mental nature,” from the earliest period of
consciousness—a considerable time/probably, before birth—down to
the last consciousness which precedes death, and warms in the con¬
templation of the amount of knowledge which might be derived from
“ sets of pictures of this kind.” Even if such pictures were attainable,
and, if attainable, capable of expression, could the consciousness of
the states and modifications of man's “ mental nature” give us the
slightest clue whatever to their mode of production, or subserve any
practical purposes whatever ? As revealed facts of man's “ mental
nature,” they stand absolute; there is nothing to connect them with
each other or with facts of any other sort except their sequence; and
dissociated from the rest of man's nature, or nature at large, in con¬
dition and causation, they cannot form the subject of comparison of
any sort; may, as phenomena of man, be interesting to poets, moralists,
and so-called philosophers, but cannot be of the slightest service what¬
ever to legislators, lawyers, or physicians, or any who have to deal
with man, his existence as a unit in creation, whose laws condition
him, his actions and reactions.
Dr. Bushnan cannot admit the contents of consciousness in toto
as facts of his science, for this goes beyond the bounds of his science
—involves objective perception, includes morphological and physiolo¬
gical psychology, which he repudiates as at all constituting or forming
a part of pure science. According to our belief and Dr. Laycock's
principles, he thus logically reduces his science to an absolute
nullity, for with us consciousness is one, as a state of knowing, is not
an object of science itself, the only truth concerning it being that it
exists. Its contents constitute truths of science which would be
absolutely perfect if consciousness contained all the facts of creation,
past, present, and future, in their actual relation. It is towards this
that conscious action and conscious conation points. It is towards
this that the brain teleiotically ideates; and if such an amount of
knowledge were possible, "the mind” would be simply an exist¬
ence, a unity in which activity as to anything beyond would be ab¬
solutely an impossibility. The existence comprehending would,
however, be absolute, have no relativity in time or space, and, as an
existence, would be the cause of all activities within, subunities
having a sequence in time and coexistence in space. This, indeed,
constitutes the scientific notion of God—designing, creating, and
upholding. Here meet the greatest cognition and the greatest
vol. viii. 35
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530 Practicable Mental Science ,
power—absolute science and absolute causation. Here rest the
causal ideas of existence—in system and inclusion. This is mind.
We have perfect and absolute in this existence what we have de¬
rivative, limited, and relative in every other, organized and disor¬
ganized. How, then, does Dr. Bushnan attain a science at all ? He
takes, admitting facts of a certain sort, an arbitrary section of the
contenta of consciousness, and predicates of them that unity of
existence which belongs to all, and that absolute causation which
obtains in the universe. In concluding our remarks upon this
section we suggest to Dr. Bushnan and his associates in belief and
attempted practice on it—
1. That the fact of relation to the external, and the fact of
impression by the external and reaction on the external, must consti¬
tute the first and most simple elementary, essential state of conscious¬
ness—acts of cognition; so that, generalised to the utmost, adult con¬
sciousness is identical with what we have every reason to suppose the
first consciousness of the individual is, namely, impression from the
spermatozoid. This generalisation establishes the unity of conscious¬
ness and cognition, the universal scope of science, and the absurdity
of artificially cramping it within the limits of a delusive unity.
2. That every fact of consciousness has a causal origin in the ex¬
ternal; and—
3. If we admitted the cognitional distinction between conscious¬
ness and external perception and the unity of the “ substance and
principle” mind, as revealed in consciousness; and if we were asked
whether we should take for practical purposes the intuitions of con¬
sciousness, as revealing “ the mind,” or the fact of man as an
object, his states and manifestations as ascertained by our senses and
external perception generally, either to the exclusion of the other, we
should unhesitatingly declare for the latter, and obtain, in the amount
and kind of facts admitted and mode of investigating, all that
Dr. Bushnan or any other practical physician at present demands
for the uses of practice.
II. Having dwelt so long upon Dr. Bushnan’s first head of
discourse, we can dispose of the rest in shorter space. The state-,
ment which formed the subject of our comments is followed by
a reiteration of the propositions—Practical psychology consists in
the study of individual minds; the study of individual minds con¬
stitutes psychology. And nothing very remarkable occurs until
we arrive at the following sentence :—“ Since it has been gene¬
rally taught that consciousness is not a separate faculty of the
mind, but a condition attendant upon every sensation, feeling,
thought, emotion, passion, volition—in short, upon every state in
which the mind can exist—the unity of the substance mind is at
once made apparent to the student” (p. 137). This is most illus¬
trative of Dr. Bushnan's system. This makes the consciousness one
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thing, the sensation, &c., another. If it does not constitute a faculty,
what does ? And then we are told that the substance mind is thus
made apparent. Here, so far from a unity, it is not only a duality,
hut a trinity :—1. Substance mind, and its states. 2. Consciousness,
and its states. 8. Body, organs, and life, constituting the third
member of triune man. Is the sensation, feeling, thought, emo¬
tion, &c., not a state of mind and consciousness of the conscious
man, whatever he is conscious of at any one moment? Are not
memory, judgment, imagination, &c., states of consciousness as well?
Does not all mean the man, or the man's brain ? Are they not all
cerebration in cognition, the process intervening between pre¬
sentation and representation, impression and expression, the mode of
reaction of the conscious man, the concrete ego ?
Of the systems of philosophy recommended to our study, Dr.
Thomas Brown's is held up to us as the most profitable for practical
purposes. We have no wish to disparage the labours or opinions of
Dr. Thomas Brown, nor of his admirer. We have read his books,
and been charmed with his acuteness, his method, and his eloquence,
and we have found throughout his work traces of the inductive and
practical. It is not the latter, however, that Dr. Bushnan gathers
and recommends for study; it is his laws of suggestion relatively
in cognitions, his systematic statement and exhibition of the most
abstracted facts in mental phenomenology, of metaphysical pecu¬
liarities—the most general modes of conscious cerebration—the
relation to each other of the contenta of consciousness in sequential
development. His laws of occurrence are the laws, not only of the
occurrence of cerebral changes to ends known in consciousness, but
the laws of general occurrence, the most general, universal, onto¬
logical facts, involving such facts and cognitions as unity, unities,
inclusion and succession in space and time, &c. These, as they are
the most general modes of existence, exist in cognition, as intuitional
experiences and beliefs, and, as such, form the most general and teleo¬
logical laws of cerebration, constituting the most general principles
of science generally and of mental science particularly, causal ideas,
intuitional, cognitions, necessary truths. But how will this know¬
ledge—excellent, useful, indispensable in its place and degree, an
important part of practical science—avail alone for practice, in in¬
fluencing the actions and habits of, not individual minds, but indi¬
vidual men and masses of them ? Dr. Bushnan cannot, on his prin¬
ciples and method, get beyond them. He recommends a noting of
particular kinds of cognitions already referred to, and abstracting or
generalising them to the degree of comprehension of the laws of
suggestion. Thus—
1. He can never get beyond the generals, unless he abandons
his mode.
2. Even here he practises “induction, observation, and gene-
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ralisation,” and calls it “ deduction, or the method opposed to
induction.”
3. His mode is faulty, vitiated by the fundamental defects before
enumerated.
4. There is nothing here practical or practicable.
III. The next section starts with the following sequence of
propositions:
1. “ The laws of suggestion, as a whole, carry us into the pith and
marrow of practical psychology.” We have shown that they, accord¬
ing to his method, do not.
2. “Man has no voluntary power over any one thought, but may,
by the regulation of volition and desire, become in a great measure
master of his thoughts—overrule and control the ordinary rules of
suggestion.” A palpable contradiction.
3. “Organic states of the living frame sometimes assume the
mastery.” Our creed is that consciousness is a perpetual induction
of the organic states of the living frame. The obscurity, confusion,
and contradiction of these paragraphs require no notice.
Then comes a statement the most scientifically audacious which
we have ever read. He says, in measured terms, that “ every act of
mind leaves behind it in the vesicular substance a material trace or
vestige, which may be organically affected and rendered active.” That
is bad enough. But he says, further, that his vestige is to concur
with the mental principle in reproducing a previous state of mind.
Here are three distinct hypotheses :—1. Material vestiges as remnants
of thought. 2. Mental principle. 3. Reproduction of previous
states of mind. How are intoxication, dreaming, insanity, &c., to be
explained ? By a fourth, that an increased momentum of blood
renders active the vestiges by a merely physical impulse. Thus, “ an
outpouring of disjointed thought may occur ;” “ thoughts may rush
onwards in mad career “ torrents of unconnected ideas may be
uninterruptedly poured forth.”
We shall not permit ourselves to criticise this statement, and
merely adduce it without remark.—(1) for the purpose of exhibiting
to what melancholy extremes a fundamental vice in philosophy,
principles, and method, will lead; (2) in order to compare it with a
passage in a reply to Dr. Laycock (Journal, July, 1862, p. 239).
Here he states that “ the belief in the external world is not a truth
of experience,” having admitted shortly before “ that consciousness
is an experience of the vital changes within us.” He imagines Dr.
Laycock dreaming, and says “ the dream is as much the reality of
a succession of states of consciousness as the reality it represents
would have been”—viz., the reality of objective cognition. These
statements suggest several remarks.
1. Both are states of consciousness, and believed as such; one
in relation, the second out of relation.
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2. Both are cerebral occurrences, known and believed as such;
the one in relation, and the other out of relation.
3. Every cerebral occurrence, every state of consciousness, is a
fact, and known and believed as a fact, the most particular and con¬
tingent as well as the most general and absolute, until further
experience disproves it.
4. Dr. Bushnan, by means of the vestige hypothesis, is suicidal,
for he admits, in the subsequent dream, of something additional to
“ the mind,” which formerly constituted the act of experience and
which now must do so equally.
Without pursuing our investigation of Dr. Bushnan* s paper
further, for it becomes as it progresses more and more confused and
impracticable, we have adduced sufficient evidence—
1. To exhibit his mode of elaborating a practical science!
2. To prove how utterly out of keeping with any other scientific
investigation what he recommends us is, and how neither science
can be added to nor practice improved on his principles, but the
one impaired and the other embarrassed.
Let us next ask shortly what mode of investigation Dr. Laycock
recommends—what are his “ principles and methods ” ?
1. He unifies science, and makes it coextensive with existence.
Psychology is with him but a subsection of the science of universal
existence, a knowledge of a special mode of existence, whose general
conditions and laws are the conditions and laws of every other mode
of existence.
2. He unifies consciousness as cognition of organic states teleolo¬
gically caused. These two propositions contain the essence of his
system, and all the particular truths of his philosophy are but sub¬
truths of these.
3. He admits not, as Dr. Bushnan does, a science of mind dis¬
tinct and separate from every other, having a different subject matter
and mode, facts and laws.
4. Neither does he admit, as Dr. Bushnan does, “ that the evidence
of intuition and the evidence of experience are wholly separate and
distinct,” but “ brings intuition, as afact of experience, into the sphere
of science for practice.” And intuitive truth is with him an experience
of the operation of an ontological law, the correlative in cognition of
a teleiotic idea in creation. Intuition and every intuition is with him
experience, the greater (experience) including the lesser (intuition).
5. Every act of experience is with him a truth, inasmuch as it is
the cognition of an actual occurrence or change. Error and delusion,
hallucination, &c., are as much facts as truths of number and form,
and, as facts of induction, capable of being compared and dealt with
generally as any other facts, so as to investigate and ascertain the
causation of the ateleiotic state, and the relations of it to actual
existence.
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Practicable Mental Science.
6. Necessary truths obtained by the experience of intuition are,
in reality, facts of induction, and have their quality of necessity in
their universality, actually and causally. They are fundamental
ontological facts, constantly and invariably dominant and existent in
creation and cognition, in brain and mind. As facts of cognition,
truths of induction^ they become a part of science to practise, fun¬
damental conditions of volitional designs to ends. But any fact what¬
ever, if known in all its true relations in time and space, is as truly
and necessarily knowfi as an abstract intuitional fact, and any fact
whatever, whether knbwn in any relation or in any real existing
relation, is also as much known as a fact as arithmetical or mathe¬
matical truth. Thus, the dream fact adduced by Dr. Bushnan is no
less a brain fact than if it constituted a waking experience or a
waking memory, and as a dream fact it stands as a fact of induction
for comparative investigation as to its causation, relations, &c.
We need hardly point out that the radical distinction postulated
between the truth of the forty-seventh proposition of the first book of
Euclid and the truth that water boils at 212° Fahr. is a verbal quibble.
The one is an intuitional experience of a universal, formal truth, and
the other is an experience of a truth as necessary in existence and
occurrence as the other, which would be as necessary in expression
if all the actual causation and relation were stated.
6. Dr. Lay cock lastly abolishes the notion of mind being an ab¬
solute unity in every man, causing the manifestations of consciousness
and representation, and states it as a causal unity in creation, as
an active agent whose manifestations can be everywhere inductively
traced. He thus opens the way to a field of science never trod
before, and obliterates the hackneyed circling delusions hedged in
formerly by an impenetrable barrier, so that from mind science one
could not travel to any other, nor from any or every other science to
mind. Now, mind science is universal, and “the mind" science in
relation with every other, so that every other science reflects light
and enlightenment upon it, and it upon every other. They are all
manifestations of causal mind, are the cognition and induction of it;
and while every fact of cognition gives a power for practice in mental
science, every fact of intuition gives a power for practice to every
other science. Cognition and intuition are one and the same ; science,
mental and physical, is one and the same; and practice, the excidence
of science, the incidence, is one and the same.
In concluding this section of our comparative review we shall
merely—
1. State as the merit, the attraction, and originality of Dr. Lay-
cock’s elaboration, that it establishes, without barrier or limit, the
universal sphere of an inductive mental science, a purely inductive
science, affording scope for the earnest labours of workers in all
departments of science to bring their results into relation, and
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Personal Identity , by Da. J. Ceichton Beowne.
holding out an illimitable field for inductive research, while in¬
vestigation is directed by the fundamental principles. The more
work that is done in this way, the more will “ the practical” gain in
certainty and success; work on any other foundation is useless and
embarrassing, and work ostensibly on any other foundation is really
instinctively and intuitively on this. Dr. Laycock has raised in¬
stinct and intuition out of unconscious forgetfulness into cognition,
science, and system.
2. We make a strong counter-assertion to Dr. Bushnan's gratuitous
accusation, that Dr. Laycock “ continually abuses the psychology of
the schools,” “ sneers at Locke and Leibnitz as being pretenders.”
Never have we, in intercourse with Dr. Laycock, from his lectures or
his writings, experienced the slightest foundation for such an un¬
founded charge. “ Sneering and abuse” are neither Dr. Laycock’s
philosophical tone nor his habit; and if he investigates new facts in¬
consistent with former tenets, or elaborates new principles in opposition
to them, or, in a solid, dignified way, refutes fallacies of former as¬
sertion and method, unfounded personalities will not avail against
the conclusion.
There still remains for performance the third and most important
portion of our purpose, the testing of the philosophy of each by
actual occurrence. This will form the subject of a future com¬
munication, when we shall inductively examine the results in ex¬
perience and practice of the methods inculcated by Dr. Bushnan
and Dr. Laycock.
Personal Identity , and its Morbid Modifications. By J. Ceichton
Beowne, M.D. Edin., L.R.C.S.E.; Ext. Mem., late Senior
President, Royal Medical Society, Edinburgh; Assistant-Physician
Derby County Asylum.
(Concluded from p. 295.)
At the close of our last paper on personal identity we had just turned
to the consideration of those apparent morbid divisions of the unity
of consciousness which are sometimes, though happily rarely, brought
under the notice of medical psychologists. Double consciousness,
as we have already hinted, is essentially a result of diseased action,
and comprehends a variety of conditions, distinguished from each
other by differences in the mental symptoms, and by the relations to
each other of the lucid and insane or of the two insane “oscillations.”
In all of them, however, there is, for the time, a change, a per¬
version, or an exaltation, of the mental identity of the individual, of
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536 Personal Identity , and its Morbid Modifications,
that principle which is, as it were, a centre round which the other
faculties of mind revolve, and about which memories cluster. In the
intensest forms of double consciousness, so called, mental identity is
separated or multiplied into two distinct parts, so that two identities
reside in the same individual, while in the milder manifestations of
this condition there is a partial division of the same principle, a con¬
fusion of two natures in the same person. Where two alternating,
though altogether unconnected, lives are lived by the same being,
there is afforded, we think, a proof that mental identity is something
more than consciousness, and so far independent in its affections.
Indeed, it appears to us that the morbid states at present under
examination would have been more aptly described as instances of
double identity rather than of double consciousness. The phrase
double consciousness is a contradiction in terms, for it is manifestly
absurd to suppose that the mind can exist in two different states at
the same moment. It is also a misleading expression, for this is not,
of course, the meaning which it is intended to convey, nor is it at all
descriptive of the conditions to which it is applied. These conditions
are not necessarily characterised by any alteration of consciousness;
that is to say, if consciousness is regarded as having reference simply
to the present existing operation of the mind, for the ma n who
inhabits alternately two distinct mental spheres may be perfectly con¬
scious in both of them. In both of them his eyes, his ears, and all
his organs of sense, may be normally active. In both of them, with
equal accuracy, he may appreciate his surroundings, govern his
movements, and express his ideas. In both of them he may be
equally conscious, but he is not similarly conscious. The same
world is inspected from different points of view in each. In the one
it may be the real world, as it is to the perceptions of ordinary
people; in the other, the world clad in the unsubstantial figments of
a feverish fancy; or in both, a shadowy world, made up of metamor¬
phosed realities. But whatever the metamorphoses may be, they
arise, not from errors of perception, but of the personality—perceiving.
A man who has passed into the abnormal phase of double conscious¬
ness sees all the familiar faces that surround him, but he does not
recognise them; he hears loved and well-known voices, but they fall
upon his ears as strange sounds; he beholds his household gods, but
these do not, as they were wont, awaken emotion in his mind; in
short, he regards everything in a new light and apart from former
associations . f The mind, shorn of its past, begins to learn the lessons
of life anew, and perceives every object in relation to its new condi¬
tion, the result of internal changes. The outward creation becomes
subordinate to the inward idea, and is regarded only as it harmonises
with the reigning delusion.
But the distinction between the two phases of double consciousness
does not merely consist in the failure of memory, in the absence ox
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by Dr. J. Crichton Browne. .
remembrances of the past, either singly or in their relations. An
American author, distinguished alike for the subtility and beauty of
his thoughts, has made identity altogether a matter of memory. He
has said, “ It is by very little things that we know ourselves. A
soul would very probably mistake itself for another, when once dis¬
embodied, were it not for individual experiences that differed from
those of others, only in details seemingly trifling.” Without specu- *
lating as to what shall eventuate in the unknown future, in that day
when soul shall meet soul, “ without the clay between,” we may
safely assert that, in the sense in which the word is here used,
identity has little or nothing to do with experiences. Apart alto¬
gether from the experiences here referred to, minds cannot be
regarded as resembling each other as much as do the waves of the
ocean, and as having as little individuality as these. Minds are not
projected upon the earth as from a machine of a fixed pattern,
according to contract. They cannot be regarded as masses of clay
left to be moulded in the hands of time. The identity of a mind does
not depend upon the result of any such moulding, nor does this fun¬
damental behef grow, and develop, and increase, according to the
number of experiences, with all their trifling accessory circum¬
stances, through which the mind has passed. A man of mature
years and intellect and of vigorous memory has not more identity
about him than the child who is just beginning to taste the sunshine
of existence. In both the vital forces are operating continuously,
and both have, therefore, a conviction of continuous existence. In
the morbid conditions of double consciousness, however, there is
something positive as well as negative. One identity is laid aside,
with all the remembrances connected with it, but another is put on,
and with the new identity a new memory acts in concert. A well-
marked illustration of much that has just been stated is to be found
in the case related by Professor Stillman, and repeated by Dr.
Pritchard. “ A lady of New England, of respectable family, became
subject to paroxysms, which came on suddenly, and after continuing
an indefinite time, went off as suddenly, leaving her mind perfectly
rational. It often happened that when she was engaged in con¬
versation she would stop short in the midst of it, and commence a
conversation on some other topic, not having the remotest connection
with the previous one, nor would she advert to that during the
paroxysm. "When she became natural again she would pursue the
same conversation in which she had been engaged during the lucid
interval, beginning where she had left off. To such a degree was
this carried, that she would complete an unfinished story or sen¬
tence, or even an unfinished word. When the next paroxysm came
on she would continue the conversation which she had been pursuing
in her preceding paroxysm; so that she appeared as a person might
be supposed to do who had two souls, each occasionally active
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and occasionally dormant, and utterly ignorant of what the other was
doing."
It is necessary to remark that in this case, as in the one imme¬
diately following, there is no distinct statement as to an impairment
of personal identity. These cases, however, are in all respects so
closely allied to others in which there was an obvious involvement
of that fundamental belief, that it is almost fair to conclude that in
them, too, it was somewhat defective. The morbid condition was
not merely the result of a failure of memory and an obliteration of
the past, for the acquisitions of the past were retained and made use
of in the new conversation, which had no connection with the con¬
versation of the previous state. The patient in both cases was a new
creature. In the case which follows, and which is recorded by my
father, Dr. W. A. F. Browne, there was in the natural and healthy
state an entire effacement of one half of the actions and impulses
which went to make up the patient's history, which rendered her the
complex being that she was, and preserved her in relation to sur¬
rounding persons and objects.
“ J. H—, about two years ago, was affected with hysteria, pre¬
vious to a great constitutional change. The symptoms noticed were
the globus and spasmodic flexure of the fingers. The phenomena
which now exist followed this state, and were not modified by the
establishment of the constitutional change alluded to. For many
hours each day the patient is in what may be called her normal con¬
dition ; for nearly an equal number she is in an abnormal state. She
has no recollection during the one what passes or what she has
done, or acquired, or suffered, during the other. There is no tie or
connection between the two periods. The somnambulic state is
ushered in by a yawn, a sensation of globus, and the drooping of the
eyelids, which remain half-closed during its continuance, but do not
obstruct vision. It generally passes away by the ejection of a
mouthful of phlegm. Between these two acts, the yawn and the
eructation, the woman is vivacious, more mirthful than when herself,
knits, reads, sings, converses with relatives and acquaintances, and is
said to display greater shrewdness than at other times. Her letters
are better in composition and penmanship than she can produce
when awake, or in her natural state. This may be called her state
of clairvoyance. When aroused, she has no recollection whatever of
anything that has taken place. She has forgotten the persons she
has seen, the songs she has learned, the books she has read, and if
she resumes reading it is at the place at which she had stopped
when in her natural condition. When she reads in her abnormal
state the same thing happens. The development of the fit is gene¬
rally sudden and unexpected, but occasionally it is determined by
noise or the movement of articles in the room, such as the fall of a
poker or an alteration in the position of a chair. Her bodily health
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639
is perfect; all her functions are regular and vigorous. She has
lately complained of headache after tne cessation of the somnambu¬
lism, and upon one occasion she described the painful sensation as
confined to one side of the head.” In connection with this case, it is
worthy of remark that it was similar to those recorded by Mr. Dyer
in the * Philosophical Transactions/ by Dr. Dewar in Abercrombie's
‘ Intellectual Powers/ and by Major Ellicott in Combes' ‘ Phreno¬
logy/ in so far as the patient was a girl of hysterical temperament,
ana manifesting symptoms of well-formed hysteria. The disease in
this case yielded to moral treatment, all the morbid phenomena dis¬
appearing before the dread of removal to an asylum.
In Major Ellicott's case the lady periodically passed through two
conditions, separated from each other by a profound sleep, and
termed by the lady's relatives the “old" and “new state.” These
two states were in no way bound together, the patient's disposition,
capacities, and attainments, being different altogether in each of
them, so that she seemed alternately to be two distinct persons.
The following instance of double consciousness is in many respects
unique, and is taken from notes of the case made by my father, under
whose care the gentleman was. A. B. felt convinced that he was
himself and another person at the same time, and could not divest
himself of the belief that in his own body were two minds, suggesting
courses of conduct widely opposed. He felt assured that A. B., his
old or original self, was a base, abandoned villain, tempting his new
or other self, to whom he attached the emphatic ego , to commit mis¬
demeanours and acts to which his feelings were opposed. The
second person of the duality struggled with and resisted the vicious
solicitations of the first, such as that he should perpetrate self-
destruction. This internal combat sometimes became objective,
when the hands, acting under the will of the original or virtuous per¬
sonalty, beat and bruised the legs, body, and head, which were
supposed to belong to the second or depraved nature. The blows
were so severe as to leave marks for days; and when these were
referred to, the voice of No. 2 said, “ Don't justify him; he de¬
served it." The struggles between the two natures generally took
place during the night, the interference of the night-watch being
sometimes required to separate the belligerent powers. In con¬
versation with those around, A. B. spoke at one time as No. 1 and
at another as No. 2. In this gentleman the normal personal
identity of the individual was set aside by an erroneous belief,
springing out of cerebral disease. A state of mental duality existed,
with this unusual peculiarity, that the two opposite mental states
did not apparently alternate, but ran parallel to each other. The
true explanation was, that the two conditions did in reality rapidly
alternate with each other, the mind being thrown first into one
attitude and then into another, according to certain principles of
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540 Personal Identity, and its Morbid Modifications ,
suggestion; just as, in reading a dialogue, we can carry on two or
more independent trains of thought, by turns. When we argue with
ourselves, when we are doubtful upon any point, and hold an in¬
ternal controversy regarding it; when we hesitate between two
courses of conduct, and submit to our own judgment the reasons for
and against each, we are, so far, in the condition of the gentleman
whose case has just been related. But our nervous systems being
healthy, and our personal identity entire, and correlating the order
of phenomena in nature, we do not project the arguments on the
one side without us and convert them into hallucinations, nor do
we conceive them to be the offspring of another intelligence resident
within us. On the contrary, we continue to regard both pro¬
cessions of thought as the products of one mind; we continue to
recognise the links that connect them, no matter how antagonistic
they may be, and to believe that two very adverse counsellors may be
united in one personality. But all this A. B. failed to do. It may
have been in him, the ideas of opposite complexions succeeded each
other with morbid celerity, scarce giving him time to scrutinise the
process of their succession; but at any rate, he utterly failed to
classify these ideas, to reduce them to order by tracing them to a
common origin, whilst he discriminated, distinguished, and analysed
them all too narrowly and minutely. This he did in obedience to the
natural bent of his mind, for even when in health he had been
always prone to indulge in abstruse and vain philosophical in¬
quiries.
It is sometimes attempted to explain cases of double consciousness,
such as those we have described, by a reference to Dr. Wigan’s bold
and startling theory of the duality of the mind. The theory, how¬
ever, we venture to think, fails to throw any light upon the condi¬
tions, for if there be two minds, capable, under certain circumstances,
of independent action, each, whilst acting independently, ought to
manifest all the ordinary mental powers, and to retain or to lose the
recollection of the circumstances of the period when they both acted
consentaneously. But if the constantly varying inequalities in the
two mental conditions of double consciousness be opposed to Dr.
Wigan’s doctrine, so also is the mere fact of the transference of con¬
sciousness alternately from one to the other. What could deter¬
mine the conscious existence of one half of the mind in this moment,
and of the other half in the next ? According to Dr. Wigan’s
theory, they should both be contemporaneously conscious. To say
nothing, however, of the other weighty objections to the duality of
the mind, we may remark that there is much more to support Sir
Henry Holland’s suggestion regarding the duplicity of the brain as
elucidating those obscure conditions which we have been examining.
It cannot be denied that there are difficulties connected with this
theory also, that the evidence is insufficient for its complete esta-
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by Dr. J. Crichton Browne.
blishment; but still it is more plausible than any other that has been
advanced, and explains circumstances that would otherwise be
without explanation. Acute or chronic disease, producing obvious
lesion, affecting one side of the brain only, might, by disturbing the
correspondence or unity of action of the two sides of the cerebrum,
occasion double consciousness, and original inequality in the
formation of the two hemispheres might also tend to disorder and
derangement'in the trains of thought, passing into actual perversion
on the occurrence of any irritation. In accepting this theory, it is
not necessary at the same time to adopt the conjecture that two
states of mind may be coincident iu time. On looking at other parts
of our constitution in which a double organ is made subservient to a
single function, we find that accident, disease, and other causes,
interfere with their normal functions, and it is therefore conceivable
that the two hemispheres of the brain, when subjected to morbid
influences, may act separately and individually as well as the organs
6f the senses and voluntary power, and by their separate action pro¬
duce incongruity and confusion, where ordinarily all was order and
unity, as a result of their entire correspondence.
Changes in the cerebral circulation seem, occasionally, to hold an
etiological relation to attacks of double consciousness. A gentle¬
man of refined mind, the notes of whose case have been submitted
to me, lost his personal identity, upon assuming the horizontal posi¬
tion. During the day his mind was clear and coherent, and for
twelve hours he could laugh at the delusions of his companions and
at his own, but at night he believed that he had two natures; he
supposed himself to be in a state of mesmerism, that he was mad,
and # had the delusions of all the persons in the same ward concen¬
trated in himself; that he was at the mercy of supernatural powers,
which ruled all his thoughts and actions, filled his mind with visions of
things past and things to come, and compelled him to accompany the
night-watch on his rounds, and perform many other inexplicable deeds.
He, the sane man, positively declared these to be the delusions of an
insane man, who was himself, and yet different. This gentleman
probably laboured also under the effects of overstrained mental
exertion. When in health he had applied himself to metaphysical
investigations with intense devotion and energy, and, indeed, his
affliction was but the reflection of his ordinary habits of thought.
High intellectual tension, especially when combined with excite¬
ment of the feelings, i3 sometimes productive of other errors of per¬
sonal identity besides double consciousness—of errors which have
not, at least, been usually enumerated as instances of double con¬
sciousness, but which, nevertheless, have many points of resem¬
blance to the ordinary standard examples of that affection. Great
intellectual efforts, violent emotions, bursts of passion, of anger, of
love, of hate, of jealousy, are occasional causes, on the psychical
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side, of all forms of alienation; and the influence of these is greatly
increased when they act conjointly with detrimental physical
agencies, such as mephitic air, abuse of stimulants and narcotics,
alterations of the cerebral structure and of remote organs minis¬
tering to respiration, circulation digestion, and the sexual functions.
But the intellectual effort, when associated with mimic emotions,
with simulated passions, put on in the representation of some other
character and personality, seems to have an especial tendency to
produce errors of identity. The individuality of the great actor is
sometimes borne away by the tide of passion, the whirlwind of con¬
tending emotions, which he has himself created. He conjures up a
shadow, and in his contemplation ofuit forgets his own substance.
It is recorded by the biographer of Mrs. Siddons that on the nights
following some of her most triumphant performances she was pro¬
foundly agitated; that for hours subsequently, when unrobed, and in
the silence and solitude of her bedroom, she walked backwards and
forwards, not quite herself, not dissociated from the feelings and sen¬
timents of the Juliet or Desdemona she had represented, and that
her looks retained the fire or disdain, as the case might be, of “ the
tragedy queen.” This observation was recorded to demonstrate the
reality and sincerity of her acting, and it certainly demonstrates
this; but it does more, by showing that her impersonation was com¬
plete, that she had not merely assumed a character, but lost her
own in the creation of the poet; merged her identity in that of
another mind differing from her own, and experienced difficulty in
casting off the fancies of an hour and in regaining her natural and
familiar modes of thinking and feeling. Dr. Andrew Combe, I
have been told by one to whom he himself described the .fol¬
lowing scene, was one evening suddenly called to the Theatre Royal
Edinburgh to see M—. The curtain had just fallen and the foot¬
lights been extinguished, and he found the company still in their
grotesque dresses, in great alarm, and rushing to and fro around
M—, who had performed the part of Midas, and was seated grasping
convidsively the arms of his chair, staring wildly and fixedly on air,
and muttering through clenched teeth, “ I can't get out! I can't
get out 1" The ears of the closely fitting dress nodded over his
brow, the paint had been partially removed by the water used to
restore consciousness, the iace was deadly pale, he was surrounded
by a cloud of smoke from the sacrifice of royal plumes of feathers,
and altogether the scene mingled much of the ludicrous with the
horrible. In a short time the exclamation “ I can't get out!"
ceased, and after a few full sighs the morbid condition passed away,
and the actor was "himself again.'' He then stated that Ins
feelings and fears had overmastered him, that he became over-
E owered by the conviction that he could not and never could denude
imself either of the character or of the leather skin; that instead
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of turning everything into gold by his touch, he was himself
transmuted for ever into a mine and mummer; and he felt as if
bound and closed up, “ cribbed, cabined, and confined,” and that all
his struggles to escape were and must be fruitless. M— was, consti¬
tutionally, a sensitive, impressionable man, and at one time a som¬
nambulist. Similar anecdotes have been related of several illus¬
trious actors and actresses. Bachel experienced attacks like those
of Mrs. Siddons. It is stated in the affecting episode of Coralie
Walton, in Vandenhoff s ‘ Dramatic Beminiscences/ that the fragile,
heart-broken girl could not, at the conclusion of Hamlet, doff either
the character or the madness of -^Ophelia. It is impossible for us to
say how often the truly great artist does really throw off his own
identity and put on that of the character, so long and ardently
studied, so triumphantly represented. That this is sometimes the
case there can be no doubt. • The heat, the anxiety, the excitement,
the glare of light, all tend to induce the morbid condition. But in
quiet retirement, or in the paths of daily life, the exclusive or ex¬
cessive study of any one character or person may bring about
mono-ideaism and interfere with identity, so that at length a man
may come soberly to believe himself to be truly the person whom
he has so minutely contemplated, probably admired, and act in all
things in harmony with his belief. Cases of monomania in which
this is an unmistakeable and permanent perversion of identity are,
afe. has been already mentioned, of rare occurrence, but they are
occasionally encountered. On visiting an asylum once I saw a man
in the dress of a patient, standing in a shady corner of the airing
court, aloof from his fellows, in the attitude of an ecstatic, with
eyes turned heavenward and hands crossed upon his breast;
Ins hair was long and hung about his shoulders, his face pale, his
expression gentle and devout, and, altogether, his aspect was so
striking as to attract my special attention, and to induce me to in¬
quire of my medical guide, whose permission I have to place the
case on record, about his history and delusions. I then learnt that
this man had for years past believed himself to be Christ, and that
he never for a moment forgot or abandoned this delusion, but that
his whole life and conversation were in accordance with a fixed and
predetermined plan, and with the impious fancy which so constantly
and exclusively occupied his mind. He had been a labourer, of
loose morality, of little lore, either secular or religious, when sud¬
denly, after a period of excitement and ardent study of the Bible,
he became persuaded that his personality was .changed. All his real
antecedents sank into oblivion. He forgot everything about the
cottage where he was bom and where he had spent his life. He
could not find his way about the fields which he had roamed over as
a boy and cultivated as a man; he denied his relatives, and treated
them as strangers, and yet he displayed considerable power of mental
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544 Personal Identity , and its Morbid Modifications ,
concentration when applying himself to the subject uppermost in
his thoughts. He carefully studied the New Testament, and adopted
the Gospel narrative as being an accurate account of his earthly
career. He would talk of the miracles which he believed he had
wrought, of the parables he had spoken; he would reprove those
who laughed at him as scoffers and blasphemers, and promise rich
rewards to the patient auditor. When placed in confinement he
continued to cherish his delusions, but was always quiet, docile, and
reserved. When I saw him even the wild fantastic edifice that had
been piled up upon the ruins of his mind had begun to crumble
away, for several circumstances in the case heralded the approach of
dementia; but still, with all the unreasoning pertinacity of Words¬
worth's little cottage girl, he adhered to his morbid convictions;
and when told that he could not be Christ, for Christ was in heaven,
replied, “ Heaven is wherever I am." -Combe mentions a case cor¬
responding to the above. It was that of a clergyman who, having
become insane, believed himself to be Napoleon Bonaparte; and
under this conviction felt the most poignant remorse for having com¬
manded the massacre at Jaffa, and thus caused the death of so many
brave men.
Of the psychical epidemics of mediaeval epochs, that of lycan-
thropy is among the most interesting, and in it there was doubtless
sometimes a modification of identity. Two kinds of lycanthropy,
however, require to be distinguished—first, that in which the
zoomorphism was limited to the body; and secondly, that in whieh
it extended to the mind. In the first variety the sufferer believed—
and this belief was fostered by the superstitions of those around him—
that at certain periods his body was transmuted into that of an
animal, while his mind remained human and unclouded. Learned
discussions took place as to whether the transmutation was real or
only apparent, but the former was, of course, the more popular view.
In the second variety it was held that the mind was mvolved, and
assimilated to that of the creature whose form was worn, its human
attributes being temporarily abolished, so that the feelings and
instincts of the brute usurped the place of the sentiments and
reason of the man. The persons afflicted with this variety of
genuine lycanthropy were impressed with the belief that they were
really animals; that they traversed mountains and forests as beasts
of prey, running down and eating indiscriminately animals and
children; and the state of the palms of the hands and nails proved
that some of the sufferers had actually adopted the mode of pro¬
gression of quadrupeds. The disease has been chiefly manifested in
pastoral districts, and may have been suggested by the superstitions
incidental to a solitary and shepherd life, and by the entire devotion
of the thoughts to flocks and herds, and the accidents to which these
are liable. It was observed among the hunters and shepherds of
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by Dr. J. Crichton Browne.
Chaldea; it has appeared in Egypt, India, Greece, Germany,
Brazil, Abyssinia, and Jura. At the present day solitary cases
are sometimes, though rarely, encountered. Those affected with it
always exhibited symptoms of grave bodily disease, for we are told
that "their looks* were pale; their eyes hollow and dry; their
tongues exceeding parched; their thirst excessive, and their legs
ulcerated.” The bodily diseases under which the unfortunate victims
of lycanthropy laboured so affected their psychical nature that they
misapprehended the external world, themselves, and their mutual
relations. The belief of the transmutation in some instances probably
depended upon morbid sensations reflected in consciousness as veri¬
ties. In modem times the demon of lycanthropy is exorcised by
tonics, chalybeates, sedatives, nourishment, and moral discipline.
It is probably true that errors of identity sometimes occur in
delirious states and during intoxication, but the difficulty of recog¬
nising them is then very great, just as it is in mania, so that it is
generally impossible to arrive at any knowledge of the condition of
this fundamental belief in a maniacal paroxysm. One anonymous
author, who has given us some powerful pictures of insanity,
blemished, however, by a varnish of inferior fiction, seems to main¬
tain that a condition allied to double consciousness may be some¬
times observed in mania, and that the wild raving of that disease
may be resolved into a comminglement of two distinct currents of
thought. A careful analysis, however, of the incoherence of several
maniacs has failed to reveal to us any principle save that of suggestion.
There are, doubtless, errors of identity, having reference to con¬
tinuous existence in the future, as when the patient believes that his
personality is about to be changed. The connection of these with
the belief in identity is shown by their coexistence with and rela¬
tions to errors such as have been already described, having reference
to the past and present. A gentleman, illustrating the doctrine of
metempsychosis, believed that he had been changed from a dog into a
man, but he also held that in a certain definite time the canine nature
would return upon him, that he would lose his human identity, and he
therefore refused to make any provision for the future, to gain any
mental acquisitions, as these would all have to be sacrificed when he
again became a dog.
It would be highly interesting to examine personal identity more
minutely in relation to the last results of the combination and mixture
of all the particulars- that go to make up the man, or what are
commonly called idiosyncrasies—that give the peculiar character to
the man and his apprehension of external nature. This we may at
some future day venture to attempt, but at. present we must be
content with having roughly indicated some of the more prominent
of the errors of personal identity, which do not as yet appear to have
received that attention which they deserve.
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PART II.—REVIEWS.
Epilepsy, its symptoms, treatment, and relation to other Convulsive
Diseases . By J. Bussell Beynolds, M. D. Lond., &c., &c.
pp. 860. London: Churchill, 1862.
Dr. Bussell Beynolds has already given to the profession several
valuable contributions in connection with diseases of the nervous
system. In the work the title of which is given above he confines
himself to the subject of epilepsy, and its relations to convulsive
diseases generally, but more especially to convulsions of chronic
character. Although his work relates to simple epilepsy, which is
not so often met with in lunatic asylums, it is not the less valuable
on that account, but rather the contrary. It will at once strike
many of the habitual readers of this Journal that the cases described
differ notably from those met with in the asylum. The one set of
cases may throw a light on the other by their very contrast, and on
this account the book will be of the greater value to our own spe¬
cialty. In the following sketch of its contents, selection will be
made chiefly from those portions of the author’s treatise which have
the above tendency, but it must be stated in limine that there is no
part which does not deserve a careful study, and the whole, for the
rewords of facts alone, will be of great value as a work of reference
on the subject. All that can be attempted here is to give an outline
map of the regions explored. This may give a general idea of the
whole work, but those who would profit fully by Dr. Beynolds’s
researches should read the work for themselves.
“ Disease,” Dr. Beynolds remarks, “ is the sum total of modifi¬
cations of function and structure present at a given time; the
measure of disease is the degree in which it hinders a man from per¬
forming any or all of the functions of manhood. The importance of
any given disease is in direct relation to that of the kind of activity
which it limits or prevents. The classification of disease is unsatis¬
factory more or less with regard to all diseases, but especially with
nervous diseases. The three elements on which classification is based
are organ, function, nature of morbid change. In the author’s work,
r On Diagnosis of Diseases of the Brain ana Spinal Cord,’ &c. p. 48,
he has given the reasons for preferring the classification of diseases
into groups approaching more nearly to a natural system.”
“ Chronic convulsive diseases are a very definitive group; they
are, with few exceptions, readily recognised as such; and I propose
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in the following work to treat of them all, pointing out wherein they
differ and wherein they agree, and advancing, by the discovery of
the conditions upon which they depend, to a knowledge of the treat¬
ment which is appropriate to each.”
Vital actions, he proceeds to observe, are dependent upon or are
correlated with some physical change in the living organism, though
the process may be too fine for our instruments of research. Some
symptoms of disease are modified vital actions, others are physical
or chemical. The vital are of two kinds, negative or positive. The
negative consist in the negation of the vital property, as paralysis,
anmsthesia, and depend on some rough or coarser lesion, as the
pressure of a tumour. The positive consist in the excess or altera¬
tion of the vital properties, and are dependent on interstitial change,
as spasm, pain, convulsion, and the like.
“ It is no objection to this general proposition that frequently,
post mortem, we can discover no organic change in the brain or
spinal cord, for convulsions belong to the secondary category of
symptoms, and depend on modifications of nutrition.
"We may find a tumour in the brain, or tubercular deposit in its
meninges; we may find disease of the kidneys, or such general
derangement of the organs as scrofula or rickets can produce; but
wherever we may find these easily discovered physical changes they
are not the immediate causes of convulsion, for convulsion is a modi¬
fied vital act of muscularity and nervous force, and its proximate
cause is in the nutritive condition of the nervous centres.”
The following corollary gives dogmatically the physiological and
pathological basis on which the author prooeeds to discuss this part
of his subject—
(1) Convulsions are modifications of vital actions, and (2) depend
on nutrition-changes in the nervous centres; (3) the immediate
and proximate cause of convulsion is the same when the convulsion
is the same; (4) the proximate cause is an abnormal increase in the
nutrition-changes of the nervous centres; (5) the remote causes are
such as induce an abnormal increase in the nutrition-changes.
These remote causes it is the object of diagnosis to discover, and
their removal the aim of the treatment.
a .—The nutrition-change may be idiopathic or primary, a morbus
per se, the sole deviation from healthy structure being the change
in question. Dr. Reynolds argues that this conclusion is war¬
rantable from experience and the admitted laws of pathology. It
may be congenital or arise from conditions operating after birth.
The sole deviation from healthy structure being the intimate nutri¬
tion-change, the tendency to which is innate or acquired; the
only variation from normal function, the convulsion. There is
no greater difficulty in understanding this condition, he argues,
than in comprehending a tubercular or a carcinomatous diathesis.
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“ For, prior to the development of either tubercle or cancer as a
deposit or growth, we assume the existence of a tendency which will
eventually reveal itself; and this is all that we assume with regard
to convulsion.”
“ Further, there is nothing in the nature of convulsive pheno¬
mena which, per se, necessitates the supposition of anything beyond
a mere modification of the ordinary healthy processes; in other
words, there is nothing for which these processes will not account.
There is muscular contraction on the one hand, and loss of conscious¬
ness on the other; but that these are quite compatible with healthy
structure is shown by their forming part of the daily life-processes
of all.”
b . —The nutrition-change may be secondary to other changes in
the organism, and be the result of such condition. Dr. Reynolds
considers that such cases should be included in one general group
of eccentric convulsions. The rationale of eccentric convulsion he
gives in the following words. In obedience to an impulse from
without, the centripetal nerve affects a change in the nutrition of
the centre, or of that organ which is common to it and to a motor
nerve.
Eccentric convulsions may occur in three ways:
“ There are, then, different combinations winch may be placed in
the same general category of eccentric convulsions:—1st. Those in
whom the organic condition, which is the immediate cause of con¬
vulsions, may be, without special predisposition on the part of the
individual, induced suddenly by an eccentric irritation. 2nd. Those
in whom that condition is produced by the joint operation of a pre¬
existing organic tendency and an external disturbance. And 3rd.
Those in whom the organic condition is, without special proclivity
to disturbance in the individual constitution, gradually brought
about by the prolonged influence of an eccentric irritant.”
c. —The nutrition-change may be general, and be a part of a
systemic or morbid tendency, the nervous centres being involved with
the other organs and tissues. Dr. Reynolds tabulates this class of
causes thu3:
“ Diathetic, or cachectic convulsions; from—
“ General nutrition-changes:
“ Healthy in kind, but morbid in degree; puberty, &c.
" Morbid in kind and degree; tuberculosis, scrofulosis.
“ Toxsemise, arising from—
“ Retained excreta; urinaemic convulsions, f renal epilepsy/
“ Metamorphosed plasma; pneumoiiic convulsions, rheu¬
matic, &c.
“ Poison introduced from without; ‘ syphilitic epilepsy/ lead,
variola, &e.”
“ When convulsions occur in a well-marked instance of any one
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of the cachexise, it may be that they are primary, or idiopathic; it
may be that they are secondary, or dependent on eccentric irritation;
and further, they may be symptomatic, or produced by the irritation
of the nervous centres, as in tubercular meningitis. But over and
above these three modes of production, there are numerous cases
which require another explanation: viz., this, that the convulsions are
the direct expression of the cachexia which is present; the nervous
centres being involved in that general nutrition-change which is the
essential element of the cachexia itself.”
d.—T he fourth group of convulsive diseases Dr. Reynolds calls
convulsions from centric disease. An intra-cranial tumour, or any
other structural change, may set up that peculiar interstitial or mole¬
cular change which is the immediate cause of the convulsion; the
tumour, or some other cerebral lesion, being the remote, not the
proximate, cause of the convulsion; these causes, then, act ec¬
centrically, though situated centrically in an anatomical point of
view.
Such is a general review of the causes of chronic convulsion.
** In this volume,” writes Dr. Reynolds, u I propose treating only
of epilepsy proper, viz., of that form of idiopathic convulsions to
which 1 believe alone this name of epilepsy ought to be applied.”
In confining himself to the one section of the list of convulsive
diseases, or to that which he calls epilepsy proper, the question
naturally arises how such are to be distinguished and separated from
the rest. This the author gives in the following words from his
preface:
“ I have analysed eighty-eight cases of simple and idiopathic
epilepsy, this being the number of examples of that disease with
regard to which I have been able to record accurate information. In
them I could trace no evidence of any other affection, and to them I
could apply no other name than epilepsy.”
It is, then, by the process of exclusion by which the separation is
to be made, and it must depend, therefore, somewhat on the amount of
acumen brought to bear on the phenomena where these boundary
lines are to be fixed.
“ Epilepsy,” says Dr. Reynolds, p. 30, u cannot be defined by any
anatomical change, for no structural condition has been hitherto
found with sufficient frequency to be regarded as an essential
element with production.” Nor can it be “defined by one symptom
which is peculiar to it, and pathognomonic of its presence.”
In the absence of positive, we must be content with negative, know¬
ledge. The author, who is next occupied by a definition for the
disease, for the above reason, probably, finds some difficulty in
arriving at a formula which will accurately include all the pheno¬
mena. His failure satisfactorily to accomplish what he seeks is a
proof of the difficulty which besets the questions. He writes;
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“ Epilepsy may, then, be defined to be a chronic disease charac¬
terised by the occasional and temporary existence of loss of conscious¬
ness , with or without evident muscular contraction ”
The italics are the author's. He will excuse the remark that, with
respect to the latter part of the phrase, surely as piuch may be pre¬
dicated of anything—of this book; and the definition becomes
reduced to “an occasional and temporary loss of consciousness.”
But, after all, descriptions are more satisfactory than what are termed
definitions, and the following is such, and follows the above
quotation:
“ Epilepsy should be regarded as an idiopathic disease, i. e.
as a morbus per se, distinct from eccentric convulsions, from toxsemic
spasms, from the convulsions attendant upon organic lesion of the
cerebro-spinal centre, and, in fact, from every other known and appre¬
ciable malady.”
The cases of epilepsy and epileptiform diseases met with in asylums
belong, in much the larger proportion, to the class of symptomatic
convulsions from brain disease, &c. But a few only are of the
description which forms the subject of Dr. Reynolds's subsequent
pages.
“ Hasse has, I think/' Dr. Reynolds writes, “ stated very correctly
the relation which central lesions occupy to the disease in question,
viz.:—‘ Es ist also ein Irrthum, das Wesen der Epilepsie in einer
groberen Lasion des Gehirns und seiner Umgebungen zu suchen,
eine solche,|wenn sie vorhanden ist, wirkt als zufalliges Moment, indem
sie, natiirlich weit haufiger als entferntere Lasionen jene. feinere
Veranderung der Himsubstanz hierbeifuhrt, welche der Epilepsie
wesentlich zum Grande liegt.'
“ M. Sandras appears to be equally correct when he speaks of
central lesions as ‘la cause predisposante de l'etat dpileptique du
cerveau.' ”
Dr. Reynolds devotes eighty pages to a critical examination, by
the numerical method, of the symptoms of epilepsy proper, dividing
them into the paroxysmal and interparoxysmaL
Epileptic patients sent to asylums are selected on account of the
existence of mental symptoms; it will be, therefore, especially in¬
teresting to know the proportion of epileptic thus affected. Pro¬
bably imbecility, which is equivalent to incapacity of earning a live¬
lihood or of taking care of themselves, is the proximate cause
for the transmission of the epileptic person to a lunatic asylum.
Dr. Reynolds found that the memory was normal, or affected only
immediately after the fits, in 43 per cent, of his cases, and more
or less defective in 56 per cent., but only to a great degree in
one sixth of the whole. Apprehension was normal in 62 per cent.,
defective in 37 per cent. The general conclusions are thus
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“ Conclusions. —1st. That epilepsy does not necessarily involve any
mental change.
“ 2nd. That considerable intellectual impairment exists in
cases; but that it is the exception, and not the rule.
"3rd. That women suffer more frequently and more severely
than men.
“ 4th. That the commonest failure is loss of memory, and that
this, if regarded in all degrees, is more frequent than integrity of
that faculty.
“ 5th. That apprehension is more often found preserved than
injured.
“ 6th. That ulterior mental changes are rare.
“ 7th. That depression of spirits and timidity are common in the
male sex, but not in the female; that excitability of temper is found
in both.”
Probably, therefore, not more than about 16 per cent, -of the
whole number of epileptics would be deemed objects for a lunatic
asylum, and of these only a twentieth would be paupers. This will
afford some notion of the prevalence of epilepsy.
For a detailed examination of all the symptoms the space will not
suffice; and this part of the work, which is much occupied by
figures, will not admit of any epitomising, but requires a careful
examination and study.
We pass to what the author has to say on what he terms the
natural history of the disease; or, (1) its prevalence, which has been
a little anticipated; (2) its etiology; and (3) the relation between
its symptoms, and (4) the mental condition of epileptics, in its
several relations. His general conclusions on these points will be
read with much interest, and especially that the presence or absence
of intellectual failure he found to be independent of hereditary pre¬
disposition to the disease, of the age at which it commenced, or the
sex; and, lastly, that the duration of epilepsy per se is without
influence upon the mental condition of epileptics (p. 173). The
above is contrary to the generally received notions and the opinion of
Esquirol, from whom we have so many of our current notions on the
disease in general. The chapter, however, requires to be studied,
and the'full force of the words “per se” must not be lost sight of.
“ The general conclusion, therefore, in regard of age at commence¬
ment and the duration of the disease, is of much interest in relation
to the mental condition of epileptics; for, while on the one hand
neither ag e, per se, nor duration per se, can be shown to determine the
presence of intellectual failure, or the degree to which that dete¬
rioration may be carried, there is, on the other hand, evidence to
show that an early commencement of the disease lessens the proba¬
bility of mental incapacity, both as regards the fact of its occurrence
at all, and also the rapidity with which it will be brought about. A
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late commencement of the disease, on the contrary, is more likely,
not only to entail intellectual failure, but to develop that condition
speedily.”
The next question which Dr. Reynolds discusses is whether the
presence or absence of motorial phenomena exerts any influence on
the mental condition of the epileptic; and he concludes, from the
analysis of his cases, that the influence either way is very trifling, but
that motorial phenomena are not unfavorable, but rather the reverse,
to the mental condition. He also finds the mind is not influenced
by the state of the general health of the patient nor by the number
of attacks, but that the frequency of the epileptic fits is one condition
which favours the mental failure. And with respect to the severity
of the attack, his evidence is not sufficient to determine its influence.
The author next examines the kind of the seizure and occurrence of
the “petit mal” the general resume of which is in the following
Words:
u That neither one of the following elements—kind of attack, fre¬
quency of either form, rate of frequency, nor duration in years—is,
either by itself or in combination with the other elements mentioned,
sufficient to determine the mental condition of the patient; for the
two cases agreed precisely in all these respects, and yet in the one
there was no trace of mental deterioration discoverable, whilst in the
other the failure had been carried to the worst degree.
“ Again, we learn also that such a high rate of frequency as eleven
hundred attacks in the year may exist for seventeen years without
producing intellectual change, whereas so low a rate as seventy-two
in the year may damage the mental condition most seriously, and that
in five years.”
Lastly, Dr. Reynolds concludes that the failure of intellect of the
epileptic bears no relation to the circumstance of the disease having
arisen through “ psychical disturbance.”
We pass now to the author’s views on the pathology.
"Pathological anatomy has shown three things:—1. That there is
scarcely any morbid condition which may not be found sometimes in
the bodies of epileptics. 2. That no structural change is constantly ,
found at all periods of the disease. 3. That some lesions are of
more common occurrence than others. While this method, there¬
fore, fails to demonstrate the seat of the disease, it furnishes proof
that many lesions have no causal relation to its phenomena, and it
affords presumptive evidence that other changes may be most duly
regarded as its effects.”
The method which Dr. Reynolds considers has been more pro¬
ductive of results is the deductive. He gives a cursory survey of the
opinions advanced on the theory of genesis of epilepsy by Georget,
Prochaska, Marshall Hall, and finishes his remarks by these words:—
“Schroeder van der Kolk has gone still further, ana has- argued with
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great force, 1 that the starting-point of the various convulsive move¬
ments in epilepsy must be sought in the medulla oblongata/
“ To this conclusion the mind has been conducted by a series of
eliminations carried on by the accumulation of physiological facts and
principles. The two essential elements of a convulsive paroxysm
being involuntary muscular contraction and loss of consciousness,
some organ has been sought whence changes common to the two
classes of phenomena should originate. The researches of Marshall
Hall proved that convulsive movements were due, not to the cere¬
brum, but to the spinal centre; Weber demonstrated that, while
galvanization of the spinal cord produced tetanic spasms, a similar
irritation of the medulla oblongata induced spasmodic phenomena in
a clonic form; and Dr. Todd showed that epileptiform convulsions
arose from galvanization of the mesocephalon and tubercula quadri-
gemina. These results have all been confirmed by Dr. Brown-
Sequard, who has shown that epileptiform convulsions occurred in
his guinea-pigs after removal of all the encephalon except the pons
Varolii and medulla oblongata. Similar results have been obtained
by Kussmaul and Tenner.”
The two phenomena, loss of consciousness and convulsion, being
the condition or state produced, and the medulla oblongata the
organ through which they are produced, the question arises, what
is the immediate operating cause ? Dr. Reynolds argues that the
former phenomenon, loss of consciousness, is a simple negative or
arrest of function of the brain proper, as proved by the fact that the
same effect results from the removal of the cerebral hemispheres, and
that the latter phenomenon, the convulsion, can be artificially
induced by direct action exerted on the medulla or upper part of the
spinal axis; that the effect, the phenomena produced, is not one of
Structural but merely functional kind, and the whole a modification
of normal action. That the change in the medulla or cerebral
hemisphere is not an alteration of structure, is shown by the con¬
dition of the patient in the interparoxysmal period, who, in many
cases, presents no deviation from health or healthy function.
- The phenomena do not differ from normal function in kind, but in
degree only. Is the alteration through the effect of increased or dimi¬
nished action of the organ involved ?
“ If there is such a thing as ‘ action' on the part of the medulla
oblongata or the spinal cord, the facts appear to me to warrant
no other conclusion than that, during the onset of the epileptic
paroxysms there is * over-action' of these centres, and that such over¬
action is their proximate cause."
The author points out that there may be two conditions which may
conduce to the same end and produce increase of action. The
impressionability of the organ acted upon may be increased, or the
excitant may be in excess, the former of which Dr. Reynolds
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believes to be the state in epilepsy, and he quotes the authority of
Dr. Brown-Sequard, who agrees with him in this respect.
“ The nature of the morbid change in epileptics is an exaggeration
in degree of the functional activity of the medulla oblongata and
upper part of the spinal axis.”
But how is this over-action brought about ? In the first place,
Dr. Reynolds believes that the condition may be idiopathic—a
morbus per se .
“ Increased activity of the reflective centre may then exist by
itself, be developed primarily, just as a similar kind of change may
occur in other organs; and this in consequence of hereditary predis¬
position, congenital disposition, or subsequent morbid change. There
is no reason why the organ at fault in this malady should not
change primarily as well as any other organ, or as well as the whole
congeries of organs which constitute the body. Deviation from
health must commence somewhere, and in true epilepsy there is
defect of evidence to show that it has commenced, or even after
many years exists, elsewhere than in the part referred to.”
The disease may be transmitted hereditarily. “ It may be the
result of intense (functional) disturbance from violent external im¬
pression.” This may be mental or bodily. It may be induced by
a general cachectic condition, affecting the medulla with the rest of
the body; or the nervous centres may be affected by the above
changes, which involve the whole organism; or, though not morbid
in kind, as dentition, puberty, and pregnancy—
“ Augmented activity in the nutritive processes of the medulla
oblongata and spinalis "is the prime and essential fact in epilepsy;
it needs the addition of but an ‘ exciting cause ’ to set in motion
the whole train of phenomena which constitute the attack.”
“ The last mode in which the medulla oblongata and the upper
part of the spinal axis may become so affected as to produce epilepsy
is by the operation of morbid, accidental, or experimental lesion in
some portion of the nervous system. That cerebral or spinal
tumour, chronic inflammation of the meninges, softening of the
brain, neuromata, &c., &c., might occasion convulsions of epilepti¬
form character, has long been known; but it has been frequently
urged in this work that these cases are to be distinguished, in the
majority of instances, from true epilepsy. Their clinical history
differs either altogether, except in the mere existence and general
form of the attack; or in part, there being, perhaps, true epilepsy,
but, over and above this, the phenomena of structural disease.”
“ But lesions may be found outside the centre of reflection, and
yet within the nervous centres, such as tumours within the cranium,
&c. When so situated, they may induce epileptiform seizures in
one of two modes: either by their irritant effect upon afferent nerves,
such as those in the meninges; or by the extension of vascular
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activity from them, as its centre, into the contiguous medulla
oblongata.”
There is another fact, which is an important circumstance in this
disease, and, indeed, iu the phenomena of the causation of all diseases,
and which does not appear yet ever to have been brought out so fully
or placed so high in the rank of operating causes as it deserves to be,
viz., the reaction that occurs often between cause and effect, and
which may be illustrated in various ways; for instance, thus a person
becomes lame from a fall, and, being lame, he is liable to other falls;
so the fall produces the lameness, and lameness falls. A person gets
an attack of bronchitis, which produces an irritative cough; the
cough increases the irritation in tne bronchus.
“ Of great interest,” says Dr. Reynolds, “ is the further fact esta¬
blished by Brown-Sequard, viz., that with the change in the centre
parts there is also an alteration in the condition of some centripetal
nerves, or of their peripheric expansion. The paroxysms are induced
by irritation of the latter, and sometimes cured by its cauterization.”
“ And Yan der Kolk suggests what is probably the true relation
of these groups of phenomena, viz., that the constant nervous irrita¬
tion,” caused by mechanical peripheral injuries “ gradually affects in
the same manner the medulla oblongata.” Again, at p. 154, Dr.
Reynolds writes—
“ The nine cases placed in the list were illustrations of confirmed
epilepsy, the attacks having been first occasioned, and subsequently
reproduced, by eccentric irritation; or, such having been the case at
one period of their history, the attacks at a later period occurred
without any demonstrable eccentric irritation.”
The next division of Dr. Reynolds's work is on the relation of the
several symptoms of the disease to the primary cause, or primary
fact, which he examines in detail. The chapter of the diagnosis
follows, of which it can be only here said that it deserves attentive
study. The author appends a copious bibliography, and the value
of the book is greatly enhanced by an admirable table of contents
and index, the former of which alone is a valuable survey of the
whole subject.
We have extended this review to some length, but not to greater
than the importance of the subject, but especially the learning and
ability displayed in the author's work, demands. The analysis may,
it is hoped, afford a general view of the author’s opinions ; but the
detail and filling in of the picture should be examined in the book
itself by every one having epileptic patients under his charge.
W. H. 0. S.
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PART 111 .—QUARTERLY REPORT ON THE PROGRESS
OF PSYCHOLOGICAL MEDICINE.
I. —Foreign Psychological Literature. By J. T. Arlidge,
A.B. & M.B. Loud., M.R.C.P. Lond.
The system of exchange with other journals has enabled us to
increase the number of periodicals from which we may cull matter
for these excerpta, and may hope to maintain and to increase their
interest and usefulness among our readers. Moreover, we shall not
restrict our choice of extracts to the contents of foreign journals only,
but extend it also to essays, brief memoirs, and to the summaries of
the contents of works of more considerable magnitude which come
before us, with the intention of more fully representing the state of
, opinion and practice prevailing on the Continent and in America,
with regard to whatever concerns the pathology and treatment of
insanity and the management of asylums. And it is another portion
of our design, when detailing the opinions and labours of our fellow-
workers in psychiatry in other countries, as far as practicable, to
form an estimate of them by the light of, and in comparison with,
those of our own countrymen; in other words, to attempt a critical
examination of their value and importance.
The enlarged scope of our task will render more acceptable to us
the receipt of essays, brochures, and reports, from abroad, both from
authors and publishers. The more fully we can be kept au
courant with foreign psychological literature, the more perfect will be
our mirror of it; and none, we believe, can be found to gainsay the
advantage of learning what plans are formed and what progress is
made in ameliorating the condition of the insane, and in unfolding
the pathology of insanity, by the distinguished physicians who labour
beyond the shores of our own country.
1. On the occurrence of Insanity among Criminals in Solitary
Dr. Gutsch, the resident physician of the prison of Bruchsal, in
the duchy of Baden, in which the solitary or cellular system of
confinement has been carried out above twelve years, has contributed
a painstaking report of his experience of the system upon the mental
condition of prisoners, to the * Allgemeine Zeitschrift fur Psychiatric’
for 1862.
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He commences his paper by pointing out the particular ar¬
rangements of the Bruchsal prison, and states that there are many
departures from the severe discipline originally pursued in the
Pennsylvanian prison, where the cellular system was first adopted.
The prison itself was constructed in 1848, after an English model.
The inmates, though completely isolated from their fellow-criminals,
both day and night, are taught and engaged in some handicraft, the
proceeds of which go to their own benefit. They are, moreover,
regularly visited in their cells by the numerous staff of warders and
superior officers, and thus, by this contact with others, by regular
■occupation and instruction, by opportunities for reading and public
worship, and by exercise in the airing-courts, the evil effects of seclu¬
sion on mind and body are, as far as consonant with the carrying
out of the plan of isolation, obviated. It is only in cases of bodily
illness of a chronic character that the plan of separate confinement is
departed from and the patients transferred to an infirmary, though
even there they are still submitted to numerous restrictions, and,
when their malady permits, are retransferred to their prison cells.
Another feature of the Baden prison is that convicts of all classes
and ages are transmitted to it, and placed under the same discipline.
Dr. Gutsch presents a tabular statement of all the cases of mental
aberration which have occurred in the prison since its institution,
and remarks that he has included in it every instance of mental dis¬
turbance, whether it was slight or severe, transitory or lasting. Prom
this table it appears that, from the opening of the prison wards in
October, 1848, until the end of 1860, there occurred 84 cases of mental
disorder among 2666 prisoners admitted within that period. The
proportion of such cases to admission is, therefore, 3*15 per cent. In
another column he exhibits the per-centage of cases on the average
numbers resident in each year; and from this it appears that in each
of the years 1853, 1854, 1855, and 1856, the number of prisoners
attacked with mental disorder exceeded that in any of the preceding
or subsequent years, ranging from 2*70 to 3’39 per cent., whilst in
other years the per-centage has on the average been under 2 per
cent, of those resident. [Respecting the social position of the 84
insane convicts, 65, or 77 per cent., were unmarried; 17, or 20 per
cent., married; and 2, or 3 per cent., widowed. Again, insanity
showed itself much more prevalent among the labouring, uneducated
class than among those of higher station and education, occurring in
3’30 per cent, of the former and in l - 08 per cent, of the latter class.
The relation observed between the onset of mental disorder and the
character of the crime of which the prisoners were guilty is shown
by another table, from which it appears that, of 1354 committed for
larceny, 24, or 1*77 per cent., became insane; of 205 committed for
murder, 21, or 10 - 24 per cent.; of 101 imprisoned for robbery, 6, or
5*95 per cent.; of 256 guilty of mutiny, insubordination, and deser-
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tion, 11, or 4*29 per cent.; of 58 confined for forgery, 3, or 5*66;
and of 87 imprisoned for incendiarism, 2, or 2*30 per cent. Other
crimes are specified, and among them two, viz., murderous assaults
and poisoning, 6 convicts having been confined for the former and
3 for the latter offence. Of the 6 guilty of assaults, 1 became in¬
sane, or 16*66 per cent.; whilst of the 3 prisoners, 1 also became
mad, or 33*3 per cent.; a ratio in each instance of an astounding
character, though valueless in drawing conclusions, owing to the very
small number of instances in question.
The necessary limits of an abstract compels us to refrain from an
analysis of this interesting paper, which occupies three sheets of the’
journal in which it is published; we therefore turn to the brief sketch
of results, appended by the author himself.
1. The general tendency of crime and imprisonment to develop
mental disorder, fostered by natural depraved predisposition, receives
a further impulse by isolation. 2. Cases of mental disorder, attri¬
butable exclusively to solitary confinement, have, during the twelve
years of the existence of the prison, been few in number; in the
majority of instances predisposing circumstances have existed in the
individuals themselves, or in conditions external to them and inde-
E endent of the confinement under which they were placed. 3. One
alf of all the cases was of an extremely slight character; and the
course and termination of most of them was very favorable, and the pro¬
portion of recoveries equal to 70 per cent. 4. Superior education
and the mental activity enforced by instruction during the period of
imprisonment operate as safeguards against the ill effects or solitary
confinement. 5. The first period of incarceration, particularly the
first two half years, are most favorable to the outbreak of mental
disturbance, whilst, on the contrary, the lapse of time diminishes the
injurious results of isolation. 6. The nature of the crime is directly
related to the proclivity to insanity; thus, for instance, theft much
less compromises the mental integrity than do erimes in which the
passions are called into violent action. 7. With respect to the high
moral value of solitary confinement as a means of stirring up or
forcibly arousing the mind, the results arrived at from experience,
after taking into account the dangers threatening the mental inte¬
grity, conclusively prove what a powerful engine we possess in that
system, and how energetically it may act in the reformation of cri¬
minals. Lastly, our conviction of the advantages of this kind of
imprisonment over all others, whether for the purposes of incarcera¬
tion or of reformation, cannot be shaken.
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2 .—On Religious Revivalism in the Orphan Asylum at Elberfeld.
(‘AUgemeine Zeitschrift fur Psychiatric,’ Drittes Heft, 1862.)
Religious revivals, so-called, which have been native to the soil of
this country since the days of Whitfield and John Wesley, and are
luxuriant in growth among our cousins across the Atlantic, have
also become transplanted to Germany, and in a paper contributed by
Velthusen, the Protestant chaplain of the asylum of Siegburg, to the
* Zeitschrift fur Psychiatric’ (3 Heft, 1862), we have a sketch of a
remarkable outbreak of religious and cerebral excitement among the
children and others in the orphan asylum of Elberfeld, in Rhenish
Prussia, in 1861. The movement commenced with a series of prayer
meetings, suggested by the Evangelical Alliance in England, held at
the commencement of the year 1861. The purpose of these prayer
meetings was to supplicate an outpouring of the Holy Spirit in
general, and the conversion of the children of the asylum in par¬
ticular. However, at first the children took no part in them, but
only the staff of the institution. On the 13th of January, at the
close of the first week of such meetings, a girl, seventeen years old,
presented herself to the superintendent, lamenting her sins, and
expressing an ardent desire of forgiveness. She was soon followed
in this course by another girl of eighteen, and in fourteen days seven
female children in all were similarly affected. At first they remained
tranquil, and pursued their usual work, weeping, however, and
praying much. On the 28th of January the excitement made its
appearance among the boys, and persisted night and day, destroying
their sleep. Sixteen of them were placed together in a room, and
rather encouraged in the religious fervour by the superintendent,
who had, we suppose we must say, the satisfaction of hearing the
boys expound and preach the Scriptures and make fervid prayers.
On the evening of the . 31st the children, boys and girls, thirty in
number of each sex, were admitted to the meeting held by their
superiors, and from this date, the third period (so distinguished by
the writer) commenced, when an unfortunate boy, who had gone to
bed before the meeting, but could not sleep, heard that his conversion
had been a special subject of prayer by his fellow-pupils, became
excited, and was seized with convulsions. The fit lasted at that time
three hours, and on the following day he had two similar attacks.
During the fit he was speechless, but not unconscious, and afterwards
lapsed into a state of ecstacy. This event made a deep impression
upon the other children. On the 2nd of February, above sixty boys
and as many girls engaged in the prayer meeting, and among them
the boy who had suffered the convulsive seizures. Like several
other lads, this one also prayed aloud at the meeting, but was pre¬
sently again seized with a fit, whereupon a great commotion ensued
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among those present, and particularly among the girls. The result
was that two adults and several children had to be carried out from the
meeting. On the 3rd of February the excitement was extended to
the little children who had taken no part in the prayer meetings,
but had been put to bed before these took place in the evening, and
infants seVen and eight years old were found crying aloud for mercy
and forgiveness. On the 5th the bodily disturbance of the sufferers
became most apparent. Many children lost their speech, beat about
with their hands, and tossed their heads so violently about that they
required to be protected against injury. In some the attacks were
persistent, in others intermittent. Within a brief period fifty children
were seized with these convulsive symptoms. On the 17th of
February the prayer-meetings were suspended, and the cases of
mental disorder fell to twelve, and soon afterwards ceased.
Velthusen, in his examination of these circumstances, seeks for
historical parallels in the accounts of religious revivals in England,
Ireland, and America. Among other things, also, he tells us that the
cholera in 1849 devastated Elberfeld, and carried off a thousand
persons, and that one consequence of this visitation was an elevation
of religious feeling amongst the inhabitants, particularly among
those of the hamlet in which the asylum is placed, and which is
about a mile out of the town itself. Another circumstance to be
noted was that the staff of the establishment partook strongly of
the religious sentiment, and held opinions much akin with those
sects in England among which revivals are a cherished institu¬
tion. Like most writers, the author of this paper attributes
such abnormal manifestations in a community to the effect of
sympathy and of imitation under high mental excitement, without
any desire to deceive except in a few instances; and in illustration
he adduces epilepsy as an imitative disease, and recognised as such
by the ancient Romans under the name of morbus comitialis. He
further appeals to ecstatic seizures recorded of monks in the dark
ages, and to various convulsive maladies attacking large numbers of
persons in bygone times, as recorded in history; in several such
instances, however, no religions element entered, but only some
strong emotional excitement. Persons of weak minds, women and
children, are most prone to such seizures, and the constant grouping
of the same persons together, whether in schools or factories, or in
other places where they are cut off from wide intercourse with people
at large, contributes strongly to the springing up of such morbid
conditions. The worthlessness of such revivals is proved by the
ephemeral character of the religious fervour, and by the absence of
any permanent advantage to the moral and religious state of the
individuals who have been their subjects, except, possibly, in a very
few instances.
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3. On Lucid Intervals, in a Medico-legal Point of View.
By Dr. Legrand du Saulle.
(‘ Gazette des Hopitaux,’ 1861.)
A lucid interval, says the writer, consists in an absolute though
temporary suspension of the manifestations and characters of the
insane state. It is not uncommon in mania (about twenty-five times
in 100), sometimes occurs in melancholia, but very rarely in mono¬
mania properly so called, and as a most exceptional event when the
mind is the prey to hallucinations or illusions, or the victim of acute
dementia. Moreover there are certain forms of mental disease which
never exhibit them; such are confirmed dementia, imbecility, and
idiocy.
The patient enjoying a lucid interval is unlike a monomaniac, who,
though, from the limited range of his aberration, he may appear like
a sound man, is nevertheless a prey to a false conception, and always
under its morbid influence in his conduct. Moreover, a lucid interval
is to be distinguished from those flashes of intelligence and of calm
which momentarily and suddenly display themselves at times in the
course of mental disorder. Such occurrences are of excellent augury,
but are most readily interrupted and arrested by any circumstance
affecting the emotions or passions. The return of calm after excite¬
ment is another condition not to be confounded with a true lucid
interval. Although agitation may cease, the mind is still unhinged,
the ideas wandering, and the conversation incoherent; there is no
genuine restoration of mental integrity and power.
When a lucid interval is genuine and well evidenced, the. former
habits and disposition of the patient reappear, the physiognomy
regains its bygone expression, and the individual is fully aroused to
an interest m his affairs; he encounters his relatives and friends
with pleasure, and casts aside the delusions and dislikes his past
delirium had entailed, asking the forgiveness and sympathy of those
who have been the subjects of them. In an especial manner his
affections and moral feelings are found to have resumed their healthy
state.
On the other hand, in mere remissions, the attention cannot long
be sustained and fixed. There is a want of decision or fixedness
about the features; replies are brief, and often evasive; the speech is
interrupted or jerking; the voice somewhat smothered, and the
general aspect wanting in steadiness and solidity. Again, with
respect to those patients who seem well, and are anxious to regain
their liberty, we may notice that they make daily protestations of
their recovery, and of their no longer being victims to their parti¬
cular delusions. Their object is to practise an imposition and to
dissimulate respecting their state; and when pressed by questions,
VOL. VIII.
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they will be found to garnish their replies by falsehoods and misrepre¬
sentations. To such the dictum specially applies —“Incumbit onus pro-
bandi sanam mentem” No obscurity need be found in making the
distinction between the sane action of a lunatic and a lucid interval.
The madman does a reasonable thing, but his understanding con¬
tinues no less disordered; a ray of light has shot across the obscurity
of his mind, but it is only meteoric, and leaves no result. On the
contrary, in a lucid interval the actions are stamped by logical
sequences, and the mental integrity is sustained in its entirety for a
given period. If to establish a lucid interval all that was necessary
were the proof of a rational act or acts, no cause, however desperate,
need fail in obtaining deponents to the fact. But, as Marc ha3 well
observed, sane action is but an act; a lucid interval is a state.
Periodic insanity is a phenomenon sufficiently well known. In it
the intermissions are frequently true lucid intervals; the relapse into
mental aberration distinctly determinable, and not seldom occurring
at a fixed period. Prom such cases the simply variable forms of
mental disturbance sketched by Esquirol are perfectly distinct. In
these latter the calm following excitement is very remarkable, yet
the patients are unfit to quit the asylum and to mingle in society.
The mind in such does not resume its natural powers and rid itself
of the delusions oppressing it, whereas in the former class of cases
the mental integrity is so fully restored that they can resume their
place and occupations in the world, and, unlike the others, become
amenable to the laws for their actions.
Now, with regard to those insane who enjoy an intermission or
lucid interval, it is a most delicate question to decide whether a
crime committed during such an interval is attributable to diseased
propensity or is the result of unimpaired consciousness; in other
words, whether it is punishable or not, as the action of a mind free
from disease. And legal authorities differ as to the allowance to be
made where antecedent mental disorder has been established.
Physicians, when called on to give an opinion in such cases,
should not set themselves in antagonism with received opinions, and
advocate a general immunity from punishment for crimes committed
against society. It is their duty to ascertain the period of the
criminal act, and how long an interval has elapsed since the accused
was mentally disordered, and to gather from the evidence offered a
knowledge of the time at which the lucid interval has commenced or
may have ended. Weighing such information by the accepted
truths of pathology and practice, the next step is to discover what
have been the insane conceptions of the individual during his last
attack, to analyse them, and to determine how far the imputed crime
stands in relation with them. If, for example, the history of the
past delirium shows that the mind has been the prey to homicidal
or to incendiary propensities, and to hallucinations of commands to
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kill or burn, then, if the act for which the accused is committed is
directly associated in character with such tendencies, a strong
opinion should be put forward that it was the result of morbid
impulse and of the absence of moral control. On the contrary, if
no such accord subsist, if some probable ground for the crime can be
suggested, and an attempt at self-justification be made, the con¬
clusion must be that it was the result of premeditation and of
responsible consciousness, though, from the known history of the
previous insanity, no opinion respecting the radical absence of
consciousness should be asserted. To sum up, it is possible to
reduce the criminal acts committed during intermissions or lucid
intervals in periodic insanity to three types:—1. The act is com,
mitted under circumstances which leave no doubt in regard to the
relative entirety of the faculties. The duty then is to point out the
possible influence of anterior attacks of insanity on the will of the
criminal, and to extenuate his culpability. Under such circum¬
stances it is for justice to be tempered with mercy. 2. The crime is
the act of an individual who, though preserving the appearances of
intelligence, is nevertheless the subject of mental oppression. The
duty then is to establish the lesion of the understanding by means
of evidence obtained by examination of the accused, and by his
general bearing and aspect. The conclusion therefrom is that there
is legal irresponsibility, and the finding of the court would usually
be—not guilty on the ground of insanity and confinement in an
asylum. 3. The act is the consequence of deliberate will, but has
been almost immediately followed by an outbreak of delirium, or by
nervous disorders more or less akin to insanity or to epilepsy.
Here the duty is to determine whether simulated disease is not the
real feature of the case, and if the morbid phenomena presented do
not constitute a too faithful transcript of former conditions ; and, in
a case admitting of more doubt, to require its provisional removal
to a suitable asylum, to institute further observations, and to furnish
a report of such further study to the judicial authorities, who will, in
all probability, be thereby guided in their decision.
With respect to the bearing of lucid intervals on the validity of
testamentary bequests, the Trench law lays down no rules. The only
reference to this matter in the Code Napoleon is —“ that to make a
will, the testator must be of sound mindbut in practice the wishes
of a person during undoubted intermissions are recognised, and it is
left for the legatees to prove that the testator was, at the time of the
execution of the will, of unsound mind.
In general, the propriety of a testamentary act is no measure of
the integrity of the mental faculties at the time of its execution, ex¬
cept so far as it can be distinctly proved that the mind was at that
period free from insanity or enjoying a lucid interval. Tor the
mental discernment indicated by the will may be a consequence of
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those temporary glimpses of a sound judgment, often enough noticed
in acute mental disorder, and not of any restoration of the reason;
therefore the act itself is open to dispute, and does not do away with
the charge of madness. For, as M. Brierre de Boismont has pointed
out, the wisdom of the act is not in itself a presumption of the exist¬
ence of a lucid interval.
Lastly, in most instances the representations made to a physician
by parties desirous of upsetting a will are marred by self-interest, by
inexactness, by exaggeration, and even by falsehood; and the advice
by Marc is very good, that to arrive at a sound conclusion the phy¬
sician should most carefully investigate the value of the documents
and evidence submitted to him; and that when such are produced
only by persons directly interested in pressing their adoption upon
him, he should only give a conditional decision; or, in other words,
should intimate it to rest upon the supposed correctness of the facts
placed before him.
4. On the Inequality in Weight of the Cerebral Hemispheres in
Epileptics. By De. Baume.
(‘ Annales Medico-Psychologiques.’ Tome viii, 1862, p. 426.)
Dr. Baume states that the observation of the inequality in weight
of the two hemispheres of the brain was first made by the late
Dr. Follet, of the asylum of St. Athanase, at Quimper, in a report
of 300 autopsies made by him between 1833 and 1854. According
to this physician, such inequality was not found except in cases of
hemiplegia and of epilepsy, and was constant in the latter affection.
Forty epileptic cases were adduced, and the difference shown to vary
from 15 to 290 grammes. To these Dr. Baume, formerly the
assistant of Dr. Follet, added, in 1855, ten other observations,
making a total of fifty. The following table exhibits the results
arrived at.
of Psychological Medicine.
565
Difference of 30
grammes
met with nine times
. 270
„ 25
w
„ four times
. 100
„ 20
99
„ seven times
. 140
„ 15
99
,, four times
. 60
„ o
99
„ once
0
Total observations
. . fifty times.
Differences 2534
Between 1856 and 1862 Dr. Baume has made the following addi¬
tional observations:—
Difference of 159
grammes
met with
once ,
159
D
125
99
99
99
125
99
102
99
99
99 *
102
99
85
99
99
99 *
85
99
70
99
99
99
70
99
55
99
99
99
55
99
40
99
99
JJ
40
99
31
99
99
twice .
62
99
30
99
99
once •
30
99
20
99
99
twice .
40
99
15
99
99
99
30
99
8
99
99
once .
8
99
4
99
99
99 •
4
99
0
99
99
four times
0
Total observations . twenty times. Differences 810
Dr. Baume gives the history and detailed account of the autopsies
of the last twenty cases of epilepsy, which we cannot detail here, and in
his resume quotes the opinion of Baillarger, that such inequalities
are rather the consequence than the cause of epilepsy, and due pro¬
bably to the congestion of the fits being more severe, and therefore
producing more atrophy in one hemisphere than in the other. Now,
in three of the oases adduced in full this opinion seems to he borne
out, so far as the fact goes that there was more post-mortem con¬
gestion of the atrophied than of the other hemisphere. But, as
Baume remarks, in those three cases the inequality of weight
appeared connected with a congenital malformation of the cranium,
and the epilepsy was itself probably due to the same cause. At the
same time the explanation of Baillarger would seem true with respect
to the similar cerebral differences in incomplete hemiplegia. Bauchet
and Delasiauve have expressed their opinion that it is premature to
assign any direct pathological relation between such inequality of the
hemispheres and epilepsy, and the latter, indeed, contests the fact of
its existence, except as an occasional event.
The existence of different opinions on such a simple matter of
fact renders it most desirable that similar researches should be
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carried on, and that the existence of inequality should be examined
in connection with all other morbid conditions, whether of the brain
itself or of its. enclosing bony case; and we heartily commend this
field of inquiry to our medical superintendents, who have ample scope
for it in the . multitudes of epileptics which crowd our asylums.
Contributions to medical science will be particularly valued in the
pages of this Journal, and it will be a great satisfaction to be able to
point to the good work accomplished by our English psychological
physicians, who ought assuredly to take a higher stand generally
as cultivators of the pathology of insanity than they hitherto have
done.
5. Hereditary Insanity.
(‘ De la Folie Her^ditaire; Rapport Medico-legal/ par le Dr. Morel, p. 29.
Paris, 1862.)
M. Morel, of the asylum of St. Yon, Rouen, has recently pub¬
lished a brochure on hereditary insanity, ‘ De la Folie Her&htaire/
&c., taking for illustration a remarkable case which not long since
created much excitement during its trial at Havre. M. Morel is
well known to our students of psychological medicine for his able
* Traite des Maladies Mentales/ and especially for his bold effort to
overturn that symptomatic classification of insanity which has so long
been in vogue, and to substitute a more philosophical one in its
place. He rejects mania, monomania, and melancholia, from the
category of mental disorders, objecting that neither excitement nor
depression of mind is a pathological entity, but only an accidental
external manifestation or symptom, dependent on various unlike
conditions of cerebral action and cerebral lesion. The divisions or
groups he constitutes are based upon the intrinsic relations which
must subsist between the form of tne insanity and the nature of its
cause, and stand thus in his classification of mental disorders:—
1. Hereditary insanity. 2. Toxsemic insanity, or insanity due to
-the introduction of poisonous agents in the blood. 3. Insanity
resulting from the transformation of certain neuroses. 4. Idiopathic
insanity. 5. Sympathetic insanity; and 6. Dementia. Of this last
group he remarks, it is not, properly speaking, a primitive form, but
rather a terminal condition, or the sequence of any and every form of
primitive insanity; at the same time it has, whatever its origin,
certain common characters and distinct internal and external signs.
This etiologico-pathogenic classification, says its author, is calcu¬
lated to facilitate the solution of the principal medico-legal problems
which can be submitted to the physician touching insanity. It is
not enough for the medical expert to simply affirm the existence of
insanity in an individual, but he must indicate the grounds whereon
he distinguishes reason from madness, and the voluntary act from the
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result of mental disease. He fails altogether in enlightening a court
in a difficult case, by affirming that the crime in question has been
the consequence of monomania, or, in other words, of an irresistible
impulse to kill, rob, or burn, or to commit any act of depravity. He
thereby supplies no rigorous facts by which alone the ambiguities and
doubts of the case can be removed, but only advances a worthless
theory. To arrive at a certain proof of the insanity of an individual,
there must be an exposition of the characteristics, whether in¬
tellectual, physical, or moral, which constitute insanity in general, and
the different varieties of it in particular. And it is not necessary to
be a physician in order to understand the necessary and serious re¬
lations which must exist between a cause ever acting on the nervous
system and disturbing its functions and the abnormal phenomena of
the understanding and emotions attributable to that cause. A
magistrate can readily conceive that the nervous disorders of a
drunkard are of a different character to those of an epileptic, that the
brain may be affected by sympathy or by actual lesion of its sub¬
stance, and that the symptoms of idiopathic differ from those of
sympathetic delirium. In fine, the actions of individuals suffering
from disorders of the nervous system bear an impress upon them
which enables them to be referred to their true pathological source,
and can furnish to judge or jury the most convincing evidence of the
morbid state of the accused.
Hereditary taint, in M. Morel’s opinion, plays a most important
part in determining the question if insanity be the cause of crime in
any case. Heredity, says he, dominates the pathogeny of nervous
affections; it forms a part of the organization of an individual, and
leads to the perpetration of acts of some particular kind, apparently
inexcusable, inasmuch as intelligence apparently survives the loss of
moral feeling. Heredity, he contends, constitutes by its influence a
special vesania, and represents the mental conditons variously called
instinctive, reasoning, and moral insanity, delirium of the actions,
perversion of the moral sense, mania without delirium, and periodic
mania. “ The principal monomanias of Esquirol, the partial mad¬
ness, the systematised delirium of some authors, and e lucid insanity,’
as lately so-called by M. Tr£lat, have their usual origin in the
faulty intellectual, physical, and moral dispositions transmitted by
progenitors.” . “ The subjects of hereditary insanity are in¬
stinctively prompted to evil, and this even at their earliest age.
Their disorder is evidenced rather by senseless, dangerous, or immoral
acts, than by delirium in speech. Some are intelligent; the memory
is not defective; their clearness of mind (lucidite) is often perfect,
and they can reason like sound men ; and when their delirium shows
itself, it is commonly restricted to a few objects.”
Both Pinel and Esquirol have fully recognised hereditary insanity
as having special characteristics. The former insists on its periodic
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form or the existence of intermissions as an essential character,
whilst the latter has well portrayed the features of hereditary in¬
sanity, exhibited in the moral and intellectual states, and in the
conduct, habits, propensities and physiognomy of its victims. The
children of lunatics, concludes M. Morel, offer a group of characters
discoverable, not only in their intellectual and moral, but also in
their physical, defects, and to these characters he applies the term
■“ stigmata of heredity.”
Proceeding to the critique of the particular case of criminality he
adduces in illustration of his general views, M. Morel remarks, on
the one hand, the difficult position in which psychological physicians
sometimes find themselves, on account of the popular feeling that
from their special studies they are disposed to discover madness in
every case of crime ; and, on the other, the strong feeling which
sets in against a criminal guilty of some foul offence, and which, even
where insanity is discoverable, tends to displace any commiseration for
him and to withhold the recognition of his irresponsibility before
the law. On the other hand, an atrocious or unheard of sort of
crime is no evidence that the person who committed it is insane.
The acts of an insane person are deducible from his malady or flow
from it as a logical sequence, just as the acts of a criminal are
traceable to his passions or to suggestions which he has freely yielded
to. The insane are rarely capable of arranging a defence of their
conduct ; they frequently conceal, it is true, their actuating motive,
but they do not invent falsehoods in excuse of a crime of which they
believe themselves innocent; and when they acknowledge themselves
worthy of death they glory in the result of their acts, as having been
committed by them in order that they might openly manifest to the
world that they have been the victims of an unjust persecution.
These last observations by M. Morel are called forth by the survey
he makes of the cause celebre of the Marshal Gilles de Ray, in the
time of Charles VII, who was found guilty of and punished with
death for the wholesale murder of young children for his morbid
diversion. And, as M. Morel remarks, this great criminal invented
falsehoods in his defence, and at the same time, by his answers to
the accusation against him, rendered homage to the voice of con¬
science by attributing his crime to the instigation of the devil and to
a morbid desire to imitate and outdo some of the Roman Caesars in
their acts of horror and inhumanity. Here the conscience was
touched by remorse, the criminality of the act admitted, and a
motive or attempted explanation suggested; and though the horrid
nature of the crime charged might possibly be imagined as assign¬
able only to mental disease, yet the evidence goes to justify the
sentence pronounced, and to annihilate the plea of insanity.
It happens with many insane that they commit acts of the most
disorderly, absurd, and dangerous character, often, as it were, in-
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stinctively and without control, and without any attempt to assign a
motive, or, at best, express a motive of the most frivolous kind.
Such are the features of hereditary insanity. In other forms of the
malady the actions are dictated either by hallucinations, especially
those of persecution, or else spring from some source of suffering,
either physical or moral in its character. In cases where instinctive
spontaneous and unforeseen impulses appear to account for a lunatic
act, such impulses imply no special form of insanity, though
they have a specific relatign with the diseased state of the individuals
concerned. And the physician would be greatly embarrassed unless
he could discover the relation of such impulsive states with certain
perverted organic functions as revealed by symptoms, such, for
instance, as severe and intolerable pains in the head, periodic neu¬
ralgias, derangements of the principal functions of the economy,
distinct or latent neuroses, &c. The last-named symptomatic dis¬
orders, latent neuroses, are well illustrated by what is now recognised
as latent or masked (larvee) epilepsy.
In the case of the hereditary insane the symptoms of their dis¬
order are frequently little noticed until they culminate in some
fatal or destructive act. Its signs are placed to the account of
eccentricity, of temper, of imitation, &c.; but the physician who has
attained a proper conception of hereditary insanity in all its bearings
wifi take a different view of their purport, and be prepared to attach to
them their true weight when the long calm or lucid interval is
broken and dispelled by the outbreak of vice and crime.
The history of M. Morel's illustrative case, and the able psycho¬
logical analyses accompanying it, are too long for an abstract of this
sort ; yet we would heartily recommend our readers to peruse the
pamphlet for themselves, and to satisfy themselves of the original and
philosophical manner in which its author handles a medico-legal
question.
6. Maniacal Delirium dependent on latent or mashed Epilepsy.
(‘ D'une Forme de Delire suite d’une surexcitation nerveuse se rattachant a une vari&d
non encore decrit d’Epilepsie,—Epilepsie Larvee, par le Docteur Morel.’ Paris,
1860, pp. 28.)
The association of maniacal delirium with epilepsy, as usually
revealed to us by convulsive phenomena, is a universally recognised
fact; but it has of late been demonstrated by M. Morel and Jules
Falret that many recurrent forms of maniacal excitement are equally
allied with epileptic disease, although this last is not evidenced by its
ordinary convulsive features. This variety of recurrent mania, de¬
pendent upon what we may call an epileptic habit, has been expressed
in France by the term “ epilepsie larvee"—latent or masked epilepsy.
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M. Morel wrote an interesting essay on this morbid condition,
under the title affixed at the head of this article. This essay is
based on clinical observation, but we have no space here for a notice
of the illustrative cases recorded, and therefore confine ourselves to
a summary of facts.
“ Epilepsy is a neurosis which, by the repetition of its paroxysms,
induces in most individuals attacked by it a series of disorders of the
sensibility, as well as of the intellectual and emotional faculties, of a
special character.
“The different lesions together constitute a form of insanity
marked by such characters as distinguish it from all other varieties
of mental disorder. Epilepsy most .frequently displays itself by con¬
vulsions, falls, and vertigo, but it may also be present in the system
in a latent or masked state, without such external symptoms, though
it still involves the same disturbance of the sensibility and of the
intellectual and emotional faculties as if it were manifested by the
usual convulsive and vertiginous attacks.”
Under such circumstances the diagnosis of epilepsy is arrived at
by detecting the principal symptoms characteristic of epileptic in¬
sanity, viz.—
“Periodical excitement, followed by prostration and stupor;
excessive irascibility, without cause; the manifestation of aggressive
violence, marked by instantaneity and irresistible impulse; exaltation
of the sensibility; homicidal and suicidal tendencies; intercurrent
insane ideas connected with the state of cerebral excitement; exagge¬
rated notions of physical power, of wealth, of beauty, or of in¬
telligence ; erotic tendencies coupled with exalted religious feeling;
hallucinations of terror; sensation of luminous atmosphere: horrible
dreams, or nightmare; gradual progressive debility of the powers
of understanding, and especially of the memory; loss of recollection
of events transpiring during the paroxysms, the insane symptoms
at each periodic attack having, both with reference to the ideas
which occupy the mind and to the actions committed, the same
identical character; and, lastly, the violence and duration of the
delirious excitement determined by the duration of the remission.”
Such cases are to be met with not only in asylums for the insane,
but also in general medical practice. In asylums two classes of epi¬
leptics are found, the one presenting the usual convulsive phenomena,
the other not, but only a group of symptoms according with those
just sketched, and yet not less dangerous. And it often happens
that, after some months, or even years, distinct epileptic attacks
make their appearance in the latter class of patients, and then it is
generally observable that a mitigation subsequently occurs in the
violence of their acts and conduct.
“ I do not,” says M. Morel, “ look upon the phenomena (sketched
above) in the light of complications of insanity. They are, in fact.
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the ultimate symptomatic expression of an epileptiform neurosis,
existing at times in an undeveloped or masked form for a long
period, and productive of a variety of madness which has been
variously designated—as mania, with fury; periodic mania; sudden or
impulsive mania; moral insanity; instinctive mania; suicidal, homi¬
cidal, &c., monomania. For my part, I regard this form of mental
aberration, attended with lesion of the sensibility, of the understanding,
and of the emotional and moral powers, as a variety of epileptic in¬
sanity. At the same time I take care to recognise the difference
between the form of epilepsy described and the epileptic, or rather
epileptiform, convulsions the consequence of alcoholism or of
softening of the brain in general paralysis.” Lastly, the consideration
of the morbid state in question has a direct and important bearing
in many medico-legal inquiries, for it shows the possibility of re¬
ferring a certain set of symptoms to their true origin—to a malady
of which the criminal acts of an individual may probably be only
the external manifestation.
7 . On the Cost of Maintenance of Chargeable Lunatics in France ,
and on Colonisation as a means of wholly or partially defraying
that Cost .
Such is the subject of a brochure by Dr. Billod, the chief physician
of the asylum of St. Gemmes, in the department of Maine-et-Loire.
For in France, as in this country, the question of the day is, what
is to be done with the ever-growing number of lunatics ?—and each
French asylum physician, like his English colleague, has a pet
scheme to adduce in response to it. The example of the colony of
Gheel now occupies the foreground in the attention of the French
physicians, and that establishment has been inspected by several of
the most eminent of their number, been reported upon, and its merits
and demerits, and its applicability to France, eagerly and repeatedly
discussed at the meetings of the f Medico-Psychological Society of
Paris/ as well as in various writings. Moreover, a scheme of colo¬
nisation, of collecting the insane in considerable numbers over a
wide area, affording ample opportunities for their out-door employ¬
ment, has been received with much favour. M. Billod is an advocate
of a plan of this sort, and writes to prove that, given so much land
and so many insane cultivators as are necessary to farm it by spade
labour, the produce will be ample to repay the cost of maintenance
of the establishment and of its inmates, cultivators and non-culti¬
vators, and also of its necessary staff of officers.
M. Billod begins his pamphlet by showing the rapid increase in
the number of lunatics in France, and appends a table of the total
number of admissions into the public asylums in each year between
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1835 and 1853 inclusive. From this it appears that, to select one
or two examples, there were 3947 admissions in 1835, 5536 in
1839, ( i . e. when the new lunacy regulations came into force),
7518 in 1845, and 9081 in 1853.
Passing by the causes and possible explanations of this rapid
increase in the number of the insane, M. Billod remarks that its
consequences are twofold—(1) the enormous tax it involves, and (2)
the overcrowding of asylums; and his remedy for both evils is ex¬
pressed in the following proposition :—that from the profits of agri¬
cultural operations, in which the cost of manual labour and of
manure is reduced to a minimum, every lunatic asylum may exone¬
rate the department which has established it from the expense of
its pauper lunatics, provided that such a sufficient extent of land be
allotted to it as may, by its cultivation, produce a revenue equiva¬
lent to the expenditure incurred in their behalf.
In establishing this proposition the author calculates that, after
eliminating the cost of labour and of manure from the charges of
cultivation, the profit remaining would be at least 15 per cent .; and
in this estimate he states he has the concurrence of some of the
best practical farmers in his district. But, he rightly subjoins, the
amount of profit must vary according to that of capital invested, as
regulated by the value of the land and its fertility, and according to
the number of lunatics.
To M. Perrus, says Dr. Billod, is the honour of having been the
first to attempt the institution of an agricultural colony, viz., the
farm of St. Anne, near Paris, as a supplementary institution to the
Bicetre. This farm comprises about 100 acres j these are cul¬
tivated by patients drafted from the Bicetre, others of whom are
occupied in a large laundry and fulling-mill attached to the farm.
The revenue of this industrial establishment increased from 1957
francs in 1833, to 53,349 in 1841. In this account of St. Anne's
farm M. Billod has forgotten to mention the extensive piggeries at¬
tached, from which, in fact, the best portion of its proceeds is derived.
But the most considerable and the most successful attempt at
colonisation in a locality apart from an asylum has been made by
the brothers Labitte, the proprietors of a large private receptacle
for the insane at Clermont, in the now well-known colony of St.
James, which forms an annexe at some distance from that institution.
This colony represents in principle the scheme M. Billod contends
for. He would have a large farm at some distance from the district
asylum, though dependent on it for its medical service and general
administration. The adoption of the system within the immediate
vicinity of an existing asylum would, he says, necessarily place the
authorities very much at the mercy of the surrounding landed pro¬
prietors, and put them to a much greater cost for the purchase of
the additional land required than if it were carried out at a distance
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from it. Moreover, the separation of the annexe would have the
advantages of dissevering the mind more completely than the asylum
precincts could do from its disordered feelings, of lessening the
ideas of confinement and of restriction of liberty, and of surrounding
the inmates with conditions more akin to those of ordinary life.
If from any cause the purchase of land were thought undesirable
or were impracticable, the rental of a sufficient area for cultivation
would be found a profitable investment. Another benefit would
accrue from the agricultural colonisation scheme, viz., the prac¬
ticability of usefully and beneficially employing the idiots and mere
imbeciles, who either uselessly crowd lunatic asylums, or are ex¬
cluded from them, as is generally the case in France, as inadmissible,
or are miserably located, as in England, in workhouse wards.
M. Billod, though advocating this so-called colonisation scheme,
nevertheless disapproves of the system as carried out at Gheel, and
would oppose its introduction into France.
Before concluding his essay M. Billod addresses himself to the
question of the distribution of the large number of lunatics in the
department of the Seine, and insists on the evils attendant on the
plan hitherto pursued, of sending those who could not find accom¬
modation in the asylums of the department to the provincial in¬
stitutions. But, he remarks, it was better in the mean time, and
until a proper scheme of accommodation could be matured and
carried out, to do this than prejudge the question by ill-contrived
additions to overgrown asylums, as has been done by the magistrates
of Middlesex in the case of Hanwell and Colney Hatch. And it is
gratifying to find that M. Billod has convinced himself that his
" honorables confreres” on this side th§ channel have had no hand
in the adoption of so absurd a proceeding.
Now, there can be no question that an agricultural establishment
after the model M. Billod places before us would be of immense
benefit to numerous patients in an asylum, to the asylum authorities
and administration, and to the ratepayers taxed for its support. As
a rule, the profitable employment of their inmates in farming and
other industrial pursuits has been much more widely carried out in
Great Britain than in France, and the Lunacy Commissioners have
been foremost in enforcing the acquisition of a fair extent of land in
connexion with our asylums; and we hope to see the day when the
system of aggregating vast numbers of insane in huge, unwieldy
buildings shall be laid aside, and be replaced by the creation of
annexes, having the character of village communities, with ample
land for the full and profitable occupation of their inhabitants. But
we must express our doubts whether the notion that by agricultural
colonies of insane, the cost of the maintenance, and that of the
asylum of which they would form appendages, could be covered by
profits accruing from them, is not Utopian. Mr. Hill, of the York
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Asylum has apparently pushed the employment of patients’ labour
as far as practicable; yet, although the returns obtained bv him
materially diminish the cost of maintenance on the whole number of
inmates, they are very far from covering it. And in dealing with
such a question, it must not be forgotten that the residents in an
asylum are patients , and cannot be systematically and regularly put
to labour, for their forced subjection to work would represent a new
form of coercion in exchange for the mechanical restraint which it
has taken so many years to abolish. M. Billod has, moreover,
reckoned on a constant 15 per cent, profit; but this is to suppose a
farmer’s paradise, where weather is always propitious, crops always
good, blight and disease unknown among crops and cattle, market
prices at a fixed and profitable figure, and labour always equal to
the demand.
Nevertheless, though the advocacy of a pet project has led M.
Billod to see only its fair side, unmarred by any drawbacks, the
general principle of his scheme is good, and the publication of his
brochure very opportune in the present dilemma of deciding how to
provide for our insane population.
8. In re Non-restraint.—Casimir Pinel v. Conolly.
(“ Examen da Non-restraint/’ ‘ Journal de Medicine Mentale,’ 1862.)
In I860 M. Morel, who had been despatched by the authorities
of the department of the Seine Inferieure to examine the English
asylums, with particular reference to the abolition of coercion in the
treatment of the insane, published an account of his observations
and conclusions, highly favorable to English opinion and practice,
and calculated to remove many prejudices against the non-restraint
system, as pursued in our country, and to promote its adoption in the
asylums of France. This work, by M. Morel, has, no doubt, become
familiar to very many of our readers, whilst, on the other hand, its
extent and importance render an abstract suitable to this paper im¬
practicable.
Our attention has been called again to this essay just now because
it seems to have aroused the wrath of Dr. Casimir Pinel, which, as
he informs us in his “ Examen du Non-restraint,” contributed to
the ‘ Journal de Medicine Mentale,’ 1862, has been bottled up in a
written but unpublished work since 1856, then called into that im¬
mature state of existence by the appearance of Dr. Conolly’s work
on ‘ The Treatment of the Insane without Mechanical Restraints.’
That his laboured MS. folios should be altogether lost to the world
was, no doubt, a painful thought for their writer, and consequently
M. Morel’s book presented the opportunity, and the pages of the
journal the means, to rescue them from oblivion.
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M. Pinel tells us, in his introductory remarks, that he has read M.
Morel’s book with great interest; but if so, he has failed both to cull
from it the instruction he might have obtained, and to dissipate a
single prejudice and misconception from his mind which he aforetime
entertained when he wrote his manuscript in 1856. In fact, we
are disposed to believe that M. Pinel was determined -to abide by his
preconceived opinions, and to publish his otherwise lost labour to
the world, with all its obsolete objections and mistaken notions intact;
for on reading through his series of papers we find scarcely any
reference to M. Morel’s work, although plenty of errors and prejudices
which would not have appeared, had he read that work with a view
to his own profit and to correct his judgment, in his now published
critique. Non-restraint and Dr. Conolly are the objects of ms attack,
and from the manner in which he deals his blows at the latter, one
might suppose he had some personal feeling against him. The only
possible interpretation for this seeming animus against our English
physician, and his claims as a benefactor of the insane, is that of an
ill-judged jealousy for the honour and merits of the great Pinel,
whose ever-esteemed name he has the good fortune to bear. But we
doubt not the shade of his distinguished ancestor would be greatly
provoked by such a purposeless and frivolous onslaught on an emi¬
nent man, who has ever recognised the great claims of the first Pinel,
and been proud, as his disciple, to develop the principles of humane
treatment of the insane he so ably propounded.
To proceed. After announcing his unborn work, M. Casimir
Pinel has the audacity to remark that his opinion, which he tells us
coincided with that also of most alienists, was that “ M. Conolly had
added nothing to what was practised in France for more than half a
century” before he wrote; and to this statement he presently sub¬
joins that “ non-restraint dates” in England from 1839, and that up
to that period the situation of our insane was most deplorable, and
that no change had taken place in the “ old regime of damp dun¬
geons, chains, handcuffs, &c.” To remedy this state of things, he says,
Dr. Conolly meritoriously took the initiative in England, and he then
endeavours to prove that that eminent physician has no claim to any
originality in opinion or in action in the reforms he advocated and
carried out, but that he was only a feeble copyist of the brilliant
examples exhibited in the treatment of the insane in the asylums of
France since the days of the illustrious Pinel.
It is astonishing to find a physician at the present day venturing
upon such opinions and statements, in direct opposition, as they are,
to facts recognised by every one conversant with the history and
progress of the moral treatment of the insane. Such a proceeding
indicates a wilful perversion of historical facts, and cannot be too
severely reprobated.
The object of his first chapter is to derogate from Dr. Conolly all
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honour as an originator of improvements in the treatment of the
insane, and his first reference is to the teachings of Soranus and of
Caelius Aurelianus. All honour, we say, to these ancient preachers
of humanity to the insane; but what effect had their teachings
on the practice of their contemporaries and of succeeding generations ?
And, again, what advance in moral or in physical science has not
been shadowed forth by the doctrines and discoveries of sages of a
by-gone age ?
But it is to his distinguished ancestor's (Ph. Pinel) works that the
writer principally refers, in order to substantiate his statement that
Conolly originated nothing new, and he quotes several passages from
them, which certainly prove how wise and humane were the ideas
promulgated by Pinel, and how far he stood in advance of his time.
But surely this was an act of supererogation, for neither Dr. Conolly
nor any other sane man questions in the least the paramount merits
of Pinel, as the great reformer of his age in the treatment of lunatics.
And, on the other hand, these quotations certainly do not prove
that the reforms he so ably promoted have not been further developed
and extended, both by Conolly and other well-known physicians.
There are few at the present epoch who would coincide with
Casimir Pinel in asserting that the management of the insane and
the amount of coercion proposed by the elder Pinel were the ne plus
ultra in perfection; that his system represents that sensible and
judicious non-restraint beyond which the condition of lunatics does
not permit an extension ; and that the camisole, mechanical confine¬
ment in bed, seclusion, and t he douche, must ever be continued as means
necessary to their salutary treatment. Indeed, it must be evident to
every unprejudiced thinker that, if to Pinel the great merit be due
of striking off the chains of the lunatic, of reducing mechanical means
of restraint to a comparatively mild character, of claiming for the
lunatic his position as the subject of disease and not as a malefactor,
and of demanding for him a mode of treatment fitted to him as a
being still amenable to kindness, and in need of the same hygienic care
as a sane man, to Dr. Conolly also is due the merit of demonstrating
that coercion is not essential as a means of treatment, and that
lunatics can be employed, clothed, amused, and dealt with generally,
as ordinary individuals, to a much greater extent than Pinel sup¬
posed to be practicable. To Dr. Conolly belongs the credit of de¬
claiming against mechanical restraint as always an evil, which ought
to be eradicated from the means of control in use; of devising various
expedients in the way of dress, bedding, &c., to meet those difficulties
in treatment which served as apologies for mechanical coercion; and,
above all, of replacing such coercion by minute supervision and by
untiring care and forethought. In short, he was foremost in de¬
veloping that state and condition, that tout ensemble of asylum
management, which M. Morel so clearly recognised and so justly
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appreciated in his able memoir above quoted, whereby alone non-
restraint becomes practicable and salutary.
It is by having been mainly instrumental in effecting this transi¬
tion, thus rudely sketched, that Dr. Conolly, as we maintain, did
materially add to the principles of treatment as advocated by the
great Pinel, and as put into practice in France prior to the time
when non-restraint became the watchword of English asylum super¬
intendents under the leadership of -Conolly. Unluckily, indeed, the
advance made has been of slower progress in France, for it was
there for a long time misunderstood and misrepresented, but now its
practicability is becoming widely admitted, and, as a consequence, it
bids fair to be soon generally adopted. Taking into consideration the
record of opinions of French asylum physicians, as collected by M.
Morel, on the subject of restraint, and the principles and practice of
the best known alienists of France, and amongst them M. Girard de
Cailleux, as set forth in published works, we are at a loss to know how
M. Casimir Pinel can substantiate the assertion he puts forth, that the
majority concur in his views, and that even those who know what is
going on in England are unanimous in denying the possibility of the
entire abolition of mechanical coercion. How can he explain his state¬
ment that not even M. Morel believes in the practicability of the total
abolition of restraint, when the whole tenor of that physician's book
on the subject irrefragably proves that he has witnessed and has con¬
vinced himself of the practicability, and when, as at p. 79, he writes
“ that he has definitely adopted the resolution" to lay aside the use of
restraint, and at p. 104 speaks of the total abolition of all means of
coercion in the treatment of the insane, as the great object to be
realised. But M. Casimir Pinel cares little for the accuracy of his
statements, as an examination of his whole paper proves. What but
the most profound ignorance or premeditated misrepresentation is
evidenced in the following remarks, that in 1884, when M. Ferrus
wrote his sketch of English asylums, “England had not modified its
system (of treatment). It was still in irons and handcuffsthat
until 1889 " nothing had been changed from the old regime of damp
dungeons, chains, and manaclesand that, as the general deduction
from all his quotations and observations, the asylums of France
were in the intervening period most admirably managed and their
inmates most happily lodged and cared for, offering in all these par¬
ticulars a most marked contrast with what existed in England.
The reform, as effected by the first Pinel, is, as we have already seen,
the model held forth to us, and the Salp6triere and Bic£tre the insti¬
tutions par eminence for our admiration, as exhibiting all those
qualities so lamentably deficient in our English asylums until 1839.
But we would call M. Casimir Pinel’s attention to the grave defects
indicated by Esquirol and Ferrus in the models he would submit to
our admiration, and to the present valuation placed upon them in the
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recent report made to the Prefect of the Seine on the unfitness of the
Salpetriere and the Bicetre as asylums for the insane. Moreover,
he should inform himself of the state of the asylums and of their
inmates in Prance generally, as'told by Esquirol and Perrus, at the
period he draws such a dark picture of those in England If he
is honest iu his inquiries, he will find that long since 1839 the con¬
dition of the insane in many provincial asylums of Prance has been
most unsatisfactory, and the buildings themselves altogether unfit
for their purpose. He will discover, too, that the humane doctrines
of his illustrious progenitor were slowly received and acted upon in
the Prench provinces, and that restraint chairs, iron rings, handcuffs,
and other instruments of coercion, in addition to his much-beloved
camisole, dark and damp cells, insufficient food and clothing, and
many remnants of barbarous treatment, lingered in use long since
1839. We can likewise, from our own personal observation of
many Prench provincial asylums, testify that in 1855 the condition
of the insane, the abuse of restraint, and the accommodation pro¬
vided, were in some of them equally bad, and in many particulars
worse, than in the worst English asylums in 1839.
But not only has M. Casimir Pinel withheld all notices of an un¬
favorable condition of things in French asylums at the period of the
history of which he professes to give a sketch, but he has implied
generally the absence of special institutions for the insane in England,
and has altogether ignored what Esquirol, Perrus, Parchappe and
others have mentioned approvingly respecting them and their inmates.
Perrus (writing in 1834) at p. 64 of this work ‘ Des Alienas/
remarks, by way of comment on the activity displayed in England
towards providing for the insane after the Act of Parliament of 1827,
how happy it would be for Prance if, by a similar measure, the
lunatics of the departments could be withdrawn from the public
gaze and from brutal treatment without being exposed to the horrors
of dungeons, and could they be transferred to suitable places of
treatment. But before proceeding with quotations from M. Perrus,.
we must state, in justice to English asylums in 1834, when his work
appeared, that his notes apply to the state of things in 1826, when
he made his visit to this country, and consequently, by reason of many
ameliorations carried out in the eight years’ interval, do not fairly
represent their condition at the date he wrote. Still, on this very
account, the remarks of M. Perrus on the comparative state of
Prench and English asylums are of more weight in dealing with the
unfair representations of M. Casimir Pinel.
Now, though M. Perrus has to complain of the prison-like
models after which the asylums existing in England in 1826 were
constructed, of their consequent heaviness of appearance and the
contracted spaces allotted for exercise out of doors, of the excessive
restraint in use by chains or other fastenings and of the want of baths
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and of classification, yet he found many things to commend, and to
recommend for adoption in the similar institutions of his native
country. For instance, he refers approvingly to the greater atten¬
tion given in England to warming the buildings, to thoroughly
drying the linen worn by patients, to the better- clothing and diet
afforded them, to their more extended employment, to the opportu¬
nities given them for religious worship, and to the better remuneration
of their attendants. Lastly, M. Ferrus has the following compli¬
mentary paragraph—that “ he cannot too often repeat, as the result
of his examination of English establishments and of his own practice,
that the most efficacious means of treating the insane at the com¬
mencement of their attack are, order, kindness coupled with firm¬
ness, diversions, and, at a later period, work.”
It is further proper to remind M. Casimir Pinel that the wants of
the insane, as elucidated by his distinguished ancestor, were more
largely and thoroughly appreciated in this country than in France,
and were sooner met by the erection of suitable asylums for their
care and treatment. In 1826, when M. Ferrus inspected them, the
English asylums were few in number, and were some of them soon
afterwards much improved; but in 1839, when our author would
intimate the condition of the insane was first cared for in England,
their number was very considerably augmented, whilst in France
comparatively few specially constructed buildings were to be found.
Moreover, at this date many and great improvements, both in detail
of construction and of internal management, had been effected. The
employment of patients in various trades and occupations had even
then been extended beyond what the first Pinel had suggested.
Indeed, the idea of employing the insane usefully, and as a means of
treatment, had been broached and acted upon in the Friends*
Retreat, at York, before Pinel's teachings had reached this country.
Moreover, at this last-named institution the use of chains to restrain
and of corporeal punishment of the insane were, at an equally early
period, interdicted. In fact, if we look through the works of several
old English physicians on insanity, we can discover many of the
humane and true principles of treatment so forcibly and eloquently
propounded by Pinel clearly recognised and enforced.
In conclusion, we are compelled to admit that a considerable
amount of restraint was in use until Dr. Conolly commenced his
attack on its employment in 1839. But was there more at that date
than in France, where Dr. Casimir Pinel tells us the principles and
practice enforced by Dr. Conolly had been in operation fifty years
before this zealous reformer commenced his operations ? The value
of the assertion we have already examined by reference to the descrip¬
tions of French asylums, and of their practice, given by French phy¬
sicians, and the same reference furnishes an auswer to the question
of the relative prevalence of mechanical coercion in France and in
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Eugland in 1889. We hesitate not to affirm that in this year
named, and prior as well as subsequent to it, mechanical restraint
had been much more extensively resorted to in France than in Eng¬
land. The mode in which the coercion was applied is of secondary
consequence. The melodramatic effect to be got by talking of the
clanking of chains is made much of by M. C. Pinel, and chains are
represented as peculiar to England since the days of his great an¬
cestor. However, if he will read his countrymen's account of French
asylums, he will find England enjoyed no monopoly in such instru¬
ments of restraint during the period in question. Unluckily for
English reputation, such appliances were most in use formerly in
Bethlem and St. Luke’s Hospitals—institutions which, from their
metropolitan position and more ancient foundation, were best known
to foreigners, and looked upon by them rather as model English insti¬
tutions for lunatics. Again, our asylum superintendents formerly
preferred, in general, an apparatus of steel rings to fix the hands by
means of belts attached to the waist, or to link the feet together,
to the camisole, as employed in France, to the use of which they
found many objections. It is not our intention, however, here to go
into the relative merits of the two sorts of restraint; both are now
condemned as bad, and few English physicians will appreciate the
great merits which the camisole evidently possesses in the eyes of
M. Casimir Pinel over the rude rings and straps of our forefathers.
Perhaps we have devoted too much time and attention to the
shallow and ill-inspired paper criticised, yet it seemed to us that its
statements should not go forth unchallenged, and that Dr. Conolly’s
merits should be redeemed from the obloquy sought to be cast upon
them. Had it been necessary, we could have shown the initiative
taken by England in the construction of specially adapted buildings
for lunatics, on the influence of its example on French asylums, on
management, and on treatment, and on the influence of English legis¬
lation in lunacy on that of France.
Death of Professor Ideler.
Among events deserving notice in a psychological record is the
death of Prof. Ideler, of Berlin, who held, as chief physician of the
section for the insane at the large “ Charite” Hospital of Berlin, and
as a copious writer, a distinguished place, particularly in Germany, in
the professional world. He was born in .1795, and in his early
medical career, from 1815 to 1821, was a surgeon in the Prussian
army. On leaving the army he entered into practice in one or two
small towns, but his ambition led him ultimately to Berlin, and to
bring himself into notice he wrote, in 1826, a work on ‘ Anthro¬
pology for Medical Men.’ Langermann brought him forward, and
directed his attention to psychology, and he soon made himself
famous by his celebrated treatise on ‘ General Dietetics,’ and by the
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comprehensive 1 Grundriss der Seelenheilkunde/ His last con¬
siderable work was the ‘ Treatise on Judicial Psychology/ published
in 1857. During the last few years of his life he was a prey to
hypochondriasis, and succumbed at the close of last July to an
apoplectic seizure.
He occupied a chair in the University of Berlin from the year
1840, and gave public clinical lectures, in summer, on dietetics, and
n winter on the treatment of insanity. Many of the lectures on the
latter subject have from time to time appeared in the ‘ Annalen des
Chari te-Krankenhauses/
His countrymen assign Ideler a high place among those who have
advanced the pathology and treatment of the insane, particularly at
that period when the practices of past barbarous ages were first in
course of being expelled from the German asylums. However,
Ideler did not follow far in the wake of the great Pinel, as regards
the moral treatment of the insane. A great amount of restraint, and
little amusement, exercise, or occupation, fell to the lot of the
inmates of the insane wards of the Charite Hospital. Those wards,
occupying part of the same building with others de'voted to syphilitic
cases, were built as a detached wing to the general hospital, but on
the same plot of ground, and were most unfit abodes for lunatic
patients. It might be supposed that the great influence of Ideler
might have secured the construction of a suitable asylum for the
insane of the capital of Prussia; but we fear he did not fully appre¬
ciate the teachings of modern psychologists respecting the wants of
the insane, and retained many practices and opinions exploded in
almost every other asylum in Germany, France, and England.
From our own observation of the Berlin insane wards, we can speak
to the extensive employment of restraint by various means, and to
the severe system of forcible douches, administered in a manner and
in a degree unseen in any other hospital for lunatics, and certainly
very contrary to the present accepted ideas of what is suited for the
insane. However, with all his errors in opinion and practice, Ideler
deserved well of his country, and will for many years be remembered
for the many good works he has done.
* The American Quarterly Journal of Insanity* 1862.
0
This journal is sufficiently well known to most of our readers by
reputation, if not by an acquaintance with its pages. It is compara¬
tively an old established periodical, published quarterly, and has now
reached its eighteenth volume. Various excellent original articles
have appeared in it from the pen of many of the distinguished asylum
superintendents of America; but the reprinting in toto, or in abstract
and translations, of papers previously published in various European
periodicals, has always constituted a more prominent feature of this
American journal.
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We h^ve now three parts before us, which might furnish several
subjects for analysis, but, owing to the length to which this paper has
already extended, we will confine ourselves to a brief but important
communication from Dr. Workman, of the Toronto Asylum, Canada,
and to the record of a Will case, having important bearings.
9. Cases of Fracture of the Ribs in Insane Patients, revealed by
Post-mortem Examination.
(* American Journal of Insanity/ April, 1862.)
The writer first notices a case reported by Dr. Gray, of the New
York State Asylum, Utica, and remarks that he is "fully persuaded
that such cases (of fractured ribs) are of more frequent occurrence
than may yet have been apprehended. The absence of all the symp¬
toms ordinarily resulting from fracture of the ribs or sternum, and
the final supervention of others having no apparent relation to the
previous condition of the patient, are abundantly adequate to the
induction of erroneous diagnosis. So far as I am aware, the existence
of thoracic injury in cases similar to that recorded by Dr. Gray has
in no instance yet recorded been inspected prior to death, and has
first come to light only through post-mortem examination. This
fact sufficiently warrants the beuef that we have not yet become so
familiar with these casualties as we might have been, and as certainly,
for our own safety, we should be.”
Dr. Workman then goes on to remark on the little value of the
opinion of surgeons unacquainted with the insane, when given in
evidence of what, from the injury discovered, they assume, from the
general symptomatology given in books and from their experience in
some individuals, to have been its cause, its necessary characters, and
the date of its occurrence.
Except the medical public generally acquire correct notions
respecting the peculiarities of disease and injury in the insane, " how,”
asks the writer, " can we hope (as alienists) to protect ourselves from
the fallacies of their testimony, whether before the tribunals of justice
or the more terrible ordeal of public judgment—a court whose revi¬
sions of error hardly ever come in time to reinstate its victims in the
position of innocent, much less of meritorious, men ?”
Dr. Workman quotes a case recorded by Dr. Smith, of the
Durham Asylum, in his report for 1860, and refers to other cases of
fractured ribs occurring at Colney Hatch and elsewhere. His
general deduction is, that the most formidable disease may exist in
the insane without any of the usual symptoms, and that death may
occur among them without a cause apparent to the physician. "The
only reliable basis of correct diagnosis in the bodily ailments of our
patients is that which is educed from constant autopsical research.”
Acting on this opinion, he has, in all cases where the true pathology
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was not evident, made post-mortem examinations, and has met with
two instances where the ribs were fractured, though in neither of them,
up to the time of death, was there present “ any symptom which in¬
dicated broken ribs, nor, indeed, any other form of chest disease, with
the exception of oedema of the feet and legs in one, and this condition
appeared only four days prior to death.” The first case occurred to
Dr. Workman in 1859. The man was thirty-three years of age, and
“reported before admission to be a furious and dangerous lunatic.
On admission he was pale, as if from inanition and want of sleep.
He was restless, noisy, and destructive at first, but in the course of
three weeks became quiet and harmless, took food well, and appeared
to rest well at night. He complained of no pain whatever, and had
no cough.” On the thirty-third day after admission oedema of feet was
noticed; this extended upwards, and on the third day after, hydro¬
thorax was evident, and he died the next day. After death the left
thorax was filled with water, the right thorax was half full, and about
three ounces existed in the pericardium. In the abdomen also there was
effusion. Seven ribs were found fractured, and presented very imper¬
fect marks of restorative action. The condition of the broken ends,
and the whole appearance of adjacent parts, proved satisfactorily that
the fractures were of a date more remote than that of his admission.”
The brain was highly congested, and the lateral ven^icles contained
about an ounce and a half of serum.
The second case w as that of a tall, powerful man, labouring under
general paralysis, admitted December 17 th, 1861, and certified to
have been insane for only eight weeks previously. He was noisy, had
no pain, appetite keen. He continued to go about until six days
before his death, when, from an apparent aggravation of his paralytic
condition, he was kept in bed. He gradually became more feeble,
but had no coma, and could swallow, though with difficulty, until a
few hours before his death, which took place on the forty-ninth day
from his admission.
Not the slightest suspicion was entertained of any thoracic injury;
but on dissecting the right side, a deposit of dark pus was found at
two points beneath the pectoralis major, and beneath these were the
fractures, occupying the first, second, third, and fourth ribs, about
an inch from their cartilaginous ends. “Scarcely a single pus-
globule was discernible, so that the deposit could not have been
recent. No separation had taken place. The right pleura was
adherent to the fourth rib. The fractures ranged in a straight line,
as if all caused by one blow, or most probably by a fall on some hard-
edged substance. In neither side of the thorax was there any deposit
of serum w'orthy of notice, and the lungs were both healthy. The
pericardium contained about three ounces of serum, and the heart
presented partial fatty degeneration. The scalp showed an old
cicatrix, about an inch and a half from and behind the anterior
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fontanelle. The dura mater was adherent to the skull from the
anterior fontanelle backward over the whole summit, and also to the
brain front the same point backward, along the great fissure, about
one and one fourth inch on each side. A considerable quantity of
fluid was diffused over the whole brain, beneath the pia mater. The
meningeal vessels were considerably congested, but slices of the brain,
under the microscope, showed little vascularity. There was general
oedema of the brain substance, and it had this form of softening only.
On the base of the brain fully three ounces of serum were found, and
behind the tentorium about one ounce.”
In the first case death was the result of asphyxia from hydro¬
thorax, in the second it was referable to the brain.
The following is Dr. Workman's practical commentary, with a
piece of advice forcibly, if not courteously, expressed:—" Now,” he
writes, "should any eminent medical gentleman, as in the Colney
Hatch case, allege that my two patients could not have had fractured
ribs, even for 'three days, without exhibiting very distressing
2 toms, which could not have been masked,' I should feel irre-
ly inclined to advise him not to make an ass of himself, and I
am sure there is not an asylum superintendent in Europe or America
who would not concur in the propriety of this advice. 'Eminent
medical gentlemen,' who have not spent their lives in the practical
study of insanity, would act very prudently in abstaining from rash
deliverances in all questions relating to the malady, in which they
find themselves in antagonism with those better qualified to give a
correct opinion.”
10. The " Parish ” Will Case.
(‘ American Journal of Insanity/ October, 1862.)
Under this name is well known a "cause celebre” recently
decided in the Court of Appeal in New York, after protracted liti¬
gation. The proceedings in the case have been published in two
volumes, in one of which the written report and opinion of one
witness, Dr. John Watson, of New York, occupies 350 pages. The
history and bearings of the case are very well discussed in the
' American Journal of Insanity,' and from this source we shall make
a brief abstract, believing that some features in the case, and the
modification of the accepted definition of incompetence in a testator
adopted, will render a notice of it acceptable to our readers.
Mr. Parish was a successful merchant of New York, and in 1842,
having amassed a fortune of 732,879 dollars, made a will, bequeath¬
ing nearly one half to his wife, 20,000 each to two sisters, and
various legacies amounting to 290,000, of which 85,000 were distri¬
buted among his wife's relations, and leaving his two brothers, James
and Daniel, residuary legatees, with a special legacy of 10,000
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dollars to Daniel, as executor. At the time of executing this
will Mr. Parish was fifty-four years of age, in good health, and in
the Ml possession of all his faculties. He had no child, and none
was ever borne to him. The will was made after much deliberation
and frequent consultations with his legal adviser.
During the seven years ensuing his property was much increased,
and several legacies lapsed by the death of legatees, children of his
brother James. By the will, consequently, this increase fell to the
benefit of the residuary legatees, a fact of which Mr. Parish was
fully aware, and properly informed of by his legal adviser; however,
up to 1849, when he was seized with apoplexy, he evinced no
intention of altering his will. On July 19th, 1849, he had apoplexy,
and whether after this attack he ever possessed testamentary capacity
was the chief point at issue in the case.
On the 29tn of August, 1849, Mr. Parish executed a codicil, pre¬
pared at the suggestion of his wife, by which she became devisee of
real estate valued at 200,000 dollars. This codicil was re-executed
on the 17th of December of the same year. In September, 1853, in
accordance with instructions from Mrs. Parish, a second codicil was
made, incorporating the first, by which, in addition to the former
bequests, she became legatee of personal property to the value of
349,460, and 50,000 were bequeathed to charitable institutions.
In this codicil the appointment of Daniel Parish as executor was
revoked, and also the legacy of 10,000 given him by the will.
On June 15th, 1854, a third codicil was prepared, also at Mrs.
Parish's suggestion, and executed as before, by which the testator
revoked the residuary devise to his brothers, and substituted his wife
as devisee of the whole remainder of the estate.
Mr. Parish died March 2nd, 1856. Prom the time of his attack
in 1849 to his decease, his wife was scarcely ever absent from his
presence, and she and her relations were his constant attendants, to
the almost entire exclusion of his own relatives, between whom and
himself, up to this period, there had never been any manifestation of
hostility, or indication of a want of mutual family affection.
Shortly after his death the will and codicils were offered for
probate before the Surrogate of New York ; and, after a long
hearing, the will and first codicil were admitted to probate, but the
second and third codicils were rejected. This decree was affirmed at
a general term of the Supreme Court, and the Court of Appeals has
sustained that decision.
The greater part of the evidence taken had necessarily reference to
the mental condition of Mr. Parish. He had threatenings of
cerebral disturbance for several years before the apoplectic fit in
1849, and had hereditary tendency to disorders of that nature. The
shock of this final attack rendered him insensible and convulsed for
several hours, and ended in hemiplegia of the right side. His
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strength improved, he regained some use of his right leg, and during
the remaining seven years he enjoyed good but not uninterrupted
health, the hemiplegia remaining. He suffered from a severe and
painful disease of the bowels in October, 1849; subsequently had
a number of attacks, supposed to depend on the cerebral lesion, and
among others one or more severe attacks of cholera morbus (?), one
or more of inflammation of the lungs, and an abscess under the jaw,
which for a time, by its size, threatened suffocation.
In addition to these disorders, even after his apoplectic attack,
Mr. Parish was subject, at irregular intervals, extending from one or
two weeks to six months and even a year, to spasms or convul¬
sions, preceded by despondency and irritability, though after they
had passed off he was generally better and brighter than before.
The convulsions are described as usually coming on suddenly, with a
noise in the throat, resembling a shriek or scream, a violent redden¬
ing of the face, and a convulsion of the whole body, the muscles
becoming alternately rigid and relaxed. Some of these paroxysms
were so violent as seriously to threaten a fatal result. The main
feature of the final illness was congestion of the lungs, complicated
in his physicians' opinions, as were likewise the other diseases
he suffered, with disorder dependent on the condition of the brain.
From his first attack his speech was virtually lost, for he could
never afterwards utter more than a few monosyllables, principally
“ yes ” and “ no," and there is even great doubt whether he ever
uttered them intelligibly. He expressed himself mostly by inarticu¬
late sounds, accompanied by motions and gestures of the left hand
and arm, and by nodding or shaking the head. The external senses,
excepting eyesight, which was always more or less imperfect, were
not seriously affected.
He would occasionally look at books and papers, but the pre¬
ponderating evidence was that he could not read at all. He was
also regularly read to by his wife’s directions, but it could not be
proved that he was interested in, or comprehended what was read.
An attempt to teach him to write with his left hand failed; block
letters were procured, but he pushed them away, and he never
adopted the use of a dictionary obtained for him to communicate
his ideas.
Subsequently to the attack he was never intrusted with the
management of his own affairs, nor allowed to have money in his
possession. He could not supply his own wants, and was washed,
dressed, and attended to like a child, and was frequently unable to
control his evacuations. His wishes, as might be expected, were
not easily ascertained, for the inarticulate sounds, and the gestures
conveying them, could only be interpreted by various suggestions
of his attendants, varied until they assumed his wish complied with,
though it would often happen that it was utterly impossible to compre-
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hend him at all, and the attempt would be abandoned by both
parties. He would also assent to contradictory suggestions.
Before his attack Mr. Parish is described by his relatives and
acquaintances as a "placid and unexcitable man/’ of great self-
respect, and with great command of temper; "his manners were
mild, gentle, and unruffleda quiet, undemonstrative gentleman,
rarely exhibiting any emotion, and deeply absorbed in his commercial
transactions. After his attack he manifested a marked change of
disposition; he occasionally shed tears; he became petulant, and
frequently violent, and in several instances exhibited a want of
appreciation of the requirements of decorum and even of decency.
He had occasional unmeaning freaks and caprices, such as searching
for his clothes in impossible places, going out to see the moon, and
.making excursions to the garret and the cellar for no ascertained
purpose, and it sometimes became necessary to use physical force to
prevent him from undertakings which threatened personal safety.
He exhibited some recollection of his former daily and familiar
places of resort and of his former habits of business, which he would
attempt, in trifling matters, to resume, as by pulling out his watch
when he passed the City Hall clock, or insisting, when driven out,
upon being taken to the bank of which he was once a director, or
to his old office, or to various tradesmen with whom he had been
in the habit of dealing. In support of the codicils an attempt was
also made to show that his intellect was never materially impaired,
but the instances adduced in evidence were trivial.
In regard to the actual execution of the codicils, it seemed that
the counsel employed to prepare them read them to Mr. Parish in
the presence of the subscribing witnesses, put to him the requisite
formal questions, and received from him, by sound and gesture, as
usual, what where supposed to be affirmative replies. The counsel
then assisted Mr. Parish by guiding his hand while he made his
mark. At least this was the case with the first and second codicils;
there was no evidence whatever whether or not he received assistance
in making his mark at the execution of the third.
Such were the main points of the case presented to the Court of
Appeals. The opinion of the court was delivered by Judge Davies,
from which we quote the comments upon the facts narrated, and the
conclusions in which the majority of the court concurred.
After adverting to the change in Mr. Parish's disposition subse¬
quently to his attack. Judge Davies says—"How diametrically
opposite to the previous conduct of his whole life is that now
exhibited, and the inquiry forces itself upon the mind, what cause
has produced these results ? Can such totally inconsistent and
opposite characters be reconciled with the theories that the faculties,
the mind, and moral perceptions of Mr. Parish underwent no change,
but were the same after July 19th, 1849, as they were before that
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day ?.We confess ourselves totally unable to assent to any such
theory. The conviction on our mind is clear that these facts and
circumstances show unerringly that the attack of July the 19th
obliterated the mental powers, the moral perceptions, the refined and
gentle susceptibilities of Henry Parish.He then ceased to be
Henry Parish, and was no longer an accountable being.” Upon the
point of Mr. Parish's method of communicating his ideas, Judge
Davies says—“With these imperfect media for ascertaining the
thoughts of Mr. Parish, it is doing no injustice to any one to
assume that they have been mistaken when they supposed they
correctly understood him.” Great difficulty was found by all in
understanding his wishes and thoughts, even if understood at all,
“ and the instances are frequent and clearly established where he
often made an affirmative and a negative motion of his head immedi¬
ately succeeding each other, to the same question, leaving the
inquirer in perplexity which he really intended.” In reply to his
indications of wants, suggestions were put on various topics by
those around him, and construed according to their suppositions of
his answers to them. “ If Mr. Parish had no power to express a
wish to destroy a will, it follows he had none to create one, and the
manifestations of his wishes depended entirely upon the interpreter
and the integrity of the interpretation. It is thus seen that great
difficulty and uncertainty, to say the least of it, attended any
expression of the thoughts or wishes of Mr. Parish, and that a large
number of those having business or intercourse with him utterly
failed to attach or obtain any meaning to his signs, sounds, motions,
or gestures. The natural and obvious deductions to be made from
all these facts and circumstances are, that Mr. Parish had no ideas
to communicate, or if he had any, that the means of doing so, with
certainty and beyond all cavil and doubt, were denied to him.”
Referring further to this inability to communicate with others, the
learned judge repeats that after July 19th, 1849, his intellectual
powers were so obliterated that “after that period he was not a
man of sound mind and memory within the meaning and language
of the statute, and was therefore incompetent to make a will.
It is not the duty of the court to strain after probate, and especially
to seek to establish a posterior will, made in conceded feeble health,
unsustained by previous declaration of intention, over a prior will,
made in health, and with care and deliberation, when the provisions
of the posterior will are in direct hostility and conflict with those of the
prior one.It would be in violation of long and well-established
principles, and an almost uniform and unbroken current of decision
in England and in this country, to admit to probate testamentary
papers prepared and executed under the circumstances these were,
by a man who was in apparent full physical health, and possessing
nearly his natural strength, who could not or would not write, who
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could not or would not speak, who could not or would not use the
letters of the alphabet or even a dictionary, for the purpose of con¬
veying his wishes, upon proof solely that they were supposed to
express the testator's wishes, from signs, gestures, and motions made
by him, and especially when it appeared that such signs, gestures,
and motions made by him were often contradictory, uncertain,
frequently misunderstood, and often not comprehended at all.”
Judge Davies states at length the three principles of law which he
conceived to be applicable to the case. The first regards testa¬
mentary capacity, the second the burden of proof, the third the
maxim “ qui se scripsit, heredem The chief interest and importance
attaching to the decision turn upon the discussion of the first of
these—the doctrine of testamentary capacity. The writer in the
‘ American Journal of Insanity' examines this last point in reference
to the opinions and decisions of various legal authorities and
decisions in courts, English and American, and remarks that “ almost
the whole weight of argument derived from the modem decisions in
England and in our sister states is upon the side of the rule stated
by Judge Davies, and supported by the authority of such jurists as
Sir John Nicoll, Lord Kenyon, Dr. Lushington, Lord Erskine, and
Chancellor Walworth.”
The Lispenard case, decided in the Court of Errors in 1841 (26
Wend., 255), had hitherto been held of binding authority; in this
case the argument allowed was based on the interpretation of the
words “ non-sane memory” in the English Statute of Wills, and on
the interpretation of some older authorities that one was not accounted
to have “ wholly lost his understanding” until he became an idiot,
so that he could not tell his own name or count twenty,” and that
therefore any one possessing a higher degree of intelligence than this
was not “ non compos mentis,” and was not disabled from making a
will. The result of the Parish decision is to supplant this too strict
interpretation of the early authorities, which is manifestly absurd
when viewed by the light of modem inquiry and knowledge of
mental disease.
The following remarks are very just :—“ While, however, the
- position assumed in the Lispenard Case has been abandoned, the
courts, in the absence of any suspicion, would doubtless require
proof of a very low degree of capacity before setting aside a will on
that ground alone. But in stating what degree of mental alienation
will avoid a will, we are confronted by a difficulty inherent in the
very nature of the subject. In fact, no accurate test can be given
by which to gauge the understanding. . . . The Parish will
case, therefore, while it lays down a more rational rule for deciding
questions of testamentary capacity than that previously established,
is, perhaps, more important as overthrowing the arbitrary standard of
the old rule than as erecting another.”
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In this well-fought Will case opinions were given by Dr. John
Watson, of New York; the late Dr. Luther V. Bell, Charlestown,
Mass.; Dr. Isaac Ray, of the Butler Hospital; Dr. D. T. Brown, of
Bloomingdale Asylum; Dr. Pliny Earle, and Dr. M. H. Ranney, of
New York City Asylum; and Sir Henry Holland, Bart. All these
physicians concurred in pronouncing Mr. Parish to have been, from
organic disease of the brain, incapable of making a will. The
opposite side was sustained by Professor Alonzo Clark, of New
York, "whose objections, however, were fully answered by Dr.
Watson.”
II .—English Psychological Literature.
11. A Case of Moral Insanity or Dipsomania.
(From ‘Clinical Medicines Observations recorded at the Bedside, with Com¬
mentaries,’ by W. T. Gairdner, M.D. Edin., Regius Professor of Medicine in
the University of Glasgow.)
Prom this acceptable contribution to medical literature, the faith¬
ful record of good work, communicated in a style as lucid as the
matter is replete with careful observation and philosophic reflection,
we shall venture to pillage a long extract, which will prove that
the specialist also may refer to it with satisfaction and profit:—
The other case of delayed cure is also connected with drink,
but although the man was very excited on admission, indeed quite
frantic from drink, I doubt if it can probably be called delirium
tremens. Since he has sobered down it has presented none of the
characters of this disease; but, on the other hand, it is very evi¬
dently a case of what is now often called dipsomania.
Remark the particulars; for the case is a type of many others.
This man came in mad with whiskey, and yet clamouring for
whiskey; absolutely maniacal in fact; but I suppose merely from
the immediate effects of drink. By and by he sobered down, and
being told most absolutely he was to have no whiskey at all, he
reconciled himself to what he thought was simply a necessity of the
case. In the course of conversation with him about this matter, I
thought I detected him in various palpable untruths; and, indeed,
it very soon became apparent to me that he was one of those unfor¬
tunate persons who hardly know whether they are uttering truth or
falsehood when they make a strong assertion. There was a shame¬
lessness and regardlessness of consequences, and even of decency,
about his whole manner, that convinced me I had to deal with
a very low type, indeed, of human nature in this case. He had not
the slightest sense of regret or of remorse, but would always take
me into his confidence, and explain to me how much he needed
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some more whiskey. The result of this unsought confidence was,
that I learned his antecedents so far,—he had been drinking until the
money was done, and till he was quite out at elbows; and then he
went and drank at the expense of anybody and everybody who
would give him whiskey, until he landed himself in the infirmary.
He had not been in the ward two days, moreover, before he deve¬
loped a new phase of degradation, for the attendant caught him
masturbating. He did not deny the fact to me, hut said it was
only once, that he had never done it before, &c. All this, however,
he said with the most perfect indifference as to whether I believed
it or not, and I could not but tell him very plainly that I did not
believe a word of it. This he received with the same cool indif¬
ference as the former charge of habitual masturbation. He is thin,
withered-looking, without colour, yet without apparent bodily
disease or deformity. There is in all this, evidence of long-con¬
tinued and probably irreclaimable bad habits, founded on a
weakening of the moral sense amounting to a kind of paralysis of
it. You cannot get hold of anything on which to act in the way
of making this man ashamed of himself. His aunt, whom I sent
for, and who speaks of him on the whole with wonderful charity and
good temper, as well as good sense, says, without reserve, that it was
always so. He has never been able to do anything for himself, or to
turn his mind to good in any shape. He never would work, and
drank at all times when he could get the drink. In fact, she says
he was always a perfect “ gowk” (i. e. a fool, a simpleton, Jamieson's
‘ Dictionary'), that is the climax of her description; and I hold that
it is both a charitable and a true description, the more so that it is per¬
fectly simple and natural, having no relation to any ulterior object
whatever, for she has plainly none in view.
Our patient has had sense enough for the most part, she says,
to keep out of the way of the police, and that is about the utmost
that can be said for him; but even that cuts two ways, for possibly
if he had been more clever and ingenious, he might have been' led
more easily into positive crime. As it is, we have pretty clear proof
that he is :—1. An utterly abandoned, and almost unconscious liar.
2. An almost equally shameless masturbator. 3. A drunkard, quite
devoid of self-control, or even of the desire to control himself.
4. A lazy and an incapable, of the most incorrigible description.
5. “ A perfect gowk/' or to use another most expressive Scotch
phrase—a ne } er-do-weel,* i. e. one who not only does not do well, but
apparently cannot do well; who has neither the capacity nor the
desire to do well. It is a case not only of degradation, but of posi¬
tive degeneration of the moral instincts; and the degradation is
* “ Ne’er-do weel, one whose conduct is so bad as to give reason to think that
he will never do well . 93 (As an adjective.) “Past mending.” Jamieson's
* Dictionary.’
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probably both physical and moral by this time; the machinery of
mind has suffered as well as the mind itself. This man, I believe,
literally cannot do good at present; you can no more expect good
conduct and high principle from such an organization than you can
from a gorilla. A long course of reformatory discipline might pos¬
sibly, indeed, even now, do something to reverse the habits of forty
years; but at this moment of time the man is in a state of moral
paralysis , powerless for good, and a prey to evil, in virtue of his
physical and moral organization, his craving appetites and deeply
imprinted bad habits. There may have been also a congenital
fault or deficiency; but about this we know, and can know, nothing
with any certainty.
What can you do with such cases ? you often meet with them in
various degrees of urgency in the highest ranks, and then they are
especially puzzling. Positions of very high responsibility have
sometimes to be filled after a fashion, and in the eye of the world, by
such persons. For example, it is quite easy to suppose that the
peerage might devolve its honours upon the head of such a being as
this, or a princely fortune might fall to be spent by him without
control; which would be truly, and in the largest sense of the word,
a flmfortune, inasmuch as it would merely give free scope to all his
base, revolting, and ruinous propensities. Then rises the question
of moral responsibility in the eye of the law, or of technical insanity
—a difficult one to settle, I need not tell you, from the legal point of
view, especially when money is plentiful. Such men are not cretins
or idiots, and yet there is something in them plainly deficient, as
compared with a sound organization. There is a certain loss of self-
control, which is not a mere vice but has become stereotyped, as it
were, and stamped down upon the habit as an infirmity extending
over the whole moral organization. But does it constitute insanity r
The legal view of the case is extremely involved, and we have no
occasion to discuss it at present, but as a practical question of
medical treatment, I would put it thus: What can you make of
him? Is there anything you can act upon through the ordinary
forces of moral discipline, and with reasonable hope of a good result
within a reasonable time ? Is there any moral leverage , so to speak,
by which you can move the sluggishness, the low tone of this man's
whole moral nature ? If so, use it by all means; but if not, or if you
fail utterly after trial, accept the alternative. I consider this a
really diseased mind, in a practical sense, as regards the medical
and moral question of cure. It is a mind plainly requiring to be
under control and coercion; you can make nothing of it other¬
wise. As to the technical question of insanity, as affecting legal
rights and responsibilities, I would not allow it to be too much
mixed up with the other, but leave it to be practically settled also
according to the nature of the interests involved. I don't care
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in the least about the word insanity; and I confess I think it quite
unnecessary to look too closely into the metaphysics of the matter.
It is to me a practical question altogether; in one case a question
of medical treatment; in another of law and of substantial justice
(though sometimes rather rough and ready justice) to the individual
and to society.
In this man's case, I should be disposed to recommend as a
matter of treatment, his being put under a certain amount of per¬
sonal restraint, with due moral and medical discipline, and this pro¬
bably for a long time. I entirely believe that this man cannot
possibly be made a useful member of society, or even otherwise than
a nuisance, without such discipline. But I feel the want in these
cases of proper support from public opinion, and from the law. I dare
not certify even this wretched being as insane, without more obvious
and striking reasons to carry conviction to every one's mind, as well as
my own, than I have at present; so he must be left to cumber the
ground. If I could even force him into the workhouse, it would be
a point gained; but I cannot force him at all; we must simply let
him go his way. Better men than he have committed murder or
suicide in the like circurastanoes, but I don't see clearly anything of
this kind impending in this case; I think he is too great a coward, and
too utterly inert, to set about doing either the one or the other; and
therein, perhaps, lies his immediate safety. But the existing state
of the law, and of public opinion, is very unsatisfactory in regard to
these cases. As prevention is better than cure, I think that society,
and the medical man as the organ of society, ought to have a much
greater control than exists at present over such cases.
The Antagonism of Law and Medicine in Insanity , and its conse¬
quences. An introductory lecture. By Thomas Laycock, M.D.,
Professor of the Practice of Medicine and of Clinical Medicine,
and Lecturer on Medical Psychology and Mental Diseases, in
the University of Edinburgh.
(‘ Edinburgh Medical Journal,’ July, 1862 .)
This introductory lecture to his course of medical psychology by
Professor Laycock is worthy of record in these pages as containing
an unanswerable argument for the addition to our medical curri¬
culum of clinical teaching of mental disease. It is indeed mournful
to think how this subject is neglected in England. A very few
lectures at St. Luke's form the whole that is done herein, and these
lectures are far from giving either a regular or systematic course of
instruction.
“ If any arguments were needed,” says Dr. Laycock in the intro¬
duction to this lecture, “ that such a course should form part of the
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medical curriculum, and be delivered in every medical school of the
United Kingdom, recent proceedings in the English Courts of Law
and in the House of Lords would amply supply them. From those
proceedings we learn how distinct and complete is the antagonism
between law and medicine, as to the principles of mental science and
its applications to mental diseases and defects. Medicine declares
that insanity is a physical or corporeal disease; law declares that it
is not. Medicine says that insanity and imbecility are different con¬
ditions ; law, that they are analogous. Medicine maintains that a
theoretical and practical study of mental diseases and defects is
necessary to the proper understanding and detection of mental
disease or defect; law denies this, and says it is a fact to be deter¬
mined by any dozen of ordinary men in consultation on the case.
Medicine says a man may be insane and irresponsible, and yet
know right and wrong; law says a knowledge of right and wrong
is the test of both soundness of mind and responsibility to the law.
Medicine says, restrain and cure the insane and imbecile offender
against the law; law says, hang, imprison, whip, hunger him, and
treats medical art with contempt. Thus law, as recently expounded
in the English Courts and the English Legislature, is entirely antago¬
nistic to medicine on all those questions of mental science which
involve the freedom and well-being of the imbecile and insane, and
which often determine whether they shall die an ignominious death
or not. This antagonism is a very serious matter therefore to the
insane, their friends, and families; more serious to the judges and
legislators of our country; and not without deep interest to th)
medical profession. For with such direct antagonism to medical
doctrines and practice on the side of law, the existing prejudices.in
the mind of the public, and which have been exhibited in very high
quarters, will be more deeply rooted; so that we shall have greater
difficulties to encounter in treating the insane, in bearing witness to
their infirmities in courts of law, and in enlightening the public on a
subject which most deeply concerns it.”
Professor Laycock enforces his argument for the necessity of in¬
struction in our schools of medicine on the question of insanity by a
reference to the debates in the House of Lords in the Chancellor's
Lunacy Bill of this year (happily amended in the Commons), and by
the trial of George Clark* at Newcastle-on-Tyne on the 27th of
February, 1862. This latter case is so instructive that we quote
Dr. Laycock's summary of it; with his remarks in full:—
“ A man named George Clark, a cabinetmaker, killed a tax-col¬
lector in Newcastle on October 1,1861, by stabbing him with a sharp-
pointed knife. In the month of May preceding the collector had dis-
* The evidence bearing on the mental state of Clark, and the charge of the judge,
are given at length and ably commented on in the * Medical Critic and Psychological
Journal,’ for April last.
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trained upon Clark’s tools for the non-payment of his dog-tax; and this
was the alleged motive, as it was clearly the exciting cause, of the
murder. He was tried on 27th February last, and defended himself.
The history of his conduct previously and subsequently to the
murder, and his conduct during the trial, abundantly proved that he
was an aggressive melancholiac; labouring under notional insanity
both at the time he committed the act, and when tried for it. The
judge laid down the law of the case to the twelve “ ordinary men”
who constituted the jury, and who, in accordance with his charge,
brought in a verdict of guilty; and then the judge solemnly pro¬
nounced the sentence of death. He told the helpless lunatic at the
bar he had no doubt, and the jury had no doubt, not only that
when he committed the murder he was responsible for his actions,
but also that he understood perfectly the whole of what he was
doing in depriving himself of counsel and defending himself; other¬
wise he (theiudge) would have postponed the trial or postponed the
sentence. Then the judge solemnly exhorted the madman to re¬
pentance and prayer, and finally petitioned the Lord to have mercy
on his soul.*
Such was the deliberate, solemn procedure in an English court of
justice in the year 1862, in the case of a maniac who, being let loose
in society by the law, became in due course amenable to the law. I
do not say that murderous maniacs should not be hung; much might
be said as to the expediency of that; but certain inhabitants of New¬
castle, in common with all who value justice rather than expediency,
Wjej-e shocked with that sad outrage on justice perpetrated in the
natne of the law, and at once took vigorous and happily successful
steps to prevent the hanging,—the humane judge helping them.
The judge was not to blame in this case, remember, but the law.
This he laid down clearly and plainly, and I may say with admirable
although inexorable justice, as between the maniac murderer and
society. The legal dicta being what they are, no other course was
judicially open to him. Clark knew what he was about, and there¬
fore he was responsible for his actions; however mad he might be,
if he knew this he must suffer the penalty; that is the law. “ In
a well-known case,” he said, “ the House of Lords put questions to
the judges, and the judges answered them in this way/’ If a man
had a delusion and killed another in consequence of it, if that
delusion would not in law justify a sane man in seeking vengeance,
neither in law would it justify an insane man. And the judge added
the theory of the law. “ In point of fact,” he remarked, “ the law
does so because it acts upon people’s fears, and it endeavours to pro¬
tect persons from the murderous attacks of others by acting upon
the terrors of those who may feel disposed to do such attacks; and if
* The. surgeon of the prison who had watched Clark for five months said he was
insane; and the Medical Inspector of Prisons, sent by Sir George Grey, concurred.
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a person has a particular delusion, but still has the power of knowing
what he is doing, and that what he is doing is wrong, the law will
make such a person responsible.” And so Clark was condemned to
be hung.
Now, there is perhaps no more instructive example on record of
the mischievous influence of an ill-considered speculation than the
opinion of the law Lords, to which the judge in this case referred the
jury, and which guided his own course in the solemn administration
of justice. It has more than the force of an Act of Parliament, but
yet is a mere dictum of a number of gentlemen learned in the law;
most learned in that—nevertheless, with no professional knowledge
of that which they had to decide upon—namely, the nature of imbe¬
cility and mental incapacity, and the bearing of mental disease upon
even their own theory of legal punishments. This dictum was duly
explained by a learned judge to twelve ordinary men, all equally
ignorant of the subject as the twelve judges. A maniac plead before
them for his life, and yet he was held to be both morally responsible
and capable of conducting his defence: the plainest facts of the case
failed to bring out the common sense of the judge or the jury,
weighed down by the legal dictum; and a maniac was not only found
guilty, but solemnly sentenced to death. The judge wisely said “ it
would be folly—almost blasphemy—to punish a man for an offence
to which he has been instigated not by his own guilty will, but by an
infliction sent upon him by Providence itself,” and solemnly sen¬
tenced the man to be killed. But be it noted, on the next morning
he wrote to Sir George Grey to express his doubts as to the man's
sanity. A certificate of insanity was then duly signed by two com¬
petent physicians, and the catastrophe of a judicial—almost blas¬
phemous—murder was obviated. But the Nemesis of legal error
still pursued the Government, for the magistrates of Newcastle,
already enlightened by the Lord Chancellor's expositions, refused to
concur with the physicians, and declared that the grounds for the
medical opinion were insufficient to constitute mental unsoundness.
The man had been fairly tried, and duly and solemnly condemned,
and they concurred with the “ ordinary men ” of the jury; so that it
only remained for Sir George Grey to get the wretched man out of
their custody by commuting his sentence to penal servitude for
life.”*
This case is certainly a singular illustration of the distinction
between law and justice.
Professor Lay cock may well conclude his lecture with the remark,
that from whatever point of view we look at the present position
of mental science and of its practical applications to mental diseases,
and to the administration of justice, it must be confessed that it is
* The prosecution, suspecting that Clark was feigning madness, 6ent Dr. Mac¬
intosh to examine him, who reported that he was insane.
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intolerable, and a disgrace to us as a nation. It is no longer to be
endured that the courts of law and schools of medicine should be at
issue as to the fundamental question, whether insanity be a disease
or not, and as to all its important practical applications. It is quite
certain that there can be no withdrawal therefrom on the side of
the profession, for to that principle and its applications must be
attributed the rescue of the insane from the state of degradation and
the cruel usage of which they were the victims at the close of the last
century; on the contrary, it will be more and more developed, for
to recede would be to reverse medical progress, and stop all the
large advance in mental science made of late years.
16.— Plural Births in Connection with Idiocy . By Arthur Mitchell,
A.M., M.D., Deputy Commissioner in Lunacy for Scotland,
Corresponding Fellow of the Edinburgh Obstetrical Society, &c.
(‘ Medical Times and Gazette,' Not. 15, 1862.)
During the last four years Dr. Mitchell had officially to examine
and report on a large proportion of all the idiots in Scotland. In
the course of his inquiries into the history of each case, from time to
time, it was stated, that the patient was one of twins. This, indeed,
occurred so frequently, that he was at length led to suspect that there
might be some connection between plural births and congenital
defects of mind. He therefore resolved to investigate the subject,
and to determine how frequently, in a known number of idiots, a twin
would appear.
As the result of this numerical inquiry, in 443 cases. Dr. Mitchell
states that—
"11 times the idiot was one of twins.
" 4 times one or other parents of the idiot was twin or triplet-
bom.
" 32 of the 443 mothers had borne twins, once, twice, or more
frequently.
"43 of the 443 families presented twins, more or less fre¬
quently. borne by mother, grandmother, aunt, or sister of
the idiot.
" I hardly think,” he adds, " that any one will peruse these facts
without feeling that some connection between plural births and
idiocy, if not proved, has, at least, been rendered highly probable.
" When compared with single births, the whole history of plural
births is exceptional; they are more fatal to the mother; they repre¬
sent a larger proportion of dead-bom children; the mortality of the
offspring in infant life is greater; premature deliveries are more
numerous; abnormal presentations and the necessity for instru¬
mental assistance occur more frequently; the children are smaller, and
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are apt to be unequally developed. All these points of different are
far from indicating vigour; on the contrary, they lead us to
anticipate, in twin children, feebleness of constitution and imperfect
development.”
Dr. Mitchell illustrates this view in a series of propositions,
worked out in the style of Professor Simpson’s numerical demon¬
strations in his obstetric papers :
I. Parturition is more fatal to the mother in plural than in
single births.
II. Plural births are more frequently premature than others.
III. Abnormal presentations, and the necessity for instrumental
assistance, occur more frequently in twin than single births.
IV. Of twin children, a larger proportion is dead-bom than
of single.
V. But not only is the death-rate among twins abnormally high
before the children are finally separated from their mothers, it also
happens that the same excessive mortality is observed during the first
week or ten days of extra-uterine life, and there is every reason for
believing that it continues for several years.
YI. Twin children, as a rule, are abnormally small at birth.
VII. In the case of the cow, the female co-twin with a male is
very generally barren.*
VIII. When both children live, and have to be nursed by one
woman, there is a risk of injury from underfeeding. I do not think
that this proposition demands any comment.
“ The foregoing facts in their aggregate prove,” says Dr. Mitchell,
“ that, when woman ceases to be uniparous, it is to the disadvantage
of herself and of her offspring, and especially to the disadvantage of
the latter. It is the departure from a design of nature, not seem¬
ingly under control, and having a cause which we do not know; but,
being a departure, misfortune is the result. Everything in the
history of twin children indicates low viability, feeble organisation,
and imperfect development; and this, apart from the risk of injury to
which they appear to be peculiarly exposed in the act of birth, would
lead us to expect among them the frequent occurrence of nervous
disorders. In whatever class the condition, during intra-uterine
existence or at birth, is unfavorable to life—in that class we are cer¬
tain to find a prevalence of cerebral disease, accompanied often
by physical defects or frailty. That twin children are in this unfa¬
vorable condition I think has been established. Woman was clearly
intended to bear only one child at a time, and the wider the de¬
parture from this intention the more marked is the consequent
* Professor Simpson has shown that this does not hold good in the human family,
though it was long believed to do so. Nevertheless, in the fact, that it is true of
any uniparous animal, we see the indication of a tendency to incomplete develop¬
ment in cases of twinning.
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calamity. If we turn from twins to triplets and quadruplets, we find
the proof of this statement. Among them premature births are still
more frequent, and the number of dead-born children still greater,
and of those who are born alive only a few reach maturity. I know
personally only one triplet case, in which all three reached adult life.
They are three men bom half a century ago, and, curiously, they are
all at present living under one roof. One is lame, one has double
rupture, and all three are eccentric. In one this eccentricity of late '
years has been intensified, and is now spoken of as insanity. He
alone is married, and one of his children is a complete idiot. I know
another case in which two of triplets reached maturity. They are
both women, and are both married. One is barren, and the other
bore two children with spina bifida, and a third anencephalous. The
mother was a tall, handsome, and intelligent woman, and bore
several other children, well-formed, and apparently quite sound both
in mind and body.
" Plural births have been thought to indicate an excess of repro¬
ductive force; and in one sense, perhaps, they may be so regarded.
But this is certain, that in families where they occur with frequency
they are often associated with illustrations of a manifest deficiency in
the reproductive powers. In many instances I have observed this
close alliance between what is held to indicate excess, and what is
held to indicate deficiency of reproductive energy. Twinning in the
human species, I think, must, at least, be looked on as a misdirection
or error in reproduction, and it is doubtful whether in any case it is
correctly spoken of as indicating high reproducing qualities. If a
woman bears twins or triplets, and if among her single-born children,
hare-lip, club-foot, dwarfage, microcephalism, and abortions occur, 1
scarcely think we can say of that woman, because she bore twins, that
the faculty of reproduction in her is strong. It is both strong and
weak, apparently excessive at one time, and defective at another; or
rather, perhaps, according to the view which I am inclined to take,
weak at all times, since an error in any process is practically weak¬
ness, whether it lead to overdoing or underdoing in the results; and
still more positively is that process weak which is influenced by a
peculiarity tending to overdo now, and to underdo then. The proof
of strength and perfection in any process is a good result, steadily
produced. The proof of weakness is a bad result, and uncertainty
in the character of the badness augments the weakness. True, it
may be said, the process in the one case is called weak from attempt¬
ing too much, and in the other from not attempting enough—in
neither case accomplishing the work well: the one, however, being a
weakness from excess, and the other from defect, with an essential
difference, therefore, in their nature.
* * * *
“ Everything, in short, points to a remarkable connection between
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twin births and defective organisation. If this be recognised as
true, then twin children ought to be treated with peculiar care after
birth, and for the first few years of life. The defect may, in many
cases, merely consist in a negation of power—a lessened viability—
rendering them- unable to resist pernicious influences, which would
scarcely affect children more favorably conditioned at birth. Care in
the nursing and general management of such cases is clearly de¬
sirable, in order to secure, as far as possible, the completion of that
development, which may be regarded as probably imperfect at birth.
All other aspects of the condition of twin children indicate the same
necessity for unusual care.”
The fact that persons-of very great intellectual and physical
vigour are every now and then found to be twin-born, in no way
interferes- with the soundness of the general conclusion to which
this research points, and the basis of which may be briefly stated as
follows:
1. Among imbeciles and idiots a much larger proportion is
actually found to be twin-born than among the general com¬
munity.
2. Am ong the relatives of imbeciles and idiots twinning is also
found to be very frequent.
3. In families where twinning is frequent, bodily deformities (of
defect and of excess) likewise occur with frequency.
4. The whole history of twin births is exceptional, indicates
imperfect development and feeble organisation in the product, and
leads us to regard twinning in the human species as a departure
from the physiological rule, and, therefore, injurious to all con¬
cerned.
5. When we pass from twins to triplets and quadruplets, every¬
thing we know regarding these latter gives support to the general
conclusion in question.
17. The Medical Critic and Psychological Journal. Edited by
Forbes Winslow, M.D., D.C.L., No. viii, October, 1862.
The current number of this journal contains the first part of a
most philosophical paper, ‘ On the Nature of Volition, Psychologically
and Physiologically considered,’ by J. Lockhart Clark, F.E.S.
It is too carefully reasoned to admit of any abstract of its
contents.
There is also an interesting paper on * English Suicide-fields’ by
J. N. Eadcliffe, Esq., the Honorary Secretary of the Epidemiologies
Society ; apparently a summary of the paper which attracted so much
notice at the late Social Science * Congress in London.
* ‘ The Social Science Review ’ for September has also three articles by Mr.
Raddiffe on this subject of suicide.
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of Psychological Medicine.
The average of suicides in England and Wales, to the population,
is 6*7 suicides to 100,000 population. Mr. Radcliffe gives the
following table, showing the counties and districts of inordinate
tendency to suicide:
The London Suicide-Field.
( Middlesex.
j Kent
Surrey
Sussex
, Hants
Proportion of suicides
to 100,000 Population.
. 10-5
. 9*7
. 9-5
. 8-9
. 6-9
The Midland Suicide-Field.
' Leicester .
Lincoln .
I Nottingham
Warwick .
Derby
8*9
87
87
8-0
777
The Forthern Suicide-Field.
Westmoreland
Cumberland
Lancaster .
Chester
9-9
8-6
7*0
7'0
18. Homicidal Mania: a Biography ; with Physiological and Medico¬
legal comments. ByD. Yellowlees, M.D., Assistant-Physician,
Royal Edinburgh Asylum, Morningside.
{Read before the Medico-Chirurgical Society of Edinburgh, 4th June, 1862;
and reprinted from the ‘ Edinburgh Medical Journal ’ for August, 1862.)
William Smith was for more than twenty years the most remark¬
able and most dangerous inmate of the Royal Edinburgh Asylum :
the story of his life is worth telling for its own sake; but yet more
so for its physiological interest, and for its bearings on some very
important and much debated questions in legal medicine. Dr.
Yellowlees has told this history with much skill. We must refer to
his paper in the 1 Edinburgh Medical Journal' for the narrative. We
quote Dr. Yellow lees' summary of the case :—
“ It is scarcely possible to find language strong enough to describe
the bloodthirsty passion which possessed the man, the devilish
ingenuity, deliberateness, and determination with which all his
attacks were made, pr the fiendish delight with which he gloried in
relating them, and revelled in the thought of a merciless and bloody
success.
“In 1855, his health began to give way, but he still iudulged in
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fierce threatenings far beyond his power of execution. In this year
restraint was finally discontinued, and he was taken regularly under
special charge of an attendant to the chapel and the weekly ball—
privileges which he highly valued. He spent his time chiefly in
writing songs, anthems, and choruses, which were the names he gave
to miserable attempts at music with original words attached.
“ In 1858, I first made Willie's acquaintance, and a visit to his
room then was a thing to be remembered. You might have noticed,
ere leaving, the strength of the door, the absence of all furniture
except a fixed bed, the height of the window which Willie insisted
on having open even in the depth of winter, and the many writings
and drawings on the wall, but your attention would certainly have
fixed itself first on Willie himself. He was always to be found sit¬
ting up in bed, with his inkbottle beside him and his manuscripts on
his knee.
“In the end of 1858, he had a slight apoplectic attack, but its
effects were very transient and did not alter his mental condition.
“In 1859, he was as poetical, loyal, and homicidal as ever. He
frequently appointed days for murdering certain people, and had
always some ingenious reason for his non-fulfilment of the threat.
When he failed to find a good excuse, he said it was in order to show
that he was a merciful man, and not the bloodthirsty villain they
took him for. In further support of this, he used to quote occa¬
sions when he might have brained or strangled an attendant and
yet refrained, not recognising that this very argument was a con¬
fession of how constantly the thought of murder was uppermost in
his mind.
“ About this time Willie was offered the privilege of a visit to
Edinburgh. Eor almost twenty years he had never been beyond the
grounds of the asylum, |ind had spent most of the time in his solitary
room. He was, from old age and increasing dementia, by no means
the formidable man he once had been; and it seemed that this indul¬
gence might with proper precautions be safely granted, and might
add a little happiness to his lonely life. He was much elated at the
prospect and very grateful. He selected the night-watch as the
person who should accompany him, and at the time appointed he
was ready, dressed in the best suit the attendants could procure.
He went to the door full of eager anticipation; but as soon as he
saw the carriage waiting for him, and understood that he was not to
walk through the town as he had intended, he turned and went straight
back to his room, threw aside the new suit, and absolutely refused
to go.
“ He had evidently intended mischief, and was so mortified at his
purpose being thus thwarted under the guise of special kindness, that
no persuasion could induce him to change his resolution.”
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PART IV.—MEDICO-LEGAL CASES.
Hall v. Semple.
The trial of Hall v. Semple, which occupied the Queen's Bench
during four entire days of last month, may have received, before
these remarks appear, a still further development in a Court of
Error; the case is one of great public interest, and although, as
being still undecided, we cannot write so freely upon it as we might
otherwise do, there are many points bearing upon the law of lunacy,
and its practical working, which it involves, and which it has
presented in an aspect entirely at variance with our own views and
experience.
The main facts of the case may be shortly stated. Mr. and Mrs.
Hall, dealers in china, in the Tottenham Court Road, have led for
thirty years a married life of perpetual disagreement. Mrs. Hall
states on oath that she believed her husband to be mad soon after
their marriage, and thinks him so still; a certain Mr. Lintot and
Mr. Guy appear to have held a s imil ar opinion, and the latter, years
ago, gave a certificate to that effect, which was then not acted upon.
In July last Mrs. Hall called upon Dr. Semple, the defendant, with
whom, she had no previous personal acquaintance, and requested him
to examine her husband, witli a view to determine the state of his
mind; this Dr. Semple did on the same day, but feeling that in a
short interview he was hardly able to arrive at any definite conclu¬
sion, and evidently unwilling to take the unsupported statements of
Mrs. Hall, he proceeded to make inquiries of Mr. Guy, to whom he
was referred, and of others in his own household and in the neigh¬
bourhood. As the result of these inquiries, and such observations as
he had made. Dr. Semple wrote a certificate. Omitting the preamble,
which was correctly written, the following were the reasons upon
which he came to the conclusion that Mr. Hall was a person of un¬
sound mind:
“1. Facts indicating insanity observed by myself:
“ He bad a wild and staring look, with restless eyes, and nervous, agitated
manner. He represented to me that his wife was raining himself and business,
and he intimated that she was improperly associating with other men; he is
evidently labouring under delusions, and he acts upon those delusions.
“2. Other facts (if any) indicating insanity communicated to me by
others:
“ He is guilty of repeated acts of violence; he constantly threatens his wife,
and often assaults her; he sleeps with a drawn sword by his bedside, and
declares he will murder any one who approaches him, and he has often threat¬
ened to stab his wife.
“Robert H. Semple,
“ 8, Torrington Square, London.
“Dated (his 29 th day of July, 1802.”
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Upon this certificate, and another from the before-mentioned Mr.
Guy, and on the authority of an order from the wife, Mr. Hall was
carried off to Mr. Elliot's asylum, Munster House, Eulham. On his
release, two days after, he brought an action against Dr. Semple,
the declaration containing the following three counts :—The first was
under the common form of trespass for false imprisonment;
secondly, that the defendant had wilfully and maliciously signed a
certificate under the statute; thirdly, that he had maliciously induced
Mr. Guy to do the same. The jury found for the defendant upon the
first and third counts, but upon the second, while they entirely
acquitted the defendant of malice, they gave it as their verdict that
he had signed the certificate without due and proper inquiry, and
had acted negligently in not ascertaining the sanity of the plaintiff,
which they affirmed. They assessed the damages at £150. The costs
on both sides, of course, fell upon Dr. Semple, and these together
amount to nearly £600.
The learned judge, Mr. Justice Crompton, who tried the case,
although in the early part of the trial he had expressed an opinion
that the question for the jury was simply whether Dr. Semple had acted
with bona fides in signing the certificate, in his summing up, which
was most elaborate and careful, directed them that an action would
lie supposing that negligence alone had been in their opinion proved.
To this ruling Sergeant Pigott, the counsel for the defendant,
tendered a bill of exceptions, contending that the defendant, if
acting in good faith, was protected by the statute of lunacy; and
that if the second count were amended by the substitution of
negligently for maliciously , the jury should be instructed as to what
omission on the part of the defendant constituted culpable negligence.
These exceptions were admitted, and it remains to De seen whether
they can be successfully argued upon a writ of error.
Assuming that Mr.Hall were sane, it is satisfactory to find that the
wrong done him was not malicious, and was soon redressed; at the
same time we cannot consider it a light thing that a sane man should
be confined even for a moment in a lunatic asylum. It is hardly two
years ago since Lord Shaftesbury told the Committee of the House of
Commons that he had never known an instance of the kind; the in¬
dignation excited in the public mind by this case was therefore not
unnatural, and it was heightened by several circumstances that
appeared in evidence, which, though really not affecting the issue,
had probably great influence upon the decision of the jury, and
certainly much increased the public exasperation. In the first
place, the plaintiff himself appeared in court, and gave his evidence
clearly ana well; secondly, it was shown that Dr. Semple, the
defendant, had written some letters after the admission of Mr. Hall
into the asylum, which, to say the least, were most uncalled for and
unwise; then, the plaintiff had been carried off from his own door
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by main force, in a cab, by two men, whose conduct very plainly
evinced their entire unfitness for the office of attendants upon the
insane. Lastly, the plaintiff, upon his arrival at the asylum, was
turned into a corridor with a number of insane patients, and left
unvisited till the next evening; he was also—and the fact seemed to
very much impress the jury—intrusted the next morning with a
razor, although stated in the order for his admission to be a
“ dangerous lunatic.”
One other mistaken impression tended to fan the public in¬
dignation. Mr. Hall was discharged from the asylum upon the
second day of his arrest by two of the Commissioners of Lunacy. It
was popularly assumed that he was so discharged because the Com¬
missioners thought him not to be of unsound mind ; it is, however,
not the least important incident in this singular case that he (Mr.
Hall) was really discharged, not because he was sane, but because his
certificates were informal; the Commissioners gave no opinion as to
his sanity. The proprietor of the asylum—not, let it be observed, a
medical man—although in his evidence he stated that he thought Mr.
Hall of sound mind, had, in fact, detained him upon a certificate of
Dr. Semple, which is very weak, and in point of law is informal, and
upon the certificate of Mr. Guy, which, as he must have known, was
absolutely invalid. While the public journals, in leader after leader,
are dilating upon this painful case, heightening to intensity the
} >opular dread of lunatic asylums, and clamouring for new lunacy
aws, with penal clauses still more severe, it is well to call attention
to the fact that in this case, redress followed rapidly upon the
wrong, the interposition of the Lunacy Commissioners was speedy and
effective, and that the law of lunacy could not be said to have failed
in its object of affording protection against improper arrest, because
in this instance it was simply set at naught, under circumstances
which will, doubtless, receive the attention of their Board. We may
say here that, although the Commissioners were attacked by the
plaintiff's counsel, their conduct throughout received the com¬
mendation of the court, and the public must feel that they exercised
a wise discretion in refraining from an expression of opinion, which
must have had the effect of prejudging a case which was certain to
appear subsequently either before their own or some other tribunal.
It is with no spirit of bitterness or sarcasm that we would mark
this painful case as one which illustrates the danger the public must
incur, if the administration of the Lunacy Law is left solely to
medical men, who, however well meaning, are without sufficient
experience to decide a doubtful case, and are, through ignorance of
technical forms, liable to involve themselves and others in serious
legal difficulties. It is but a few months ago that physicians
engaged specially in the study of insanity were exclaimed against as
theorists, their evidence was to be excluded from courts of justice.
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it was recommended that their asylums should be handed over to
intelligent laymen, and it was gravely asserted that men of common
sense and knowledge of the world were equally competent with them
to decide as to the existence or non-existence of insanity.
With certainly no amicable feeling towards ‘ mad doctors/ an
amendment of the Lunacy Act passes through the legislature, and, by
a sort of poetical justice, the first trial that occurs after this becomes
law presents us with the spectacle of an apparently sane man who,
upon the informal certificates of two gentlemen who are not * mad
doctors/ is dragged off in the most barbarous manner to an asylum,
whose proprietor, again, is not a f mad doctor/ but who nevertheless
keeps the patient, whose sanity he says he recognised, till his dis¬
charge by the Commissioners in Lunacy on account of the hopeless
invalidity of his certificate. In all these proceedings, from fust to
last, no f mad doctor* appears upon the scene, and we are surely
justified in expressing an opinion that, if the advice of a physician
experienced in cases of insanity and accustomed to weigh evidence,
had been sought, a grievous wrong might have been avoided and a
great public scandal prevented. But this does not seem the view of
the public, who, although the lunacy law was in this case broken,
and cannot, therefore, be said to have failed—although the Com¬
missioners in Lunacy promptly redressed the wrong that had been
committed, for which no ‘ mad doctor* was responsible—renew their
clamour against our profession, and ask angrily for new laws and
for vindictive punishments.
Although it must remain impossible that under any system that can
be devised all wrong or error shall be prevented, the case of Mr.
Hall was one well calculated to raise to an extreme degree the alarm
of the public. The imprisonment of a sane man, even for an hour—
the assault upon a citizen at his own door, and his being carried off
late at night, suddenly and illegally, to an asylum, might warrant still
greater indignation than has been expressed. It was tersely said that
the fact of no malice being proved made the matter worse, as it is far
easier to guard against knavery than against ignorance and folly. The
result of the case, however, goes to prove that prompt redress must
follow errors such as those committed in the course of this extra¬
ordinary case; we should, however, think the verdict of the jury
more satisfactory if Dr. Semple had not been, as it were, made the
scapegoat in the matter, while the principle involved in the question
is left uncertain. We have no desire to defend Dr. Semple;
honorable and conscientious though he is deservedly considered,
there can be no doubt that in this case he was first careless, and
afterwards too zealous; his letters to the asylum were indefensible,
inasmuch as, if Mr. Hall were a dangerous lunatic, he must have
been so for the last twenty years past, and there had been no recen-
symptoms to warrant Dr. Semple*s opinion, even if he had not ext
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ceeded his duty in giving it. Moreover, in the defence of the
action he seemed to allow judgment to go by default; and as he
did not attempt to justify his views, he must therefore be taken to
have written a certificate which was untrue or erroneous, or else of
having expressed opinions founded upon facts which were insufficient
or on theories not susceptible of either explanation or defence. The
argument set up by Dr. Semple's counsel, and most ably and suc¬
cessfully pleaded, went to this :—the defendant had acted in good
faith, and there was no such culpable negligence shown as could
justify damages; and even if there were, he was protected by the
statute. We believe that upon the last point Dr. Semple will
ultimately succeed, and that the verdict will not stand. In this we
must not be misunderstood; we do not say that sane men are to be
assaulted and carried off to lunatic asylums, and that the pleas of a
good intention and bona fides should bar their right to damages;
we do not say that any of those directly or indirectly concerned in
such a supposed transaction ought to escape punishment; but we do
maintain that it is contrary to the statute in lunacy, and that it
will prove highly detrimental to the best interests of the public, if
medical men, proved to have given a certificate in lunacy in good
faith, and under an Act which they consider to authorise their pro¬
ceedings, should be held liable to an action in the form of that
taken by the plaintiff in the case of Hall v. Semple. The result
must be that in many cases of lunacy no certificate will ever be
obtained; it will not be easy to find a physician willing to take the
risk of heavy damages being given against him, upon the opinion of
a jury being contrary to his own. Again, the medical man called into
a case of alleged lunacy will find himself in this dilemma: should
he certify to the patient's insanity, if he is mistaken he is exposed to
the danger of an action from the patient ; on the other hand, should
he not certify, and disastrous consequences follow, he is clearly liable
to a charge of negligence, which the public will itself punish, even
if it does not meet the tender mercies of a jury.
The question really of interest is—supposing a patient consigned
in error to an asylum, and detained there, either culpably or other¬
wise, does an action lie against the physician or physicians who, in
good faith, signed the certificates; and if so, what form should that
action take? To understand the exact bearing of this question,
we must recal to remembrance the exact wording of the present cer¬
tificates in lunacy.
Formerly the physician signing certificates declared it as his opinion
that the alleged lunatic was a proper person to be confined, but the
physician, according to the recent forms, expresses only an opinion
that the patient is of unsound mind, and fit to be detained under
care and treatment; this certificate is in the same terms whether
the patient be sent to an asylum or to a lodging, or kept under
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restraint in a private house; the physician signing need not know
which of these three is the result of his signature, and frequently
certificates of this description are given, with the addition that the
case is not one for which an asylum is necessary. Under these circum¬
stances, then, it is absurd to hold the physician responsible for an
assault upon the patient or for his being carried off to an asylum.
With this he has nothing to do; his function begins and ends with
the expression of his medical opinion. Before any proceedings can
be taken upon this opinion, that of another independent medical man
must be obtained, and accompanied by an order from some relative,
which specifies the place to which the patient is to be sent. Thgse
documents being complete, the proprietor of the asylum or private
house who receives the patient can produce them in bar of any pro¬
ceedings against him for the reception of the patient. But the legal
forms by no means end here; the certificates must be copied and
transmitted within twenty-four hours to the Commissioners in Lunacy,
who jealously scrutinise their wording, and make searching inquiry
in case of any irregularity in their form; then, at the end of two days,
the proprietor of the asylum makes a statement as to the mental
condition of the patient, and from that moment assumes the responsi¬
bility of his detention.
In the case of Hall v. Semple an infraction of the law took place.
Mr. Hall was seized without proper authority, was received into
the asylum without proper authority, and detained there without
any authority at all; for this the proprietor of the asylum must
answer. It is clear, and the jury specially so decided, that Hr. Semple
had nothing to do with these proceedings, and therefore, we submit,
that he was not liable for damages. Another point in this case is
curious, as involving a legal doubt, that will probably receive its
solution in a court of appeal. In point of law. Dr. Semple never
signed a certificate at all; the paper he wrote was informal, and was
never amended. How could he, therefore, be liable for proceedings
taken upon it which were not even within his cognizance, and which
it did not authorise ?
But in the consideration of this question we will dismiss for the
moment the plaintiff and defendant in this case; we will assume a
certificate to have been perfected, and a sane man legally incarcerated
till discharged by the proprietor of the asylum. In such a case is
there any, and what, remedy ? We are happy to say that such a case
has never yet been recorded. Should it, however, occur, the mode of
redress is obvious, and consonant with our ideas and right and
justice. The proprietor of the asylum pleading the authority of the
certificates, the alleged lunatic properly takes his action against the
medical men signing them; he does not encumber the record with
pleas of falsehood or malice, but simply proceeds as in an action for
libel. Supposing Mr. Hall do be sane, it is obvious that Dr. Semple
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libelled him in certifying that he was of unsound mind, and for that
he is liable for damages, the amount of which a jury would probably
estimate, supposing any charge of mala fides abandoned, not alone
upon the time that the physician had given to the case, but also to
the amount of previous study he had brought to bear upon the.
subject before he judged himself qualified to declare a fellow-citizen
legally dead.
It must not be thought that in this view of the case we have any
desire, by a legal quibble, to lessen the responsibility of medical men
signing certificates of lunacy; we would only define exactly what their
legal responsibilities are. In the event of a practitioner maliciously and
falsely certifying a man to be insane, no punishment could be too
great, whether that man was or was not carried off to an asylum;
but his doing the same thing in good faith, and for the protection of
the patient and the public, should be liable only to the ordinary
proceedings all professional men are subject to for errors in
judgment.
It may be said that in the case of Hall v. Semple the verdict of
the jury would have been the same whether the action had been
entered for libel or in the form it was. This may be so, but the
length and cost of tbe proceedings would have been lessened, and,
moreover, a precedent would not have been put upon the books
which must virtually take the examination of doubtful cases of
lunacy out of the hands of independent medical men; and no one
will venture to sign a certificate of lunacy, however convinced he
may feel that the patient is insane, because he cannot feel sure that
- the patient may not be dragged off the same night to an asylum,
whose proprietor may, nevertheless, differ in opinion from the medical
man, and so render him liable to an action, and throw upon him all
the odium attending the assault that has been committed. Until the.
case of Hall v. Semple is finally decided we would advise medical
men who know nothing of lunacy, or have only that dangerous know¬
ledge of it that iar still more mischievous, to abstain from signing
certificates of lunacy in doubtful cases, unless their opinion is forti¬
fied by some physician who may be supposed to really know some¬
thing of the subject; and we would counsel that section of the public
who were clamouring last year to deprive themselves of the advantage
of the experience and knowledge of “ mad doctors” in courts of law,
and in the signature of certificates, whether auy case could have been
worse managed than that of Hall v. Semple, in which not one mad
doctor was engaged.
We would touch very gently upon one other feature in this
remarkable trial. Now that the eloquent tones of the talented counsel
for the plaintiff cease to vibrate upon the ears of the jury, are they
still so certain that Mr. Hall is as injured as they supposed ? The
learned Master in Lunacy, in the case of Mr. Windham, properly dwelt
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upon the fact that the existence or non-existence of insanity is one
of “ evidence and degree.” We do not believe that Mr. Hall is a
dangerous lunatic; but we are by no means inclined to imitate the
example of the jury, and declare him positively of sound mind, while
he continues to “ intimate” that his wife is an adultress. It is true
that jealousy is no proof of lunacy, but a medical practitioner may
be forgiven if he should be doubtful as to the perfect sanity of any
man who is said to insinuate that his wife has been guilty of
adultery, although no shadow of suspicion has ever rested upon her
reputation, and he himself cannot apparently offer any reasonable
grounds for his opinion. In the case of Mrs. Hall it should be
remembered that such suspicions would seem more than absurd, if
the medical man were cognizant of the facts that the wife was of fair
character, of advanced age, the mother—indeed, the grandmother—of
many children, and living at that moment under her husband's roof.
But whether Mr. Hall was or was not of sound mind on the 29th
of July, 1862, there can be no doubt that, even if insane, he suffered
a grievous wrong in being dragged with brutal violence to an asylum,
in contravention of the usual forms of law; if sane, the wrong was
still greater; in either case, the safeguards against error or malice
that, as we maintain, the law of lunacy amply provides were, in his
instance, flagrantly set at nought.
We do not say that Dr. Semple was altogether blameless in this
sad affair; we have pointed out where we think he erred; it may be
also that he was mistaken in his opinion that Mr. Hall was of
unsound mind, as he was in the idea that he was. a dangerous
lunatic ; for such an error in judgment, if proved against him, he
would be clearly liable to an action for libel; but we assert that,
neither legally nor morally, is Dr. Semple responsible for the proceed¬
ings connected with his seizure, for which Mr. Elliot, the proprietor
of the asylum, should alone answer.
A very slight examination of the question will, we think, render
it obvious, not only that this is really the law of the case, but that it
is for the best interests of the public that the law should be so laid
down. The proprietors of asylums are bound to be well acquainted
with the symptoms of insanity, and perfectly familiar with all the
legal formalities bearing upon its treatment. If they are once allowed
to evade this responsibility, the result will be most disastrous, inas¬
much as their superior knowledge will cease to be necessarily trusted to
detect the error or prevent the wrong for which it properly renders
them liable. The public, through the press, loudly proclaims its fear
that under the present law termagant wives or unscrupulous relatives,
aided by inconsiderate medical practitioners, may legally incarcerate
sane men in lunatic asylums; but surely Mr. Hall's case does not
warrant this alarm. It is true that he was captured and imprisoned,
but so he might have been “ burked ” or “ garotted; ” one proceeding
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was as little warranted by the law of lunacy as the other. The jury
were as incorrect in fining Dr. Semple for proceedings which his
isolated and incomplete certificate did not justify, as they would
have been had they brought him in as guilty of murder supposing
that the keepers sent to seize Mr. Hall had killed him in the
struggle.
It has never yet happened—in the case of Mr. Hall it certainly did
not happen—and we believe under the existing law it never can
happen, that a sane man should be dragged to an asylum, under two
certificates of lunacy and an order from a relative, except as the result
of wicked and useless conspiracy, which would, in asylums under the
supervision of the Commissioners in Lunacy, meet instant discovery
and punishment. That such a wrong may be perpetrated through
error or ignorance on the part of two medical men is a new ground
of alarm, which, as we have seen, Mr. Hall's case does not justify j
for we contend that the greatest safeguard against this existed in
the fact that, till this verdict, the proprietors of asylums were
deemed primarily responsible for any wrongful detention of a patient,
inasmuch as their position should presume their competency to dis¬
cover any error, and their means of observation should render such
discovery easy and certain.
But, we repeat, it would be a great mistake to imagine we
advocate the monstrous doctrine, that a man who is a registered
surgeon or apothecary, is therefore chartered to issue with impunity
certificates of lunacy against any one whom, in his ignorance or haste,
he may choose to consider insane; the common law of England pro¬
vides a remedy against such an abuse, and it is essential for practi¬
tioners to remember, when called upon to sign certificates of lunacy,
that, however bond fide their opinion may be, it renders them liable to
an action for libel, whether their certificate is or is not followed by the
committal of the patient to an asylum. We do not object to this
severity in the law; the liberty of the subject cannot be too zealously
guarded; and so far from believing that the grievous wrong suffered
oy Mr. Hall should go unpunished, we avow our conviction that
he would have been justified, both in law and in equity, in proceeding
against the servants of Mr. Elliot for a brutal assault, and also against
Mr. Elliot, the proprietor of the asylum, who illegally received and
restrained him. But this trial of Hall v. Semple, if the verdict of the
jury stand, goes a step beyond, and raises a new r point, which we think
has pressed hardly upon Dr. Semple, and will be found eventually
mischievous to the public, as deterring practitioners from signing
certificates of lunacy, although the safety of the patient or his fnends
require they should do so.
Law-breakers cease to fear the law when the penalties attending
its violation become uncertain; law becomes a terror to the good
when it is uncertain in its definition of what is or is not unlawful
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Mr. Hall did not choose to proceed against Mr. Elliot; he does not
think it right to enter an action for libel against Dr. Semple; was it
because he feared that such a course would produce but scanty
damages ? He, however, files a declaration, upon every count of
which he is defeated, and at last wins his cause by the judge amend¬
ing the word malice, and leaving the question to the jury—whether
they found Dr. Semple guilty of culpable negligence ?
If the verdict against Dr. Semple stand, the signing of certificates
of lunacy will for the future be fraught with peril. How is negligence
to be defined ? How long should physicians examine personally, and
perhaps exasperate, alleged dangerous lunatics, with arms in their
houses ? How many and what inquiries are they to make before they
may safely express their conviction that a man is insane, whom they
believe to be so, without a dread of damages for negligence, in addi¬
tion to an action for libel? Some physicians can detect the signs of
lunacy, not its imitation: are they liable for damages if, in a case of
feigned insanity, they unsuspiciously sign a certificate? Again,
are physicians who, by placing patients under restraint who have
attempted or threaten suicide, liable to the accusation of negligence
for not seeing that such patients were only suicidal, not insane ?
The question of culpable negligence in declaring a man insane
cannot be left to a jury, unless they try also the issue as to whether
the man was sane at the time of such declaration, as they must do if
the action were one for libel. The learned judge in the case of Mr.
Hall expressly warned the jury that they were not to try the sanity
or insanity of the plaintiff (report in the ‘ Times ’); it is singular, there¬
fore, to find that the jury declare Mr. Hall to be sane, which they
were told not to consider, and which is clearly irrelevant, and finding
Dr. Semple negligent in thinking him insane five months before,
although they had most imperfect evidence before them to prove he
was otherwise, the only independent practitioner called for that
purpose having signalised himself by declaring, in cross-examination,
that delusions did not prove insanity. "We will only conclude by
addressing to Dr. Semple the pertinent question of Montague
Chambers :—“ Why, sir, did you not consult in this case some of
those gentlemen who make insanity their study ?” and by recalling
to the memory of the jury and the public the solemn words of the
Judge—it “ would be dreadful if a medical man were to be visited,
in cases of this kind, for consequences arising from mere error in
judgment or mistake in fact/’
T. Harrington Tuke.
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PART V.—NEWS, CORRESPONDENCE, APPOINT-
MENTS, LIST OF MEMBERS, &c.
Proposed Library of the Association.
The President and Committee desire to bring before the Asso¬
ciation the question of gathering a small library composed of the
English and Foreign Journals of Insanity, of asylum reports and
similar papers, to which hereafter, by purchase or donation, the
standard works in psychology might be added.
Even in London there exists no complete series of these journals
and reports, the best collection being that in the College of Surgeons*
library. It is self-evident that a complete series of these papers
ought to be in the possession of the Association. The same ob¬
servation applies to the several reports of the Co mmis sioners in
Lunacy in England, Scotland, and Ireland.
The editor is endeavouring to arrange a complete series of ex¬
changes with all the journals on insanity published in Europe and
America. Again, if the superintendent of each asylum would send
a complete set of the published reports and rules of his asylum, a
nucleus for the collection would soon be formed. A similar success
might, it is hoped, attend the application by this Association to the
Commissioners in Lunacy for a copy of their reports. The several
parliamentary returns might also readily be obtained, and it is
believed that authors (members of the Association and others),
would, from time to time, add copies of their published works to the
collection. The honorary secretary (Dr. Harrington Tuke) has placed
a room in 37 Albermarle Street at the free disposal of the Association
for the safe custody of such a library—a room which will, at all
times, be open to the members of the Association who may wish to
consult their books. The President and Committee trust, therefore,
that this appeal may not be made in vain. They undertake that
the reports thus sent shall be bound in their series of years, marked
with the name of the Association, and carefully preserved with all
other books and documents which may from time to time be added
by gift or otherwise to the library.
The receipt of any reports or books thus presented will be duly
acknowledged in the Journal. Dr. Erlenmeyer, editor of the ‘ Archiv.
der Deutschen Gesellschaft fur Psychiatrie,* offers a copy of a large
work on ‘ Asylum Construction* which he has in the press for tins
proposed library, and there exists both in Germany and France a
great willingness on the part of alienist physicians to bring their
writings under the notice of their English brethren, so that the editor
feels confident that this appeal would be liberally responded to from
abroad.
40>§
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The Yarra Bend Asylum, near Melbourne.
The lunatic asylum for the great colony of Victoria is at Yarra
Bend, Melbourne, and contains upwards of 700 patients. This
asylum has been under the superintendence of Dr. Bowie, who,
in May last, brought an action for libel against the proprietors
of the ‘ Melbourne Argus/ for various articles in that paper im¬
peaching the excellency of his management. The ‘ Argus’ pleaded
justification, and thereupon ensued a nine days’ trial, the report
of which would, at least, fill two numbers of this Journal.
Except on one point, namely, the alleged pregnancy of a patient,
who turned out to have been a servant, the plea of justification
was maintained. The revelations of the trial form an admirable
picture of the old concomitants of restraint; it is like reading
from the reports of the Parliamentaiy Committee in 1815. There
is neither novelty nor instruction in it that we should cumber
our pages with any lengthened account of the manner in which lunatics
are treated in the richest of our colonies. The following extract is
from the evidence of Mr. Whittenbury, a surgeon, who recounts
what he saw when he was visiting the asylum to see a friend.
“ I will mention one particular circumstance. Having heard
that there were patients under restraint at Yarra Bend, and not
having seen anything of the kind, I asked Dr. Bowie if he
would show me some patients under restraint. He said, ‘ Oh,
yes; I will show you several.’ He showed me one case. I
believe the patient was a man named McDonald—a tall, powerful
man. I believe he had not been attended to for several days.
At all events. Dr. Bowie said—calling to some of the keepers
— f We had better attend to this case now; Dr. Whittenbury
wants to see it.’ At a given signal, the bolts were shot, and
four attendants sprang into the cell. Two of the men seized
the patient by the neck and shoulders, and the others seized him
by the legs. The four men then threw him upon the ground, and
held him there, while a? fifth attendant removed some straw and
dirty things out of the cell. This occurred about four or five
o’clock in the evening. The cell was very dirty. The attendant
who took the straw away afterwards returned with some clean sheets
and a blanket or rug. The patient was naked, with the exception
of having on what is called a lunatic or skeleton jacket, which
fastened the upper portion of the arms to the breast. To effect
their escape from the cell, the attendants bound the patient’s legs
and feet together, and then rushed out, and bolted the door after
them. The lunatic’s strength was so great that he immediately
jumped up, and almost instantaneously burst his bonds asunder,
and sprang at the grating of the cell. I had never seen such a case
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in my life before, and was quite shocked. The cell was a stone
cell. No doubt the circumstance of the four men springing upon the
lunatic irritated him. T should think it was altogether unnecessary
to use such violence, from what I have read as to the treatment of
violent lunatics.”
This is just old-fashioned brutality, and the rage and fear which
it generates ; but Dr. Bowie was an ingenious man, and did not by
any means adhere to the old path. As an example of this, take his
method of preventing escapes by padlocking patients together.
O'Grady, an attendant, said; "In one case, in which two patients
tried to run away, they were put in jackets and padlocked together,
side by side. They only remained in that position five or six days.
They were connected together in that manner all the day, except
at meal hours, but not at night.”
Dr. Bowie freely admits the fact, and explains it thus:
" Melbourne and Hughes combined together to effect their escape,
and Melbourne got upon the parapet of a wall with that object in view.
I therefore considered that I was justified in fastening them toge¬
ther. It was done without any ill-nature, but for the purpose of
making them tired of each other’s company, and preventing them
associating with each other for the future. The restraint did not cause
them any pain. I had used it with two patients before, for the
same object, and it answered exceedingly well. In that case, the
two men had been exceedingly troublesome, and I fastened them
together for two or three days. One of them said, ‘ If I was only
quit of this partnership, I would not behave so again.' He behaved
very well after they were separated.”
This Siamese-twin plan of restraint was certainly ingenious, but
Dr. Bowie's highest flight of invention was his discovery of a pecu¬
liar method of restraint, of which, pretty well posted up as we are, we
have never before heard. This is Dr. Bowie's own description of
the invention, and the manner in which it was used.
The Attorney-General .—"With regard to the bags, will you
explain to the jury what they are, and where they were borrowed
from ?''
" The origin of their invention is very simply told. When I was
in practice in Scotland I had the charge of an insane woman, upon
whom we could get no strait-jacket or anything else to secure her. I
then bethought myself of a sack. We got one, made it into a kind
of dress, and put her into it, and I had the satisfaction of seeing
that woman cured. I saw the advantages of the thing, and I used
it afterwards. It was used in the asylum to keep the patients warm,
and to prevent them injuring themselves. An insane person will
often throw himself out of bed, leaving his bedclothes behind him;
and to prevent him taking cold, we roll him in a blanket, and then
put him into the bag. It was never used as a punishment. My
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directions to the attendants were, never to use a jacket or bag with¬
out consulting me. If an extreme case arose, a man might be
put into a jacket, but I must be told immediately. If an attendant
had not done this, he would have been discharged. The bags were
of different sizes. None of them were tight. A patient in a bag
had more freedom for his hands than in a jacket. My positive
instructions were, that if a patient relieved himself in his night-dress,
another bag should be put on.”
, The opinion of the patients who had practical experience of the
doctor’s ingenious method of keeping them warm, was not quite so
complimentary to it as the inventor no doubt would have desired.
Here is the description given of it by Dr. Carr, a much enduring
patient:
“ I remember being visited by Dr. M'Crea in September, 1858.
I had been seven or eight days in continual restraint. A strait-
waistcoat, padlocked, with the hands behind, was placed on me in the
first instance. It was put on in such a way as to create actual
physical torture. Over that waistcoat was placed a bag. There were
three or four bags used in the asylum, with all of which I have
acquaintance. The bag was not removed by an attendant for seven
or eight days, and it was not until I was questioned by Dr. M'Crea
that it became known that I succeeded in releasing myself from the
i 'acket in the space of fifty-four hours after it was put on. The bag
[ could remove and put on at pleasure, so that I might appear, when
any one entered the cell, in just the same condition as when the bag
was first placed upon me. The jacket was put on in the aftemoon>
and the bag not until the evening. Before the bag was put on 1
managed to make a small orifice in the canvas stitching, and acting
on that, and breaking a padlock, I was enabled ultimately to free
myself.
“I made a complaint to Dr. M'Crea, and also, I think, to Dr. Eades
and Mr. Barker, of the treatment which I had received. The result
of this complaint was, that I was replaced in the canvas jacket.
Dr. Bowie came to the door of the cell, and said he did not care what
orders the Board gave, I should be placed under restraint, and should
so remain as long as I was in the asylum. My hands were padlocked
up against the shoulder-blades, and I suffered in consequence a
greater amount of physical pain. I had not committed, by deed or
word, any breach of the regulations. The jacket was kept on about
half an hour, when Mr. Barker entered the cell, and by his orders the
jacket was removed. I will describe the feelings which I experienced
the first night on which I was put into the bag. The bag was com¬
posed of strong No. 1 canvas, impervious to water, wlflch was passed
over the feet, and slipped up the body, fitting closely, the hands
having tp be placed flat against the sides. The bag came close round
mg neck—so close, indeed, that even the bugs could not get ingress
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between the bag and the neck. I continually passed urine into the
bag, and there it was next morning, accompanied sometimes with
faecal matter. The head was not protected from vermin, though
sometimes by day, and occasionally by night, a stiff canvas cap was
added, and padlocked under the throat. My own head was bitten all
over with bugs and fleas—particularly bugs .”
The poor doctor did not succeed in his intention to describe his
feelings, but he said enough to enable us to guess what they must
have been like; fastened in a water-tight sack, with his arms close by
his sides, his head and face bitten all over with fleas and bugs, parti¬
cularly bugs, but the sack so tight round his throat that the bugs
could not get down, and the whole body in a filthy water-tight stew.
Faugh ! ! !
Dr. Carr does not say that the treatment he endured was barbarous;
but Dr. M'Crea, the visiting physician to the asylum, does say so,
for the following passage from his evidence refers to the particular
occurrence described by Dr. Carr:
“ The proportion of patients restrained was large—much larger
than it ought to have been. The means of restraint used were bags,
t 'ackets, and mittens. Dr. Bowie always represented to me that the
rags were used at night, especially in winter-time, to prevent patients
catching cold. If they were used only for that purpose, I can’t
imagine there would be any objection to them. There were a number
of restless patients, who would not lie at night with the bedclothes
over them, and it was necessary to put on them these bags, which
were lined with flannel. But on the 7th of September, 1858, during
an official visit, I found a patient in a bag of a very different charac¬
ter. That patient was Dr. Carr. To the best of my recollection,
that bag was not lined with flannel, and it was fastened round the
patient’s neck. I forget the nature of the fastening—whether it was
tied or padlocked. This was in the day-time, when a patient had no
bedclothes to kick off. Dr. Carr said he had been there seven days.
The bag was not very tight; he could move his arms inside; but the
bag was to restrain him, not to keep him warm. I conceived the
treatment improper and barbarous, and I ordered Dr. Carr to be
taken out of the Dag immediately. Dr. Carr was perfectly quiet and
perfectly rational. His hands and nails were tolerably clean, and I
asked him how he could reconcile that fact with the statement that he
had been seven days in the bag. I understood him to say that, in
forty-eight hours after he was put in the bag, he managed to free
himself.”
Here is the account of another patient from the evidence of
Thomas Hugman, which is not at all more flattering to the system:
“ There was a patient named Fitzgerald. He died on the 22nd of
March last, near Dr. Callan’s residence. He came up from H ward.
He was very sickly and feeble, and seemed terrified. He was very
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destructive with regard to his clothes, and, in consequence, was put
into a bag during the night. It was a narrow kind of bag, made of
very rough canvas—what sailors would perhaps call No. 3 canvas. It
was very dirty—almost black.
“ Fitzgerald was confined in that bag all night. He could not
move his arms. He was placed on the bed, and lay there like a
mummy. The bag was fastened by leather straps and a padlock. In
the day-time, he was put into the airing yard. He had on some
patent gloves—canvas gloves without fingers, fastened by a leather
strap and padlock which screwed up, and if screwed up tight, would
give excruciating pain to any man.”
It would appear that the sacks were used very freely. Dr,
Michael Barry, who visited the asylum officially, as it would seem, in
company with the Mayor of Melbourne, says:
“ I have seen most of the principal asylums in France, Ireland, and
England. I was struck with the appearance of great despondency
presented by the patients at Yarra Bend Asylum. Although things
appeared clean to the eye, they were unpleasant to the nose. Almost
everywhere there was an offensive smell, particularly in the dormitories
and airing ground. There was particularly a smell of uriue. That
struck me to be the case almost everywhere I went. I thought the
per-centage of restraint used at the asylum was most unnecessary.
There seemed to be various bags and sacks used for restraint. I saw
seven or eight people shut up in things of that kind.”
There were complaints about the food also, and the poor patients
at Yarra Bend might have exclaimed with Prince Hal, “ Oh, mon,
strous; what, only two pennyworth of bread to all that sack!”
Dr. Bowie, indeed, though not a very wise man, might have been
called the great Sackem of Melbourne. However, it is said that he
is going, or gone, so that we may infer, argol, that he has himself
been invested with the collar and badge of the sack.
There is much more instructive matter in the report of the
trial than we are able to extract, which we regret, for we trust that
it will be long before we again have such an opportunity of enriching
the anthology of restraint. It is an old tale, that the habitual use
of restraint is accompanied by everything else which is objectionable
in the management oi an asylum, and especially by a disregard of all
proprieties and decencies, and we are therefore not surprised to find
proof of all this in this Yarra Bend trial. Let the following little
fact show what the cleanliness of the place must have been. Samuel
Wainwright, a former attendant, said: "The wards were cleaned
with sand and lime. Soap and water were not used. If there was
any dirt the sand and lime would be left on. You can hide dirt
with sand and lime, but you cannot remove it.”
Dr. Bowie did not deny the fact of his mode of cleaning, and
gave the credit of it to the Commissioners in Lunacy. “ Hot sand
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and lime were used to scrub out the cells. The patients were not
in the cells at the time. The sand and lime were scrubbed off in
half an hour after they were put on. That process is recommended
by the Commissioners of Lunacy. It takes away all the offensive
smell.” In the same spirit, we suppose, he made use of Dr.
Conolly's authority for fastening patients to their bedsteads at
night, and asserted that in every English asylum he had visited,
mechanical restraint is used. Of a verity, ideas do seem to stand ,
topsy-turvy at the antipodes.
We are happy to say that the Victorians commissioned the mem¬
ber for Pontefract, our old colonist, to send them out a medical
superintendent from home, and that Dr. E. Paley, late of Camberwell
House, a member of this association, has been selected for the office,
and sailed on Christmas Eve.
Dr. Paley carries with him to his distant home the warm wishes
of all who know him. No better man could have been found to
represent English Psychology in this distant colony. Dr. Paley
combines experience, temper, and judgment, and he has invariably
gained the respect and esteeem of all with whom he has worked.
We found him a formidable as well as courteous opponent at the
election to the Sussex Asylum in 1858. We trust to hear from
Dr. Paley of his impressions of the colony of Victoria. The salary
of the appointment is £900, with allowances equal to £400, including
a house.
Death of Sir Benjamin Brodie.
“ On the eve of eighty years, a life not more distinguished by its
length than by its usefulness and success, professional and social,
came to an end at Brome Park, in Surrey, on Tuesday last. Sir
Benjamin Brodie, whose death we have now to chronicle, had long
been ailin g ; the great “ medicine man” of our time having been
racked with pains in the shoulder-joints, and with disease in the
eyes, beyond the power of art to reach. Partial blindness had for
some years past clouded his studies, as it had interrupted the dis¬
charge of his duties as President of the Royal Society. From the
latter office he retired in favour of General Sabine. His mind,
however, continued active in his study ; he read and took part in
the controversies of the day, and to the last kept a ready and flowing -
pen in his hand. Brodie was born on the 9th of June, 1783, at
Winterslow, in Wilts, of which place his father was rector ; was
educated at home; was placed under Mr. Wilson at the Hunterian
School in Great Windmill Street, whence he removed, in 1803, to
St. George's Hospital, and became a member of the College in 1805.
From that date hi3 rise was steady, being helped by the literary
power and professional success of his lectures. On the death of
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Sir Everard Home, he succeeded to the vacant office of Serjeant-
Surgeon, when he was made a baronet by King William. In 1851
he became a D.C.L. of Oxford, and in 1858 President of the Royal
Society. The professional works of Sir Benjamin are very justly
esteemed; the non-professional works, such as the recently-published
‘ Psychological Inquiries, * have less weight and value. The writer
was a very clever surgeon, but he was not a man of genius. His
„ mind was solid, practical, and commonplace. No great discovery
will bear his name. But he will be remembered among his brethren
as a man who not only raised himself in the world, but did some¬
thing to elevate his craft. No surgeon before him had risen to the
high dignity of President of the Royal Society. It was a position
which remained to be won, and he won it. That will be his dis¬
tinction with posterity.”— Athenaum, October 25th, 1862.
Sir Benjamin Brodie was elected an honorary member of this As¬
sociation in 1856, and was, he informed the present editor, a regular
reader of the ' Journal of Mental Science/
Appointments.
James Strange Biggs, M.D. St. And. M.R.C.P., to be Medical
Superintendent of the Surrey County Asylum, Wandsworth.
William Godwin Coombs, M.D. St. And., Assistant Medical
Officer to the Devon County Lunatic Asylum, Exminster.
F. H. Hargood, M.R.C.S. Eng., late Assistant Medical Officer to
the Middlesex County Lunatic Asylum at Colney Hatch, to be As¬
sistant Medical Officer to the Lancaster County Lunatic Asylum,
Rainhill.
William Helps, M.D. St. And., F.R.C.P. Edin., to be Resident
Physician to the Royal Hospital of Bethlehem.
H. W. Jackson, M.R.C.S., to be Assistant Medical Officer of the
Surrey County Asylum at Wandsworth.
John Meyer, M.D. Heidelberg, M.R.C.P., to be Medical Super¬
intendent of the Criminal Lunatic Asylum at Broadmoor.
William Orange, M.R.C.S., to ^e Deputy Superintendent of the
Criminal Asylum, Broadmoor.
Edward Paley, M.D. St. And., M.R.C.S., to be Medical Superin¬
tendent of the Yarra Bend Asylum, Melbourne, Victoria.
George Paterson, M.D. Edin., F.R.C.P. Edin., to be Deputy
Commissioner in Lunacy for Scotland.
J. Yellowlees, M.D. Edin., to be Medical Superintendent of the
District Asylum, Stirling.
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INSANE
! r SVorld. As we here add only common observations,
lit» and conclusions of our Tables. We commence, of
Ei e, and we can certainly not be responsible for any
m my, from the sources of Dr. H. Laehb’s, of Berlin,
OBSERVATIONS.
building is quite new, and will be opened in the spring of
53. It is situate near the village Czernouitz, two miles
m Brunn,* the capital of Moravia. No cretins.
ouilding is old, and the average of ten years shows that
) patients have been daily treated there. Graetz* is the
iital of Styria, and has also a small asylum for cretins.
\ e number of cretins in Styria is altogether 5856.
\ wilding is old, and only for curable and very dangerous
ients. Hall is four miles from Innsbruck,* the capital of
rol. Tyrol has 83 cretins.
\ wilding is old. Klagenfurth* is the capital of Karnthen,
—; ich Austrian province has 3058 cretins. In the town of
-Twmmr-inno— w/wui - j rt furron 1 urenff ) rrcnxjo nnronj
is included in the first figures.
The tower is an old horrible building of 1784, with all the
ollections of the barbarous treatment of that age.
j situated, with a beautiful park, three miles from Vienna,*,
iblished by Dr. Gorgen, whose son, and late superinten-
t, died last year, to the regret neither of science nor
oanity. Dr. Eeidesdorf, one of the present superintend
ts, is also a lecturer on mental science at the University
Vienna.
j ;e establishment for the higher class in the “ Landstrasse”
urb.
, for middle class.
ormerly a very old building, and only enlarged and re-
ned in October, 1862, ana has accommodation for 600
ents.
'he next railway station is “ Kennelbach,”* two miles
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I
Books received .
G21
BOOKS RECEIVED.
‘ Epilepsy : its Symptoms, Treatment, and relation to other Chronic
Convulsive Diseases.’ By J. Russell Reynolds, M.D. Lond. pp. 360.
London, Churchill, 1861. ( Reviewed in this number of the
Journal!)
‘ On Chronic Alcoholic Intoxication, with an inquiry into the
influence of the Abuse of Alcohol as a predisposing cause of Disease.’
By W. Marcet, M.D., F.R.S., second edit., pp. 258. London,
Churchill, 1862. (To be reviewed in a subsequent number.)
‘Air and Water : their Impurities and Purification.’ By H. B.
Condy, pp. 80. London, Davies, 1862.
The use of the Permanganates as a deodorizer is of special value in
asylums for the insane, from the non-poisonous nature of these sub¬
stances. We nearly lost a patient once, who managed to drink some
chloride of zinc (Sir W. Barrett’s fluid), which was being employed
for sanitary purposes.
‘D’une forme de Delire suite d’une surexcitation Nerveuse se rat-
tachant it une variete non encore d’ecrite d’epilepsie Epilepsie Larvee.’
Par le Docteur Morel, pp. 28. Paris, 1860.
‘ De la Folie Hereditaire, rapport Medico-legal, &c.’ Par le Dr.
Morel, pp. 29. Paris, 1862.
‘ Le non-Restraint ou 1’Abolition des moyen concitifs dans le Traite-
ment de la Folie.’ Par M. le Dr. Morel, pp. 117. Paris, 1860.
‘ Ueber die Physiologische Bedentung der Religion.’ Vortrag von
Dr. Geerds. Berlin, 1862 (pamphlet).
‘Die Seelen Heilkunde in der Gegenwart.’ Vortrag von Dr. H.
Laehr. Berlin, 1861 (pamphlet).
‘ Fiinf Kardinal-Fragen du administrativen Psychiatrie.’ Von Dr.
Mundy, in London. Osnabriick, 1862.
A German reprint of an article contributed to the pages of this
Journal.
‘The Momingside Mirror’ (monthly).
‘ The Antagonism of Law and Medicine in Insanity and its conse¬
quences, an introductory Lecture.’ By Thomas Lay cock, M.D.
Edinburgh, 1862.
‘ Homicidal Mania, a Biography.’ By Dr. Yellowlees. Edin¬
burgh, 1862.
‘Employment for Patients in British Lunatic Asylums.’ By
Edward Jarvis, M.D. Dorchester, Massachusetts, U.S.
VOL. VIII. 41
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622
Periodicals received in Exchange.
PERIODICALS RECEIVED IN EXCHANGE WITH THE
'JOURNAL OF MENTAL SCIENCE/
The Editor is desirous of extending the exchange list , and for which the Book-
Post offers such facilities , both at home and abroad
ENGLISH.
'The Medical Critic and Psychological Journal/
' The Dublin Quarterly Journal of Medical Science/
' The Medical Circular/
' The Social Science Review/
'The London Medical Review' (monthly).
AMERICA.
'The American Journal of Insanity/ (We were charged Is. 2 d.
on the July number from the postage being underpaid.)
FRENCH.
' Journal de Medecine Mentale/
GERMAN.
' Allgemeine Zeitscrift fur Psychiatrie/
' Archiv der Deutschen Gesellschaft fur Psychiatrie und Correspon-
denz-Blatt.
English books for review, pamphlets, exchange journals, &c., to be
sent either by book-post to Dr. Robertson, Hayward's Heath, Sussex;
or to the care of the publisher of the Journal, Mr. Churchill, New
Burlington Street. French and German publications may be forwarded
to Dr. Robertson, by foreign book-post, or to Messrs. Williams and
Norgate, Henrietta Street, Covent Garden, to the care of their
German and French agents, Mr. Hartmann, Leipzig; M. Borrari,
9, Rue de St. Peres, Paris.
After the first of January, 1863, the arrangements with the
German Postal Union come into operation. A uniform charge of
3 d. per two ounces is to be made on all books, printed papers, &c.,
between England and all parts of the German Postal Union.
The Editor requests that Asylum Reports may be sent to him in
duplicate, one copy for the Journal, and the other for his private
collection.
Dr. Arlidge, Newcastle-under-Lyme, being engaged on Lunacy
Statistics, would be glad of copies of the several Asylum Reports as
they appear.
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MICHIGAN STATE UNIVERSITY
THE
ASSOCIATION OF MEDICAL OFFIC ERS
OF
ASYLUMS AND HOSPITALS FOR THE INSANE.
GENERAL COMMITTEE AND OFFICERS, 1862-3.
JOHN KIRKMAN, M.D.
DAVID SKAE, M.D.
JOSEPH LALOR, M.D.
WILLIAM LEY, Esq.
C. L. ROBERTSON, M.B.
C W. P. KIRKMAN, M.D.
(.J. MILLAR, L.R.C.P.
| ROBERT STEWART, M.D.
} JAMES RORIE, M.D.
HARRINGTON TUKE, M.D.
THOMAS C. BURTON, M.D.
JOHN CONOLLY, M.D., D.C.L.
JAMES G. DAVEY, M.D.
JAMES GILCHRIST, M.D.
JOHN HITCHMAN, M.D.
JOHN H. PAUL, M.D.
PRESIDENT.
PRESIDENT ELECT.
EX-PRESIDENT.
TREASURER.
EDITOR OF JOURNAL.
AUDITORS.
HON. SECRETARY FOR
IRELAND.
HON. SECRETARY FOR
SCOTLAND.
GENERAL SECRETARY.
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MEMBERS OF THE ASSOCIATION.
Richard Adams, L.R.C.P. Edin., M.R.C.S. Eng., County Asylum,
Bodmin, Cornwall.
Thomas Aitken, M.D. Edin., Medical Superintendent, District
Asylum, Inverness.
Thomas Allen, Esq., M.R.C.S., Medical Superintendent, Warneford
Asylum, Oxford.
John Thomas Arlidge, M.B. Lond., M.R.C.P. Lond., Newcastle-
under-Lyme, Stafford (late St. Luke’s Hospital, London).
Henry Armstrong, M.D. Edin., M.R.C.S. Eng., Peckham House,
London.
Samuel Glover Bakewell, M.D. Edin., Church Stretton, Salop
(late Oulton House Retreat).
M. Baillarger, M.D., Mejnber of the Academy of Medicine, Visiting
Physician to the Asylum La Salp6tri£re ; 7, Rue de I’Universite,
Paris. (Honorary Member.')
M. Battel, late Director of Civil Hospitals, 46, Boulevart de l’Hopital,
Paris. (Honorary Member.)
M. BriIsrre de Boismont, M.D., Member of the Academy of Medi¬
cine, 303, Rue du Faubourg, St. Antoine. (Honorary Member.)
H. Berkeley, M.D., Medical Superintendent, District Asylum,
Mullingar.
James Strange Biggs, M.D. St. And., M.R.C.P. Lond., Medical
Superintendent, County Asylum, Wandsworth, Surrey.
George Birkett, M.D. Load., M.R.C.P. Lond., Northumberland
House, Stoke Newington.
George Fielding Blandford, M.B. Oxon., M.R.C.P. Lond., Black-
land’s House, Chelsea.
John Hillier Blount, M.D. Lond., M.R.C.S. Eng., Editor of Falret’s
‘ Clinical Lecture on Mental Medicine,’ Bagshot, Surrey.
- Theodore S. G. Boisragon, M.D. Edin., late Medical Superintendent,
County Asylum, Bodmin; Duddeston Hall, Birmingham.
Robert Boyd, MID. Edin., F.R.C.P. Lond., Medical Superintendent,
County Asylum, Wells, Somersetshire.
William A. F. Browne, M.D. Edin., Commissioner in Lunacy for
Scotland; 35, St. Andrew’s Square, Edinburgh; Nith House,
Dumfries. (Honorary Member.)
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Members of the Association, 625
William Valentine Browne, M.D. St. And., M.R.C.S., Assistant
Medical Officer, Sussex County Asylum, Hayward’s Heath.
James Crichton Browne, M.D. Edin., Assistant Medical Officer,
County Asylum, Mickleover, Derby.
Thomas Nadauld Brushfield, M.D. St. And., M.R.CJ3. Eng.,
dical Superintendent, County Asylum, Chester.
Edward Lanodon Bryan, M.D. Aberd., F.B.C.S. Eng., late Medical
Superintendent, Cambridge County Asylum; Patriot Place, Brighton.
John Charles Bucknill, M.D. Lend., F.&.C.P. Lond., Visitor in
Lunacy; 34, Cleveland Square, Bayswater. Editor of Journal, 1852-62.
President, 1860. (Honorary Member .)
John Buck, Esq., M.R.C.S., Medical Superintendent, Leicestershire
and Rutland County Asylum, Leicester.
Joshua Bull, M.D. Edin., and A.B. Trinity College, Dublin, Cittadella
House, Cork, Ireland.
C. Mountford Burnett, M.D. Aberd., M.R.C.S. Eng., Westbrook
House, Alton, Hampshire.
John Bush, Esq., M.R.C.S., The Retreat, Claphara.
J. Stevenson Bushnan, M.D. Heidlb., F.R.C.P. Edin., Laventoek
House, Salisbury.
Donald C. Campbell, M.D. Glas., M.R.C.P. Lond., F.R.C.P. Edin.,
Medical Superintendent, County Asylum, Brentwood, Essex.
M. Calmeil, M.D., Member of the Academy of Medicine, Paris,
Physician to the Asylum at Charenton, near Paris. (Honorary
Member .)
Francis Wood Casson, Esq., M.R.C.S., Borough Asylum, Aulaby
Road, Hull.
Darwin Chawner, M.D. Edin., M.R.C.P., Visiting Physician, Lincoln
Hospital for Insane, Minster Yard, Lincoln.
Barrington Chevallier, M.D. Oxon., M.R.C.P. Lond., The Grove,
Ipswich.
Thomas B. Christie, M.D. St. And., M.R.C.P. Lond., F.RjC.P. Edin.,
Pembroke House, Hackney.
John D. Cleaton, Esq., M.R.C.S. Eng., Medical Superintendent,
West Riding Asylum, Wakefield, Yorkshire.
Thomas Smith Clouston, M.D. Edin., L.R.C.S. Edin., Assistant-
Physiciaif, Royal Asylum, Edinburgh.
John Conolly, M.D. Edin., F.R.C.P. Lond., D.C.L. Oxou., Con¬
sulting Physician, County Asylum at Hanwell, Middlesex; 37,
Albemarle Street, and The Lawn, Hanwell. President, 1851 and
1858.
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626
Members of the Association,
James Coxe, M.D. Edin., F.R.C.P. Edin., Commissioner in Lunacy for
Scotland; 35, St. Andrew’s Square, Edinburgh. (Honorary Member.)
William Corbet, M.B. Dublin, F.R.C.S. Ireland, Resident Phy¬
sician, State Asylum, Dundrum.
James Cornwall, Esq., M.R.C.S., The Retreat, Fairford, Gloucester¬
shire.
Nicholas C. Corsellis, Esq., M.R.C.S. Eng., late Medical Superin¬
tendent of the West Riding Asylum, Wakefield; Benson, Oxford:
George Russell Dartnell, Esq., M.R.C.S. Eng., Deputy Inspector-
General, Army Medical Department (formerly in charge of the
Military Lunatic Hospital, Great Yarmouth); Arden House, Henley-
in-Arden, Warwickshire.
James George Davey, M.D., M.R.C.P. Lond., late Medical Super¬
intendent of the County Asylums, Hanwell and Colney Hatch,
Middlesex; Northwoods, near Bristol, and 52, Park Street,
Bristol.
Barry Delany, M.D. Queen’s Univ., Ireland, Resident Physician,
District Asylum, Kilkenny.
James De Wolf, M.D. Edin., Medical Superintendent Hospital for
Insane, Halifax, Nova Scotia.
Warren Hastings Diamond, L.R.C.P. Edin., M.R.C.S. Eng., Effra
Hall, Brixton.
Thomas Dickson, L.R.C.P. Edin., late of Cheadle Asylum, Cheshire;
Wye House, Buxton, Derbyshire.
J. Langdon Haydon Down, M.D. Lond., M.R.C.P. Lond., Assistant-
Physician, London Hospital; Resident Physician, Asylum for Idiots,
Earlswood, Surrey.
Joseph T. Duffey, M.D. Glas., Eagle House, Finglas, Dublin.
Valentine Duke, M.D. Edin., L.R.Q.C.P. Ireland, Visiting Physician,
Asylum Society of Friends, Bloomfield, Dublin; 33, Harcourt
Street, Dublin.
James Foulis Duncan, M.D. Trin. Col. Dub., L.R.Q.C.P. Ireland,
Visiting Physician, Farnham House, Finglas; 19, Gardiner’s Place,
Dublin.
James Duncan, M.D. Lie. Med. Dub., L.R.C.S. Edin.; 39, Marl¬
borough Street, Dublin, and Farnham House, Finglas.
Nugent B. Duncan, M.B. Trin. Col. Dub., F.R.C.S. Iceland; 39,
Marlborough Street, Dublin, and Farnham House, Finglas.
Peter Martin Duncan, M.B. Lond., M.R.C.S. Eng., late Med.
Super., Essex Hall Asylum; 8, Belmont, Church Lane, Lee, Kent.
James Eastwood, M.D., The Retreat, Fairford, Gloucestershire.
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Members of the Association. 627
Richard Eaton, M.D. Queen’s Uuiver. Ireland, L.R.C.S. Ireland,
Resident Physician, District Asylum, Ballinasloe.
John Eustace, jun., B.A. Trin. Col. Dub., L.R.C.S. Ireland; 47*
Grafton Street, Dublin, and Hampstead House, Glasnevin, Dublin.
William Dean Fairless, M.D. St. And., M.R.C.S. Eng., Assistant
Medical Officer, District Asylum, Montrose.
M. Falret, Doctor in Medicine, Paris, Member of the Academy of
Medicine, Physician to the Asylum La Salpetri&re; 114, Rue du
Bac, Paris. (Honorary Member.)
George Fayber, M.D. St. And., F.R.C.S. Eng., Hurst House and
Burman House, Henley-in-Ardeu, Warwickshire.
C. F. Flemming, M.D., Editor of the Zeitschrift fur Psychiatrie,
late of the Sachsenberg State Asylum, Schwerin, Mecklenburgh.
(Honorary Member).
James Flynn, M.B. Trin. Col. Dub., Resident Physician, District
Asylum, Clonmel, Tipperary, Ireland.
Richard Ford Foote, M.D. St. And., M.R.C.S. Eng., late Medical
Superintendent, County Asylum, Norfolk; Constantinople.
Charles Joseph Fox, M.D. Cautab., Brislington House, Bristol.
Francis Rer Fox, M.D. Cantab., Brislington House, Bristol.
Edwin F. Fox, Esq., M.R.C.S. Eng., Visiting Surgeon, Brislington
House, Bristol.
John Mitchell Garbutt, L.R.C.P. Edin., Dunston Lodge, Gates-
head-on-Tyne.
Gideon G. Gardiner, Esq., M.R.C.S. Eng., Brooke House, Clapton.
Samuel Gaskell, Esq., F.R.C.S. Eng., Commissioner in Lunacy;
19, Whitehall Place. (Honorary Member.)
James Gilchrist, M.D. Edin., Resident Physician, Crichton Royal
Institution, Dumfries.
Thomas Green, Esq., M.R.C.S. Eng., Medical Superintendent,
Borough Asylum, Birmingham.
Francis James Hammond, Esq., M.R.C.8. Eng., Assistant Medical
Officer, County Asylum, Farnham, Hampshire.
Henry Lewis Harper, Esq., M.R.C.S. Eng., Assistant Medical
Officer, County Asylum, Chester.
Sir Charles Hastings, Rut., M.D. Edin., D.C.L. Oxon., Member of
the G^peral Medical Council. Worcester. President, 1859.
George W. Hatchell, M.D. Glas., L.R.Q.C.P. Irelaud, Inspector
of Asylums, Ireland; 13, Hume Street, Dublin. (Honorary Member.)
William Helps, M.D. St. And., F.R.C.P. Edin., Resident Physician,
Bethlehem Hospital.
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628 Members of the Association.
John Dale Hewson, M.D., Ext. L.R.C.F. Eng., Medical Superinten¬
dent, Coton Hill Asylum, Stafford.
Robert Gardiner Hill, M.D., L.R.C.P. Edin., M.R.C.S. Eng., late
Medical Superintendent, County Asylum, Lincoln; Shillingworth
Hall, Stamford, Lincolnshire.
William Charles Hills, M.D. Aber., M.R.C.S. Eng., Medical Super¬
intendent, County Asylum, Norfolk.
Samuel Hitch, M.D., M.R.C.P. Lond., M.R.C.S. Eng., late Medical
Superintendent, County Asylum, Gloucester; Sandywell Park, Chel¬
tenham. Treasurer and General Secretary , 1841-51.
Charles Hitchcock, M.D., L.R.C.P. Edin., M.R.C.S. Eng., Fid-
dington House, Market Lavington, Wilts.
John Hitchman, M.D. St. And., M.R.C.P. Lond., F.R.C.S. Eng., late
Medical Superintendent, County Asylum, Hanwell; Medical Superin¬
tendent, County Asylum, Mickleover, Derbyshire. President, 1856.
Samuel Hobart, M.D., F.R.C.P. Edin., M.R.C.S. Eng., Visiting
Surgeon, District Asylum, Cork; South Mall, Cork.
Sir Henry Holland, Bart., M.D. Edin., F.R.C.P. Lond., Physician
in Ordinary to the Queen, F.R.S., D.C.L. Oxon.; 25, Brook Street,
Grosvenor Square. ( Honorary Member .)
William Charles Hood, M.D. St. And., M.R.C.P. Lond., F.R.C.P.
Edin., Visitor in Lunacy; 49, Lincoln’s Inn Fields. ( Honorary
Member.')
S. G. Howe, M.D., Boston, United States. ( Honorary Member.)
John Humphry, Esq., M.R.C.S. Eng., Medical Superintendent,
County Asylum, Aylesbury, Bucks.
William James Hunt, M.D., L.R.C.P. Edin., M.R.C.S. Eng., late
Assistant Medical Officer, County Asylum, Worcester; Hoxton
House, London.
Herbert Iles, M.D., L.R.C.P. Edin., M.R.C.S. Eng., late of The
Retreat, Fairford; Park Street, Cirencester, Gloucestershire.
Henry Jacobs, Esq., M.R.C.S. Eng., Hoxton House, Hoxton.
Robert Jamieson, M.D. Edin., L.R.C.S. Edin., Medical Superinten¬
dent, Royal Asylum, Aberdeen.
Edward Jarvis, M.D., Dorchester, MasB., U.S. (Honorary Member.)
Octavius Jepson, M.D. St. And., M.R.C.S. Eng., Assistant Medical
Officer, County Asylum, Hanwell, Middlesex. •
George Turner Jones, M.D., L.R.C.P. Edin., Medical Superinten¬
dent, County Asylum, Denbigh, N. Wales.
John Kitching, Esq., M.R.C.S. Eng., The Friends’ Retreat,
York.
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Members of the Association. 629
John Kirkman, M.D., Medical Superintendent, County Asylum,
Melton, Suffolk. President.
William Philips Kirkman, M.D. St. And., M.R.C.S. Eng., Medical
Superintendent, Cumberland and Westmoreland County Asylum,
Garlands, Carlisle. Auditor.
Joseph Lalor, M.D. Glas., L.R.C.S. Ireland, Resident Physician,
Richmond Asylum, Dublin. President, 1861.
Robert Law, M.D. Trin. Col. Dub., F.R.Q.C.P. Ireland, Visiting
Physician, State Asylum, Dundrum; 25, Upper Merrion Street,
Dublin.
Martin S. Lawlor, M.D. Edin., L.R.C.S. Ireland, Resident Physician,
District Asylum, Killarney, Kerry.
George William Lawrence, M.D. Lond., M.R.C.P. Loud., M.R.C.S.
Eng., Medical Superintendent, County Asylum, Fulbourn, Cam¬
bridge.
Thomas Laycock, M.D. Gottingen, F.R.C.P. Edin., F.R.S. Edin.,
M.R.C.P. Lond., Professor of Medicine and of Clinical and
Psychological Medicine, Edinburgh University. (Honorary Member.)
Henry Lewis, Esq., M.R.C.S. Eng., late Assistant Medical Officer,
County Asylum, Chester; 54, Paradise Street, Lambeth.
William Ley, Esq., M.R.C.S. Eng., Medical Superintendent, County
Asylum, Littlemore, Oxfordshire. Treasurer. President, 1848.
James Murray Lindsay, M.D. St. And., L.R.C.S. Edin., Medical
Superintendent, Murray’s Royal Hospital, Perth.
John Lorimer, M.D. Edin., L.R.C.S. Edin., late Assistant-Physician,
Murray’s Royal Asylum, Perth; Physician, Crumpsall New Hos¬
pital and Workhouse, Manchester.
William H. Lowe, M.D. Edin., F.R.C.P. Edin., Saughton Hall, Edin¬
burgh.
Thomas Harvey Lowry, M.D. Edin., M.R.C.S. Eng., Mailing Place,
West Mailing, Kent.
William James Lynch, Esq., F.R.C.S. Ireland, Hartfield House,
Drumcondra, Dublin.
Donald Mackintosh, M.D. Durham and Glas., L.F.P.S. Glas.,
Dimsdale Park Retreat, Darlington, Durham.
Alexander Mackintosh, M.D. St. And., L.F.P.S. Glas., Royal Asylum,
Gartnavel, Glasgow.
William Carmichael Mackintosh, M.D. Edin., L.R.C.S. Edin.,
Assistant-Physician, Murray’s Royal Asylum, Perth.
John Macmunn, M.D. Glas., L.F.P.S. Glas., Resident Physician,
District Asylum, Sligo.
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630
Members of the Association.
William W. Mackreight, M.D. Glas., M.R.C.P. Lond., late County
Asylum, Somerset; The Bungalow, Torquay, Devon.
Charles William C. Madden, M.D. Edin., L.M. Edin., Assistant
Medical Officer, County Asylum, Wells, Somerset.
John Manley, M.D. Edin., M.R.C.S. Eng., Medical Superintendent,
County Asylum, Enowle, Fareham, Hants.
William G. Marshall, Esq., F.R.C.S. Eng., Medical Superintendent,
County Asylum, Colney Hatch, Middlesex.
Henry Maudsley, M.D. Lond., M.R.C.P. Lond., M.R.C.S. Eng.,
late Medical Superintendent, Royal Asylum, Cheadle; 38, Queen
Ann Street, Portman Square.
David M. M'Cullough, M.D. Edin., M.R.C.S. Eng., Medical Super¬
intendent of Asylum for Monmouth, Hereford, Brecon, and Radnor;
Abergavenny.
Robert M'Kinstry, M.D. Giess., L.R.Q.C.P. Ireland, Resident
Physician, District Asylum, Armagh.
John Meyer, M.D. Heidelb., M.R.C.P. Exam. ‘Lond., late of the
Civil Hospital, Smyrna, and Surrey Asylum; Medical Superintendent,
State Asylum, Broadmore, near Sandhurst.
John Millar, M.D., L.R.C.P. Edin., L.R.C.S. Edin., late Medical
Superintendent, County Asylum, Bucks.; Bethnal House, Cam¬
bridge Heath. (Auditor.)'
Patrick Miller, M.D. Edin., F.R.S. Edin., Visiting Physician, St.
Thomas’s Hospital for Lunatics; The Grove, Exeter.
Henry Monro, M.B. Oxon, F.R.C.P. London, Censor, 1861, Visiting
Physician, St. Luke’s Hospital; Brook House, Clapton, and 13,
Cavendish Square.
M. Morel, M.D., Member of the Academy of Medicine, Paris, Phy¬
sician in Chief to the Asylum for the Insane at St. Yon, near Rouen.
(Honorary Member.)
Sir Alexander Morison, M.D. Edin., F.R.C.P. London, late Con¬
sulting Physician, County Asylum, Hanwell, and Visiting Physician,
Bethlehem Hospital; 24, Pembridge Gardens, Notting Hill.
William Chapman Moss, M.D. Vermont, U.S., M.R.C.P. London,
Longwood House Asylum, Long Ashton, Bristol.
George W. Mould, Esq., M.R.C.S. Eng., Medical Superinteudent,
Royal Lunatic Hospital, Cheadle, Manchester.
Henry Muirhead, M.D. Glas., L.F.R.S. Glas., late Assist. Med. Officer,
Royal Asylum, Gartnavel; Longdales House, Bothwell, Lanarkshire.
Jakomir Mundy, M.D. Wurtzburg, Licentiate in Medicine and
Surgery, Briinn, Moravia; 14, Old Cavendish Street.
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Members of the Association.
631
Robert Nairn®, M.D. Cantab., F.R.C.P. Lond., Censor, 1856-
58, late Senior Physician to St. George’s Hospital, Commissioner
in Lunacy; 19, Whitehall Place, and Richmond Green. (.Honorary
Member.')
Frederick Needham, Esq., M.R.C.S. Eng., Medical Superintendent,
County Asylum, Bootham, Yorkshire.
Charles Hayes Newington, M.D. Ext., L.R.C.P. Lond., Ticehurst,
Sussex.
Samuel Newington, M.D., B.A. Oxford, M.R.C.P. Lond., Ridgway,
Ticehurst, Sussex.
Henry Niven, L.R.C.P. Edin., County Asylum, Essex, H.E.I.C.S.
Medical Department, Bombay.
Daniel Noble, M.D. St. And., F.R.C.P. Lond., Visiting Physician,
Clifton Hall, Retreat, Manchester.
John Nugent, M.B. Trin. Col. Dub., L.R.C.S. Ireland, Senior In¬
spector of Asylums, Ireland; 14, Rutland Square, Dublin.
Richard Oliver, M.D. Edin., M.R.C.P. Lond., Medical Superin¬
tendent, County Asylum, Bicton, Shrewsbury.
Edward Palmer, M.D. St. And., M.R.C.P. Lond., Medical Superin¬
tendent, County Asylum, Lincoln.
Edward Paley, Esq., M.R.C.S. Eng., late Resident Medical Officer,
Camberwell House, Camberwell; Medical Superintendent, Yarra
Bend Asylum, Melbourne, Victoria.
William Henry Parsey, M.D. Lond., M.A. Lond., M.R.C.P.
Lond. Medical Superintendent, County Asylum, Hatton, Warwick¬
shire.'
John Hayball Paul, M.D. St. And., M.R.C.P. Lond., F.R.C.P.
Edin.; Camberwell House, Camberwell.
Thomas Peach, M.D., J. P. for the County of Derby; Langley Hall,
Derby. (Honorary Member.)
Edward Picton Phillips, Esq., M.R.C.S. Eng., Medical Superin¬
tendent, Haverfordwest Boro’ Asylum ; High Street, Haverfordwest,
Pembrokeshire.
Francis Richard Philp, M.D. Cantab., F.R.C.P. Lond., late
Physician to St. Luke’s Hospital; Colby House, Kensington.
Thomas Power, M.D. Edin., L.M. Dublin, Medical Superintendeut,
District Asylum, Cork; Visiting Physician, Lindville House,
Cork.
Thomas Prichard, M.D. Glas., M.R.C.P. Lond., F.R.C.P. Edin., late
Medical Superintendent, Glas., Royal Asylum; Abington Abbey,
Northampton.
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632
Members of the Association.
Jambs Rae, M.D. Aberd., L.R.C.P. Edin., Deputy Inspector-General,
Lunacy Department, Naval Hospital, Haslar, Hants.
John Ray, M.D., Physician, Maine Hospital for the Insane, U.S.,
Providence, Rhode Island, U.S. ( Honorary Member.)
Charles A. Lockhart Robertson, M.B. Cantab., M.R.C.P. Lond.,
F.R.C.P. Edin., late Assistant-Physician, Military Lunatic Hospital,
Yarmouth; Medical Superintendent, County Asylum, Hayward’s
Heath, Sussex. ( General Secretary , 1855-62.) Editor of Journal.
George Robinson, M.D. St And., F.R.C.P. London, Visitiug Phy¬
sician, Bensham Lunatic Asylum, Gateshead ; Eldon Square, New-
castle-on-Tyne.
William Francis Rogan, M.D. Trin. Coll., Dubl., L.R.C.S. Edin.,
Resident Physician, District Asylum, Londonderry.
Thomas Lawes Rogers, M.D. St. And., M.R.C.P. Lond., M.R.C.S.
Eng., Medical Superintendent, County Asylum, Rainhill, Lancashire.
James Rorie, M.D. Edin., L.R.C.S. Edin., Medical Superintendent,
Royal Asylum, Dundee. Honorary Secretary for Scotland.
Andrew Ross, M.D., St. And., M.R.C.P. Lond., Waterloo, Portsmouth.
Richard H. H. Sankey, Esq., M.R.C.S. Eng., Assistant Medical
Officer, Oxford and Berks County Asylum, Littlemore, Oxford.
W. H. Octavius Sankey, M.D., M.R.C.P., Lond., late Resident Phy¬
sician, Fever Hospital; Medical Superintendent, County Asylum,
Hanwell, Middlesex.
George James S. Saunders, M.B. Lond., M.R.C.S. Eng., Medical
Superintendent, County Asylum, Exminster, Devon.
Frank Schofield, Esq., M.R.C.S. Eng., Camberwell House, Cam¬
berwell.
Edgar Sheppard, M.D. St. And., M.R.C.P. London, F.R;C.S. Eng.,
Medical Superintendent, County Asylum, Colney Hatch, Middlesex,
James Sherlock, M.D. Edin., M.R.C.P. Lond.,- F.R.C.S. Edin.,
Medical Superintendent, County Asylum, Powick, Worcester.
David Skae, M.D. St. And., F.R.C.S. Edin., Medical Superintendent,
Royal Asylum, Edinburgh. President Elect.
John Sibbard, M.D. Edin., M.R.C.S. Eng., Medical Superintendent,
District Asylum, Lochgilphead, Argyllshire.
Frederic Moore Smith, M.D. St. And., M.R.C.S. Eng., late Assist¬
ant-Surgeon, 4th Reg.; Hadham Palace, Ware, Herts.
George Pyemont Smith, M.D. Edin., M.R.C.S. Eng., The Retreat,
Mount Stead, Otley, Yorkshire.
Robert Smith, M.D. Aber., L.R.C.S. Edin., Medical Superintendent
County Asylum, Sedgefield, Durham.
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633
Members of the Association.
John Smith, M.D. Edin., L.R.C.S. Edin., late Physician, City Lunatic
Asylum ; Visiting Physician to Sanghton Hall; 20, Charlotte Square,
Edinburgh.
Hans Sloane Stanley, Esq., Chairman of Visiting Magistrates,
County Asylum, Hampshire. (Honorary Member .)
William Stamer Stanley, M.D., L.M. Dub., L.K.Q.C.P. Ireland,
Orchardstown House, Rathfarnham, Dublin.
Henry Steyens, M.D. Lond., M.R.C.P. Lond., M.R.C.S. Eng., late
Medical Superintendent, St. Luke’s Hospital; 78, Grosvenor Street,
London.
Henry Oxley Stephens, M.D. Aber., M.R.C.P. Lond., M.R.C.S.
Eng., Medical Superintendent, Boro* Asylum, Stapleton, Bristol.
Henry H. Stewart, M.D. Edin., F.R.C.S. Ireland, Resident Superin¬
tendent Physician, Royal District Asylum, Lucan, Dublin.
Robert Stewart, M.D. Glas«, L.A.H. Dab., Medical Superintendent,
District Asylum, Belfast. Honorary Secretary for Ireland.
William Phillimobe Stiff, M.B. Lond., M.R.C.S. Eng., Medical
Superintendent, County Asylum, Nottingham.
George James Stilwell, M.D. Edin., M.R.C.P. Lond., M.R.C.S.
Eng.; Moorcroft House, Hillingdon, Middlesex, and 3, Lower
Berkeley Street, Portman Square.
Henry Stilwell, M.D. Edin., M.R.C.S. Eng.; Moorcroft House,
Hillingdon, Middlesex.
Alexander J. Sutherland, M.D. Oxon., P.R.C.P. Lond., F.R.S.,
Censor, 1847, Consulting Physician to St. Luke’s Hospital; Black-
land’s, and Whiteland’s House, Chelsea, and 6, Richmond Terrace,
WhitehaU. President, 1854.
J. Gustayus Symes, Esq., M.R.C.S. Eng., Medical Superintendent,
County Asylum, Dorsetshire.
Joseph R. Symes, Esq., M.R.C.S. Eng., Assistant Medical Officer,
County Asylum, Devizes, Wilts.
William Barney Tate, M.D. Aber., M.R.C.P. Lond., M.R.C.S. Eng.,
Medical Superintendent of the Lunatic Hospital, The Coppice, Not¬
tingham.
John Terry, Esq., M.R.C.S. Eng., Bailbrook House, Bath.
John Thurnam, M.D. Edin., F.R.C.P. London, L.R.C.S. Edin., late
of The Retreat, York; Medical Superintendent, County Asylum,
Devizes, Wilts. President, 1855. «
Ebenezer Toller, Esq., M.R.C.S. Eng., late Assistant Medical
Officer, County Asylum, Colney Hatch; Medical Superintendent, St.
Luke’s Hospital, London.
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634
Members of the Association.
Daniel Hack Tuke, M.D. Heidel., L.R.C.P. Load., M.R.C.S. Eng.»
late Visiting Physician, The Retreat, York; Wood Lane, Falmouth.
Thomas Harrington Tuke, M.D. St. And., F.R.C.P. Edin., M.R.C.P.
London; The Manor House, Chiswick, and 37, Albemarle Street,
Piccadilly. Honorary General Secretary.
Francis Delaval Walsh, Esq., M.R.C.S. Edin., Medical Superin¬
tendent, Lunatic Hospital, Lincoln.
John Warwick, Esq., M.R.C.S. Eng., 39, Bernard Street, Russell
Square, W.C.
John Ferra Watson, Esq., M.R.C.S. Eng., Heigham Hall, Norwich.
Francis John West, Esq., M.R.C.S. Eng., Medical Superintendent,
District Asylum, Omagh, Tyrone.
James Wilkes, Esq., F.R.C.S. Eng., Commissioner in Lunacy; 19,
Whitehall Place, and 18, Queen’s Gardens, Hyde Park. {Honorary
Member.)
Edmund Sjparshall Willett, M.D. St. And., M.R.C.P. Lend.,
M.R.C.S. Eng., Wyke House, Sion Hill, Isleworth, Middlesex.
Caleb Williams, M.D. Aber., M.R.C.P. Lond., F.R.C.S. Eng., Visit¬
ing Physician to The York Retreat, and to Lawrence House, York;
73, Micklegate, York.
William White Williams, M.D. St. And., M.R.C.P. Lond.,
M.R.C.S. Eng., Medical Superintendent, County Asylum, Glou¬
cester. General Secretary , 1847-1855.
Duckworth Williams, Esq., M.R.C.S. Eng., Assistant Medical
Officer, General Asylum, Northampton.
Richard Wilson, Esq., M.R.C.S. Eng., Medical Superintendent,
County Asylum, Morpeth, Northumberland.
Francis Wilton, Esq., M.R.C.S., Assistant Medical Officer, County
Asylum, Gloucester.
Edwin Wing, M.D. Lond., M.R.C.S. Eng., Medical Superintendent,
General Lunatic Asylum, Nottingham.
' William Wood, M.D. St. And., M.R.C.P. Exam. Lond., M.R.C.S.
Eng., Visiting Physician, St. Luke’s Hospital, late Medical Officer,
Bethlehem Hospital; Kensington House, Kensington, and 54, Upper
Harley Street.
Alfred Joshua Wood, M.D. St. And., F.R.C.S. Eng., Medical
Superintendent, Barnwood House Hospital for the Insane, Glou¬
cester. •
Andrew Winter, M.D. S(. And., M.R.C.P. Lond., Coleherne Court,
Old Brompton.
David Yellowlees, M.D. Edin., L.R.C.S. Edin., late Assistant
Medical Officer, Morningside Asylum; Medical Superintendent,
District Asylum, Stirling. m
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INDEX TO NOS. IV—VIII (New Series).
The contents of No. IV of Vol. I (New Series) were omitted in the index to that
volume; they are, therefore, distinguished in this index to Vol. II by adding the
numbers to which they belong.
Address of Dr. Kirkman, President of the Association, 311
Appointments, 158, 449, 460, 620
Arlidge, J. T., M.B., reports on foreign psychological literature, 250, 395, 556
lunacy statistics, 420
Association intelligence, 309, 444
Asylum reports, 276
Asylums and the insane in France and Belgium, by W. C. McIntosh, M.D., 1
Brierre de Boismont, des hallucinations (review), 293
Browne, W. A. F., M.D., on an idiot family of seven, 429
J. Crichton, M.D., personal identity aud its morbid modifications,
385, 535
Buckniil, John Charles, M.D., on the death of Prince Consort (No. IV), 609
on kleptomania, 262
on Dr. Gairdner and medical evidence (No. IV),
595
on report of inspectors of lunatic asylums in
Ireland (No. IV), 590
on modes of death among the insane, 336
on statistics of insanity (review), 297
on social science review, 306
on Scotch lunacy bill, 308
on the new lunacy bill, 152
Bushnan, J. Stevenson, M.D., on practical use of mental science, 132
on principles and method of a practical science
of mind, 235
vol. vm. 42
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68 6
INDEX.
Case of morai insanity or dipsomania, by W. T. Gairdner, M.D., 590
Cases illustrative of mania with general paralysis, by K. McLeod, M.D.,
(No. IV), 546
illustrative of the use of Roman baths in mental disease, by C. L.
Robertson, M.6., 99
Considerations with regard to hereditary influence, by H. Maudsley, M.D.,
482
Cottage system of treatment of insane, by J. Mundy, M.D., 329
Coxe, Dr., lunacy in France (No. IV), 560
Death of Prince Consort (No. IV), 609
of Sir B. Brodie, 619
of Professor Ideler, 580
Duncan, P.M., M.B., physiological anomalies of idiots (No. IV), 515
Epilepsy, by J. R. Reynolds, M.D. (review), 546
Gairdner, W. F., M.D., and medical evidence (No. IV), 695
General statistics of asylums for the insane, by J. Mundy, M.D., 621
Genesis of mind, by H. Maudsley, M.D. (Part I, No. IV), 461
(Part n), 61
Hall v. Semple, by Harrington Tuke, M.D., 603
Hood, W. C., M.D., statistics of insanity (review), 297
Iddison, Adam, pathological anatomy of the brain in insanity, 37
Idiot family of seven, by W. A. F. Browne, M.D., 429
Kirkman, Dr., president’s address, 311
Kleptomania, by J. C. Bucknill, M.D., 262
Laycock, Thomas, M.D., on the principles and method of a practical science of
mind, 495
Lunacy statistics, by J. T. Arlidge, M.B., 420
in France, by Dr. Coxe (No. IV), 560
acts amendment act, 458
Macllwaine, Rev. W., on oenomania or methyskomania (No. IV), 530
Maudsley, Henry, M.D., on genesis of miud, 61, 461
on psychological inquiries (review), 211
on middle-class hospitals for the insane, 356
on considerations with regard to hereditary influence,
482
McIntosh, W. C., M.D., notes on asylums in France and Belgium, 1
McLeod, Kenneth, M.D., on practical mental science, 513
on two cases illustrative of mania (No. IV), 546
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INDEX.
637
M ddie-ciass hospitals for the insane, by H. Maudsley, M.D., 356
asylum in Sussex, the want of, and suggestions for its establish¬
ment, by C. L. Robertson, M.B., 465
Mitchell, A., M.D., plural births in connection with idiotcy, 597
Modes of death among the insane, by J. C. Bucknill, M.D., 336
Mundy, J., M.D., on cottage system of treatment of insane, 329
on general statistics of asylums for the insane, 621
New lunacy bill, 152
Observations deduced from statistics of the insane, by Dr. Ren&udin (No. IV),
534
(Enomania or methyskomania, by Rev. W. Macllwaine (No. IV), 530
Pathological anatomy of the brain in insanity, by Adam Iddison, 37
elements of general paresis, by E. Salomon, M.D., 365
Personal identity and its morbid modifications, by J. Crichton Browne, M.D.,
385, 535
Physiological anomalies of idiots, by P. Martin Duncan, M.B. (No. IV), 515
Plural births in connection with idiotcy, by A. Mitchell, M.D., 597
Practical use of mental science, by J. Stevenson Bushnan, M.D., 132
Practicable mental science, by K. McLeod, M.D., 513
Principles and method of a practical science of mind, by J. Stevenson Bushnan,
M.D., 235
and method of a practical science of mind, by T. Laycock, M.D.,
(No. IV), 495
Problem of mind propounded to metaphysics and science, 176
Progress of psychological medicine since the time of Dr. Cains, by C. L.
Robertson, M.B., 197
Proposed new lunatic asylum for the county of Surrey (No. IV.), 600
Psychological inquiries, by Sir B. Brodie (review), 211
excerpta, by J. T. Arlidge, M.B., 250, 395, 556
Renaudin, Dr., observations deduced from statistics of the insane (No. IV),
534
Report of inspectors of lunatic asylums in Ireland (No. IV), 590
on Gheel, by the French Commission, 102
on English psychological literature, by C. L. Robertson, M.B., 590
Revised rules for district asylums in Ireland, 119
Robertson, C. Lockhart, M.B., on cases illustrating use of Roman bath, 99
progress of psychological medicine, 197
the want of a middle-class asylum in Sussex,
465
utilization of asylum sewerage, 343
English psychological literature, 590
editorial note, 461
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688 INDEX.
Rorie, J., M.D., on treatment of hallucination by electrization, 363
Salomon, E., M.D., on pathological elements of general paresis, 365
Special general meeting of the association, 444
Treatment of hallucination by electrization, by J. Rorie, M.D., 363
Tuke, Harrington, M.D., on Hall v. Semple, 603
Utilization of asylum sewerage, by C. L. Robertson, M.B., 343
Warwick, J., motion to inquire into the proceedings of the Commissioners in
Lunacy, 346
Yarra Bend Asylum, 614
PRINTED BY J. S. ADLAKD, BARTHOLOMEW CLOSE.
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