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THE JOURNAL 


OF 


MENTAL SCIENCE 


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


EDITED BY 


HENRY Eee M.D., 


ee 


ge “AND 


THOMAS. 8. ‘CLOUSTON, M.D. 


** Nos vero intellectum aedine arebus. non abstrahimus quam bey rerum imagines.et 


radii (ut in sensu fit) coire Neat f. 


FRANCIS BAcoN; Proleg. Instaurat. Mag. 


VOL. XXIII. = ~2 


LONDON: 
J. anp A. CHURCHILL, 
NEW BURLINGTON STREET, 


MDCCCLXXVITII, 


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


INDEX TO VOL. XXIII. 


Abscess of the brain and motor centres, 400 
Albuminuria in inebriates, 126 
» ° after epileptic and paralytic attacks, 602 
Alcoholism, alcoholic delirium and their treatment, 267 
Alcohol, abuse of (see also Drink), 287 
Alleged increase of insanity, 45, 581 
American asylums, 117 
x Psychological Literature, 279 
Amusements as a treatment in insanity condemned, 305 
Animal heat, observations on, 380 
Aphasia, a theory of, 403 
Apoplexy, aphasia, and mental weakness, 525 
Appointments, 150, 307, 456, 613 
Asylum reports, 284, 599 
Asylums and their neighbours. Can neighbours help ? 10 
Asylum, an expensive, 102 
Bacon, Dr. Mackenzie, 612 
Bearded women, two cases of, 86 
Blandford, Dr. G. Fielding—President’s address on lunacy legislation, 309 
Brain, motions of, 424: 
Brown, Dr. Joseph J., pathology of transient hemiplegia, 213 
re 9 case of hemiplegia with closure of carotid artery, 571 
» Dr. W. J.. monomania with self-mutilation, 242 
Bucknill, Dr., on specialism, confession and the physician, 362 
- Cancerous mont and melancholia, 565 
_ Canine hallucination, 106 
Care and cure of the insane (Rev.), 393 
Causation of insanity, 300, 581 
Cerebellum, structure of, 399 
Cerebral vibrations and thought, 1 
Chapman, Dr. T. A., comparative mortality of asylum patients, 54 


Misapprehensions as to the curability of the admissions, 185 
BP ilerotorin delusions, 576 


Chronic insane, care of with friends, 301, 444 

Circulation, inter-cranial and inter-ocular, 283 

Classification and nomenclature in nervous disorders, 379 

Climacteric period in relation to insanity, 382 

Clinical instruction in French asylums, 14/7 

Clouston, Dr. T. S., case of melancholia with cancer, 565 
false membranes under the dura mater, 349 

Coloured ‘light, treatment by means of, 344 

Comparative mortality of different classes of patients, 54, 

Comte’s positive polity, 270 

Conscience in animals, 253, 272 

Contagioas communication of insanity, 129 

Convolutions of the brain, primary, 399 

Criminal lunacy in England, 165 

Curability of insanity, 101, 185 

Cure of insanity by strangulation, 305 


616 INDEX. 


Davies, Dr. F. P., photochromatic treatment of insanity, 344 

Delusion as a premonitory symptom, 248 

Dements and imbeciles, care and maintenance of, 324 

Dependence of the waking condition of the brain on external irritations, 118 

Disease of the mind (Rev.), 601 

Drink and insanity, 134, 267, 286, 287, 299, 302, 303, 372 

Drunkards, 250, 418, 452 3 

Electrical excitation of the brain, 400 

Electricity in paralysis, 611 

English psychological retrospect—syphilis and insanity, 407 
» asylum reports, 284 

Hpilepsy—extraordinary number of convulsions, 89 


ss lesions in, 402 
ie relation to criminal responsibility, 141 
BA reparative power in, 291 


Essai de Psychologie: La Béte et Homme (Rev.), 272 
Evidence before the House of Commons on Lunacy Law, 457 
“ Family care” of the chronic insane, 301, 444 
Fatalisme, théorie du a par B. Comt, (Rev.), 274 
Feeding, artificial, 92, 130 
Feelings, contrary sexual, 607 
Fleming, on the motions of the brain, 424 
Fraternal congratulations of American superintendents, 575 
French psychological literature reviewed, 115, 128, 267, 270, 272, 274 
Ganghonic cells, Schwalbe on the nuclei of the, 124 
General paralysis, unilateral sweating in, 196 
Fe 5 notes on its pathology, 383 
ee A at the age of sixteen, 419 
cures of, 605 

German psychological literature, 118, 275, 390, 397, 602 
Government grant, effect of, 582 
Grubelsucht: the metaphysical mania, 608 
Harbinson, Dr., pathological notes, 355 
Hay fever; its nature and treatment (Rev.), 112 
Hawkins, Rev. H., asylums and their neighbonrs, 10 
Hemi-anesthesia of cerebral origin, 126 
Hemiplegia, alternating and transient, 144, 213 

i. from closure of carotid artery, 571 
Hereditary ataxia muscularis, 605 
Hints on insanity, by Dr. Millar (Rev.), 392 
Histological notes on the brain, etc., 377, 398, 420 
History de progrés de la médicine mentale (Rev.), 115 
Homicide in asylums, 64 ' 
Howe, Dr. T. G., memoir of, 148 
Hydrophobia in man, spurious, 549- 
Hyoscyamine in the treatment of insanity, 368, 381 
Hysteria and insanity, 423 
Idiocy and imbecility, by Dr. Ireland or ), 264 
Idiocy and intemperance, 372 
Idiots, training of, in private houses, 58a 
Imbeciles and dements, care of, 324 
Increase of insanity, alleged, 45 
Indian hemp, a cause of insanity, 612 
Insanity in ancient Greece and Rome, 151 

9 the middle ages, 329 

5 modern times, 532 

» and its treatment, by Dr. Blandford (Rev.), 592 


INDEX. 617 


Insanity and intemperance (see also Drink), 97, 372 
Trish lunatic asylum service, 559 
», - reports, 297, 298, 299 
Irritability of the brain, or Kopfdruck, 6C3 
Knavery and superstition, 456 
Lawson, Dr., on the treatment of insanity by hyoscyamine, 368, 381 
Lewis, Dr. Bevan, case of disseminated cerebral sclerosis, 564 
Lindsay, Dr. Lauder, pathology of mind in the lower animals, 17 
spurious hydrophobia in man, 549 
iterature, the profits of, 613 
Lunacy blue books, 577 
Lunacy Law, Committee of the House of Commons, 148, 438, 457 
» legislation (President’s address), 309 
in Scotland, 611 
Mackenzie, Dr -G. EL. , vascular lesions with insanity, 76 
Macleod, Dr. M.. Di3 iapaiemiont or loss of one or more of the special senses, 
as a cause of insanity, 95 
Malta, treatment of lunatics in, 70 
Marriage as a preservative against relapses of insanity, 609 
Maudsley, Dr. H., the alleged increase of insanity, 45 
McDowall, Dr. T. W., two cases of bearded women, 86 
Medico-psychological association, meeting in London, Jan. 31st, 134 
Pe Glasgow, Feb. 21st, 141 
Melancholia from hereditary predisposition, 359 
55 with cancerous tumour of the middle lobe of the brain, 563 
Memory, delusions of, 609 
Metaphysical mania, 608 
Mickle, Dr. W. J., unilateral sweating in general paralysis, 196 
Mind in the lower animals, 17, 272 
Morison lectures on insanity, by Dr. Sibbald, 151, 329, 532 
Mortality of different classes of patients in asylums, 54 
Murad V., insanity of, 610 
Murder under the influence of an insane impulse, 281 
Nerve cells and tubes, histology of, 124, 398 
Newington, Dr. H. H., epileptic convulsions and nutrient enemata, 89 
New Zealand, report of the asylums in, 599 
Nicholson, Dr. David, criminal lunacy in England, 165 
Night supervision of epileptics, 285, 288 
' Nutrient enemata, use of, 91 
Object and aim of psychiatria, 127 
On the way to madness or suicide, letter of a patient, 107 
Pacinian bodies found in the human coeliac plexus, 127 
Pathologic anatomy of the b!ood vessels of the brain (Reyv.), 275 
Pathological significance of false membranes under the dura mater, 349 
Pe illustrations of the localisation of motor functions, 420 
pes notes, by Dr. Harbinson, 355 
Peripheral nerve cells, 398 
Pessimism: a history and criticism (Rev.), 386 - 
Petition of superintendents and others to the Lord Advocate, 146 
Photochromatic treatment of insanity, 344: 
President’s address at the annual meeting of the association, 309 
Prevention of insanity, 99 
Principles of punishment, by Serjeant Cox (Rev.), 116 
Probationary leave of absence of patients, 281 
Rabon, Dr., composition of the urine of the insane, 222 
Reflex movements and functions of the brain, 120, 121 
Remedy, an antilunatic, 105 


618 : INDEX. 


Reparation of brain tissue after injury, 282 
Restraint, mechanical, justifiable, 285 
Rogers, Dr, T. L., care and maintenance of imbeciles and dements, 324 
Rupture of the rectum in a lunatic, 128 
Sclerosis of the brain, 564 
Scotch asylum reports, 297 
Self-mutilation, 242 
Semicircular canals, their relation to equilibrium, 121 
Sensibility and its alteration in melancholia, 131 
Senses, loss of as a cause of insanity, 95, 143 
Shuttleworth, Dr., on intemperance as a cause of idiocy, 372 
Sibbald, Dr., Morison lectures for 1877, 151, 329, 5382 
Sleeplessness, beer used against, 611 
Specialism, confession, and the physician and the priest, 362 
Spiritualism, consolations of, 105 
Spiritual body ; an essay in prose and verse (Rev.), 110 
Statistical tables of the causes of insanity, 573 
Stirling, Dr. W., recent progress in histology, etce., 118 
Stomach, alterations of, consequent on lesions of the brain, 123 
Strangulation, cure of insanity by, 305 
Sutherland, Dr. H., delusion as a premonitory symptom, 248 
Syphilis of the nervous system, 283, 407 
Taine, M., cerebral vibrations and thought, 1 
Temperature in the insane, low, 401 
Tetanus, pathology of, 283 
Treatment of lunatics in Malta, from 1530 to the present time, 70 
Vagabond papers. Sketches of Melbourne life (Rey.), 397 
Vascular lesions with insanity, 76, 275 
Vision, theory of, 257 
Voluntary patients, 582 
Unbewussten, eine positive Kritik des, 390 
Unconsciousness of genius, 103 
Unilateral sweating in general paralysis, 192 

ss atrophy of the face, 126 
Urine, composition of in insanity, 222 
Walls round airing courts, discontinuance of, 298, 299 
Weight, loss or gain of, in patients under care, 303 

» Of the brain in the insane, 378 
West Riding Asylum medical reports for 1876, 377 
Whitcombe, Mr., letter on insanity and drink, 97 
Willard Asylum, 449 
Workhouse treatment of the chronic insane, 288 
Work done in asylum paid for, 572 
Yellowlees, Dr., two cases of homicide in asylums, 64 


(The Editors are indebted to Dr. A. H. Newth, Sussex County Asylum, for the 
compilation of this Index.) 





THE JOURNAL OF MENTAL SCIENCE 


[ Published by Authority of the Medico-Psychological Association. | 








BO AA. One: APRIL, 1877. Vou. XXIII. 








PART 1.—ORIGINAL ARTICLES. 
Cerebral Vibrations and Thought.* 


I.—I believe,” says Professor Tyndall, “ that all the great 
thinkers who have studied the subject are ready to admit 
the following hypothesis, that every conscious act, whether 
in the domain of the senses, of thought, or of emotion, corre- 
sponds to a certain definite molecular state of the brain ; that 
this relation of the physical to consciousness invariably exists, 
so that, given the state of the brain, we may deduce from it 
the corresponding thought or feeling; or given the thought 
or feeling, we may deduce from it the state of the brain. but 
how to make this deduction? At bottom it is not a case of 
logical deduction ; it is, in fact, a case of empirical associa- 
tion. It may be replied that very many of the deductions of 
science have this empirical character; such is that by which 
it is affirmed that an electric current circulating in a given 
direction will make the magnetic needle deviate in a definite 
direction. But the two cases differ in this, that if the 
influence of the current upon the needle cannot be shown, it 
can at least be imagined, and that we have no doubt what- 
ever that ultimately the problem will be mechanically resolved, 
while we cannot even picture to ourselves the passage from 
the physical state of the brain to the corresponding facts of 
feeling. Let it be admitted that a definite thought corre- 
sponds simultaneously to a definite molecular action in the 
brain. Well, we do not possess the intellectual organ, we 
have not even the rudiment apparently of the organ, which 
would enable us to pass by reasoning from one phenomenon to 
the other. They are produced together, but we know not 
why. If our intelligence and our senses were perfect enough, 
vigorous enough, enlightened enough to enable us to see and 
* Translated from the “‘ Revue Philosophique de la France et de Sa 


for January, 1877. : 
XXIII. ) 1 


2 Cerebral Vibrations and Thought. (April, 


to feel the actual molecules of the brain; if we could trace 
all the movements, the groupings, the electric discharges, if 
they exist, of these molecules; if we knew perfectly the 
molecular states which correspond to this or that state of 
thought or of feeling, we should be still as far as ever from 
the solution of the problem: what is the connection between 
this physieal state and the facts of consciousness? The 
abyss which exists between these two classes of phenomena 
will be always intellectually impassable. Let us admit that 
the feeling of love, for instance, corresponds to a spiral move- 
ment of the molecules of the brain to the right, and the 
feeling of hate to a spiral movement to the left, we should 
know that when we love, a movement is produced in one direc- 
tion, and that when we hate, a movement is produced in 
another direction; but the why would remain still un- 
answered.”’* 

Thus the most ordinary experience shows us the two 
facts inseparably connected, and their representations show 
them absolutely irreducible into one another. On the one 
hand, we find that thought depends upon cerebral molecular 
movement;-on the other hand, we cannot conceive that it 
depends upon it. Thereupon physiologists ignore the latter 
truth, and say—‘ Mental phenomena are a function of the 
nervous centres, Just as muscular contraction is a function of 
the muscles, just as secretion of bile is a function of the 
liver.” On their side, philosophers ignore the former truth, 
and say, ‘‘ Moral phenomena have nothing in common with 
the nervous centres, and belong to beings of a different 
nature.” Whereupon cautious observers intervene, and 
conclude—“ It is true that mental phenomena and molecular 
movements of the nervous centres are inseparably connected; 
it is true that to our mind and in our conception they are 
absolutely irreducible into one another. We are stopped 
before this difficulty, and do not even attempt to surmount 
it; we resign ourselves to ignorance.” As for us, if we 
endeavour to make a step forward in this obscurity, it is be- 
cause it seems to us that we have already made several steps.t 
On the one hand, we have seen that our most abstract ideas, 
being signs, are reducible to images; that the images them- 
selves are revived sensations; that, therefore, our entire 
thought may be reduced to sensations. The difficulty is, 

* These are probably not the exact words of Prof. Tyndall, the paragraph 


being a re-translation from the French of M. Taine.—A. C. M. 
+ “ De l’Intelligence,” tome I. a 


1877.) Cerebral Vibrations and Thought. 8 


then, simplified,.and the only concern now is to compre- 
hend the connection between a molecular movement and a 
sensation. On the other hand, we have seen that sensations, 
apparently simple, are compounds; that these compounds, 
apparently irreducible into one another, may be composed of 
similar elements; that at a certain degree of simplicity their 
elements are no longer perceived by consciousness; that 
thus sensation is a compound of rudimentary actions capable 
of indefinite degradations, incapable of coming under the 
grasp of consciousness, and of which the reflex actions attest 
not only the presence but the power. The difficulty is found 
to be simplified a second time, the only concern being to 
comprehend the connection between these phenomena and 
molecular movements. The obscurity remains always very 
great, for we can conceive these phenomena only after the 
type of ordinary sensations, and between this conception 
and that of a movement there lies an abyss. But we know 
that ordihary sensation is a compound; that it differs from 
its elements ; that these elements elude consciousness; that 
they are not on that account less real and active; and that 
in this lower and deep penumbra in which sensation is born 
we shall, perhaps, find the connection between the physical 
and the moral world. 

Il.—Let us at the outset state the difficulty in all its 
force. Since mental phenomena are only more or less de- 
formed or transformed sensations, let us compare a sensa- 
tion with a molecular movement of the nervous centres. Let 
us take the sensation of the yellow of gold, of a sound like ut, 
that which the emanations of the lily produce, the taste of 
sugar, the pain of a cut, the sensation of tickling, of heat, 
of cold. The necessary and sufficient condition of such 
a sensation is an intestine movemént in the grey substance 
of the annular protuberance, of the tubercula quadrigemina, 
perhaps of the thalamus opticus—in short, in the cells of a 
sensory centre; that this movement is unknown is of little 
consequence; whatever it be, it is always a displacement of 
molecules, more or less complicated and propagated ; nothing 
more. Now, what relation can we imagine between this dis- 
placement and a sensation? Cells, formed of a membrane 
and of one or several nuclei, are scattered through a granular 
substance, a sort of soft pulp or greyish jelly composed of 
nuclei and innumerable fibrils. These cells branch into fine 
prolongations, which probably unite with the nervous fibres, 
_ and we suppose that by this means they communicate amongst 


A Cerebral Vibrations and Thought. [April, 


themselves and with the white conductors. Place before your 
eyes and memory the anatomical preparations and microgra- 
phical plates which show this apparatus; suppose the power 
of a microscope indefinitely augmented and the magnifying 
effect to be increased to a million or a milliard diameters ; 
‘suppose physiology to be mature, and the theory of cellular 
movements to be as advanced as the physics of ethereal 
undulations; suppose that we know the mechanism of the 
movement which is produced in the grey substance during a 
sensation, its course from cell to cell, its differences according 
as it excites a sensation of sound or a sensation of smell, the 
‘relation which it has to calorific or electrical movements, 
still more, the mechanical formula which represents the 
mass, the rapidity, and the position of all the elements of 
the fibres and of the cells at any moment of their movement. 
We shall still only have motion, and the motion, whatever 
it be, whether rotatory, undulatory, or of other kind, in 
no way resembles the sensation of bitter, of yellow, of cold, 
or of pain. We cannot convert either of these two concep- 
tions into the other, and, therefore, the two phenomena seem 
to be of absolutely different quality; so that analysis, instead 
of filling up the gap which separates them, seems to enlarge . 
it infinitely. 

I1J].—Repulsed on this side, we must turn to another. In 
truth, we are unable to conceive the two phenomena as 
reducible the one into: the other; but that may be owing to 
the manner in which we conceive them, and not to the 
qualities they possess. Their incompatibility is, perhaps, 
apparent, not real; it may arise from us, not from them. 
Such an illusion would be nothing unusual. As a general 
rule, it suffices for one and the same fact to be known to us 
by two different ways to make us conceive it as two different 
facts. 

Such is the case with the objects which we know by the 
senses. One born blind, after being operated upon, is some 
time before he is able to bring his perceptions of touch into 
accord with his perceptions of sight. Before the operation 
he represented to himself a china cup as cold, polished, 
capable of imparting to his hand a certain sensation of 
resistance, of weight, and of form; when for the first time 
it strikes his sight and gives him the sensation of a white 
cup, he conceives the white and lustrous object-as a different 
one from the thing resistant, heavy, cold, and polished. He 
would remain at that point if he made no new experiences ; — 


1877.] Cerebral Vibrations and Thought. 5 


the two things would always seem to him to have different 
qualities; they would form two worlds, between which there 
would be no passage. In like manner, the eyes being shut 
and no warning given, you behold a bright light, at the same 
time you hear a sound, and at last you feel in the arm the 
_ sensation of a blow from a stick. Try this experiment upon 
an ignorant person or upon a child: he will believe that he 
has been struck, that some one whistled, that a bright 
light entered into the room; nevertheless the three different 
facts are but one—the passage of an electric current. One 
must be skilled in acoustics to show that the action that 
excites in us, by our tactile nerves, the sensation of vibration 
and of tickling is the same which, by our acoustic nerves, 
excites in us the sensation of sound. Moreover, recently,* 
“the phenomena of heat, of electricity, of light, sufficiently 
ill-defined in themselves, were produced by as many suitable 
fluid agents endowed with special action. A more profound 
examination has enabled us to recognise that this conception 
of different specific heterogeneous agents has at bottom only 
one sole cause; it is that the perception of these several 
orders of phenomena is generally effected through different 
organs, and that, in acting more particularly upon each of 
our senses, it necessarily excites special sensations. The 
apparent heterogeneity would be less, then, in the actual 
nature of the physical agent than in the functions of the 
physiological instrument which forms the sensations; so that 
in transferring, by an erroneous ascription, the differences of 
the effect to the cause, we should in reality have classed the 
mediate phenomena by which we are conscious of the modifi- 
cations of matter, rather than the actual essence of these 
modifications. . . . All the physical phenomena, what- 
ever their nature, seem to be at bottom the manifestations 
of one and the same primordial agent.” Thus the concep- 
tion we form bears always the deep impression of the pro- 
cedure which forms it. We are, then, obliged to take 
account of this impression; wherefore, as soon as we find 
in ourselves two ideas received by different ways, we should 
gvuard ourselves against the tendency which leads us to estab- 
lish a difference, above all, an absolute difference, between 
their objects. 

Now, when we examine closely the idea ofa sensation, and 
the idea of a molecular movement of the nervous centres, we 


* M. de Sénarmont, Cours professé a l’école ee cité oe Saigey, 
‘La Physique Moderne,” p. 216, 


6 Cerebral Vibrations and Thought.  [April, 


find that they are acquired not only by different but by con- 
trary ways. ‘The first comes from within, without anything 
intermediate ; the second comes from without, through several 
intermediates. To represent to one’s-self a sensation, is to 
have present the image of that sensation, that is to say, that 


sensation itself directly repeated and spontaneously revived. | 


To represent to one’s-self a molecular movement of the nervous 
centres, is to have present the images of the tactile, visual, 
and other sensations, which it would excite in us, if it acted 
upon our senses from without, that is to say, to imagine the 
sensations of white, of grey, of a soft consistence, of cellular 
or fibrous form, of little tremulous points; it is, in short, if 
we go farther, to combine internally the names of movement, 
rapidity, and bulk, which designate aggregates and abstracts 
of muscular and tactile sensations. In fine, the first repre- 
sentation is equivalent to its object; the second, to the 
croup of sensations which its object would excite in us. Now, 
we cannot conceive processes of formation more unlike. In 
the one case, from sense to sense, the two representations 
reached us by two different roads, but both external, so that 
nothing prevented them from starting from a common point. 
In the other the two representations arrive by two opposite 
roads, the one from within, the other from without, in such a 
manner that these roads continue perpetually divergent, and 
that we cannot conceive them to have the same point of de- 
parture. Thus the radical opposition of the two processes of 
formation suffices to explain the mutual irreducibility of the 
two representations. One and the same phenomenon, known 
by these two ways, will appear double, and, whatever the bond 
which experience establishes between its two appearances, we 
shall never be able to convert the one into the other. Accord- 
ing as the representation comes from without or from within, 
it will appear always as a without or as a within, without our 
ever being able to convert the without into the within, or the 
within into the without. 

IV.—It may be then that the sensation and the intestine 
movement of the nervous centres are at bottom only one and 
the same event, condemned, by the two modes in which it 
is known, to appear always and irremediably double. 
Another class of reasons leads to a similar conclusion. In 
fact, we have seen that our sensations are only compounds of 
elementary sensations, these again compounds, and so on; 
with each of these degrees of complexity the total is pre- 


sented with an aspect quite different from that of its ele-. 


E8774} Cerebral Vibrations and Thought. 7 


ments ; consequently the more simple its elements are, and 
the farther they are removed from the grasp of conscious- 
ness, the more different they must be from the total acces- 
sible to consciousness; so that the aspect of the infinitesi- 
mal elements at the bottom of the scale and that of the total 
sensation at the top of the scale must differ entirely. Now, 
such is the aspect of the molecular movements compared 
with that of the total sensation. Nevertheless, nothing 
hinders the molecular movements from being the infinitesimal 
elements of the total sensation. Thus the fundamental 
objection is removed. If our two conceptions of the mental 
event and of the cerebral event are irreducible into one 
another, that may without doubt be owing to the fact that 
the two events are actually irreducible into one another, but 
it may be owing, also, first to the fact that the event, being 
one, is known to us by two absolutely contrary ways, and 
next to the fact that the mental event and its ultimate 
elements must necessarily be presented to us under absolutely 
opposite aspects. 

There is then ground, and equal ground, for the two 
hypotheses—for that of the two heterogeneous phenomena, 
and for that of one and the same phenomenon known under 
two aspects. Which shall we choose? If we adopt the 
first, we are in face of a connection, not only unexplained 
but inexplicable. For the two phenomena being by nature 
irreducible the one into the other, they form two separate, 
isolated worlds. We _ exclude by hypothesis every more 
general phenomenon of which they would be distinct forms 
aud particular cases; we declare beforehand that their 
nature furnishes nothing which can lay the basis of their 
reciprocal dependence ; we are then obliged, in order to 
explain this dependence, to seek beyond their nature, there- 
fore beyond all nature, because they in themselves constitute 
all nature—consequently,in fact, in the supernatural ; thus we 
should call a miracle to our aid, the intervention of a superior 
being. The philosophers. of the seventeenth century, 
Leibniz and Malebranche at the head of them, clearly per- 
ceived this difficulty, and boldly concluded that there is a 
pre-established harmony, the artificial agreement of two in- 
dependent clocks, an extrinsic adjustment coming from on 
high, a special decree of God. Nothing can be less in con- 
formity with the methods of scientific induction; for these 
exclude all hypothesis which does not explain, and, as has 
been shown elsewhere, the principle of explanatory reason 


8 Cerebral Vibrations and Thought. (April, 


(raison explicative) isan axiom which admits of no exception.* 
We are then brought back to the second supposition. On 
the face of it it is as plausible as the first. Moreover, it has 
in its favour analogies ard a number of precedents; for, 
like many other physical and psychological theories, it takes 
into account the play of vision, the influence of the perceiv- 
ing and thinking subject, the special structure of the observ- 
ing instrument. Besides this, as it does not make any third 
cause intervene, any imaginary or unknown property, it is as 
little hypothetical as possible. In short, it shows, not only 
that the two phenomena may be connected, but that always 
and necessarily they must be connected; for, from the 
moment that it reduces them to one, endowed with two 
aspects, it is clear that they are like the right and the wrong 
side of a surface, and that the presence or absence of the one 
infallibly entails that of the other. We are then authorised 
to admit that the cerebral phenomenon and the mental 
phenomenon are at bottom only one and the same phenome- 
non under two aspects, the one mental, and the other phy- 
sical; the one accessible to consciousness, the other accessible 
to sense. 

V.—What is the vaiue of each of these two points of 
view, and what is it necessary to deduct from them in order 
to arrive at the true nature of the phenomenon? We have 
come here to the point of junction of the moral and phy- 
sical world. It is from this point that the two opposite and 
indefinite lines which human experience travels start; the — 
two trains thus formed advance, and separate more and more 
as they become more loaded at each station. We see by that 
the importance ofthe central phenomenon; whatever it be, it 
communicates its character to the rest. Now, of the two 
points of view by which we attain it, the one, which is con- 
sciousness, is direct ; to know a sensation by consciousness, is 
to have present its image, which is the same sensation revivi- 
fied. On the contrary, the other point of view, which is 
external perception, is indirect; it does not teach us 
at all as to the special characters of its object ; it simply 
teaches us as to a certain class of its effects. The object is 
not shown us directly, it is denoted indirectly to us by the 
group of sensations which it excites or would excite in us. In 
itself, this physical and sensible object remains quite unknown 
to us; all that we know of it is the group of sensations 
which it provokes in us. All that we know of the cerebra 

* Voir “De ]’Intelligence,” Livre iv.,ch. iii, 553. A baw 


487%] Cerebral Vibrations and Thought. 9 


molecules are the sensations of grey colour, of soft consist- 
ence, of form, of volume, and the like, that, directly, or 
through the microscope, in their natural state or after pre- 
paration, these molecules excite in us, that is to sav, their 
constant effects upon us, their fixed accompaniments, their 
signs, only signs, signs and indicia of theunknown. There is 
then a great difference between the two points of view. By 
consciousness, I attain the fact in itself; by the senses I 
attain only a sign. A sign of what? What is it which is 
constantly accompanied, denoted, signified by the intestine 
movement of the nervous centres? We have previously 
shown this in setting forth the conditions of sensations 
and images; it is the sensation, it is the image, it is 
the internal mental phenomenon. Henceforth everything 
is harmonious. This mental event which consciousness 
directly attains can only be attained indirectly by the 
senses; the senses know of it only its effects upon them; 
that is the reason they make us conceive it as an in- 
testine movement of the grey cells; as it only acts upon 
them from without, it can only appear to them ‘as external 
and physical. We see here a direct and notable confir- 
mation of the accepted hypothesis, and we now understand 
why the mental phenomenon, being one, appears to us neces- 
sarily double; the sign and the event signified are two 
things that can no more be confounded than separated, 
and their distinction is as necessary as their connection. 
But, in this distinction and in this connection, all the advan- 
tage is on the side of the mental fact; it only exists; the 
physical fact is only the manner in which it affects, or might 
affect, our senses. For to the senses and the imagination, 
sensation, perception, in short, thought, is only a vibration of 
the cerebral cells, a dance of molecules; but thought is so 
only to the senses and imagination; in itself it 1s another 
thing, is defined only by its proper elements, and, if it bears 
a physiological appearance, it is because we translate it into 
a foreign language, in which it necessarily bears a character 
that is not its own. SA TAIN, 


10 | [April, 


Asylums and their Neighbours. Oan Neighbours help? By 
" Rev. H. Hawkins, M.A., Chaplain of Colney Hatch 
Asylum. 


‘“’ What can man’s wisdom do 
In the restoring his bereaved sense ?” 
Kina LEAR. 


The aim of this paper will be to endeavour to show that 
neighbours of public asylums for the insane—occasionally 
using the term neighbours with some latitude—may, under 
certain circumstances, contribute to the well-being of selected 
patients, by services of various kinds; moreover, that not 
only residents in the vicinity, but alsv friends at a distance, 
may have a share in alleviating the affliction, perhaps even 
of promoting the convalescence, of inmates of these hospitals. 
Among 65,000 persons approximately computed as the number 
of patients in asylums and other institutions, there are many 
who are absolutely friendless and unvisited. Some come from 
distant counties, or even from foreign countries, beyond the 
range of practicable visits; others have outlived their rela- 
tives and friends; or these have, in course of time, discon- 
tinued their intercourse; others, again, saddest case of all, are 
perhaps deliberately deserted, purposely shunned, from selfish 
apprehension lest responsibility of maintenance or of assist- 
ance should be incurred, or from reluctance that their ac- 
quaintanceship with an inmate of a lunatic asylum should 
become known. So, from one cause or another, there are not 
a few patients who become, abruptly or gradually, cut off 
from communication with the outside world, practically for- 
gotten as ‘“‘ dead men out of mind.” Yet, in many of these, 
there must surely exist yearnings after sympathy and that 
disinterested friendship which, “all for love and nothing for 
reward,” would take a personal interest in themselves. 

Could not these longings for friendship, in some cases at. 
least, be gratified ? Might nota patient, unvisited and friend- 
less, yet capable of appreciating personal attention, be some- 
times placed in communication with a kind-hearted sensible 
neighbour, willing, as it were, to adopt any solitary inmate 
who would be cheered by the sympathy of even volunteer 
friendship ? In order that a relationship of this kind should 
be established between an asylum and its neighbours, it would 
be necessary that a mutual friend, acquainted, through official 
connection, with the institution, and with the circumstances 


IB Asylums and their Neighbours. 11 


of its inmates, and intimate also with the neighbouring resi- 
dents, should act as a link between the two. 

Before referring to some of the ways in which a kindly- 
disposed neighbour might pay considerate attention to selected 
patients, it should be premised that it is assumed, as matter 
of course, that all volunteer action must be carried on with 
the concurrence of the authorities, and in strict conformity 
with regulations. Only thus would amateur aid be acceptable, 
or, indeed, tolerated. The lady visitor (usually it would be a 
lady) must claim no exemptions or special privileges. She 
must accept precisely the same conditions of attendance as 
the humblest friend of any poor patient. 

She must visit on appointed days, within prescribed hours, 
in the common room, and, in all other particulars, must pay 
careful attention to the rules for visitors. 

On such terms how much real good might be effected 
by a self-constituted friend, conscientiously abiding by the 
requirements of the institution with which she might be 
associated. 

T'o a patient who rarely or never had been visited, what a 
novel pleasure it would be to find some one from the outside 
world taking friendly interest in herself. How greatly would 
any unaccustomed little gift be appreciated. The prospect of 
another visit, even after a long interval, would help to relieve 
the monotony and dulness of asylum life. Itis not too much 
to assert that such sympathy might impart fresh interest to 
existence, and, in some cases, accelerate recovery, or render 
less wearisome continuance within hospital walls during the 
period of necessary sojourn. 

Others, however, might be willing to shed a ray of light 
into the gloom of some solitary heart, who yet, either from 
distance or other cause, could not pay personal visits. Could 
not the post be made a substitute? The writer knows in- 
stances in which a kind letter from an ame inconnue, whose 
face has never been seen, has brought no trifling delight 
to a patient. A Christmas, Haster, or birthday picture-card, 
an almanac, a book, a few stamps, a ribbon—trifles of small 
cost, or great value, would be welcome gifts to many. A 
newspaper, especially if illustrated, would almost always be 
acceptable. For to many, now, as in Cowper’s days— 


“Tis pleasant through the loopholes of retreat, 
To peep at such a world, to see the stir of the great Babel, 
To hear the roar she sends through all her gates.” 


12 Asylums and their Nerghbours, [ April, 


To some a communication through the post might come 
almost as an angel’s visit. 

We will now consider the sad case of friendless convales- 
cents. It is not, probably, a mistaken assumption that con- 
valescents, after mental illness might sometimes, if not fre- 
quently, be sooner restored to society if they had either home 
of their own, or friends able and willing to receive them, or 
to provide them with suitable situations. . Many, now in 
asylums, might perhaps be discharged with profit and comfort 
to themselves, if occupation adapted to their strength and 
capacities, together with kindly treatment, could only be 
ensured for them on leaving. This supposition, no doubt, 
implies that there are patients who, after having become, to - 
a certain point, convalescent, are yet still retained under 
treatment. But whatistobedone? Take the case of delicate 
females, who having regained their sanity have no suitable 
home to which they can resort, or friends who would afford 
them temporary shelter. Such convalescents are often physi- 
cally unequal to the effort of struggling for daily bread, and 
if they made the attempt, would almost certainly fail in the 
endeavour. Besides, in addition to other impediments, the 
prejudice caused by their residence in an asylum must be 
taken into account. There is, indeed, that perfugium 
miserts, the Workhouse, and it is Just because that refuge 
would be their sad alternative, that authorities of asylums, 
from motives of humanity, sometimes continue to afford 
shelter to friendless convalescents—young women without 
relatives or friends, deserted wives, respectable widows, 
governesses, sempstresses and others—rather than consign 
them to the Workhouse. 

In a well-ordered asylum, convalescents of weakly physique 
enjoy many privileges which, those especially of gent.e nur- 
ture, would grievously miss if they were transferred to the 
‘* House.” The social classification, the comparative privacy, 
the comforts and refinements, the recreations and indulgences 
which alleviate the sadness of their position, might not be 
attainable there. 

Of course, the large majority of convalescents are dis- 
charged, and return to their houses and occupations. The 
difficulty is with those patients of feebler organisation, who, 
having regained their mental health, have no private resources, 
and are unable to earn their living. 

For such as these, a House of Rest, between the hospital 
and outside world, would be simply invaluable. The Conva- 


£877.} by Rev. H. Hawkins, M.A. 13 


lescent Home, as supplementary to the asylum, is still a 
missing link. Who will help to supply it? Might not 
neighbours of public asylums become their benefactors by 
providing, for some at least of the friendless invalids on their 
discharge, temporary rest, and opportunity of resuming, at 
less disadvantage, their place in active life ? 


**°*Tis not enough to help the feeble up, 
But to support him after.” 


That invitation of the Saviour to His harassed followers is 


wonderfully soothing—‘‘ Come ye yourselves apart and rest 


awhile.” 

To suggest another mode of possible usefulness. Would it 
be quite out of the question for neighbours, under special 
circumstances, to give a trial as domestics in their households 
to female convalescents, of whose complete recovery and fit- 
ness for service they might receive a confident medical 
euarantee? The question of their reception must obviously 
in each case be entertained with caution. But a generous 
venture, in offering work and a home to one upon whom, 
from the nature of her recent malady, many would look 
askance, would be an act of real benevolence. 

It has been suggested that residents in the vicinity of 
asylums might occasionally show no little kindness by invit- 
ing well-behaved convalescents to spend a few hours away 
from the hospital. 

By communication with the authorities, such a treat might 
be feasible. A genial welcome, the use of a room, a comfort- 
able tea, some pleasant conversation, would afford genuine 
pleasure, and the hope of a renewal of the invitation would 
be cherished as a prospect of an agreeable change from the 
monotony of their ordinary surroundings. 

Indirect yet efficient help might be given to asylum work 
by the recommendation of the vocation of attendants to in- 
telligent and respectable young men and women in quest of 
situations. Instead of dissuading qualified persons from 
taking employment as attendants, their advisers might ren- 
der good service by directing attention both to the honourable 
character and the responsibility of the duties, and also to the 


- reward and prospects attached to their efficient discharge. 


Some neighbours might, in other kindly ways, express their 
sympathy with their afflicted brethren, lying as it were at 


| their gates. Choice fruit and flowers from hothouses and 


gardens, presents of game (how characteristic is the Queen’s 


14 Asylums and their Neighbours, (April, 


remembrance of the hospitals !), musical instruments, pictures, 
books, permission to selected patients to walk in their parks 
or grounds; such-like attentions, besides conferring pleasure, 
would furnish welcome proof that, by the donors, the claims 
of neighbourhood were not forgotten. 

There is yet another mode in which help might be given— 
by assistance rendered to the amusements of the inmates. 
The offer of an entertaining lecture, of a reading, or a song 
at an evening’s entertainment, might be cheerfully accepted. 

The writer of this paper is able to testify to the gratifica- 
tion afforded by “‘ neighbours’ help” in many interesting mis- 
sionary addresses—in numerous sermons by various preachers. 
It is obvious that the ministrations of strangers must be pe- 
culiarly welcome to congregations, usually restricted to the 
services of the clergyman of the institution, and debarred 
from seeking in “pastures new” occasional variety. Many 
who have thus visited asylums have been pleased beyond 
expectation with the orderliness and attention of their hearers, 
and doubtless have conveyed to others their favourable im- 
pressions. 

Might not gentlewomen in search of employment, and 
maintenance in some cases, find their vocation in the wards 
of asylums? The work even in the lower departments would 
be more congenial to many than domestic service, which has 
been suggested. There are, in the larger institutions, various 
offices of higher and lower grades, in which a lady’s cultiva- 
tion and refinement would exercise wholesome influence, both 
upon the patients and her fellow-attendants. She would find 
no work which has not already been undertaken by Christian 
women for love’s sake. The tenure of office is more certain, 
less dependent upon contingencies and upon the will of indi- 
viduals, than in private households. Wages are, of course, 
proportionate to the position held, and gradually rise to a 
certain point; after long meritorious service there is prospect 
of a pension. Education, intelligence, and good behaviour 
would probably ensure promotion to the higher posts. The 
hours of daily duty, though long, are detinite; there are 
intervals of leave and an annual holiday. Work in the wards 
offers unusual opportunities of ministering comfort to the 
afflicted, and is commended to the consideration of gentle- 
women in quest of occupation by which they could earn their 
living. | 

Communities of women already occupy usefully various 
fields of labour within the English Church. For several years 





1877.] by Rev. H. Hawkins, M.A. 15 


past important London hospitals—University, King’s, Charing 
Cross—have availed themselves of the services of Sisterhoods 
or religious communities in their wards. The day may come 
when their work will be welcomed in and for asylums also, as 
supplementing the labours of those who are otherwise work- 
ing on behalf of the mentally afflicted. As prevention is 
proverbially better than cure, neighbours’ help might often 
be usefully given in promoting the health, in the full mean- 
ing of the word, of those whom their counsel would be likely 
to benefit. Friendly hints, for instance, by district visitors 
and others, on the importance of temperance in all its bear- 
ings—of fresh air, personal and household cleanliness, cheer- 
fulness, domestic comforts and embellishments—might some- 
times lead to results which would be safeguards, to some extent, 
against mental disturbance. 

But, if in no other way, could not neighbours help the 
asylum by their prayers? Could they not offer, with special 
application, petitions for the mentally afflicted? The remem- 
brance of ‘the afflicted and distressed in mind,” in one of the 
Church’s prayers, touched the heart of poor Charles Lamb. 
Supposing that aid of other kinds were not ina person’s 
power to offer, or, if offered, were not accepted, still an 
affirmative reply might be given to the question, “Can 
neighbours help?” if heed were given to Hooker’s remark, 
“ When we are not able to do any other thing for men’s 
behoof, prayer is that which we always have in our power to 
bestow, and they never in theirs to refuse.” 

If this brief paper has succeeded in any degree, in showing 
that communities within asylum walls, and their neighbours 
outside, might stand towards each other, not only in kindly, 
but also in helpful relationship, it has not missed its mark. 
Asylums and their neighbours may be mutual benefactors. 
For asylums are not only harbours of refuge, but beacons of 
warning—of warning against all violations of the laws of 
moral and physical health; moreover, they are monitors of 
the blessing of sanity. ‘There is a line in a modern poet 
which asserts that “the world ’s a rcom of sickness.” It is 
no mean privilege to illumine, by benevolent words or 
deeds, or by the secret influence of intercession, one of its 
darker recesses. Many persons, gifted with kindness and 
discretion, living in the neighbourhood of public asylums 
would, it is believed, be found willing—with the sanction and 
under the control of the authorities—to be fellow-helpers in 
their work. 


16 Asylums and their Neighbours, [April, 


Before concluding, allusion may be permitted to one or two 
objections which might be taken, by some persons, to the 
introduction into asylums of volunteer visitors. It might be 
feared that they would have a tendency to interfere with the 
discipline of the establishment, by not strictly conforming to 
its rules. Their honorary share inthe work might cause 
amateurs (as some might apprehend) to consider themselves 
privileged to act, more or less, independently of ordinary 
regulations. In so doing they would become hindrances 
instead of helps. For, clearly, asylums for the insane are no 
places for the exercise of undisciplined guerilla ministrations. 

But, in reply, it may be sufficient to remark that the good 
sense of such neighbours as would presumably be invited to 
become visitors might ordinarily be relied on, to respect and 
adhere to prescribed requirements; and if, in any instance, 
a volunteer deviated from the instructions laid down for the 
cuidance of visitors, he or she would be amenable to the 
usual consequences of breach of rules. 

Another objection which might present itself might, per- 
haps, arise from a fear lest the visits of amateur friends 
should be too emotional. Not having, like relatives and old 
acquaintances, subjects of mutual interest in the past for 
topics of conversation, it might be supposed that the very 
strength of sympathy which would induce such persons to be 
willing to visit, would, occasionally, cause them to address 
themselves unduly to the emotions of patients. But, in fact, 
many of the patients’ own friends, by indiscreet allusions to 
personal or domestic incidents, would often be far more 
likely to do harm, than visitors more remotely connected. 
Moreover, the same authority which would check any breach 
of discipline, would be in readiness to repress the exercise 
of any injurious influence which a visitor was known to exer- 
cise. It is, however, confidently maintained, as the result of 
some experience, that, with due care and proper selection, 
the benefit of neighbours’ friendly visits would gradually be 
found to constitute no inconsiderable item in the comfort and 
happiness of those patients who, in this manner, became 
recipients of “ neighbours’ help.” 





1877.] 17 


The Pathology of Mind in the Lower Animals. By W. 
Lavper Linpsay, M.D., F.R.S.E., Physician to the 
Murray Royal Institution (for the Insane), Perth. 


_ In a paper on “The Physiology of Mind in the Lower 
Animals,” in the Journal of Mental Science for April, 1871 
_ (p. 79), I endeavoured to prove that other animals than man 
possess the same kind of moral and intellectual endowments 
and apply them to the same practical purposes that he does. 
‘The object of the present paper is to show that Mind in the 
lower animals, or certain of them, is liable to be affected by 
the same causes of disturbance—is subject to the same forms 
of defect or disorder—as in man. 

The phenomena and causation of moral or intellectual 
deficiency or derangement in the domestic animals at least— 
those that subserve so many of his purposes—ought to 
possess the highest interest to man; for a knowledge of 
them is of the utmost importance to his own welfare. But 
there are probably few subjects concerning which he is more 
ignorant and indifferent. In the very outset of our inquiry, 
and, indeed, as its raison d’étre, it is desirable to set forth 
some of the results to man himself—as well as to the animals 
implicated—of man’s ignorance of the various forms of 
mental impairment in other animals, and of the causes pro- 
ducing such impairment. The two grand results, so far as 
man 1s concerned, are— 


1. Danger to human life; and— 
2. Pecuniary loss. 


Of these two considerations, unquestionably that which will 
prove most influential in securing for the subject of insanity 
in the domestic animals some degree of attention is the 
latter—the cost in cash of such disability to man. 

Pecuniary lossto man from animal insanity, and from his 
ignorance of its nature and of the means of preventing and 
removing it, occurs in two very common forms—by the 


1. Accidental death ; or— 
2. Deliberate destruction by man—of valuable animals— 
dogs, horses, or cattle. 


Insane animals meet with—rush upon—accidental death, 
sometimes wholesale, ina considerable variety of ways. In 
their panics or stampedes they court the deadliest dangers, 

XXIII. 2 


18 The Pathology of Mind in the Lower Animals, [April, 


perishing sometimes—for instance, in the case of sheep—by 
scores. They murder each other, commit suicide, and so 
mutilate themselves or their fellows that speedy or lingering 
death results. 
On the other hand, man commits with the utmost delibera- 
tion—by municipal edict in some cases—wholesale havoc 
among animals that are merely suspected of being “ mad,” 
whatever be the nature of their alleged madness. He poisons, 
shoots, or drowns kennels of hounds that are supposed to be 
rabietic, or that may possibly become so; nay, he goes so 
far as to put out of existence hundreds of dogs in a single 
city simply because of his ignorant, superstitious, unfounded 
dread of what is very much a mere bugbear—Hydrophobia. 
A signal example of this kind of human stupidity on a large 
scale occurred lately in the case of the city of Glasgow—the 
second in point of population in the empire. Three deaths 
in man had occurred within a few weeks of each other in 
two hospitals—the Royal and Western Infirmaries—from 
what was called hydrophobia attributed to dog-bites. But, 
in the first place, so rare is hydrophobia in Scotland—so few 
of its medical practitioners had ever seen a genuine case, the 
result of the inoculation of the specific virus from a rabietic 
dog—so little idea is there even among the medical profession 
either in North or South Britain of the distinction between 
real and spurious Hydrophobia,* that it cannot be said there 
was anything like sufficient proof that the fatal cases in man 
alluded to were genuine hydrophobia. Nor was there any 
satisfactory proof that the persons who died with symptoms 
of or resembling those of hydrophobia, were bitten by dogs 
at all; or that when bitten, the dogs themselves were really 
rabid—affected with rabies, or in any other sense mad. 
Nevertheless, a popular panic followed the deaths in ques- 
tion: a vivid imagination conspired with ignorance and 
superstition to create the belief that rabies was rampant ; 
that danger to human life from dog-bite and hydrophobia 
was necessarily and equally so; and that the only means of 
safety—of preventing or stamping out the disease and its 
cause in man—lay in the destruction of all the stray dogs of 
the city. “ An official return shows that the number of dogs 
taken charge of by the Glasgow police during the recent 
crusade was 1,295, and that of these, 1,155 were killed.”’+ 
* On this subject see what I have said in a paper on ‘“ Madness in Animals,” 


in the “ Journal of Mental Science ” for July, 1871, pp. 185-193. 


+ “Scotsman” of November 13, 1876 ; and‘ British Medical Journal’ of 
November 16, 1876, p. 663. 


1877. |] by W. Lauper Linpsay, M.D. 19 


Such a “massacre of the innocents” bids fair, and well 
deserves, to figure in all future histories of Popular Errors 
and their Results. 

For, such a slaughter was the result of error—and the 
error was the result of ignorance and superstition, imagina- 
tion and panic. Professor Macleod, of the University of 
Glasgow, publicly stated after the said panic and massacre, 
‘* There is a huge lot of nonsense talked about hydrophobia, 
and people need not be in the least afraid of it.” If the 
people, as a whole, could and would only believe this—which 
is true; were they convinced that, as I have pointed out 
elsewhere, rabies in the dog and hydrophobia in man are 
equally rare,* and that in nine cases out of ten what are so 
called rabies and hydrophobia are erroneously so called, 
they would be quite easy in their minds concerning dogs 
and dog-bites; there would be none of that morbid fear 
and fancy that, in conjunction, produce the spurious disease 
in man—a spurious disease, be it observed, that is quite as 
fatal frequently as the real one. In fact, man will bea great 
gainer when he can realise the part played by fear and 
jancy—morbid in their character, and begotten of ignorance, 
prejudice, and superstition —in the genesis of the most 
dreaded and fatal of human diseases, especially of the 
epidemic kind. 

Very slowly indeed, however, are even medical men in becom- 
ing alive to, or aware of, the fact that many fatal diseases, 
such as cholera, hydrophobia, and tetanus, owe their origin 
and their fatality, not to any blood-poisoning—not to the in- 
troduction from without of any disease-germs, figurative 
or real, but simply to imagination. Quite lately Dr. Messer, 
of H.M.S. “ Pearl,” has been pointing this out as regards the 
tetanus resulting from supposed arrow-poison. He shows 
that the wounds inflicted by poisoned arrows in the South Sea 
Islands are followed not by blood-poisoning—not by any 
specific disease traceable to the supposed ‘* poison ”’—but by 
a series of morbid mental and motor symptoms; the first 
including Fear, Mental Hxcitement, Nervousness, Supersti- 
tion, Suspicion, Delusion, and actual Insanity ; while the 
second embrace Hysteria and Tetanus, preceded by morbid 
Sensations. Further, he proves that the so-called “ poisoned ” 
arrows are really not poisonous, and that their supposed 
poison cannot produce Tetanus. 


* Vide Paper on ‘‘ Madness in Animals,” p. 185. 


20 The Pathology of Mind in the Lower Animals, [April, 


Nor are such mistakes in popular practice as those con- 
nected with the slaughter of hecatombs of dogs that, if per- 
mitted to exist, might some day or other become rabid, bite a 
man or child, and so give rise to human hydrophobia—con- 
fined to Glasgow. They are or have been committed also in 
London, though not perhaps on such a scale. ‘The Times, 
writing in June, 1874, on Canine Rabies, says :—‘*A dog 
which is thirsty and bewildered is almost certain to be con- 
demned as rabid, even although there may not be a particle 
of evidence to justify the charge. During the last few 
weeks we have had to record several groundless alarms of 
this description; and many dogs—probably none of them 
mad—have been destroyed.” In fact, the Police Returns 
showed that sixty-seven dogs—reputed to be mad—were 
destroved within the metropolitan district alone between Ist. 
January and 3lst May, 1874. A sheep worried by one of 
these sixty-seven dogs ‘‘is said to have died of rabies five 
weeks afterwards. In the other sixty-five cases there was 
no evidence of madness (in the dogs) beyond the fact of the 
accusation !’? Commenting on this, Berkeley tells us (in his 
“Fact against Fiction ”)—‘‘ The probabilities are that not 
one of the dogs was either mad, or in the shghtest danger of 
becoming so; and that, if they had been shut up and watched 
for a time, the symptoms which gave rise to the belief 
would have been found to admit of some different interpre- 
tation.” 

Great, however, as is popular ignorance concerning the 
etiology and symptomatology of insanity in other animals 
than man, and even, indeed, in man himself—and serious as 
are the results of such ignorance equally to man and other 
animals—so much is already known of the causes and forms 
of mental defect or derangement in such animals as the dog, 
horse, and elephant, that the subject of animal insanity is 
much too vast and important for treatment in a single paper. 
All that can be fitly attempted at present is to owtline the 
subject in order to give a general idea of its extent and im- 
portance, reverting by and by to the discussion of specially 
interesting details. 

Generally, then, it may be stated that insanity in the lower 
animals is virtually the same as that of man—in so far as 
concerns— 

1. Its Etiology or Causation. 

2. Its Symptomatology and Forms, including its Pro- 

dromata, or early—apt to be unobserved—stages. 


1877. | by W. Lauper Linpsay, M.D. 21 


3. Its Diagnosis and Prognosis, with their difficulties. 
4, Its Duration and Terminations. 

5. ‘he Principles of its Treatment. 

6. Its Curability and the tendency towards recovery. 


But there are certain peculiarities in the case of the lower 
animals, the most important of which is the facility with 
which artiicial insanity may be produced in them by means, 
for instance, of— 


1. I]]-usage ; or by 
2. Brain or Blood-poisonine—by the Alcohols or by various 
Narcotics or Lrritants, fluid, solid, or gaseous. 


Hence in many animals the whole course of insanity—its 
genesis, symptoms, and terminations, as well as the means of 
controlling it, and its morbid anatomy and histology when 
a fatal issue has been produced or permitted—may be con- 
veniently studied. And hence, also, the value of such a form 
of pathological experimentation, as yielding results calculated 
to throw light on the Natural History of Insanity in man. 

In connection with this aspect of the question—the arti- 
ficial production of msanity in the lower animals, and the 
results that may be expected to accrue to psychological and 
pathological science from a careful study of the insanity so 
produced—while it may be shown, on the one hand, what we 
already know concerning mental and moral defect and dis- 
order in these animals, it may, perhaps, much more easily be 
indicated, on the other, how much we have still to learn. 
There are, indeed, numerous problems of the most interesting 
kind awaiting solution connected with the physiology as 
well as the pathology of mind; and if such problems are to 
be solved at all, it will probably be by experimental study of 
the phenomena, both normal and abnormal, of mind in the 
lower animals. The problems in question are of very various 
character and value, as the following illustrations may suffice 
to show :— 


1. The connection, if any, between mental conditions, and 
changes in the structure or composition of the brain, spinal 
cord, or other portions of the nervous system. 

2. The relative frequency of insanity or its special forms in 
domesticated, as compared with wild, animals, or in domesti- 
cated and wild individuals of the same species. 

3. The relative liability of sex and age to insanity, or cer- 
tain forms thereof. 


22 The Pathology of Mind in the Lower Animals, [April, 


A. The nature of the morbid influence of the human breath 
on certain insects. 
5. The modus operandi as excitants of certain smells (or 
odours), and colours. 
6. The nature of barking or baying at the moon by dogs 
or other animals. 
7. The true character of the “madness” of “ March 
hares.” 
8. The causes—if causes can be said to exist—of many 
morbid antipathies. | 
9. The relative frequency of insanity, or certain of its 
forms, in different— 
(a) Individuals. 
(6) Breeds or races. 
(c 
( 


) Species; and 
d) Genera. 

10. The results of artificial breeding and life in relation to 
the genesis of insanity, or a predisposition thereto. 

11. The hereditary transmission of morbid moral or in- 
tellectual qualities or conditions. 

12. The comparative frequency of human and animal in- 
sanity under the same or similar circumstances ; and of— 

13, Animal insanity in earlier and later times. 

14. The nature and cause of migrational excitement. 


[have on several former occasions expressed the opinion*— 
and I cannot repeat it too frequently or emphatically—that 
the study in a scientific spirit of the pathology of mind in 
the lower animals offers a far more promising field for orrginal 
inquiry than any other department of so-called ‘* Psycholo- 
gical Medicine.” AndIam glad to find that some of our 
most eminent naturalists and mental philosophers are now 
expressing opinions of a similar kind. Thus Dr. Carpenter 
says, ‘* Scientific study of the various forms of abnormal 
mental activity ..... rightly cultivated, is probably the 
most promising field of Psychological Inquiry.’’+ These 
views are shared by Professors Huxley and Maudsley, of 


* Vide Pamphlet on (1) “The Physiology and Pathology of Mind in the 
Lower Animals.” Edinburgh, 1871; and papers on 
(2) “Insanity in the Lower Animals,” in the “ British and Foreign Medico- 
Chirurgical Review ” for July, 1871. 
(3) ey of Disease in Man and other Animals.” Jbid., January, 


(4) “The Transmission of Disease between Man and the Lower Animals.” 
“‘Hdinburgh Veterinary Review,” July, 1858. 
+ Preface to his “ Mental Physiology.” 1874. P. ix. 


1877.] by W. Lauper Liypsay, M.D. 23 


London; Bain, of Aberdeen ; and Youmans, of New York—as 
I have reason to beheve—in some cases from their published 
avowals,* in others from their written correspondence. 
There are many. energetic young medical men connected 
with our specialty longing for distinction, to whom such a 
field is invitingly open. If they would but betake them- 
selves to the study of Comparative Psychology, and to that 
department thereof especially which relates to Mental Patho- 
logy, they would find a new and wide—almost inexhaustible 
—opportunity not only of distinguishing themselves, but of 
adding to human knowledge, and thereby to human, as well 
as animal, happiness and well-being. Letmethen commend 
the experimental and scientific study of the pathology of 
mind in the lower animals—in some of its many departments 
or details—to those capable youths who at present fritter 
away their time, temper, and opportunities on subjects that 
are both trite and trivial; who expend their ingenuity in im- 
proving upon Nature by drawing hard and fast lines of de- 
marcation where she draws none; who have a genius for the 
coinage of new and puzzling terms, the addition of which 
to the already bewildering terminology of comparative psy- 
chology only makes “confusion worse confounded ;” who 
devote so much energy to fruitless, and, perhaps, undignified 
squabbles concerning the classification or nomenclature of the 
insanities of man; who report flippantly of cures due to their 
skill that are more probably temporary recoveries in spite of 
their interference—triumphs of the vis medicatria Nature 
over the Nimia diligentia of unscientific medicine; who 
describe, as characteristics of insanity or the insane, condi- 
ditions of the brain that are to be found—if looked for with 
the same care and desire—in the sane inmates of any large 
poorhouse or hospital—conditions that cannot claim even, in 
some cases, to be considered morbid; who discover in the 
last fashionable drug, or mode of drugging—apparently just 
because it is the last and most fashionable—a panacea for 
all the ills of the insane ; who delight in barren statistics that 
have already been tabulated a thousand times with results of 
no practical value; or whose cacoéthes scribendi has deluged 
psychological literature with a rudis indigestaque moles of 
useless or mischievous speculation. 
Unfortunately, in commending experimental investigations 
concerning even the mental faculties of, or mental conditions 


* Thus Professor Huxley’s opinion has been given in my paper on “ Insanity 
in the Lower Animals.” (Foot-note to p. 3.) 


24 The Pathology of Mind in the Lower Animals, [April, 


in, the lower animals, we are brought at once face to face with 
the deplorable “ Vivisection Act” of last session.* The 
direct tendency and effect of that Act—which was the result 
of a weak pandering to popular prejudice—is to degrade 
science, to interfere with scientific progress, and the accu- 
mulation of knowledge of a kind calculated to be beneficial 
to man and his subject animals in a thousand ways. For 
myself, though I see numerous paths of experimental re- 
search opening up before me, and inviting me to enter upon 
them, and though some of these investigations would have 
for their subjects such vermin as rats or mice—such cage 
birds as parrots and starlings—such inmates of domestic 
aquaria as gold and other fish—all of which are vertebrates— 
I am debarred from engaging in them by reason of my re- 
luctance to take out a “licence,” and so subject myself to the 
inquisitorial indignities and degrading penalties imposed by 
a misguided Government. But there may be many younger 
men, with equal desire for original research, more happily 
circumstanced as to a Government “licence,” or as to a will- 
ingness to take advantage thereof: and to them I again com - 
mend a kind of inquiry upon which I cannot myself—for the 
present, at least—enter. 

At one time (in 1853), when, in conjunction with the late 
Dr. Warburton Begbie, I was in medical charge of the City 
Cholera Hospital of Edinburgh, I had a comparatively ex- 
tensive experimental establishment. There were two large 
buildings of several storeys—one of them quite empty, the 
other nearly so—with ample grounds and outhouses, placed 
at my disposal. These buildings and their appurtenances 
contained abundance of suitable accommodation for labora- 
tories of experiment, as well as of research; and accord- 
ingly, in addition to apartments at the top of the house, well 
lighted, and devoted to microscopical and chemical research, 
i had others on the ground floor occupied by animals that 
were the subject of several distinct lines of experiment, 
including— 

I.—Cholera—artificially produced, and studied in all its 

stages, 

II.—The antagonism of medicines and poisons; and— 
Ill.—The difference in action of the same medicines or 

poisons in different animal species and genera. 


The animals selected for the purposes of experiment were 
* “ The Cruelty to Animals Act,” 1876. 


1877.] by W. Lauper Linnsay, M.D. 25 


mostly wandering, homeless street dogs of the kind lately 
and literally drowned “ by the thousand ” in Glasgow because 
they might, had their lives been spared, have become rabid 
and bit people ;—drowned without their lives or deaths 
_ being of the slightest use to science or thereby to mankind. 
The existence of my animal hospital and experiments was 
well known to the late Sir Jas. Simpson, Professor Syme, 
Professor Alison, Professor Hughes Bennett, and other then 
living celebrities of the Edinburgh medical world. But 
_ these gentiemen did not give-me the benefit even of their 
moral support or approval. Nor could they; inasmuch as 
some of them, if not all, ridiculed the idea of expecting to 
find the diseases of other animals comparable, and still less 
identical, with those of man! The consequence was, that popu- 
lar and professional rumour having partly misrepresented, 
partly misunderstood the aim and character of my experi- 
ments, a dread that threatened to take practical shape arose 
among the patrons of the hospital of which Dr. Beebie and I 
had charge as physicians—he as senior and non-resident and 
I as junior and resident—these patrons being the august Town 
Council of Edinburgh. And this dread, with the action to 
which it was likely to give rise, led me abruptly to bring my 
experiments to a close, not, however, before I had accumu- 
lated many results, some of which were soon afterwards pub- 
lished both in France, England, and Scotland. So far as con- 
cerns the cholera experiments, Dr. Warburton Begbie, who 
had studied them in the various stages of their progress, in 
giving an account of the Transactions of the City Cholera 
Hospital in 1855,* described them as “having first exhibited 
the communicability of cholera to the lower animals, and so 
determined the contagious nature of cholera.” 

The animal species and genera in which various forms of 
mental peculiarity, defect, or disorder have been noted by 
different observers—veterinarians, physicians, travellers, or 
naturalists—are considerable, both as to number and variety, 
including as they do among the Mammalia— 


1. Quadrumana: the Gorilla; Orang; Mandrill, or other 
baboons; the Araguata, Titi, Capuchin, or other 
monkeys; certain apes; and the Lori. 

2. Ungulata: The Horse; Mule; Ox; Goat; Pig; the 
Moose, and other kinds of deer; the Chamois; Sheep ; 
Hippopotamus ; Buffalo; Quagea; Gnu; Camel; and 
Dromedary. 


* “ Hdinburgh Medical and Surgical Journal,” January, 1855. 


26 The Pathology of Mind in the Lower Animals, [April, 


. Carnivora: The Dog; Cat; Fox; Wolf; Tiger; 
Ocelot; Ferret; Badger; Brown or other bears. 

. Proboscidea: The Hlephant. 

. Rodentia: The Rabbit; Hare; Common Rat; Ham- 
ster; Beaver; Guinea Pig. 

. Marsupialia: The Tasmanian Devil, and Wombat. 

. Insectivora : The Hedgehog, and Mole. 


In other classes of the Vertebrata, we have yet to look for 
indications or examples of mental defect or derangement 
among Pisces, Amphibia, and Reptilia. But among the 
Aves, on the other hand, there are many instances, including 
the— 

Parrot. 

Chilian Sea Eagle. 

Clawed Harpy Hagle. 

American Goatsucker. 

Australian and British Magpies. 

Common Raven. 

Jackdaw. 

Indian Crow. 

Sparrow Hawk. 

Piping and other Bullfinches. 

Canary. 

Turtle Dove and other kinds of Pigeon ; anid 

Common Fowls or Poultry. 


Among the Invertebrata, the only signal illustrations of 
mental excitement and aberration are to be found in the 
class Insecta, of the sub-kingdom Annulosa, and in the 
order Hymenoptera—in Ants and Bees. But if we regard 
alcoholic ntoxication as involving morbid mental phenomena, 
or phenomena thereto allied, and inebriation as a kind of 
temporary mental derangement, we meet with abnormal psy-_ 
chical conditions as low in the zoologicalscale as the Medusidee 
belonging to the sub-kingdom Celenterata. For, quite lately, . 
Romanes has shown that the outward phenomena of tipsi- 
ness may be artificially produced in the common Meduse of 
our coasts.* 

Referring to the foregoing list of animals in whom, by 
various authors, conditions of mental peculiarity, excitenient, 
depression, want, or disturbance have been observed, it has to 


<—1Q Gtk €9 


* He read a paper on the Medusa, describing inter alia their experimental 
intoxication, ai the British Association in Glasgow i in 1876; as reported in the 
“North British Daily Mail” of September 13, 1876. 


1877.] by W. Lavuprr Linpsay, M.D. 27 


be explained that these conditions are most diverse in their 
nature, according, sometimes, to the genus or species affected, 
sometimes to the producing cause. ‘Thus, in the dog, the 
commonest form of insanity 1s that of rabies ; but ordinary 
mania and melancholia are also frequent. In the horse and ox 
it is ephemeral mania that usually attracts notice, and leads to 
the adoption of hasty and unnecessary measures for the des- 
truction of the animals affected. In such birds as the magpie, 
‘the usual form of mental or moral perversion is kleptomania, 
the theft of articles utterly useless totheanimal. In various 
young animals—dogs and cats especially, for they are seldom 
permitted by man or their fellows to grow to maturity—there 
is sometimes simply mental want or defect, congenital in its 
origin, and amounting in some cases to idiocy, while it 
embraces all the shades of fatuity or wmbecility, marked in 
all cases by inability to provide for themselves. 

Inthe catalogue of animals above given, both sewes and all 
ages are represented ; as are also wild and domesticated indivi- 
duals, species, or genera, with pet and menagerie animals. 
Sometimes one sex, sometimes another, is more specially 
affected by this or that form of insanity, so that at present it is 
impossible to say whether, on the whole, males or females are 
most liable. For, while females are more impressionable than 
males, in connection with .such functions or conditions as 
pregnancy and parturition, the males are more subject to the 
excitement of the rut: so that in them—in the stags or bucks, 
for instance, of various deer, including the red, fallow, and 
roe deer—erotomania is most frequently developed. 

The causes of mental defect and disturbance among the 
lower animals are almost infinite, as varied and numerous 
nearly as those of human insanity; because, if certain causes 
be held peculiar to man, there are certain others equally 
entitled to rank as characteristic of other animals. In 
general terms it may be asserted,in the first place,that all the 
causes of other and ordinary bodily diseases, and especially of 
those of the brain and nervous system, along with such 
diseases themselves when developed, are to be regarded as con- 
ducing to animal as to human insanity. I have shown else- 
where* to how many human diseases other animals are 
liable, from how few—if any—they are exempt. Here it may 


* Vide papers on (1) ‘Community of Disease in Man and other Animals,” 
‘British and Foreign Medico-Chirurgical Review.” January, 1874. (2) “The 
Transmission of Disease between Man and the Lower Animals,” ‘“‘ Edinburgh 
Veterinary Review.” July, 1858. 


28 


The Pathology of Mind in the Lower Animals, [April, 


suffice to enumerate such nervous affections—involving motion 
as well as consciousness—as apoplexy, epilepsy, catalepsy, 
chorea, hysteria, convulsions, and paralysis. Conducing 
equally to abnormal mental and bodily conditions, and to the 
one through the other, are :— 

1, All kinds of oe of food, water, sleep, fresh air, 


2. 


o -_ w~ 


CO Clee at  S. 


11. 


exercise, occupation, recreation, society, hght, gratifi- 
cation of instincts. 

All sorts of excess: of food; emotion or passion, suchas 
anger or erief, rivalry or jealousy, fear or fright, 
joy or expectancy, anxiety or despair; heat or cold, 
gratification of instincts. 


. All forms of physical exhaustion—however produced— 


as by overwork. 


. All other kinds of i-usage, suffered at the instance of 


man. 


. All kinds of bodily pain, or suffering, such as that of 


toothache. 


. Certain physiological or pathological conditions or 


changes, such as incubation, sterility, or moulting. 


. Surgical or other mutilations of organs, such as castra- 


tion. 


. Wounds, accidentally or intentionally inflicted, such as 


from blows on the head. 


. Animal, or other poisons, such as those of fly-plagues, 


or contained in improper food, or in drugs artificially 
administered. 


. Predisposition, temperament, heredity, diathesis. 


Of a more special character, acting principally on the 
mind, are such causes as— 
Want of leadership or government. 


12. Sense of danger, of homelessness or desertion, of 
calamity, of suffered wrong. 

13. Nostalgia. 

14. Braidism. 


Now the reader may classify or arrange such causes in his 


own 


Li 
a. 


way. He may divide them in the orthodox fashion into 
Those that are (a) Predisposing, indirect, or remote; and 
(b) Exciting, direct, or immediate. 
Or that are (a) Moral; and 
(b) Physical. 


I make no such attempt, for a variety of reasons, and 
among others, that I believe all such classifications ‘to be 
arbitrary, artificial, and inexact, whether or not they are con- 





1877.] by W. Lauper Linpsay, M.D. 29 


venient for the student. It is of much. more consequence to 
‘point out, in connection with the subject of causation, that—- 

1. Sometimes there is an absence—apparent or real—of all 
cause, which is tantamount to saying that causation is fre- 
quently unknown, however demonstrable the effect may be. 

2. Or the triviality, or inadequacy, of the cause is remark- 
able. 

3. The apparent cause may not be the real one. 

A, Certain assigned causes are highly problematical, such as 
lunar influence in other animals, as in man. 

5. Frequently there is a combination—it may be a com- 
plexity—of causes. 

6. The same result may issue from different causes : just as 

7. The same cause may give rise to different results. 

8. The cause, where present, may be obscure, or obvious. 

9. What appears to be a cause may in reality be an effect ; 
for instance, in the case of nostalgia and intoxication. 

10. Many causes are exceptional, or peculiar ; their nature 
and operation have not been explained, and are not under- 
stood ; they, therefore, court investigation. 

The commoner forms of mental defect, impairment, or 
derangement, among the lower animals, are the following :— 

1. Original (or congenital) defect, ranging in degree from 
slight mental imbecility to idiocy (or amentia) ; and including 
especially certain kinds of stupidity, for instance, that which 
renders an animal incapable of education, or of taking care 
of itself. | 

2. Acquired impairment, of the nature of loss, weakness, 
weakening, or want of mind, or fatuity, including all 
shades of Dementia. 

3. Abnormal or excessive mental excitement, culminating in 
Furiosity and Mania. 

4, Hixtreme or inordinate depression of spirits, or des- 
pondency, of all degrees up to abject Melancholia. 

5. Perversion of one or more of the appetites, affections, 
or propensities—what is called in man Moral Insanity, 
including sleptomania, dipsomania, and erotomania. 

These forms of insanity include, as in man, aberrations of 
_ speech, or other forms of language, and necessarily of the ideas 
of which language is the expression. In other words, there 
are not only delusions, expressed by pantomimic language, 
for instance, in the rabies of the dog; but even incoherency of 
speech, in the senile dementia or in the intoxication of the 
parrot. 


30 The Pathology of Mind in the Lower Animals, [April, 


The forms of insanity mentioned also include what in man 
is termed Monomania,* when some prevalent morbid idea, 
feeling, or impulse takes apparently entire possession of the 
mind for themoment. Examples are to be found in morbid 
- fear or suspicion, which amounts sometimes to what, in man, 
is known as the monomania of fear, or suspicion; panpho- 
bia, an overwhelming general dread ; morbid impulse, such as 
that which leads to suicide, homicide, or murder of each other, 
mutilation of themselves or others, or general destructiveness 
both of property and life; morbid propensity or appetite, 
such as that which urges to morbid forms of theft, the abuse of 
intoxicants, and the excessive excitement of the sexual passion, 
and which gives rise to those forms of insanity usually 
designated in man, moral—to wit, kleptomania, dipsomania, 
and erotomania. In the same way it is quite as permissible 
or proper to speak, in other animals as in man, of suicidal, 
homicidal, murderous, or destructive mania, or monomania, if, 
indeed, it be strictly correct to use such terms in either 
case. 

There are, moreover, certain forms of insanity that are 
secondary in their character, developed as morbid mental 
phenomena in various bodily or general diseases, such as 
rabies, distemper, sturdy, plague, or epilepsy. Such forms, 
which are not always minor in their importance, though not 
primary in their incidence, are frequently spoken of, with no 
great propriety, as sympathetic or symptomatic. It is more 
correct to speak of the insanity of rabies, distemper, sturdy, 
or plague, or of epileptic mania. 

Paralysis is another of the bodily disorders that may 
accompany, precede, or follow mental defect, or derangement 
in the lower animals. And paralysis itself may sometimes 
amount to what ordinary medical or veterinary writers de- 
scribe as a “general” paralysis.; Thus Dr. Richardson 
mentions a horse struck by hightning so severely that “ it died 
ultimately from wasting and general paralysis.”{ It has yet 
to be shown, however, whether in cases of so-called general 
paralysis, in the horse or other animals, there is any associa- 
tion of morbid mental conditions, and if so, whatis their cha- 
racter, and what the nature of the association. That there is 
such an association is most likely, but its existence has yet 


* Cases are given in my “Illustrations of Animal Reason,” p. 141. 

t See what I have said on this subject in my paper on ‘Community of 
disease,” p. 15. 

{ “Diseases of Modern Life,” p. 76. 


a 


1877.] by W. Lauprr Liypsay, M.D. 31 


to be proved. The study of this particular form of associa- 
tion of mental with bodily disorder is of special interest in con- 
nection with the subject of what is called general paralysis 
(or paresis) in the human insane, which I have never been 
able to regard as the specific disease it is usually represented 
to be. 

And further, certain kinds of insanity—especially those of 
an emotional character—are apt to become, by imitation and 
sympathy, eprdemic.* 

Just asin the case of causation, the reader may amuse 
himself with classifications of the forms of animal insanity. 
He may divide them into. insanity of (1) Feeling, (2) Action, 
(3) Thought; or into the old orthodox mania, melancholia, 
amentia, dementia, and monomania: or he may attempt to 
arrange according to causation, real or supposed, and con- 
struct his genera and species, with their varieties, almost to 
an unlimited extent. I make, myself, no attempt at elaborate 
classification, for many reasons, of the same kind as those 
that apply to all efforts at the classification of causes; in- 
eluding among other reasons this sufficient one, that in so far 
as the forms of insanity are frequently as shifting and com- 
plex as its causes, all such arrangements are artificial and 
inexact, however great their semblance of, or pretence at, 
precision. Itis much more important for us to know what 
forms are preventable and non-preventable, and what is the 
extent of man’s responsibility in the incidence and develop- 
ment of animal insanity. This opens up the question of 
curability, in regard to which—as to the general principles of 
treatment—there is not much to be said that does not apply 
equally to human insanity. 

Short of insanity, there are, in other animals, as in man, 
many morbid mental states—including the following :— 

1. Changes of character or disposition, including temper 

changes, such as moodiness, sulkiness, surliness, or 
general irritability. 

. Changes of habit. 

. Perversion of the affections, especially the maternal. 

. Development of morbid appetite. 

. Mental confusion or bewilderment. 

» Delirium. 

. Volitional defect or disturbance: want of exercise, loss 
of the power of control, or morbid feebleness of will. 


“TO Or & CO DO 


* Vide paper on “ Mental Epidemics among the Lower Animals,” “ Journal 
of Mental Science,” January, 1872. 


32 The Pathology of Mind in the Lower Animals, [April, 


As in man, too, such mental states frequently constitute the 
prodromata, or premonitory symptoms of insanity; while at 
other times the mental aberration stops short at this stage. 
And it is at this early stage more particularly that man has 
so much in his power in preventing insanity in, or in restoring 
the mental equilibrium of, animals that are so serviceable to 
him; provided only he understands the significance of such 
symptoms of threatened—nay, to some extent, of existing— 
mental derangement. 

The following illustrations will serve to show the different 
degrees, as well as kinds, of mental excitement and depression, 
defect and derangement, that occur in the commoner animals 
—whether wild, captive, or domesticated—in short, in the 
different conditions of existence, in both sexes, and at all ages. 

The insanity of rabies in the dog is of special interest from 
the occurrence of visual, aural, or other classes of sensorial 
delusions, and from its general resemblance to that of the de- 
lirium tremens of man. Its phenomena have been described 
by many authors, medical and veterinary. The following de- 
scriptions may be held typical of all, for there is usually little 
variation in detail. The Times (in June, 1874) writes of the 
rabietic dog in general that it ‘ makes furious attacks upon 
amaginary enemies ; or barks or howls in response to 1magin- 
ary sounds, sniffing at the air, or suddenly barking without 
apparent cause.” M. Bouley, of Alfort, the distinguished 
French veterinarian, who has made a special study of canine 
rabies, cautions us to ‘‘ beware of the dog that 5 eas 
exhibits aggressive movements against phantoms.” Berkeley 
(ing. his “ Fact against Fiction’) asserts, also in connection 
with rabies in the dog :—“ The canine race are subject to as 
many delusions of the brain almost—not quite—as men and 
women are.” Youatt, again—a thoroughly competent veteri- 
narian—tells ns of a rabid dog, that—“ Ina moment the dog 
- quitted the sofa ” (it had been resting), “and, with a furious 
bark, sprang against the wall as if he would seize some 
imaginary object that he fancied was there.” . . . He 
would ‘‘ watch the nails in the partition of the stable in 
which he was confined, and fancying them to move, he would 
dart at them, and injure himself from being no longer able 
to measure the distance of the object.” He may “seem to 
imagine that something is lost, and he will eagerly search 
round the room, and particularly every corner of it, with 
strange violence and indecision,” and Youatt points out, too, 
that its delusions of sight and sound are of exactly the 








1877.] by W. Lauper Linpsay, M.D. 33 


same kind as those of man. Youatt speaks also of ‘the 
foes that he fancies are threatening him on every side.’’* 

Clara Rossiter, in her “ Anecdotes of Pets,”’+ describes a 
certain kitten as an “oddity . . . apparently not pos- 
sessing all its senses. It was painfully melancholy, and slept 
away its whole existence ””—dying in infancy. Here probably 
we have a case of zdiocy, or congenital imbecility, associated 
with, or depending upon, some wasting disease of the body. 
Mrs. ‘Burton, too, speaks of an“ idiotic-looking cur 
too weak to ficht for itself,’{ in the suburbs of Damascus. 

A correspondent of the “ Daily Telegraph,’§ narrating the 
shooting exploits of the Prince of Wales in the Terai of 
Nepaul, tells us that the tiger is seized “ with a mad frenzy 
in the moment of despair”—as the Felide in general are. 
“Wounded and hopeless, he would charge an army, and die 
tearing at his wounds, if his fangs and claws can find nothing 
nearer °—on which to wreak his fury. This may be con- 
sidered an acute mania, suddenly begotten by being brought 
to bay after all the noisy and harassing persecution of the 
hunt; the mania being characterised by a morbid destructive- 
ness that vents itself on the animal’s own person, if there be 
no opportunity for giving it an outlet on man or other enemies 
_or prey. Other forms of self-mutilation are common in other 
kinds of mental derangement—mostly, however, of the mani- 
acal type. 

“The mandrill is lable to terrible gusts of passion, during 
which it seems to be bereft of reason, and possessed with an 
insane fury,’ says the printed official “‘ Guide to Edmonds’s 
Menagerie” (p. 13). This illustrates the very common rela- 
tion of anger, rage, or passion to mania; the one passing into 
the other so imperceptibly, that it is frequently difficult, if 
not impossible, to draw the line of demarcation between them. 

A cat, which was made for experimental purposes the sub- 
ject of theine injection, “seemed to be frantic” in its “ fits” 
of intense cerebral excitement,” a condition in which “it 
appeared to be extremely susceptible to irritation ;” in other 
words was “easily irritated.” || The morbid mental condition 
artificially generated would appear to have been extreme 
excitability, or irritability, culminating in paroxysmal mania ; 

* Work on the Dog, pp. 131-3. 

+ As quoted in the “ North British Advertiser,” of Aug. 22, 1874. 

T “Syria,” vol. i, p. 255; 

§ Of March |, 1876. 


: || The late Prof, Hughes Bennett, in the “ British Medical Journal,” Dec. 5, 
1874, p. 697. 


XXIII. 3 


3 


34 The Pathology of Mind in the Lower Animals, (April, 


and the condition in question is simply one of many that 
are artificially producible, and that are too frequently, by 
man, produced by means and for reasons that cannot always 
claim the apology of being scientific experiments. 

A correspondent of “ Land and Water’’* thus describes the 
migrational excitement and play of a shoal of new-run 
salmon in the Clare-Galway river, above Lough Corrib :— 
“The salmon evidently enjoyed the changing weather; and 
having indulged in a few playful and delusive rises, got more 
and more excited till they seemed to have gone simply mad ;” 
sometimes “springing upwards straight into the air to shake 
off the sea parasites, which still clung about them.” Whether 
this be a mere “revelling in their first re-taste of a fresh- 
water river,’ or a desperate effort to get rid of troublesome 
parasites, such a sort of frantic leaping frequently includes 
leaping ashore, and wholesale loss of life in consequence. 

Capt. Burnaby, in his famous “Ride to Khiva” (1876, 
p. 83), informs us—“T once rodeacamel in love . . . He 
was known by the name of the ‘Magnoon,’+ or the Mad 
Camel; but whether, on account of his susceptible heart or 
not, | cannot say.” Hrotic forms of insanity—the erotomania 
of authors—is better known as it occurs among stags, stal- 
lions, and other male animals—to which sex, however, it is by 
no means confined, for Nymphomania is to be met with as 
well as Satyriasis. It is well known that stags in spring are 
‘““transported with erotic fury,’ and in them the character 
of this dangerous furiosity is generally recognised. But 
though it is common to speak of an eccentric man being “ as 
mad as a March hare,” the phrase is obviously employed 
without any intelligent understanding of its meaning, and of 
the propriety, or rather impropriety, of its application. 

An “infuriated ox,” in Dundee, in July last, during the 
hottest weather of the year, in the course of being driven 
through the city streets, probably to the slaughter-house, is 
described as at first “ becoming frightened, and running down 
the street at-a furious rate . . in its mad career : 
The spectacle was evidently greatly relished by a large section 
of the younger portion of the community, as the ox was 
followed by hundreds of young boys and girls.Ӥ This is but 


* As quoted by the ‘“‘ Dundee Courier,” of Nov. 13, 1876. 


+ Majnton is the usual Arabic word—used throughout the East—for a 
human madman. 


t “Animal World,” July, 1876, p. 98. 
§ “Dundee Advertiser,” of July 9, 1876. 





é 


| 1877.] by W. Lauper Linpsay, M.D. 35 


an illustration of a very common form of ephemeral mania, 
dangerous to human life—the result of man’s injudicious 
management. Nothing, in such cases, can be more likely to 
_ produce mania from morbid terror or mere bewilderment, 
amid the confusing sights and sounds of a city street, than 
the raising of the “mad” hue and cry, and the pursuit of 
what is generally a harmless, and simply frightened, animal 
with shouts and yells, accompanied by blows, and the offering 
of formidable-looking obstacles to the poor brute’s efforts to 
reach solitude and silence,.in its familiar green fields of any 
kind. : 
Burton* describes melancholia, or a tendency thereto, as a 
characteristic of the gorilla in its native state and country,t 
and nostalgia as affecting it on shipboard, and as apt to be 
fatal. Melancholia, or the minor allied conditions of sadness, 
apathy, moroseness, despondency, or depression, seem to be 
common in all the quadrumana that are usually brought to 
Europe for menagerie purposes; and it is noteworthy that 
this mental condition is frequently, if not always, associated 
with pulmonary consumption—a disease that, in the whole 
monkey and ape tribe in captivity in our climates is very 
fatal.t It has further to be remarked that both consumption 
and melancholia may stand related to the physical element of 
cold§ in our climate, and to the lack of exercise, and the other 
concomitants of an artificial, unnatural existence, more than 
to the psychical influence of removal from their native forests 
and all the freedom of forest life. Burton recommends, in 
the treatment of the melancholia or nostalgia of the gorilla, 
the supplying to it, as a companion and valet, of a human 
native of equatorial Africa. And were companionship and 
nursing all that are required, more might be said in favour of 
such an arrangement than may at first sight appear possible. 
For, however much man may object to regard an anthropoid 
ape as a “brother,” the behaviour of menagerie apes and 
monkeys, on being visited by negroes, shows unmistakably 
that they claim kindred with “ black men” as their brethren. 
In reference to nostalgia, too, Miss Gordon Cumming, | 





* “ Gorilla Land,” Vol. i, pp. 245 and 250. 

+ But this must surely be after, and as the result of, capture: for how other- 
wise could its mental condition have been examined, or observed and described ? 

~ See what I have said on the subject of tubercular disease in the lower 
animals, in my paper on “Community of Disease,” p. 10. 

§ Vide paper on ‘The Causes of Insanity in Arctic Countries,” ‘ British and 
Foreign Medico-Chirurgical Review,” Jan., 1870. 

|| “From the Hebrides to the Himalayas,” 1876, Vol. ii, p. 92. 


36 The Pathology of Mind in the Lower Animals, [April, 


speaking of the non-success of all attempts to introduce the 
camel and dromedary into Hurope and America, says that 
the animals alluded to “seem to pine for home, and very 
quickly droop and die.” This pining to death is much more 
common in animals that are not subjected to any change of 
climate, or even to any change of scene, but in whom, never- 
theless, thereisamoreor less sudden, unexpected, and complete 
severance of cherished attachments and associations. In no 
animal is fatal marasmus, preceded by abstinence from food 
and drink, and produced by the profound melancholia of grief, 
so common as in the dog, from loss of a master, friend, or 
companion. 

The “ Anima] World ”* tells us of a female pet dog that 
was fond of travelling with her master and mistress, and 
became delighted at the sight of the preparations for travel, 
enjoying all the “ pleasures of hope.” ‘The sight of car- 
riage or railway made her wild with excitement.” Indeed, 
she became “‘so mad with excitement, that we lost all control 
over her”? in a rabbit warren, probably from sudden awaken- 
ing or reawakening of a long dormant or hitherto ungrati- 
fied instinct. On the other hand, she manifested her despair _ 
at the sight of trunks, or other paraphernalia of travel, when 
she knew she was not to be one of the travelling party. 
Here we have a highly excitable, probably highly-bred dog, 
luxuriously brought up, equally liable to elation and depres- 
sion, both in their normal and abnormal degrees or forms. 

In confinement, Indian crows lose all their amusingness to 
man—“ all their cunningand knavery . . . . The only 
faculty” (one of them) ‘exhibited was insatiable hunger, com- 
bined with «mbecility. The other (free) crows seemed to despise 
him, although he flapped his wings imploringly to them; and 
they always helped themselves unresistingly to his food.”+ 

Jesse tells us of black beetles, that “if they are touched by 
the (human) breath, it has such an effect on them that they 
lose all recollection of where they are and what they are 
about, and rush and flounder away in a kind of madness, 
forgetting in their haste and agony their proper retreats, and 
scrambling anywhere, in all directions, until they have 
managed to hide themselves ;”’? and the same author assures 
us that “hees are exasperated by breathing on them.”{ If 

* Of April, 1876, p. 52. 

+ Article on “The Indian Crow,” in “Chambers’s Journal,” for July 22, 
1876, p. 480. 


ft “Scenes and Tales of Country Life,” edition of 1875 (Golden Library 
series), pp. 227 and 301. 


1877. | by W. Lauper Linpsay, M.D. 37 


the fact be as stated, we have yet to seek for its explanation. 
At present we do not know whether it is by virtue of its car- 
bonic acid, or heat, or moisture, or of what other quality, that 
man’s breath so singularly affects certain insects. Nor, in- 
deed, do we know the exact species or genus either of beetle 
or bee that were made the subject of the very simple experi- 
ment described by Jesse, and which can surely be repeated 
without a “ licence ” under the Vivisection Act. There are 
endless genera and species of “‘bees;” and it so happens, 
as if to illustrate the inexactitude even of naturalists, in the 
nomenclature of the animals whose mental qualities they 
describe and discuss in their “ anecdotes,” that the name 
“black beetle” is far from being distinctive. Though it might 
fitly be applied to a great number of our common Coleoptera, 
_ 1t would appear to be popularly used in reference to two very 

different animals—the better known of which is not a beetle 
at all, though an insect. These two insects are— 

1. The common cockroach (Blatta orientalis), belonging to 
the Orthoptera ; and 

2. A beetle, known also as the “‘ Darkling Beetle,” and the 
‘“‘Churchyard Beetle”—Blaps mortisaga—belonging to the 
Coleoptera, a frequent companion of the cockroach in British 
pantries and cellars.* 

In 1875 an elephant, mad with toothache—or said to be so 
—was shot in India, as reported by Mr. R. W. Morgan, Deputy 
Conservator of Nilgherry forests. But the animal was also 
a ‘solitary,’ or “rogue” elephant, a “ wouty” of the 
natives,t one that had been banished from its herd for some 
misdemeanour, under which circumstance the animal usually 
becomes morose, ferocious, and destructive. So that, in this 
particular case, there was probably more than the mere 
furiosity or mania of physical agony. In other cases in 
elephants, however, we know that toothache has sufficed to 
induce mania, just as the mere presence of intestinal worms, 
and the eccentric irritation they produce, do so in the dogt. 

Maudsley describes a male canary as “mad with rage,” at 
the want of offspring, his fury leading to, or followed by, 
fighting to exhaustion.§ We know that barrenness or 
sterility frequently begets more or less profound mental dis- 

* According to ‘‘Chambers’s Encyclopcedia,”’ articles ‘‘Blaps,” ‘ Black 
Beetle,’ and ‘‘ Cockroach.” 

+ “Daily Review,” Sept. 21, 1875. 


{ Vide (1) paper on “ Community of disease,” p. 20; and (2) “ Illustrations 
of Animal Reason,” “ Scottish Naturalist,” 1875, p. 104. 
§ “Genesis of Mind,” 1st paper, p. 492. 


38 The Pathology of Mind in the Lower Animals, [April, 


turbance in female animals. But in such a case as this canary, 
that it was mad, and from want of offspring, requires further 
proof or confirmation ; a remark, however, that applies equally 
to many assertions made as to the fact and cause of madness 
in the lower animals. 

The Ettrick Shepherd speaks of “the central lands of 
Africa, where lions go raving mad for water.”* That they 
do become insane occasionally from thirst is possible, even 
probable. But I have met with no confirmation of the Shep- 
herd’s assertion in the narratives of any modern travellers. 
And, on the other hand, there are other cases in which, as re- 
gards, for instance, delusion or insanity in certain of the lower 
animals, the Shepherd, Christopher North, and De Quincey 
have obviously been drawing on their imagination, in whole 
or In part. 

Thus delusions are ascribed to the young Newfoundland 
dog, ‘“ O’Bronte,”’+ under the influence of opium. De 
Quincey refers to its being “in the dream world,” { as he 
himself so frequently was as the result of his opium-eating. 
But, so far as the dog is concerned, there is here an obvious 
error founded on the false analogy of the occasional effects of 
opium or its derivatives on man. There is no evidence that 
opium, or its salts, even in large doses, affect dogsin the way 
in which they do man. In fact, there is ample evidence to 
the contrary. More than 20 years ago I had myself occasion 
to point out, as the result of experimental inquiry, that large 
doses of opium [in the forms of tincture, to the extent of 
three drachms at a time; or of dry muriate of morphia, to the 
extent of 20 grains] might be administered to dogs without 
appreciable effect. Sometimes vomiting was produced by 
morphia in solution, or there was mere quietude, with or 
without drowsiness. But there was no coma, and no con- 
traction of pupil, in any of my experiments, whereas a single 
grain of strychnia produced immediate and fatal results$ in 
dogs. Nevertheless, the rhapsodical assertions of even poets 
and visionaries on such a subject deserve the notice of the 
comparative psychologist, and may lead him at least to expose 
and destroy popular errors by his investigation of the grounds 
on which poetical fancies have been based. 

* “The Comedy of the Noctes Ambrosiane,” selected and arranged by 


John Skelton, Advocate. Edin., 1876, p. 343. 
+ “Comedy of the Noctes,” p. 370. 


{ JZbid, p. 379. 
§ Vide my paper on the “ Non-susceptibility of the Lower Animals to the in- 
fluence of certain Poisons,” “ Association Medical Journal” for first half-year 


of 1854 (June 9th). 


1877. | by W. Lauper Liypsay, M.D. 39 


Speaking .of certain Mexican ants, Capt. Kennedy, of 
H.M.S. “ Reindeer,” tells us, “ It is said that corrosive subli- 
mate, sprinkled across their path, will drive them mad, when 
they attack and destroy one another.”* I have met with a 
similar statement elsewhere. It is a suggestive one, leading 
to the consideration of the operation of many of man’s drugs 
indirectly on theanimal mind. This department of experimental 
pathology I venture specially to commend to the notice of 
so ingenious and inteiligent an experimentalist as Sir John 
Lubbock. He has told us what have been the results in his 
hands of subjecting ants to the influence of chloroform and 
alcohol, results that only bear out what has been seen in 
many higher as wellasin certain lower animals. But I would 
suggest his extending his experiments by making use of cor- 
rosive sublimate, and other substances that are poisonous to 
man. We know a good deal as to the physical effects of 
such poisons on many animals, thanks to the research of 
modern physiologists and pathologists, especially of the 
German experimental school. But we have as yet much— 


- almost everythinge—to learn of the mental effects of the same 
_ substances in the same animals. 








“Science Gossip’ t describes a lapwing as being “ mad- 


-dened by its nest being discovered,” or by the mere supposition 


or apprehension that it had been discovered, by man or other 
enemies. This is but a common illustration of the frenzy of 
maternal anxiety or alarm—an emotion that is quite as 
poignant in many other animals as in woman. 

““ Chambers’s Journal’’}tells us of the talking 1 sleep of a pet 
starling that pronounced a dog’s name, and so during sleep 
called the dog, while it never did so in the waking state. The 
parrot, too, prattles in its dreams, and there is sometimes in 


' these dreams the same kind of incoherence or inconsecutive- 


ness of speech and idea, apparent or real, as there is occasion- 
ally in senile dementia, or other forms of insanity, in the 
same animal. Such facts suggest the propriety of experiment 
on talking birds as ameans of discovering the mental effects 
of medicinal and other substances. For in them we have the 
additional element of language, and of man’s own language, 


| to assist us in our conclusions. 


It would be easy for me, from the notes accumulated during 
the last five years, to. multiply such dllustrations of animal 


insanity, to an extent that would probably be both wearisome 


* Tn his “ Sporting Adventures in the Pacific,” 1876. 
+ Of November, 1875, p. 262. 
t~ Of September 16, 1876, p. 595. 


40 The Pathology of Mind in the Lower Animals, [| April, 


and perplexing to my readers. It would not be proper and 
prudent, however, to do so without some classification of such 
illustrations, whether practical or scientific. And there are not 
a few groups of such practical importance to man, and so 
numerous and interesting in themselves, that a description of 
them would occupy in each case one or more average-sized 
“articles.” Thus the category of “The forms of insanity 
usually confounded with rabies,” is of sutiicient importance 
and extent to occupy at least one goodly-sized essay; and 
the same may be said, for instance, of “The forms of mania 
producible or produced by man’s ill-usage.” Obviously, 
therefore, the illustration of animal insanity, its forms and 
causes, cannot be further proceeded with here or at present. 
But inasmuch as my present object is to introduce the subject 
of the pathology of mind in the lower animals to stu- 
dents of the pathology of mind in man, with a view to in- 
duce them to betake themselves to a new and extensive field 
of investigation, it seems to me proper here to append a biblio- 
graphy, containing a list of the chief works I have had 
occasion to peruse in my own inquiries, and which works may 
prove equally useful to other inquirers. 


Bibliography. 


[Being a list of works containing descriptions of, or refer- 
ences to, the various forms of madness or insanity—imbe- 
cility or idiocy—in the lower animals. | 

1. “Traite de la Folie des Animaux de ses Rapports avec 

celle. de l’Homme.” 2>vols. 8vo. Paris. 1839: 
By the late Dr. Pierquin, Physician to the Charité 
Hospital, Paris. 

The work was founded on a memoir presented to the 
Paris Royal Academy of Medicine, where its title was re- 
ceived with boisterous merriment (vol. i, preface p. vi.), and to 
the Institute (in 1829). Portions of it were published in 
Majendie’s “Journal de Physiologie” in 1830. It was 
also submitted to the “Société Francaise de Statistique Uni- 
verselle,”” and the “ Société Statistique du Marseille,” where 
it was reported upon, as by the Academies of Paris. Abun- 
dant criticisms appeared also in various German _philoso- 
phical, scientific, or medical journals, in or about 1830. 
The sections of the work, as published in 1839, had the 
advantage of critical revision by Georges and Frédéric 
Cuvier, Paris; Professor Majendie, Paris; Drs. Bottex 


mS77.. | by W. Lacper Lrypsay, M.D. 41 


(Physician to the Lunatic Hospital at Antiquailles), Guislain 
(Ghent), and Esquirol (Paris), the eminent psychologists ; 
Drs. Schnell (Berne), Mathey (Geneva), Hazard, Segalas, 
and others. The book embodies, in foot-notes, the comments 
made by some of these distinguished writers, such as Ma- 
jendie, Bottex, and Schnell. Like all truly scientific natur- 
alists and physicians, Pierquin was characterised by 
cautiousness in the acceptance of facts and in generalisa- 
tion from them. His important work, which is not at all 
known apparently in this country now-a-days, is entitled, 
nevertheless, to rank with the recent productions of Charles 
Darwin, Houzeau, Wallace, and Herbert Spencer. It was 
far in advance of its day. It is by no means confined, as its 
title would seem to imply, to the insanity of the lower 
animals, but contains also a large amount of detail relating 
to mental physiology. Thus, while he has chapters or sec- 
tions on the probabilities of the occurrence of insanity in 
animals, ancient theories regarding animal insanity, the 
etiology of madness in animals; others treat of the history of 
the development of the science of comparative psychology, 
the influence of the maternal imagination, free-will, antipa- 
thies, the moral sentiments, the various expressions of in- 
telligence, and the physical signs of, the passions. His 
volumes contain also numerous anecdotes, from classical 
times downwards, illustrative of the intelligence and instinct 
of the lower animals. 

2. Works by the late Delabere Blaine. 

He was “first an army surgeon, and subsequently the 
greatest veterinarian of this or probably of any other 
nation,” according to George R. Jesse, himself the author of 
the better known “Researches into the History of the 
British Dog.” 

a) “Canine Pathology.” 8vo. London. 1844. 
(6) “Outlines of the Veterinary Art.” 2nd edition. 
1816. 

3. Works on the Dog, Horse, and Sheep, by the late 
William Youatt, President of the Royal College of 
Veterinary Surgeons, London; Veterinary Surgeon 
to the Zoological Society of London and to the Royal 
Society for the Prevention of Cruelty to Animals ; 
Lecturer on Veterinary Medicine at University College, 
London; and Editor of the “ Veterinarian.” 

(a) “The Dog. ” 8vo. Illustrated. 1845. Published 
under the superintendence of the “Society for the 


42 The Pathology of Mind in the Lower Animals, [April, 


Diffusion of Useful Knowledge,” by Chas. Knight 
and Co., London. 

An admirable text-book or student’s manual. 

(b) “* The Horse.”? Hdited by the late Professor Spooner, 
of the Royal Veterinary College, London. 8vo. 
Illustrated. London. 1857. Published as one of 
“The Farmer’s Series,” by the ‘Society for the 
Diffusion of Useful Knowledge.”’ 

(c) “The Sheep.”? 8vo. London. 1856. 

4, “The Dog in Health and Disease.” By J. H. Walsh, 
F.R.C.S., Hiditor of the “ Field;” better known under 
his nom de plume of ** Stonehenge.” 8vo. Illustrated 
with woodcuts. 1st edition, London, 1859 ; last, 1872. 

5. “The Veterinarian: a Monthly Journal of "Veterinary 
Science.” Edited by Professor Simonds, of the Royal 
College of Veterinary Surgeons, London, assisted by 
Professors Brown, Tuson, and Cobbold, all of the 
said College. 8vo. Now in its 49th or 50th volume. 

6. “The Veterinary Journal and Annals of Comparative 
Pathology.” Hdited by George Fleming, author of 
‘‘ Rabies and Hydrophobia,’”’ and other well-known 
veterinary works. 

Begun in July, 1875, and issued monthly. Similar in its 
scope and size to the “‘ Veterinarian,” but more scientific and 
of greater interest, therefore, to the comparative psychologist 
and pathologist. 

7. “The Edinburgh Veterinary Review and Annals of 
Comparative Pathology.” Edited by Professor John 
Gamgee, Principal of the New Veterinary College, 
Hdinburgh, and thereafter of the Albert Veterinary 
College, London. 

Published in Edinburgh in 6 vols. between 1858 and 
1864. 

8. “Fact against Fiction: the Habits and Treatment of 
Animals Practically,’ including observations on 
Hydrophobiaand Distemper. By the Honble. Grantley 
Ff’. Berkeley. 2 vols. 8vo. London. 1874. 

9. “On the Hereditary Transmission of the Effects of 
certain Injuries to the Nervous System” in the lower 
animals. By Dr. C. EH. Brown-Séquard, F.R.S8., of 
Paris, London, and Boston, U.S. ‘“‘ Lancet,” January 
2, AST, pe Fe 

10. “Chambers’s Encyclopedia: a Dictionary of Universal 
Knowledge for the People, illustrated with maps and 


Bo7 75] by W. Lauper Linpsay, M.D. 43 


numerous wood engravings.” Hdited by Andw. 
Findlater, M.A., LL.D. 10 vols. 8vo. 1860-8. 
Article on Rabies, Vol. viii. 

11. “The Ox: its Diseases and their Treatment.’ By 
J. R. Dobson, Veterinary Surgeon. LTlustrated. 
Crown 8vo. London. 1864. 

12. “The Insect World.’ By Louis Figuier, of Paris. 
3rd English edition. By Professor Martin Duncan. 

| (Cassells, London, 1872). 
Abounds in pictorial vlustrations, of which four full-page 
ones are specially interesting, viz.— 

(a) P. 451, that representing the horses of a diligence 
rendered furious by a cloud of cockchafers. 

(6) P. 57, a herd of horses attacked by gadflies. 

(c) P. 60, a herd of cattle attacked by bot-flies ; and 

(d) P. 66, sheep attacked by the breeze-fly. 

18. Works by George Fleming, F.R.G.S., Veterinary 
Surgeon in H.M. Royal Engineers, Chatham, and 
Hditor of the “ Veterinary Journal and Annals of 
Comparative Pathology.” 

(a) “ Rabies and Hydrophobia.”” 8vo. London. 1872. 

(b) “ Animal Plagues: their History, Nature, and Pre- 
vention.” 8vo. London. 1871. 

(c) “‘ Panics among Horses.” ‘“‘ Veterinarian,” October 
and November, 1871. 

(d) <‘ Madness among Dogs.” A lecture at Manchester 
in 1874, reported in the “Animal World” for 
November, 1874. 

14. “ Rabies and Hydrophobia.” By the late Thos. Lindley 
Kemp, M.D., of Edinburgh. “ Edinburgh Medical 
and Surgical Journal,” January, 1855. 

An admirable history of and commentary on both diseases 
—the canine and the human. 

15, “ Antiquarian Scraps relating to Insanity.” By T. W. 
Macdowall, M.D., F.S.A. Scotland (of Morpeth). 
“ Journal of Mental Science,” Oct., 1873. 

16. “Experimentation on Animals for the advance of Prac- 
tical Medicine.”” By B. W. Richardson, M.D., F.R.S., 
in “‘ Nature ” for 1876. 

17. Works by W. Gordon Stables, M.D., R.N., author of 
‘Medical Life in the Navy.” 

(a) “Cats: their Points and Characteristics, with Curi- 
osities of Cat Life and a chapter on Feline Ailments.” 
8vo. London. 1874. 


AA The Pathology of Mind in the Lower Animals. | April, 


(b) “The Domestic Cat: a manual for the use of Cat 
Fanciers. With complete instructions how to keep, 
feed, and treat them when ill.” A volume of Rout- 
ledge’s ‘Books for the Country.” Feap. 8vo. 
London. 1876. 

18. “Sur quelques Recherches expérimentales sur la Rage.’’ 
By Dr. Breschet, in ‘‘ L’Expérience.” Paris. October 
8, 1840. 

19. “The Cat: its History and Diseases.” By the Honble. 
Mrs. Cust. 1870. 

20. “The Darker Superstitions of Scotland.” By the late 
Sir John Graham Dalyell. 

Contains instances of insanity in the lower animals 
ascribed to witchcraft and demomacal possession. 

21. “ Veterinary Medicines: their Actions and Uses.” By 
Finlay Dun, formerly lecturer on Materia Medica and 
Dietetics, in the Edinburgh (or Dick) Veterinary 
College, and now of Weston Park, Shipstown, Stour. 
Ath edition. Edinburgh. 1874. 

Gives an index of the diseases to which the domestic 
animals are subject. 

22. “ Dogs and their Management.”” By Edward Mayhew, 
M.R.C.V.S.. 12mo. London. 1869. (1st edition, 
1860; 2nd, 1864). 

23. “ Sheep: their History, Structure, Economy, and 
Diseases.”? By the late Professor (W. C.) Spooner, of 
the Royal College of Veterinary Surgeons, London. 
Illustrated new edition. 1874. 

24, “Mental Neurology.” By Hlias Weith, Veterinary 
Surgeon of Vienna; mentioned by Pierquin. 

25. * Trials of Animal Maenetism on the Brute Creation.” 
By J. Wilson. 8vo. 1889. 

26, “'The Surgeon’s Vade Mecum.” By Dr. Druitt. 5th 
edition. London. 1851. Chapter on hydrophobia, 
which includes rabies. 








1877.) A 


The Alleged Increase of Insanity. By Henry Mavpsry, M.D. 


Six years ago I endeavoured to show, in a paper read 
before a quarterly meeting of the Medico-Psychological 
Association,* that there were not sufficient reasons to 
warrant the popular opinion, shared by some who had done 
more than accept a common notion without inquiry, that 
insanity was steadily increasing upon us year by year in this 
country; that, in fact, the undoubted great and rapid increase 
in the registered insane population of England was in the main 
to be attributed to other causes than an actual steady increase 
in the production of insanity. As the result of the enquiries, it 
seemed very uncertain whether we manufactured more mad- 
ness now than formerly, but very certain that we take more 
care of, and know a great deal more about, the “madness which 
we do manufacture. The conclusions reached were these :— 
1. There is no satisfactory evidence of an increase in the 
proportion of occurring cases of insanity to the population, 
and no satisfactory evidence, therefore, of an increased 
liability to insanity. 

2. It was not necessary to assume the reality of such an 
increase in order to account for the undoubted great increase 
in the number of registered insane persons. 

3. The difference between one insane person in 802 of the 
population in 1844 and one in 400 of the population in 1870 
is mainly, if not entirely, owing to the fact that in the former 
year the official returns included only about half the actual 
insane persons in the country, while in the latter year, regis- 
tration having been made gradually more complete, the 
official returns included a great many more of them. 

4. Some part of the difference was owing probably to the 
fact that certain patients were registered as lunatics then 
who would not have been thought, and certainly would not 
have been classed as lunatics a quarter of a century before. 

5. A lower rate of mortality, and a lower percentage of 
recoveries on the admissions, might account for a part of the 
increase in the total amount of the registered insanity. 

6. The proportion of admissions to the population, which 
represents approximatively the occurring cases of insanity, 
did not, when the necessary allowances were made for dis- 
turbing causes, yield evidence of any serious increase. 

* Published in the “ British Medical Journal,” January 13th, 1871. See also 


“The Alleged Increase of Lunacy”’ by Dr, L. Robertson, “ Journ, Ment. Sci,” 
1870. 


AG The Alleged Increase of Insanity, [A pril, 


Five years having passed since these conclusions were 
formulated, it becomes interesting to apply the same line of 
examination to their records, and to enquire whether the 
results tend to support or to subvert them. At the outset 
the large and steady increase which has gone on in the total 
number of registered insane persons is startling enough. In 
1844, when the returns were confessedly so incomplete as not 
to warrant safely any deductions, the number was 20,611; in 
1859 it was 86,762; in 1865 it was 45,950; in 1870 it had 
risen to 54,713; and on the Ist January, 1876, it was 64,916. 
Or, to put the matter in a hardly less striking form, the pro- 
portion of total lunatics, including idiots, to the population 
was—in 1859, 18°67 to 10,000 persons ; in 1865 it was 21°78; 
in 1870 it was 24°31; and on the 1st January, 1876, it was 
26°78. Broadly speaking, then, we may say that there is 
now one insane person to 375 of the population, while in 
1859 the proportion was about one in 540 of the population 
—unquestionably a sufficiently rapid, if not an alarming, 
increase for a quarter of a century; for it is clear that if it 
goes on with the same ruthless speed for the next half century 
matters will look very formidable. In fact, those who would 
explain the increase by a greater liability of the population 
to go mad run no small risk of proving a great deal too 
much ; for if the alleged increased lability is to continue in 
action in the same ratio in the years to come as they assume 
it to have done in the past twenty-five years, it is quite 
evident that the population of the country must be so widely 
infected that the sane people will be in a minority at no very 
distant day. | 

When we look more carefully into the matter, however, we 
find cogent reasons to conclude that much, at any rate, of the 
very great increase in the number of insane persons is owing 
to the successive Governmental regulations which have been 
made and enforced for the better supervision and care of the 
insane. Each new Act of Parliament concerning them has 
been an instant and effective means of swelling their num- 
bers. The effect of the Lunacy Act of 1845, which enjoined 
on counties to build asylums in order to make suitable pro- 
vision for their insane poor, was at once to increase largely the 
number of those who were registered as lunatics. Before 
that Act, they had in most counties been kept at home, or 
farmed out by their relatives, or taken care of in some other 
way of which there was no official knowledge. When the 
asylums were built, they were sent there; the result being not 
only to bring them thus upon the register, so that they were 


1877.] by Henry Mavpsiey, M.D. 47 


known, but in most cases probably under better care, so that 
their lives were prolonged. There can hardly be a doubt that 
the insane poor live longer now in well-conducted asylums, 
where they are well fed, well clothed, and well housed, than 
they did in their former neglected state, when they were ill- 
fed, badly clothed, and miserably housed. If we take one 
only of the conditions of proper care—namely, a liberal diet 
—we find that it exercises a great effect upon the average 
mortality of an asylum. In the late Dr. Thurnam’s work on 
the “Statistics of Insanity” there is an instructive com- 
parison between the mortality of three asylums in which the 
diet was liberal and that of four asylums in which it was 
poor and insufficient. In the former the mean annual 
mortality was 9°35 per cent., while in the latter it was as 
much as 14°54 per cent. The contrasted experience of the 
once notorious York Asylum, before and after it was reformed, 
yields a more striking illustration of the influence of proper 
care and treatment of patients upon their mortality ; for the 
mean annual mortality for six years before 1814—which was 
the year in which the great abuses of its management were 
exposed—was 14°8 per cent., while it did not exceed 7:24 
per cent. for a quarter of a century after the reform. We are 
warranted, then, in the conclusion that, to some extent, the 
numbers of the insane have risen because they have not been 
kept down so much by death as was the case formerly. 

There was another Lunacy Act which, passed in 1853, had 
the effect of increasing the number of registered lunatics. It 
was an Act which prescribed a quarterly return of the pauper 
lunatics not in asylums by the medical officers of the unions. 
While very few of those who were residing with their relatives 
and with others had been returned before the Act came into 
operation, there was a considerable increase afterwards; the 
number in 1871 being 7,331. On the lst January last it was 
less, being only 6,526. There is no reason whatever to believe 
that the increase was owing to the fact that more pauper 
patients were residing in private houses in 1871, or are so 
residing now, than was the case twenty years ago; on the 
contrary, we are perfectly sure that fewer pauper patients are 
placed under private care now than then, the whole tendency 
of recent legislation having been to force them into asylums. 
The increase was due to the more complete system of regis- 
tration which was enforced by the Lunacy Act of 1853. It 
will be seen, by and by, that the effect of recent legislation 
has been to remove any motive for retaining pauper patients 
in private houses, and to furnish strong motives for sending 


48 The Alleged Increase of Insanity, [ April, 


them to the workhouse or to the asylum. We need not 
wonder, then, that the numbers in private houses have 
diminished somewhat since 1871, but may justly expect that 
they will diminish still more. Whether they are in the 
asylum or out of it, however, matters not to our present 
purpose; so long as they are registered, they will go to swell 
the increase which is to be attributed to the Act of 1853. 

Although the registered number of private insane patients 
living with their friends or others is not large—being only 439 
on the Ist January last—the registration of that number is due 
to the enforcement from time to time of the statutory pro- 
visions of the Lunacy Acts by the Lunacy Commissioners. 
Years ago few or no returns of these cases were ever made, 
and it has required many prosecutions of those who have 
received single patients without complying with the proper 
legal forms to diffuse the imperfect knowledge which yet 
exists of the illegality of receiving an insane patient for 
profit without the proper order and two medical certificates. 
The Commissioners take credit, in their Annual Report, for 
the zeal with which they hunt out these cases ; and the insti- 
tution of a criminal prosecution in a ‘ sensational” case 
from time to time serves to foster public appreciation of their 
activity and usefulness. 

If we look at the numbers of the admissions of patients 
of all sorts during a series of years, we shall have better 
evidence of the number of occurring cases of insanity than 
we get from looking at the total number under care. The 
following table records the admissions from 1859 to 1875 * :— 

































































| 1859. 1860. 1861. 1862. 1868. 1864. 1865. 
County and Boro’ md tai <a 
Asylums ...... 6228 6629 6268 6145 6212 6570 7468 
In Registered 
Hospitals, Li- 
censed Houses, 
and under Pri- 
vate Care ...... 3082 2883 3061 2983 2603 2675 2841 - 
TOGA scccucssses 9310 9512 9329 $078 8815 9245 10309 
1866. | 1867. | 1868. | 1869. ; 1870. | 1871. | 1872. | 1873. | 1874. | 1875 
County and Boro’ 
Asylums ...... 6889 | 7406 |} 7870 | 8115 | 8587 | 9792 | 8837] 9426] 9698 |11020 
Registered Hos- 
pitals, &, ...... 3119 |} 3150 | 38158 | 8047 | 3002 | 2703 | 3269 | 3292 | 3534 | 3255 
otal erences 10008 ' 10556 11023 | 11162 | 11589 © 12495 | 12106 ' 12718 | 13227 |14275 








* The admissions into Broadmoor Criminal Lunatic Asylum not being counted. 


a 


Bere.) by Huanry Mavunpstzy, M.D. 49 


During the first six years the admissions of pauper patients 
did not vary much, the variations certainly not being such as 
to indicate a steady increase in the rate of the production of 
insanity ; an inference which will appear the more conclusive 
when it is remembered that in those six years the total popu- 
lation of the country had risen steadily from 19,686,701 to 
20,883,889. Notwithstanding the increase in population, the 
admissions in 1864 were less than in 1860; in 1863 less than 
1859; and least of all in 1862. In 1865, however, the number 
mounted up suddenly and considerably from 6,570 to 7,468. 
What extraordinary cause can we discover for so abrupt and 
exceptional an increase other than an extraordinary outbreak 
of madness in the population ? In 1862 an Act of Parliament 
was passed which rendered pauper lunatics chargeable upon 
the common fund of the union of parishes instead of, as had 
formerly been the case, upon the particular parishes to which 
they belonged. It was natural that the parishes, so soon as 
they realised the meaning of the Act, should lose all desire 
to spare themselves expense by taking care of their harmless 
lunatics, imbeciles, and idiots at home, and should be eager 
to throw the burden of them upon the common fund. Other 
parishes would not spare the fund if they did, they would 
argue. ‘The economical motive for keeping the patients out of 
asylums was gone; and the consequence was that numbers of 
them were sent to asylums. No sooner was a poor person’s 
mind affected so as to prevent him from following his work 
and to throw him upon the rates, than it became an object 
to get rid of him, in order to save the trouble and share the 
expense of his maintenance, or from a vague apprehension of 
the responsibility incurred by his detention out of an asylum. 
‘The reports of the Medical Superintendents of County 
Asylums soon began to express dissatisfaction that their 
wards were filled with chronic and incurable cases, which 
might well be taken care of elsewhere, to the exclusion of 
acute and curable cases which specially needed the appliances 
of the asylum. Dr. Thurnam, alluding in one of his reports 
to the supposed increase of insanity, said :—< Part of this 
increase must be referred to the facilities afforded by recent 
legislation to the admission of patients, many of whom are 
sent labouring under slight and transient forms of mental 
disorder, such as in former days would never have been 
‘removed from their homes. Some are brought who ought 
to be cared for elsewhere—in workhouses, or even in prisons. 
| Not a few superannuated and paralytic old people, when they 
XXIII. 4 





50 The Alleged Increase of Insanity, [April, 


become troublesome in the wards of their workhouse, are 
at once removed to the asylum. In other instances, men are 
brought who should be regarded as offenders against the laws 
and punished accordingly. It is an abuse of an asylum to 
send to it a man who, maddened by drink, assaults his wife 
or child, or commits some other vagary or act of violence.” 
The repetition of complaints of this kind on all sides led to the 
proposal, which has been carried out In some instances, to 
establish less expensive buildings, intermediate between the 
workhouse and the asylum, for the care and treatment of 
harmless lunatics and imbeciles. Of the effect of the Act to 
increase largely the admissions there can, therefore, be no 
manner of doubt. Nor can we reasonably suppose that its 
effect was exhausted by the large increase which it produced 
in 1865; it began to take effect then, and has continued to 
affect, in less degree, no doubt, the number and character of 
the pauper admissions since. It will account, probably, for 
much of the gradual increase from 1865 to 1874, which, when 
we allow for the increase of the population, is hardly of a cha- 
racter to warrant the supposition of an increased liability to 
insanity; for while the ratio of pauper admissions to the 
entire population in 1865 was as 1 to 2,531, it was in 1872 
as 1 to 2,610—certainly not a very serious increase. 

As showing the character of the pauper admissions in the 
year 1865, when there was the abrupt increase, I may point 
to the fact that the percentage of recoveries to the admissions 
that year was evidently below the average, being in County 
and Borough Asylums 33°88, against an average of 35°61 for 
the years 1859-1875. Parish and workhouse officers willingly 
saw lunacy in forms of imbecility and illness in which they 
would never have dreamt at one time of doing so; and their 
one idea, once they had made the discovery, was to get rid of 
the responsibility attaching to the care and treatment of the 
patient, by sending him to the asylum. 

Looking back to the table of admissions, it will be seen 
that the number made a more than usual rise in 1875, having 
previously made an extraordinary rise in 1871. The expla- 
nation of the increase in 1871 is to be found, probably, in the 
opening of the Metropolitan asylums for imbeciles at Leaves- 


den and Caterham ; for the removal tothem of many chronic — 


patients from the county asylums made room in the latter 
for the reception of a number of pauper patients who had 
been previously resident in licensed houses as private patients 
paid for by their unions. The consequence was an 


5 5 


1877.] by Hunry Mavpstry, M.D. 51 


extraordinary increase in the number of admissions into 
county asylums for that year, and a diminution of the 
patients in some licensed houses. There is some reason, 
too, to think that the opening of the Metropolitan asylums 
specially for imbeciles led to the removal from workhouses of 
many who had not previously been discovered to be lunatics ; 
but as this cause would not directly affect the number of 
admissions into county and borough asylums, it is of interest 
to us here only as an indication of the growing habit of mind 
to widen the area of certifiable insanity. 

What was the cause of the extraordinary increase of 
pauper admissions in 1875? An Act of Parliament passed 
by a Conservative Government in 1874, in order to redeem 
the pledges to relieve local rates which its supporters had 
made when touting for votes at the general election. By 
that Act it was enacted that 4s. a week of the cost of 
maintenance of every pauper lunatic in an asylum should 
be defrayed by the State. The effect has been to empty the 
workhouses of all the cases which it was possible, by any 
device, to send to the asylum, and to remove the last vestige 
of desire which there might be to retain a pauper patient 
under any sort of care outside an asylum. The Government 
has, in fact, said to parish officials—“ We will pay you a 
premium of 4s. a head on every pauper whom you can by 
hook or crook make out to be a lunatic and send into the 
asylum.” And just as in olden times a reward of so much 
for each wolf’s head led to the rapid extinction of wolves in’ 
England, so we may expect that this premium on lunacy will 
tend to diminish materially, and, perhaps, to render gradually 
extinct, the race of sane paupers in England. Not only are 
unfit cases sent to the asylums, but chronic and harmless 
patients, who might very properly be provided for in work- 
houses, are detained in asylums because Boards of Guardians 
will not take them back once they have got rid of them. 
Why should they when they would lose the 4s. a head and 
still have to take care of them? ‘The Act was an ill-con- 
ceived measure which no true statesman would have proposed, 
for it gave the local authorities power of spending money 
granted by the State without the State having any control 
over the manner in which it was spent. It was a bribe to 
the constituencies, and its operation, as might have been 
expected from its origin, has been disastrous. The admis- 
sions of pauper patients will probably continue to increase in 
consequence of its operation. 





o2 The Alleged Increase of Insanity, [April, 


In confirmation of what has been said concerning the 
admissions of 1875, I may point, as I did with respect to 
1865, to the smaller proportion of recoveries. In county and 
borough asylums the recoveries were in the proportion of 
34°11 per cent. of the admissions, which is nearly 4 per cent. 
lower than those of 1874, and 1:5 per cent. below the average 
of the last 17 years. This smaller ratio of recoveries was 
no doubt due to the larger proportion of chronic cases 
included among the admissions, and may be represented as 
the measure of the success of the Act of 1874 in transform- 
ing aged and broken-down paupers into lunatics. 

If we now look to the admissions of private patients, we 
shall not find any trustworthy evidence in favour of the 
opinion that, so far as regards them, insanity has undergone 
an increase out of proportion to the increase in the popula- 
tion. There have been variations, but these variations have 
_ been fluctuations, not steady augmentations. In 1859 the 
admissions were 3,082, and they did not, notwithstanding | 
the yearly increase in the population, reach that height 
again for seven years, when, in 1866, they were 3,119; and 
if we calculate the ratio to the population, we shall find that 
in 1859 it was 1 in 6,190, and in 1866 actually less, being L 
in 6,864. In 1875 this ratio was less still, being 1 in 7,356. 
In fact, in the year of the greatest number of admissions 
since 1859—that is, in 1874, when they were as high as 3,534 
—the ratio to the population did not reach that of 1859, 
being 1 in 6,691. Certainly these figures do not point to an 
increased production of insanity in the non-pauper class; if — 
they prove anything, it is rather an actual decrease. And 
they will appear more striking when it is remembered that 
the more numerous and powerful causes of insanity which are 
supposed to be at work in these latter days would presumably 
operate upon the class from which private patients come to 
at least as great an extent as upon the pauper class. No 
doubt insanity is sometimes a pauperising disease, and many 
persons who, while in health of mind, would be above the 
rank of paupers, are compelled, when struck with insanity, 
to fall into that rank; but that is a consideration which need 
not greatly affect our conclusion, seeing that it is a cause of 
increase of pauper insanity which has always been at work. 

Unless there lies hidden some fallacy in the foregoing 
general and somewhat hurried considerations, it would seem 
fair to conclude—first, that there is no evidence of an in- 
creased production of insanity amongst the non-pauper class; 
and, secondly, that the undoubted increase of the admissions 


1877.] 7 by Henry Mavupstzy, M.D. 53 


into pauper asylums is to be attributed mainly to the succes- 
sive statutory regulations by which persons have been 
steadily forced into asylums. At any rate,it would seem right 
that those writers who speculate upon the reasons why so 
many more persons go mad now-a-days than in the days of 
our grandfathers, and who grow melancholy over the sup- 
posed decadence of the race, should take more pains than 
they do to establish the fact before theorising concerning 
its causes; for at present they are very much like the learned 
philosophers who, when Charles II. propounded to them the 
solution of the problem why a vessel full of water weighed 
no heavier when a fish was put into it than it did before, 
set out various ingenious explanatory reasons without ever 
thinking of trying the experiment. In the before-mentioned 
paper, which I read in 1871, I ventured “‘a prophecy that, 
twelve years hence, the ratio of admissions to the popula- 
tion will not be greater, if it be not less, than it is now.” 
The prophecy seems to be in a fair way of satisfactory fulfil- 
ment as regards private patients, but it does not seem at all 
likely to be fulfilled in regard of pauper patients. The 
danger of prophecy, even when based upon tolerably definite 
data, is that one cannot exclude intervening causes of dis- 
turbance which cannot be calculated upon. How was it 
possible to foresee in 1871 that a Conservative Government 
-would come into power and forthwith put a direct premium 
on the manufacture of lunacy? It was impossible. The 
great educator and guide of the Conservative party, speaking 
_ from his long and intimate experience, himself on one occa- 
sion enunciated solemnly the dictum that it was impossible 
to foresee and baffle “the unconscious machinations of 
stupidity.” It was a plagiarism, but only too true—Mit 
Dumunheit kampfen die Gotter selbst vergebens. 

If we were asked whether we cure more insane persons 
now-a-days, when we treat them well, than our uninstructed | 
forefathers cured when they treated them ill, we should be 
disposed to declare offhand that we certainly do. And yet 
there is no evidence that we do. In Dr. Thurnam’s valuable 
| work on the “ Statistics of Insanity,” which was published 
in 1845, just after the non-restraint system of treatment and 
| other reforms had been introduced into asylums, and which 
| deals, therefore, with their statistics under the old dispensa- 
| tion of mismanagement, it is stated that, as regards asylums 
_ that have been established during any considerable period— 
| say twenty years—a proportion of much less than 40 per 
| cent. of the admissions is, under ordinary circumstances, to 





54, The Alleged Increase of Insanity. (April, 


be regarded as a low proportion, and one much exceeding 45 
per cent.as a high proportion. Now, the average percentage 
of recoveries of all sorts of insane patients for the last 17 
years was 34°03, and in county and borough asylums 35°61; 
so that when our results are measured by Dr. Thurnam’s 
standard, they yield nothing to boast of. It would be wrong, 
however, to attribute the lower percentage of recoveries to 
the ill-success of our present mode of dealing with insanity ; 
it is no doubt owing in great part, if not entirely, to the 
greater proportion of chronic and incurable cases among those 
who have been admitted during the last twenty-five years. 
Formerly acute and violent cases only were sent to asylums, 
and they would yield a larger percentage of recoveries, as 
well, probably, as a larger percentage of deaths. Of the 
admissions, fewer recover and fewer die each year now than 
then; the result being the steady accumulation of a residue 
of chronic and incurable insanity beyond what occurred 
then. It is a question, however, deserving attention whether 
the present practice of crowding the insane of all sorts into 
large asylums, where the interests of life are extinguished, 
and where anything like individual treatment is well-nigh 
impracticable, is so much superior to the old system in 
effecting recoveries as some persons imagine. 


Note on the Comparative Mortality of different Classes of 
Patients in Asylums, By T. A. CHapman, M.D., Medical 
Superintendent of the Hereford County and City 
Asylum. 


I.—It is well known that the very different death-rates 
obtaining in different asylums depend much more on the 
different classes of patients they contain, than on any differ- 
ences in the hygiene, or other conditions of the asylums 
themselves. Very little has, however, been done to obtain 


any accurate measure of the mortality rates that obtain — 


amongst different classes of patients. The statistical tables 
of this association, which have now been used in the annual 
reports of asylums for a dozen years, contain much material 
that may be used for elucidating the matter. It is somewhat 
surprising that the valuable statistics contained in these 
tables have not been made use of to any extent either for this 
or any other purpose; the impediment, probably, is the con- 
siderable labour involved in any extensive analysis of their 
numerous data. 





1877. | The Mortality of Patients in Asylums. 55 


A number of years ago it occurred to me to obtain from 
them a measure of the rates of mortality obtaining among 
the newer and older asylum residents ; and below, in Table L., 
I give the result I then obtained. I have often since 
expected to find the matter somewhere comprehensively 
dealt with, but as this has not occurred, I have made a similar 
abstract from more recent materials, and append the results. 


TABLE I. 


Showing the Death-rates per cent. among patients of different 
periods of Asylum residence, based on 70 Asylum-years, 
during the years 1865-1869 inclusive. 





Mortality per cent. 


Average No. Resident. Deaths, on Average 
Duration of Number Resident. 
Residence. 

M. F, Total. | M. F, | Total.) M. F. | Total. 














Underlyear | 3488 3045 7033 | 1008 | 675 | 1683 } 28°89 | 19°04 | 23°93 
1 to 2 years | 1955 2136 4091 301 | 191 | 492 15°39 | 8°94 | 12°02 
2to 3 years | 1454 1759 8213 191 | 145 | 386 71818 | 8:25 | 10°45 


3to 5 years | 2254° | 2598 4852 188 | 185] 373] 834] 7:12, 7°69 





S&tol0years| 3477 4475 7952 209 | 244) 453] 6°01 | 5°45) 5°67 


Over 10years} 3694 4864: 8558 186} 286] 422 — 5°03) 485) 4:93 











Totals ...| 16322 | 19377 | 35699 | 2083 | 1676 | 3759 | 12°76 | 865 10°47 





It is necessary, in the first place, to explain how I obtain 
the figures used. In Table VI. of the association tables the 
deaths are arranged according to the duration of residence in 
each case, and if we can obtain an average number resident 
corresponding to each of the durations given in this table, 
we have the materials for calculating the mortality amongst 
patients of those periods of residence. The last column of 
Table IV. of the association tables gives this with sufficient 
| accuracy for the present purpose. An average number resi- 

dent should be obtained by an average of numerous periodical 


56 The Mortality of Patients mm Asylums, [ April, 


censuses, and these figures being the result of only an annual 
census would probably be misleading, were they used in the 
case of any individual asylum, as a true average number resi- 
dent; but by taking the sum of these figures for a large 
number of asylums this inaccuracy is largely, and for the pre- 
sent purpose sufficiently eliminated, just as for any one 
asylum they are eliminated by a sufficiently frequent census. 
They remain, however, affected by one error, which must be 
borne in mind in accepting the following figures. The 
variations in these numbers that may take one direction in one 
instance, and another in another, by mere chance, are elimi- 
nated by taking a sufficient number of instances, but a varia- 
tion which affects most of these numbers in the same direc- 
tion will remain. Such a deviation exists in the fact that the 
number of patients in most asylums is increasing, and that 
the census used being made at the end of the year, is larger 
than the true average number resident. The figures obtained 
are, therefore, somewhat greater than the real average 
number resident, by the extent of about half the average 
annual increase. ‘The annual increase occurring in the num- 
ber of patients in asylums is about 1°6 per cent. The error, 
therefore, is about 8 percent. As this increase has been 
going on with tolerable regularity for a number of years, it 
will affect.the numbers at the different periods of residence 
about equally, so that for purposes of comparison amongst 
themselves the rates of mortality deduced from them may 
be taken as accurate, though absolutely they will be some- 
what lower than the true percentages. To obtain an 
exact measure of the extent to which they are so, I have 
for the year 1874 placed for comparison the mortality 
percentage on the figures used, i.e. on the numbers resi- 
dent at the end of the year, against the mortality calculated 
on the true average number resident for the year of the 25 
asylums whose statistics for that year I have used. ‘The 
difference is barely over a hundredth part, and may be safely 
neglected. 

Table I. gives the results I obtained six yearsago. Tables 
II., III., and IV. give those obtained for the last four 
years. I have used in these latter the reports of all English 
county and borough asylums, excepting one or two, which I 
had not got, a number that do not give the association 
tables, or do not give them in their entirety, and some others 
whose statistics were not of sufficient duration for the pur- 
pose. 

The close agreement in the results for the several years 


~~ 








1877.] by T. A. Cuapman, M.D. 57 


with each other, and witk the results calculated in the 
totals for the four years, shows that sufficient numbers are 
used to eliminate most sources of error due to individual 
deviations. The absolute agreement in the percentage for 
both sexes taken together, during the first year of residence 
for the three years, 1873, 1874, 1875, is very remarkable. For 
the year 1872 the asylums, whose statistics are used, appear 
to have had a very low mortality. The higher mortality of 
the year 1875 appears to have especially affected patients of 
from seven to ten years’ residence. In 1873 the male mortality 
of one to two years’ residents is large, but with these excep- 
tions any general deductions might almost equally be drawn 
from the results of either of the years or from the total. 

It is hardly necessary to state any of these deductions, as 
they are sufficiently obvious on an inspection of the tables. 
The most obvious is the very high rates in the earlier years of 
residence, amounting during the first year to nearly one-third 
of the average number resident in the case of males, and to: 
over one-sixth of that number among the females. These 
rates rapidly diminish, being about half this during the 
second year of residence, until at the end of five years the 
sources of excessive mortality appear to be nearly exhausted. 
The lowest mortality is not, however, reached until the end 
of seven years, when the rate is about half that obtaining 
amongst the total asylum population. After ten years there 
is a very slight but distinct increase of the rate, which would 
be more obvious, but for what appears to be the somewhat 
exceptionally high rate of mortality among female patients 
of from seven to ten years’ residence during the year 1875. 
The difference ofthe rates of male and female patients obtains 
almost throughout, the male mortality exceeding the female 
during the first year, nearly as 2 to 1; during the second as 
3 to 2; the difference diminishing until as the period of least 
mortality approaches, viz.,from five to seven years, the female 
mortality is slightly in excess. ‘This result is shown in the 
figures of three of the years, as well as in the total, and is 
probably, therefore, a rule, and not a mere statistical acci- 
dent. In the following years the male mortality is again in 
excess, in the ratio of about six to five. 

The total mortalities for the several years are so closely 
proportional to the mortalities for all county and borough 
asylums, as given in the Reports of the Commissioners in 
Lunacy, that it would appear that the selection of asylums 
made has happened to be fairly representative of all. 


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1877.] The Mortality of Patrents in Asylums. 61 


Il.—A further means of throwing a little light on this 
subject might, it occurred to me, be found in a statistical 
table, which I have been in the habit of framing each year, 
to show the general mental state of the patients in the Here- 
ford Asylum. This table is in the form annexed, but I have 
placed in it for the sake of larger numbersthe sums of the 
figures for the past four years. 

Each class in this table forms a well-defined natural group, 
capable, no doubt, of further sub-division, but clearly marked 
off from the others, except the two last groups. ‘These are, 
really, one group, rather arbitrarily divided into two, accord- 
ing to the line separating chronic mania from dementia, a 
line which hardly exists, as the majority of cases might 
easily be placed under either head. These groups might, 
perhaps, have been advantageously divided otherwise, but for 
the present purpose we must use them as we have them, and 
ought, perhaps, to take them as one group. They include, 
in fact, all cases in the Asylum, except those separated under 
the previous headings; they include many cases that have 
not been long in the Asylum, many aged and many feeble, 
and their mental conditions are much more various than a 
division into chronic mania and dementia only implies. 

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year, and a list of the patients in each group preserved, it 
occurred to me that the death-rate in each group during the 
following year would be of interest. In order, so far as my 
small numbers will permit, to eliminate the variations . due 
to particular years, I have added together the figures for the 
four years, and added in the third column the percentages 
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the Ist of January ; nonotice being taken of the admissions 
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during the year. This I have made and placed in the fourth 
column of the table. The diminution in the case of con- 
genital cases without epilepsy, and in those of chronic in- 
sanity, is so small that hardly any correction is necessary. 
But in the case of the probably curable and of the general 


The Mortality of Patients in Asylums, [April, 


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1877. ] by T, A. Cuapman, M.D. 63 


paralytics, the reduction amounts during the year to 50 per 
cent., in the former chiefly by recoveries, on the latter by 
deaths, so that the average number resident of these is not 
more than 70 per cent. of the number resident on Januarv Ist. 

The average mortality of all patients in the Asylum is 
added for comparison; this includes the admissions of the 
year with their higher rate. 

A comparison of the figures with those classed according to 
the duration of residence leads to the conclusion that the 
high mortality during the earlier years of residence is espe- 
cially due to the presence among them of general paralysis 
and other fatal forms of brain disease. LEpileptics also 
appear to have a high death-rate, and as these are not elimi- 
nated during the first few years of their residence, there can 
be no doubt that the mortality of the older residents, apart 
from the epuepuics, would be much less than is shown in 
Table IV. 

The low rate ae mortality among all classes of cases, 
except paralytics and epileptics (excepting also the admis- 
sions of the year, but including those that remain of the 
previous year’s admissions) is worth attention. There are 
included in the numbers on which this is calculated all aged 
people, and all sick and feeble, provided they be not epileptic 
or paralytic (these two classes do not include many aged, 
whereas the whole number resident includes 22 per cent. aged 
over 60). Asone practical application of these figures, I 
remember a great point in favour of boarding out patients 
with cottagers was that their mortality there was about 5 per 
cent., against double that figure in asylums. Now, 5 per 
cent., with not only epileptics and paralytics excluded, but 
also the aged and feeble, will not compare favourably with 
4-7 per cent., including the aged, feeble,and a fair proportion 
of recent cases. 

It is also worth noting that the mortality of congenital 
imbeciles, free from epilepsy, and including many miserable 
idiots, is not very far from that of the general population. 

It might, perhaps, be argued from the figures that chronic 
mania is less fatal than dementia; that patients rust away 
more often than they wear out; and whilst this may be so, 
“since many patients are never better in health than when 
suffering from a certain amount of subacute excitement, I 
think the true explanation of the figures above is that the 
more aged patients tend to be classed as dementia, the 
younger as chronic mania. There are various other deduc- 


64 The Mortality of Patients in Asylums. (Apri, 


tions that might be drawn, but the numbers are much too 
small for much confidence to be placed in them. Among 
such deductions are such as that acquired is more fatal than 
congenital epilepsy, and that epilepsy is more fatal among 
males than females. 

These figures are sufficient to give some definiteness to the 
statement that the mortality of different asylums must 
depend so much more on the classes of patients it contains, 
than on its hygienic condition, or on the success of the thera- 
peutic measures employed in it, that the rate of mortality 
taken alone may really be said to throw no ight whatever on 
these questions. 





Two Cases of Homicide in Asylums. By D. YELLOWLEES, 
M.D., F.F.P.8.G., Physician Superintendent, Glasgow 
Royal Asylum. 


The good order, quietness, and contentment of a modern 
asylum for the insane are apt to appear to outsiders mere 
matters of course. Ahke at employment, exercise, and 
recreation, the patients behave so well that it seems as if 
they could never do otherwise, and the occurrence of any 
casualty among them is apt to excite surprise and dissatis- 
faction, as if it could only have resulted from mismanage- 
ment or carelessness. 

No asylum officer can entertain such a delusion. He knows 
too well how many elements of danger exist latent under the 
pacific surface, and how suddenly and causelessly they may 
explode in dangerous and reckless violence. Such maniacal 
outbursts can in many cases be neither anticipated nor pre- 
vented, and they have found victims alike among patients, 
attendants, doctors, and commissioners. 

The two following cases of homicide have occurred in 
patients under my care :— 


T. G., age 80, single, employed in tinworks, was admitted to the 
Glamorgan County Asylum, November 20th, 1868. This was the 
first attack ; it had lasted about four months, and the assigned cause 
was a blow on the head with a glass, which he had received in a 
brawl. There was no known hereditary predisposition. His habits 
had latterly been intemperate. He had been dangerous to others, but 
neither epileptic nor suicidal. 

Alteration of appearance and character, refusal to work, wandering 
about unfrequented places, assaulting his father without cause or 


1877.] Two Cases of Homicide in Asylums. 65 


warning, and threatening to split open his sister’s head, were the 
alleged indications of insanity. 

At first he was quiet, reserved, and slightly demented ; would not 
associate with the other patients, nor join in conversation or amuse- 
ments ; but was obedient and orderly in his behaviour, and assisted 
willingly in the work of the ward. 

About six months later these good effects of asylum life had in 

great measure disappeared. He had become obstinate and peculiar, 
refused to speak to his relatives when they visited him, disliked work 
of any kind, and was addicted to masturbation. 
im In 1870, when at work in the garden, he made a sudden and un- 
provoked attack on the gardener with his hoe, and became gradually 
more variable, irritable, and uncertain in his conduct, although 
generally quiet, retiring, and orderly if not interfered with. 

In 1871 there was little change. 

In 1872 he became more uncertain and dangerous, and several 
times assaulted the attendants, blazing up quite suddenly, or without 
any but the most trivial excuse, into fierce and dangerous violence. 
| He continued as reserved as ever, speaking very little, save perhaps 
}mumbling to himself, avoiding observation, and fond of getting into 
closets or out-of-the-way places, but was still useful in the ward, 
| assisting his own attendant readily, and doing his allotted work very 
i well. 

_ There was no material change during 1873, nor does the case-book 
irecord any special outburst of violence. 

_ On the evening of May 380, 1874, while waiting in the ward 
iscullery to begin his usual work of mopping the floor after the 
iscrubbers, he found in the mop closet of the scullery a garden spade, 
}which one of the attendants had been using in the airing-court, and 
jhad most carelessly left there. Another patient, John G., was 
‘coming for a mop, when T. G. met him at the scullery door, and, 
)without the slightest warning or provocation, cleft his skull with the 
ispade, inflicting fatal injury. He was about to repeat the blow when 
iseized by the attendant, who was following John G. to the scullery. 
{On being asked why he had done it, he said that his victim “had 
jdone a deal of harm to him and to everybody in the world, and to the 
‘beasts and the horses; and that he had taken his bread and cheese.” 
tHe showed not the slightest concern or remorse, and instead of 
one questions put to him, often said, ‘‘ I am very sore.’ 

| The Coroner's jury found that John G. had been killed by T. G., 
\ but ‘not feloniously, nor of malice aforethought, the said T. G. not 
ibeing of sound mind, memory, and underoeandine. but lunatic and 
distracted.” The Coroner refused to commit T. G. for trial, holding 
\that he was already in legal custody as insane, and ipso facto irre- 
sponsible to law. He was, however, under the direction of the Lunacy 
(Commissioners, committed to Cardiff Gaol by a magistrate, on a 
lcharge of murder. At the Assizes the Judge refused to try such a 























XXIII. Hy) 


66 Two Cases of Homicide in Asylums, (April, 


case, or to take any evidence in the matter, and ultimately the lunatic 
was transferred from gaol to the Criminal Lunatic Asylum, Broad- 
moor. 


Dr. Orange has kindly supplied by letter the following 
information as to T. G.’s condition and conduct at Broad- 
moor : — 


He has very frequently attempted to injure others, both patients 
and attendants, since he has been here. 

On one occasion he was observed to be restless, and was in conse- 
quence asked by the attendant what the matter was. He said he was 
looking for something “long” with which to knock out the brains of 
that fellow, pointing to another patient. 

On another occasion he turned suddenly round towards one of the 
attendants, and raising his hands as if in the attitude of holding a 
spade or broom, he said, “ I'll do it yet some day,” in a very excited 
manner, | 

On another occasion he pushed an imbecile, and when the attendant 
told him he ought not to do that, he immediately attempted to close 
with the attendant, and throw him. These are examples of the kind 
of acts to which G. is prone. 

The habit which you mention (masturbation) is still continued, and 
when asked how he is he generally answers, “‘ Very sore, very sick, 
very sick, and sore.” 

He requires very close watching to prevent him from doing serious 
injury, and it is quite impossible at present to make use of him in any 
industrial occupation. 


The second case was of a different character. 


W. M., age 32, married, a butcher. Was admitted to the Glasgow 
Royal Asylum, 12th July, 1875. This was his first attack; it was 
said to have lasted only three days, and religious excitement was the 
assigned cause. There was no known hereditary predisposition. 
His habits and tone of mind had been religious, He was not epi- 
leptic, but was both suicidal and dangerous. He had been extremely 
maniacal at home, and wished to leap out of the window to get to 
Jesus. On admission he was violent, noisy, and incoherent, gesticu- 
lating wildly, and shouting about Jesus and Heaven. He continued 
maniacal for some days, but after the first fortnight became greatly 
better, and hopes were entertained of his recovery. 

Soon, however, he began to relapse, suddenly broke a window 
because he was going to hell, and gradually sank into a state of 
torpor and apathy,so profound that for a week he lay in bed motion- 
less and speechless as a log, and had to be fed by the tube, all efforts 
to rouse him proving utterly in vain. 

This condition passed off gradually, extreme unwillingness to take 
food being the chief obstacle to progress. Six months after admission 





1877.] by D. Yurrownuns, M.D: 67 


he had materially improved, and was daily at work in the garden. 
He was still, however, dreamy, childish, and apathetic, took little 
Interest in anything around him, sometimes wept and sometimes 
_ laughed without any apparent reason, became very stout, and re- 
-sembled a general paralytic who had early lapsed into amiable, 
indolent, obese dementia. 

In February, 1876, it is noted that he seldom speaks, or answers 
questions, but frequently laughs without apparent cause. When 
pressed to tell why he is so silent, ‘he gives some incoherent reply 
about Jesus commanding him, or that he is in heaven or hell.” 

_In April there was little change. He slept and ate well, 
occasionally worked in the garden, spoke little, and seemed more 
demented. 

He slept in a dormitory with an attendant and four other patients. 
About 1.20, on the morning of May 29th, while all the others were 
quietly asleep, he silently rose from bed, and with the earthenware 
chamber utensil suddenly smashed in the skull of the patient who 
was sleeping in the bed next him. He held the utensil by the lip, 
and struck with the base, so that it was not broken, and the others 
were awakened by his repeated blows on the shattered skull. The 
victim, who died within an hour, had been on very friendly terms with 
his murderer, and had shown him much kindness during the worst of 
his illness, There had been no unpleasantness nor ill-feeling of any 
kind between them, and no more unlikely tragedy could possibly have 
occurred in the asylum. 

Every effort was made, both at the time and subsequently, to get 
_ from the murderer some explanation of the assault, or some reason for 
it, but every attempt was foiled by his total silence, } 

He rarely spoke at all, except to the attendants, and whenever the 
murder was referred to he became instantly and doggedly silent. 
He evidently understood what was said to him, but nothing could 
overcome the passive resistance of total dumbness, or elicit the least 
indication of his mental condition when the deed was committed. 
There was not the slightest sign of sorrow or remorse, and after the 
first night he slept and ate as usual. 

The Procurator- Fiscal being unwilling to remove him to prison, 
he remained in the asylum until arrangements were made for his 
trial at the High Court of Justiciary, and special precautions were 
taken against suicide, not without good reason, as it ultimately proved. 

When taken before the Court, on July 8rd, the plea of insanity 
was urged in bar of trial, and he was committed to the General 
Prison at Perth during Her Majesty’s pleasure. 

The prison authorities were strongly warned as to his suicidal 
impulses, and every precaution was doubtless taken; but one day, 
about a week after admission, he twice dashed himself head-foremost 
against the wall, and died, a few days later, from injuries to the 
spine. 








68 Two Cases of Homicide mm Asylums, [April, 


Remarks :—Homicide by insane persons is usually due 
either to a motiveless murderous impulse, to an imaginary 
command from heaven, to some delusion concerning the victim, 
to a desire to save loved ones from imaginary evil, or lastly to 
evil passions, such as revenge or jealousy, which the insane 
mind could not control. 

In asylums an additional cause exists ; for a sense of unjust 
detention often prompts the vengeance, or confirms the delu- 
sion, and thus precipitates the fatal outbreak. 

The two cases just reported seem to belong respectively to 
the first and second of these categories. 

The case of T. G. was clearly one of motiveless murderous 
impulse. He had no real animosity against the man he 
killed, nor any fixed delusion about him. The delusions he 
afterwards expressed when questioned were rather his insane 
explanation of the deed than the efficient motives which 
prompted it. There had been no previous quarrel, and there 
was no act or word of provocation; the mere possession of 
a deadly weapon seemed to evoke the murderous impulse, 
which vented itself recklessly and fiercely on the nearest 
victim. The attendant felt quite certain that had he pre- 
ceded G. to the scullery the blow would certainly, and as 
readily, have fallen on himself. 

There seem to be three varieties of this uncomplicated 
homicidalimpulse. The first and purest is a simple, causeless, 
conscious impulse to kill, often directed against relatives or 
dear friends, confessed and deplored by the subject of it, but 
so overwhelming that he entreats these persons to avoid him, 
and begs to be protected from himself, lest he be irresistibly 
impelled to commita horrible crime. Many such cases are on 
record, and they constitute a very definite and painful group. 
I believe they are usually associated with deranged bodily 
health, specially with climacteric disorder. 
~ In the second group the homicidal act is sudden and cause- 
less, suggested merely by the presence of a suitable and easy 
victim, and by a convenient opportunity. The murderer has no 
conceivable or no sufficient object for the deed, shows no 
proper appreciation of its enormity, and feels neither remorse 
nor regret, although he may dread the consequences of the 
crime, and have cunning enough to try toescape them. This 
type is also readily recognised in recorded cases. It seems to 
be usually associated with a degree of natural imbecility and 
defective moral sense, which condition has generally been 
confirmed, rather than counteracted, by early training. 


EE 


1877. | by D. YettowiEEs, M.D. | 69 


In the third form of homicidal impulse the deed is the 
sudden climax and result of an habitual tone of mind, which 
may or may not have been recognised as insanity, but which, 
at least in its extreme forms,is incompatible with mental 
health. The man is reserved, self-centred, sullen, and 
repellent. The enjoyments and friendships of life have no 
attractions for him, its disappointments and failures he re- 
gards as personal wrongs. Some early misfortune has soured 
all the milk of human kindness in his breast, some injury to 
the nerve-centres has perverted his whole being, or some 
vicious habit has wasted his brain power, thus at once con- 
tributing to his failure in life’s effort, and rendering him 
unable to correct the false views of the conduct of others by 


- which most men are prone to excuse their own shortcomings. 


This morbid mood deepens as the man nurses his vague sense 
of wrong and failure, and as he feels himself daily insulted 
by the happiness and success of others. His own success—if 


he ever does succeed—he can regard only as victory over 
opponents, his failures as the base triumph of enemies. 











: Humanity seems leagued against him, and he defies and 


detests humanity. 

In the worst cases this Ishmael-mood boils over in fierce 
outbreaks of violence, or it concentrates itself in hatred to 
certain individuals, who are deemed the authors or instigators 
of the wrongs, and who thus become the objects of most 


| dangerous delusions. 


T. G.’s case seems to belong to this third group. The injury 


| to the head, aggravated by intemperate habits, perverted his 


whole nature ; he gradually became the silent, sullen, irritable, 


_ dangerous man we have seen, and the sudden explosion of 
| fatal violence seems but the natural outcome of such a 


character. Happily before the sad climax was reached 
there was ample time for the mental weakness to become 
obvious. Had he succeeded in executing any of his murder- 
ous threats before admission to the asylum he would assuredly 
have met a murderer’s doom. 

His history at Broadmoor shows that the progress of years, 
and slowly increasing dementia, have but lessened his self- 


| control, without modifying the form of his insanity or 
} moderating its explosions. . 


W. M.’s case apparently belongs to the second category of 
homicides by insane persons. 
Although the patient’s obstinate silence effectually baulked. 


all attempts to get his own explanation of it, there can be 


70 Two Cases of Homicide in Asylums, [ April, 


little doubt that the deed was done in obedience to what his 
insane mind deemed a religious duty or a Divine command. 

_ Wild religious mania was the original form of his malady, 
religious ideas frequently appeared in its later and more 
demented stage, and he repeatedly spoke of being commanded 
by Jesus. It seems, therefore, almost certain that an insane 
religious impulse prompted alike the murder of his com- 
panion and the suicide which closed his own tragic story. 

The reckless completeness of both deeds almost suggests 
this origin. There is no trace of doubt, hesitation, or fear, 
no shadow of the possibility of failure; the command is 
Divine, the obedience absolute. 

The connection between murder and suicide in cases of 
religious mania is frequent and well-recognised. W. M.’s 
suicide was pathologically a normal development of his 
disease, and, the impulse to self-destruction once awakened, 
it is very doubtful whether any precautions would have 
long prevented it. | 

The case teaches strikingly that impulses or hallucinations 
connected with religious or Divine subjects are never quite 
free from danger, for by their very nature they exclude all 
other considerations, and demand unquestioning and absolute 
obedience. 


TREATMENT OF LUNATICS IN MALTA. 


[This interesting account of the treatment of the insane in 
Malta was written by F. V. Inglott, CM G., the Comptroller of 
Charitable Institutions im the Island, and sent by him to the 


late Sir James Clark, Bart. It has been furnished to the | 


Journal by Dr. Arthur Mitchell, Commissioner in Lunacy 
for Scotland. It bears date 8rd November, 1867. A few verbal 
changes have been made in passing it through the press, and 
some unimportant passages have been onitted.—Ep. | 


Treatment of Lunatics under the Government of the Knights 
of St. John. 


1530 to 1798. . 


Under the Government of the Knights no separate esta- 
blishment existed in Malta for the treatment of the insane. 
Individuals becoming affected with any form of mental disease 
were conveyed to the Sacred Infirmary, or General Hospital, 


; 








1877.] Treatment of Lunatics in Malta. 71 


and there placed for a time in separate small wards reserved 
for their custody,* with such personal restraint as might have 
been considered necessary to retain them either bound to the 
beds or disabled from approaching others. 

If found violent and unmanageable, the patients were 
transferred to wards in the basement of the hospital,+ and 
there secured by chains to the wall, and placed under such 
other personal restraint as was suggested by the ingenuity 
of the attendants, to overcome the violence of these un- 
fortunate persons. f 

When declared incurable, or when the population became 
too numerous, the patients were removed to the Ospizio (a 
sort of Hdétel des Invalides) for aged and infirm paupers, 
at that time situated in the Stores at Floriana, which are 
now occupied as barracks, and there confined in small case- 
case-mated rooms, chained to the walls and otherwise re- 
strained. } 

The treatment they received, both in the General Hospital 
and in the Ospizio, is described by living witnesses as having 
been far from humane. They were badly housed, badly 
clothed, badly fed, and too often unmercifully beaten. 


Treatment of Lunatics under the French Republic. 


1798 to 1800. 


It does not appear that the manner of treating the 
insane was interfered with by the French during the short 
time they remained in possession of the island (from 12th 
June, 1798, to 4th September, 1800, two years and three 
months). 

The only change made by them was the removal of all 
the sick and other lunatics from the General Hospital of the 
Knights to the Monastery of Penitent Prostitutes, vacated 
for that purpose, in order that the former building might be 


* See “ Notizia della Sacra Infirmeria,” published in 1725, pages 8 and 18— 
a document preserved in the Government Archives. 

+ These wards had windows on a level with the street; and passers-by were 
in the habit of looking through, and of exciting the patients to violence. 

¢ John Howard, when visiting this Hospital, in April, 1786, is said to 
have seen the patients served by the most unfeeling and inhuman persons, 
and to have once found eight or nine of the attendants highly entertained with 
a delirious dying patient. (See an “Account of some Foreign Prisons and 
Hospitals,” by John Howard, p. 59 of the quarto edition, published in 1791.) 


72 Treatment of Lunatics in Malta. [ April, 


oceupied as a Military Hospital for the use of the local 
earrison.* 

The male lunatics were placed in the basement of the 
right wing of the Monastery, and the female were sent to 
the Ospizio. Individuals still living declare that they had 
seen the stone pavement of the wards considerably worn 
from the constant friction of the chains with which the 
patients were secured. 

No records can be found from which any statistics could 
be collected referring to the periods when Malta was under 
the government of the Knights or under that of the French 
Republic. It is supposed that the Registers were either 
destroyed or mislaid during those eventful times of the local 
history. 


Treatment of Lunatics under the Government of Great 
Britain. 


1800 to the present time. 


No improvement was introduced by the British Government 
in the management of the insane until 1816, when Sir 
Thomas Maitland was able to achieve a complete reform in 
the administration of the public charities of the island.f 
The Ospizio, a short time before this period, was transferred 
to the building it now occupies,t to make room for the mili- 
tary; and, in distributing the occupation of the new 
premises, a space was allotted for the reception of all the 
insane. 

The records of this department afford no proof that any 
particular treatment was at this time adopted, and, judging 
from the small, dark, ill-ventilated single-bedded rooms, 
which were provided for the restraint of the violent and 
dangerous, the condition of the unhappy sufferers was not 
much ameliorated; but from statements made by some of the 
old attendants still in the service of the Institutions, an 
improvement was made in all the supplies. 


* See “ Journal of the Taking of Malta by the French Republic,” by Barone 
Azzopardi, page 63. 

+ See Notification of Government of 25th June, 1815; Minute of Govern- 
ment of 15th January, 1816; and Instructions to Permanent Committee of the 
Charitable Institutions of 14th January, 1816. 

{ The Powder Mill of the Government of the Knights, situated at a very 
short distance from the Stores, which were formerly occupied by the aged poor 
of both sexes, and are now used as barracks. 


1877.] Treatment of Lunatics im Malta. 73 


Things remained more or less in the same condition until 
the year 1835, when an important change was effected. 
Large Government tenements (Villa Franconi and adjoining 
premises) having become vacant, a thought arose of convert- 
ing them into a mad-house. The insane in the Ospizio were 
accordingly gradually removed thereto, in proportion as the 
necessary accommodation was prepared for their reception ; 
and in 1837, the establishment being very nearly completed, 
special medical officers were appointed to carry out the 
details of its internal organisation.* But structural defects, 
deficiency of space, and, above all, the absence of discipline, 
soon reduced this first attempt to create a “separate lunatic 
asylum ”’ into a “ perfect horror.” 

‘The appointment of a highly enlightened Governor,t how- 
ever, in 1847, soon wrought a wonderful change in the whole 


- administration of the island, and principles were adopted and 


improvements introduced, which placed the charitable insti- 
tutions in the way of a most complete reform. New buildings, 
suited for their special objects, were proposed, among which 
was an asylum for the insane;{ but the reform was hardly 
commenced when the Governor retired, and all progress was 
consequently arrested. 

His successor, the late Sir William Reid, feeling the 
necessity of providing for the class of patients in question, 


" was advised to call for plans of the special building required 
_ through a public competition,$ and the plans sent in by an 
- Italian refugee || were selected as the most complete for the 
- intended object. 





Lhe works were commenced in July, 1853, but were not 
completed at the expiration of Sir Wilham Reid’s govern- 
ment (April, 1858). 

The next energetic régime of the island] hastened the 
works to completion, and effected such improvements as 
were found practicable in a building already roofed in before 


| it was discovered that the Italian had closely copied the plans 


of the Wakefield Asylum,”** built many years ago (1818). 


* See Letter to Government of Permanent Committee of 4th November 
1837, and reply thereto by Government. 

+ The Right Hon. Richard More O’ Ferrall. 

~ See Governor’s Addresses to Council of 10th August, 1849, and 8th 


| January, 1850. 


§ See Government Notice of 24th September, 1852. 
|| Sigr. Francisco Ciunciolo. 
€ Sir J. Gaspard Le Marchant’s Government. 


** See plans illustrating M. Parchappe’s work on the construction of Lunatic 
Asylums. 


74 Treatment of Lunatics in Malta. [April, 


It has been thought necessary to enter into the above his- 
tory of the present asylum as a defence against “ its evident 
structural defects,’ which have proved to be serious obstacles 
in establishing the various branches of its internal organisa- 
tion, and have yielded, and still yield, detrimental results on 
its sanitary statistics. 

The building having been completed, and prepared for the 
reception of the patients, the suftering population in the 
house at Floriana was, on the 16th July, 1861, transferred to 
the new establishment, situated in the open country at a 
distance of five miles from Valetta. 

It is from this date the humane system of treating lunatics 
commenced. 

No kind of curative statistics can be gathered from the 
very imperfect and insufficient records kept at the Ospizio 
and Villa Franconia Mad House. Comparative results 
cannot, therefore, be prepared ; and it is generally asserted by 
those who are acquainted with the former and with the present 
systems, that no proper comparison between them could be 
made, because the difference between them is so great that 
they have nothing in common to compare. 

A varied refectory, healthy recreation, daily ablutions, and 
a cheerful building soon gave a“ tone to the general health,” 
which told remarkably on the discipline of the new estab- 
lishment. 

Amusement and occupation were substituted for restraint 
and confinement; and punishment (seclusion) was restricted, 
as in a well-regulated family, to those members only who 
continued incorrigible in spite of all means of persuasion, 
and was only resorted to when gentle but firm treatment 
proved of no avail. 

The only authorised means of per sonal restraint were 
declared to be—the jacket, which is a loose covering, secured 
with leather straps; the wristband, to shackle one or both 
hands; and the mainchaud, which is applied to those patients 
who cannot keep their hands from doing mischief. 

These changes in the management were found sufficient to 
produce a wonderful improvement in the mental state of the 
patients. 

A moral and physical treatment was established; statistical 
registers were commenced; and a complete case-book, con- 
taining the medical history of each patient, may now be 
inspected as affording the best testimonial of the character 
of the establishment. 








Pe Ee ee ee, ee ee ee. een ae 


ee 





#37 7.] Treatment of Lunatics in Malta. | 75 


The most beneficial influences have been brought to bear 
upon the mental state of the patients, and occasional enter- 
taining spectacles have been introduced which have hitherto 
had very satisfactory results. 

The population of the asylum, with one or two exceptions, 
being all Catholic, the efficacy of the chapel ceremonies and 
of religious festivities has been tested as “‘ curative means,”’ 
and has been found wonderfully successful. 

As the asylum was occupied on the 16th of July—a day of 
ereat devotion in the island, being dedicated to the com- 
memoration of the Apparition of the Blessed Virgin on 
Mount Carmel—advantage was taken of the circumstance, 
and an annual festival established to commemorate the 
opening of the asylum, on which occasion the patients take a 
very great interest in the various decorations, and a sharp 
rivalry is observed between the male and female divisions in 
dressing the wards and refectories. 

Endeavours have successfully been made to induce the 
public to take an interest in the new treatment of the 
insane, and valuable presents have been made to the institu- 
tion by several benevolent individuals, especially by Mr. Henry 
Graves, of Pall Mall, London; Mr. Charles “Mclver, of 
Liverpool ; and the Hon. Dr. Sciottino, of Malta. 

A cosmorama, a beautiful alethoscope, and a magic lantern, 
afford great indoor amusement to the patients during the long 
winter evenings, and music and serenading in the airing- 
courts are resorted to in summer. 

The almost general absence of restraint, the association of 
the patients, the variety of dress, and the small number of 
attendants, give an appearance to the asylum not commonly 
met with in similar establishments, and have induced high 
professional authorities * to declare “ that the administration 
of the Malta Asylum is exceedingly perfect ;” that in all 
essentials and even in all details it is a model establishment, 
| and one of the most successful examples of the non- restraint 
| system. 

_ The defective construction of the asylum has afforded, at 
_ least, one advantage—that of being able to carry on the 
service witha diminished number of attendants.t+ 

The day-rooms, or Salles de Reunion, being in the point of 


* Dr. Kingsley and Dr. Sutherland. 

+ This advantage is to be attributed to the principle upon which the asylum 
was originally conceived, viz., that of the ‘surveillance panoptique,’’ which is 
| generally objected to as faulty. 


76 Treatment of Lunatics in Malta. [April, 


intersection or centre of the wards, and the principle of 
association being a prominent feature of the system in 
operation, one attendant is able to superintend a very great 
proportion of the population. In the ward for the violent 
and dangerous only, two officers have hitherto been found 
necessary; in all the other wards, one is quite sufficient, 
provided the patients be made to give assistance, which is 
insisted on. 

The proportion of attendants to patients, for day and 
night duties, is, at this moment, 1 for every 21 patients in 
the male division, and 1 for every 22 in the female division. 

The combined action of the various appliances above 
described, notwithstanding the structural defects already 
mentioned, and other obstacles and difficulties, has been 
attended with pleasing results, and has earned a curative 
character for the establishment not at all discouraging. 

The Registers show that from the opening of the new 
establishment, in 1861, to the present date, the average pro- 
portion of cures to admissions has been 43°46 per cent. In 
the year 1865 the cures rose one-third above the average 
of the preceding years, which may be considered as 
avery satisfactory, if not the highest, proportion that can 


be obtained in any asylum; and if a complete system of | 


hydrotherapeutics, the Hammam or Turkish bath (a 
powerful curative means in this climate), and more extensive 
and varied industrial occupation be introduced, the propor- 
tion of cures will be greater, and the cost of the general 
maintenance of the asylum less. 








CLINICAL NOTES AND CASES. 





Vascular Lesions with Insanity. By G. Hunter Macxenziz, 
M.B. (Hdin.), Senior Assistant Medical Officer, County 
Asylum, Gloucester. 


The determining causes of the pathological states met with 
in the cerebral cells may be due to morbid activity of the 
cells themselves (Virchow), or to abnormal conditions of the 
vascular system influencing their nutrition. These may be— 
(1) inefficiency of the vis-a-tergo; (2) diminution of the 
nutritive properties of the blood; or, (8) obstruction in the 
vessels to the blood-supply; and their frequent association 
with insanity affords every reason for regarding them, in 
numerous instances, as direct cause and effect, and for view- 





aye Cree Calo ee 


eT ee ee 





1877.] Clinical Notes and Cases. Ue 


ing many of the changes in the brains of the insane as of 
a secondary nature—the results of defective nourishment. 
Mal-nutrition of a nerve-cell must invariably induce abroga- 
tion or diminution of its normal functional activity, with 
atrophy of its structural elements. The condition of fatty 
and granular degeneration of the cellular elements of the 
brain is so universally met with, as to fail to account for the 
great diversity of clinical phenomena, and hence the various 
morbid states of the vascular system in the insane become of 
considerable primary etiological importance. As results of 
this disordered circulation, there is induced an asthenic irri- 
tability, and subsequently the destruction of the normal exci- 
tability of the cerebrum, associated with the characteristic 
physical appearances of wasting and decay. 

The following cases are recorded as instances of insanity 
with well-marked vascular lesions :— 


1.—Case of Thrombosis of the Internal Carotid Arteries (Syphilitic) 
— Dementia— Death. 

K. W., widow, xt. 82, admittedinto the Gloucester County Lunatic 
Asylum on 9th Feb., 1876. 

History.—No hereditary taint ; father phthisical. Age at commence- 
ment of attack, 31. There is a history of epileptiform convulsions 
dating from about a year preceding her admission into the Gloucester 
Asylum. Husband suffered from venereal disease, which patient’s 
mother believes he communicated to his wife. Has had 3 children, 
one of whom (the eldest) is alive. The two youngest lived a few 
weeks only; they were weakly, and covered with a copious skin erup- 
tion about the genitals and anus. Had menorrhagia at last confine- 
ment, about 2 years ago. Has been subject to bilious attacks and 
indigestion. 

Condition on Admission.—Heart and lungs healthy; pupils un- 
equal, the left being the larger. Impaired articulation and locomotion. 
Suffers from complete dementia, as indicated by entire loss of memory, 
and inability to comprehend the simplest questions. 

Course of Case (condensed ).—The right hemiplegic convulsions fre- 
quently recurred, becoming gradually aggravated in character, and on 
the 16th October, 1876, culminated in complete paralysis of the whole 
of the nght side, with marked difficulty of deglutition, and almost 
complete abolition of consciousness. These partly disappeared in a 
few hours, and were succeeded in the arm by a condition of tonic 
spasm. The pupils contitiued unequal, the left being dilated and 
sluggish ; there was visible pulsation in the episternal notch, and the 
heart’s action was irregular. The paralysis never entirely disappeared; 
| when conscious, she complained of ‘‘ pins and needles” in the right 
| arm, and headache. On the 81st October she is reported as having 


78 Clinical Notes and Cases. [April, 


had fits all night, the eyes being turned to the left and the mouth 
drawn to the right; there were no convulsions of the hmbs. At 9 
a.m. on the same day her condition was as follows :— Face pale; con- 
junctiva injected and nearly insensible; loud moist tracheal rales. 
Resp. 36; pulse 100, very small; there was greenish-yellow froth 
issuing from the mouth and nostrils; sensation was greatly diminished 
in right leg ; arms flaccid and relaxed; right pupil alone sensitive to 
light. Nitrite of amyl by inhalation was tried; only ou the first 
application was facial flushing produced. She died at 10.15 p.m. 

Autopsy, 41 hours after.—Body well nourished; rigor mortis well 
marked. 

Head.—Pericranium fairly injected, cranium soft and of moderate 
thickness. Meningeal vessels full. 2oz. fluid in arachnoid cavity. 
Weight of brain 46 oz. Brain of normal consistence throughout; it 
seemed well-nourished and symmetrical, with the exception of the 
vessels on the surface of the left hemisphere; these were dilated, and 
contained dark blood (not hypostatic). The left internal carotid 
artery, at its termination, was entirely occluded by a thrombus extend- 
ing into the commencement of the left middle cerebral; this vessel, 
beyond the occlusion, was fairly distended with dark blood. The pos- 
terior branch (4th of Duret and Heubner) of the left middle cerebral 
was greatly dilated, and contained a long, thready, organised clot. 
The Ist and 2nd branches of the posterior cerebral—supplying the 
uncinate gyrus and its vicinity—were larger and fuller than the cor- 
responding vessels on the opposite side. ‘The branches of the anterior 
cerebral were also larger, and the main trunk of this vessel, running 
posteriorly along the convolution of the corpus callosum, was espe- 
cially prominent—its fellow being a mere twig. The left corpus 
striatum had a small patch of a faint yellow colour on its ventricular 
aspect. 

Microscopical Hxanunation of Recent Brain.-—The blood-vessels of 
the left corpus striatum were of large size, with well-defined, regular 
walls, and, at places, cohering granules in the perivascular canals. No 
puckerings, contractions, or thickenings of the vessels were present. 
The nerve-cells, with their nuclei, had mostly degenerated into fatty 
granular masses. No difference in the microscopical characters of the 
two hemispheres was detected. 

Thorax and Abdomen.—The heart was healthy, weighing 72 oz. 
The right lung sank in water; it was full of sanguineous froth, and 
nearly solid. ‘The gall-bladder was distended. The other viscera 
were normal. 

The right and left carotid vessels, with their branches, were hardened 
in a solution of chromic acid and bichromate of potash. Microscopic 
examination of sections thus obtained, showed that the lesion was 
symmetrical, and that the right carotid was affected in a similar 
manner and locality to the left, but to a much less degree. At 
its division into its cerebral branches, the endotheloid and sub-endothe-- 





| 
: 





1877. | Clinical Notes and Cases. 2 0 


loid layers of the interna had entirely lost their normal appearance, 
and undergone marked alteration from hyperplasia and exudation, lead- 
ing to encroachment upon the lumen of the vessel, but nowhere to 
complete occlusion. This abnormal epitheloid lining was easily de- 
tached from the elastic layer of the inner coat, which, at places, had 
become wholly obscured by infiltration. There seemed also to be 
hyperplasia of the outer (fibrous) coat. (See Plate, fig. I.) 


The physical symptoms of this case were firstly those of 
irritation, and subsequently of gradually increasing paralysis, 
from partial cerebral ansemia. The immediate cause of this 
was for some time doubtful. Theage of the patient excluded 
atheroma, and consequently atheromatous thrombosis of the 
vessels ; and the healthy condition of the heart and lungs, 
and gradual accession of the symptoms, forbade the idea 
of embolism. It was distinguished from hemorrhage by its 
slow progressive development, and from cerebral congestion 
by the mental and physical symptoms being more profound 
and permanent, and latterly by the existence of paralysis. 
Marasmic thrombosis was possible, but from its rarity, and 
the condition of the patient, might be left out of considera- 
tion in determining the nature of the lesion. By the process 
of exclusion, and not from any peculiarity in the symptoms, 
we were forced to consider whether the lesions might not be 
due to specific causes acting through the medium of the blood 
or blood-vessels. If the symptoms had depended on the 
altered condition of the blood alone, it is fair to infer that 
they would have been more general in character, since the 
brain would have been affected in its entirety. A diagnosis 
—arrived at before a history of specific disease had been ob- 
tained, but too late to warrant a trial of appropriate treat- 
ment—was accordingly made of syphilitic thrombosis of the 
cerebral vessels, most probably of the left middle cerebral 
artery, acting alone, or in conjunction with the syphilitic 
virus, and leading to abnormal circulation in the left hemi- 
sphere. 

The prevalence of arterial lesions in syphilis is now well 
recognised. Though not the most general affection in specific 
disease of the brain, syphilitic arteritis at the base, and con- 
stituting the sole syphilitic cerebral lesion, is not uncommon. 
A case has been described by Heubner in which the right 
anterior cerebral, the left middle cerebral, the basilar, and the 
left vertebral arteries were obliterated in part of their course 
by thrombosis of syphilitic origin. A similar class of cases is 


briefly referred to by Von Pierson, in which the blood-vessels 


80 Clinical Notes and Cases. _ [April, 


at the base are affected—such affection being, as in the 
present instance, the sole syphilitic cerebral lesion, and in- 
variably beginning in the endotheloid and sub-endotheloid 
layers of the tunica interna as a cellular hyperplasia. In this 
respect syphilitic disease of the larger vessels at the base 
appears to differ from a similar affection of the smaller arteries 
of the substance of the brain, by the changes in the latter 
consisting mainly in chronic thickening of the middle and 
fibrous coats from deposition of plasma, as pointed out by 
Batty Tuke. The result, in both cases, is the same—eradual 
diminution of the calibre of the vessel, leading to complete 
occlusion. It is still a matter of doubt whether, in throm- 
bus of syphilitic origin, there is anything of an actually 
specific nature, and whether the differences between it 
and a non-syphilitic affection are not rather those of degree, 
arrangement, and period of accession, than of a histological 
or generic character. Its specificity is affirmed by Heubner, 
and denied by Friedlander, who found artificial thrombosis 
in animals to be identical with that produced by syphilis 
in man. 

Though carefully searched for, no other manifestation of 
syphilis was found. The only corroborative evidence of the 
specific nature of the lesion, therefore, lay in the history. 
The sequence of the physical and mental phenomena may also 
be confirmatory. These agree, in a great measure, with those 
described by Wille as characteristic of a variety of syphilitic 
insanity, viz., the early accession of motor and sensory symp- 
toms, the gradual decrease of mental power passing into 
dementia, and the subsequent onset of convulsions and para- 
lysis. It is uncertain whether the preliminary hypochon- 
driasis was present. ‘To overcome the progressive obstruc- 
tion in the internal carotid, and subsequently in the left 
middle cerebral arteries, the vessels on which lay the stress 
of establishing the collateral circulation had become markedly 
enlarged. This was notably the case with the branches of the 
anterior and posterior cerebral arteries running towards the 
area of distribution of the middle cerebral. The difference 
in size between those vessels and the corresponding vessels of 
the opposite hemisphere was very decided. ~ 

I have elected to describe this case as a simple vascular 
lesion, for, if we except the age of the patient, there was 
nothing in the clinical, physical, or mental symptoms to indi- 
cate its specific nature, and which might not have occurred in 
the course of a corresponding affection of non-syphilitic origin. 


eee eS ee ee ee ee a ee ee ee 


| 








1877.] Clinical Notes and Cases. 81 


2—Case of Aneurisms of the Basilar and Posterior Cerebral 
Arteries, and Embolism of the Right Internal Carotid Arteries, with 
left Hemiplegia—Dementia—Death. 


M. G., xt. 53, female, married; re-admitted into the Gloucester 
County Lunatic Asylum on the 18th October, 1876. 

History.— Date of first admittance, 15th May, 1873. The leading 
features of her insanity were incoherent talking and great loqua- 
city. She quieted considerably, and, on the application of her re- 
latives, was discharged relieved on the 20th August of the same 
year. Re-admitted as above. The following additional particulars 
were ascertained :—Patient is second youngest in a family of 10, three 
of whom are alive. No hereditary taint; no relationship between 
father and mother. Had a “stroke” 8 years ago, which came on 
suddenly, while engaged in ordinary domestic work. On this occasion 
she lost the power of the whole of the left side, as well as of speech. 
Was very ill for some time and never quite recovered. Has suffered 
from frequent attacks of rheumatism. Cause of insanity unknown to 
relatives; has not been intemperate, nor suffered from poverty. Cata- 
menia ceased at the age of 48. Has had 10 children, of whom 6 are 

dead. | 
- State on Admission—Physical Condition.—In poor general condition ; 
pupils in medium contraction, and equal; left side partially hemi- 
plegic; articulation slow, hesitating, and thick, from inability to con- 
trol the finer movements of the tongue; deglutition difficult; pulse 
100, very small, so as to be scarcely perceptible; microscopical exami- 
nation of blood normal. (Patient would not allow her chest to be 
examined.) 

Mental Condition.—As on first admission. 

Course of Case (condensed).—On account of her nocturnal restless- 
ness, she received occasional draughts of chloral hydrate. On the 
25th October her condition was, pulse 80, intermittent ; pupils con- 
tracted and equal; heart’s action irregular; mitral systolic bruit; 
mental state unchanged, Her condition remained almost unaltered 
until the 17th January, 1877, when she suddenly lapsed into a con- 
dition of incomplete coma, with the symptoms of serous effusion on 
the brain. She remained more or less in this condition until her death 
on the 21st January. 

Autopsy, 80 hours after.—Body well nourished ; cadaveric rigidity 
well marked. 

Head.—Calvarium soft and thin. Parietal layer of arachnoid 
readily separated from dura mater; 6 oz. serous effusion in arachnoid 
cavity ; brain firm, of normal consistence, with puncta cruenta (venous) 
much larger, and more abundant than usual; it weighed 353 oz. On 
the basilar artery were 2 contiguous aneurismal dilatations of about 
equal size—being about 4 inch in length, by + inch in breadth at their 
widest (central) part. Projecting from the posterior cerebral artery 


XII, 6 


? 





82 Clinical Notes and Cases. [ April, 


into the locus perforatus posticus, was a third aneurism, saccular in 
form, and about the size of a cherry-stone. The aneurisms contained 
clotted blood, decolorised in the centre. The inferior half of their 
walls was thin, and consisted of the outer coat alone. There was 
softening of both crura cerebri, but mainly of the right. (Secfig. TI) 

Thorax.—Heart flabby; left ventricle dilated. The cusps of the 
mitral valves were shortened and thickened; the valve was incompetent ; 
weight of heart, 124+ oz. Atheroma of aorta just above valves. The 
left internal carotid artery had an independent origin from the aorta, 
and the left external carotid and left subclavian arteries sprung from 
the aorta by a common trunk, from which the left vertebral artery was 
also given off. 


The pathological conditions met with in this case render 
it interesting. The history of the first attack, dating eight 
years previous to admission into the asylum, pointed to 
cerebral hemorrhage, or embolism, as the lesion. Against 
the latter was the fact that the resulting hemiplegia was © 
left-sided, whereas unilateral paralysis from embolism is 
almost universally right. In endo-carditis, or other heart- 
affections in which deposits are detached, and carried in the 
current of the circulation to the brain, the course generally 
taken is that which lies nearest the axis of the aortic blood- 
current, and hence the frequency of embolism of the left 
internal carotid artery or its branches. In this case the 
internal carotid arose from the arch of the aorta by a smaller 
trunk than usual, and to the consequent lessening of the 
volume of blood entering was probably due the fact of 
the deposit taking its unusual course. The embolism was 
recent, and it is possible that the first attack may have also 
been of an embolic nature, with subsequent re-establishment 
of the circulation. 

On re-admission, the partial left hemiplegia, thick arti- 
culation, childishness, and weakness of the emotional facul- 
ties, with valvular disease of the heart—all of long standing 
—pointed to serious organic cerebral disease, most probably 
hemorrhage. The fatal illness was sudden in its onset, and 
was throughout unattended by any direct symptoms, except 
coma of varying degrees of intensity. The sequence of some 
of the lesions found on autopsy appears to have been de- 
tachment of a fibrinous concretion or clot from the heart, 
and its impaction in the right internal carotid artery, with 
subsequent fluxionary hyperemia in the collateral branches, 
and distension of the vascular tumours. As a consequence 
of that distension, and of the extreme tenuity of the aneu- 





1877.] Clinical Notes and Cases. 83 


rismal walls, transudation of serum took place; this, in its 
turn, compressed the ven galeni and the longitudinal sinus, 
congestive hyperemia ensued, and the amount of effusion 
progressively increased. 

Cerebral aneurisms are not common. They are most fre- 
quently met with in persons of advanced age, and are gene- 
rally situated on the basilar artery, where also they attain 
their largest size. Gouguenheim collected statistics of 68 
cases, and of these 17 were basilar. With regard to their 
anatomy, Virchow and Kolliker have shown that they are of 
four varieties, according to the coat or coats forming their 
walls. From their entirely vascular nature, and consequent 
hability to sudden and marked alterations in bulk, they con- 
stitute the most dangerous class of brain tumours. It has 
been pointed out by various writers, amongst others by 
Niemeyer, that tumours of the brain may attain a large size 
‘without producing marked symptoms, if they be of slow 
growth, and non-vascular; if, however, they be connected 
with a vessel, or are richly supplied with blood, they may, 
though small, by their sudden alteration in size, produce 
serious effects, not through direct pressure, but. by encroach- 
ing on the cranial cavity, interfere with the capillary circula- 
tion, and produce collateral cdema. From the attempts of 
the basilar artery to aid in establishing a collateral circula- 
tion, on the internal carotid becoming blocked, the aneurisms 
must have become unusually distended, and diminished to a 
corresponding degree the space of the posterior cranial fossa. 
The extensive serous effusion was therefore due to two causes 
—direct transudation through the aneurismal walls, and the 
ensuing congestion of the cerebral veins and sinuses. 

There appears to be no known symptom, nor set of symp- 
toms, which can justify a diagnosis of aneurism of the basilar 
artery. Griesinger affirms the compression of both carotids 
firmly against the transverse processes of the cervical ver- 
tebree, and consequent production of convulsions, to be pa- 
thognomonic. The correctness of this is denied by Niemeyer, 
who, while laying down a number of symptoms as indicative 
of encroachment on the space of the posterior cranial fossa, 
does not venture to differentiate between the various causes 
to which this may be due. From the mental condition of 
the patient, it could not be ascertained if all Niemeyer’s 
symptoms were present, but she undoubtedly suffered from 
diminution of sensibility and motor power, but no complete 
paralysis and anesthesia, and impaired articulation and 


84 Clinical Notes and Cases. [ April, 


locomotion. The peculiar dizziness referred to by him—which 
does not occur while the patient is quietly lying or sitting 
down, but results from certain bodily movements, and which 
he considers an invariable symptom of diminution of the 
space of the posterior cranial fossa—appeared absent. 

The abnormality in the origin of the branches of the arch 
of the aorta is unique. In only two recorded cases has the 
common carotid artery been absent (Quain); then the in- 
ternal and external carotids arose separately from the arch 
of the aorta. The present appears to be the only case on 
record where the left external carotid, subclavian, and verte- 
bral arteries sprung from the aorta by a common trunk, the 
left internal carotid arising separately. 


3.—Case of Embolism of Left Middle Cerebral Artery—Mania— 
Hemiplegia—A phasia—Death. 

History —M. K., female, married, et. 50, admitted 22nd February, 
1868, into the Gloucester County Lunatic Asylum, suffering from 
religious mania with delusions. Her father and brother had been 
insane. Was discharged recovered on the 10th December, 1867, and 
re-admitted on 22nd February, 1868, suffermg from a relapse. On 
re-admission she had a well-marked double mitral bruit. 

Course of Case.-—During her residence in the asylum, she continued 
in a condition of recurrent excitement; the heart’s action becoming 
very irregular, with occasional great dyspnea, Treatment of the 
cardiac complaint was frequently attempted, but was invariably refused 
by the patient. On the 24th October, 1876, she is reported as suffer- 
ing from great cardiac irregularity and weakness, with dyspnoea and 
cdema of legs and feet. On the 26th of the same month, at 4.30 
p.m., she suddenly became aphasic, with increased cyanosis of lips and 
face, and augmented dyspncea. ‘There was no paralysis of limb ; the 
mouth, however, was slightly drawn to the left side, and the power of 
articulation was abolished. A considerable amount of excitement 
was present. About 20 minutes after the onset of the aphasia, an 
attack of complete right hemiplegia supervened, the face being drawn 
more completely to the left, and the pupils in medium dilatation, with 
the right, if anything, a little the larger. Both were sluggish, and 
the eyes were more prominent and staring than usual. On this and 
the succeeding day she attempted to articulate, and puckered the 
mouth well, but could only say, “tit, tit, tit.’ On the 27th, the 
pulse was weak, fluttering, and intermittent; the cervical veins were 
enlarged, full, and pulsating. She can move the right leg slightly ; 
is quite intelligent, and has been so during the whole of the attack. 
On the 31st there were some convulsive movements affecting the right 
side, and the eyes were turned to the right ; the pupils were insensible 
to light, and dilated, the right being still slightly the larger. Pulse 





























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1877.] Clinical Notes and Cases. 85 


almost imperceptible. She subsequently became insensible, and died 
on the 3rd Nov. 

Autopsy, 26 hours after—Considerable cedema of feet and legs ; no 
cadaveric rigidity. 

Head.—Calvarium thin, with adherent membranes; superficial 
cerebral vessels very full and tortuous; weight of brain, 47 oz. 
In the course of distribution of the left middle cerebral artery and 
its branches, patches of softening had occurred— 

(a.) At the extremity of the superior temporo-sphenoidal convolu- 
tion (adjoining the sylvian fissure). 

(b.) At the operculum (the junction of the 3rd left frontal, ascend- 
ing frontal, and ascending parietal convolutions). 

(c.) At that part of the anterior convolution of the Island of Reil 
which immediately adjoins the operculum. . 

(d.) There was marked softening, with red extravasation, of the 
posterior thirds of the 2nd and 38rd left frontal, and, toa less degree, 
of the ascending frontal convolutions. This involved, mainly, and 
very extensively, the white matter, and extended in the direction of, 
and to, the ventricular wall, 

(e.) Softening, but not marked disintegration, of the left corpus 
striatum was also present. 

Microscopically, the softened white substance showed numerous 
irregularly defined and broken nerve-fibres ; in the gray, oil globules: 
were abundant. 

Thorax.—8 oz. serous effusion in cavity of pericardium; weight 
of heart, 184 0z.; right cavity full of clotted blood; aorta greatly 
dilated, as was also the tricuspid orifice. The cusps of the tricuspid 
and mitral orifices were thickened and contracted; the right lung 
was studded throughout with hemorrhagic infarcti. 

Abdomen.—Liver cirrhotic; kidneys granular and contracted with 
embolic infarcti in process of disintegration ; spleen fibroid; mucous 
membrane of stomach rough, and dusky from venous congestion. 

_ This case is simply recorded as an example of insanity 
associated with the other sequels of long-standing heart 
disease, and as a contribution to the already numerous 
instances of embolism of the left middle cerebral artery 
| following valvular disease of the heart, in which the sudden 
nature of the lesion prevented the anastomosing vessels 
accommodating themselves to the increased current of blood 
| necessary to the establishment of the collateral circulation. 





EXPLANATION OF ILLUSTRATIONS. 


| Fig. 1.—Transverse section of the internal carotid artery, at its termination, 
showing syphilitic thrombosis, and partial infiltration of the elastic coat. 
(X 150.) 

Fig. 2.—Showing aneurisms of the basilar and posterior cerebral arteries. 


86 Clinical Notes and Cases. [April, 


Two Cases of Bearded Women. By T. W. McDowaxt, M.D., 
Northumberland County Asylum. 


The illustrations which accompany this short paper are 
interesting examples of a sexual deformity very seldom met 
with in young women. I have not thought it necessary to 
collect the literature bearing on this subject, and I do not 
know of any special papers on it. In various works, how- 
ever, it is referred to in a stereotyped fashion. The general 
opinion seems to be that it is almost exclusively among 
women who have passed the period of sexual vigour that 
beards are found; that such women are of a masculine dis- 
position of body and mind; that the characteristics of their 
sex are usually imperfectly developed ; and that they are, as 
a rule, barren. Whether such opinions are correct or not I 
cannot say, but they do not apply to the cases about to be 
described. Both these women appear to be perfectly de- 
veloped in their sexual characteristics ; one, indeed, now a 
widow, is the mother of three children. In both cases the 
hair began to grow on the face shortly after the patients 
arrived at the age of puberty. The deformity caused them 
ereat annoyance, so much so that one of them appears to 
have been teased into an attack of mania by her 
neighbours. In her case a hereditary tendency to insanity 
existed, and one of her sisters is now insane. By cutting, or 
shaving, they attempted to diminish the disfigurement, but, of 
course, with only temporary benefit. There can be no doubt 
that some irregular action of the nervous system is the cause 
of the growth of the hair in these cases; and it would be an 
interesting investigation, had we the materials, to discover if 
bearded women were more subject to nervous diseases than 
their more favoured sisters. 


Case I.—I had this patient under observation some years ago in 
the Perth District Asylum. For the photograph, and a copy of the 
notes in the Case-book, I am indebted to my esteemed friend ana 
former chief, Dr. W. C. McIntosh. She was first admitted to the 
Perth District Asylum on 2nd March, 1868. She was then 28 years 
of age, unmarried, and formerly employed as housekeeper to her 
father, or as a general worker. She was suffering from her first 
attack of insanity. Her relatives stated that the first symptom 
observed was depression, which was speedily followed by maniacal 
excitement. One medical certificate is to the following effect: ‘She 
suddenly starts up and walks about the house laughing and talking to 
herself, quoting Scripture in an irregular and incoherent manner. She 
says that she does not require to work, that she has worked long 








BEARDED WoMEN. 











1877.| Clinical Notes and Cases. 87 


enough for others, and now she may take ease for herself. Her sister 
states that for nearly a year she has been conducting herself as above 
stated, and, also, that at times she was dull and melancholic, sitting 
quiet without speaking, and at other times becoming excited, running 
out of the house, and walking about without any purpose.” ‘The 
second certificate was to a similar effect, it being added that she 
imagined her mother still alive, and that she laboured under various 
delusions. State on Admission: She was of average height, pale, 
and rather emaciated. Her general health was fair; the circulatory, 
respiratory, and digestive systems were normal. Her relatives stated 
that she menstruated regularly. She had a remarkable deformity, 
which she appeared anxious to conceal—a well developed beard. She 
had also whiskers and moustache, but they were less marked. The 
hair was black, and almost quite straight; fine, but not more so than 
is frequently observed on men’s faces. it varied in length, according 
to situation, being longest on the chin and shortest on the upper lip. 
In the former position the average length was between 2 and 24 
inches. 


The following entries in the Case-book sufficiently illustrate 
the condition of the patient during her residence in the 
Asylum :—“ January 1, 1669.—She has enjoyed excellent 
health since admission. ‘The mental condition is but slightly 
improved, but, on the whole, she is less restless and noisy. 
She is generally employed in the laundry, and is most indus- 
trious and happy, but she frequently becomes noisy, abusive, 
and incoherent, and then requires to be sent to the airing 
court. When in such a condition she walks about very 
quickly, rolls on the ground, or lies crouched up in a corner. 
She appears to imagine that persons around her laugh at her 
on account of her beard, so she generally wears her dress over 
her head, and conceals the under part of her face. When 
— quiet she appears quite happy and cheerful, and, although she 
has occasionally asked to go home, she on one occasion told 
her father that she was quite content in the Asylum, and had 
_ plenty of food and plenty of work.” “‘ May 29th, 1871.—During 
_ this spring the patient suffered from pneumonia, and is still 
pale and emaciated. She often sits for a long time in a corner 
/ with her dress drawn over her head, and when disturbed be- 
comes noisy and abusive. Very much against Dr. McIntosh’s 
advice she was to-day removed by her father from the 

Asylum.” . 
| On January 21st, 1871, she was re-admitted in a state of 
mania, but of this it is not necessary to furnish details. 


Casz IJ.—E. D. H. was admitted to the Northumberland County 
Asylum on 25th January, 1876. She is now about 26 years of age, 


88 Clinical Notes and Cases. [April, 


a widow, the mother of three children. It is supposed that her illness 
was caused by fatigue and anxiety connected with the fatal illness of 
her husband, she being pregnant at the time. It is, however, more 
probable that her illness was due to her confinement, which occurred 
almost immediately after her husband’s death, for, although she had 
been naturally enough much depressed during the distress in 
her family, it was not till three days after the birth of her last child 
that the depression became morbid. She became stupid and lost, and 
frequently said that she had no chance of being saved. She was 
restless, sleepless, and refused her food. 


There is an hereditary tendency to insanity. Her father 
died at the age of 56, of chronic brain disease, probably 
apoplectic softening. He had an apoplectic fit, and was 
paralysed for a time, but my informants could not give me 
trustworthy particulars. He was at first melancholic, and 
rapidly became demented. She is one of eleven children, in 
none of whom, except herself, is there any physical or mental 
peculiarity. Her brother-in-law states that she was always a 
merry, cheerful young woman, and showed little annoyance at 
the unusual growth of hair on her face. She generally kept 
it short by shaving or cutting. 

State on Admission.—She laboured under melancholia, with 
various delusions and hallucinations of the senses of hearing 
and sight. She seemed much depressed, the memory was 
defective; questions required to be repeated over and over 
again before she would answer. She said that she had seen 
angels, and heard them singing. 

It is unnecessary to give a detailed account of her bodily 
condition, or of her state since admission. At the present 
time (January, 1877) she is in good bodily health, but has 
made little progress in her mental condition. She seldom 
speaks, pays but little attention to what goes on around her, 
is exceedingly lethargic in her movements, and appears to be 
gradually drifting into a state of mild dementia. 

As to her physical development, it is womanly in all 
respects, except the beard and whiskers. Her hair is light 
brown; eyes blue-grey. As may be seen from the accompany- 
ing illustration (No. 2), there is certainly nothing masculine 
in her appearance or expression. ‘The hair is arranged on 
her face in a fashion very much like what is seen in Case I. 
It is, however, somewhat coarser, and slightly curled. Some 
of the hairs removed from the tufts near the chin measure 
nearly three inches. 


1877. ] Clinacal Notes and Cases. 89 


Case of an Extraordinary Number of Convulsions occurring in an 
Epileptic Patient, with Remarks on Nutrient Enemata. By 
H. Hayes Newrnearton, Ticehurst. 


Miss X. Y., et. 25, was admitted August, 1876. 

The family history in this case is very bad on both sides. At the 
age of 12 she was first noticed to be strange at times in her manner— 
becoming suddenly absent-minded and irritable—and these symptoms 
were often accompanied by a peculiar flushing of the face. At times, 
too, she gave way to uncontrollable screeching, especially. on some 
trifling irritation. .She grew up to be an emotional and wayward girl, 
requiring the guidance of an elderly governess and companion. A 
year or two ago she commenced to have attacks of petit mal, both by 
night and by day. Ifshe had them nocturnally she would be tolerably 
free from them by day for some time. On several occasions she had 
attacks while out riding, but only once or twice sufficiently severe to 
place her in danger of falling from her horse. She became erotic, 
and developed a delusion that a young gentleman was madly in love 
with her, though she could give no verbal nor literary proof of such 
being the case. At last she became dangerous—on one or two occa- 
sions jumping up suddenly from her seat and trying to strangle her 
sister. She was placed in the family of a surgeon, who soon, how- 
ever, saw that it was hardly a case for domestic treatment, and 
eventually she came into our charge. 

On admission she was tolerably calm and collected, but filled with 
religious notions, more or less absurd and self-satisfied. The day after 
admission she was excited at being detained, crying passionately, and 
vowing vengeance on all concerned in her being confined in an asylum. 
In a day or two she began to see that this was not the right way to 
convince us of what she was certain of—that she was sane. She 
accordingly exercised some self-control, with very good effect; and 
for three months went on very quietly, exhibiting only some mental 
enfeeblement, with at times obstinacy and a great power of quoting 
scripture, writing religious poetry, and describing beautiful visions 
that occurred to her during sleep. At night also she had occasionally 
anomalous seizures, which none of the nurses who sat up with her 
could describe in such a manner as to give us sufficient grounds for 
diagnosing their nature. For a long time after her admission no 
history of her former condition reached us. But about the beginning 
of November the true character of the seizures became apparent, as 
one or two occurred before us, and then there was no doubt about the 
matter, especially as we found out at the same time what had occurred 
previously. She had, after this, a period of intense religious excite- 
ment, during which she made a full declaration of her love matters to 
us. This ended by her becoming fixed in a delusion that she was 
Jesus Christ. She refused all her food, and at last the stomach-pump 
had to be resorted to. This period she travestied into the circum- 


90 Clinical Notes and Cases. [ April, 


stances attending the Crucifixion in a manner very painful to the 
lookers-on, showing a most morbid knowledge of the real events of 
that time, and a wonderful ingenuity in fitting facts. She had names 
for us all—Peter for myself, as I had to use the instrument, and 
therefore “smote”? her. The operation had to be repeated a few 
times ; she then had a succession of fits, and had to keep her bed on 
the 13th of November. She had been taking bromide of potassium 
and bromide of ammonium in various doses and combinations. All 
through her illness she has shown herself to be very susceptible of 
bromism; the peculiar eruption and gastric disturbance appearing 
after only a few days’ dosing. As the fits were not in the least re- 
duced in number, as will be seen, the medicine was stopped, and no 
other remedies tried, except blistering the back of the neck and fre- 
quent turpentine injections. I much regret that the record of the 
number of fits occurring between Noy. 13th and Nov. 20th has been 
lost ; but I have now before me a list of the number after the latter 
date, each seizure being noted down at the time, a watchbook and 
pencil being ready on the mantlepiece for the purpose. Before giving 
the almost incredible number of these it will be well for me to describe 
them, first saying that very many of them came on in my own presence 
and that of other medical men; and from the nurse’s description there 
is no doubt that all were of a similar nature. The first warning was 
a fixing of the eyes, with the peculiar abstracted look of wondering 
horror so often seen in epileptics. The head was slowly drawn to one 
side or the other, and fixed over the shoulder. The jaw was drawn 
forcibly down, and the features assumed a curious expression, exactly 
resembling those of the Child with the broken drum, whose pas- 
sionate, screeching grimaces must be familiar to most. The muscles 
of the chest became fixed, and sometimes there was a slight gurgle, 
but never any resemblance to the epileptic cry. The pupils were 
slightly contracted, but not always; and sometimes one side of the 
face acted more strongly than the other, producing an appearance of 
unilateral facial palsy. The pulse was full and labouring, and a trifle 
slow. This condition lasted a few seconds—from five to twenty, and 
occasionally more—and then the usual clonic spasms came on. These 
were not severe, and were almost entirely confined to the muscles of 
the face and neck. The iris could also be seen wavering towards the 
end of the seizure. Consciousness was entirely abolished at the com- 
mencement, but soon returned if a succeeding fit did not follow too 
closely to allow of this. The type of the seizures will thus be seen to 
have been purely epileptic, though of the milder form. 

The record of seizures commences at 9 a.m. on the 20th. During 
the twelve hours to 9 p.m. she had 274; by 9 a.m. on the 21st she 
had 884 more, making 622 in twenty-four hours. This is nearly at 
the rate of one every two minutes, and no two fits were more than five 
minutes apart. At 9 a.m., 22nd, she had had exactly 400 more, At 
9am., 28rd, 525 more. At 9am., 24th, 395. From 9 a.m. 24th, 





1877.] Clinical Notes and Cases. 91 


she slept a great deal, having only three fits to 2.45, when they came 
on again, and lasted through the night, there being 214 recorded 
by 9 a.m. on the 25th. From this time they rapidly left her, only 
about 30 occurring on the 26th, and none on the 27th. 

~ Though, of course, any one of the fits might have been fatal under 
the preceding and succeeding circumstances, and the prospect of her 
pulling through was very remote, yet only on the evening of the 24th 
did death seem to be actually impending. The interference with the 
circulation was very marked, deep cyanosis appearing, and most 
ominous rales in the chest were heard all over the room. For some 
days before the fits became so numerous a peculiar form of stomatitis 
appeared, aphthous patches covering pretty nearly all the visible sur- 
faces of the tongue, gums, and cavity of the mouth. The growth 
from these was horribly offensive, and from one place on the roof of 
the mouth a long membranous piece hung down for two inches. This 
was removed, and left only an abrasion in the mucous membrane, 
there being no erosion underneath. This trouble yielded afterwards to 
borax and honey, but while it existed made it impossible to administer 
any food by the mouth, even had not the frequency of the fits prevented 
such being done. On the 17th, therefore, the patient was fed per anum, 
and from this date to the 25th nothing, not even a drop of water, 
passed her lips. The injections consisted of one egg, one ounce of 
brandy, and one ounce of a strong mixture of Liebig’s extract. This 
was administered every five hours. 

Since this attack the patient, though quite strong in body, has 
never recovered her former mental state. She is childishly obstinate, 
full of delusions, and easily excited. She is liable to recurrence of the 
fits in batches, and these are followed by an increase of impairment of 
speech, which symptoms came on after the large series, and has never 
left her entirely. She has written to me a detailed account of her 
former life, portions of which I append, as showing how curious are 
the twists and turns of a mind slowly carried on to insanity by the 
milder grade of epilepsy. The visions are peculiarly characteristic, and 
I have good grounds for tracing their immediate connection with her 
erotism, and the means that she takes to gratify it. 


Remarks.—The point that first attracted attention in this 
case is the frequency of the epileptic seizures, and for this 
alone it would, I believe, be worth placing on record. The 
only cases that have in my experience come at all near this 
have been some of general paralysis, but in these the fits 
have been so run together, and marked by continued stupor, 
that a line can at once be drawn between them and the one 
under consideration, in which the seizures were so completely 
separated from each other, that each constituted a distinct 
trial of the patient’s power of resisting death. More wonder- 
ful still than the number of the attacks is the fact that the 


92 Clinical Notes and Cases. [April, 


patient pulled through, and had her bodily health fully re- 
established. The case is valuable as showing that uncompli- 
cated epileptic seizures do not necessarily tend to death, 
however frequent they may be. With regard to attempting 
to stay the disease with medicine, &c., the best plan, I feel 
sure, is to throw it all to one side as more likely to do harm 
than good, and to devote all one’s energies to the adminis- 
tration of proper and sufficient nutriment. This is simple 
enough in most cases, but not so when circumstances prevent 
the natural mode being adopted. Feeding per anwm is not in 
very general favour, nor are its benefits, I believe, sufficiently 
understood or resorted to by the majority of practitioners. 
One often hears it said, “ If it has come to feeding by injec- 
tion there is no hope for the case.”’ Such is too often true, 
for the reason that it is adopted too late, when the system 
is played out, and has not sufficient energy left to accommodate 
itself to the new mode. Just in such a case after fatal ter- 
mination it is often said, ‘* You may put up as much food as 
you like, but very little is absorbed, and it does little good.” 
But our present case completely answers that; for not only 
was the patient’s strength and pulse kept up for a period of 
eight days, during which a powerful and continued strain 
was thrown on her constitution, but this was done on an 
amount that is not more than persons under ordinary circum- 
stances would take the equivalent of. 

The principal points to be attended to are—1st. To carefully 
select the materials that may be considered best to be in- 
jected, and having chosen them not to vary them unless 
urgent circumstances require it. The reason of this is that 
the bowel must naturally make preparations to qualify itself 
to take up its novel duties, and this cannot be done at once. 
Therefore, when it has so prepared itself it must be unwise to 
throw it out of gear again by altering either the consistence 
or character of the nutriment. 2nd. To avoid the addition of 
any chemical or manufactured adjuvant, e.g., hydrochloric 
acid, pepsine, &c. ‘These are not only unnecessary, but posi- 
tively prevent the continuance of the treatment for more than 
a few days. 3rd. To prevent the return of the injection. 
As is well known, the quantity of it has a great deal of in- 
fluence on its retention or rejection, As a rule no more than 
4oz. in bulk should be administered at one time. But how- 
ever small the injection is, it is of little use trying to send it 
up if, as the case often is, feecal collections block the way. 
Asa preliminary, therefore, a large soap-and-water enema may 





a377.| Clinical Notes and Cases. 93 


be used; a considerable quantity of oil being added if the 
mass is sufficiently hardened to resist the water. This may 
be repeated every other day. At the commencement of the 
treatment in spare people, position does not much matter; 
but in weakened or fat people it is of great consequence that 
the patient lie on the back, and the instrument be passed 
between the legs. The effort to roll over, after the injection 
has been given on the side is quite sufficient to ensure its 
returning in many cases. There need be no hurry to withdraw 
the nozzle of the tube, since its sudden removal often causes 
irritation and consequent ejection. If there be a round shield 
to the instrument, and this can be held to the perineum for a 
short time, so much the better. It is also a good plan to have 
a small piece of warmed flannel ready to be placed against 
the anus on the withdrawal of the tube. This is comfortable, 
and often allays the sudden impulse to use the commode or 
bed-pan. Butin spite of all these precautions the bowel 
may, and most likely will, become irritable enough to render 
it incapable of tolerating the injection. And when this 
occurs, as a rule, the sponge is thrown up, and the fight given 
over. “ ‘There is no hope now, the patient can’t swallow, and 
the bowel won’t retain the injection—he must die.” A per- 
fectly simple and common-sense remedy for this is to plug 
the anus. We have under our care still an old gentleman 
whose case has been several times mentioned, with regard 
to the extraordinary number of times that he has been fed 
with the stomach pump (over 12,000 times at the present 
moment). He periodically gets blocked up, and most alarm- 
ing symptoms appear. The only way to clear him is to 
administer large doses of oil both by the stomach and bowel, 
which latter is then plugged, and the “result” waited 
for. Notwithstanding the large quantity injected per 
anum, none of it is allowed to return by the plug, which 
consists of a sponge squeezed tight and oiled in the 
hand of the operator. I am convinced that if due attention 
is paid to these points, the treatment of many cases might be 
‘made more successful; and when it is successful there can be 
no doubt left in the minds of the patient and others that good 
luck has less to do with it than it has, or is said to have, on 
‘most occasions. ; 


Letter written by Miss X. Y., Dec. 30th, 1876 :— 


_ Was a highly imaginative child, loved to invent stories about people 
and things, telling them again, and delighting in seeing the pleasure 


| 


94 Clinical Notes and Cases. [April, 


and sometimes surprise caused by relating them, encouraged in this idea 
by ——. My mother, finding these stories continued, which J 
never saw any harm, whipped me for telling them, hoping thus to 
check what she thought was wrong, and fearing that as I grew older. 
the habit of inventing would develop into real lies, which, thank 
God, they never did. The shame connected with the punishment 
caused, as a child, the vile inclination which I never had before, when- 
ever the subject of whipping children was mentioned. This lasted 
only a few months, when my father died suddenly. This aroused me, 
and I saw the evil in its right light asa sin in the sight of God; 
prayed earnestly against it, and was thus enabled to conquer it. I 
was then nine or ten years old, and at that age gave up my heart 
entirely to God, having been well taught on religious subjects by my 
parents and by my good governess. Trouble on trouble came ——, 
and I had no one to confide in, and I longed to unburden my heart to 
some loving friend on earth; finding none, used to wander by myself 
and poured out my heart to my loving Heavenly Father. Before this I 
used to flush up suddenly, but now I had slight convulsive palpita- 
tions down the left side, taking me quite suddenly. And sometimes I 
muttered or spoke in them. My sister used to scold me for doing so, 
not knowing whatit was. On my return to the attacks increased, 
so as to cause me to call out “ Mother,” or ‘ Willie,” as the case 
might be. I was taken to Dr. , but the complaint increased, and 
I was told by an aunt injudiciously that I had epileptic fits. They 
came now only at nights. My sisters never took much notice of me, 
thinking me a grave, reserved girl. Was obliged to give up all 
study, &c., and so used to brood over the past. My dreams were all 
of heaven, and day-dreams I had none of earthly happiness. I had 
nothing but sorrow. Fits became more frequent. I began to enjoy 
church again, and read deep books on the subject nearest my heart, 
and praised be God’s holy name, I had sweet visions in the fits at 
night, and great joy in spirit. About a year ago I metone I believed 
loved me, and I returned it; then the vile inclination returned. I 
wrestled in prayer against it, but being very ill at the time I yielded, 
believing (in the delusion caused by ill-health, and having no one to 
confide in) that it was what is called love. The course of true love 
did not run smooth in my case. W., being poor and very proud, did 
not like to propose, but we understood each other. This so tried me 
that I began to have screaming fits whenever misunderstood. I did 
nothing but dream of my darling, became worse, had delusions on the 
subject of love, went to , and then came to you. On the 10th of 
November I had a most wonderful vision, which clearly showed me 
that my strange illness has been entirely the result of being misunder- 
stood. The agony of that day was the beginning of my taking no 
food, believing that I was to follow my Blessed Master even to the 
grave. Icourted not my life, “but felt ready not only to be bound, 
but to die for the Lord Jesus.’ I went through the whole Bible his- 











1877. |] Clinical Notes and Cases. 95 


tory during the illness, and took the form of every woman from Eve 
to the Virgin; and went through in agony all our Blessed Lord’s 
sufferings, repeating to myself or aloud, I know not which, all the 
words on the Cross; hence my delusions, calling my kind doctors 
biblical names. 


Cases of Insanity in which Impairment or Loss of one or more 
of the Special Senses seemed the exciting Cause of the Disease. 
By M. D. Mactrop, M.B., &c., Edin. Assistant 
Medical Superintendent, Garlands Asylum, Carlisle. 


Blindness or deafness, occurring singly, have usually a 
modifying action more or less marked on the ordinary mental 
manifestations of their subject. That this effect of the loss of 
the senses may be so marked as to amount to actual insanity 
the following cases would seem to show. 


Case I.—J. H., male, 54 years, from Westmoreland, schoolmaster. 
Admitted 5th March, 1870. First attack. Was of a quiet, sociable 
disposition, and of sober, industrious habits. No hereditary predispo- 
sition. ‘Ten years before admission he began to lose his sight, and 
has gradually become totally blind. Of late he had become suspicious 
of his wife and family, mistrusting the fidelity of the former, and 
accusing the latter of forming conspiracies to poison and injure him. 
He was at times violent and excited, and the two days before admis- 
sion he was unmanageable. ' 

When examined on admission he was found quiet, and slightly 
depressed in mind. Memory good, conversation coherent. He 
expressed the conviction that his wife had committed adultery with a 
neighbour, which was said to be a delusion. 

His bodily health was good. He was totally blind from cataract, 
for which he had been unsuccessfully operated on. > 

During his stay in the Asylum his mental state remained unchanged. 
Suspicion of everybody to a most exaggerated degree was the chief 
characteristic of his insanity. He had delusions about his wife’s un- 
faithfulness, about his food being poisoned, about conspiracies being 
formed to injure him. He thought that nearly every one who came 
near him was going to injure him in some way. He was at times, 
from the influence of those delusions, excited, and violent in his con- 
duct. He was removed by his friends in October, 1878. 

Casz II.—B. D., female, 76 years. Widow, from Carlisle. Washer- 
Woman. Admitted 22nd November, 1872. First attack. Wasa 
quiet, respectable woman. Hereditary history unknown. Two years 
ago became blind, and since then has been more or less insane, suffer- 
ing from hallucinations of sight and hearing, being at times excited. 

On admission she was found to be slightly excited. She had 
distinct hallucinations of vision and hearing. She fancied that people 
came to disturb her, to rob her, and to cause her various ills. Her 


96 Clinical Notes and Cases. [April, | 


mind was somewhat enfeebled, chiefly with reference to those halluei- 
nations. Her memory was accurate for past events, but was failing 
with regard to recent ones. Her conversation was; for the most part, 
coherent, but, she being somewhat deaf, it was difficult to converse 
with her. 

Physically, she was a hale old woman. She was quite blind from 
cataract, and was deaf; but would hear if loudly spoken to. Heart 
somewhat weak, 

She got worse mentally. She was at times very noisy at night, 
and imagined she was put out in a field, and that men with horses and 
carts came to hurt her. She was suspicious of nearly every one who 
came near her, and often vigorously assaulted any one whom she could 
lay hold of, under the impression that she had one of the people who 
caused her so much annoyance. Her increasing deafness, along with 
her complete blindness, prevented her recognising her situation, or 
those around her. She died of senile exhaustion in December, 1874. 

Casz IIJ.—A. H., female, 61 years. Widow, from Wigton. Ad- 
mitted the 8th July, 1874. First attack. Quite blind, and almost quite 
deaf. Had been noisy and violent. Noisy at night, and not taking food. 

On admission was excited and restless, shouting vigorously ; but 
evidently not aware she was talking in a more than ordinarily loud 
voice. Her mind was evidently much enfeebled. Her memory could 
not be judged, as she could hear no question. When she spoke she 
was seemingly addressing people of her own household. ‘She was 
energetically defending her character from .imputations as to its — 
respectability, which she imagined some one present was making. 

Her physical state was feeble. She was quite deaf, and almost 
quite blind. She had cataract and opaque cornee. Heart weak. 
Appetite poor. 

Since her admission she has improved in bodily health and habits. 
Her mental state has undergone little change. She is quieter. She has 
hallucinations of sight and hearing, chiefly about people who are alleging 
evil of her, and doing her other harm. She is still in the asylum. 

Caszr IV.—S. C., female, 78. Widow, from Wigton. Admitted 
11th November, 1876. First attack. (Got quite blind and deaf. 
Has been noisy and restless, and during last few nights has not slept. 

On admission she was very talkative and restless. Mind enfeebled. 
- Incoherent. She had no idea as to where she was; thought she was 
still at home, and lectured her son and daughter (whom she thought 
were present) vehemently for their misconduct to her. 

Her bodily health was very feeble. She was quite blind and deaf. 
Her taste and smell were impaired. She could speak easily and 
distinctly. 

After a few days’ nursing and attention she became quiet. She is 
perfectly helpless, and has no notion of time or place. She thinks her 
attendants are her family, and talks to them as such. As far as is 
possible for her, she is clean in her habits. The excitement and rest- 
lessness showed before admission were no doubt due to her having 


£877. ] Clinical Notes and Cases. od 


been imperfectly looked after, and, with her helplessness, caused her 
to be sent to the asylum. The deprivation of her senses, and probably 
some delusive impressions from them, prevented her from acting 
rationally. 

There is an apparently great similarity in the above cases, 
which I have selected as a typical and progressive series. The 
similarity consists in the prominence of the two symptoms, 
exaggerated suspicion and hallucinations of the affected 
senses, and consequent irrational conduct. All were blind, the 
first blind only, the latter three blind and deaf, the deafness 
varying in degree. In the first case there were no distinct 
hallucinations, but suspicion, and delusions of conspiracies. 
In the second and third cases hallucinations were most 
prominent. In the last case there was simply fatuity, and a 
sight remnant of suspicion; the loss of her senses rendering 
her quite helpless. Had she been able to see, or even to hear, 
she would have been only a mild case of dotage, and might 
have been cared for at home. 

The importance of the integrity of the senses in relation to 
mental health is great, as the proper performance of so many 
of the functions of life is dependent on them. Deprivation, 
partial or total, of the means of obtaining information regard- 
ing surroundings might fairly be expected to originate some 
derangement, both as regards the impression which the 
individual receives or retains respecting these, and his manner 
of reacting on them. Dr. Ireland* has shown deprivation of 
the senses to be a cause of non-development of mind, and it 
may be inferred from the foregoing cases that loss of the 

Senses may sometimes excite insanity of a more or less distinct 
type. 











OCCASIONAL NOTES OF THE QUARTER. 





Insanity and Intemperance. 


We extract from the “ Birmingham Daily Post” of De- 
cember 26th, 1876, the following instructive letter by Mr. 
Whitcombe, the Assistant Medical Officer of the Borough 
Lunatic Asylum :— 

Sir,—The evil effects of intemperance cannot be too widely pro- 
claimed, and, perhaps, a better knowledge of them would tend to 
| check some who have already given way to excess in drink, while it 
may deter others from falling into a like destructive course. 

* “ Hdinburgh Medical Journal,” Feb. 1874. 
XXIII. 





98 Occasional Notes of the Quarter. (April, 


With this view I have endeavoured to collect and tabulate informa- 
tion as to the influence drink has in populating our lunatic asylums, 
from which a tolerably correct estimate may be formed of its cost. 

The records of the Birmingham Borough Lunatic Asylum show 
that during a quarter of a century ended December 51st, 1876, no less 
than 3,800 pauper patients were admitted into that institution, of 
whom 525, or about one-seventh, had their malady caused by drink. 
In the same period, out of 764 private patients admitted, 142, or 
about one-fifth, were attributed to the same cause. These patients 
resided in the asylum for periods varying from one month to twenty- 
five years, or an average of twenty-three months for each pauper, and 
twelve months for each private patient. The last annual report of 
this asylum shows that the average number resident during the 
twenty-five years was 456, and that the charge for maintenance, &c. 
(exclusive of building and repairs), averaged 8s. 63d. per head per 
week. Taking one-seventh of the average number resident as the 
proportion of cases caused by intemperance, at the average weekly 
cost per head, we have an expenditure of £1,443 10s. per annum; or 
£386,087 10s. for maintenance alone. Add to this one-seventh of 
the cost of building, &c., and we have a total expenditure during the 
twenty-five years of more than £50,373. 

Large as this sum is, it cannot be looked upon as the aggregate cost 
of these cases of drink. The individual loss to the patients them- 
selves, and the probable pauperism of whole families, are items which, 
though incalculable, must not be overlooked. In making these cal- 
culations I have strictly adhered to those cases which were acknow- 
ledged by the friends and relatives to have been the result of intem- 
perance, excluding all of a doubtful character, 

It may be interesting to observe that the occupations of those 
persons who became insane through drink varied considerably, and 
included 169 different employments. Among the females, two-thirds 
were either unoccupied or only had home duties to attend to. 

It is also worthy of notice that only thirty-six out of the whole 
number of private and pauper cases admitted through intemperance 
are stated to have had a “good” education, although the majority 
could read and write. 

It would be too great a tax on your columns to enter more minutely 
into these local statistics, and I would just refer to the subject 
generally. The last report of the Commissioners in Lunacy gives 
the total number of pauper lunatics in asylums, registered hospitals, 
and licensed houses in England and Wales on the Ist of January 
last, as 85,872; the number of admissions during the year 
1875 as 11,020, and the average cost per head per week as 10s. 03d. 
From the annual reports of fifty-five asylums for the last five years 
I gather that out of a total of 33,527 patients admitted, 3,172, or 
about one-eleventh, had their malady ascribed to drink. This, I think, 
may be taken as a fair average of the whole, and shows that during 





1877. | Occasional Notes of the Quarter. 99 


the year 1875 no less than 1,000 persons became insane through 
drink, and were admitted into asylums, and maintained at a cost of 
10s. O4d. per head per week, or at the rate of £26,108 per annum. 

To ard this further, and take the eleventh part of our asylum 
population in England and Wales as the proportion caused by intem- 
perance, we have a total of 3,216 persons, maintained ata cost of 
about £83,964 per annum, exclusive of the eost of buildings. Great as 
these calculations show the influence of intemperance to be on insanity, 
it must not be forgotten that insanity is only one of the evil effects of 
intemperance. Could it be possible, by any means, to bring within 
the pale of statistical evidence the vast amount of sickness, pauperism, 
crime, and misery which is the result of drink, we should have such a 
startling account that thousands would join that band of earnest 
philanthropic workers who are striving by legislation or other means 
to eradicate this growing national curse. 

Birmingham for the year 1875 shows a much larger proportion of 
cases of insanity from intemperance than any of the fifty-five asylums 
I have quoted, with the single exception of Broadmoor Criminal 
Asylum. Surely, this fact should urge our local legislators to be 
foremost in attempting to allay such an evil. 

Thanking you for inserting this in your columns, 


I am, Sir, your obedient Servant, 
EDMUND B. WHITCOMBE, M.R.C.S.E. 





GENERAL STATEMENT OF Furty-FIvE ASYLUMS. 


The following table is a summary of the experience of the fifty-five 
asylums for the last five years :— 











Patients Admitted. Caused e Intemperance. 

M. F. Total. M. BE, Total. 
WS7i— 3,028... 2,987 ... GON... 274 40° 128°... 602 
1872 — 2,820 ... 3,041 ... 5,861 ... 414 ... 1564 ... 568 
1873 “== 23,5034 (%.,) 3,206105.56)140 2.5 AOE. 12 | 862 
1874 — 38,544 ... 8,416 .,.: 6960 ... 541... 141... 682 
WS == 40g. 1 4gBOAn soc. 80D). 4,1 BAB 56, BER; ogy (88 
16,583 16,944 32,527 2,416 756 3,172 


The Prevention of Insanity. 


In the Twenty-first Annual Report of the Trustees of the 
State Lunatic Hospital at Northampton, Massachusetts, we 
were attracted by a paragraph headed as above. Dr. Pliny 
Earle has taken to heart the complaint of some critic that 
superintendents of asylums. do not give people any instruc- 
tion as to the means of preventing insanity. In order to 
remove this reproach, he has made the following remarks, 


100 Occasional Notes of the Quarter. [ April, 


which, though brief, he considers to be compendious, and to 
cover the whole ground. They may, he thinks, furnish texts, 
or the suggestion of texts, for several scores of essays or 
sermons, and “ philanthropists, humanitarians, or ministers 
of the churches may thus make use of them, and disseminate 
the knowledge to a multifold extent.” Here they are :— 


Inasmuch as every person is liable to an attack of insanity, it is 
desirable that all should know by what means it may be avoided. 
Science has furnished no preventive, and the measures which are 
best calculated to act as such are those which characterise a life 
governed by prudence, moderation, and good judgment, and sound 
common sense. It is rational to conclude that the most certain 
method of preventing the attack of any disease is to preserve one’s- 
self from the influence of the causes of that disease. He who would 
evade the intermittent fever must not expose himself to the malaria 
whence the intermittent originates. The sources of insanity are in 
the custom, habits, and other influences of civilised life. The neces- 
sary inference is, that if we would escape insanity, we must lead a life 
as near to nature as is possible amid all the surrounding artificialities 
of civilisation. Descending more nearly to particulars, the approxi- 
mate causes of the disorder are those acts or agents which exhaust 
or depress the nervous power, and consequently debilitate the whole 
system. The man, then, who would secure immunity from insanity 
must either wholly avoid those acts or agents or preserve a constant 
watchfulness to prevent himself from being subjected to their opera- 
tion to the extent of exhaustion or depression. He must be moderate 
in all things; curbing his appetites and passions; shielding himself, 
as far as possible, from the manifold causes of bodily disease ; remem- 
bering that nature has been kindly mindful of her children in supply- 
ing them with an exhaustless fountain of the purest drink, without 
either fermentation or distillation; making neither gold, nor power, 
nor fame his god; mistaking neither nervous excitement for religion, 
nor high political agitation for a healthful preserver of good govern- 
ment; tempering his grief by a prudent judgment; converting his 
disappointments into counsellors of wisdom; and accepting all the 
blessings, whether physical, intellectual, or moral, which a bountiful 
Providence has bestowed upon him, and wisely using them “as not 
abusing” them. 


How unlucky that a lean person cannot grow fat on the 
smell of a cook-shop! We hope that our readers do not 
share our feelings, but we must confess that, after perusing 
Dr. Pliny Earle’s compendious remarks, we felt very much 
like a person might be imagined to do who, having been 
invited to a magnificent feast, was fed upon the smell of the 
dishes. Dr. Pliny Earle quotes that great philosopher, 
Sancho Panza, as to the blessings of sleep. He should have 





1877.] Occasional Notes of the Quarter. 101 


remembered, when enlightening the darkness of people with 
regard to the prevention of insanity, the painful feelings of 
that same Sancho Panza on the occasion when, having been 
made Governor of Barataria, he found the successive courses 
of his elaborate banquet appear and disappear with great 
display without his being allowed to eat anything, and at 
the end of it was left as hungry as at the beginning, with 
the additional bitterness of tantalising disappointment. 





Curability of Insanity. 


In the same Report Dr. Pliny Earle, discussing the 
different percentages of recoveries in different asylums, and 
pointing out how much the temperament of the observer 
affects his view of what is a recovery—how much, in fact, 
should be allowed for the personal equation—gives a striking 
illustration of the uncertainty of the statistics of insanity, 
from the medical history of the Worcester Hospital. Two 
Superintendents held office for a period of three years each, 
and the statistics of admissions and recoveries for each of 
these periods are as follows :— 


First Period. 


OFFICIAL YEAR. Admissions. Recoveries. ie eee 
1868-69 : . 337 149 44°21] 
1869-70 é ‘ : 384 158 41-1] 
1870-71 : ; é 470 209 44°46 

Total é ol 516 43°32 
Second Period. 

1872-73 < 3 : 407 98 24°08 

1873-74 5 5 : 400 71 L775 

1874-75  . j a 362 90 24°86 

Rotel 2000 07 WGk69 259 22-16 


Thus, although the number of admissions (1,169) in the second 
period was but twenty-two less than (1,191) in the first, the number 
of recoveries (259) was but one more than half as great. The 
proportion of recoveries of the first period is to the proportion 
of the recoveries of the second, as 195 to 100, or as 100 to 
51:15. ‘There is, in my opinion, but one explanation of this most 
surprising difference ; and that is, the difference in the physical and 


102 Occasional Notes of the Quarter. (April, 


mental constitution of the two men by whom these statistics were 
reported. Were it possible to apply to the two sets of cases a 
standard of sanity, and an accurate measure of mentality, it would 
doubtless be found that there were as many recoveries in the second 
period as there were in the first. 


An Hapenswe Asylum. 


We take the following from the same report in regard to 
the State Hospital for the Insane, Danvers, Massachusetts :— 


Let it be granted, for the present purpose, that the building may 
give suitable domicile to five hundred patients. From the data 
given, the fact is derived that the cost of the hospital will be at the 
rate of three thousand six hundred dollars per patient. 

If a State can afford to expend that sum of money in a dwelling 
for each of a large class of its wards, we may celebrate the advent of 
a new era in political economy, or be forced to acknowledge that the 
hitherto recognized principles of that science are all at fault. No 
monarchical State, it is safe to assert, has ever attempted such an 
enterprise. If a republic, more hazardous, ventures to do it, then we 
may readily believe that it was not without good reason that Montes- 
quieu declared that ‘“ republics fall by luxurious habits.” If pro- 
vision so costly of mere shelter and lodging, preparatory to the 
further provision of clothing and sustenance, for dependent persons, 
many of whom are fully capable of earning their support, be not a 
remarkable evidence of luxurious habits, it would be difficult, how 
closely soever the various spheres of society might be scrutinized, to 
discover any such evidence. 

Perhaps something may be excused to the inherent fondness for 
ostentatious display manifested by the race in all ages, conditions, 
and degrees of enlightenment. Having no sovereign, under what- 
ever title, upon whom to lavish the means for external grandeur, we 
build palaces for our insane as a substitute; and even many a royal 
palace, and that, too, in the European nations, is neither so large nor 
So pretentious, architecturally, as the hospital at Danvers. Three 
thousand six hundred dollars per patient, for a place of domicile! 
Scattered all over Massachusetts there are hundreds, perhaps thou- 
sands, of farms, averaging one hundred acres of land each, with a 
good country dwelling-house of two stories in height and from three 
to five rooms upon the ground floor, a suitable barn and (often) other 
out-buildings, and wood sufficient for the perpetual maintenance of 
two fires; and any one of these farms may be purchased for less 
money than that. The marketable value of more than five hundred 
such farms will be spent in the construction of that hospital, If the 
Commonwealth should buy that number of them, and give them, in 


1877. ] Occasional Notes of the Quarter. | 103 


perpetuity, to the five hundred perpetuity persons who otherwise will 
occupy that hospital, and then pay to each of those five hundred 
persons three dollars and fifty cents. weekly for his support, would 
not the proceeding be considered a most glaring instance of extrava- 
gance? Yet this, substantially, is precisely what the Commonwealth 
is doing, and will do, at Danvers. 


The Unconsciousness of Genius. 


Sir James Paget’s neat and graceful, but not very deeply 
thought out, Hunterian Oration at the College of Surgeons 
has excited in the bosom of the “ British Medical Journal ” 
a gushing enthusiasm which it apparently finds a difficulty to 
express adequately. It is described as ‘‘a masterpiece of 
modern oratory,” “a gem of critical literature,” as “ resplen- 
dent with purple patches” (whatever they may be), and 
“starred with gems of thought,” as presenting “a picture 
which will live in literature and which shines with all the 
beauty of truth ;” and so on in similar outbursts. Probably 
Sir James Paget will be more surprised than any one else to 
find that he has produced such a gigantic work of genius, 
and, if he accepts this almost feminine effusiveness seriously, 
may consider himself as an instance aptly proving the truth 
of an opinion which he expressed in his oration, that true 
ereatness is ever unconscious of its powers. Of one character 
of Hunter’s mind he spoke thus :— 


I mean the unconsciousness of its own mental power. He could 
be provoked, in his later life, into saying that he knew better than 
some of those that spoke ill of him; but he said he felt a mere pigmy 
in the presence of the work he had to do; and even the sensitiveness 
and vexation with which he sometimes speaks of rivals is enough to 
prove that he doubted whether he did work good and great enough 
for permanent renown. He stands as he stands all other tests, so 
this of mental greatness, well—the test of self-unconsciousness; and 
it is happy for science he did so. 


Is it then so certain that the test of mental greatness is 
unconsciousness of its power? We know that an opinion of 
this kind is sometimes confidently enunciated, and used as a 
sort of rod to correct the presumption of young ambition, 
and that Shakespeare is quoted as an example and a proof. 
On the face of it, however, it seems rather strange that the 
person who of all men is supposed to have the greatest 
power of insight among his cotemporaries should have the 


104 Occasional Notes of the Quarter. [ April, 


least insight into his own powers. A man may feel himself a 
pigmy in the presence of the exhaustless field of work which 
Nature offers him to do, as Newton did and as Hunter did, 
and at the same time feel himself something like a giant 
among the pigmies who are associated with him in doing it. 
We are not qualified by adequate study of Hunter’s character 
to controvert Sir James Paget’s opinion with regard to his 
unconsciousness of his mental powers, although we should 
have thought that the evidence pointed to a pretty good 
opinion of them on his part; but we hesitate not to question 
his general dictum, and to assert with some confidence the 
error of the notion that Shakespeare was unconscious of his 
mental powers. Any one who will read his ‘ Sonnets ” care- 
fully may convince himself that Shakespeare had, even early 
in his career, a well-grourded conviction that he was pro- 
ducing work which would not soon die. 

Now with the drops of this most balmy time 

My love looks fresh, and Death to me subscribes, 
Since spite of him I’]] live in this poor rhyme, 
While he insults o’er dull and speechless tribes. 
And thou in this shalt find thy monument, 


When tyrants’ crests and tombs of brass are spent. 
Sonnet cvil. 


Tt seems almost as improbable that Shakespeare should 
have done what he has done, and have been unaware of his 
mental greatness, as that a victor in the Olympian games 
should have been unaware of his superior bodily powers and 
training. Certainly he was no mere automaton. Hear what 
Coleridge, who, perhaps, of all men since Shakespeare had 
the most Shakespearian range and depth of thought, said of 
him and his work :— 


No man was ever yet a great poet without being at the same time 
a profound philosopher. or poetry is the blossom and the fragrancy 
of all human knowledge, human thoughts, human passions, emotions, 
language. In Shakespeare’s poems the creative power and the in- 
tellectual energy wrestle as in a war embrace. . . . . . What 
then shall we say? Even this; that Shakespeare, no mere child of 
nature; no automaton of genius; no passive vehicle of inspiration 
possessed by the spirit, not possessing it; first studied patiently, 
meditated deeply, understood minutely, till knowledge, become 
habitual and intuitive, wedded itself to his habitual feelings, and at 
length gave birth to that stupendous power by which he stands alone 
with no equal or second in his own class; to that power which seated 
him upon one of the two glory-smitten summits of the poetic moun- 
tain, with Milton as his compeer, not rival. 


1877.] Occasional Notes of the Quarter. 105 


Now Milton, in early manhood, set before himself with 
deliberate resolve the aim to produce a great work which 
should be immortal, showing a confidence in his powers 
which to others might well have seemed insane presumption. 
if then we are to accept Sir James Paget’s test of mental 
greatness, we must conclude that Shakespeare and Milton, 
having been plainly conscious of their mental powers, were 
not great men. What too of Turner among painters? 


An Antilunatic Remedy. 


The following epitaph wiJl perhaps be interesting to 
those who hold the doctrine that alcoholic indulgence has 
its compensating uses in the prevention of insanity. It is 
given by M. Lejoncourt, in his “ Galerie des Centenaires :” — 


Sous cette pierre git Brawn, qui, par la seule vertu de la biére forte, 
sut vivre cent vingt hivers. Il était toujours ivre, et, dans cet état, 
si redoutable que la mort elle-méme le craignait. Un jour que, 
malgré lui, il se trouvait rassis, la mort, devenue plus hardie, lattaqua 
et triompha de cet ivrogne sans pareil. 


If the doctrine be true that surcease of sorrow by alcohol 
will hold insanity at bay, an apt emendation may be sug- 
gested in the well-known words of the Friar to Romeo— 


Tl give thee armour to keep off that word 
Adversity’s sweet milk, strong alcohol, 
To comfort thee, though thou art sorrowful.* 


The Consolations of Spiritualism. 


We extract froma lecture in the “‘ Spiritualist ’? newspaper 
the following remarks, which the lecturer pours out after 
some reflections upon the dreary belief of materialists 
“inside and outside the churches” :— 


And in modern times, and in Christian countries, when by the side 
of the grave the earth falls upon the coffin of the loved one, and the 
ery arises of “ Earth to carth, ashes to ashes, dust to dust,” how 


* We put the proposed emendations in italics, lest some one should hereafter 
seriously quote the lines as Shakespeare’s. We observe that the Hditor of the 
‘“‘Philadeiphia Medical Times” quotes with serious approval ‘‘ Punch’s” regula- 
tions that inall future football matches a surgeon shall be on the ground, an 
ambulance in attendance, a ward prepared at a neighbouring hospital, &c., 
and strongly recommends them for adoption in America. 


106 Occasional Notes of the Quarter. [April> 


coldly fall the words of the speaker, how unreal seem the pictures of 
life after death. But when at the spirit circle the departed wife of 
Mr. Livermore, the New York banker, appeared to him radiant with 
life, and with more than human beauty, came to him with joy in her 
face, and the bright light of happiness in her eyes—came to him with 
flowers from the land beyond the tomb, and wrote long messages to 
him before his eyes in her well-known handwriting, that he might be 
sure afterwards that it was not a mere heavenly vision too bright for 
earth,—when such a revisitation as that took place, where was the 
gloomy influence of the voice of the conventional preacher ? where the 
chilling effects of all the gloomy paraphernalia of death? and where— 
above all these—was the inconsolable grief for the loss of the loved 
one gone before? What, think you, is the amount of responsibility 
of those authorities in our land who exert all the temporary influence 
they possess to keep back from mankind such a revelation and conso- 
lation as this ? 


But where would be the consolations of the revisit if the 
bereaved husband did not greatly desire it? Who is to keep 
quiet those restless spirits which, having plagued you while 
embodied, will not leave you in peace when they have got 


themselves disembodied? With a doctrine, as with a tree, 


when it is undergoing decay parasites grow upon it and 
hasten its decomposition. 





Canine Hallucination. 


A dog, into the stomach of which M. Magnan forced five 
erammes of the essence of absinthe, was first attacked with 
violent convulsions; at the end of an hour, without any pro- 
vocation, it started up suddenly on to its feet, its hair stand- 
ing-on end, its countenance fierce, its eyes bloodshot and 
glaring. It looked fixedly towards a completely bare wall, 
on which there was nothing whatever to attract its attention, 
leaning forward on its feet, with extended neck, ready to 
make a spring. It advanced and retreated alternately, 
barked with rage, and seemed to engage in a furious fight, 
Snapping its Jaws and jumping quickly about as if to seize 
its adversary; it then shook its head from side to side, with 
clenched teeth, as if it were tearing its prey. By degrees it 
became calm, looked several times, growling, in the same 
direction, and after a while settled down entirely. 


| 


1877.) Occasional Notes of the Quarter. 107 


On the way to Madness or to Suicide. 


Dr. Maudsley has received the following painfully interest- 
ing letter, which we should not publish now but for the 
writer’s desire that his case, so well analysed by himself, may 
be of scientific service. He has not sent his name and 
address, so that it has been impossible to suggest a word in 
season—supposing that any word would be in season—in his 
case. How sad to think that he is going the way of unwisdom 
in his course of life; flying, as he is, from that which would 
alone save him from himself—sympathy with, and work for, 
his kind! Action is the true cure for his suffering, and the 
motto which he should take to heart is the motto, “ Laborare 
est orare.” Let him get a good mission—it matters not much 
what: the establishment of a St. George’s Union of persons 
who would have bread made of something better than wheat, 
if he will—and throw himself heart and soul into it, and he 
will save himself in saving others. The highest results of 
the wisest striving culminate in a more or less complete 
self-surrender; and if a man could carry such self-surrender 
to its utmost reach, he would attain to that state of complete 
annihilation of self in which sorrow and pain could not touch 
him more, but he would, even before being delivered from 
the burden of the flesh, have his perfect consummation and 
bliss in the blessed nothingness of Nirvana. 


Paris, December 18, 1876. 
Prof. Henry Maudsley, London. 


Sir,—For some time past I have been impressed with the idea 
that my mental condition was not r7ght—that during the past two years 
a perceptible increase in morbid derangement of the mental faculties 
—slight, indeed, but progressive—has taken place. There are some 
Secrets which a man prefers never to tell, some confessions never to 
make, and this is one of them. After all, it may be only fancy; and 
why confess to that which, if known to others (as it mzght not be, 
except by your own confession), renders you a man marked for life? 
Task myself this question, and resolve to be silent. But then, as a 
medical man, I know the importance of early symptoms. I know 
that in many cases of mental alienation they are entirely overlooked, 
until some catastrophe suddenly reveals the disease. And I have 
finally concluded to state my case to you, holding back my name. If 
nothing further happens to me—if years go by and find my fears to 
be fancies, my apprehensions absurd—I shall write you again, and so 
inform you. If worse happens, I shall leave among my papers from 
this day an injunction to my friends that they furnish you with full 
information. 


wae 
pa 


108 Occasional Notes of the Quarter. [April 


In my family history there is no case of actual insanity, so far as 


IT know. My father was always a morbid, solitary man, preferring to 
be alone, unsociable, inclined to melancholy. He married my mother 
for a second wife at the age of 40, The union was unhappy. Poverty 
came, and with it children. And to neither did he take kindly. I 
do not remember ever sitting down of an evening and conversing 
with him in my life. Probably all the words he ever said to me, from 
youth to the day of his death (when I was 25), could have been 
spoken continuously in two hours. We learned to know that he 
preferred not to talk, and so did not talk to him, nor, while children, 
in his presence. He grew somewhat more communicative in later 
years, and died of typhoid pneumonia, at the age of 69. 

By his first wife he had a son and two daughters, The son (my 
half-brother), at 28, was attacked by small-pox. In some way the 
"expression of a young lady to whom he was engaged, referring to his 
probable disfigurement from the disease, was reported to him. The 
same night he sent his nurse out of the room, got out of bed, and 
procured a razor, returned to his bed, and cut his throat. One of my 
half-sisters—the youngest—-died of consumption at 21; the other, 
married, is still living, age 44, and has a large family. Health good. 

My mother was the youngest child .of a large family, and born 
when her mother was 48 years old. She was always delicate as a 
girl. At 24 she married my father, several years her senior. During 
the first years of her married life she was especially unhappy, and, 
I believe, during an attack of fever, attempted suicide. Her first 
child (myself) was not born till four years after marriage, but on my 
fourth birthday I had three brothers—a birth each year following 
mine. Asa mother, she was always excessively devoted, kind, and 
desirous for her children’s improvement. She laboured very hard 
to educate us, depriving herself of food and raiment to give more to 
her children. I am able to see, however, two mental peculiarities, 
which, to a certain degree, I think, have been inherited by all her 
children—I1st, a tendency to exaggeration, leading her so far astray 
from actual facts as to form entire perversions of truth. The exact 
truth I do not think she ever told upon any subject whatever; it was 
always discoloured by passing through her imagination. As she 
grew older this trait increased. 2ndly, an intense suspicion of the 
motives of every person’s actions, especially where she was con- 
cerned in the slightest degree. No action ever occurred, admitting 
misconstruction, where the misconstruction did not to her appear 
most probable. Regarding actions which did not concern her, this 
peculiarity became an analysis of motives which pierced through 
hypocrisy and cant unerringly ; its intensification regarding anything 
relating to herself led her into error, I think, often. She was always 
emotional—probably hysterical, in the medical usage of the term. 

So much for family history. 

Tam 34; always enjoyed good health ; married at 26 ; no children. 


ie Sl 


1877.] Occasional Notes of the Quarter. 109 


Was a book- keeper, or cashier, in a large establishment for 13 years. 
About six years ago began the study of medicine while performing 
my ordinary duties, which occupied only part of my time. Three 
years since, while thus employing my time to increase my income, 
took a house, and took into my family a number of pupils attending 
a school or college, becoming responsible for them at all times. I 
worked hard, and worried more. At last I could not hear a door open, 
or a voice unusualty loud, or a sudden noise of any kind, without its 
causing palpitation of the heart and a nervous shock. I lost flesh 
and sleep, and finally threw up my engagements, stopped study, and 
came abroad. 

I have wandered for two years. I eat well and sleep well. My 
wife has joined me. I have, with her, about £200 a year and no 
responsibilities. 

But I am subject to fits of great despondency, in which death seems 
better than life. During them I am lable to treat my wife unkindly 
—not using violence, of course, but using the unkindest expressions. 
She seems in my way—in some vague, indefinite manner. Then 
Iam gloomy, morose, silent, or talking much to myself. The cloud 
lifts in a few days, and I enjoy life, for a time, comparatively well, 
without enjoying it ever very much. 

My sight has slightly failed, especially in the right eye. I have 
always been myopic, but some progressive change has taken place 
during the past eighteen months. 

My imagination grows more vivid; I seem to see faces in care- 
lessly-arrayed drapery, stains, or any carelessly-placed objects. Not 
that I ever mistake them for other than they are, but that a resem- 
blance to something alive is instantaneously and unconsciously per- 
ceived in any form or outline seen. 

I cannot fix my attention as I once could; I cannot study and 
remember well. With an intense hatred of doing nothing, I seem to 
_be forced to accomplish nothing. I do not take pleasure even in my 
profession ; but then I have never practised. I long to be porne, but 
am perforce an idler. Then I have no drawings homeward—only 
an attraction to go—to go somewhere, somewhere else. My penman- 

ship, style of writing, has changed. I have grown very irritable— 
chiefly at myself or inanimate objects which w7ll annoy me. 

I know I am not insane to any degree now. I have no illusions or 
delusions. My sleep is very good—I sleep, in fact, too long; but 
my mental health is not what it once was.’ 

If this self-diagnosis is of any use to you, sooner or later you shall 
hear the sequel, either from myself or others. It is only because 
I hear that it might be of possible value that I have written it—not 
for any benefit to myself. 


I remain, sir, your obedient servant, &c. 








110 [April, 


PART II.—REVIEWS. 





The Spiritual Body: An Essay in Prose and Verse. By 
JoHn Cuartes Ears, B.A. Longmans, Green, & Co. 
1876. | 


This volume is half prose and half poetry, and we shall 
best give a notion of its aim and character by quoting the 
following three verses :— 


IMMORTAL FORM. 


Immortal life implies immortal form, 

Else could we never hope to find a place 
Of peace and reparation after storm, 

Nor see the world’s Redeemer face to face. 


Whatever promises of life He gave— 
Of life beyond this vestibule—imply 

That none of those He came to seek and save 
In body or in soul can ever die. 


No, not one instant will He suffer Death 
To triumph o’er the work of His own hands, 
The natural body draws its last, last breath— 
Lo, in its place the spirit-body stands! 


The author tells us that when the idea of the spiritual 
body was first suggested to him it broke on his mind like a 
flash of heavenly ight; and now that he has brooded over it 
for years, it seems to him the true and only solution of many | 
scriptural, theological, and scientific difficulties. Having 
never experienced the sensation, we know not what sort of 
inspiration a flash of heavenly light may be, but we should 
have thought that Mr. Harle might have got the idea any day 
in any ordinary way from Paul’s Epistle to the Corinthians. 
Perhaps, however, he means that the “spiritual body” of 
the Apostle was mere words to him, until, by aid of scientific 
conceptions of extremely fine and subtile matter, he suc- 
ceeded in forming for himself a distinct conception of it. 
For we have now, he says, “no difficulty in believing, on 
scientific grounds, that the air around us may be tenanted by 
intelligent spirits in robes of finest matter, invisible to us ~ 
under ordinary circumstances, yet not of necessity either 
invisible, inaudible, or intangible.” If it be so, we sincerely 
hope that science will make haste to discover some subtile 
agent which, diffusing itself actively, will speedily disinfect 
the atmosphere of beings who have such an unfair advantage 
over us. 


1877. | Reviews. 111 


The spiritual body is a perfect resemblance and reproduc- 
tion, under altered conditions, of the natural body ; it retains, 
therefore, the indelible traces which successive acts of con- 
sciousness leave within us. We are writing daily our 
thoughts and deeds on imperishable tablets; shall be wit- 
nesses hereafter for or against ourselves, when we come up 
for judgment; carry with us through the gates of death our 
condemnation or acquittal. Heaven, hell, and purgatory are 
present as well as future, and we are all even now in one or 
the other of these states. This was Swedenborg’s idea, we 
believe, and it is certainly a consoling reflection; for it may 
comfort our hearts when we see the oppressor triumphant 
and the wicked man prosperous, to know, although he does not 
know it, that he is in hell; it would be a greater comfort to 
a malignant heart, perhaps, to feel that the treacherous man 
who dealeth very treacherously could, by one lurid flash of 
infernal light, be made to know himself that he isa damned 
soul. As itis, unfortunately, he seems to be quite happy to 
be in hell, or, at any rate, like the recently parturient female, 
to be as well as can be expected under the circumstances. 

The spirit-body possesses the power of projecting itself to 
a distance, and retaining its connection with the natural 
body by a cord of light. This explains St. Paul’s experience 
in being caught up into the third heaven, and it was in this 
way “ that St. Alphonso Liguori assisted at the death-bed of 
Clement XIV. on September 21st and 22nd, 1774, while he 
remained, as to his body, in his arm-chair perfectly motionless 
and without articulating a single word during a day and 
night.” That the spirit-body can thus manifest its presence 
outside of its more material tenement is a well-established 
fact, supported by the testimony of persons of every shade 
of opinion on matters connected with science and religion, 
among whom Mr. Harle quotes, as distinguished witnesses, 
Mr. Malcolm MacColl, Serjeant Cox, and the authoress of 
“The Gate’s Ajar.” It is this spiritual body which will rise 
from the grave of the natural body at the moment of death, 
and will preserve the identity of the latter under altered con- 
ditions. And when the end comes, those who have risen from 
the dead will come with Christ in their spirit-bodies, and 
meet “in the air”? those who, remaining alive on earth, will 
be instantly changed as if by death, but without death, into 
the like spiritual “form. All which though the present re- 
viewer most devoutly disbelieves, yet he holds it not unmeet 
it should be thus set forth, as an ensample to future times of 


112 Reviews. | [ April, 


the state of what its writer believes to be advanced religious” 
thought in the nineteenth century. 

Mr. Earle writes clearly and vigorously, and there can be 
no question that he is very much in earnest. We should not, 
perhaps, agree with some of the reviewers, whose complh- 
ments he has extracted by way of recommendation of his 
book, that he is a great poet; but as we began this notice by 
giving our readers a specimen of his poetical powers, we will 
end with another poetical quotation :— 


A TRUER TRUTH. 


The truth that Paul delivered is o’ergrown 
With rank tradition, but the hour is nigh 
When isles that in perennial summer lie, 
And icy tracts where arctic tempests moan, 
And bamboo plains within the torrid zone, 
And mission ships that in all waters ply, 
And darkling tribes that for the true faith sigh 
And aspirations after science own, 
A truer resurrection truth shall know— 
That death from death a double life will save, 
A body from the body will set free— 
That mortal sowers in the furrow sow 
The husk that mingles with earth, air,and wave, 
But do ‘‘ not sow the body that shall be.” 


In the mouths of those who, like Mr. Earle, thus spiritualise 
matter or materialise spirit—let them choose which expres- 
sion they will—where lies the reproach of “‘ materialism” ? 


Hay-Fever, or Summer Catarrh: Its Nature and Treatment. 
By Gzorce M. Bearp, M.D. Harper Brothers: New 
York. 1876. 


We are afraid that Dr. Beard writes not wisely but too 
fluently for his permanent fame. The hurry of American ~ 
life, at any rate in New York, seems to drag the doctors on 
with it; the consequence being that we get too much hasty 
work which has the look of appealing more to popular 
admiration than to mature professional appreciation. We 
are not thinking of Dr. Beard in the least when we say that 
New York has given birth to much objectionable popularisa- 
tion, if not charlatanism, of medical thought and practice, 
disguised sometimes with great ingenuity in a scientific garb ; 
and we were very sorry when the “ Chicago Journal of Ner- 
vous and Mental Diseases,” which began so well, was trans- 
planted to that dangerous soil. It would be a rash and un- 
warrantable thing to express an opinion concerning the status 


1877. | Reviews. 113 


- of a profession ina country with which we are not practically 
acquainted, but we have thought sometimes that a supreme 
professional representative body, with some power to regulate 
the conditions of admission to degrees and upholding a high 
standard of professional ethics, would have a _ beneficial 
influence upon the standing and the tone of the American 
medical profession. We feel the less hesitation to express 
that opinion, as we learn from the ‘ Philadelphia Medical 
Times” that a Russian physician, Dr. Wiwodzow, who was 
sent to Philadelphia by the Russian Government, has recently 
communicated to the Society of Physicians of St. Petersburg 
the disappointing results of his visit. “He had become 
thoroughly acquainted with the organisation of the medical 
institutions, and had come to the saddest conclusions with 
reeard to them. He said that the medical sciences were 
utterly neglected, that young men entered the Universities 
entirely unprepared for a medical study, and that, besides 
this, the whole course extended only over two years.” The 
editor of the “‘ Medical Times ”’ seems to endorse these stric- 
tures, for he says :— 


Our medical educational system is certainly well fitted to serve— 
like the ‘frightful example” of the temperance lecturers—to show 
the results of leaving the medical profession at the mercy of itself and 
of every dishonest member in its ranks. We sincerely desire—hope 
would express too much of expectation—before we go hence to see 
the strong hand of law laid upon the present unbounded license, if not 
licentiousness, of medical education. It is a matter which must 
prove a perplexing puzzle to most foreigners, how with such a system 
we can develop, as we do in every practical branch of medicine, 
scores of physicians fitted to stand before kings and princes, many of 
them indeed even veritable kings in their professional realms. 


Dr. Beard always displays originality of thought, although 
apt sometimes to think original what is only original to him, 
and gives clear and vigorous expression to his views, and we 
| once expected from hima thoroughly systematic and original 
| contribution to medical science worthy of his powers, but we 
feel doubtful now whether he will not dissipate himself in 
multitudinous channels. The small work which he has just 
published on ‘‘ Hay-Fever” contains the results of very 
painstaking enquiries, and is an instructive contribution to 
| medical science, but it will not commend itself altogether to 
| English tastes. A title-page of elaborate details, informing 
| us among other things that the book deals with a “July 
SALE. 8 









114 Reviews. [April, 


cold, hitherto undescribed,” and recording the author’s 
qualification as a member of we know not how many learned 
societies (of most or all of which, we presume, any qualified 
medical man who will pay the required money might become 
a member); and numerous letters from patients and others, 
giving in detail stories of their own illnesses and of their 
father’s and grandfather’s illnesses ;—these are calculated to 
produce—in this country, at any rate—a less favourable 
feeling with regard to the book than it really deserves. 

The two main conclusions to which Dr. Beard’s laborious 
enquiries have led him are that hay-fever is more markedly 
hereditary than any disease of which statistics have been 
gathered; and that the majority of its victims are of the 
nervous diathesis, and suffer otherwise from an indefinite 
number of nervous symptoms. His theory, in fact, is that 
the disease is a complex resultant of a nervous system 
especially sensitive, acted upon by the enervating influence 
of heat, and one or other of several exciting irritants. 


The transmissibility of the disease from parents to children; the 
temperaments of the subjects; the capricious interchanging of the 
early, the middle, and the later forms; the periodicity and persistence 
of the attacks and their paroxysmal character ; the points of resem- 
blance between the symptoms and those of ordinary asthma; the 
strange idiosyncrasies of different individuals in relation to the 
different irritants ; the fact that it is a modern disease peculiar to 
civilisation ; the fact that it most abounds where functional nervous 
disorders are most frequent, and is, apparently, on the increase part 
passu with other nervous diseases ; and, finally, the fact that. it is 
best relieved by those remedies that act on the nervous system—all 
these otherwise opposing and inconsistent phenomena are by this 
hypothesis fully harmonised. 


The data upon which he bases his theory will be found set 
forth at length in the volume, which contains also a summary 
of the theories and observations of other persons. 

A detailed review of the history, the symptoms, and the 
treatment of hay-fever would be out of place in this Journal, 
but the reasons which Dr. Beard adduces in favour of his 
opinion that it is primarily and essentially a neurosis, and 
that it runs in families, founded upon an analysis of the 
statistics and histories of two hundred cases, will be found 
interesting and suggestive. Dr. Beard mentions several 
curious instances of individual susceptibility to various irri- 
tating substances, e.g., one strong man was seized with 


1877. | Reviews. 115 


asthma whenever rice was threshed near his house; a woman 
had a fit of asthma if she entered a room when a feather-bed 
was being shaken; a physician of New York cannot sleep on 
a feather pillow, &e. 





Histowre de Progres de la Médecine Mentale depwis le com- 
mencement du XIX* Siecle jusqwa nos Jours. Par le 
docteur F. Lentz. Gand. 1876. 


To this essay the Medical Society of Gand awarded the 
Guislain prize. Certainly the author went the right way to 
work, by his extreme glorification of Guislain, to prejudice in 
his favour the awarders of a Guislain prize. He declares 
him to have accomplished the greatest progress in mental 
science since Pinel, to have revolutionised the study of mental 
diseases, and to have done so much that researches since his 
time have added next to nothing to his clear and elevated 
views. His work, he tells us, will remain a lasting monu- 
ment, the glory of which no one will ever share; and mental 
pathology at this moment awaits anxiously the advent of 
another Guislain, who shall make cosmos out of chaos. His 
influence was so great that there 1s not a branch of psychi- 
atry at the present day which is not based upon his patholo- 
genic principles; not a branch thereof in the progress of 
which he has not almost always had the lion’s share. It was 
he who made the first scientific path in mental etiology, in 

which Griesinger in Germany and Morel in France have done 
no more than follow him. There can be no question that 
Guislain did great service to his country by the reforms which 
he effected in the administration of Belgian asylums, and 
that his scientific merits were of a very high order; but 
whether he was so great a genius, and did so much for 
psychology, as his proud and admiring countryman alleges, 
one who is not a Belgian may well feel less confident. 

Making due allowance for his patriotic partiality, Dr. Lentz 
appears to have given, on the whole, a clear and just sum- 
mary of the progress of knowledge of mental diseases and 
their treatment. The story which he has to tell is chiefly a 
story of French progress; for it is surprising how small a 
| place the work of this country, or of any other country but 
| France, has in the development of this branch of medicine, 
| when the record comes to be written. The few English 
names which Dr. Lentz finds occasion to mention he seems 





116 Reviews. [April, 


to mention rather out of an amiable desire not to leave this 
country unnoticed, than because he has much to say about 
their contributions to progress. One name, that of Conolly, 
which he mentions once only, we believe, and in the most in- 
cidental manner, might properly have filled a larger place in 
a so-called history of the progress of mental medicine. It is 
too evident, however, that Dr. Lentz does not in the least 
comprehend the great principles which underlie the applica- 
tion of the non-restraint system, and we much fear that, in 
regard to this matter, he is still in the bonds of darkness and 
the thrall of iniquity. He speaks highly of Morel and of 
Griesinger: has it never occurred to him that these men 
who made a practical study of the non-restraint system 
in English asylums, and who ever afterwards were earnest 
advocates of it, were not likely, being wise in other matters 
above other men, to be fools in this ? 





The Principles of Punishment as applied to the Administra- 
tion of the Criminal Law. By Epwarp W. Cox, Ser- 
jeant-at-Law. 1877. : 


Itis a thousand pities that Mr. Serjeant Cox does not give © 
us more of his mature experience as a magistrate, and less 
of his crude experience as a psychologist. If he would only 
let the “‘ spirits” be, he would get more attention given to 
the valuable suggestions which he has to offer with respect 
to the principles by which punishments of criminals should 
be determined. We have found this book suggestive and in- 
structive; the opinions put forward in it are informed by a 
long practical experience of criminals; and the reader will 
not find himself either sickened by a sentimental or offended 
by a brutal view of these pests of society. 

Hverybody knows that many crimes are committed without 
being punished, and any one who has lived to middle age has 
found out probably that it is better to suffer a great wrong 
than to go intoan English law court. A man who prosecutes 
a thief who has robbed him, or a swindler who has cheated 
him, or a ruffian who has half murdered him, is no doubt a 
benefactor to society, but he is as great an enemy to his own 
comfort and interests as it is possible for a man to be. What 
does the reader think of the following estimate of the chances 
of-a prisoner’s escape ? 


Bro? /.| Reviews. 112 


Experts have estimated the chances of escape as thus: In but one 
Jarceny in eight is the thief detected, of those detected only one in 
three is prosecuted, from reluctance to incur certain trouble and 
probable cost. Of those who are finally prosecuted, nearly one-half 
are acquitted. Thus the chances are largely against any particular 
crime bringing the criminal to punishment. 


Serjeant Cox thinks that if punishment could be made to 

follow surely and speedily upon the heels of crime, criminals 
would almost cease to be. It is plain that they are not likely 
soon to cease to be from that cause ; for the chances of escape 
now are about twenty to one in favour of the prisoner, 
instead of being twenty to one against him. 
_ We have made sometimes sharp criticisms of Mr. Serjeant 
Cox’s writings, but in this volume he has written only of 
what he understands thoroughly, and it seems to us that all 
those who are concerned in the administration of the law will 
find in it useful suggestions and sensible advice given in a 
kind and manly spirit. | 





Notes on Asylums for the Insane in America. By Joun 
CuHarues Bucknitt, M.D., F.R.S., F.R.C.P. 


This little book is a reprint of articles which have appeared 
in the ‘“ Lancet,” and our readers already know its contents. 
Dr. Bucknill’s criticisms of American Asylums have caused 
much controversy both here and over there, and we have 
reason to believe that they have done good. But Americans 
say that these notes were not taken on the spot in each 
asylum visited, and therefore, that they abound in inaccu- 
racies. The preface to the book was not published in the 
“ Lancet,’ which at once repudiated Dr. Bucknill’s assump- 
tion there made, that its “Editor ” had come to a better way 
of thinking. 


118 (April, 


PART lli—=PSYCHOLOGICAL RETROSPECT, 


1.—German and French Retrospect. 


Recent Progress in the Histology, Physiology, and Pathology of the 
Central Nervous System. By Wm. Strruine, D.Sc., M.D., C.M., 
Demonstrator of Practical Physiology in the University of 
Edinburgh. 


On the Dependence of the Waking Condition of the Brain on 
Eaternal Irritations.—Dr. Emil Hewbel, of Kiew (‘ Pfluger’s Arch.,”’ 
Band xiv., p. 158), publishes a long contribution to the physiology of — 
sleep and the confirmation of Kircher’s experimentum mirabile and 
hypnotism. But it is not a little strange that in connection with this 
subject the name of Braid, of Manchester, is never mentioned. 

It is a well-known fact that many animals which have been held or 
prevented from moving for a short time, and when they have become 
quiet are again loosed, remain for a few minutes quite motionless, often 
in the most unpleasant and unnatural position. Kircher, who, in 
1646, experimented on hens by drawing a line with chalk before their 
eyes, was the first who directed attention to this subject. Recently, 
in Germany, J. Czermak experimented upon the ordinary hen, on the 
turkey, duck, goose, swan, on pigeons, and on small singing birds. 
He recognised the fact that this condition might be produced by 
simply holding these animals gently for some time, and then carefully 
removing the hand. He regarded the result as a genuine hypnotic 
condition. 

Preyer, of Jena, experimented not only on hens, but also on rabbits, 
guinea pigs, and on frogs. He remarked that the animals closed their 
eyes for a short time, and he explained the phenomena as due to the 
condition of terror or fright produced in the animal by the experi- 
menter, After a time, he says, the animal becomes quiet, and if the 
hands are now gently removed it remains quiescent for a short time, 
because it believes it is still held. The author in his explanation 
neither agrees with Czermak nor with Preyer. He finds that of all 
animals the frog (Rana temporaria) is best suited for this experiment. 
If a frog be placed on its back, with its leg and thigh flexed on the 
abdomen, and so retained by the hands until the attempts at movement 
have ceased, and if the hands be then gently removed, it will be 
found that all movements have ceased, and, in the greater number of 
experiments, the frog remains for one to two, not unfrequently three 
to four, hours—nay, even five to six hours—completely motionless, 
not making the slightest voluntary movement ; not the slightest 
trace of movement, except of respiration and circulation, is to be 
observed. The duration of this condition varies in different frogs, 
and it may take from ten to fifteen minutes to produce it. Some- 
times the condition may be produced within a minute or two. 


1877.| Psychological Retrospect. 119 


With regard to the explanation of these phenomena, the author 
rejects both that of Preyer and that of Czermak ; the former 
because his explanation does not meet those not infrequently occurring 
eases in which the condition occurs, where the animal has made no 
considerable resistance, and has not, therefore, had the opportunity 
of acquiring the necessary experience; further, Preyer could not have 
his animals for hours in this condition, but only the initial stages were 
exhibited by them. 

It is important to notice that the author finds that a frog whose 
cerebrum has been removed can be thrown into the same condition, 
which can be produced as rapidly and lasts as long as in the normal 
frog. Even when the lobi optici are removed, it can be produced, but 
the animal generally remains for a shorter time in the supine position, 
In this case, with only the medulla and cerebellum present, it cannot 
be said that the condition of tbe animal results from consciousness, 
and it cannot be regarded as the expression of “ resigned terror.” 

That the explanation of Czermak, that it is a ‘genuine hypnotic ” 
condition, due to fixing and steadily gazing at an object placed in 
front of the eyes, isfalse, is shown by the fact that it may be produced 
in frogs totally blinded by section of their optic nerves ; and birds 
whose eyes were completely closed exhibited the phenomena most 
strikingly. | 

The experiments of Goltz showed that after the removal of various 
parts of the brain, a frog might be brought to lie on its back, and it 
may be assumed that as long as this toleration of the supine position 
lasts voluntary movement and consciousness are suppressed. The 
‘author regards the condition as a normal physiological one, as an 
ordinary or more or less deep sleep. 

The phenomena exhibited by an animal in this condition are— 
Cessation of voluntary motion; closure of the eyelids, total or 
partial, and often considerable contraction of the pupil. Very im- 
portant changes occur in the respiratory and circulatory systems. At 
first, when the animal struggles there is acceleration both of the 
respiration and of the heart’s action. But as soon as sleep com- 
mences, a regular rhythm and slowing of the respiration occurs ; the 
latter more pronounced the deeper the sleep. The respiration may 
sink from 90-100 per minute to 88-26 in a minute, and the respira- 
tions become more and more superficial, and sometimes almost imper- 
ceptible. There is also pronounced relaxation of all the voluntary 
muscles. Czermak observed cataleptic phenomena sometimes appear. 
The author has observed a similar condition. Further, the reflex ex- 
citability in the later stages is always more or less diminished ; and, 
lastly, the skin was observed to become paler in colour, 

A frog in this condition can be awakened in the simplest 
and easiest manner. ‘This seems to show that one has not to 
deal with a pronounced alteration of the peripheral or central nervous 
system, but rather with a physiological condition, viz., that of sleep. 


120 Psychological Retrospect. (April, 


Both light and a noise easily awaken the animal. What is the cause 
of this sleep? The change from the waking condition to that of 
sleep is caused by the removal of those stimuli which, by acting on the 
sensory nerve under ordinary conditions, excite the brain. Those exci- 
tations which powerfully excite the brain are conveyed to it through | 
the organs of sense, through the eye and ear specially, and also through 
the sense of smell; numerous and important excitations also occur 
through the sensory nerves of the skin. Here it is specially to be 
noted that when the frog lies upon its back a smaller cutaneous area, 
and one less sensitive, is affected ; besides, when the lower limbs are 
flexed on the abdomen, the plantar surfaces of the feet, richly supplied. 
with nerves, are excluded; also a great number of impressions that 
proceed from muscles in action are aiso excluded. The excitations — 
proceeding from the viscera are normally of little consequence. Itis 
to be noted that the experiment succeeds best when all these sources 
of irritation of the brain are as much as possible avoided. It is often 
impossible to produce the condition with the animal on its belly. The | 
author regards it as certain that as soon as the animal is placed under 
conditions, so that all, or the chief mass of, the excitations continually 
affecting the brain through the sensory nerves are suddenly removed, 
the waking state of the brain cannot be preserved, but must pass into 
sleep. The author sees a confirmation of his views in the theory of 
sleep recently advanced by Pfluger. 

It is further to be noted that the brain not only soonest, but also 
relatively and most completely, loses its capacity for acting during 
sleep. It, therefore, follows that the brain is much more dependent 
than all other centres on the supply of external excitations through 
centripetal nerves. The results may be summed up thus: By esta- 
blishing certain external conditions, every frog can at any time be 
thrown into a state of longer or shorter sleep, which can be interrupted. 
at any moment; the conditions for the production of this sleep 
consist in removing as completely as possible the excitations con- 
tinually proceeding from the sensory nerves to the brain. 

Reflex Movements produced by Mechanicai Stimulation of the 
Cranial Dura Mater.—Bochefontaine (‘‘ Comptes Rendus,” Ixxxii1., 
No. 6) finds that if the dura mater covering the central part of the 
hemispheres is slightly stimulated, and that mechanically, the eyelids 
of the same side close. Sometimes the upper lip, ear, and ale nasi 
of that same side are affeeted. - If the stimulation is made stronger, 
then the muscles of the extremities of the same side reply, and on 
still further increase of the stimulus, the muscles of the opposite half 
of the body are affected, but always less intensely than those on the 
side stimulated. A similar result is generally obtained by stimulating ~ 
a point situated on the anterior part of the dura; if, on the contrary, 
the more posterior portions, or those of the dura lying more ex- 
ternally, are stimulated, only the muscles of the trunk respond, whilst 
the muscles of the eyelids and face remain passive. The action of the 


1877. | | _ Psychological Retrospect. 121 


muscles of the trunk and face is opposed to what one would expect 
from the decussation of the fibres in the medulla oblongata. The 
author does not attempt to explain this. Further, the result is the 
same after the removal of a part of the grey and white cerebral 
substance. 

On a Difference in the Reflex Functions of the Medulla Oblongata 
and the Spinal Cord in the Rabbit—Owsjannikow (“ Ludwig’s 
Arbeiten,” 1874, p. 457) finds that ordinary reflex movements, 7.¢., 
those that imply a conduction from the anterior to the posterior ex- 
tremities, and vice versa, still continue when the medulla oblongata is 
divided transversely 6 mm. above the apex of the calamus scriptorius, 
while they are only Jocal when the section is made 1 mm. lower down. 
If the section is made to the middle line, 5 mm. above the calamus 
scriptorius on the left side, and 6 mm. on the right, general reflex 
movements are still present with this modification, however, that on 
stimulating the left leg the right arm contracts more strongly than 
the left. The seat of the general reflex movements very probably 
does not lie in the middle line. 

The fact that after strychnine poisoning and section of the medulla 
below the calamus scriptorius, general tetanus can be produced by 
almost any sensory stimulus, seems to show again this localisation of 
general reflex movements. But this tetanus is fundamentally different 
from the co-ordinated reflex movements which vary with the strength 
of the stimulus. 

Curschmann on the Relation of the Semi-Circular Canals to the. 
Bedily Hqulibrium.—H. Curschmann (“ Archiv fur Psychiatrie,” 
Band y., and “ Centralblatt fur die Medicinischen Wissenschaften,” 
No. 21) experimented on pigeons. The anatomy of these structures, 
and the method of operating, are to be found in the original. It isto 
be specially noticed that Curschmann in operating tried to avoid as 
much as possible injury to the bones of the skull and the osseous 
canals, and only to destroy the membraneous canals. 

If on one side a large piece or the whole of a horizontal canal be 
destroyed, as Jong as the animal is at rest nothing special is to be 
observed; only the animal is more sluggisk and is not able to fly. If 
the animal be made to move, it makes a circle towards the opposite 
side. Further, trregularity in the use of the left leg is detected, 
which is placed down awkwardly. The animals are also awkward in 
feeding. Nothing abnormal is noticed regarding the position of the 
eyes. Further investigations showed that the muscular force on the 
injured side was unimpaired, only the capacity for co-ordination 
appeared to be affected on the one side. The better co-ordinated 
muscles of the intact side, when the animal moves, exert their 
superiority and incline the animal to the affected side. There is no 
internal impulse to these movements. 

If the horizontal canal be destroyed on both sides, even then 
nothing beyond a little sluggishness is to be observed. In moving 


122 Psychological Retrospect. [April 


however, the animals (which when at rest keep the head quite steady) 
execute circles first to the one side and then to the other. Then the 
head begins to move in a horizontal direction from one side to the 
other. To take food is, under these circumstances, impossible. The 
abnormal position and movement of the head and the disturbance in 
the equilibrium of the body are co-ordinated, but the former are not 
the cause of the latter. The action of flying is quite lost in such 
animals; the proper muscular force of the wings, however, is intact, 
If only section of one horizontal canal is practised, the symptoms are 
only distinguished in degree from those of the severer operation ; 
they gradually become less perceptible, and at the end of the first 
week may have disappeared entirely. 

The results of injuries to both vertical canals are essentially the 
same. In extensive destruction of the canals on both sides, the 
animals when at rest are extraordinarily sluggish; while moving, the 
body vibrates first forward then backward; they. do not run in a 
circle, but run rapidly forwards, and then equally so backwards, and 
fallforwards. In moving forwards powerful efforts are made to prevent 
the falling forwards. In such movements, the head vibrates from above 
downwards; the peculiar torsion of the head described by Goltz also 
occurs, but is not constant, and the author shows that it is to be 
ascribed to injury of the dura orcerebellum. ‘That the disturbance in 
the equilibrium of the body is caused by the abnormal position of the 
head, as maintained by Goltz, is rejected by the author, for in uni- 
lateral lesion of the canals the head exhibits no movements, whilst 
they appear characteristically in the body. It is also to be noticed 
that after one of the vertical canals was injured on both sides, a 


diminution of the pathological phenomena occurred in two experi- 


ments, which never occurred in bilateral injury of both horizontal 
canals. 

On injuring only the vertical canal on one side, the phenomena are 
few. ‘The position of the head and body at rest are normal ; that of 
the head is not even changed during movement; the capacity for 
flying is relatively little interfered with. In running, the foot of the 
operated side is awkward ; some animals fall forward or backward, but 
generally with a tendency to stumble towards the injured side. The 
phenomena may all disappear early and completely. 

If all three canals are destroyed on one side, little abnormal is 
observed during rest; while running, there is a combination of 
mouvements de manéege and oscillations of the body forwards and 
backwards. 

In bilateral destruction of all three canals the movements are quite 
irregular, and the head is tossed in an irregular manner in a circular 
direction. While sitting at rest, the position of the head and body 
are again normal, so that even after complete destruction of all the 
membranous canals, complete loss of the bodily equilibrium does ng 
ensue, nor is hearing thereby abolished. 


t 


ee 


1877. | Psychological Retrospect. 123 


Physiology of the Vagus.—Rossbach and Quellhorst (‘ Verhandl. 
d. Physik-med. Ges. in Wurzburg,” ix. p. 13, and ‘* Centralblatt,” No. 
42) show that vaso-motor nerve-fibres run in the abdominal part of the 
vagus to abdominal viscera. Stimulation of these fibres causes con- 
| traction of the vessels of the abdomen, and increase of blood pres- 
sure. In order to stimulate the vagus, the vertebral ends of several 
ribs were removed, and thus a window was madein the thorax, and the 
nerve carefully separated from the cesophagus, and divided. Both 
electrical and mechanical stimulation caused considerable increase of 
blood-pressure in the carotid and crural arteries, whilst the frequency 
of the pulse remained unchanged. 
| It is well known that, if in an animal the vagus in the neck is 
| divided, and its peripheral end stimulated, so that the heart is brought 
toa standstill, an increase of the blood-pressure above the normal 
takes place after cessation of the stimulation. According to these 
/authors this increase also takes place when the terminations of the 
/vagus in the heart have been paralysed by a moderate dose (0°004 
grms.) of atropin, so that stimulation of the vagus can no longer arrest 
the action of the heart. In both cases this increase of the blood- 
/ pressure is ascribed to stimulation of those vaso-motor fibres which 
run in the abdominal vagus to the abdominal organs, for it never 
} occurs when the abdominal vagi are divided. 
Brown-Séquard on the Alterations in the Mucous Membrane of the 
| Stomach consequent on Lesions of the Brain—Dr. Brown-Séquard 
(“ Progrés Médical,’’ 1876, No. 8) records that after injuries of the 
| corpus striatum, crus cerebri or spinal cord, softening and ulceration 
of the gastric mucous membrane occur; hemorrhage generally after 
}injury of acertain part of the pons. There is no hemorrhage after 
| paralysis of the vaso-motor nerves ; on the contrary, the arteries and 
veins contract and the blood stagnates in the capillaries, which then 
| rupture. 
Generisch onthe Pacinian Bodies found in the Human Celiac Plecus.— 
A. Genersich (** Wiener Medicinische Jahrbuch,” 1876, p. 133) investi- 
gated the Pacinian bodies occurring in the cceliac plexus in the bodies 
of 82 individuals who died of different diseases. He found these 
| bodies in 73 cases, their number and size being independent of sex 
| and the disease. ‘The size, on the contrary, had a nearly constant re- 
| lation to the age of the individual. » In children, and in youth, their 
| length was about 1 to 1:5 millimétres, their breadth 0°5 to 1:0 milli- 
| métres, in more advanced life they were somewhat larger; the largest, 
| 3°6 millimétres long, and 2°3 millimétres broad, were found in 
| patients over fifty. The description coincides exactly with that given 
| by Axel Key and Retzius. The very large forms found in old indi- 
| viduals are produced by cedematous swelling. Asthe cause of this 
| edema, occurring independently of general dropsical swelling, the 
| author assumes a local origin. According to him a fibrous thickening 
| of the capsule takes place, which interferes with the return of the 









124 Psychological Retrospect. (April, 


blood and lymph, and so produces the edema of these small organs. 
As this fibrous thickening occurs especially in old age, it explains the 
increase in size observed to take place at this period. 

In one case calcification of the artery of the pedicle without any 
obvious change of the terminations of the nerves was observed ; in 
another case both the stem and the interior of the Pacinian corpuscle 
had undergone fatty degeneration. 

Ranvier on T-shaped Nerve-Tubes, and their relation to Ganglionic 
Cells —L. Ranvier (“ Comptes Rendus,” December 30, 1875, and 
“ Centralblatt fur die Medicinischen Wissenschaften,” No. 30) inves- 
tigated the spinal ganglia and the ganglion Gasseri of rabbits, by the 
interstitial injection of perosmic acid, and agrees with former authors 
that the cells are unipolar. Whilst former authors imagined that the 
fibres springing from the cells passed either towards the centre or the 
periphery, Ranvier is convinced that these fibres, after a longer or 
shorter twisted course, are inserted in a [-shaped manner into one of 
the nerve fibres of the posterior root, and become united to it. This 
insertion always takes place at a Ranvier’s node. 

The author does not affirm that the processes of unipolar cells all 
end in this way. Still, he remarks, that on teasing the posterior root 
just at the spinal ganglion, an extremely large number of T-shaped 
nerve-fibres are to be found. The author also remarks on the possi- 
bility that the processes of the unipolar ganglionic cells may not be » 
inserted singly on to single nerve-fibres, but that several of them may 
perhaps unite in a common trunk, which becomes inserted in a T-form 
on a fibre. 

Schwalbe on the Nuclei of the Ganglionic Cells ——Professor G. 
Schwalbe (“Jena’ische Zeitschrift fiir Naturw,” Band. x.) remarks 
that if a perfectly fresh and completely transparent retina of a sheep — 
is spread out in aqueous humour, with its inner surface upwards, on 
an object glass, it is easy to detect in the parts lying next the ora 
serrata, the ganglionic cells sharply defined, as here the nerve-fibres 
are reduced to sparsely scattered bundles. Round bright spots, just 
like fluid in a cavity, are to be observed in a dimly glancing homo- 
geneous mass. On more exact observation, a round nucleus is to be 
detected within each bright spot, with all the characters of a nucleus 
of a ganglionic cell. The remaining part of the space is clear, with 
the exception of a small amount of a finely granular substance around 
the nucleus. On adding iodised serum the whole transparent space 
becomes turbid, and appears finely granular. As an argument against 
the supposition that the granular layer is nervous, the author cites 
the completely different optical properties of fresh ganglionic cells, and 
fresh granular substance. The latter appears as if it were permeated ~ 
by innumerable small vacuoles. The shining homogeneous substance 
between the ganglion cells shows no trace of tissue elements, and is 
obviously comparable to the cement substance of epithelium. The 
nuclei of the ganglion cells of the retina possess a membrane, whose 


1877.] Psychological Retrospect. 125 


inner surface is provided with fine projections. Sometimes they con- 
tain a toothed nucleolus, provided with fine processes. In adult animals 
the difference in size of the ganglionic cells is comparatively trifling. 
In young animals, however, (calf) it is extraordinarily great, and the 
same is true of the nuclei. The smallest nuclei are the youngest. 
They are without trace of nucleolus, and consist of a regularly dis- 
tributed granular mass. No differentiation into nuclear membrane 
and contents is present. The substance, out of which the nuclear 
membrane and the nucleoli are ultimately formed, is at first regularly 
distributed through the whole nucleus and completely fills it, and is 
permeated by numerous small vacuoles filled with another mass. 
During the growth of the nucleus, the vacuole substance increases, 
without any essential increase of the other constituents of the nucleus 
being visible. The consequence of this is, that the latter is torn into 
several portions, of which one always encloses the surface of the 
nucleus, and becomes the so-called nuclear membrane, with a number 
of irregular projections, the nucleoli adjacent to the wall, projecting 
into the interior of the nucleus, whilst other portions roll themselves 
together into one or more nucleoli. In proportion as the clear sub- 
stance in the interior of the nucleus increases, the internal projections 
of the nuclear membrane, in consequence of the extension of the latter, 
are caused more and more to disappear. The whole process may be 
regarded as one of vacuolation, similar to what occurs in plant-cells, 
in the separation of protoplasm from the cell-juice. In ganglion cells 
in other localities (anterior horn of the spinal cord in the rabbit and 
pig, ganglion Gasseri of rabbit, spinal and sympathetic gangha of 
frog) the nuclear membrane is absent, and therewith the nucleoli 
adherent to the wall (7.e. thickenings on the interior of the membrane). 
The clear juice of the nucleus with vacuolated nucleolus adjoins the 
cell-substance directly. 
These observations of Schwalbe contradict the results of Auerbach, 
that the nucleoli wander from the protoplasm of the cell into the 
nucleus. According to Schwalbe, these arise like the nuclear mem- 
brane from the original nuclear substance; in that, the latter, by the 
accumulation and increase of the clear nuclear juice, is broken up into 
Several pieces. Further, no increase of the nuclear substance takes 
place; this remains constant, and during the increase of the nucleus 
diminishes relatively. Thus it arises, that in ganglion cells, in oppo- 
sition to the results of Auerbach for other cell nuclei, one observes a 
plurinucleolar condition preceding the uninucleolar, and that the latter 
may pass into an anucleolar condition, in which the entire nucleolar 
substance is employed as nuclear membrane. The author arrives at 
the conclusion that Auerbach’s results on the origin and increase of 
nucleoli are not to be generalised. 
In the body of the spinal ganglion-cells of the frog, two substances 
are to be found, one of which forms a very delicate network, which 
reaches from the surface of the membraneless nucleus to the surface 


126 Psychological Retrospect. [April, 


of the cell; whilst the other, the clearer, fills the meshes. The sub- 
stance of the nucleolus is optically different from these two substances, 
whilst the nuclear juice appears to be identical with the mass filling 
the meshwork. There are, therefore, three substances to be distin- 
guished in the ganglion cells—the nucleolar substance, the cell-juice, 
and the reticular substance. The view of Max Schultze regarding 
the fibrillar condition of the nerve-cell, according to Schwalbe, de- 
pends upon an imperfect interpretation of the reticular substance. 
Lastly, the author remarks regarding the difference in structure in 
nerve-cells of different localities. 

On LHemi-anesthesia of Cerebral Origin. —A. Pitres (“ Progres Médi- 
cal,” 1876, No. 29) found in the case of a woman aged 58, suffering 
from hemiplegia of the left side, that the sensibility of the skin on 
the paralysed side was in all respects diminished. The same was true 
for taste on the left side of the tongue, and also for the sense of 
smell in the left nostril. The left eye was turned inwards, and the 
movements of both eyes towards the left were limited. The acuteness 
of vision of the right eye was diminished one-half, while that of the 
left was still more affected. The field of vision of both eyes was 
limited concentrically for white, and relative for other colours, 
Neither atrophy nor neuritis of the optic nerve was present. Trans- 
verse and vertical section of the right hemisphere exhibited, in the 
middle of the thalamus opticus, an almond area of a yellowish colour, 
stretching upwards; the nucleus caudatus was destroyed to the extent 
of 2 centimetres, the internal capsule was affected at the place of junc- 
tion of the posterior with anterior, three-fourths. Here the most 
internal part of the corpus lenticulare exhibited a light yellow colora- 
tion, but elsewhere it was intact. Other parts were unaffected. 

Unilateral Atrophy of the Face.—Courtet (‘* Gaz. Hebdom.,” 1876, 
No. 18) relates the case of a soldier, aged 22, who, in youth, had 
suffered from epileptic attacks, was affected later in life with neuralgic 
toothache, and had suffered from chronic lead poisoning. Up to 15 
years of age he remained free from nervous complications. There 
then appeared on the right side of the chin a small bluish, smooth, 
shining spot on the skin, from which the hairs fell out. 

Gradually. the spot extended over the whole right side of the face; 
this was accompanied by pain in the parts, together with contraction 
of the muscles of the lower jaw, and fibrillar contractions on the 
affected side. The motility and sensibility of the right half of the 
face remained normal. ‘The electrical excitability of the muscles, the 
sense of taste on the atrophied half of the tongue, and the secretion 
of tears and saliva, were all intact on the affected side; the secretion 
of sweat was somewhat diminished on the right lower half of the 
face. The growth of the beard on the left side was normal, whilst 
the right side was smooth, Treatment with the induced current had 
no effect. 

On Albuminuria in Inebriates.—D. C. Furstner (“ Archiv. f. Psych. & 


1877.] Psychological Retrospect. 127 


Centralblatt,” No. 42) found that about 40 per cent. of the cases 
of deliriwm tremens treated by him suffered from transitory albumi- 
nuria, and, indeed, in a series of cases, the amount of albumen ran 
parallel to the intensity of the delirium, whilst in others it only seemed 
to be related generally to the delirium. Of those suffermg from 
marked epileptic seizures, about 50 per cent. presented this symptom. 

In chronic alcoholism, albuminuria occurred much less frequently ; 
indeed, only occasionally; and it appeared as a slight turbidity on 
) applying the test. 

When the delirium tremens is complicated with acute diseases, as 
pneumonia, the origin of the albumen is doubtful. 

Two cases, notwithstanding the complication with pneumonia, pre- 
‘sented no trace of albuminuria. Two cases occurring in patients 
suffering from nephritis showed an enormous increase during the 
‘delirium, whilst afterwards they excreted the old amount of albumen. 

The albuminuria cannot be ascribed to increased muscular work, for 
quiet patients also are affected. The transitory nature and the micro- 
Scopic appearance of the urine speak against renal disease. 

The author regards it as due to a temporary increase of the arterial 
blood-pressure in the kidneys, and connects it with other evidences of 
hyperemia in such patients. It may be that there is a transitory 
affection of Cl. Bernard’s albumen centre in the medulla. 

On the Object and Aim of Psychiatrie. An introductory lecture, by 
Dr. Eduard Hitzig, Professor of Psychiatrie in Zitirich. 1876.—Dr. 
Hitzig contrasts the number of insane persons confined in asylums in 
the canton of Ztrich with the number in England and Prussia. In 
Zurich the number of insane is as 1 to 252 of the population; in 
England and Prussia as 1 to 400 and | to 450 respectively. The 
author regards as the highest object of psychiatrie the prevention of 
the origin of psychical diseases. As the most common cause of dis- 
| ease, the author points out heredity. Insanity must be regarded as a 
disease of the nervous system, which does not always produce the 
same form of disease, and may arise from other forms, so that epilepsy, 
deaf mutism, and such diseases, may alternate in different genera- 
tions. It is not to be believed that all the children of a person 
who at one time has suffered from insanity must be insane. Many 
May remain free, some may perhaps be characterised by uncommon 
endowments. 
| The author points out the great importance of not overworking the 
| brain in children whose parents have shown a tendency to insanity. 
The effects of dipsomania upon the person himself and his posterity 
are then discussed. The children of drunkards inherit the same if 
not a greater tendency to disease of the nervous system than tlie 
children of nervous, or even of insane, parents; in fact, they die 
| often at a younger age from convulsions and other epileptiform con-~ 

ditions. With the cure of acute delirium tremens little good is ob- 
tained. If the patient is to obtain the necessary power to resist 








128 Psychological Retrospect. [ April, 


temptation, he must remain, after the end of the acute stage, under 
strict supervision for several months. 

The question of limiting the personal freedom in such cases is then 
discussed, and answered in the affirmative. The causes of the per- 
sistence of insanity are then discussed. The appropriate use of 
asylums is regarded as of great importance. The chances of a cure 
become rapidly smaller with every week that the patient comes later 
into the asylum. According to Nasse, with a duration of the disease 
for one month before admission, 57°5 per cent. were cured; from seven 
to twelve months 9-1 per cent.; and for more than twelve months only 
2 per cent. The author is strongly of opinion that an examination 
in psychiatrie should be made compulsory upon the student. 


2.—Lrench Retrospect. 
By Dr. T. W. McDowa tt. 
(Continued from Vol. xxii., page 628.) 


Case of Rupture of the Rectum in a Lunatic.—This rare accident 
occurred to a patient who had been in the Montdevergues Asylum 
since 1869. She was born in 1838, married, and the mother of three 
children. The first symptoms of insanity appeared at 25 years of age, 
from an unknown cause. The attacks returned almost every month, 
and continued five or six days. During the intervals the patient was 
quite sane. She was not sent to an asylum until, on 24th November, 
1868, during an attack which began two days before, she cut off the 
head of her sucking child with a hatchet. Her symptoms were © 
those of religious melancholia with suicidal tendencies, and they con- 
tinued unchanged till the time of her death. Small, thin, delicate, 
the woman never spoke, and stood motionless in a corner; she often 
refused her food. She took no care of her person, and offered a 
passive resistance to everything required of her. It was necessary 
to keep her under constant supervision on account of her incessant 
attempts at suicide. One day she forced a pin into her throat, 
causing numerous abscesses before it was removed. 

On 26th September, 1874, after having had her supper with the 
other patients, she went to the closet. She there, according to 
her account, made vain efforts at defecation and was seized with a ~ 
violent colic. She, however, said nothing about it, and went to bed 
at the usual hour. Only a few minutes afterwards she was heard 
groaning and twisting about in her bed; almost immediately she 
vomited violently. The nurse hastened to her, and, wishing to change 
the patient, she perceived that the intestine projected from the anus. 
It was found that a portion of the small intestine had escaped by the 
anus, and hung between the thighs as a large bundle formed of several 


P77. | Psychological Retrospect. : 129 


coils. The seat of rupture could not be discovered by the introduc- 
tion of the finger, and although the bowels were returned, they 
immediately escaped again. She died next day at noon. 
- At the post-mortem examination there was found a rent across the 

rectum seated in the anterior wall, a little above the recto-vaginal 
cul-de-sac, and four to five centimetres long. Towards its central 
part there was a small reddish spot about the size of a 20 centime 
piece, which presented none of the characters of ecchymosis, but a 
diffuse redness of an inflammatory appearance. In this neighbour- 
hood the tissue of the intestine was slightly thickened and friable. 
Opposite this spot, upon the posterior wall of the rectum, there was 
a small superficial ulceration. The length of the small intestitie 
which protruded from the anus was about 50 to 60 centimétres. 

Continuing his examination, Dr. Christian found in the posterior 
wall of the rectum, about two centimétres above the anus, an ordinary 
sewing needle. It lay horizontally, the point directed to the left. It 
appeared as if imbedded in the wall of the intestine, and had evidently 
been there a considerable time, for it was black, rusty, and encysted 
in a thick black membrane. 

There can be no doubt. that the rupture in the rectum was not self- 
inflicted, but resulted from softening of the tissues, due to the presence 
of the foreign body. 
On the Communication of Insanity by Contagion.—It is a matter of 
every-day observation that the intimate association of individuals is 
followed, in many cases, by -the communication of peculiarities of 
thought and habit. No surprise need, therefore, be excited when two 
or more members of a family or community become insane about the 
same time, especially in the former, where all may suffer from a strong 
ihereditary tendency to mental disease. The extraordinary epidemics 
of the middle ages, the modern outburst of religious excitement, are 
illustrations, on a grand scale, of the transmission from one person to 
another of an abnormal condition of mind. It must not, however, 
be imagined that where two members of a family become insane about 
the same time their disease has a common origin; as a rule, it 
jis quite the contrary. Thus a woman becomes insane after child- 
| birth; her husband soon afterwards loses his reason through the 
/maisery his wife’s illness has brought upon him and his family. 
| Dr. Brunet’s paper is introduced by an old article from the Droit, 
jwhich contains some interesting accounts of so-called contagion of 
jinsanity. He considers that it ‘indicates an exact knowledge of the 
subject,”’ though it contains the following statement :—“ Other kinds 
jof insanity are equally contagious, and there is in man such a 
jtendency to imitation that no one can live continually with a madman 
}without losing his own reason.” That is a pleasant prospect for 
asylum officials. Ought not Dr. Brunet to act on his opinion and 
|retire ? . 
| Itis unnecessary to reproduce the cases forming the subject-matter 

XXIII. : 9 















| 
| 


150 Psychological Retrospect. [ April, 


of the paper; such cases must have come under the notice of almost 
every asylum superintendent. The concluding paragraphs summarise 
the whole matter, and the following is their substance :— 

In lunatic asylums patients may communicate their delusions to 
one another. It sometimes happens that patients suffering from 
maniacal excitement without well-marked delirium have at the 
commencement of convalescence ideas of persecution through their 
constant association with lunatics labouring under this form of 
insanity. Returning home has been sufficient to cause this complica- 
tion to disappear. 

Insanity by contagion is generally easy of cure: the delirium is 
less firmly rooted, and the organic changes in the brain are less pro- 
found, than if they were due to the influence of the exaltation of the 
affective faculties. It is developed in the following manner :—Belief 
in the delusions of lunaties with whom they live is at first vague, 
confused, intermittent ; it gradually becomes firmer, continuous, and 
at last there appear genuine attacks of partial or general insanity. 
Persons who are thus affected by this contagion not only believe in 
the reality of the imaginary persecutions of their neighbours, but 
themselves are the victims of these persecutions; and acute mania, 
with its most serious symptoms, may occur. 

Prolonged contact with lunatics, without producing imsanity, may 
cause irritability of character and excitement of the selfish instincts. 
[ That is quite true, and agrees with my own observation. | 

Cerebral physiology easily explains the phenomena. Our ideas and 
feelings depend in a great measure on our surroundings. “ Sumimus 
e conversantibus mores,” said Seneca; the Bible pointed out the same 
long before that philosopher, and it can scarcely be disputed in the 
present day. 

On Artificial Feeding of the Insane.—The method deseribed by Dr. 
Ritti is suitable only for exceptional cases, and is not likely to come 
into general use. It consists in placing a bolus of food in the throat 
and causing the act of swallowing to be performed by the stimulation 
of the muscles of the gullet by electricity. Although it is described 
as easy in performance, it nevertheless demands some amount of 
skill, easily enough acquired by practice, great rapidity in execution, 
and especially an intelligent assistant. It was tried in only one case 
-—a melancholic, in whom various kinds of treatment failed to arrest 
progressive emaciation. Dr. Ritti placed the poles of a Ruhmkorff coil 
alternately on the nape and the lateral parts of the neck, but with no 
effect. As the persistent refusal of food might be due to a state of 
anesthesia of the mucous membrane of the pharynx, he passed a 
current from the level of this organ to the superior and lateral part 
of the neck, immediately below the angle of the lower jaw. Through | 
the influence of the electricity all the muscles of the region con-_ 
tracted, and there was observed at the same time the phenomenon of 
the second stage of deglutition, the upward movement of the larynx. | 


i 





1877. ] Psychological Retrospect. 131 


A bolus of food was now introduced, the patient offering no resist- 
ance; the mouth was kept shut by the hand; the current was imme- 
diately passed, and the substance was swallowed. The operation was 
repeated until enough food had been introduced. As the patient 
became accustomed to the process, he offered considerable resistance, 
and increased the difficulties much. 

On the General Sensibility and its Alterations in Melancholics.— 
For this paper Dr. Semal was awarded the Aubanel prize. An 
ordinary summary would fail to do it justice, but in order that some 
idea of its scope may be given, it may be best to reproduce almost 
literally the remarks on it by the Prize Committee and then to append 
a table of contents. 


This memoir is particularly noticeable for its physiological part. 


It not only shows that the author has a very extended knowledge of 


the most recent works upon psychology and the physiology of the 
nervous system, but indicates a very superior mind, perfectly capable 
of dealing with the most difficult and abstruse questions in physiology 
and pathology. | 

In place of contenting himself with the usually accepted opinions 
on sensations and general sensibility, he has more thoroughly 
examined the question submitted to him. Before studying the dis- 
orders of this function in melancholics, he has endeavoured to grasp 
precisely and scientifically the exact meaning of the term general 
sensibility. But in attempting to solve this problem, he was not long 
in discovering that it was more obscure and complex than at first sight 
appeared. 

What, indeed, is to be understood by the term general sensibility ? 
It ought to include all the sensations of the human organism which 
are not special. But from time immemorial the existence of five 
Special senses has been admitted—sight, hearing, taste, smell, and 


‘touch. But having apportioned the bodily sensations to these five 


senses, what remains for what we have agreed to call general sensi- 
bility? It is here that the true difficulty of the problem commences. 
The majority of ancient and even more modern physiologists have 
really confounded general sensibility with the sense of touch; at 
most, and that very vaguely, they distinguished between external and 
internal general sensibility. It was first Cabanis, and afterwards 
Bichat, who began to establish a clear and exact distinction between 
the general sensibility seated in the skin and that having its seat in 
the internal organs. These were called by Bichat the animal and the 
organic sensibility, or the external and visceral. Later, other physio- 
logists have admitted the existence of an objective sensibility, in 
which the impression was caused by external objects, and a subjective 
Sensibility, by which we are conscious of modifications occurring in our 
own body. 

Since that time they have further extended their minute obser- 
vations on the various kinds of external and internal sensibility, and 


132 Psychological Retrospect. (Apri, 


have increased the number. They first recognised a sixth or genital 
sense ; then those of heat, pain, muscular activity, &c. Gerdy espe- 
cially carried this subdivision to an extreme. He considered as 
distinct sensations tickling, itching, &c. Finally, Beau, by 
separating analgesia from anesthesia, physiologically and clinically, 
drew a distinction between the sensation of contact and that of pain, 
which is now generally accepted. The result has been a very great 
confusion, which still exists, between general and tactile sensibility. 

We all understand, under the name of general sensibility, all the 
internal, visceral, or organic sensibilities of Bichat, which enable us 
to perceive changes occurring in our own body, as the sensation of 
hunger, thirst, sexual desire, sickness, or fatigue, &c. ; but when we 
come to the skin and the tegumentary organs, how are we to distin- 
guish the sensation of heat, cold, muscular activity, tickling, itching, 
&e., from the tactile sensation properly so called—that is to say, from 
touch? The difficulties are very great and almost insoluble, and one 
is almost forced to admit special senses for heat, pain, or muscular 
activity, and even of special nerves, conductors of them. 

The author of the memoir has sought some means of escape from 
the difficulty, and of arriving at a solid basis upon which he can 
classify scientifically the disorders of general sensibility in me- 
lancholia. 

After having studied most profoundly the works of modern 
psychologists and physiologists, whose deep and original views he 
explains with remarkable ability, he arrives definitely at the general 
conclusion which he has made the physiological and clinical basis of 
his whole memoir. To define general sensibility, and distinguish it 
from special, we must no longer seek the basis of the distinction in 
the part of the external or internal nervous system which is affected, 
or in that which transmits or perceives the sensation, or in the nature 
of the sensation perceived by the sentient subject, but in the charac- 
ter of the external causes which affect the nervous system. Now, in 
general physics, as in physiology, we must recognise, as special 
stimulants of the senses, light, sound, sapor, odours; but all other 
impressions received by the organism are due to the modification pro- 
duced on our external or internal sentient extremities by the three 
great general properties of matter which govern the external world, viz., 
motion, heat, and electricity, a trinity of forces which resolves itself 
into the unity of motion, the producer of heat and electricity. It is 
those general properties of matter which, acting upon the periphery of 
our nervous system, produce in it a modification which we call general 
sensibility, in opposition to special sensibility produced by special 
excitants—light, sound, odours, and sapors—acting upon special — 
nerves, upon special organs, and there producing phenomena of | 
special sensibility. 

Such is the leading idea forming the basis of this paper. Physiologi- 
cally and clinically, he rests entirely upon this definition and new concep- | 


(1877.] Psychological Retrospect. 133 


tion of general sensibility. The necessary consequence of this doctrine 
is to suppress the sense of touch in favour of general sensibility, as 
formerly general sensibility was suppressed in favour of touch. Thus, 
by totally different paths, the physiology of sensation returns to its 
starting-point, but under an infinitely more scientific form. 

However, the author does not draw back from the logical conse- 
quence of his definition of general sensibility, for he says:—‘‘ We 
consider light, sound, odour, and sapor as essentially special and 
transitory attributes of matter, and nature compels us to regard them 
thus, because, in order to make them apparent, it has employed special 
agents which are the organs of sense properly so called. It may 
cause astonishment that no mention is here made of touch, but in our 
opinion touch does not exist as a distinct sense.” 

The section of the paper referring to pathology is less complete. 
The author only quotes a few detailed cases, because he considers 
them useless for his purpose, but he carefully studies, in several 
successive chapters, from his point of view of general sensibility, the 
disorders of this function, either generally in connection with each 
sense or in their relation of cause and effect with melancholia, and 
specially hypochondriasis and the monomania of suspicion. He 
mentions incidentally new facts and interesting and often original 
questions, which cannot’ be now mentioned, but which certainly add 
greatly to the merit of this paper; and he concludes as follows :— 
“ Alterations of general sensibility form the basis of melancholia ; 
the psychical element and the special sensations only operate in the 
_ expression and external form of the various phases of melancholia.” 


Part 1.—Psycho-physiological considerations on the whole Nervous 
System. Chap. 1. The Nervous System. Chap. 2. Nervous 
Motion. Chap. 3. The Causes of Stimulation of Nervous Motion. 
Chap. 4. Sensations. Chap. 5. General Sensibility. 

Part I[.—Disorders of the General Sensibility. Chap. 1. General. 

Chap. 2. Pain. Chap. 3. Hyperesthesia, Hypesthesia, and Syn- 
esthesia. Chap. 4. Pseudo-esthesiz, Illusions, and Hallucinations. 


Disorders of External General Sensibility. 


I. Sensations of Contact. II. Thermic Sensations. III. Elec- 
tric Sensations. 

Disorders of Internal General Sensibility. 

A. Muscular Sensibility. I. Fatigue. IJ. Muscular Hypes- 
thesia. JII. Muscular Pains. IV. Vertigo. V. Cata- 
leptic Symptoms. 

B. Disorders of General Sensibility localised in the organs of 
nutrition. I. Buccal, Pharyngeal Symptoms. II. Abdo- 
minal Symptoms, 

C. Simple Disorders localised in the organs of respiration and 
circulation, 

D. Symptoms localised in the Genito-urinary Organs. 


134 Psychological Retrospect. (April, 


Part III.—Alterations of the medullary sensibility. I. Disorders of 
the instinct for muscular action. II. Disorders of medullary sensa- 
tions proceeding from the digestive organs. III. Disorders of the 
medullary sensations proceeding from the respiratory organs. 
IV. Disorders of the medullary sensations proceeding from the 
circulatory organs. V. Disorders of the sensations proceeding from 
the genital functions, 

Part IV.—Cecenesthetic Disorders. I. Ccenesthetic perversions. 

_ I. Hypochondriasis. III. Melancholia. 

Part V.—Psycho-pathological considerations upon the genesis of 
Melancholia, I. Distinction between the rational state and 
insanity. II. The physical constitution of melancholics. III. Pre- 
vious mental character of melancholics. IV. Mesological influences 
on the forms of melancholia. V. Influence of disorders of sensi- 
bility on the forms of melancholia. 








PART IV.-NOTES AND NEWS. 


MEDICO-PSYCHOLOGICAL ASSOCIATION. 


A quarterly meeting of the Medico-Psychological Association was held in 
London, on Wednesday, January 31st, at the rooms of the Medical and Chirur- 
gical Society, in Berners street, the President, Dr. W. H. Parsry, in the chair. 

The Secretary, Dr. W. Ruys WILLIAMS, read the minutes of the last quarterly 
meeting, which were confirmed. 

Dr. J. C. BucKNILE read a paper on “ The Relation of Drink to Insanity.” 


(We regret that we have received no abstract of this paper, and that our readers 
must form their opinions of the views expressed in it fromthe following discussion. 
The reporter did not take notes of it as it was read, being under the impression — 
that it would be sent to the Journal, according to the usual custom.) 


The PRESIDENT said they must all feel indebted to Dr. Bucknill for the very 
important, useful, and deep-thinking essay they had heard read. It deserved 
an earnest discussion, which should be taken, as requested by Dr. Bucknill, 
under the four separate heads that he had set forth. They would be glad to 
hear the opinions or suggestions of any gentleman present, but it would be 
convenient that every one should confine himself, for the time, to the particular 
question under its proper head, and he might then speak again, if he chose, 
upon the other parts of the subject. The first subject, then, for their discus- 
sion would be that of the pathological modes in which it was thought intempe- 
rance in the use of drink could produce insanity. 

Dr. SavacE observed that it might have been expected, in a review of this 
subject, that more would be said of the pathology of general paralysis in its 
relation to drink. A young practitioner would think he should find excess in 
drink one great cause of general paralysis and consequent insanity. But 
looking at the cases of insanity where there had undoubtedly been excess in 
drink, he found mere wasting of the nerve tissue, choking of the nerve vessels, 
or thickening of the walls of the capillaries, or general degradation of all the 
tissues. There was a state of denutrition, which must gradually waste away 
the brain, till the man became demented, and finally died. Such a case was not 
unfrequently called one of general paralysis. All these injurious effects were no 
doubt produced by an excessive use of that which, perhaps, might, at an earlier 


| 1877. | Notes and News. 135 


stage of the disease have served to prevent the waste of nerve tissue, the 
alcohol having the atriptic effect which Dr. Bucknill ascribed to it; but, on the 
other hand, it was certainly the means of doing great mischief, especially 
among drinkers of the more ardent strong liquors. He did not for a moment 
believe that alcohol was the only thing which had these pernicious effects ; 
they might equally be produced by other kinds of poisoning. But, after all, it 
was probably better to estimate the pathological result in the old way. If a 
portion of nerve tissue or of brain were put into alcohol, they would see it 
became hardened and, as it were, fibrous. And so it would be in the living 
body ; if a man soaked himself with alcohol, his nerves and brain would be 
injured in the same way, and his powers, both of perception and of action, 
would be deadened. 

No other speaker arising to continue this first topic of the discussion, 
the PRESIDENT remarked it would be paying Dr. Bucknill a high compli- 
ment if they were to assume that his paper was so exhaustive that no one 
could enlarge upon it. But let them pass on to the second division of his 
subject, which was his proposed amendment in the mode of keeping statistics 
of drink insanity. He said he had been much struck with Dr. Major’s statistics, 
quoted by Dr. Bucknill, and he wished to hear some comments upon them from 
members of the Association who had large asylums under their government, 
For his own part, he could not help quite agreeing with Dr. Bucknill’s remark 
that a great deal too much effect was attributed to drink as the originating 
cause, not merely as the exciting cause, of insanity. He had very little doubt 
that the experience of Dr. Major among a manufacturing population, which 
was likely to have much hard drinking, would lead him, as similar experience 
had led other physicians in such localities, to the conviction that drink was 
actually a very important cause of insanity in different forms. But from his 
own experience, he must say that he had not been led to the same conclusion. 
He looked upon drink as merely—almost exclusively—an exciting cause. It 

was, moreover, his impression that if strong drink, though an exciting cause, 
were to be removed, the amount of insanity would not, on the whole, be 
diminished. He derived this opinion from his own experience of twenty-five 
years in a rural county, with a population of less than 300,000, out of which 
he had last year received 157 patients. It happened last year that in order to 
give the information desired by the Lunacy Commissioners there were returns 
of the causes of insanity to be filled in. This was done by the very able senior 
assistant in his own asylum. The result was that out of the 157 cases there 
were only seven in which drink could be put down as the direct or indirect 
cause of insanity. It might, of course, be only accidental with so small a 
number, but on analysing these seven cases he found only two in which drink 
was given as the cause, the only real cause, of insanity. In one of these cases 
‘there was epilepsy combined with the insanity, and in four other cases there 
was an hereditary taint. Four of the seven persons were females, while three 
were males; and it singularly happened to be in two of the females that the 
insanity was ascribed purely and simply to drink. In all the males there was 
hereditary insanity also, Now, in that county (Warwickshire) he was sure 
they had as much insanity, as large a proportion of admissions to the asylums, 
as in most populous towns; but drunkenness was not the vice of that county. 
Indeed, there was very little of it, for the county population of which he spoke 
did not include Birmingham. This was a subject to which he had paid some 
attention, as a study of symptoms and of the means of cure, for several years 
past, but had not been able, before last year, to obtain any precise statistics. 
The proportion of cases supposed to result from drink had seemed to vary from 
five, six, or eight per cent. to eleven per cent. or more. Last year, however, 
Statistics were carefully obtained, with the extraordinary result he had men- 
tioned. He did not, indeed, think any of the statistics were yet sufficiently 
Certain to be made the ground of any positive conclusion; but something 


136 : Notes and News. [Apri, 


might be got at by putting together the results of different experiences and 
observations. In the meantime it was his own impression that the notion of 
drink being the cause of insanity was a hobby which had been rather over- 
ridden. He even thought we should, perhaps, have as much insanity as now if 
we had not the drink. 

Dr. Hack TuxKeE could not agree with the remark the President had just made. 
Tt seemed rather late in the day to be discussing whether drink was a frequent 
cause of madness. He would call attention to the testimony of an eminent 
French physician—Dr. Morel—who stated to him that the increase of 
insanity in France was in direct proportion to the increase in the use of 
spirits, and more especially of absinthe. He said that in districts where the 
people used vin ordinaire there was very little insanity. These statements 
as to the effects of spirit-drinking applied more particularly to Paris and 
to Rouen where Dr. Morel then resided. He (Dr. Tuke) said that during 
the late war in France there was an immensely increased habit of drinking, 
and from this cause, rather than from political or military excitement, there 
was an increase of insanity. He should have thought they were all aware of 
too many facts already on record proving this effect of strong drink, to enter- 
tain any doubt of its being, on the whole, even the largest factor in the causa- 
tion of insanity. 

Dr. W. Woop considered the doctrine propounded by Dr. Bucknill to be one 
of the most dangerous he had ever heard. It seemed quite extraordinary, with 
all their experience of insanity, that they should be told there would be as 
much inganity if alcoholic drink were entirely abolished. He confessed that 
his own experience did not at all justify that conclusion. If it were to be 
admitted that strong drink only operated as an exciting cause of insanity, 
surely upon that ground alone its effects were most pernicious. The example 
of statistics in the Warwickshire Asylum last year, to which the President had 
referred, was open to some objection as ground for a general conclusion upon 
this subject. It was well known that an agricultural population was temperate 
compared with a town population. In a county where he (Dr. Wood) had had 
some experience, such was the manner of living of the lower classes, from 
whom the inmates of a county asylum would be drawn, that strong drink was 
almost unknown to them ; indeed, they could not afford it. He should, there- 
fore, be inclined to think any results from the experience of an agricultural 
county might lead to a fallacious estimate of the general effect of strong drink. 
But he should be most unwilling to have the opinion promulgated, upon the | 
authority of that Association, that strong drink did not produce insanity. He 
could not conceive any opinion more likely to do harm. His own experience 
was, on the contrary, that strong drink was a fruitful cause of insanity; and 
if it was regarded as only an exciting cause, he did not think its importance 
much less upon that account. Why, surely nobody would attempt to dispute 
the awful consequences of excess in drinking or the terrible forms of insanity 
that it produced. They were among the most hopeless cases of insanity—he 
did not mean as to the result of the disease, but as to the chances of reclaim- 
ing or restoring the individual to his proper place in society. The members of 
the Association ought, therefore, to use extreme caution in expressing their 
opinions upon this subject, lest they should be misunderstood, and quoted as an 
authority for the maxim that after all there was not much harm in drink. 

Dr. Boyp observed that, some years ago, inquiries were instituted by the late 
Dr. Dalrymple previously to bringing in his Bill for the legal custody of 
drunkards, and he (Dr. Boyd) then carefully went over the statistics of the. 
Somerset Asylum, extending to three thousand cases. He found that the pro- 
portion of cases directly attributable to drink, so far as he could make out, 
was 19 per cent. The proportion among females was comparatively small. 

Dr. W. Ruys WittiAms could not but sympathise, as, of course, they all did, . 
with the feeling expressed by Dr. Wood. About twelve months ago, if he (Dr. 


1877.] Notes and News. 157 


Williams) had been asked for his opinion, it would have been very much the 
same as Dr. Wood’s; and he did, in fact, say in his last report that he con- 
sidered intemperance a true agent, and one of importance in causing insanity. 
Now, he was not aware that he had yet altered his view of that question; but 
facts were stubborn things, and his own analysis of a number of cases had 
shown results which seemed different from what he should have expected. Out 
of 250 admissions to Bethlem in 1875, only seven males and seven females 
were set down as cases of insanity caused by drink, and in 1876 about the same 
average. But the curious part of it was that the female cases seemed rather 
to predominate over the males. There was, however, in a London Asylum very 
great difficulty in getting at the fact of intemperance in cases of insanity. 
Several of these cases had been put down, from the statements of friends or 
relatives, as persons of sober and temperate habits, and there might be some 
fallacy in relying upon the statistics of drinking as the cause of insanity. But 
still the result of this late experience would be to make him very careful here- 
after about committing himself to the. statement that drinking was a true and 


important agent in the causation of insanity, though he quite agreed that 


excess in drinking was a very great evil. 

Dr. Mayor wished it to be understood that these classifications of cases in 
which alcohol was stated to have had some influence in the causing of insanity 
were due entirely to Dr. Bucknill, and not to himself. It was Dr. Bucknill who 
had suggested that it would be absurd to lump all those cases together as due 
to alcohol ; and when he (Dr. Major) came to examine them carefully, he saw 
the truth of that remark. The result upon his own mind was that he had 
come to.the determination never, upon any consideration, to state in round 
numbers that a certain proportion of cases of insanity were caused by drinking. 
What he intended henceforth to say was this, that in his own experience, be it 
limited or be it large, there were so many cases which were directly caused by 
alcohol, and so many other cases which were caused by alcohol combined with 
something else. He would not even accept as conclusive any statements which 
represented in round numbers a certain proportion of cases to be due to 
alcohol, without so distinguishing and subdividing them. His _ conviction, 
which was firm and deliberate, of the utility or necessity of this rule in dealing 


’ with statistics, would apply, not only to alcohol, but to many other so-called 


causes of insanity. He had often contemplated drawing up a table of those 
causes, but had found the attempt involved in such perplexity that it soon 
broke down. The causes of insanity were, in many a case, so much bound 
together that to give an adequate account of them would be to write the whole 
history of that case, which could not be put down in a table. He was, 
therefore, almost in despair of compiling such a table. The only step he 
could take was that of the subdivision of these cases in which alcohol was 
concerned into four classes:—I1st, comprising those in which there had been 
nothing but alcohol, pure and simple, acting on the nervous system; 2nd, where, 
in addition to the effects of alcohol, there was hereditary insanity; 3rd, the 
cases in which, besides alcohol, there was some other physical cause of insanity 
—starvation and want, inanition, or bodily ailment of some kind; 4th, where 
there had been mental excitement or disturbance, as from worry or grief, or 
business anxieties or over-work. 

Dr. NICOLSON gaid his experience had been rather among criminals, and these 
were divided into such habitual criminals as were in that way all their lives, 
and those who had begun life respectably but had been tempted somehow to 
commit a crime. The former class were certainly not led into it by drinking. 
The latter class would often mention drinking as the cause of their fall, but it 
would appear from closer examination that they had taken to drinking under 
the influence either of a sudden exaltation or a sudden depression, arising out 
of some departure from their regular and ordinary course of life. The habit 
of drinking had, then, grown upon them, till their position and actions were 


138 Notes and News. (April, 


embarrassed by it, and they resorted to some criminal act ; but it could not be 
said that drinking was the original cause of their becoming criminals. On the 
other hand, he believed that the disturbance of mind, under certain circum- 
stances, might be counteracted, upon a particular occasion, by the beneficial 
effect of alcohol properly used; but if taken in excess time after time, it was 
likely to bring a man either to insanity or to a state of mind in which he would 
more easily be prompted to criminal actions. He thought Dr. Wood had rather 
misunderstood Dr. Bucknill, who had not denied that drink led, in some cases, 
to insanity, but had affirmed the possibility of its use, within reasonable bounds, 
counteracting the dangerous tendency of mental excitement or depression ; and 
so far he agreed with Dr. Bucknill. 

Dr. MaupsLey régretted that the discussion had wandered so far away from 
the particular topic which had been set before them by their President; but 
he was afraid that he should in that respect only imitate those who had pre- 
ceded him in the discussion. He, like Dr. Wood, felt something of alarm 
at the tendency of much that had been said, so far as it might induce the 
public to suppose that this Association did not think intemperance such a 
formidable cause of insanity as it was usually considered to be. Now, he 
dissented in toto from such an opmion. He believed that intemperance, 
apart from any hereditary predisposition to insanity, was one of the most 
frequent and most powerful causes of insanity. 

Dr. BuckniLL—That is what I said myself. 

Dr. MaupstEy replied that Dr. Bucknill had certainly the advantage of 
having considered the question at his leisure. The experience of Bethlem 
Hospital, to which Dr. Williams had referred, was likely to be fallacious, 
because the class of patients received there were not people among whom 
one would expect drinking to be the cause of insanity. There were no paupers 
in Bethlem, and it was among the poorer classes that drinking was most 
prevalent. It would, therefore, be misleading to depend on the statistics of 
Bethlem Hospital upon this question. The proposal for tabulating more 
correctly the cases of insanity produced by drink was one not easily to be carried 
out with perfect accuracy—that is, so that the tables should be entirely trust- 
worthy. The experience of Dr. Major, at Wakefield, quoted by Dr. Bucknill, 
would seem to show that 10 or 11 per cent. of those cases were independent 
of any hereditary predisposition, and that in only 1% per cent. there was here- 
ditary predisposition. He (Dr. Maudsley) must say that his own experience 
was utterly and entirely opposed to this view of the matter, and had rather 
led him to believe that neither alcohol nor anything else often caused insanity 
without some hereditary predisposition. Why, if a man had a perfectly 
sound and stable nervous system, with no predisposition to insanity, he 
might go on drinking to a good old age, and die quietly in his bed. Many a 
man had done so, having a sound nervous system to begin with, and others 
might, no doubt, continue to do so; but if a man did go with a feeble nervous 
system, the alcoholic excess would be likely enough to cause insanity. They 
would, however, find the greatest difficulty in ascertaining what were all the 
predisposing causes of insanity, and distinguishing them as bodily or mental. 
For example, there was phthisis, which Schréder van der Kolk and 
others had put down as a predisposing cause of insanity: was that bodily 
or mental P Was it the bodily disease, the tubercle, that caused insanity, or 
was it not rather the peculiar mental temperament which accompanied phthisis P 
He must again demur to the proposition of Dr. Bucknill, that the use of 
alcohol now and then, or, perhaps, habitually, might tend to prevent insanity— 
that it was an armour to guard the man against that dread calamity—“ a very 
present help in time of trouble.” He believed that if alcohol were so used it 
would be at the cost of frightful sufferings at a later period. He who 
took alcohol to protect himself against depression from any present calamity 
or anxiety would, no doubt, get the better of it for that time, but what would 


1877. | Notes and News. 139 


he do the next time? Instead of summoning the whole energies of his mind, 
by a strong effort of will, to encounter the trouble, he would again resort to 
the alcohol, so more and more weakening his powers of mind, debasing his 
moral sentiments, and becoming more helpless amidst gathering difficulties. 
He would next, perhaps, find himself sleepless at night, and would have re- 
course to chloral night after night, till at last he might go mad or become a 
complete wreck. The man who took to alcohol as a remedy for mental trouble 
was a man wasting the capital of his life, and was sure to become bankrupt in 
the end. 

Dr. Masor said he had not intended or wished to set his own experience in 
opposition to that of Dr. Maudsley, but as he found in the asylum last year a 
certain number of cases in which hereditary predisposition to insanity was 
specified, and a number in which it was not, he had merely set down those 
numbers. He did not say it would always be the same as a matter of general 
experience. 

Dr. Mavupstey asked, in return, how could they find out the hereditary pre- 
disposition and family history of all those. unfortunate paupers in a county 
asylum? Even in his private practice among families of the higher class he 
had found it was most difficult, sometimes almost impossible, to learn the truth 
about the previous existence of insanity in a family. He related an anecdote which 
would exemplify this remark. 

Dr. BuckNiILL thought the family history of paupers in the rural districts 
was not difficult to ascertain, in general, from the local poor law authorities and 
other informants. 

The PRESIDENT likewise believed there would be less difficulty in getting 
this information about the poor in the country than about the richer classes in 
town. 

Dr. WICKHAM said that he and Dr. Clouston some years ago made a table of 
the causes of insanity in all the cases admitted into their respective small 
asylums. They put down many questions, in every possible form, to be 
answered in each case, inquiring especially as to the condition and habits of the 
father and mother, the brothers and sisters, and other relatives. In each case 
they made a personal investigation with the utmost care; they saw the husband 
or wife, or other near relative, but the stupidity they had to contend with, the 
reckless misrepresentations, the determination not to answer. those questions 
defeated their attempt. He had long been of opinion that intemperance was 
not so large a cause of insanity as was generally supposed ; but the statistical 
information obtained during three or four years was likely to be extremely 
faulty. There was always a wish to conceal the fact of drunkenness having 
existed in a husband or father. The best thing to be done with these tables of 
the causes of insanity, such as they were, was to throw them into the fire and 
try to get at the facts in some other way. His own experience led him to think 
every class of cases might in this respect be sub divided into twenty other 
classes, from the variety of combined causes and circumstances. 

The PRESIDENT now observed that it was too late for them to proceed with 
the discussion of the remaining points, and he would invite Dr. Bucknill to 
reply at once. 

Dr. Buckniut had very little to say in reply to those who had spoken. With 
one or two slight exceptions, he quite agreed with all they had said, and he 
had been much gratified by the kind reception of his paper, to which he had 
expected a larger amount of opposition. But he did regret that so intelligent 
a physician as Dr. Wood should have so completely misunderstood him. Dr. 
Wood had imagined him to have said that intemperance was not a cause of 
insanity [Dr. Wood—* No, no!’’], or not so great a cause as was generally 
supposed, but he (Dr. Bucknill) had guarded himself by declaring that he 
thought intemperance in drink was by far the most potent of all the removable 
causes of mental disease. 


140 ~ Notes and News. (April, 


Dr. Woop explained that his observations were rather directed to what the 
President had gaid than to what Dr. Bucknill had said. The President, if he 
was understood correctly, had said that he believed if strong drink were 
entirely abolished there would be just as much insanity. 

Dr. Bucknitu had not heard the President say that. 

The PrEsIDENtT—Not so strongly as Dr. Wood puts it. 

Dr. BucknixLu had taken care to guard himself, as he thought it likely he 
would be misunderstood. He had stated as his strong opinion that “‘ intem- 
perance was by far the most potent of all removable causes of mental disease,” 
but he had asked whether they believed that if all the people in this 
country were to become total abstainers, while all the other conditions of 
their life-battle remained unchanged, the total number of admissions to 
lunatic asylums would be diminished 15 per cent., or whatever might be the 
full extent of the number of cases now stated to be caused by drinking. 
He did not believe that it would be so. There would still be those other 
causes of insanity—grief and sorrow, misery and poverty, and the continual 
struggle of many people to live. The statistics of New England, where 
there was less drinking than in any other civilised community, showed that — 
these causes were still fertile in the production of insanity ; the percentage of 
cases in the New England asylums to the population was quite as great as 
in our own country or in other States of the Union. He could not undertake 
to answer Dr. Maudsley’s objections to the statistics of Dr. Major. There 
were great differences of opinion ; some people had even fancied that 80 per cent 
of the cases of insanity were caused by drink. Dr. Maudsley seemed to think 
an hereditary tendency produced more insanity than any other cause, but he 
(Dr. Bucknill) could not agree in that opinion; they must be content to differ. 
He believed there need not be such very great difficulty in getting at the per- 
centage of hereditary cases in the pauper asylums, and it would surely prove 
to be of minor amount than from other causes. 

The PresipENtT thought it was about 30 per cent. 

Dr. BUCKNILL, in conclusion, said he was much gratified by the reception 
given to his views, which might have appeared startling to many persons. He 
entirely agreed with Dr. Maudsley in saying that if a man resorted to alcohol 
for relief from every little care and trouble, and continued habitually to do so, 
it would go badly with him; but he (Dr. Bucknill) said that alcohol was not so 
uniformly mischievous or destructive of mental functions as had been repre- 
sented, and on the principle Ubi virus, ibi virtus, he had no doubt alcohol might 
be preservative, or even conservative, taken in proper doses, at certain times 
and in certain cases. He thought a physician having to deal with cases of im- 
pending insanity might sometimes prevent it by the wise and judicious 
administration of alcohol upon some occasions; but, of course, if it were used 
as the mere indulgence of the ignorant and vicious, it would have all those 
evil results that were commonly seen. 

This closed the discussion, and the Secretary (Dr. W. R. WILLIAMS) 
announced that the meeting had arrived at its termination. There were two 
or three members who had prepared and placed at his disposal papers 
which they had not time to hear read. One was contributed by Dr. Chapman, 
Superintendent of the Hereford Asylum, upon “The Comparative Mortality of 
Different Classes of Patients” (See Original Articles, p. 54). Dr. Boyd, also, 
had kindly offered to read a paper on ‘The Influence of Age in Mental 
Disorders.” The Association was much obliged to both those gentlemen, as well 
as to Dr. Bucknill. 

A vote of thanks to the President and Fellows of the Royal Medical and 
Chirurgical Society, for kindly granting the use of their rooms, closed the 
proceedings. 





ae; - 


1877. | Notes and News. 141 


QUARTERLY MEETING OF THE MEDICO-PSYCHOLOGICAL 
ASSOCIATION, HELD IN GLASGOW. 


A meeting of the Medico-Psychological Association was held on the 21st 
February, 1877, in the Hall of the Faculty of Physicians and Surgeons, 
Glasgow. There were present Drs. McIntosh (Murthly), Clouston (Edinburgh), 
Yellowlees (Glasgow), Brown (Hdinburgh), Macleod (Carlisle), Tuke (Hdin- 
burgh), Anderson (Rosewell), Clapham (Wakefield), Robertson (Glasgow), 
Watson (Cupar), Munro (Dumfries), and Rutherford (Lenzie). Dr. Yellowlees 
(Glasgow) in the chair. 


“ON THE RELATION OF EPILEPSY TO CRIMINAL RESPONSIBILITY.” 


Dr. J. Barry TUKE read a paper on the above subject. 

The CHAIRMAN said—The occurrence of acute maniacal attacks between 
epileptic seizures suggests the question, “ Is this owing toa fit that has happened 
out of its time, or is it an acute maniacal attack independent of epilepsy ?” I con- 
fess, to a strong suspicion, that in many of these inter-current maniacal attacks 
there has been an epileptic seizure unobserved. I do not think the periodicity 
of epilepsy is usually so absolute that you can count upon the same length of 
interval; and my impression is strong that frequently there has been an un- 
observed fit, perhaps nocturnal, so that the nurse has not noticed it, and that 
this maniacal attack is really the excitement in connection therewith. Dr, 
Tuke spoke of three things which might possibly occur in lieu of fits, a period 
of unconsciousness, an acute maniacal attack, and a morbid impulse to 
violence ; and the interest of this paper very much centered in the possibility 
of these occurrences as apart from fits, and in the conduct such morbid 
impulses might occasion. I repeat my impression that very often epileptic fits 
occur unobserved, even under the best care; and, as we all know, slight 
seizures are followed by quite as much excitement as the more severe ones, or 
even by greater excitement. I confess to a lurking suspicion, whenever I find 
an epileptic patient wilder, more stupid, or more dangerous than usual, that he 
has had a fit which we have not noticed; and I suspect, practically, that is 
what we all feel. It is difficult to be quite sure there has not been a fit. I 


_. concur entirely with Dr. Tuke that in a matter so grave as homicide occurring 


in a person hitherto non-epileptic, and apart from any epileptic fit, we are not 
justified in saying that the case was one of masked epilepsy. I suspect we 
have been rather too ready to infer epilepsy merely from impulsive explosions 
of that kind. There is no doubt that impulsive explosions happen in other 
forms of disease than epilepsy, and it is not necessary always to summon up a 
theory of epilepsy in order to explain these explosions. Dr. Tuke made a 
distinction between epeliptics and epileptic lunatics, and between the acts of 
violence done by the one and by the other. JI am not disposed to make that 
distinction so marked ashe does. I think that any act of violence committed 
by an epileptic would be very much the same as an act of violence committed 
by an epileptic lunatic, I do not see that you can differentiate the two 
violences. If a man has epilepsy, a tendency to violence is one of the normal 
manifestations of his disease, whether he has shown former insanity or not. 
Dr. Tuke make a remark, which is generally true, that deliberation is not 
characteristic of epileptic violence. Ido not know that he is justified in say- 
ing “never,” As a rule, certainly, what he said is true, that epileptic 
violences are abrupt, sudden, reckless, and not planned; but Iam not sure that 
an epileptic is never a scoundrel, and that he cannot plan mischief, and carry it 
out just as others do. I have a feeling that we do not give lunatics sufficient 
credit in their manifestations for having the same evil passions as sane people, 
and that while lunacy may lessen their self-control, yet their criminal conduct 
may be attributable as much to evil passions as to disease. 

Dr, CLouston—In regard to the question of whether the violent acts of 


142 Notes and News. [Apri, 


epileptics may not be planned with deliberation, I may mention a case in 
point. Shortly after I went to the Royal Edinburgh Asylum I had as a 
patient, a young Irishman, who had, up to the time that he was twenty-four, 
done his ordinary work as a labourer; was married, and had a family. After 
he came to the Asylum he took epileptic fits regularly at intervals, with the 
usual epileptic irritability ; and on no less than two occasions did the attendant 
find that, while in the irritable state, he had stolen another person’s stocking ; 
had, when he was out walking, put a stone in the toe of the stocking, and 
twisted up the leg of it, and made an instrument with which, on one occasion, 
he stood ready to fell an attendant, and on another occasion had intended to fell 
myself; and that he carried about this stocking at the one time for several — 
days, at the other,.I have reason to suppose, for at least a week. After he came 
to himself, and the epileptic irritability passed away, he brought out the stock- 
ing, and told the attendant and myself. Now, if that man had committed murder, 
most unquestionably it would have been a planned and premeditated murder, 
as much as if he had been no epileptic at all, and yet the whole thing was owing 
to the epilepsy, and of course he could not he held responsible. With regard to 
the question Dr. Tuke has brought forward, as to whether there is a possibility 
of a criminal act being done during an epileptic paroxysm, and as the result of 
‘an epileptic state in a person never epileptic before, I confess that I agree 
with him that there is no evidence on the point—no satisfactory evidence—al- 
though not only Falret, but even a higher authority, Trousseau, adopts Falret’s 
views, and puts it down as his own opinion that criminal acts committed in 
such circumstances must be epileptic. In connection with this matter many of 
you may have seen in the “ Journal of Mental Science” and elsewhere Dr. H. 
Jackson’s views as to epilepsy. You are all aware that he employs the term in 
a wide sense, and that he adduces many instances of want of consciousness in 
an epileptic coming on instead of an epileptic fit. You all know, probably, 
also, his theory that in these cases the explosion, to use his term, has been 
confined to the intellectual cells of the brain. He says that epilepsies may be 
confined to the intellectual portions of the brain, to the emotional portions of 
the brain, to the sensory portions of the brain, to the motor portions of the 
brain, or that these may be mixed up in various ways and degrees, and I must 
say that this theory has the charm of giving unity to a great many phenomena 
that hitherto we have not been able to group together. Dr. H. Jackson looks 
on what we call the ordinary motor epilepsy, as, in reality, a lower sort—an | 
epilepsy of merely the motor-centres, affecting, as a general rule, first the 
motor-centres, and then spreading to the intellectual; but he holds that the 
two things may be separate and distinct. In connection with this matter my 
experience and my belief are not those of Dr. Yellowlees, that when an 
epileptic is irritable he is most likely to have had an unobserved fit. 

Dr. YELLOWLEES—I did not mean to put it so strongly as that, for I do not 
doubt that the explosion may take a mental, instead of a physical form; but I 
believe that slight fits often occur unnoticed in connection with these apparently 
purely mental symptoms, and I think we have no right to call such explosions 
epileptic at all, unless their true character has been interpreted by the 
occurrence of an ordinary epileptic seizure at some previous or subsequent ~ 
period. 

Dr. CLouston—I wish to mention, in connection with this, a curious case 
that came under my care at Carlisle Asylum. The patient was a woman who 
for many years had taken regular attacks of epilepsy, distinguished in no 
particular way ; but about the climacteric period, and ever afterwards, she took 
epileptic attacks of mania. At last, following the usual course of nearly all 
epilepsies and all insanities, she became demented and chronically irritable, 
but irritable at certain times more than others, and her insanity had the 
peculiar want of consciousness and peculiar conditions that we associate 
with epilepsy. I may mention, also, that for some six months the attacks 


4 


1877.] Notes and News. . 143 


were prevented by the use of bromide of potassium, just as we all believe it 
acts sometimes in cases of epilepsy. Has it never occurred to any members of 


_ this Association that a few epileptics, though occasionally subject—some of 
them only at distances of many years—to attacks of irritabilily, were yet, on 


ordinary occasions, extraordinarily good-tempered, obliging, and most useful to 
attendants? Where do we find a man who will take care of idiots and weakly 
people better than some of these epileptics to whom I refer? We have one 
very remarkable instance of this at Morningside at present; a man who takes 
regular fits of epilepsy, and, yet, who is the kindliest possible nurse. There 
was in the Edinburgh Asylum, at one time, an upholsterer who never had an 


attack of epileptic irritability, although he was sometimes stupid; a 


remarkably kind, pleasant man, always doing his work, and whom I never 
knew to be guilty of violence. I think we ought to give these epileptics 
credit for saintliness, as well as for the devilishness which is ordinarily 
associated with them, because many of them seem to make up for the 
attacks of irritability by being extraordinarily kind and good on other 
occasions. 

Dr. D. M. McLeop read a paper, “Cases of Insanity in which Impairment 
or Loss of one or more of the Special Senses seemed the exciting Cause of the 
Disease.” (See Clinical Cases, p. 101.) 

Dr. RoBERTSON said—In the interesting paper to which we have just listened 
Dr. McLeod has not referred particularly to the causation of insanity in such 
cases. One way in which it was produced was by the shutting out of impres.- 
sions from the brain. The basis of thought is to a large extent removed, and 
the mind is very apt to get into an unstable condition. Another way was by 
the direct extension of the disease from the sense-organ affected to the brain. 
I believe that in some cases insanity is produced in this way. If I mistake 
not, Dr. Clouston and Dr. Tuke have each described a case of this kind; but I 
think that the main cause in such cases is not improbably the despondency and 


- gloom—the emotional depression—that are apt to arise in the sufferer’s 


mind from the knowledge of their loss, and that possibly their means of liveli- 
hood are cut off, that they have become wrecks in life. The mind broods on 
the loss, and in that brooding it seems to me that hallucinations are apt to arise 
in connection with the sense affected. You would notice that in the cases sub- 
mitted by Dr. McLeod the hallucinations were mostly connected with vision. 


His patients were all blind; their minds dwelling on their loss, the part of the 


brain connected with the vision would be very apt to get into an unhealthy 
condition. I think I have seen that, in patients who had become deaf, the 
hallucinations of hearing have been a prominent feature, probably arising in 
the way I have indicated. 

Dr. ANDERSoN—The object of Dr. McLeod’s paper seems to be to establish a 
form of insanity connected with the deprivation of one or more of the special 
senses. -There can be no doubt that the mere deprivation of impressions from 
without may cause a certain amount of cerebral change; indeed, I think it 
wonderful, when we consider how largely cerebral activity depends upon 
sensory impressions, that their impairment or loss is not a more frequent cause 
of insanity. Perverted impressions are frequently the exciting cause of a 
maniacal attack, and if sometimes we can by any means shut out the impress 
ions, as by closing the eyes, the excitement ceases or is diminished. I recently 
demonstrated this in the case of a person who was labouring under extreme 
fear, being under the impression that his soul was lost. If we laid him on a 
sofa and closed his eyes, he became calm and fell asleep in a few minutes. 

Dr. RopErtson—lI think M. Voisin, in his recently published work on insanity, 
refers particularly to recovery from insanity after restoration of the particular 
sense affected—sight, for instance. Many of us must have met with cases in 
which, if you plug the ear of patients labouring under auditory hallucinations, 
for a time, at least, the hallucinations, if not put away altogether, are moderated 


144, | Notes and News. [Apri], 


in degree. Ihadacase of that kind under my care lately, in which the patient 
himself was in the habit of putting cotton into his ears to keep out the impres- 
sions which his diseased brain transformed into erroneous ideas. 

The CoarrRMAN—I remember a case in the Edinburgh Infirmary of a man who 
wasable himself to explain his wild and morbid fancies after his recovery. It 
was to his extreme satisfaction that he discovered that the gallows prepared 
for his execution was the gas pendant in the middle of the room, the loop of 
it being the noose for his neck, the masonry of the wall being the ladder which 
was to lead up to the gallows. These things showed that his hallucinations 
were dependent upon external objects, and were his insane transformations of 
them ; and that may be the case much oftener than we suppose. 

Dr. CLouston—Most of us know the case of the celebrated Laura Bridgman, 
who was deprived of three senses: she had no sight, no hearing, and no speech. 
The way in which she, who appeared to be a mere idiot, was transformed by 
the genius of Dr. Howe into a very reasonable woman was through the educa- 
tion of her sense of touch making up for the want of all the other senses, and 
giving her ideas of the external world. She is an example of an idiot being 
converted into a sensible person through sense impressions conducted in a 
certain way so as to evolve, first simple ideas, and then ideas of a more com- 
plicated nature. In regard to the pathological propagation of disease through 
the senses, there is another view of some of those cases—that perhaps general 
disease of the brain was going on, which affected the centres of a special sense 
first before it affected the entire brain. Of course, in this case, if Ferrier’s 
views are true, disease occurring in the optic convolutions of the brain, if they 
happened to be bilateral, would undoubtedly cause blindness, and it does not 
take much imagination to suppose that this would spread and cause general 
intellectual disturbance afterwards, if one wanted a pathological theory for 
this condition. ; 

The Cuairman—I do not understand Dr. McLeod to say that he has dis- 
covered a special type of insanity at all. 

Dr. McLzop—No. As regards the particular cause of insanity caused by lost 
senses, I was first directed to the subject by Dr. Ireland’s paper on idiocy 
caused by deprivation, and shortly afterwards the last case came in, which was 
very apparently sent to the asylum on account of deprivation of the senses. 
If the woman could have seen and heard, she would have been kept at home. 
It accordingly struck me to look out some cases of a similar kind, and I 
found several so very much alike in their chief symptoms, that I thought it 
possible they might be occasioned by similar exciting causes in each case. All 
the cases were old people, strongly predisposed to insanity by age. This 
deprivation was the last straw which broke the camel’s back; that is my idea. 
I could find no literature on the subject of the relation of special senses to 
mental disease, and therefore I was impelled to suggest this. 

Dr. JoszerH J. Brown read a paper on “The Pathology of a Case of 
Transient Alternating Hemiplegia.” (This will appear, with illustrations, in 
our next number.) 

Dr. TukE—It is only by such a process of pathological observation as Dr. 
Brown has pursued in this case that we can come to definite conclusions. As 
to the special points in his paper, I am very much inclined to agree with him 
in everything he said; but it is a paper that would require to be studied 
carefully before one could speak upon it. 

Dr. Ropertson—Dr. Brown’s case is of great interest, and has been admirably 
described. It is of a very exceptional character, and I have not met with one 
like it. I have often seen temporary hemiplegia follow unilateral convulsions, 
and also after epileptic seizures affecting particularly the one side, which is 
much the same thing. In one case of well-marked hemiplegia, recovery took 
place in ten minutes; but I have not seen ephemeral hemiplegia, such as 
occurred in Dr. Brown’s case, without being preceded by convulsions. I must 


1877. ] Notes and News. | 145 


say that the question arose in my mind, when Dr. Brown said that there had 
been no defect in articulation in any of the seizures, nor had the face been 
affected, Might there not be a mistake P—particularly when it occurred in an 
insane person. And this thought was strengthened when he said that some of 
the lesions were very marked in the region of Broca’s convolution, for the 
centre for articulation, according to Ferrier, was quite near that part of the 
brain. Still, when one looks at the specimens shown by Dr. Brown, it is very 
evident that the brain has been markedly diseased, and the hemiplegic attacks 
may have occurred in connection with the minute hemorrhages described in 
the paper, and these might have resulted from the bursting of the small 
aneurisms. 

Dr. ANDERSON—I am desirous of knowing from Dr. Brown whether he 
considers degeneration of the blood vessels, which in apoplexy are generally 
held to be the exciting cause, was the starting-point in this case, or whether 
he thought it was secondary to degeneration of the brain. It seemed to me it 
was secondary. A case of degeneration by aneurism of an artery was brought 
under my notice in a youthful person who died from apoplexy of the cere- 
bellum. There was throughout the whole of the blood vessels of the brain 
complete degeneration of this kind, but what killed the person was apoplexy 
of the cerebellum. In that case there was no doubt that the apoplexy began 
in the blood vessels. 

Dr. Brown—In this case I think the degeneration was of the blood vessels 
first; it was almost a natural process in this person, an old woman of 73. One 
would naturally expect her vessels to be very much affected, and when she had 
some exciting cause to act on her brain, of course the circulation was disturbed 
and the blood vessels could not recover as healthy vessels would; and she went 
on having these attacks of excitement, and ultimately got into dementia. In 
this case, seeing how much the vessels were affected all throughout, not only in 
the brain, but in the body, I think the vessels were first affected, and in con- 
sequence of mal-nutrition the cells and other tissues followed. In regard to 
speech, at first the muscles of the face during her illness were not affected, and 
the tongue was not affected; aphasia was not an early symptom. It came on 
late, and was marked and transient, but towards the last month of her life it 
was almost constant. It was, then, difficult to make out whether there was 
not paralysis of some of the facial muscles. 

Dr. CLouston—In two similar cases of alternating and transitory hemiplegia 
I observed the chief lesion seemed to be a degeneration of the white matter— 
the white tracts leading from the corpus striatum upwards—and I formed the 
theory that the paralysis was owing to imperfect conduction, a great number 
of the fibres having been destroyed. In this case certainly those white tracts 
do not seem to have been specially affected. On the other hand, notwithstand- 
ing Dr. Brown’s explanation, I have great difficulty in realising the fact that the 
bursting of an aneurism, about the size of a pin point, in a convolution could 
have caused hemiplegia of nearly the whole of one side. That is my chief 
difficulty in regard to this case pathologically. Then there is another difficulty 
I used to notice in those cases under my observation. A hemiplegia which had 
begun in the morning used to get considerably worse by night, after the 
exhaustion of hanging about and walking, for the patient could scarcely be got 
to sit down. A night’s rest would often completely restore her and put away 
the hemiplegia, so that she would walk two or three days with both sides alike, 
and then the other side would become affected. That is a point not quite ex- 
plainable pathologically. 

Dr. Brown said that was easily explained by Ferrier’s experiments, where 
temporary paralysis always resulted from over-stimulation or destruction of 
even a small portion of brain convolution. He looked on the disturbance 
caused by the bursting of one of those aneurisms as analogous to that pro- 
duced by Ferrier by over-stimulation or destruction. 


XXIII, 10 


146 Notes and News. (April, 


Dr. CLouston—The outward appearance of the convolutions was most peculiar. 
When a few of the convolutions were stripped of the pia mater, it seemed as 
if you had sprinkled them with a brush dipped in ferruginous water—an ap- 
pearance I never saw before in any brain. 

It was agreed that the next meeting be held in Edinburgh in the first fort- 
night of November, and that the Spring meeting be held hereafter in the first 
fortnight of February. 

On the motion of the CHAIRMAN, a cordial vote of thanks was awarded to the 
Faculty of Physicians and Surgeons for the use of their hall. 





A meeting of Medical Superintendents of Scotch Asylums was held in the 
Hall of the Faculty of Physicians, Glasgow, on Wednesday, 21st February, Dr. 
McInrosu, Medical Superintendent of Perth District Asylum, in the chair. 

The CHAIRMAN stated that the object of the meeting was to receive the 
report of the committee appointed at the meeting held in Hdinburgh on the 
lst November last to consider what action should be taken by them towards 
legalising the granting of superannuation allowances to asylum officers and 
servants in Scotland. The committee had held three meetings—one in Perth, 
one in Edinburgh, and one in Glasgow. They had also had an interview with 
the General Board of Lunacy, and had received several valuable suggestions 
from the Commissioners, together with the assurance that in this movement 
they had the sympatay and good wishes of the Board. As the result of their 
labours, the committee submitted to the meeting, for their approval, the follow- 
ing amended petition to the Lord Advocate, and recommended that the Asylum 
Superintendents, together with representatives from the several Asylum Boards, 
should seek an interview with the Lord Advocate on the subject :— 


UNTO THE RIGHT HONOURABLE THE LORD ADVOCATE FOR SCOTLAND. 


The petition of Superintendents and other Officers of the Scottish Royal, 
District, and Parochial Asylums for the Insane, adopted at a meeting held 
in the Hall of the Faculty of Physicians and Surgeons, Glasgow, on the 
21st February, 1877, 


HuMBLY SHEWETH,— 


I. That provision has been made by the Legislature for granting super- 
annuation allowances to the officers and servants of the County and Borough 
Asylums in England and the District Asylums in Ireland. 

II. That in the Act 29 and 380 Vic., cap. 51, sec. xxv., the Directors of the 
Chartered Asylums in Scotland were empowered to grant superannuation 
allowances. 

III. That while under these provisions the number of pensions has not been 
relatively large, or the cost great, their effect has been to promote the efficiency 
“of the service. 

IV. That there is no such provision for the same classes of Officers in the 
District and Parochial Asylums of Scotland, however long or meritorious their 
services may have been, or however much they may be incapacitated by injury, 
accident, or otherwise. 

VY. That this is not only an injustice to such Officers and Servants, but it is 
directly calculated to impair the efficient working of the Asylums by drawing 
away the staff to more favoured Institutions. 

VI. That there is reason to believe that when the Act alluded to in Clause II. 
(see Clause II.) was passed, in 1866, provision would also have been made for 
pensions in District Asylums had they not been at that time few in number 
and only recently established in Scotland. Now there are eleven District 
and six Parochial Asylums, some of which have been in operation for nearly 
fifteen years. 


1877.] Notes and News. 147 


VII. That the opinion of the General Board of Lunacy, as published in 
their ninth annual report (1867) is in favour of such a provision being extended 
to all Scottish Asylums, and that a Committee of your Petitioners had similar 
assurances at a recent interview with the General Board. 


Your Petitioners would, therefore, humbly pray that Section xxv. of the Act 
(Lunacy Scot.) 29 and 30 Vic., cap. 51, be repealed, and that the following be 
substituted :— 

“Tt shall be lawful for the Directors or Managers of any Royal Asylum, and 
_ for the District Boards and Parochial Boards in the case of District and 
Parochial Asylums in Scotland, to grant out of the moneys lawfully applicable 
to the building or repairing of such Asylums, a Superannuation allowance to 
any Officer or Servant who shall have been in office for not less than fifteen 
years, and the said Superannuation allowance not to exceed two-thirds of the 
total money value of the appointment held by such Officer or Servant at the 
date of superannuation; and it shall also be lawful for the said Directors, 
- Boards, or Managers to grant out of the funds above mentioned a Superannta- 
tion or other allowance of such amount, on such conditions and for such periods 
as to them may seem fit, to any Officer or Servant who, having held office for 
less than fifteen years, may nevertheless have peculiar claims for such allow- 
ance on the ground of injury, ill-health, or otherwise.” 


The meeting, after some discussion, approved of the petition, and it was 
resolved, on the motion of the CHAIRMAN, seconded by Dr. CouLron, that it be 
printed and a copy sent by the Secretary to each physician and medical — 
superintendent of an asylum in Scotland for signature, and that the signatures 
be embodied in one general document for presentation to the Lord Advocate, 
a copy being sent to every chairman and secretary of an Asylum Board. The 
Secretary was also authorised to arrange that a deputation consisting of all 
physicians and medical superintendents, supported by influential members of 
Asylum Boards, should wait upon the Lord Advocate on an early day. 


CLINICAL INSTRUCTION IN FRENCH ASYLUMS. 


We are happy to say that the resumption of the courses of clinical instruc- 
tion in mental diseases in the Paris asylums, which had for some time been 
suspended by order of the Government, has been authorised. Here is the 
decree of the Prefect of the Seine :— 

“Te Préfet de la Seine, en exécution de la décision prise par M. le Ministre 
de l’Intérieur, en date du 15 novembre, et portant: 1° Que des conférences 
cliniques de pathologie mentale seront ouvertes 4 Vasile Sainte-Anne et dans 
les quartiers d’aliénés de Bicétre et de la Salpétriére, 4 partir du 1¢™ décembre 
prochain; 2° Que ceux qui voudront suivre ces conférences devront se pourvoir 
préalablement d’une autorisation du Directeur de 1’établissement, laquelle sera 
délivrée — aux éléves en médecine sur le vu d’un certificat de la Faculté de 
médecine attestant que le titulaire a subi avec succés le troisiéme examen de 
fin d’année,—aux médecins et magistrats sur la présentation de leur carte 
personnelle,—anx avocats sur le vu d’un certificat délivré au secrétariat 
général du ministére de la justice ; 

“ Arréte: Des conférences cliniques de pathologie mentale seront ouvertes 
dans les conditions ci-dessus indiquées, 4 lasile departemental de Sainte-Anne 


et dans les quartiers de Bicétre et de la Salpétriére, a partir du 1° décembre, 
1876.” 


148 Notes and News. (April, 


THE LUNACY LAWS. 


The Government have assented to a motion made in the House of Commons 
for the appointment of a Select Committee to enquire into the operation of the 
lunacy laws. The following Select Committee was appointed, and is now 
taking evidence :—Mr Stephen Cave, Dr. Lush, Mr. Woodd, Mr. Ramsay, Mr. 
Leighton, Mr. Tremayne, Mr. Herschell, Mr. Goldney, Mr. Joseph Cowen, 
Mr. Kavanagh, Mr. Butt, Mr. Birley, Mr. Hopwood, Mr. Stewart, and Mr. 
Dillwyn:—Power to send for persons, papers, and records. Five to be the 
quorum. 


MEMOIR OF THE LATE DR. S. G. HOWE. 


The Forty-Fifth Report of the Perkins Institution and Massachusetts 
Asylum for the Blind, over which Dr. Howe presided since the foundation, 
has, as an appendix, an interesting “Memoir of Dr. Samuel Gridley Howe, by 
his widow, Julia Ward Howe, a lady of high literary distinction.” There are 
also memorial tributes from other hands, and a most excellent and charac- 
teristic photograph which recalls the venerable philanthropist most vividly to 
remembrance as we saw him, fully engrossed with his benevolent labours 
fourteen years ago. 

The death of Dr. Howe took place on the 9th of January, 1876; on the 
ensuing day the Governor of the State of Massachusetts intimated the fact by 
a special message to the Legislature then in session. ‘The funeral services, on 
the 13th, were attended by many members of the Senate and House of Repre- 
sentatives ; and appropriate services were performed at the Massachusetts 
Blind Asylum and at the Church of the Disciples. A committee of the two 
Houses was also appointed to report resolutions in honour of the distinguished 
citizen. It was felt, however, that the usual funeral honours were insufficient 
to testify the respect and affection with which Dr. Howe was regarded by all 
classes of the community in his native city, and a committee was therefore 
appointed to arrange for a memorial service at the Boston Music Hall, in which 
the whole public could take part, This was held on the 8th of February, from 
2.30 to 5.30 p.m., His Excellency the Governor of Massachusetts presiding ; the 
spacious hall being filled in every part by an attentive audience. Brief 
eulogies in prose and verse were delivered by friends of Dr. Howe, and appro- 
priate and pathetic music contributed by the blind pupils whom he had edu- 
cated. Among the pieces produced on this occasion was an original poem 
recited by Dr. Oliver Wendell Holmes, one of the medical professors of 
Harvard University. Hx-Governors of the State and the ex-President of Brown 
University were among the speakers, and testified in eloquent language to the 
high and influential position which Dr. Howe occupied in the estimation of his 
fellow-citizens. 

Certainly few men have better merited a high place in the temple of fame 
for works of the highest benevolence, and for self-denying exertions on behalf. 
of the most helpless and neglected of the human family. With abilities and 
force of character, and a most favourable combination of circumstances which 
could have secured a successful issue to any enterprise, Dr. Howe made his lot 
with the blind, the imbecile, the oppressed, the prisoner, and the slave. To 
them he gave his life, and he devoted himself to labours on their behalf at a time 
when public sympathy with the helpless was at a much lower ebb than it is in 
these days. 

We can do no more than present the merest sketch of Dr. Howe’s active 
life. Immediately on the completion of his medical studies he sailed for 
Greece, then in the throes of her life-struggle with her oppressors the Turks; 


fo/7.| Notes and News. 149 


and for six years he fought with them, sharing, like Byron, in all the perils and 
hardships of the terrible strife, and when he left them he returned to America, 
only to rouse the sympathy of his countrymen on behalf of the suffering 
Hellenes. He collected 60,000 dollars and great supplies of clothing, with 
which he returned to Greece, and carefully superintended the distribution of 
the bounty. He devoted part of the funds to the construction of works of 
public utility, which bear the name of America to this day. He established an 
industrial and agricultural colony on the Isthmus of Corinth, on a large grant 
of land given by the Government for the purpose—school, house, and church 
being among the constructions. 

Dr. Howe published, in 1828, a ‘‘ History of the Greek Revolution,” which 
possesses much interest. He never lost his interest in the Greeks; and in 
1866, during the Cretan struggle, he revisited the scenes of his early enter- 
prise, conveying substantial relief and comfort, clothing and food, to the 

~hungry and naked women and children of the heroic island. At the risk of his 
life, Dr. Howe visited Crete, and conferred with the active agents in the 
conflict. 

On the occasion of Dr. Howe’s death, the Greek Government sent a most 
graceful expression of the affection and gratitude with which “the most 
ardent and distinguished Philhellene” was regarded by the Government and 
people of Greece. 

On returning to America in 1828, Dr. Howe found a new object of interest, 
which was destined to prove the central and most engrossing object of his 
life: this was the education of theblind. To furnish himself thoroughly for this 
work, he returned to Paris to study the methods then so successfully prosecuted 
by the Abbé Haiiy. He was here no uninterested spectator of the political events 
of the time. The Poles were then struggling for liberty, and contributions of 
money and clothing had been forwarded from America, consigned to General 
Lafayette in Paris, who had again and again tried to get them across the 

Prussian frontier. Dr. Howe undertook the perilous mission, which he success- 
fully accomplished. Returning by Berlin, whither he had gone to inspect the 

_ School for the Blind, he was arrested by the Prussian police on the very night 
of his arrival. He had only time to dispose of papers which would have im- 
plicated others in the heinous undertaking ; and these he deposited in a bust 

of the King of Prussia, where they were subsequently found by a friend, 

guided by his directions. He was most rigorously treated, and it was only 
after very persistent efforts by the American Minister at Berlin that, after six 
weeks’ detention, he was conveyed six hundred miles in a carriage with two 
gendarmes across the frontier, which he was admonished never to cross again. 
He returned to America to assume the arduous duty of teaching the blind, 
to which he continued, till within a few years, to devote his personal efforts. 

_ He had to train his assistants, and to educate the public mind to a practical 

‘interest on the subject. Laura Bridgman will ever be associated with the 
name.of Dr. Howe as a monument of unflinching hopefulness and energy. 

Dr. Howe did not give himself to the ordinary practice of his profession, but 
he took the entire medical charge of the pupils of the two institutions of which 
he was the founder, the benefactor, and the superintendent up to the time of 

) his death. In the cure both of the blind and idiotic he laid great weight on 

_ Tegulated bathing, and diet, and exercise. 

_ As a member of the Boston School Committee, in which he was long asso- 
Ciated with Horace Mann, he gave most valuable assistance in the public school 
Operations of the city. Along with Charles Sumner he took an active part in 

_ the reformatory discipline of prisons, and was, like him, an advocate of the 
Separate as opposed to the silent system. He was one of the founders of the 

: Discharged Convicts’ Aid Society, and continued its president till his death. 

Dr. Howe was for ten years Chairman of the Massachusetts Board of State 
| Charities—a department of State which controls the whole circle of the 


150 Notes and News. 


dependent and criminal classes—paupers, disabled soldiers, vagabonds, deaf 
mutes, the blind—prisons and reformatories, training ships, asylums, and the 
general care of the insane, imbeciles, and educable idiots. Over and through 
this extensive field Dr. Howe’s active energies and benevolent spirit presided 
for all these years, and his sound and practical views were of incalculable 
benefit to the State. He strongly deprecated the aggregation in large masses 
of any class of the objects of his interest, and we wish we had space to 
present his wise words of warning against the folly in which we are indulging 
in this direction. It was said that his eight simple rules should be written in 
letters of gold over every burean of relief, over every board of charities and 
eleemosynary institutions. There was in them that which met the demands of 
a great organisation; there was in them that which turned men from what 
would lead them to run in ruts; there was in them that which met the 
dangers which tend to make us build up institutions and forget why we built 
them up ; which make us build great hospitals, forgetful of the sick; and make 
ereat organisations for the relief of the poor, forgetful of the poor who are to 
be relieved. 


Respect for the family—the great social unit—pervaded all Dr. Howe's 


writings, and we need sorely to have his wise words laid upon our hearts. 
Thus we have endeavoured to sketch one of the noblest lives of our day and 
generation. All that is most sterling in American character may be said to 
have found its embodiment in Dr. Howe. Clearly the world is better for his 
life. Let us treasure and heed its lessons. 
Deo Bs 


Columbia Lodge, Liberton, Edinburgh. 


Appointments. 
Butuen, B. R., M.R.C.S.H., L.S.A.L., has been appointed Junior Assistant 
Medical Officer and Dispenser to the Middlesex Lunatic Asylum, Banstead 
Downs. 


Denne, T. V., M.R.C.S. and L.R.C.P., Assistant Medical Officer to the Bristol 


Lunatic Asylum, has been appointed Assistant Medical Officer to the North- 


ampton General Lunatic Asylum, vice Dr. Bell, resigned. 


Dunoan, A. T., L.F.P.8.G., has been appointed Assistant Medical Officer to 
the Joint Counties Lunatic Asylum, Carmarthen, vice Martin, resigned. 

GREENE, R., Senior Assistant Medical Officer to the Sussex County Asylum, 
Haywards Heath, has been appointed Medical Superintendent of the Hast 
Riding Asylum at Beverley, vice Mercer, deceased. 

Hoee, R. B., M.R.C.S.E., L.S8.A.L., has been appointed Second Assistant 
Medical Officer to the Kent Lunatic Asylum, Barming-heath, vice Young, 
resigned. 

MacDowett, HE. C., M.D., L.K.Q.C.P.I., has been appointed Visiting and 
Consulting Physician to the Sligo District Lunatic Asylum, vice Little, 
deceased. . 


Murcuison, ¥F., M.B., C.M., L.M., has been appointed Second Assistant | 


Medical Officer to the Middlesex Lunatic Asylum, Banstead Downs. 
NicHortson, W. R., M.R.C.8.E., L.S.A.L., has been appointed Assistant 


Medical Officer to the North Riding Lunatic Asylum, Clifton, Yorkshire, vice | 


Purdon, resigned. 


| 


} 
} 
t 
' 


SNELL, G., L.R.C.P.Ed., M.R.C.S.E., has been appointed Assistant Medical | 
Officer to the Glamorganshire Lunatic Asylum, ‘Bridgend, vice Maclachlan, | 


resigned. 


THE JOURNAL OF MENTAL SCIENCE. 
[Published by Authority of the Medico-Psychological Association] 








No. 102, ®¥,S82™8, JULY, 1877. Vor. XXIII. 











PART 1.-ORIGINAL ARTICLES. 


Morison Lectures on Insanity for 1877.* By Joun Srepaxp, 


M.D., F.R.C.P.E., Deputy-Commissioner in Lunacy for 
Scotland. 


Lecture I.—lInsanity in Ancrent GREECE AND Rome. 


The first and one of the most important questions to be 
determined in dealing with the subject of insanity is the 
meaning which we ought to attach to the word insanity 
itself. The condition which the word is supposed to indicate 
has most important relations, both social and scientific. It 
is a frequent subject of popular discussion, and it forms an 
important elementin many eaquiries—philosophical, medical, 
and juridical. Speaking generally, it may be said that it in- 
variably signifies a marked abnormality of mental condition. 
But it is frequently necessary that we should be able to form 
a much more precise idea of the degree as well as the kind of 
abnormality that it implies. And averysuperficial examina- 
tion is sufficient to show that the degree and the kind vary 
greatly, according to the point of view from which the 
subject is regarded, 

It may perhaps seem inappropriate that I should occupy 
your attention in this place with the signification of the 
term in its popular acceptation ; but I believe that it is of 
special importance to us as physicians that we should have a 
very complete appreciation of this aspect of the subject. In 
the discharge of many of our duties as private practitioners 
and as servants of the State, we have to take this popular 
idea carefully into consideration. And I think it is impos- 
sible to gain an intelligent view of any of the special rela- 
tions of insanity without having first correctly appreciated 


* These lectures were delivered during March before the Royal College of 
Physicians of Edinburgh. 
<<Ui. 11 


152 Morison Lectures on Insanity for 1877, (July, 


its position in regard to the community in general. JI shall 
not be able to present a very sharply edged definition or 
description of this popular acceptation. The nature of the 
subject scarcely admits of it; for we find that the limits 
popularly assigned to the term have been both vague and — 
shifting in character. ‘To obtain a comprehensive view of it, 
we should, therefore, require to understand its historical 
development; we should have to examine the mode in which 
the idea first originated in the early history of civilisation, 
and to trace the steps of its development down to the present 
time. This historical examination is indispensable to a 
proper understanding of the form which many similar ideas 
have taken in the public mind. The ideas which we form of 
sanity and insanity, of virtue and vice, of purity and im- 
purity, of luxury and hardship, of enlightenment and super- 
stition, and even of good and evil, are more or less correlated 
to one another. And they have all received modifications of - 
form or colour at different periods when mingling with the 
stream of human thought in its progress onward from age to 
age. Sir George Cornewall Lewis, a most learned historian 
as well asa most careful reasoner, insists strongly on the 
importance of the historical elements in such studies. In a 
letter to Mr. Grote he said, “‘ It seems to me that there is too 
little consensus about elementary facts in the moral sciences 
for any abstract treatment to be of much avail; and I have 
come to the conclusion that an enlightened commentary 
upon historical data well ascertained, is the best form in 
which instruction in such subjects can be presented to the 
public.’”’* 

It may be well to point out that a recognition of the 
changes which such ideas have undergone does not affect the 
question of whether or not they may also exist as typical 
ideas, based upon unchanging conditions, and, therefore, in- 
dependent of historical development. It is sufficient for our 
present purpose, if we perceive that the popular conception of 
them must be an outcome of the thought of past generations, 
as well as a result of contemporary discussion and speculation. 
But it must not be supposed that the changes of conception 
in different periods were merely speculative or theoretical. 
They were also real and practical. Neither can they be con- 
sidered as untrue when considered in relation to the changing 


* Letter from G. C. Lewis to G. Grote, October 21, 1847. Life of Grote, 
1873, p. 118. 


1377. | by Joun Sippatp, M.D. 153 


circumstances of successive times. What would be properly 
regarded as virtue in a savage might be vice if manifested by 
a member of a highly civilised community. What is luxury 
in a tent becomes hardship ina town. And “preposterous 


would be the pedantry,” as Isaac Taylor remarked, “of a 


writer who, in discoursing of Superstition or Enthusiasm, 
should confine himself to such a definition of those terms as 
might comport with the sense they bore centuries ago, in the 
minds of Lucian, Plutarch, Epictetus, or Aristotle.” And if 
we were able to ascertain with accuracy the facts which bear 
on the history of the development of these ideas, we should 
not only have a fuller appreciation of their present position, 


but we should probably be able to perceive also in what 


i 


direction their further development or modification is to be 
anticipated. | 

It would be very useful, therefore, if we could obtain a 
history of the idea of insanity in its relation to European 
civilisation. It is to be regretted, however, that the mate- 
rials at our disposal for this purpose are but meagre; and I 
must ask you to accept what I lay before you as a very im- 
perfect exhibition of them. I cannot pretend to have ex- 
plored any recondite sources of information, and I can 
only hope to indicate the phases through which the idea 
has passed by a reference to the more salient points in its 
history. The problem which we have to solve is to ascertain 
the kind and degree of that mental abnormality which at 
different epochs was treated as insanity. It will, therefore, 
be necessary that we should start with a common under- 
standing of what is implied by these words—“ treated as 
msanity.”’ I, therefore, define the phrase as meaning— 
subjected to such exceptional treatment on account of abnormal 
mental condition as, without holding the person legally respon- 
sible for that condition or its consequences, involves interference 


_ with its liberty, in order to save himself and others from injgurious 


consequences. It thus includes all abnormal mental conditions 


which society interferes with, except where criminal respon- 


sibility is in some way attributed to the persons who are 
affected by such conditions. : 

The classic civilisation of ancient Greece, so perfect in 
some of its features, so defective in others, presents us, in 


its annals, with only a fragmentary view of the idea which 


its public opinion had formed of the limits of insanity. But 
we must recognise, as is indicated by a very slight consider- 


154 Morison Lectures on Insanity for 1877, [July, 


ation of the facts, that in this and all other periods we have 
two sets of ideas to deal with. One of these, whose varia- 
tions are restricted within comparatively narrow limits, 
characterises the philosophic thought of the highest intel- 
lects ; the other, whose variations are sometimes both rapid 
and important, characterises the views which are practically 
acted on by the community. The philosophic ideas may, in 
most cases, be found, when looked for in after years, clear 
and well defined, crystallized in the permanent literature of 
the epoch. But when we try to discover what have been the 
common ideas of the community, we must often be content 
with a mere inference from what seems to have been their 
effects, and what seems to have been the influences which 
have acted upon them. This separation of the enquiry into 
two channels, though more or less necessary for all periods, 
is peculiarly so in dealing with our knowledge of ancient 
Greece. 

Very little light is thrown on the subject of insanity by 
that single reference to it in Homer, when the bard calls up 
the dim figure of Bellerophon— 

“Hated of all the gods, straying o’er Lycian plains, 

Hating his heart, and shunning the footsteps of hig kind.” 
But that insanity existed in the same forms then as it does 
now, is abundantly evident from the descriptions of it which 
we find so admirably given by the dramatic writers. The 
pictures which they paint are excellent representations of 
some of those phases of insanity with which we are most 
familiar at the present day.* 

We may select as typical of the phase most frequently 
delineated the representation of the insanity of Orestes by 
Huripides, in the Electra and in the [phigenia. The hero is 
described as impelled by his sister’s pleading, to avenge his 
royal father’s death by the murder of his mother Clytem- 
nestra, and he is seized with consequent remorse. ‘This 
drifts rapidly into deep morbid depression, ending in an 
explosion of maniacal excitement. He is described by 
Hlectra as “sick,” and “languishing upon his couch.” 


‘* His mother’s blood he shed has tortured him 
With madnegs ; for—” 


* I wish to record my obligation to Dr. Gasquet for the aid received from 
his papers on the Madmen of the Greek Theatre, in the numbers of this | 
Journal for July, 1872, and six subsequent numbers up to April, 1874. Ihave | 
in several instances availed myself of his excellent metrical translations.—J. 8. | 


1877. | by Joun Srppatp, M.D. 155 


she says, in recognition of the Divine influence, whose 
vengeful action he had so impiously provoked— 


‘“‘T may not speak of them, 
The Gracious Ones, who hunt him down with fear. 
Five days have passed since that his mother’s corse, 
But lately slain, was purified by fire. 
These five days gone, he hag not tasted food, 
Nor washed; but hid within the coverlets. - 
If eased his body be from his disease, 
He weeps in conscious grief. Then from his bed 
He swiftly leaps, as bounds an unyoked steed.” 


During the fits of excitement, hallucinations of vision 
manifest themselves. 


“‘ O, mother, urge them not,” he cries, 
“ The blood-faced furies, with the snaky hair; 
There, there they stand, ready to leap on me.” 


In the Iphigenia, the herdsman describes Orestes as 
shouting— 


‘“¢ Pylades, sees’t thou yonder Fury, and 
Another hellish Dragon, who is armed 
With fearful snakes, and strives to slay me too. 
Ah, and that third one, breathing fire and death, 
Bearing my mother in her arms, flies down 
Towards yonder rock, which she would hurl at me. 
Alas, she’ll slay me, Whither shall I fly.” 


The herdsman then explains that nothing was visible of all 
the ghosts Orestes seemed to see. 


‘‘He but mistook the lowing of the kine, 
And barking of the dogs, for sounds 
Which we are told Furies are wont to utter. 
We meantime, close together, silent sat, 
Asmen about to die. For he drew forth 
His sword, and, rushing on the cattle, smote 
Them, like a lion, on their flanks, until 
(For thus he thought to ward the Furies off) 
A bloody foam rose on the very sea?” 


* % % % % 
“The fit of madness past, the stranger fell 
With slaver dropping from his chin; while we 
Seeing him timely fallen, did our best 
By throwing stones to strike him; but his friend 
Wiped off the slaver from his mouth, and sheltered him 
By spreading out his garment—warded off 
Each threatened blow, and gave him every care.” 


We have here a graphic description of a maniacal 
paroxysm preceded by a period of deep dejection, which we. 
would now call melancholic. The ignorant herdsman is 
naturally alarmed at the symptoms; but Pylades, aware of 


156 Morison Lectures on Insanity for 1877, [July, 


the objectless character of the violence, treats the patient 
with intelligent kindness. We might extend the illustra- 
tions of insanity to many other forms described or alluded 
to by the Greek writers. But it will be sufficient here to 
remind you of the old gentleman, who is described by 
Aristophanes in the “ Wasps.” His is a form of madness 
more troublesome than dangerous; and the case is an illus- 
tration of the fact that the Greeks were sometimes able to 
attribute to their true origin symptoms of mental disease 
which fell far short of wild fury, or speechless stupidity. 
The story also possesses a peculiar interest from its illustra- 
ting the kind of treatment popularly thought suitable to such 
a malady by Athenians who lived so early as the fifth 
century before Christ. The patient is thus described by one 
of his servants :— 
‘‘ My master’s madness, I can tell ye now, if ye be silent; 

He loves the law courts more than ever mortal did before him, 

And grieves if he can’t get a place on the first bench of judges. 

At night he gets no wink of sleep, and if perchance he doses, 

His mind is always on the strain from watching for the time-glass,* 

So used is he to hold the ballot ball, that when he rises 

"Tis with three fingers joined as though about to offer incense ; 


And if he sees on any door chalked ‘ Demos is so handsome,’ 

He’ll go and scribble by the side, ‘O Voting Urn, how lovely !’ 

* x ** * * * * 

This is his madness, which, in spite of warnings, e’er increases ; 

We, therefore, keep him locked in here, from fear that he escape us. 
His son has taken much to heart his father’s strange disorder; 

He sought to make him stay at home, by using moral suasion, 

And failed, then had him bathed and purged ; but all was unavailing.” 


We find among the stories told by Atheneus, in his Deip- 
nosophists, those Alexandrian Noctes Ambrosiane, an actual 
instance of a somewhat similar form of insanity, which was 
successfully subjected to medical treatment in the case of 
Thrasylaus, son of Pythodorus. This young man “ was seized 
with such an insanity that he imagined all the ships which 
came into the Pirezeus were his own ; reviewed, dismissed, and 
launched them ; received those which arrived in port with as 
much joy asif he were the proprietor of the merchandise they 
brought home, of which if any were lost, he made no enquiry 
about it, but rejoiced greatly for whatever came safe. 
Thus,” he is said to have “ passed a life of much pleasure. 
But his brother Crito, returning from Sicily, had him secured, 
and put under the care of physicians. Being cured of his 


* The rrePidoa. 


1877. ] by Joun Sippatp, M.D. 157 


insanity, he declared he had never before lived with so much 
satisfaction and pleasure, for he had had nothing to disturb 
him, and a multitude of things to afford him delight.” 

The most cultivated intellects of Athens seem generally to 
have concurred with Hippocrates in regarding mental 
derangement as a disease similar in its nature to bodily 
disease. ‘The evil humours of the body,” says Plato, 
“may disorder the soul, producing manifold forms of melan- 
choly and dejection, of rashness and cowardice, of oblivious- 
ness and ignorance.” And the author of tae Second Alci- 
biades, who, if not Plato himself, was an imitator who 
wrote what Plato was believed to think, represents Socrates 
as saying, “There are different kinds of unsoundness of 
mind. Those who are afflicted by it in the highest degree 
are called mad. Those in whom it is less pronounced are 
called wrongheaded and crotchety, or, as persons fond of 
smooth words would say, enthusiastic or excitable. Others 
are eccentric; others are known as innocents, incapables, 
dummies, or are called by other like names. All these kinds 
of unsoundness of mind differ from one another, just as 
diseases of the body do.” The Stoics, whose school was influen- 
tial in Greece, and became much more so afterwards under 
the Roman Empire, took a very broad view of the relations of 
abnormal mental states. They divided men into two classes, 
the wise and the foolish—just as sticks may be divided into 
straight and crooked sticks; and they called special atten- 
tion to the fact, as it was neatly put by them, that: very 
_ few sticks in this world are absolutely straight. We should 
- not be justified, however, in suggesting that comprehensive 
conceptions such as these fairly indicated the practical ideas 
of the period in regard to insanity. ‘‘ The general public of 
ancient Greece,” as is remarked by Professor Mahaffy, “ did 
not approach so nearly to the enlightenment of its intel- 
lectual leaders as our modern public does. We find, for 
example, in the ordinary life of Athens, cruelties and bar- 
 barities so violently in conflict with the humanity of a 
Socrates, a Euripides, or a Plato, as to astonish us and make 
us doubt our estimate of Attic culture.’ We have sufficient 
evidence to show that in one sense the Greek public was 
often disposed to take a broad view of insanity by regarding 
very harmless deviations from ordinary conduct as indicating 
its existence. An interesting illustration of this is afforded 
in the commission which Hippocrates received from Abdera 
to make inquisition into the mental state of the worthy 


158 Morison Lectures on Insanity for 1877, [July, 


anatomist Democritus, who had caused anxiety to the in- 
habitants by his practice of dissecting the bodies of the 
lower animals. 

But in the relation of insanity to supernatural influences, 
the philosophical and vulgar ideas were widely divergent. 
The madness of Orestes, Ajax, and other similar examples 
that are pourtrayed by the dramatists, is represented, in 
accordance with the popular belief, as being induced by the 
special interposition of Apollo, or some other divine power. 
But when used in the philosophic writings, such language 
seems generally to imply merely that madness was like all 
other mundane states, controlled by the supernatural machin- 
ery of gods and goddesses, who constituted the over-ruling 
providence of the classic mythology. In the general litera- 
ture of Greece, we find the sume phrases introduced, when 
ordinary disease, or any similar interruption of the ordinary 
course of events, is described in arhetorical or poetic manner. 
But there were certain unmistakable, morbid, mental con- 
ditions, that were associated in the minds of the people with 
their religious rites. This was the case in the prophetic 
utterances at Delphi, and in the epidemic religious excite- 
‘ments when persons were supposed to be “aspired or 
possessed.” It was supposed to be under inspiration by 
Dionysus that the Bacchic maidens believed they drew milk 
and honey from the flowing river. 

These associations must necessarily have prevented the 
less enlightened portion of the community from acquir- 
ing the really broad views which we find expressed in the 
philosophic writings. But there were two other circum- 
stances which must have exercised a most important in- 
fluence on public sentiment. These were, the frequent 
political disorganisations caused by war, and the existence 
of the class of slaves. The influence of such circumstances 
would necessarily be to divert attention from complicated 
political or philanthropic questions. It is seldom, if ever, 
indeed, that the public. mind of a community makes 
any earnest attempts to solve difficult or complicated 
questions, until some practical necessity forces them inexor- 
ably on its attention. Experience has shown that the modes 
in which such practical necessity may arise in connection 
with insanity are, when questions of capacity or responsi- 
bility before the law require to be solved, and when public 
provision for the care and treatment of the insane requires 
to be made. The question of mental capacity did sometimes. 


BO? /.| by JoHN Srppatp, M.D. 109 


require to be dealt with in ancient Athens; but it was only 
as part of the process whereby aged and infirm fathers might 
be stripped by their sons of every kind of power and 
authority. This proceeding, which seemed to be regarded 
in cultivated Athenian society as quite consistent with 
justice and filial duty, was frequently resorted to. But the 
inquiry which it involved was inspired rather by a wish to 
facilitate the complete removal of the feeble from 
power and influence, than from any desire to protect 
their rights. But even if such a desire had existed, or if 
there had been a demand for a system of jurisprudence, 
under which nice and exceptional questions of liberty or 
responsibility could be determined, a necessary condition 
for their practical development would have been a pro- 
longed and uninterrupted period of political tranquility. It 
is obvious, also, that any comprehensive system of public 
benevolence, under which any public provision for the 
Insane was possible, would have required a similar con- 
dition for its development. The frequent occurrence of 
devastating wars was therefore an insuperable obstacle to 
the directing of public attention in a practical manner to 
these subjects. It is evident, also, that the existence of 
slavery, if it were of the specially harsh form in which it was 
to be found in Sparta and some other localities, must have so 
familiarised the mind with cruelty and injustice, as to render 
impossible any public feeling of philanthropy. But even in 
Athens, in the age of Pericles, where slavery existed in a 
milder form, the indifference to the rights of others, always 
induced by the presence of a class recognised by law as 
servile, combined with the disregard of human life, which is 
begotten by the frequency of war, was sufficient to prevent 
public attention from being forcibly directed to what would 
probably appear to be, at such a time, evils of only minor 
importance.* It is indeed curious and instructive to observe 
how an extraordinary refinement of thought and manners is 
Sometimes found compatible with a brutal ferocity of dispo- 


* The number of slaves in the time of Pericles, in Athens, appears to have 
been 400,000, to a free population of 30,000, including metics. As an illustra- 
tion of the extent to which mental abnormality is treated as insanity among 
a servile class, compared with the way in which it is regarded among free 
Citizens, it is interesting to note that in the United States census for 1850, 
the proportions of lunatics registered among the white population and the free 
blacks are almost identical, being 1:49 per thousand among the whites, and 
151 per thousand among the free blacks. In contrast with this, the number 
registered among the slaves is only ‘47 per thousand. 


160 Morison Lectures on Insanity for 1877, [July, 


sition. And perhaps the most memorable illustration of this _ 


was the sacrifice of three thousand Athenian prisoners at 
Aigospotami, which took place during the most brilliant 
period of Attic history. With all its refinement, it could 
not be at such a time that legislative protection would have 
_ been largely extended to the rights of the insane; nor is it 
likely that any careful provision was made for their treat- 
ment at a time which has left no record of the existence of 
any public institution for the care of persons sick of ordinary 
diseases, except one allusion to a house used for that purpose, 
said to have been situated in the Pireeus. 


We are probably warranted in concluding that though the 


higher intellects of the time had a wonderfully clear and just 
perception of what ought to be regarded as mental disease, 
it was only in dealing with persons of the most elevated 
social class that such views were practically applied; 
that the total number of those who were recognised as insane 
was comparatively small; and that only a small proportion 
of these would experience the benefits of considerate care 
and treatment. 

I believe there is no trace in the Solonian legislation, of 
any provision for dealing with questions of insanity, except 
in rendering the wills of insane persons invalid, and if we 
may regard it as coming under the same head, the limitation 
of the control of prodigals over their property. 

There may have been, and I have no doubt there were, a 
large number of persons of abnormal mental condition, who 
would now have been counted among the insane. But it is 
evident that governments of that day did not much concern 
themselves about persons who did not require to be inter- 
fered with except for their own personal benefit. It was 
only in cases, therefore, where danger to the community was 
apprehended, that public interference did take place. Weak- 
minded and harmless lunatics were dependent on voluntary 
care. Dangerous lunatics who were imprisoned, and harm- 
less lunatics who were cared for by their friends, thus include 
all who can be said to have been treated as insane. Those 
who wandered about the unsettled localities alone, or as 
members of the vagabond herds, were practically disregarded 
altogether by civilised communities. 

The Romans, in the period of their greatest intellectual 
glory, had made themselves inheritors of the Greek civilisa- 
tion, and, to a great extent, they adopted the Greek ideas. 


The teaching of the philosophic schools of Greece was 


1877. | by JoHn Sippatp, M.D-y 161 


imported into Rome, and became incorporated with its 
literature. Cicero, who was most conspicuous in presenting 
the Greek modes of thought to the attention of his country- 
men, speaks of Plato, Aristotle, and Zeno as “the only 
teachers who arm and instruct a citizen for the duties of 
social life.’ He accordingly adopts very comprehensive 
views of the nature of insanity. “All fools,” he says in his 
Tusculan Disputations, “are disordered in mind ; all fools, 
therefore, are insane. For it is the opinion of philosophers, 
that sanity, or health of mind, consists in a certain tran- 
quillity, or equanimity, or as they term it, constancy. And 
they consider the mind, when void of these qualities, as 
insane; since sanity can no more exist in a disordered mind, 
than in a disordered body. We separate, however,” he says, 
“this insanity from fury; for, being of the nature of folly, 
that term possesses a wider signification.” The distinction 
here drawn between insanity and fury—insania and furor— 
was an important practical distinction in ancient Rome. 
Those persons who laboured under the disorder called furor 
were piaced, by the Laws of the Twelve Tables, under tute- 
lage, which freed them from responsibility for their acts, and 
deprived them of liberty, except such as their tutors granted 
tothem. The tutors thus became responsible for them, and 
had power to imprison them, or dispose of them in whatever 
way they deemed best. Furor is defined by Cicero as con- 
Sisting in a confusion of the mind in regard to everything— 
mentis ad omnia cecitas; a definition which perhaps survives 
‘Im our modern expression, “blind fury.” The law also took 
cognizance of persons suffering from a less violent kind of 
Insanity, under the name of mente captt. These were 
associated in law with the “deaf and dumb, and those who 
laboured under persistent disease,” as requiring to have their 
property placed under the care of curators, “‘ since they are 
unable to take charge of it themselves.” But there was also 
Included among those to whom curators should be appointed 
the class called prodigals. This class, according to the defini- 
tion of insanity with which we started, must, therefore, be 
counted by us among those whom the Romans treated as 
insane. ‘They are defined by Ulpianus, as persons “ who have 
neither method nor purpose in their expenditure, but squander 
their means in havoc and dissipation.” They are, therefore, 
‘persons who are subjected to exceptional treatment on account of 
their abnormal mental condition, with the intention of saving 
them from the injurious consequences of that condition. 


162 Morison Lectwres on Insanity for 1877, [July, 


Dementes, that is, furiost or mente capt, when under 
tutors or curators, were held to be incapable of civil actions, 
and were held irresponsible for crime. The condition of 
tutelage, was, however, suspended during remissions or 
intervals in the disease. 

The dangerous lunatics were removed, under the authority 
of tutors, to places of detention, “ carceres.”” And it appears 
to have been the practice also to send insane persons to be 
subjected to treatment in the houses of physicians. In the 
Menaechmi, the Comedy of Errors, by Plautus, we find the 
doctor sending for four men to remove the supposed lunatic 
to his house, and declaring his intention of making him 
“ drink hellebore some twenty days,” when he got him safely 
lodged there. 

The evidence upon which the Roman magistrate declared 
a person to be furious, was not the opinion of experts, but 
such evidence as showed that the fact was admitted by the gene- 
ral vorce of those to whom the circwmstances of the case were well 
known. We thus find that careful provision was made for the 
treatment of the Roman citizen when he became insane; and it 
is probable that the religious tolerance or indifference, which 
prevailed until the time of the Christian prosecutions, must 
also have been accompanied by a very considerable diminu- 
tion of the superstitious element which had complicated the 
idea of insanity among the Greeks. The Romans looked on 
this condition as a disease which was to be cured, if at all, 
by ordinary medical treatment. Seneca makes this possi- 
bility the distinguishing mark of the kind of insanity which 
implies civil incapacity.* ‘We say that every fool is 
insane,” he says, “‘ we do not, however, attempt to cure them 
all with hellebore, but trust many of them to vote in our 
assemblies, and to exercise magisterial jurisdiction.” This 
remark received a melancholy illustration in the history of 
his pupil, Nero; one of the cruelties by which the tyrant 
marked his mad career being to condemn the great philo- 
sopher to death. It is curious, with reference to the remark 
of Seneca, which has just been quoted, to note that Nero 
was actually called upon by the satirist, Persius, to “clear his 
mind with hellebore, instead of meddling with government, 
for which he was, by nature, so unfit.” 

Descriptions and allusions might be cited from many 
authors, showing that the forms of insanity were, in Rome, 


* De Benificiis, lib. ij. cap. xxxv. 


1877. | by Joun Sippatp. M.D. 163 


as we have found them to be in Greece, similar to what are 
met with at the present day. Ovid, Plautus, Horace, and 
Virgil, all make reference to them. But it is unnecessary to 
occupy time by quotation of the passages. 

The state of the community, which a consideration of the 
provisions of the Roman law for dealing with insanity 
naturally suggests, is one which, so far, may properly be 
regarded with satisfaction. And in the earlier days of the 
Republic, perhaps, it deserved to be so regarded. But after 
that period, we require to take an element into consideration, 
which must produce an important modification of our 
opinion. In considering the condition of a civilized com- 
munity at the present time, the persons whose condition 
would occupy the most important place in our imagination 
would be labourers, artizans, members of learned professions, 
and active members of the commercial class, But a few 
sentences will be sufficient to show how little the vast mass 
of the Romish population was benefited by the legislation 
intended only for those enjoying the privileges of citizenship. 

The class of slaves were entirely excluded from these benefits. 
“During the latter times of the Republic, and under the 
Empire,” says Dr. Smith, “this class had greatly increased. 
‘The first question asked respecting a person’s fortune, was, 
‘How many slaves does he keep?’ Ten slaves seems to have 
been the lowest number which a person could keep, in the 
age of Augustus, with a proper regard to social respectability. 
The immense number of prisoners taken in the constant wars 
of the Republic, and the increase of wealth and luxury, 
augmented the number of slaves to a prodigious extent. A 
freedman, under Augustus, who had lost much property 
during the civil wars, left, at his death, as many as 4,116. 
Two hundred was no uncommon number for one person to 
keep. The mechanical arts, which were formerly in the hands 
of clients, were now entirely exercised by slaves, a natural 
growth of things; for where slaves perform certain duties, or 
practise certain arts, such duties or arts are thought degrad- 
ing toafreeman. And it must not be forgotten, that the 
games of the amphitheatre required an immense number of 
slaves, who were trained for that purpose.” Slave-dealing 
was one of the most lucrative of commercial avocations, and 
high prices were paid for those who might be sources of 
pleasure or profit to their owners. Hunuchs, literary men, 
and doctors, were esteemed among the most valuable. 

Lhe proportion of the slaves to the rest of the population, 


164 Morison Lectures on Insanity for 1877, [July, 


is described as being much smaller in the provinces than in 
the capital, and glowing descriptions have been given of the 
order, comfort, and happiness which prevailed over the Empire 
during the period between Trajan and Marcus Aurelius. But 
I confess that when the condition of slavery was so widely 
spread, and when, as we know, vice and cruelty were rampant 
among those occupying the highest places in the governiment, 
Tam unable to believe that the social state of the community 
generally was orderly and happy, or that among the mass 
of the population the sick and the insane could be kindly 
and intelligently cared for. As for the slaves, they could 
not, indeed, be killed with impunity, and after the edict of 
Claudius the killing of them was looked on as murder. But 
their treatment was certainly inhuman enough. It is not 
necessary, for proof of this, to show that every Roman 
wished to follow the example of Velius Pollio, who, in the 
time of Augustus flung such slaves as displeased him into his 
fishponds, to feed his lampreys. It is sufficient to know that 
slaves were often to be seen in chain-gangs, labouring as 
draught animals upon the farms—that some were specially 
bred for slaughter in the sports of the arena, and that 
masters had been frequently known to get rid of old and 
useless slaves, by exposing them to starvation on an island 
inthe Tiber. When almost the whole of the working classes, 
and a large proportion of what would now be called the 
middle class of the population, was in this condition of 
slavery, and might be subjected to such cruel treatment, it 
is impossible to believe that the helpless or troublesome 
among them could have generally received much considera- 
tion, or even mercy. We can make no attempt to estimate 
the proportion of these lower strata of the community which 
was regarded as insane, in the sense of being irresponsible, 
and deserving of protection. Neither can we indicate the 
nature of such protection as was provided. But there can 
be no doubt that in the latter days of the Empire the number 
of persons who were objects of benevolent solicitude must 
have dwindled rather than increased. Whatever healthy 
energy of public spirit had previously existed, was then 
rapidly and hopelessly passing away. Almost every insti- | 
tution or pursuit by which virtuous habits would naturally | 
have been formed, had been tainted or destroyed, while | 
agencies of terrific power were impelling the people to vice. 
The rich, excluded from the most honourable paths of am- 
bition, and surrounded by countless parasites, who inflamed 


1877.| by Joun Sippatp, M.D. 165 


their every passion, found themselves absolute masters of 
innumerable slaves, who were their willing ministers, and 
often their teachers in vice. The poor, hating industry, and 
destitute of all intellectual resources, lived in habitual idle- 
ness, and looked upon abject servility as the normal road to 
fortune.* The decay of Paganism and the rise of Chris- 
tianity did not suffice, in this poisonous moral air, to check 
the growth of superstition, which found a fitting pabulum in 
the ignorance and vice which prevailed. The dark ages 
were at hand. The principles, the habits, the convictions 
which held society together, were giving way, one after the 
other, before luxury and selfishness. The entire organiza- 
tion of the ancient world, was, as Mr. Froude expresses it, 
“on the point of collapsing into a heap of incoherent sand.” 

I fear that I may seem, in this lecture, to have wandered 
round about the subject of insanity, when I ought to have 
presented it definitely to your minds. But you will 
doubtless appreciate the difficulty of catching more than 
mere fragments of the popular ideas in any age of the world. 
And in dealing with the earlier periods of history, it is 
impossible to get into very direct contact with them. I 
hope, in dealing with the next period, to bring the subject 
somewhat more satisfactorily before you. 


eee 


A Chapter in the History of Criminal Lunacy in England. By 
Davip Niconson, M.D., Deputy Superintendent, State 
Criminal Lunatic Asylum, Broadmoor. 


Criminal Lunacy is a many-sided subject: but 1 have no 
intention here of entering upon it from any special stand- 
point, whether social, legal, or medico-psychological. I 
merely wish to recount, briefly and without detail, such 
general matters of interest connected with successive methods 
of dealing with criminal lunatics as can be linked together 
in the form of a historical sketch, which does not pretend to 
be a criticism. 

I propose to deal with the subject as extending over four 
periods into which, as it seems to me, the narrative of events 
may legitimately be divided. I venture to think that these 
‘Periods, the last of which brings us up to the present time, 
will serve a useful purpose by indicating the nature of the 


* ‘See Lecky’s Morals, I. 278. 





166 The History of Criminal Lunacy in England, [July, 


provision that has been made from time to time for the custody 
- and care of criminal lunatics. They are the following :— 
I1.—Period of penal association with prisoners in gaols— 

up to end of 18th century. 

II.—Period of treatment as ordinary lunatics in asylums— 
1800-1840. | 

IlT.—Reactionary Period—1840-1860. 

TV.—Broadmoor Period—or Period of Centralization—the 
present method of disposal. 


I. Period of Penal Association with Prisoners in Gaols. 


Up to the end of the 18th century we find insane offenders 
against the laws of the country herded with common felons 
in prisons and gaols. Writing a hundred years ago, Howard, 
whose penetration appears to have left no blot unexplored, 
says,* “I must here add that in some few gaols are confined 
idiots and lunatics. These serve for sport to idle visitants at 
assizes and other times of general resort. ‘The insane, where 
they are not kept separate, disturb and terrify other prisoners. 
No care is taken of them, although it is probable that by 
medicines, and proper regimen, some of them might be 
restored to their senses, and to usefulness in life.” And in 
a foot-note he observes that, “many of the bridewells are 
crowded and offensive, because the rooms which were designed 
for prisoners are occupied by lunatics.” We may take it that 
during this period the mere fact of being insane had in itself 
a bearing sufficiently criminal to warrant incarceration, with- 
out investigation as to the rationale of acts committed. On 
the other hand, it was only in keeping with the anomalous 
state of things at the time to be told that the Attorney- 
General stated to the House of Commons that it had been 
found that persons who had committed the most shocking 
acts, and been acquitted on the ground of being deranged in 
their intellect, had been again allowed to go at large, and 
again commit similar atrocities. “There are,’ said he, 
‘several instances of His Majesty’s subjects having lost their 
lives for want of a due provision, in this respect.”” When we 
think what the recognized methods of treatment, not only of 
prisoners, but of ordinary lunatics, were last century, it 1s 
Aes that lunatics in gaol must have had a rough time 
of it. 

The case of Margaret Nicholson, who, in 1786, attempted, 
to assassinate George the Third with a knife, points to the! 


* “State of Prisons,” 2nd ed, p. 10. 


| 
} 


| 


1877.] by Davin Nicotson, M.D. 167 


first origin of difficulties arising with regard to lunatics 
committing criminal acts. After being examined by the 
Lords of the Privy Council, she was found to be insane on 
the evidence of Drs. John and Thomas Monro. It was pro- 
posed to commit her to Tothill Fields’ Prison, but this was 
objected to on the ground that she was a State prisoner; and 
ultimately “the unhappy woman was conveyed to a cell pre- 
pared for her in Bethlehem.” Again, John Frith, an un- 
doubted lunatic, did not meet with such consideration at first, 
atter he attempted,in 1790, to assault His Majesty, by throwing 
a stone at him as he passed in the Royal carriage. The lunatic 
was imprisoned in Newgate for nearly two years, and then 
tried for high treason. He was discharged from gaol, upon 
condition that he should be properly secured and looked after 
as a lunatic. The ill-wind that brought about good for 
criminal lunatics lay in a third attack upon the King’s 
Majesty. This attack was made in 1800, by Hadfield, who 
shot at the King in Drury Lane Theatre. Hadfield’s insanity 
being clearly proved at the trial, the Judge, Lord Kenyon, 
_ directed the jury to return a verdict of “Not guilty.” Then 
it was that the difficulty arose: What is to be done with 
him? “ For his own sake,” said the Judge, “and for the 
sake of society at large, he must not be discharged, for this 
is a case which concerns every man of every station, from the 
kine upon the throne to the beggar at the gate—people of 
both sexes and all ages, may, in an unfortunate frantic hour, 
fall a sacrifice to this man, who is not under the guidance of 
sound reason; and, therefore, it is absolutely necessary for 
the safety of society, that he should be properly disposed of, 
all mercy and humanity being shown to the unfortunate 
creature: but for the sake of the community, he must some- 
how or other be taken care of, with allthe attention and all 
the relief that can be afforded him.” It being settled that 
the safety of the community required that Hadfield should be 
taken care of, and it being found that although the Judge of 
every Court might be “competent to direct the confinement 
of a person under such circumstances,” they could “ only 
remand him to the confinement he came from,” Mr. Garrow 
suggested that “it would be for the benefit of posterity if 
the jury would state in their verdict the grounds upon which 
they gave it, viz., that they acquit the prisoner of this charge, 
he appearing to them to have been under the influence of 
insanity at the time the act was committed. There would 
then be a legal and sufficient reason for his confinement.” 
XXIII. 12 


168 The History of Oriminal Lunacy in England,  [July, 


The jury acquiescing in, and following up, this recommen- 
dation, acquitted the prisoner on the ground of insanity. In 
this manner arose the verdict usually returned by juries in 
cases of insane offenders against the law.* 

Criminal lunacy was thus explicitly placed upon an acknow- 
ledged and legal basis. But, there having been established 
a form of lunacy, which, from its social and legal aspect, was 
criminal, it was necessary to make some arrangement for the 
disposal and treatment of the criminal lunatic. Accordingly, 
we find that, a few days after the acquittal of Hadfield on the 
erounds stated, the Attorney-General introduced into the 
House of Commons the “ Insane Offenders’ Bill,’? which was 
an Act for the safe custody of insane persons charged with 
offences. He pointed out the defective state of the law as to the 
regulation of the custody of such persons, ‘‘ and,” said he ‘‘ it 
will appear to be humane to give to the executive government 
some discretion to dispose of them.” This Act (89 & 40 
Geo. III., c. 94), received the Royal assent on the 28th of 
July, 1800, and it provided that, “‘in case of any person charged 
with treason, murder, or felony, proving to have been insane 


at the time the offence was committed, and being acquitted, © 


the jury shall declare whether such person was acquitted on 
the ground of insanity, and upon such finding, the Court shall 
order such person to be kept in strict custody in such place 
and in such manner as to the Court shall seem fit, until His 
Majesty’s pleasure shall be known. And the same with regard 
to persons indicted for any offence and found upon arraign- 
ment or upon trial to be insane.” 

The passing of this Act—the first bearing on Criminal 
Lunacy—brings us to the threshold of the second phase of 
our subject. 


II. Period of Treatment as Ordinary Lunatics in Asylums. 


The Insane Offenders’ Bill, although it provided for the 
safe and proper custody of criminal lunatics, was, for some 
years, comparatively a dead letter, as it had made no provision 
for the charge of their maintenance and care, except where 


they had sufficient property of their own to be applied to that 


purpose, as in the case of ordinary lunatics. The unfortu- 
nate criminal lunatic, therefore, who could not pay his way 
elsewhere, was still doomed to imprisonment in gaols along 
with convicted felons, and it was found impossible to remove 
him. The evils arising from this state of things were mani- 


* Vide Hood’s “ Criminal Lunacy,’’ Churchill, 1854, p. 17. 


1877. ] by Davip Niconson, M.D. 169 


fold. First of all, as between one criminal lunatic and another, 
there was the unrighteous and destructive savour of “one law 
. for the rich and another for the poor,” a result which was 
purely accidental, and arose from incompleteness of provision 
made under the Act. Again, it burdened the county in which 
the insane offender was tried with the expense of his main- 
tenance, &c., to the relief of his friends or of the parish to 
which he belonged; and it was not likely that counties were 
to be at too much trouble about the safe custody or comfort 
of such undesired and improper burdens. Further, the gross 
injustice was perpetuated of herding the criminal lunatic 
(with perhaps no former offence recorded against him) along 
with habitual criminals of naturally vicious dispositions and 
propensities; so that not only was the criminal lunatic de- 
prived of a legitimate chance of cure for his diseased mind, but 
his affliction was lable to be aggravated by his surroundings. 

The accumulation of criminal lunatics in gaols and the 
evils connected with it became obvious and notorious, and 
demanded a remedy. Accordingly, in 1807, on the motion of 
Mr. W. Wynn, a select committee was appointed by Parlia- 
ment, “to inquire into the state of Criminal and Pauper 
Lunatics in England and Wales,” &c. The Report of this 
Committee, printed on the 15th of July in the same year, 
and the appendix, containing the minutes of evidence and a 
letter from Sir G. O. Paull to the Home Secretary, are valu- 
able and instructive documents. The Committee point to the 
inconveniences arising from the system that existed, and 
express their full concurrence with Sir George Paull’s opinion 
that to confine criminal lunatics in a common gaol is equally 
destructive of all possibility of the recovery of the insane, 
and of the security and comfort of the other prisoners. They 
illustrate the risks by the following case :—‘* Aaron Bywater 
was acquitted of a murder committed by him, under the influ- 
ence of insanity, and he was ordered to be detained in the 
county gaol, where hestillremains. In less than three weeks 
afterwards, though ordered to be strictly watched, he was 
allowed, during an apparently lucid interval, to escape out of 
the gaoler’s sight, and murdered one of his fellow prisoners.” 
In their concluding remarks the Committee foretoken the 
arrangements now made for such persons. “It therefore 
appears to be highly desirable that a building should be 
erected for the separate confinement of all persons detained 
for offences committed during a state of insanity,” and that 
the magistrates shall arrange for the maintenance of the 
lunatic from his own property, or by his parish or the county 


170 The History of Criminal Lunacy in England, — [July, 


in which he is tried. In his “Letter,” Sir G. Paull, speak- 
ing of criminal lunatics, says, if they “are to be so confined 
as not to excite the idea of a criminal punishment, places 
suited to their care must be constructed, and modes of re- 
straint determined,” &c., and he thinks that, instead of these 
places being made “sole and independent, wards for this 
purpose should be parts of extensive and independent insti- 
tutions, and that their primary construction should be at the 
_ expense of the Crown or National Fund.” 

In 1808 an Act was passed providing for the maintenance of 
criminal lunatics, and.in July, 1816, another Act directed that 
offenders becoming insane after conviction should be removed 
to a lunatic asylum. Both these Acts were repealed in 1828, 
by 9 Geo. IV., c. 40, which made other provisions on the sub- 
jects, in ss. 54 & 55; but these two sections were themselves 
repealed in 1840, when further provision was made (by 3 & 4 
Vict., c. 54) for the confinement and maintenance of insane 
prisoners. - 

The recommendations of the Select Committee of 1807 led up 
to negotiations between the Government and the governors 
of Bethlem Hospital, and it was arranged that the latter 
should erect, at the Government expense, “a separate prison 
for the reception of 60 criminal lunatics,’ who should be 
maintained at the annual charge of the State. These pro- 
posals were made and agreed to in 1808, but it was not till 
1816 that two wings were added to Bethlem, one for male 
and another for female criminal lunatics, at a total expense 
of about £20,000, for 60 patients. In afew years this accom- 
modation had to be doubled at Bethlem; and in 1849 a de- 
tached ward was erected at Fisherton House Asylum for the 
excess of patients. 

The operation of the various Acts passed in the first half 
of this century had served to distribute the criminal lunatics 
throughout the county and other asylums of the country; 
and to close the record of the second period of our history, 
I submit a return* showing that distribution in 1852:— 


M EF. Total. 


In County Asylumsg ia sai ie) AF 38 175 
Hospitals... ce , ss ua 8 0 8 
Metropolitan Houses _,... at gee ou! 10. _- 41 
Provincial Houses... 98 ss aa 39G 12 108 
Bethlem Hospital .., as ah a) ESO 19 104 

Total sich ny POON 79 436 


* Seventh Report of Commissioners in Lunacy. 


1877.| by Davip Niconson, M.D. 171 


The number here given does not include some criminal 
lunatics who were still in gaols, nor those in Government 
Convict Prisons. 


III. Period of Reaction. Objections to Indiscriminate 
Association. 1840-1860, et postea. 


‘*'Tempora mutantur et nos,” &c.; the cry now came to be, 
not that criminal lunatics are cruelly “committed to the 
dungeons of gaols,” but that ordinary lunatics are “ pained 
and degraded ” by having to associate with criminal lunatics. 

There can be no doubt that as the middle of the century 
was approached, the current of opinion had decidedly set in 
against mingling the two classes of patients in ordinary 
asylums, and a generally expressed objection was raised on the 
part of asylum authorities. The Commissioners in Lunacy, 
in several of their earlier Reports, refer to this objection, and 
in February, 1852, they took active steps in the matter, and 
endeavoured to collect all the information they could respect- 
ing it, by addressing a circular to the visitors, superinten- 
dents, and proprietors of the various asylums, licensed houses 
and hospitals throughout England and Wales. 

In their Seventh Report, published in 1853, the Commis- 
_ sioners give the following summary of the main objections, 
“expressed by almost all the Superintendents and Proprietors 
of Lunatic Establishments in England ” :— 

1, That such association is unjust, and that it gives pain 
and offence to ordinary patients (who are generally very sen- 
sitive to any supposed degradation) and also to their friends. 

2. That its moral effect is bad, the language and habits of 
criminal patients being generally offensive, and their propen- 
sities being almost invariably bad. That in cases of simulated 
insanity (which seem to be not unfrequent) the patient is 
generally of the worst character, and that even where the 
patient is actually insane, the insanity has been often caused 
by vicious habits. That patients of this class frequently 
attempt to escape, and cause insubordination and dissatisfac- 
tion amongst the other patients. 

3. That a necessity for stricter custody exists for one class 
than for the other, and that this interferes with proper dis- 
cipline, classification, and general treatment, and strengthens 
the common delusion that an asylum is a prison. 

4, That criminal patients concentrate attention on them- 
selves, and deprive the other patients of their due share of 
care from the attendants. 


172 The History of Criminal Lunacy in England,  [July, 


5. That the effect on criminal patients themselves is bad ; 
that they are taunted by the other patients, and are irritated 
on seeing such other patients discharged. 

They add the following remarks :—“At the same time, 
there appears to be a small number of gentlemen who state 
that they have not observed any practical inconvenience to 
arise from the association of criminal with other lunatics in 
the asylums under their care. This statement, however, has 
been generally coupled with an intimation that the fact of the 
patient’s criminality has been unknown in those asylums, and 
has occasionally been accompanied by an opinion that a dis- 
tinct asylum is desirable for criminal patients whose offences 
have been heinous, or whose conduct is characterized by great 
violence. In considering the subject in all its bearings, it is 
obvious that there exist certain difficulties which prevent our 
drawing a very strict line, within which all such patients (and 
such patients only) as are unfit to associate with the ordinary 
inmates of lunatic asylums shall be comprehended.” And 
they point out, too, that a few only of the reasons adduced 
by the superintendents of asylums for the non-association of 
the two classes ‘‘ have reference to the criminal deeds and 
propensities of patients, the majority of them applying solely 
to the patient as a person branded with crime by some 
sentence or decision of the law.” 

“It is clear,” they say, “that a patient of decidedly homi- 
cidal tendency, or one who has perpetrated or attempted some 
heinous offence, and has only been saved from the category 
of criminals by the prudence of his friends, who have placed 
him in the security of an asylum before he came under the 
cognizance of the law, may often be an associate equally 
objectionable as any of those who come under the denomina- 
tion of ‘ Criminal Lunatics.’ ” 

But one, at least, of the “small number of gentlemen ” 
referred to by the Commissioners, speaks out with no feeble 
or uncertain note. Dr. Bucknill, then Superintendent of the 
Devon County Asylum, in his “Inquiry into the Proper 
Classification and Treatment of Criminal Lunatics,” published 
in 1851 by Churchill, passes under review the bearings of the 
question as it then existed. As his remarks form a 
contemporaneous record of what was going on during 
this period, a few quotations from them will show how the 
current of professional opinion on the subject was fashioned, 
as well as his own impressions, and the ground upon which 
they were formed. “Ata meeting of the Association of 


1877. | by Davip Nicotson, M.D. 173 


Officers of Asylums and Hospitals for the Insane, held last: 
July (1851), it was agreed to petition Government to provide 
a new asylum for criminal lunatics. The arguments used by 
the ditferent advocates for such a measure appear somewhat 
incompatible with each other. Those put forward by the 
officials of county asylums were that the latter are not suffi- 
ciently secure for the detention of persons dangerous to the 
public, and that the society of criminal lunatics is mis- 
chievous, corrupting and offensive to their fellow patients. 
The eminent London physicians, practising in this depart- 
ment of the profession, pleaded imploringly for the removal 
of the unfortunate inmates from the criminal ward at Beth- 
lem, a place which they designated as a prison and a grave, 
and illustrated by the well-known line of the Italian poet— 


‘Who enters here must leave all hope behind,’ 


They claimed for these criminal lunatics a Government 
establishment, like the one provided in Ireland, where, in a 
country situation, a ‘happy valley’ is formed to make loss 
of liberty not irksome but delightful. The contrast of these 
different motives for a new institution will seem greater when 
it is remembered that the majority of criminal lunatics in 
county asylums are harmless and innocent, while those in 
Bethlem are the most vicious and guilty of their class—that 
a really dangerous character can be drafted from a county 
asylum to Bethlem, while the quiet and least depraved patients 
are drafted from the latter place to an asylum in the country. 
According to some, Bethlem is too much like a prison for the 
worst of a class; according to others, a county asylum is too 
little like a prison for the best, The evils of the present 
system are described as they are seen from different points of 
view. The governors of county asylums finding that some 
criminal lunatics cannot be influenced by the gentle and in- 
dulgent régime of the establishments over which they preside, 
allow the feelings excited by the few to be extended to the 
whole class, and demand their removal to a Government 
asylum, where a more efficient discipline can be practised. 
The metropolitan physicians practising in lunacy see the un- 
fortunate persons whom they perhaps have been instrumental 
in saving from capital punishment condemned to perpetual 
imprisonment in a place, the gloominess and deficiencies of 
which it may not be easy to overstate. I do not wish it to be 
thought that these apparent inconsistencies are any proof 
that new arrangements are not urgently needed, but rather 


174 The History of Criminal Lunacy in England,  [July, 


as indications that the present system is bad on both sides, and 
that a new establishment, without revised principles of classi- 
fication, would be an insufficient remedy.” (Page 10, et seq.) 

He further states (p. 17) that, as regards the relations exist- 
ing between criminal lunatics and other patients, his own ex- 
perience is in direct opposition to that which has been recorded 
by his professional brethren. “I have,” says he, “ carefully 
watched to detect any repugnance or unfriendly feeling 
among the inmates of this establishment towards their fellow 
patients who were known to have committed offences against 
the law, and have not only failed to do so, but have heard 
expressions of sympathy and pity.” Hepoints out (page 20) 
‘““how purely accidental it is whether an insane person is 
admitted into an asylum under a State warrant, or under the 
ordinary justices’ order, and how arbitrary is the classifica- 
tion of so-called criminal lunatics. There are few insane 
persons, who, if left at large and neglected, would not be 
liable to commit offences of some kind against the law, and 
a large number of patients admitted into asylums under the 
ordinary forms have committed offences which would have sub- 
jected them to imprisonment and trial, had not their mental 
infirmity been obvious......... It therefore appears to 
depend more upon the manner in which insanity develops 
itself, and upon the persons who first appreciate its nature, 
than upon any distinctive kind of the malady, whether a 
patient happens to be classed as a criminal or as an ordinary 
lunatic.”” He embodies the conclusions to which he at that 
time came, in the following propositions :—1. That a distinct 
institution is not necessary for the treatment of all lunatics 
in detention under warrant from the Crown or Secretary of 
State, generally called criminal lunatics. 2. That such an 
institution is desirable for the detention and treatment of 
lunatics of criminal disposition, many of whom are not 
criminal lunatics. 38. That lunatics of criminal disposition 
require treatment different from that suitable to ordinary in- 
sane patients, and partaking of the nature of correction. 

The following remarks by the same writer, are well 
worth keeping in mind :— 

“It should not be forgotten that there is a distinction 
between vice and crime; and that the removal from county 
asylums of all lunatics who have committed offences against 
the law would still leave behind the depraved and vicious 
persons, whose society is more contaminating than that 
of the violent and thievish....... - The meshes of the 


1377.| by Daviv Nicotson, M.D. 175 


law do not catch all the scoundrels in society, but they are 
all liable to become insane. Vice is probably more infectious 
and polluting than crime; and while the latter is often the 
result of insanity, the former is very frequently the cause of 
it. My experience leads me to believe the vicious and de- 
praved inmates of asylums are more objectionable as com- 
panions to the other patients than the so-called criminal 
lunatics.” 

In Dr. Bucknill’s “ Inquiry,” written 26 years ago, the 
following classes of cases are given as suited for a Central 
Government Asylum :— : 

1. Convicts who become insane while undergoing their 
sentences in Government prisons. , 

2. Criminal lunatics whose dangerous propensities or de- 
praved character render them objectionable inmates of ordi- 
nary asylums. 

3. Lunatics of like character to the aforesaid, but who had 
not been sent to gaol and thence to the asylum under warrant 
for the commission of any particular offence, although their 
lives may have been habitually criminal. Also patients com- 
mitting heinous offences while under detention, as the man 
who recently murdered another in Kent Asylum. 

The classification here suggested is admirable on theoretical 
grounds, and in some ways even if taken practically. But, if 
we were critically inclined, it is conceivable that not un- 
important difficulties and objections could be raised against 
the full carrying out of such a mode of classification in 
practice. 

Let us now return to another writer of authority on the 
subject, the late Sir Charles (then Dr.) Hood, Resident Super- 
intendent of Bethlem. For several points brought forward 
in this communication, I am indebted to his excellent little 
work,* entitled, “Suggestions for the Future Provision of 
Criminal Lunatics.” After giving some account of the 
general subject of criminal lunacy, and statistics bearing 
upon it, with Bethlem as a centre-piece, he comes to the 
question of the provision to be made for criminal lunatics. 
“Ts it desirable,” he asks (page 135), “that one great central 
or State asylum should be erected for their common recep- 
tion? It appears to me—but I advance this opinion with 
much deference—that very serious objections may be urged 
against congregating all the criminal lunatics of the country 


* Published by Churchill, in 1854. 


176 The History of Criminal Lunacy in England,  [July, 


under one roof. We must remember that these persons 
belong to very different classes of society ; and they are com- 
mitted for trial under very different circumstances. Would. 
it be fair or humane to shut up a lady or a gentleman, who 
may, under a momentary insane impulse, have committed a 
very trivial misdemeanour, in the same ward, or even in the 
same establishment, with women or men belonging to the 
lowest classes of society, who may have committed revolting 
and nameless offences? There is no family in the kingdom 
—from the domestic circle of the highest peer of the realm, 
down to that of the humblest peasant—that may not be 
stricken with the calamity of insanity; and a very trivial 
transgression may render the afflicted person amenable to 
trial in a public court of justice. Acquitted as insane, is the 
hapless offender—who may be highly connected, well educated, 
and habitually sensitive and refined—to be cast amongst coarse 
and ruthless ruffians, whose hands—insane as they may have 
been when they committed such offences—have been tainted 
with the most atrocious and loathsome crimes ?” He further 
puts it by way of argument that the centralization of criminal 
lunatics would greatly interfere with their cure. ‘“ How,” he 
asks, ‘‘can criminal lunatics ever recover if they are to be 
associated only with one another—listening to their mutual 
incoherencies and misdeeds, and breathing (so to speak) only 
the contaminating atmosphere of insanity?” As a matter of 
distance, too, any central asylum, Sir Charles thinks, would 
be inconvenient for poor relations who wished to visit patients, 
and he is of opinion that in the public eye such a place 
‘would be regarded in the light of a bastile—however well 
conducted—desecrated byno slight amount of popular odium.” 
The expense of building, too, would be an objection, he says. 

Unfortunately, Sir Charles does not favour us with any 
benefits that might possibly accrue from the erection of a 
central asylum; and we are left to suppose either that there 
are none, or else that, if there are, he does not care to mention 
them. However open to criticism these remarks may be, we 
refrain. 

The principal suggestions made by Sir Charles, as to the 
classification and disposal of criminal lunatics, are the follow- 
ing (p. 167) :— 

1, That in their distribution, a principle of classification 
should be recognized, and that the highest class of offenders — 
should, under the Queen’s warrant, be confined either in | 
Bethlem or in some other recognized State asylum. | 

2. That criminal lunatics who have committed offences of | 


1877. | by Davip Nico.son, M.D. 177 


a minor description, should be confined under the Secretary 
of State’s warrant in county asylums, where special provision 
should be made for them, and where they might associate 
with ordinary lunatics at the Superintendent’s discretion. 

3. That convicts becoming insane in prisons should not be 
sent to county asylums, but that a criminal ward, or some 
other appropriate place in connection with the infirmary of 
the prison, should be appointed for their confinement. 


IV. Broadmoor, or Centralization Period. 


It will be remembered that the far-seeing Committee of 
1807 expressed in their Report the desirability that “a 
building should be erected for the separate confinement of all 
persons detained for offences committed during a state of 
insanity.” But Iam not aware that anything further was 
done regarding the erection of a central establishment until 
in March, 1852, the Harl of Shaftesbury, in the House of 
Lords, moved an address to the Queen, “ praying that Her 
Majesty would be graciously pleased to take into consider- 
ation the expediency of establishing a State asylum for the 
care and custody of those who are denominated Criminal 
Lunatics.” The proposition met with general approval, but 
nothing could be done until a Bill on the subject had been 
passed by the House of Commons, whose sanction for the 
expenditure of a considerable sum of money on such a build- 
ing was a preliminary necessity. The noble Lord then with- 
drew his motion. 

During the following session, Lord St. Leonards, in laying 
before the Upper House the Bill for the “ Regulation of the 
Care and Treatment of Lunatics,” referred to the subject, 
and called the “attention of Her Majesty’s Government to a 
duty which he thought peculiarly devolved upon them, that 
of introducing a measure for the providing, generally, for the 
criminal lunatics of the country. The law at present did not 
stand well on that subject.” 

As all the wards provided by Government at Bethlem and 
Fisherton for criminal lunatics were full, and as further 
accommodation became necessary, the Home Secretary, in 
1856, gave instructions for steps to be taken, with a view to 
the erection of a Government establishment, such as would 
meet the requirements. Hence the purchase, in 1857, of 290 
acres of land in the parish of Sandhurst, in Berkshire. A 
sum of £5,391 was paid for this property, equivalent to about 
#18 12s. an acre.* Upon this estate, under the exclusive 


* Ten years later 33 adjoining acres were added, at about £56 per acre. 


178 The History of Criminal Lunacy m England, (July, 


direction of Sir Joshua Jebb, R.H., Broadmoor Asylum was 
built. The total expenditure, including purchase of land, 
erection of main buildings, offices, and attendants’ cottages, 
farm buildings, schoolhouse, and other necessary adjuncts, 
amounted to £166,350. 

The Asylum buildings consist of two central and four 
detached blocks for males, and two distinct blocks for females. 

The first members of the Council of Supervision were 
appointed in 1861, but the Chairman, the Right Honourable 
Sir Wm. Hayter, Bart., still actively presiding, is now the 
only one of the original number alive. 

The Asylum was opened in 1863. Dr. Meyer was the first 
Medical Superintendent, and, upon his death, in 1870, he 
was succeeded by Dr. Orange, who had held the post of 
Deputy Superintendent, since the opening. 

In the meantime, while the Asylum was in process of erec- 
tion, an Act of Parliament (23 & 24 Vict., c. 75) was passed 
on the 6th of August, 1860, “ to make better provision for 
the custody and care of Criminal Lunatics.” By this Act it 
was made lawful, Ist, for “Her Majesty to appoint that any 
asylum or place in England which Her Majesty may have 
caused to be provided or appropriated, and may deem suitable 
for this purpose, shall be an Asylum for Criminal Lunatics.” 
2ndly, for the Secretary of State to direct that criminal 
lunatics (whether found insane before or upon trial, or after 
conviction, sentence, or imprisonment) be confined in such 
asylum until lawfully removed or discharged. 38rdly, that 
nothing in this Act is to affect the authority of the Crown to 
make other provision (in any county asylum or other place for 
the reception of lunatics) for the custody of criminal lunatics. 

Broadmoor was established under this Act, and its further 
sections provide for the appointment of the Council of Super- 
vision and of the officers, and for the making of rules for the 
government of the asylum, as well as for details regarding 
the treatment and the removal and discharge of criminal 
lunatics. It further makes provision for the re-capture and 
re-confinement of criminal lunatics in case of escape, and for 
visitation by the Commissioners in Lunacy. 

Broadmoor has accommodation for 563 patients, 413 males 
and 150 females ; and the proportion of attendants to patients 
is about as one to five. 

With the view of showing the legal position of the criminal 
lunatic, the various stages at which his insanity may be 


attested, and the present mode of disposal, I have drawn up 
the following scheme :— 


1877.) by Davip Niconson, M.D. 179 


1. Certified to be insane 


moor or other Asy- 
; whilst awaiting trial. 
2 


lum until sane and 


Bee in Broad- 
fit for trial. 


Untried... ss. 
2. Found insane on ar-) 


Unconvicted. raignment. 





Tried... ... .. ss. «3 Acquitted on the! Detained in Broad- 
ground of insanity. > moor during Her 
Majesty’s pleasure. 
Death... ... ss: oss so 4 Reprieved - on the | 
ground of insanity. J 


Criminal Lunatic. 


Convicted. sane whilst undergo- moor or Convict 
ing sentence of penal Prisons till expiry 


[ Penal Servitude ... ... 5. Convicts : certified in-+) Detained in Broad- 
servitude. ; of sentence. 


certified whilst under- 
going shorter senten- 
ces in gaols, 


Removed to County 


Ordinary Imprisonment. 6. Ordinary prisoners : 
Asylums, 


From a socio-legal point of view it is apparent that some dis- 
tinction must be taken to exist between the criminal lunatic 
who has, and the criminal lunatic who has not, been con- 
victed, and that it would be unjust to place the two groups 
altogether in the same category. An exception arises respect- 
ing the comparatively few individuals who have been sentenced 
to death, and who have been certified to be insane before any 
portion of their sentence has been carried out. They become, 
to all intents and purposes, un-sentenced, seeing that their 
sentence is revoked, } 

When Broadmoor was built, however, no provision was 
made for the practical carrying out of this distinction ;.and 1t 
soon became evident that any attempt to treat the two classes 
on the same footing, and by promiscuous association, must be 
not only unsatisfactory but also unsafe. 

The period in the history of criminal lunacy with which 
we are now dealing, has been characterised by the recogni- 
tion and establishment, upon practical experience and froma 
medico-psychologicai standpoint, of the principle that there 
are two distinct classes of criminal lunatics requiring different 
methods of management and treatmeut. 

In his Report for the year 1872, Dr. Orange, the Superin- 
tendent of Broadmoor, works out this distinction, and I give 
his remarks in extenso :-— 

“‘ Criminal lunatics are composed of two classes differing in 

many very important particulars one from the other. 
__ * One class consists of those who, having been charged with 
the commission of some criminal act, have, either whilst 
awaiting trial, or when arraigned, or when tried, been found 
to be insane, and have in consequence been ordered to be 
detained during Her Majesty’s pleasure. The other class 
consists of those who have been removed on the ground of 


180 The History of Criminal Lunacy mm England, [July, 


insanity to Broadmoor, from convict prisons, whilst under- 
voing various terms of penal servitude. 

‘¢ The former class consists, mainly, of persons whose offences 
have been isolated criminal acts, the direct results of their 
insane state, and who, up to the time of the outbreak of their 
insanity, have, in many cases, led honest and industrious lives. 
The criminal acts committed by this class of inmates being 
chiefly acts of personal violence, there is a special source of 
danger attending their treatment on account of the fact that 
recurring paroxysms of insanity in the same individual are 
commonly attended with the same outward manifestations 
and modes of conduct, and, thus, persons whose insanity has 
led them on one occasion to suddenly attack those living 
with them are very prone to attempt similar acts in sub- 
sequently recurring paroxysms, and this is most especially 
the case with regard to those inmates who have been sent to 
Broadmoor in consequence of causing the death of patients or 
attendants in other asylums, or workhouses, or similar 
institutions. But, as in these cases the homicidal act is 
almost invariably preceded by the maniacal state, expressed 
sometimes by unusual restlessness and hilarity, sometimes by 
unusual taciturnity, and at others by some special trait 
peculiar to the individual, careful observation generally 
reveals the signs of an approaching storm, and thus gives 
the opportunity of averting its graver consequences. The 
dangerous propensities of patients of this class, when suffer- 
ing from more than usual mental disturbance, render greater 
vigilance and a larger staff necessary ; but in other respects 
the description of treatment which they require is similar to 
that approved in the case of other insane persons. 

“The other class, consisting of those removed from convict 
prisons whilst undergoing penal servitude, differs widely from 
the class just described. Instead of being composed of 
persons who have committed criminal acts in the frenzy of 
mania, it consists chiefly of those whose offences against law 
and order are part of their every-day life. | 

“It is not intended at the present time to enter upon the 
discussion of the question how far criminal habits may be the 
result of natural defect of mind and inaptitude to earn an 
honest living, but simply to consider the characteristics of 
this class of patients at the time when they become inmates 
of this asylum, and the bearing which those characteristics 
exercise upon their treatment. 

« Persons becoming insane whilst undergoing sentences in | 
convict prisons, or in county or borough gaols, are all equally 


ore). by Davip Niconson, M.D. 181 


included in the term ‘criminal lunatic,’ but usually those 
only from convict prisons come to Broadmoor; those from 
county or borough gaols going to the county asylums. 

“The average daily population of the convict prisons in 
1871 was 8,218 men and 1,217 women, and it is from this 
population that the class of inmates now under consideration 
is drawn. ‘They are, therefore, chiefly old offenders. 

“The medical officer of Millbank Prison states in his report 
for the year 1869, that of 28 prisoners certified during the 
year to be insane, 24 were known to have been previously 
convicted, and that in one case 14 previous convictions had 
been recorded, in another 13, and in another 10. Whilst on 
the one hand, therefore, the degree of mental defect pre- 
viously existing would not appear to have been sufficient to 
warrant the signing of a certificate of insanity by the 
surgeons of the prisons through which these persons had 
formerly passed, so on the other hand it had not formed any 

impediment to the full development of a life of crime, or to 
the acquirement of those habits of lawless violence, of 
antagonism to order, of contempt for honest work, and of 
the use of language of the foulest description, which charac- 
terise this class of inmates, and which cause their manage- 
ment, when they are aggregated in considerable numbers, to 
present special difficulties not encountered in dealing with 
other insane persons. 

“At the close of the year, the 507 patients then in the 
asylum were composed in the following proportions of the 
two classes which have been described; 268 men and 75 
women belonged to the class found insane either before or at 
the time of trial, and 138 men and 26 women had been 
removed from convict prisons. Although it is not intended 
to raise the slightest doubt that these 138 men and 26 women 
are, by reason of their mental condition, quite unfit subjects 
for penal discipline, or that their proper place is in a lunatic 
asylum, it may still be open to question whether it is either 
just or expedient to permit those other inmates, whose lives 
have not previously exposed them to such evil influences, to 
be contaminated by the degraded habits and conversation of 
the convict class, or to cause those belonging to one class to 
suffer from restrictions which are only necessary for the 
‘other class; and yet this is what at present happens in 
consequence of the intermingling of the two classes in the 
proportion just stated. ‘These remarks apply with greater 
force to the male division than to the female, in consequence 
of the proportion of convicts being greater amongst the men 


182 The History of Criminal Lunacy m England, [J uly, 


than amongst the women, and also because, as the female. 
division is not fully occupied, a better classification of the 
existing inmates is possible. The male division is, however, 
now full, and the present seems therefore an opportune time 
for submitting the foregoing remarks, with the view that in 
any plan which may be adopted for providing further accom- 
modation, the desirability of affording effectual separation of 
the two classes may be considered. 

“ In the original construction of the asylum it is understood 
that one of the intentions in adopting the block system was 
to enable classification to be made, but the blocks, as at 
present existing, do no admit of this being effectually done. 

“The Commissioners in Lunacy in their Report upon the 
Asylum, presented in March 1872, make the following 
remarks upon the subject:—‘ We invariably found upon 
inquiry that the noisiest wards contained the largest number 
of this class (the convict class). It is our opinion, many 
times strongly expressed in these reports, that all the bad 
qualities of such inmates are exaggerated by excessive 
seclusion ; but we freely admit the difficulty of dealing with 
them in the present circumstances of the asylum, so restricted 
as it isin the amount of accommodation necessary to afford 
proper facilities for a more equable distribution of cases, with 
suitable regard to the general comfort of the wards.’ 

‘* Hven in the existing state of the asylum there is, however, 
a continued improvement in the condition of the worst class 
of patients, an improvement to which the Commissioners in 
Lunacy also bear testimony in the Report from which the 
foregoing paragraph is quoted.” 

And in his report for the year 1874, Dr. Orange speaks 
thus :—“ The comparative freedom from acts of insubordina- 
tion and disorder during the past year may fairly be ascribed 
in part to the diminution in the number of men of the convict 
class, and in part to the plan which was, during the year, 
carried out, as far as the construction of the asylum would 
permit, of restricting the convict class to a certain number of 
wards set apart for them, instead of allowing them to inter- 
mingle with the other class as formerly” 24.) a. sige oN 
the treatment of men who were criminals before they were 
insane, and who, at the time of being certified to be insane, 
are actually undergoing imprisonment for crimes which they 
committed when they were sane, and who, in the event of 
their recovery from insanity, are liable to return to prison to — 
complete the terms of penal servitude to which they have been | 
sentenced, not only is a stricter system of discipline necessary, 


1877. | by Davip Niconson, M.D. 183 


but a stricter system than that ordinarily employed in the 
treatment of other classes of the insane may legitimately 
be used. The diminution which took place in the number 
of the convict class during the past year rendered it possible 
to make some partial advance towards effecting a separa- 
_ tion between the two classes, although the construction of 
the asylum does not at present permit of that separation 
being made complete; and in those wards to which some 
of the convicts were restricted a system of treatment, such 
as here adverted to, was, as far as possible, established. 
The result was that the wards from which the convicts 
were withdrawn quickly showed a much improved condition, 
and, at the same time, the chief sources of trouble formerly 
experienced in dealing with the convicts themselves were 
removed. On the other hand, to allow persons of the convict 
class to have the free range of a large establishment, organised, 
in all material respects, like a modern County Asylum, is to 
place in their hands facilities for doing mischief of all kinds, 
which cannot be effectually counteracted by even a very large 
staff of attendants.” 

And the Commissioners in Lunacy in their Report for the 
year 1874, thus express themselves :—“ After much considera- 
tion of the subject, we are clearly of opinion that the separa- 
tion of the classes, advocated by the Broadmoor authorities, 
should take place. The forced association of honest and 
well-conducted persons who, solely owing to mental disease, 
have broken the law with convicts whose criminal acts had, 
probably, been the cause of their mental disorder, is evidently 
unjust, and there is every reason to believe that the success- 
ful management and treatment of both classes could be more 
safely and efficiently conducted in separate institutions, with 
different rules and modes of treatment, and wherein the 
Structural arrangements can be specially adapted to the 
varying requirements of each.” 

The result of these representations and expressed opinions 
was, that provision has been made for male convicts who 
become insane during imprisonment, by setting apart a wing 
of the invalid prison at Woking for their reception and 
treatment. The beneficial working of this arrangement is 
_ thus referred to by Dr. Orange, in his last report (for the year 
1875) :—“ The cessation of the stream of new recruits has 
_Yendered it possible to carry out still further the separation 
of the class sentenced to penal servitude from the other and 
larger class, consisting of those acquitted on the ground of 

XXIII. 3 


184 The History of Criminal Lunacy in England,  [Tuly, 


insanity, or found to be insane before trial, and the results of 
another year have strongly confirmed the opinion expressed 
in previous reports as to the utility of such a separation. The 
gain to those wards which have been freed from the convict 
class is very marked, whilst in the other wards into which 
the convicts are now collected, a system of treatment, based 
upon a full recognition of the fact that the inmates were 
criminals before they became insane, and that the occurrence 
of insanity by no means causes them to forget their previous 
habits and propensities, has resulted in rendering those wards 
as tranquil and orderly as any other part of the asylum.” 
But the beneficial results of this new system were not limited 
to the wards of Broadmoor. It was calculated to exert a 
favourable influence, of the nature of a reflex action, upon the 
standing army of convicts undergoing penal servitude in the 
various Government prisons ; and in their report for the year 
1875 the Directors of convict prisons thus speak of it :-—‘‘ The 
change was, no doubt, a judicious one in respect of the 
separation of men who were actual criminals undergoing 
sentence, fromthose who had been acquitted on the ground that 
their crimes were to be attributed to their insanity, and who, 
therefore, might fairly be treated with a degree of indulgence, 
which, so faras it is not a part of the medical treatment, 
would be inappropriate in the case of a convicted criminal ; 
and there is good reason for anticipating that a propensity to 
sham insanity, or to that deliberate abandonment of self- 
control which resembles, or which may actually develop into 
insanity, will be checked by the knowledge that it will not 
lead to the comfort and comparative freedom of ‘ The Farm’ 
(as the Broadmoor Asylum is termed among the convicts).”’ 

It is not to be understood that all insane convicts exhibit 
the characteristics of the class; but the type is sufficiently 
well marked in a large majority. | 

I may mention that a Departmental Committee was ap- 
pointed last year to consider the question of the expenditure 
required for the maintenance of Broadmoor Asylum, and their 
report has recently been laid before the House of Commons ; 
but as nothing has yet come of it, the details and suggestions 
of that report and its two dissentient “minutes” do not 
come within the scope of this paper. 

In conclusion, it may be stated that from time to time, 
Superintendents of County Asylums have expressed them- 
selves as having a grievance in the arrangement by which | 
criminal lunatics—whether those undergoing short terms of | 
Imprisonment and received from gaols, or whether insane | 


FS77.| by Davip Niconson, M.D. 185 


convicts received from Broadmoor at the expiry of their 
sentence of penal servitude—continue to be sent to the 
Asylums of the county to which they belong. At the meet- 
ing of the Medico-Psychological Association in London, in 
1873, Dr. Chapman proposed the following resolution, which 
was carried :—‘ That this association take steps to prevent 
criminal lunatics being sent to County Asylums.” A com- 
mittee was appointed “to consider the best means for carry- 
ing out the resolution,” but, so far as I am aware, nothing 
further has been done in the matter. 

The following is the number of criminal lunatics under 
detention in asylums and other licensed houses on the 29th 
of September, 1875, as given in the “ Judicial Statistics’ (1875) 
for England and Wales :— 


M F, Total. 


Broadmoor State Asylum. . . . 3890 109 499 
ComtywAsylums . 4 12+ ts ip 184 37 121 
City and Borough Asylums .. . 6 4 10 

_ Metropolitan Licensed Houses . . 3 0 3 
Provincial Licensed Houses . . . 87 8 45 
otal sie) .& > 4s: Dee 158 678 


This number does not include criminal lunatics in prisons 
and gaols. <A reference to the Report of the Directors of 
Convict Prisons, for 1875, shows that there were 67 convicts 
(one of them a female) under treatment as insane at Millbank 
and Woking Prisons. 


On some Common Misapprehensions as to the Curability of the 
Admissions of County Asylums. By T. AucERNoN CHap- 
man, M.D., Medical Superintendent of the Hereford 
County and City Asylum. 


It has long been well-known that the curability of cases of 
insanity diminishes rapidly as the duration of the disease in- 
creases. In this respect it follows a parallel course to all 
other diseases, and indeed to every other evil under the sun. 
I do not propose in any way to object to this fact, or to dis- 
pute the accepted measure of the relation between duration 
and curability. The object I have in view is to call attention 
to one or two very grave fallacies of almost equally wide 
acceptance in the supposed application of this well-known 
relation. One meets everywhere with the statement that a 


186 The Curability in Cownty Asylums, [July, 


large proportion of the patients sent to our County Asylums 
suffer from mental disorder of considerable duration, say over 
twelvemonths—so far true—but it is added that these cases 
ought to have been sent to the asylums when recent, in which 
case a large proportion of them would have recovered, and 
the accumulation of chronic cases in asylums would be largely 
or completely checked. All this sounds very logical, but as I 
propose to show, it is quite untrue, and to those who are well 
acquainted with the fact, must be so obviously incorrect, that 
one is surprised to meet this statement in various forms in a 
very large proportion of thereports of Medical Superintendents 
of Asylums, in Medical Journals, and elsewhere; nor do I 
recollect seeing anywhere a hint as to the erroneous use of 
statistics on which it rests. I cannot, perhaps, give a better 
view of the remarkable and erroneous opinions to which this 
error leads than by giving in full a recent instance from a 
leading Medical Journal of the deductions drawn “from it. 
In the “ British and Foreign Medico-Chirurgical Review,” 
for January, 1877, p. 83, we read as follows :— 


‘¢ A moment’s consideration of the ratios of recoveries and of deaths 
at once makes plain the cause of the notorious accumulation of chronic 
lunatics in asylums. It is well worthy of inquiry why only from 30 
to 388 per cent. of those admitted into asylums are discharged re- 
covered. Jor psychological writers assure us that insanity is a curable 
disease, and that by prompt and proper treatment 70, and even more, 
per cent. of its victims may recover. One reason assuredly is to be 
found in the oft-reiterated complaint of the number of incurables 
taken to asylums. But how comes this to pass, or at least to go on 
year after year? We can well allow for it when a new asylum is 
opened, and all the workhouses in its district proceed at once to 
transfer their old patients to it ; and the many unknown, or little 
known, poor lunatics scattered up and down the country are taken to 
it by their relatives, who gladly rid themselves of their burden and 
cost; but we do not comprehend why a perpetual stream of incurables 
should be forthcoming. The chronic cases must have once been acute, 
or at least have had a beginning when a chance of recovery was pos- 
sible; and it may be asked why did they not gain admission to the 
asylum when in the recent and more hopeful condition? ‘That they 
did not, and do not, is a proof there must be something wanting in 
the laws of lunacy, or in the machinery for administering them. 
There is a clear demand for some plan to secure the immediate transfer 
of lunatics—at least of thosé who by their lunacy become chargeable 
——to an asylum where they can receive individual attention, and obtain 





medical, as well as moral treatment for their malady; not to an in-_ 


stitution simply because it is called an asylum, and where after admis- 


1877.] by T. AtgERNon CHapman, M.D. 187 


sion they will be treated only as so many additional units in the 
throng of hundreds, to be simply subjected to the routine and dis- 
cipline of those around them, and among whom they soon become . 
almost lost to observation; for if so their prospects of cure may, at 
the best, be little improved by their admission. Were we to go fully 
into this question, we should have to embark on the wider one, to uch- 
ing the best forms of accommodation to be provided for recent and for 
chronic cases; but here at present we can only express the con- 
viction that the present organisation of our asylums is not calculated 


to keep under the accumulation of the insane by promoting their 
recovery.” 


Though somewhat out of order, I may here state that the 
fallacy I allude to appears in the above, when the writer says 
that he does ‘‘not comprehend why a perpetual stream of 
incurables should be forthcoming, that the chronic cases 
must once have been acute, or at least have had a beginning, 
when a chance of recovery was possible.” Whereas, in truth, 
it would be more correct to say that these chronic cases 
never were acute, and had not a beginning when there was a 
chance of recovery, and for this reason: that the mass of 
these chronic cases are congenital idiots and imbeciles, cases of 
senile dementia, and of various forms of progressive brain 
disease ; I should not, indeed, be guilty of gross exaggeration 
if I said they all were such. The source of the error probably 
lies in the circumstance that when insanity is discussed the 
writer thinks of mania and melancholia, to which indeed the 
term used to be almost restricted, and even so lately as—say 
30 years ago—these formed the great majority of the so- 
called insane. But now the-case is very different. If we 
understand by insane those who are now sent to County 
Asylums, we must include all sorts of mental weakness, 
whether it be congenital, in all forms of idiocy from the 
lowest to mere simplemindedness; whether it be dotage, 
from slight garrulousness to complete dementia; whether it 
be mental defect due to various forms of paralysis or epilepsy, 
with many others. All are called insane, and all are sent to 
the County Asylums. 

I may perhaps best approach the matter by referring to 
Dr. Thurnam’s statistics of insanity, where we first have the 
elation of duration to curability placed on a clear statis- 
tical basis in his Tables E and F—tables on which Table 
VII. of the Medico-Psychological Association is founded. 


The portion of Table F, relating to recoveries, is as 
follows :— 


188 The Ouwrability in County Asylums, [July, 


TABLE F. 


Showing the Average Proportion of Recoveries in Cases of 
Recent and Longer Duration, when admitted to the 
Retreat, 1796-1844. 





Proportion per cent. of 
Recoveries on the 


Duration of Disorder when Admitted. Admissions. 


Males. |Females.| Mean. 





nc a CEE ED RR RR ERED 





—aaee | eee ES | eS ES 


First Class—First attack and within : 2 ; 
B MONG -siissdinsacossecoeene } 79°24 77°19 78°18 
Second Class—First attack above 3 . : 5 
within 12 months ......... } 46°15 43°76 45 
Third Class—Not first attack and within : : ; 
2 MOPS sosicescwoncens'scas een ; 55°55 oe Coe 
Fourth Class—First or not first attack 


and more than 12 se partit 14°65 | 23°38 19°16 





EET Cee ae 





AVOEAZO s Feecsonsocsesecstssorees 43°46 | 50°26 | 47:07 








I am not aware that these figures have, by further ex- 
perience and on a larger scale (Dr. Thurnam’s total number 
of cases was 701), been in any way amended; and believe 
that a similar series of cases would be admitted to produce 
similar percentages. Individuals have in series of selected 
cases shown as high a percentage of recoveries as 90 p.c.; 
and for my present purpose, it is necessary to point out that 
Dr. Thurnam’s cases are, from the point of view of a County 
Asylum of the present day, a series of selected cases. Idiocy 
and serious brain disease were almost entirely absent from 
them, general paralysis is not mentioned, and diseases of the 
nervous system caused but 16 per cent. of the deaths; 
epilepsy appears to have been rare, and more or less uncom- 
plicated mania and melancholia formed more than three- 
fourths of the cases. I take Dr. Thurnam’s table, however, 
as a basis for comparison. For the results obtained in © 
County Asylums, I have taken the figures in Table VII. in 
all the Reports for 1875—+, e., all the reports which give this 
table—there still being several asylums which fail to give the 

tables of the Association in their entirety. These figures are 
open to much exception as to accuracy. I assume that the 
admissions of 1875, and also its recoveries, are those of an 


1877.] by T. Auarrnon Cuapman, M.D. 189 


average year—both points open to some doubt. Further, 
since the admissions year by year increase, and the recoveries 
belong, to a considerable extent, to the previous year, the 
admissions will, so far, exceed the average proportion to the 
recoveries. All these sources of error are not great, and 
would be of no moment for my present object, which is not 
to deal directly with the question of the relation of curability 
to duration, but with some supposed deductions therefrom. 
But it is affected by two other sources of error. One is that 
in some instances the compilers of the statistics appear to 
have taken for the recoveries not the duration on admission, 
but the duration on discharge; thus crediting to the longer 
durations recoveries belonging to the shorter ones. The 
other is, that in some instances the durations are taken from 
Relieving Officer’s “Statements,’’ instead of from the result of 
eareful enquiry by the Medical Officers of the Asylum, with 
the effect of classing amongst the short durations many in- 
curable cases of long standing; it being a constant practice 
to enter in the “‘Statement” not the real duration, but the 
duration of more pressing symptoms immediately preceding 
admission. If any one chooses, therefore, to use these 
figures for any purpose, he must bear in mind that they are 
from these various causes exceedingly untrustworthy. 


TABLE I. 


Showing the Average Proportions of Recoveries in Cases of 
different Durations as gathered from Reports of County 
Asylums for the year 1875. (Table VII.) 







Percentage of 

Admissions, Recoveries. Recoveries 
Duration in on Admissions. 
Classes, 


















M, F, | Tot. | M., FF. | Tots | M; F. |Mean. 











ee | 





Class 1 ............| 15387 | 1688 | 3225 | 690 | 820/ 1510] 45 48 46 


Class 2...) 478 | 543 | 1021] 112 |) 184; 296] 23 34 29 
Class 3............| 675 | 761 | 1436] 303} 416 | 719} 45 o4 50 
Class 4..........+.-| 865 | 968 | 1883 97 85 | 182] 11 9 10 





ES SSS EES AS emt | eee 


bac anss¥s 3555 | 3960 | 7515 | 1202 | 1505 2707 | 33 38 36 


| 








With all its errors, this Table will, however, suffice to give a 


190 The Curability in County Asylums, [July, 


measure to the fallacy I have alluded to, which may be briefly 
stated as follows :—That in Class 2, instead of these patients 
being sent to the asylum when the disease has lasted over three 
months, they should have been sent before, in which case 46 
per cent. would have recovered, instead of 29; or, to take the | 
actual figures, 469, instead of 296, would have recovered. 
And in the case of Class 4, 46 per cent. would have recovered 
had they been sent timely to the asylum, instead of 10 per 
cent.; or, in actual numbers, 843 would have recovered 
instead of 182; or, both taken together, 1812 would have 
recovered instead of 478; or if I had taken in the above table 
the whole admissions of the year, viz., 11,020, instead of 7,515 
only, 1,924 patients would have recovered, where only 701 
actually did so—that is to say, 1,223 persons by neglect 
somewhere, instead of being restored to sanity were left to 
swell the ranks of the chronic insane. I have stated reasons 
for believing that in the above Table the errors diminish 
the recoveries of the shorter durations, and increase those of 
the longer, 7.e., the figure 46 is unduly small, the 29 and 10 
are unduly large; were these corrected, this figure 1,223 
would be considerably increased. The Commissioners in 
Lunacy state the total increase of pauper lunacy during 1875 
at 1,004. According to the argument, pauper lunacy, 
if properly looked after, would be a diminishing instead 
of an increasing quantity. I think I have fairly and 
duly stated the argument, and primd facie it seems to be a 
good one; yet nothing can well be more erroneous. In 
order to show this, I have carefully tabulated all the pauper 
admissions to the Hereford County and City Asylum since 
its opening, omitting only the transfers from other asylums; 
and in the first place, I throw them into the form of Table L, 
and before going further, a comparison between this (Table 
II.) and Table I. will yield some instruction. In the first 
place, the total percentages of recoveries for either sex separ- 
ately, or for both, are very close, the advantage being in 
favour of Hereford by a trifle. The difference is probably 
wholly accounted for by the fact that Table I. contains 
transfers, Table IT. does not; and I may use this close agree- 
ment, as indicating that the Hereford Statistics are fairly 
representative of County Asylum Statistics generally. 
Otherwise it might be objected that the numbers are too 
small to admit any valid conclusion; but against this, 
there is the further most important consideration that 
these are the whole statistics of the matter for a defined 
district for five years, and are probably much the same as 


1877. | by T. Aucrrnon Cuapman, M.D, 191 


if they had extended over a longer time, or, for the same 
time, over a larger district. In short, there is a strong 
presumption that they are nearly a correct average, which 
the agreement with Table I. as to the ratios of total re- 
coveries renders almost a certainty; differing, therefore, 
altogether from an equally small number of admissions of 
any of our large asylums, just as Thurnam’s statistics of 
only 701 cases give accurate results because they represent 
all the cases from a defined source for a long period. 

But when we come to compare the Tables in detail, we 
find much variance; and I am not only inclined to believe, 
but feel, indeed, convinced, that had the Tables from which 
I have compiled Table I. been as carefully drawn up as 
Table II., there would have been a more close agreement 
throughout. I have no doubt that in Table I., from the 
causes alluded to above, the admissions of Class 1 have 
been largely increased at the expense of Classes 3 and 4, 
and that the recoveries in Classes 2 and 4 have been 
increased at the expense of Classes 1 and 38. Had I 

taken Table II. as the basis of the calculations above, 
we should have found that the supposed number of cases in 
which recovery was prevented by delay in treatment was 
actually 2,737 instead of 1,223. 


TABLE II. : 
Showing the Admissions and Recoveries and the Per- 
centage of Recoveries on Admissions in all Cases 
(except Transfers) admitted into the Hereford County 
and City Asylum previous to July 1st, 1876, arranged 
according to the duration on admission. 





Percentage of 
Admissions. Recoveries. Recoveries 


Duration in on Admissions, 


Classes as in 
previous Table. 











M. F, Tot, M. EF. Tot. M. FE. |Mean., 




















First Class ...... 52 34 86 32 21 53 62 62 62 
Second Class...) 13 10 23 1 3 4 8 30 TZ 
Third Class...... 29 40 69 22 28 50 75 70 72 
Fourth Class ...) 54 47 | 101 0 1 1 _— 2 1 





_ TS ES | NE | Ge | ES Se | eee cf nes | ce | a pe og 


Total ,.,......| 148 | 1381 | 279 50 53 | 108 36 40 38 





192 The Curability mm County Asylums, (July, 


I proceed to an analysis of Table IT. in detail, which will 
enable me to prove the various positions I have advanced. 
In the first class in Table II. the admissions are 86— 


M. 52, F. 34. The recoveries 53—M. 32, F. 21, or rather 


over 62 per cent. in each instance. If we analyse the cases 
included in these figures we find as follows :— 


Analysis of Cases in Class I., Table II. 


M. EF. Total 
Suffered from incurable brain disease . . 4 4. 8 
Moribund oh admission > 9... 06) 0 2 
Doubtful as to short duration,senile dementia 1 2 3 
e - “othter st! SAS eye Pe eee 1 4) 
Associated with congenital deficiency. . . 2 0 2 
Inéurabless 240. a. pn. co ho (pees!) 
Recovered =. (oi cs. 86s Gene en. 2 eee 
Convalescent. 2.) 0. se ua pues See ee ee 1 3 
Presumably curable, have not recovered. . 5 eames 8, 
total. .onecks @ 02 Spee 


If we take the curable cases only, the percentages are as 
follows :— 
Recovered & 
Admissions. Convalescent. Percentages. 
Class I. M. Ff. Tl. 5 My .oF. TL. ” Mee 
Incurables omitted 89 27 66 34, 22 156 87 ~81: 64 


This is unquestionably as good a result as any statistics of 
the treatment of the insane that have been published. It is 
perhaps hardly necessary, but, in case of misunderstanding, I 
here repeat, that I give these figures as being in my opinion 
fairly representative of County Asylums—and not because 
they are those specially of the Hereford Asylum. 

In Class 2 we have 23 admissions, 18 M. and 10 F.; the 
recoveries being 4, 1 M. and 3 F. respectively. 


; Analysis of Cases in Class II., Table IT. 
. Fey Total 

Suffering from incurable brain disease 5 2 7 

5 », Senile insanity . ate 3 1 4. 

. » incurable bodily disease . 0 i i 

Cases of gradual progressive insanity 0 2 2 
Incurables 8 6 14 

Recovered 1 3 4 
Convalescent. se tee genera ey 1 0 | 
Probably curable, did not recover. 3 1 e 


fot 
©9 
_— 
So 
ho 
© 


1877. | by T. AueeRNon Cuapman, M.D. 193 


Of the latter four in the above analysis two ought to have 
been sent to the asylum earlier, though one of these two 
would have had bad prospects owing to hereditary predisposi- 
tion, however early treated ; in the other case the delay was 
clearly due to the relatives of the patient, and not to any 
want of machinery. 

_ The percentages of recoveries on the curable cases only, are 
as follows :— 
Recoveries & 
Admissions. Convalescent. Percentages. 
Class II. My. E,.4. My ed Th Me eS. TL, 
Incurable omitted . 5 4 9 ck aithiore, O 40° 75° 55: 


The proportion of incurable cases due to brain disease and 
senile insanity is here much larger than in Class L., viz., 11 
out of 23, or nearly 50 per cent.; against 11 out of 86, or 
about 13 per cent. | 

Class 3 presents many points of much interest and im- 
portance, though as these do not directly bear on the present 
question, I will only note that the recovery rate exceeds that 
of the same class atthe Retreat, without any allowance being 
made for the greater intrusion of incurable cases. This may, 
however, easily result on such small numbers by the presence 
of a few recurrent cases more in the one series of cases than 
in the other. : 

They analyse as follows :— | 


Analysis of Cases in Class III., Table IT. 


M. F. Total 
Baomeisease (GO. Ps) 4 «Ser we . . I 0 ih 
Mietibund On admission’. . . .. . . Q i 1 
ducurabicey fF . 24. CL 1 g 
eererciee st te vy A ey DF 2S HO 
Menyaescenee Gui pee se 4 whe Od 5 6 
Probably curable, but failed to recover . . 5 6 %o ld 
29 40 69 


It is to Class 4 that I desire to draw special attention, 
because here are the cases supposed to be injured by not 
being placed under treatment in proper time. I should first 
_Yemark that the Association Table stops short with Class 4— 
_ Cases of Insanity of more than 12 months’ duration—and con- 

'-Sequently of the four headings given, this being the most ap- 
_ propriate, is selected for the tabulation of idiots—only the 
Hereford and Abergavenny Asylums having made a Class 5 


i 


194 The Curabelity in County Asylums, [ July, 


for congenital cases. I have, therefore, included them under 
this class in the present analysis. Idiots were so rare in the 
Retreat, that Dr. Thurnam did not require to frame a separate 
class for them in this table. 

Table II., Class 4, includes 101 cases—54 M. and 47 F, 
There is only one recovery; a very different proportion to 
that in Dr. Thurnam’s Table F. The following analysis will 
fully show the cause of the difference :— 


Analysis of Cases in Class IV., Table IT. 





M,. E. Total 
Suffering from incurable brain disease . . 9 4 18 
ss », Senile insanity . Ais ~ 14 
y sp. is WMOCY Se: kegs eh ey ae ae 
ys) 4 ODUCDSY. waa ee ee ee i} a 
Had previously been in this or some other 
Asylum. 9). “ccs gh eae eee 4 12 
Suffering from progressive physical disease. 0 1 1 
Cases of gradually progressive insanity . 4. 9 18 
Incurables who could not have been 
placed under treatment in a cur- 
able‘stage’ f° 2 2 a a 
Incurable cases of long duration and doubt- 
ful history cele NE Set Sa eee 3 5 
Probably more curable if sent earlier . . 0 4. 4 
54 47 101 
Of the latter one recovered. 
Admissions. Recoveries. Percentage. 
Class IV. Me * ave Coase aes M. F, T% 
Incurable omitted Oe ty 5 Wiebe | 25°. 2am 


It comes then, to this, that the statement that these cases 
have been deprived of timely treatment is not applicable to 
101 cases, but at most only to four; not to 36 per cent. of — 
the admissions, but to little over one per cent, or including 
the two cases noted under Class If., we cannot make more | 
than 6 cases out of 279 that were presumably injured by — 
delay in sending them to the Asylum. Their recovery rate was — 
46 p.c.; if sent to the Asylum within three months, it ought — 
to have been 84 p.c., and extending the figures to the 11,000 
annual admissions of County Asylums, it would result that 
89 patients failed to recover owing to this cause, instead of | 
1,223, or 2,737 as caleulated above according to the usual 
fallacy. But, in further modification of even this conclusion, 
these cases deserve a word of suggestion. 


£377. | by T. Auanrnon Cuapman, M.D. 195 


Is it just to assume that had these been sent earlier, 
say within three months, 84 per cent. would have re- 
covered? I think not. In Class I. 10 curable cases out 
of 66 failed to recover in the asylum. We know that 
not a few cases of insanity are successfully treated out of 
asylums, even amongst the class of people who furnish the 
patients of County Asylums; and is it not fair to assume 
that if not 84, yet some only slightly smaller percentage of 
eases so treated recovered, and that the patients sent to 
the Asylum were an uncured residuum, which would also 
have been left had all been sent early to the asylum ? 

There is one of the above sets of cases that perhaps requires 
a word of explanation, viz., those of gradually progressive 
insanity. These are always of long duration, they have no 
acute onset; one day the patient’s friends become alive to 
the fact that the patient’s oddities and eccentricities have 
been growing and increasing, after some further time and 
observation they perhaps discover some delusion, or are 
otherwise convinced that the gradually advancing change 1s 
due to insanity. They perhaps now call in a medical man, 
and very frequently he fails to detect anything, and refuses 
to certify ; and it may be several years more before the 
patient is actually sent to an asylum. ‘These cases not only 
in their nature baffle any suggestion to send them to the 
asylum early, but they give the impression, to me at least, 
that if they could be dealt with even many months before the 
relatives detect any change whatever, they would prove as 
incurable as they undoubtedly are when they reach the 
asylum, that they depend on some progressive degeneration 
toward which the train is advancing, long before any distinct 
Symptoms of insanity appear. 

1 think I have succeeded in showing that in this district, 
at least, there is very little to be done in placing patients 
more promptly under treatment, and very little to be donein 
improving their prospect of recovery after they are so placed. 
Further, that this district may be taken in both these respects 
| aS an average one. [am aware that there are some districts 
where the prospects of recovery are distinctly injured by 
placing recent cases in workhouses ; but even so, it is doubt- 
ful whether these are sufficiently numerous to materially 
affect the average. In this district acute cases are never sent 
| to workhouses except for a day or two, on the way to the 
| asylum, in occasional cases. 

It nevertheless remains a great fact that a mass of in- 





196 The Curability in County Asylums. [July, 


curable cases are being forced into our County Asylums; and 
although they were never curable cases, and although the 
remedy does not therefore lie in the usually supposed direc- 
tion, the jumbling together of idiots, dotards, and paralytics 
with those who are more strictly speaking insane, is much to 
be deprecated. Some suitable provision for their care re- 
quires to be made. The asylum unquestionably is not such a 
provision, although it is felt practically to be the most 
suitable that at present exists. 


Unilateral Sweating in General Paralysis of the Insane. By 
W. Junius Micxiz, M.D., Medical Superintendent, Grove 
Hall Asylum, London. 


In this communication it is proposed— 

(I.) To relate three cases of general paralysis in which 
localized copious perspiration affected one side only of the 
face and head, and to mention a fourth case in another insane 
patient. 

(II.) Next to refer to some other cases of unilateral sweat- 
ing mentioned by authors, but not occurring among the 
insane; and 

(III.) Lastly, to speak of the pathology of this symptom. 

I. By reference to the subjoined notes, it will be seen that 
the unilateral perspiration of the face occurred under dis- 
similar conditions in the three cases of general paralysis; in 
one, without any local paralysis or convulsion, but associated 
with old-standing disorganisation of the eyeball of the same 
side ; in another, occurring some time after a peculiar change 
in the mental state, and at first with very slight and very — 
transitory unilateral facial paralysis ; while in the third the 
unilateral perversion of secretion accompanied unilateral con- 
vulsions and hemiplegia of the corresponding side. All these 
patients were soldiers.* : 


Case I.—General Paralysis of two years and eight months total 
duration. Protracted liability (18 months) to right Unilateral Sweating 
of Face. Old Destruction of Right Eye. No Local Paralysis or 
Convulsion. 

J. C., of the 1st Batt. 2nd Regiment, admitted at the age of 88, 
suffering from well-marked general paralysis. He survived his ad- 


* Dr. Maudsley kindly informs me that he recently saw a melancholic patient 
of the hypochondriacal type who said that whatever he did he only sweated on © 


one ha It is not said, however, that the sweating on that side exceeded the 
normal. 


1877.| Unilateral Sweating in General Paralysis. 197 


mission for more than two years, and had external lesions attributed 
to syphilis. At first there were delusions, excitement, and incoher- 
ence—the delusions being of a most extravagant and exalted nature, 
and the excitement occasionally most vehement. Later on he was 
more irritable, morose, and abusive or threatening in his language, 
while his delusions exhibited more silliness and absurdity, and at last 
he was bedridden and quite demented. For many years the right 
~ eyeball had been shrunken and disorganised, and sight lost in that eye. 
A crop of boils appeared shortly after his admission. During the last 
thirteen months of life he was quite unable to leave his bed, owing to 
the extreme motor paresis. Demented, he was also at times irritable 
and obstinate, rarely, however, speaking save when roused by paroxys- 
mal excitement and objectless resentment. He would lie with the 
head stretching forwards, reflex power was impaired in the lower ex- 
tremities, he offered much resistance to passive motion, but rigid con- 
traction of the lower limbs was unusually long delayed. During the 
early part of this period he contracted bedsores, and required cathe- 
terisation, but the strength and nutritive powers revived under the 
treatment used. He made a good recovery from a carbuncle on the 
back several months before his death, but grew thinner in spite of 
good feeding. Congestion of the lung bases was frequent, and before 
death the same occurred with hypostatic pneumonia of the base of 
the right lung. 


From almost the beginning of this period of thirteen 
months of confinement to bed, he was subject to frequent per- 
spirations of the right side of the face, strictly limited to that 
side, or very much more marked there, when from any cause 
the patient was in a general slight perspiration. On some 
occasions the beads of perspiration bedewing the right 
side of the face, stopped short at the zone of the upper 
lips, but, on other occasions, the surface over the body of the 
inferior maxilla on the right side was also perspiring freely. 
The sweating, confined to the right side of the face and head, 
did not appear on every day throughout the whole thirteen 
months, nor did it usually last all day. The left side of the 
face appeared to be normal as regards perspiration. As is 
usual, the perspiration of the right side was more copious 
over the supra-ciliary ridge, the side of the nose, and the 
upper lip. The right eye, the sight of which had been des- 
troyed, was occasionally injected. 


Short Abstract of the Notes of the Autopsy. 60 hours after death. 
Old brownish ulcer scars on both legs, scattered whitish cicatrices 
about the body, bubo scar in right groin, calvarium of ordinary thick- 
ness, its internal surface has a “ worm-eaten ” appearance in the 
regions of the middle meningeal arteries. The calyarium is not sym- 


198 Unilateral Sweating in General Paralysis, [July, 


metrical, the left half looking the more capacious and projecting a 
little further behind. A small bony spine at the,centre of a middle 
fossa of the base of the skull. Dura mater thick and adherent. Con- 
siderable subarachnoid serum. Olfactory nerves adherent to gyri and 
soft. Right optic nerve degenerated and atrophied, its cross section 
being one-half that of the left nerve ; right optic tract atrophied, right 
third nerve soft, the fifth nerves separates with a touch from the Pons — 
Varolii. The arteries at the base are rather thick-walled, the arach- 
noid at the base is thickened, and there are interlobular adhesions. The 
veins of the cerebral pia mater are congested. ‘The combined pia 
mater and arachnoid are slightly opaque, are thick, tough, and cede- 
matous, fluid filling the sulci on the superior and lateral surfaces of 
the cerebrum, especially in the frontal and parietal regions. There is 
widely-distributed adhesion of the meninges to the cortical grey 
matter of the cerebrum, so that when the membranes are stripped off 
shreddy portions of the grey matter separate with them. These con- 
ditions of the surface and of the meninges, the adhesion and decorti- 
cation so common in general paralysis, are best marked over the first 
and second frontal, first parietal, supra-marginal, and first and second 
temporo-sphenoidal gyri. Their distribution is nearly symmetrical in 
the two hemispheres. Entire cerebrum of somewhat diminished con- 
sistence; grey cortex rather thin, numerous puncta sanguinea in 
white substance. Right hemisphere 162Zoz., left ditto 170z. Cere- 
bellum 5h0z. Pons and M.O. loz. Heart 10o0z., rather flabby, show- 
ing very slight granulo-fatty degeneration under the microscope. 
Aorta highly atheromatous. Kidneys 6 and 620z., slightly adherent 
capsules, not granular, nephritic changes from refluent altered urine. 
The posterior surfaces of both lungs are congested and cedematous, 
and have old pleuritic adhesions to the thoracic parietes, while there is 
also hypostatic pneumonia of the base of the right lung. 


Casz II.—General Paralysis of two years total duration. Left 
Unilateral Epileptiform Convulsions, and left Hemiplegia. Left Uni- 
lateral Facial Sweating. 


J. B., of the 9th Lancers. A well-marked case of general paralysis, 
admitted xt. 48, having had exalted delusions, and shown some 
troublesome excitement, and later on becoming the subject of a rapidly 
invading dementia. Several months after the stated commencement 
of his mental disease, he had a bout of fits, followed by hemiplegia 
on the left side, and greater difficulty in swallowing. At this time 
there was great distortion of the right ear, and slight of the left, 
from old othamatomata, It was at this period that the left unilateral 
Sweating was first noticed. The fits recurred, were mainly of the left 
side, began in the left side of the mouth and face, and there remained 
behind them dysphagia, prostration, left unilateral sweating of face 
and head, a higher temperature in the left than in the right axilla, 
and sinistral hemiplegia of the “common form.” More particularly, 


1877. | by W. Jutivs Micxiur, M.D.° ~~ 199 


the following was the order of events :—On Dec. 2nd, left unilateral 
convulsions ; on the third, left hemiplegia; dysphagia; general feeble- 
ness and mental confusion; hemiplegia marked in upper extremity, 
moderate in lower extremity and in face, head and eyes very slightly 
deviated to the right, no paralysis of orbicularis palpebrarum ; pupils 
equal, sluggish, small, and irregular in shape; this had also been the 
condition of the pupils on admission. There was general slight per- 
spiration, very much more copious on the left side of the face, tem- 
perature in both axille 100°6°; pulse 66a.m.,86p.m. 5th. Pupils as 
before, but the left one was contracted. Fits recurred, affecting mainly 
or only the left side of the face and left upper extremity, and during 
them the left side of the tongue was severely bitten. Three hours 
after a severe fit on the 6th, the temperature was 99°8° in the right, 
and 100°9° in the left, axilla, P. 90, R. 20. Sinistral hemiplegia as 
before, except for slight rigidity of the left leg. During a fit the 
mouth and face were much convulsed on the left side, the eyeballs 
were turned upward and jerked towards the left side, the eyelids and 
frontalis being about equally affected on the two sides, the tongue was 
actively convulsed and was bitten on the left side, the left upper 
extremity was convulsed to a moderate degree. By the 10th, although 
fits recurred occasionally, attention, comprehension and general in- 
telligence were improved. Temp., R. axilla, 98°5°, L., 98-99, P. 73, 
R. 20. Speech shuffling and indistinct. Hemiplegia and state of the 
pupils and of sweating much as before, the beads of perspiration 
standing on the left side of the face only, the rest of the skin being 
dry. The fits continued now and then until the 18th, and again 
between the 22nd and 27th. By the latter date there was thecal 
abscess with much inflammation of the left hand. Temp., R. axilla, 
100°2°, L. ditto, 100°6° ; pulse 98, weak. The loss of consciousness 
following the fits was of very short duration, but there was consider- 
able drowsiness. Thus, for about twenty days, severe fits recurred 
nearly every day, and reduced the patient to a condition of extreme 
prostration, causing also left hemiplegia and left unilateral sweating, 
which last was observed from time to time throughout tbe three 
weeks ; while the temperature was higher in the /eft axilla by from °4° 
to 1:1°, F. From this exhaustion and paralysis he made a good 
recovery, living for seventeen months afterwards, and rarely again 
showed any tendency to unilateral sweating, but suffered from both 
occasional epileptiform fits and epileptiform vertigo, and from transi- 
tory paralysis, especially on the left side. In his vertiginous attacks 
there were pallor of face, cold clammy sweats, and a frequent feeble 
and small pulse. During this latter period there was at times cardiac 
intermittency, and at first the left, then the right, and finally the left 
pupil again, was the smaller. 


In this case it was only during a period of several weeks 
that the left unilateral sweating of the face was noticed. 
<Xd01. 14 


200 Unilateral Sweating in General Paralysis, —[July, 


During the same period there were frequent convulsive 
seizures mainly of the left side, leaving behind them incom- 
plete left hemiplegia, and a higher left axillary temperature ; 
while of the small, irregular, sluggish pupils, the left was the 
smaller at this period. But the left pupil was also usually 
the smaller long after the period of local sweating. The higher 
left axillary temperature and the free perspiration of the 
face upon the left side were found, on several occasions, many 
hours after a fit, and the latter was not at all due to the mere 
over-exertion of muscles on one side during the convulsive 
selzures. 


Casz III.—Unilateral Sweating of the Face in a Case of General 
Paralysis, when of one half-year’s duration. No Convulsion ; only 
slight transient Paralysis of Face on the same side. 


C. L., of the 2nd Batt. Grenadier Guards, et. 27. Admitted when 
mental disease was of three months duration, he had secondary syphi- 
lis, and slight tuberculosis at the apices of the lungs. At first there 
had been a maniacal attack undergoing remissions and exacerbations, 
but this subsided. Slight mental symptoms—abstracted expression, 
slight loss of memory, and prevarication in his replies—continued for 
a time after admission, together with faint physical indications of 
general paralysis, but two months after admission the latter became 
more marked. A few days later, after he had been flushed and con- 
fused for a day or two, it was found that the paretic signs had taken a 
great leap, the speech, gait, and cheirography being much affected. 
So paretic was he, that he was unable to leave his bed. Perspiration 
was free, but no note of its being unilateral was then made. He 
complained of headache, of pains “all over him,” of giddiness and 
of mental confusion. He refused food, and hypochondriacal delusions 
supervened. Three weeks afterwards he was still confined to bed; 
there was frequently profuse sweating on the right side of the face, 
usually limited to that side, but occasionally with a little on the left 
side also, and for one or two days this was associated with a slight 
paralysis of the right side of the face, the left side of the mouth 
being very slightly drawn up, the left corner more fully raised by 
voluntary effort, and the movement of the left nostril rather more 
obvious in deep inspiration than that of the right. The grasping 
power of the hands was alike, and was feeble. The pupils, which had 
hitherto been fairly normal, were now somewhat wider and sluggish, 
but equal in size. The left conjunctiva was injected, and the mucus 
increased on one occasion. The ears were alike. The unilateral sweat- 
ing on the right side of the face recurred from time to time for several 
weeks. He ceased to be the subject of the peculiar hypochondria, 


and during the temporary improvement his friends applied for, and- 
obtained, his discharge. 


1877. | 6by W. Jurius Micxiz, M.D. 201 


With the partial hyperidrosis in this case there was no 
convulsion, as far as 1s known, at any time, and no localized 
palsy, except the very slight transient paralysis of the face, 
at the onset, on the same side. Occurring thus, however, 
the sweating would seem to be of paretic origin. 

In another case under my care here, in which left uni- 
lateral sweating of the face was pretty well marked in a 
phthisical patient with chronic delusional and emotional 
derangement, the principal changes found at the autopsy, 
besides the pulmonary (which were more advanced in the 
left lung), were a localised destruction and disappearance of — 
the grey cortical matter of part of the left parietal lobe of 
the brain (supra-marginal gyrus), and a branched calculus 
filling up the pelvis of the right kidney, which organ had 
undergone a considerable amount of secondary wasting. 
There was the usual sweating of phthisis in this case, but 
even then the perspiration was much more abundant on the 
left side of the head. The skin was sallow, dingy, and 
coarse; the hair harsh, dry, of dull hue, and standing on 
end, 


II.—Cases of Unilateral Sweating mentioned by various 
writers. 


A man who always sweated after eating, and on the left 
side of the head only, is cited by Hartmann. 

Débrousse-Latour* quotes several cases. One from the 
*“‘ Histoire de ’ Académie Royale des Sciences ” for 1740, of 
a partial perspiration affecting one half of the visage; 
another from Bichat, in which there was sweating of the left 
side of the head, associated with sinistral hemiplegia ; anda 
third from Dr. Roques. The patient was a young man who 
had cerebral congestion, and after four months treatment 
was the subject of sweatings on the right side of the head 
and the shoulder, augmented by emotion or by eating a meal ; 
and at the end of fourteen years the parts which were the 
site of this hyperidrosis were wasted, and the hairs of the 
Same side whitened. Dr. Daniel H. Tuke+ quotes a case 
from Gratiolet, “in which emotional excitement had the 
effect of causing the perspiration of the head to be afterwards 
limited to one side.” Hrasmus Wilson{ mentions a patient 
who was suffering from “severe gastric disorder,” and whom 
* Des Sueurs Locales. Paris, 1873, p. 35. 


+ Influence of Mind on Body, 1872, 
{ On Diseases of the Skin, 1867, p. 810-1. 


202 Unilateral Sweating in General Paralysis, (July, 


he saw upon one occasion “ with rills of perspiration running 
down one side of his forehead and face, the opposite side 
being dry ;” and he cites also the case of a young actor, who, 
having become violently heated when playing one evening, 
and having to go on the stage a second time with his features 
converted by paint to represent those of an old man, was 
puzzled by the bursts of laughter which greeted him. “On 
retiring to his dressing room... . the mystery was ex- 
plained, it was not his brilliant acting alone which had 
brought down such noisy honours on his head, but the 
drollery of his face, one half of which was washed clean of 
its wrinkles by partial perspiration, and displayed the 
juvenile features of twenty, while the other half exhibited 
the careworn lines and withered seams of eighty. In his 
case, while one half the face was affected in this peculiar 
manner, and the other half was dry, his chest was acted on 
in a precisely opposite way, the perspiratory side being 
reversed.” Dr. W. T. Gairdner* has observed strictly limited 
unilateral sweating of the head, and contraction of the 
pupil of the same side, in two cases of thoracic aneurism. 
In one of these the left + was the side affected, in the other 
the side is not stated ; nor is it stated ina similar case, under 
the care of Dr. A. Clark,t in which thoracic aneurism was 
accompanied by unilateral sweating of the head and myosis 
on the same side. Partial ephidrosis occurred in a boy aged 
six, the subject of epileptiform seizures and under the care 
of Dr. Anstie.§ Convulsive fits in infancy had been followed 
by permanent internal strabismus of the left eye. Some 
years afterwards there was a choking sensation in the 
throat, and visible hyperemia of the left side of the face, 
which side, also, was frequently covered with perspiration, 
After this had lasted several days he had four convulsive 
seizures, mainly on the left side. Other fits were preceded 
and accompanied by the same phenomena, and in the 
intervals there was weakness on the left side and a tendency 
to rigidity of the left limbs. Later on, and immediately 
before an epileptiform seizure, “the whole left side of the 
face and the left ear were flushed deep red, the surface pun-— 
gently hot and bedewed with a copious sweat—the heat and 
sweating were found to extend over the whole left side of the 
* Clinical Medicine, 1862, p. 557-8. | 
T Vide W. Ogle, infra. 

t “Medical Times and Gazette,” April 7, 1866, p. 367. 
§ Stimulants and Narcotics, 1864, p. 96. 


1877.] by W. Jutius Micxir, M.D. 203 


head, and to cease abruptly at the median line.” Treatment 
which procured the discharge of a large quantity of scybala, 
“was almost immediately followed by the entire disappearance 
of the unilateral heat, and sweating, and of the choking 
sensation.” In an epileptic under the care of Dr. Ramskill,* 
unilateral sweating of the face was noticed whenever he had 
been walking briskly. ‘“'The perspiration was profuse on the 
right side, and was abruptly limited at the middle line of the 
nose and lip, but extended very slightly to the left of the 
middle line of the forehead.” In a man aged 41, the 
subject of locomotor ataxy, Dr. Bazire}+ noticed that during 
the paroxysms of pain in the lower extremities beads of 
perspiration stood on the left side of the forehead, the right 
remaining dry. The right pupil had been contracted for 
five years, ever since an attack of right ocular palsy, from 
which he had recovered. At the period when left unilateral 
Sweating was noticed, the right pupil remained contracted, 
and of the size of a pin’s head; the left was three times the 
size of the right, while there were ptosis, external strabismus, 
and diplopia of the left eye. Dr. R. Bartholow { mentions 
four cases. In one, with a ‘thoracic, probably aneurismal, 
tumour was unilateral sweating confined to the right side of 
the head, while the right pupil was contracted. In another, 
the sweating of the right side of the face was sometimes 
associated with nausea and a feeling of great depression at 
the epigastrium, and the pupils were alike. The patient 
was a retired merchant, aged about 50, and in good health. 
No abnormality of the skin or thoracic organs was discovered. 
In a third, there was sweating of the left side, especially of 
the head, in a phthisical labourer, aged 39, who suffered 
from nausea, epigastric distress, and occasional vomiting, 
and in whom the left pupil was more contracted than the 
right and less responsive to light. In a fourth, a lady, 
aged about 40, without any other apparent departure from 
health, there were irregular attacks of redness and increase 
of temperature of the right side of the face and head, 
suffusion of right eye and dimness of vision, and in one of 
these attacks he saw a strictly limited and abundant 
moisture break out over the reddened parts. Dr. 8. Weir 


* “Medical Times and Gazette,” loc. cit. A woman also, et. 35, had this 
symptom, “ but there was no other discoverable deviation from health,”’ Ibid. 

+ Appendix, Trousseau’s Clin. Med. New Syd. Soc., vol. i., p. 188. 

t Quarterly Journ. of Pyschol. Med. and Med. Jurisp., New York, 1869, p. 
1386. 


2 


204 Unilateral Sweating in General Paralysis,  [Tuly, 


Mitchell* records a case in which two years after a bullet 
wound in the neck “ there was complete but permanent reflex 
paralysis of the left arm, and also more permanent palsy of 
the right arm,” with sight ptosis, contracted pupil and im- 
perfect vision of the right eye, defective secretion of sweat 
on the right neck, arm, and chest, and “rather excessive 
perspiration on the left side of the face and neck.” And here 
we may add a case by Dr. Wm. Ogle,f which has an in- 
teresting relation to several of those I have mentioned, 
although there does not seem to have been any marked 
local increase of perspiration. ‘Two or three years previously 
the patient had had severe suppuration on the right side of 
the neck, probably with destruction of part of the right 
cervical sympathetic. On the right side the eyeball was 
retracted, the palpebral fissure narrowed, the pupil con- 
tracted, the face redder and hotter during gentle exercise, 
and sometimes during repose. But violent exercise or 
feverishness reversed the condition of the two sides of the 
face. While there was readily induced sweating of the left 
side of the face, head, and neck, the right remained dry, 
even when he was ina Turkish bath, and he complained of 
deficient secretion from the right nostril, right eye, and 
right side of the mouth. Dr. Ogle thought that at first 
there was hyperzemia and increased secretion on the side of 
the nerve lesion, but that long afterwards there was a 
deficiency of secretion there, partly from changes in the 
vascular walls, the sequele of vaso-motor paralysis, and 
partly from paralysis of hypothetical vaso-dilator nerve- 
fibres. 

Besides the above cases in which perspiration affected the 
face or head on one side only, there are others in which it 
affected the entire lateral half of the body, and was limited 
thereto. Debrousse-Latourt mentions two such reported by 
Joseph Frank. One was that of a girl, aged 12, who with- 
out known cause and without ill effect upon her general 
health, was for six years the subject of sweating on the 
entire left half of the body, and especially when eating. 
The other, a lady, during the whole of her pregnancy was 
so drenched with perspiration on the left side that the drops 
trickled from the fingers of the left hand when she held it 
down, and she was obliged continually to renew the left 

* Injuries of Nerves and their Consequences, Philad., 1872, p. 322. 


+ Med. Chir. Trans., 1869, p. 151. 
£ Op. cit., p. 86. 


£877. | by W. Juxius Mickie, M.D. 205 


sleeve of her apparel. A night watchman, et. 38, is reported 
by Dr. Russell,* of Birmingham, in whom attacks of burn- 
ing pain in the left arm extended to the face, trunk, and 
lower extremity of the left side, and profuse perspiration 
broke out over all the hot parts, while speech was tem- 
porarily impaired, and there was tonic spasm of the left 
limbs (?), followed by pecular epileptiform seizures. He had 
frequent recurrences of the heat and perspiration, “ confined 
on every occasion to the left limbs and left side of the face 
and body.” The left face became flushed, the perspiration 
was profuse, and was accompanied by shght watering of the 
left eye and slight dimness of vision. The illustrious 
Haller also spoke of himself as being subject to unilateral 
perspiration of the right side.t 

Several interesting examples are also to be found in the 
monograph of Hartmann.{ One is that of a man, the 
subject of ephidrosis of the right side during his whole 
lifetime. Of the others, two were women, who, during 
pregnancy, had perspirations on one side of the body only, 
and this occurred in successive pregnancies. Another was 
a@ married woman, a chronic sufferer from cardiac palpi- 
tation, who was also affected with copious perspirations 
limited to the left side of the body. In his own case the. 
ephidrosis was of the entire right side of the body, and had | 
been easily brought on by various causes during the whole of 
lifetime.§ The right side also was the seat of various In- 
firmities from which the left was free, such as hemicrania, 
asthenopia, paresis of right side of tongue, and rheumatic 
and pectoral pains afflicting the right side, as well as other 
symptoms limited to that half of the body. Hartmann also 
quotes an extraordinary case from Bartholine, in which an 
individual is said to have had the power of sweating at 
will. 

Tikirty-twre cases of unilateral sweating have been men- 
tioned in this paper, including the four reported by myself. 
In twenty-three of these the face or head of one side was 


* “ Medical Times and Gazette,” loc. cit. 

+ Elementa Physiologie Corp. Hum., MDCCLXIII., Tom. v., Alb. v. Haller. 

t~ De Sudore unius lateris, Pub. Diss. Halee ad Salam, 1751. ; 

§ He suggests a congenital difference in the vessels of the two sides. 
_ Dextri mei lateris arteriolas cuticulares vasa esse debilia et laxiora dextris, 
sub prima mei corporis formatione ita constructa patebit, si consideretur,” etc., 


|| “ Quotiescunque voluit manum vel sudantem, vel siccum, exhibere 
potuit.” 


206 Unilateral Sweating in General Paralysis,  [July, 


affected, while in nine there was perspiration of one lateral 
half of the body. In four of the twenty-three cases, how-- 
ever, ephidrosis was not absolutely confined to one side of 
the head or face; for in one the same side of the body was 
affected, but to a much less degree; in another, the chest of 
the opposite side sweated; in a third case the tip of the 
shoulder, and in a fourth the neck of the same side, was im- 
plicated. In seven of the twenty-three, the sweating was of 
the right side of the head or face, in nine it was of the left, 
and in seven the side affected was not mentioned, or has not 
been ascertained. There seem to be no special differences 
between the pathological conditions associated with the 
unilateral sweating on the two sides respectively. 

To recaprtulate. The obvious pathological conditions associ- 
ated with unilateral ephidrosis of head or face were as follows:— 

In 3, General paralysis of the insane (with complications). 
1, Chronic insanity (melancholia agitans) : phthisis; 

local wasting of brain; renal calculus. 

», 2, Epilepsy, or epileptiform seizures. 

», 1, Progressive locomotor ataxy. 

» 1, Hemiplegia of same side. 

1, Antecedent cerebral congestion; subsequent wasting 
of sweating parts. 

» 1, Preceded by violent emotional excitement. 

Pe nn oe lee of upper extremities following injury to 
neck. 

3, Gastric disorder, or morbid sensations referred to 
stomach or epigastrium (in 1 with phthisis). 

», 1, Violent exercise and heating. 

53 4, Thoracic aneurism (once perhaps a tumour). 

4, No special obvious pathological condition or cause. 

Of the nine cases of ephidrosis of one entire lateral half of 
the body, three occurred during pregnancy, one of these being 
of the right side, one of the left, and in one the side is not 
stated: a fourth, with epileptiform seizures: a fifth, with 
persistent and severe disorder of the heart’s action: a sixth, 
with various infirmities and afflictions of the same side of the 
body; and the remaining three with no other apparent de- 
parture from health. 


Iil.—The Pathology of this Symptom. 


Reverting more particularly to the four cases I described 
in Section I, the first question is whether in cases such as 
those the local perspiration was due, on the one hand, to 


39 


99 


be) 








1877. | by W. Junius Micxur, M.D. 207 


some lesion of the vaso-motor system, or, on the other, to a 
morbid excitation of nerves which control the secretory 
activity of the cells of the glands. 

That much of the perspiration appears to be the result of 
mere transudation, affords a presumption in favour of the 
view that the symptom in question may, partly at least, 
depend upon local vaso-motor changes. Further, as to 
this hypothesis that partial hyperidrosis is due to local vaso- 
motor lesions, the first suggestion that occurs to one is that 
the symptom might be due to a paresis or inhibition of the 
cervical sympathetic nerve or ganglia of the corresponding 
side.* So long ago as 1816, Dupuy, in the course of his experi- 
ments, found that the removal on one side of the superior 
cervical ganglia of the sympathetic in horses, produced an 
injection of the conjunctiva, an increased temperature in the 
ear, and an abundant perspiration of the head and neck on 
the same side; and that increased perspiration of the same 
side of the head also followed upon section of the cervical 
‘sympathetic nerve on one side. Prof. Claude Bernard has 
obtained the same result, and has carried the experiment 
further. Division of the sympathetic in the neck of a horse 
he found to be succeeded by increased temperature in the 
parts supplied by the divided nerve, while the skin over the 
same area became covered by a profuse perspiration. Galva-_ 
nization of the divided extremity of the nerve, on the other 
hand, arrested the secretion of sweat. With reference to the 
theory under debate, and in relation to the three cases I des- 
eribed of unilateral sweating of the head in general para- 
lytics, it is of interest to note the description given by Poin- 
caré and Bonnet, and others, of the marked pigmentation 
and sclerosis of the ganglia of the cervical sympathetic some- 
times seen in general paralysis. These observations render it 
possible that in cases such as I have related, the diseased 
condition of the cervical sympathetic ganglia may induce dis- 
order of secretion through injury to vaso-motor filaments. 
But against this view, one would imagine that a lesion of the 
cervical sympathetic sufficient to induce such marked uni- 
lateral secretion would probably induce also, to a greater or 
less extent, many of those other effects which are so well seen 
as the result of section of the cervical sympathetic in the 
lower animals. We should anticipate that upon the side of 
the lesion, and limited thereto, there would be an obviously 


* Unilateral sweating with thoracic aneurisin is, in all probability, due to 
pressure upon the sympathetic of one side. 


208 Unilateral Sweating in General Paralysis,  [July, 


increased secretion of tears and of palpebral mucus, contrac- 
tion of pupil, narrowing of palpebral fissure, shrinking of 
eyeball, flatness and dimness of cornea, hyperemia, height- 
ened sensibility, and increased temperature; or, in general 
terms, the dilatation of vessels, afflux of blood, and increase 
of vital properties summed up by Brown-Séquard as the 
phenomena following a paralysing lesion of the cervical sym- 
pathetic, to which may be added an increased redness of 
venous blood in the hyperemic region. Certainly, most of 
these symptoms were absent in my own cases, and of others 
the existence was doubtful, or, when present, their interpre- 
tation ambiguous. Moreover, in Dr. 8. W. Mitchell’s* 
account of injury to the cervical sympathetic on one side by 
a rifle-ball traversing the neck, although many of the above- 
mentioned symptoms were present, yet no mention is made 
of unilateral sweating; and no mention is made of it in Dr. 
F. Warner’st case, in which a unilateral lesion of the cer- 


vical sympathetic seemed to follow upon certain convulsive — 


seizures. Indeed, an instance is recorded by Dr. W. Ogle,t 
in which, with symptoms of destruction of part of the right 
cervical sympathetic, the left side of the face alone sweated, 
the secretions of the skin of the face of the eye, nostril, and 


mouth of the right side being lessened. This defect of secre- - 


tion, however, was a latesymptom. (Vide supra.) 

That the sympathetic does affect secretion, is, however, 
certain, division of the sympathetic fibres supplying a gland 
causing afflux of blood thereto, and an abundant flow of the 
secretion ; while excitation ofthe same fibres causes contrac- 
tion of the vessels, diminished blood-supply, and lessened 


secretion. The effects are of vaso-motor origin, including in 


this term both vaso-inhibition or dilatation, and vaso-con- 
striction, the muscular walls of the vessels of the gland being 
relaxed in the one case, and contracted in the other. But it is 
generally believed that the real source of the vaso-motor nerve- 
filaments is from the cerebro-spinal system. As Austin Flint 
expresses 1t—* There can be no doubt of the fact that the sym- 
pathetic branches contain filaments capable of modifying the 
calibre of the blood-vessels, and that the cerebro-spinal nerves 
also contain filaments possessing analogous properties. : 
The first important question is whether the vaso-motor fila- 


* Injuries of Nerves and their consequences. Philad., 1872, p. 318. 
¢ “British Medical Journal,” April 14, 1877, p. 453. 

{ “‘ Medico-Chirurgical Transactions,” 1869, p. 151. 

§ “Physiology of Man,” Vol. iv., 1872, pp. 435-6. 


: iy 


37 7. || by W. Jutivus Micxuz, M.D. 209 


ments be derived from the sympathetic ganglia, or from the 
cerebro-spinal centres. All experiments upon the question 
just proposed tend to show that the vaso-motor nerves are 
derived exclusively from the cerebro-spinal system, and do 
not originate in the sympathetic ganglia. Without citing 
the numerous confirmatory observations of different physi- 
ologists, it is sufficient to state that Schiff has experimentally 
demonstrated, in the most conclusive manner, that the vaso- 
motor nerves are derived from the cerebro-spinal centres and 
not from the sympathetic ganglia.” Brown-Séquard,* indeed, 
had long ago expressed the view that the fibres of the sym- 
pathetic supplying blood-vessels had their place of real origin, 
partly in the spinal cord, partly in the medulla oblongata, 
and partly in higher portions of the encephalon. For a time 
physiologists placed the great vaso-motor centre of the body 
in the medulla oblongata, but recent investigations have 
proved the existence of vaso-motor centres in the brain and 


spinal cord as well, and though the principal centres are in 


the cerebro-spinal system, the sympathetic ganglia also 
appear to contain other vaso-motor centres, while the experi- 
ments of Lister and Goltz seem to indicate that changes in 


_ the calibre of the arteries are under the immediate control 
_ of minute perivascular vaso-motor centres, and that the other 


so-called vaso-motor centres can act upon the blood-vessels — 
only through the medium of these perivascular centres. “ If 
we are to bring the experimental data furnished by recent 
research into anything like harmonious order, we must assume 
a whole series of vaso-motor centres, standing to one another 
in a hierarchical relation of progressively increasing gene- 
rality of operation. Next above the perivascular centres are 
the sympathetic ganglia. . . . . . Above them in the 
scale are a series of vaso-motor centres échelonnés down the 
whole length of the cord. Higher still is the vaso-motor 
centre in the floor of the fourth ventricle,’’} and, lastly, are 


‘those in the brain. Now in relation to the hypothesis that 


the unilateral sweating in the general paralytics was due to 
vaso-motor change, the existence of vaso-motor centres in the 


_-brain is peculiarly interesting. Brown-Séquard{ caused 


symptoms like those of paralysis of the cervical sympathetic 

on the same side, or at least of its ocular, auricular and facial 

filaments, by thermal irritation or mechanical injury of cer- 
* “ Physiology and Pathology of the Central Nervous System,” Chap. ix. 


+ “Brit. and For. Medico-Chirurgical Review,” Oct. 1876, pp. 272-3. 
t “ Archives de Physiologie, Normale et pathologique,” 1875, pp. 859-60. 


210 Unilateral Sweating in General Paralysis, [July, 


tain parts of the brain of rabbits and dogs—active congestion 
of blood-vessels, elevation of temperature, contraction of the 
pupils, and partial closure of eyelids, upon the same side. 
And the similarity in effect goes still further, for whereas 
section of the cervical sympathetic on one side is sometimes 
followed by atrophy of the brain and eye of the same side, 
thermal excitation of parts of the brain of two rabbits and 


a dog was followed by atrophy of the eye of the same side. 


The above effects followed thermal excitation of the middle 
and posterior lobes more than of the anterior, and of the 
regions bordering the median line rather than of those which 
are placed laterally. Then the experiments of Eulenberg and 
Landois* show that limited destruction of the brain cortex 
on one side was followed by relaxation of the arterioles, and 
a heightened temperature, in the limbs of the opposite side 


of the body; while Bochefontaine+ produced increase of the. 


submaxillary secretion, as well as’ contraction of the intes- 
tines and of certain viscera, by electrical excitation of a defi- 
nite limited part of the frontal lobe of certain animals. These 
observations would indicate that if the local sweating in the 
general paralytics was due to vaso-motor derangement, the 
latter might be of centric origin, and referable to some part 
of the widely-spread morbid changes of general paralysis in 
brain and cord, implicating certain vaso-motor centres dis- 
tributed in the cerebro-spinal system. 

Coming now to the second of the hypotheses above- 
mentioned, it may be asked whether the phenomenon of 
local unilateral ephidrosis is in reality due to any local vaso- 
motor derangement; for the general question at once arises, 
whether the influence of the nervous system upon secretion 
is really exerted primarily through the vaso-motor fibres 
acting upon blood-vessels, or whether it is exerted through 
nerves by which a reflex action affects the secreting cells, 
and which, therefore, may fairly be called secretory nerves— 
whether this influence upon secretion is, or is not, the sole 
function of the nerves in question. An influence of this 
kind, through whatever channel it flows, is something very 
different from a stimulation or a repression of the secretion 
of a gland by the dilatation or contraction of the muscular 
walls of its blood-vessels effected by the vaso-motor system. 
Bernard, however, was led by his experiments to believe that 
the action of the nervous system upon the circulation of the 


* Quoted in “B, & F. M.-C. Rev.,” loc. cit., p. 274. 
Tt “Gazette Medicale de Paris,’ Adut 28, i875, p. 436. 


| 


: 


1877. | ‘by W. Junius Mickie, M.D. 211 


blood accounts for all the alterations produced by that 
system in the various secretions, and that “there is no 
occasion to have recourse to the theory of the direct in- 
fluence of nerves upon secretion.”” He believed that in 
their effects upon the arterial vessels of the glandular 
system the sympathetic and the cerebro-spinal nerves anta- 
gonise each other ; that excitation of the sympathetic caused 
in the parts supplied a contraction of the arterial vessels, a 
diminished blood-supply, a lowered temperature, and a 
lessened or arrested secretion; whileexcitation of the cerebro- 
spinal nerve-supply of a gland induced an active dilatation 
of its vessels and a corresponding afflux of blood—that this 
hyperemia roused the chemical and secretory changes, aug- 
menting the. temperature and the secretion of the part. 
Moreover, that section of these nerves produced opposite 
effects upon secretion. Thus, stimulation of the cerebro- 
spinal nerve supplying the gland was followed by local 
changes in circulation and secretion similar to those arising 
from suspension of the influence of the sympathetic upon 
blood-vessels in the same part. ‘The nerves derived from the 
cerebro-spinal system, which he found thus to antagonise the 
action of the sympathetic upon the glandular system, he 
called the motor nerves of the glands, and he differentiated 
the particular motor nerves of several glands. But others 
have held the view that there are secretory nerves which 
convey impressions from the central nervous system and 
rouse the secretory activity, while their inhibition arrests se- 
cretion. Undoubtedly, to be continued, this secretory activity 
must be accompanied by a hyperemia of the gland, a local 
vascular condition similar to the dilatation of vessels pro- 
duced by what Bernard would describe as _ vaso-dilator 
nerves. Not to speak of H. F. Campbell’s theoretical views 
as to the “secretory and excito-secretory system of nerves,” 
there seems to be reason founded upon experiment for be- 
lieving thatcertain nerves have this function. Bernard himself 
demonstrated the probable centres of some of these nerves— 
centres by whose excitation the secretion could be produced 
in a reflex manner. Experiments have also shown the 
- independence—in some places, at least—of the vaso-motor 
(dilator or inhibitory) and the secretory nerves of the 
glands, although, as already stated, they are usually excited 
simultaneously. In his recent Goulstonian Lectures, Dr. L. 
Brunton has cited several interesting illustrations of this 
fact, as, for instance, how the action of the two sets of 


212 Unilateral Sweating in General Paralysis, [ July, 


nerves—vascular and secretory—-of the submaxillary gland 
is differentiated by experimentation with drugs. The 
powerful effects occasionally produced upon secretion and 
upon nutrition by the various emotions, by disorders of 
sensory nerves—as neuralgia—and even by intellectual 
tension, can scarcely be fully explained by the vaso-motor — 
effects produced at the same time. We might add that 
electrical excitation of the brain, as already stated, has been 
seen to produce secretory changes, that local hzmorrhage 
into parts of the nervous centres may occasionally produce 
notable results of the same kind, and with reference to per- 
spiration, also, that it has been produced by neuralgia, and _ 
by excitation of the- nerves of taste by salt and by sugar. 
Whilst, therefore, both the sympathetic and the cerebro- 
spinal system influence secretion, and both the vaso-motor 
and the so-called secretory nerves, it 1s mainly to the 
cerebro-spinal centres that we may perhaps look for the 
nervous influence on secretion, and mainly to the secretory 
nerves for the more immediate channel of that influence. It 
is only necessary to recall the cerebro-spinal morbid changes 
in general paralysis to find the origin of a reflex morbid in- 
fluence upon secretion through the cerebro-spinal fibres 
supplied to the glandular system. But the simple structure 
and secretion, with the wide distribution of the sudoriferous 
glands, places them under relations to the nervous system 
somewhat different from those of the more complex secre- 
tory or excretory organs. 

In conclusion, whether we refer the local disorder of 
secretion to a diseased condition or reflex functional de- 
rangement of part of the vaso-motor system, on the one 
hand—and perhaps this is the preferable theory; or, on 
the other, to that of nervous centres and fibres which 
have a more immediate effect upon secretion, it is obvious 
that the pathological changes in the nervous system in 
general paralysis suffice to explain the occasional appearance 
of that localised unilateral sweating which has been the 
subject of this paper. 

Returning for a moment to cases of unilateral sweating 
such as those I quoted from various authors, Dr. Bartholow 
would divide them into four classes. In the first are those 
connected with aneurismal and other tumours in the thorax, 
the pressure of which usually causes paralysis, but some- 
times irritation of the cervical sympathetic, or its branches, of 
one side ;—in the former instance producing local vaso-motor 


1877.] by W. Jutius Mickie, M.D. 213 


paralysis and increase of secretion; in the latter, acting 
directly upon the gland cells and exalting their functional 
activity. In support of this latter view he cites the experi- 
ments of Pfluger and Wittich. In the second class are 
those occurring in certain neuroses; as he believes, from a 
reflex action of the nervous system of animal life upon the 
-vaso-motor nerves. ‘The third class comprises those which 
are connected with a peculiar stomach disorder, and are 
caused by gastric or intestinal irritation reflected to one side 
of the head, just as neuralgia of a fifth nerve may come 
from intestinal irritation. In cases of the fourth class there 
is no apparent derangement of any other part or organ, and 
his theory is that “‘ some disorder exists in one or more of the 
ganglia of the sympathetic.” 








Pathology of a Case of Transient Alternating Hemiplegia. 
By JosrpH J. Brown, M.B., F.R.C.P.E., Assistant 
Physician Royal Edinburgh Asylum. 


(Read at a Quarterly Meeting of the Medico-Psychological Association, held at 
Glasgow, on February 21st, 1877.) 


The occurrence of transient hemiplegia is so unfrequent in 
nervous affections, and the pathological conditions causing 
the symptoms are so obscure and uncertain, that any addi- 
tional information regarding the nature of the lesions in 
such cases is of importance, and so I venture to bring before 
the Society the following case :— | 


A. M., «et. 73. Widow. From Edinburgh. Was admited into 
the Royal Edinburgh Asylum on October 10th, 1873. | 
. History is very short and incomplete, asno relatives visited the patient, 
and we were unable to obtain a full account of her symptoms previous 
to admission further than that this was her first attack of insanity, 
and that it had lasted for upwards of two years. There was no here- 
ditary predisposition as far as could be ascertained, and the supposed 
cause of the attack was the sudden death of her daughter. She was 
not epileptic or suicidal, but decidedly dangerous; she has been at 
intervals during the last two years restless and excited, frequently 
talking incoherently, at nights sleepless, noisy, and occasionally 
violent. No facts can be got as to her motor symptoms, but as far as 
it is known she never showed symptoms of paralysis previous to 
admission. ‘The excitement has increased of late, and for this reason 
she was placed in the asylum. sd al 

On admission her mental symptoms were those of mania, with some 


214 A Case of Transient Alternating Hemiplegia, [J uly, 


enfeeblement. She talked incessantly and quite incoherently, was 
restless, obstinate, and wayward, gesticulated in an extravagant 
manner. She also had fleeting delusions regarding people around her 
trying to injure her, putting poison in food, trying to steal her money, 
clothes, &c. Her bodily condition was average, she was fairly 
nourished, and there was no disease of any organs. ‘There was arcus 
senilis, but she could see fairly well, and hearing was not affected. 
No symptoms of paralysis. 

October 11th.—Patient has had a very restless and sleepless night, 
talked incessantly and quite incoherently. She is somewhat settled 
this morning, and appears more confused than she was yesterday on 
admission. There is slight paralysis of the left arm and leg this 
morning, the grasp of the left hand being weaker than that of the 
right, and walking is interfered with, owing to a slight dragging of 
the left leg. She inclines distinctly to the left side, but the common 
sensibility of the affected side is little, if at all, impaired, and the 
reflex action is good. There is no paralysis of the muscles of the 
face, the tongue is protruded straight, and the articulation is un- 
affected. Pupils equal, moderately dilated, sensible to light. 


From this date the entries in the case book are almost a 
repetition of the same symptoms, so I shall only give a 
summary of the progress of the case taken from these 
entries. 

The patient continued in much the same mental condition 
for some months, at nights being restless, sleepless, and 
talkative, destructive in her habits, and occasionally violent. 
During the day she was confused in her ideas, and the 
excitement was not so great; she could answer questions 
fairly well, and though her memory was impaired, she could — 
tell her age, where she was, and take some interest in events 
going on around her. The excitement gradually became less 
pronounced, and she got more and more enfeebled; she 
forgot her age, talked in a childish, facile manner, and her 
memory became much impaired. Even in this demented state 
she occasionally had returns of slight excitement, when she 
would gesticulate, wander about the ward without any 
apparent object, and at night she was very sleepless. 

Her bodily condition got weaker, her appetite failed, and 
she became greatly emaciated. Attacks of transient hemi- 
plegia, sometimes of one side, sometimes of the other, are 
recorded as occurring every few days, and a description of 
one of these will suffice, as they were almost identical, except 
in their duration. 

This hemiplegia almost always followed on an increase of — 
the excitement—indeed, so marked was this that when the 


£377:1 by JosepH Brown, M.B. 215 


nurse heard the patient noisy during the night, she con- 
cluded the patient would “ be down” on one side or other 
the next morning. The motor power was impaired, the 
grasp of the affected hand being weaker than that of the 
other, and the patient inclined markedly to the affected side. 
Progression was slow, and the leg seemed slightly dragged. 
There was no paralysis of the facial muscles, and the tongue 
was protruded straight; there was no tremor of these mus- 
cles such as is frequently seen in many other nervous affec- 
tions, nor had the patient convulsions of any description since 
admission to the asylum. Common sensibility remained 
fairly acute, and the reflex action was good. Towards the 
latter period of the patient’s life sensibility did become im- 
paired, sight seemed to be lost, as she never made any signs 
of discomfort when a bright light was held close to her eyes, 
and the hearing also was affected. 

This hemiplegic condition lasted, as a rule, for one or two 
days. Sometimes I have seen it continue for four, but never 
longer; then it rapidly passed away, and the patient walked 
about actively for a woman of her age, employing herself, as 
far as she was able, in the work of the ward. The attacks 
followed each other irregularly, at times the patient remained 
free for a week, but this was rare, the symptoms returned as 
suddenly as they had disappeared, but by no means always 
attacking the same side. Occasionally, when one side was 
paralyzed, and before recovery took place, the other side also 
became affected, and then the patient was confined to bed, 
being unable to walk or use her arms. 

There were also in this patient transient aphasic symptoms 
of an amnesic nature. She could repeat after you the first 
two or three words of a sentence, or latterly only the first 
syllable of a word, but forgot the remaining words or syl- 
lables, or said one word several times till she thought she 
had completed the sentence. The aphasia was in no way 
regulated by the severity of the motor symptoms, nor did it 
constantly occur with these, but the confusion and stupor 
was always greater when the aphasia existed. Towards the 
latter days of the patient’s life she was constantly aphasic. 

Patient got completely demented mentally, and her bodily - 
condition gradually became weaker and weaker till she died 
from exhaustion on August 2nd, 1876. 


Post-mortem examination thirty hours after death.—Body greatly 
emaciated, 
Head.—Skull cap symmetrical, thickened, but not condensed, the 


MKT, 15 


216 A Case of Transient Alternating Hemiplegia, [July, 


thickening of the bone more marked over the anterior lobes. Dura 
mater very adherent to skullcap, thickened, and leathery. Pia mater 
was also thickened and opaque, this opacity being best seen along the 
lines of the larger vessels. When an attempt was made to strip the 
pia mater from the brain, it was seen to be more or less adherent to 
the subjacent grey matter, and portions of the substance remained 
attached to the membranes after its removal; this adherent condition 
of the pia mater was most marked at the vertex of the left hemi- 
sphere over the posterior and middle lobes of the organ. The mem- 
‘brane stripped more readily from the convolutions of the right hemi- 
sphere, though even here there was more or less adhesion to the 
underlying grey matter. 

The convolutions were atrophied, and the sulci were wide and filled 
with clear serous fluid. 

After removal of the pia mater the convolutions of the right 
hemisphere were seen to be spotted with dark coloured points, varying 
in size from a pin head to a split pea; they were most numerous 
towards the vertex at the posterior extremities of the frontal convolu- 
tions, on the ascending frontal and parietal convolutions, and on the 
anterior parietal convolutions, they were also observed on the occipital 
and tempero-sphenoidal convolutions, but there they were distinctly 
less numerous. On closer examination these spots were seen to vary 
in colour from a dark brown to a bright red, and the brain substance 
immediately surrounding a few of the larger sized spots was de- 
generated, being dark and gelatinous in appearance. The conclusion 
arrived at from this inspection was that they were due to hemor- 
rhages which had occurred at various periods during the patient’s 
illness. 

The convolutions of the posterior portion of the frontal lobe, the 
parietal lobe, and anterior portion of the occipital lobe of the left 
hemisphere were soft in consistence, and spots such as have just been 
decribed were seen on their surface. 

The third anterior frontal convolution of this (the left) hemisphere 
was particularly soft, dark in colour, and almost gelatinous, with 
numerous hemorrhagic spots on its surface. 

The arteries at the base were enlarged, tortuous and varicose in 
appearance ; at certain places the middle and posterior cerebral 
arteries were especially cord-like and firm to the touch. The 
appearance of the conyolutions at the base was normal, and the pia 
mater stripped off freely. The medulla, pons, and cerebellum seemed 
pale in colour, but otherwise normal. 

On section the grey matter of the convolutions was softer than 
normal, and contained these dark coloured softenings. The white 
substance was also soft, and in the left hemisphere points of grey 
degeneration were occasionally seen. The lateral ventricles were 
dilated and filled with clear fluid, and the lining membranes of these 
ventricles were abnormally tough. 


1877. | ‘by Josspu Brown, M.B.- 217 


~The corpora striata and optic thalami appeared perfectly normal, 
both externaily and on section. 

Spinal cord.—Dura mater slightly adherent, no congestion. Pia 
mater was clear, slightly congested in the dorsal region, and contained 
innumerable cartilaginous bony plates along the whole length of 
the cord, but more especially in the dorsal region. The cord on 
section presented nothing abnormal to the naked eye beyond a slight 
congestion in a few of the sections, but by no means distinctly 
marked. 

_ Heart normal, lining membrane of aorta was very atheromatous, but 
not ulcerating. Coronary arteries tortuous and large. Other organs 
normal, 3 

Microscopic examination.—I|st, Brain: Sections taken from various 
conyolutions of both hemispheres showed disease of the nerve 
elements to a greater or less degree, and speaking generally the con- 
volutions of the left side were more affected than those of the right. 

The pia mater was hypertrophied, and the vessels in it were 
markedly diseased, miliary or Charcots aneurisms being very numerous. 
These aneurisms were best seen in recent specimens, but could also be 
seen in the prepared pia mater (specimen now exhibited Being a pre- 
pared portion of pia mater). They varied in size, and were fusiform 
or saccular in shape, but mostly saccular. 

Vessels of the brain substance proper were also much diseased, and 
in some sections this condition was very striking. The muscular coat 
was the one generally affected, it being greatly hypertrophied, and in 
some instances to the complete obliteration of the lumen of the vessel. 
The outer or fibrous coat was also much increased in thickness in 
many of the vessels, but was not so constant an occurrence as the 
hypertrophy of the muscular coat, though equally well marked. The 
Increase of this outer coat frequently filled up the perivascular canal, 
and in this coat, as well as external to it, were deposits of hematoidin 
crystals, amorphous and granular matters. The perivascular canals 
were dilated with the brain tissue around them, compressed, and 
taking the carmine dye more deeply than the tissue further from the 
canal. In many places the canals were left as large circular spaces, 
the contents having evidently been washed out in the preparing of the 
section. There was a decided tendency in many of the vessels to a 
Separation of the fibrous or outer coat from the middle muscular one ; 
or, again, the inner coat separating from the middle one, thus forming 
in transverse section two distinct concentric rings, an outer fibrous and 
an inner muscular, or the reverse, as case might be. (See fig. I.) 
| Aneurisms of some of the smaller arteries of a saccular shape 
chiefly were seen in the grey matter of the brain. (See fig. II.) 
Some of these aneurisms were ruptured, and the remains of the blood 
clot could be distinctly seen ; in other instances, they were unruptured 
and compressed the brain substance around them, as is shown in 


Figure II, 





218 A Case of Transient Alternating Hemiplegia,  [July, 


The large and medium sized vessels were chiefly diseased, but in 
some instances the minute vessels seemed to be affected also, but not 
so distinctly. 

The cells were more or less affected, and, as a rule, where we had 
the vessels diseased, there the degeneration ‘of the cells was best seen. 
Some of the cells were atrophied and shrivelled, but the common 
affection was the fuscous or granular degeneration. This was best 
studied in the large cells, and was almost everywhere seen to be in 
the first stage, viz., that of deposition. The cell was swollen and had 
lost its clearly defined outline; its processes were few or entirely 
lost; and, involving the whole or part of the cell, was the yellowish 
granular looking material; the nucleus, and, in many instances, the 
nucleolus remaining intact, or merely clouded over by the deposit. 

The nerve tubes appeared normal, and the neuroglia, with its 
nuclei, could be pretty well demonstrated. 

In the white matter, and occasionally also in the grey, amyloid 
bodies were found. They were not numerous, nor were they seen in 
groups, but were generally scattered indiscriminately through the 
brain substance, or they followed the lines of the vessels. 

The dark coloured softened spots on the surface of the convolutions 
when examined in the recent state, consisted of broken down nerve 
elements, molecule and granular matter, degenerated brain cells, and 
masses of hematoidin crystals of all shades of colour, from a deep 
brown to a light yellow. When sections were made through a 
softened spot after hardening in chromic acid, the external or convo- 
lutional margin of the section was undefined and rugged ; there was 
great deposit of hematoidin, either in masses or scattered irregularly 
in the grey matter, or collected around and in the outer sheaths of the 
vessels. (See Vig. III.) The grey matter itself was more or less broken 
up and disorganized, and the vessels near the softening, as a rule, were 
diseased in the manner already described. This destruction of the grey 
matter was seen to be on the external surface, and did not extend so 
deeply as to involve its whole thickness, being seldom deeper than the 
large cells of the fourth layer. 

Spinal cord.—Pia mater was seen to be thickened, and many of the 
vessels in it were dilated, filled with blood, with their muscular coats 
somewhat hypertrophied. The arachnoid fibrous layer, or that 
portion of the pia mater external to the principal vessels, was more 
affected than the inner layer. Vessels of the cord were well seen, 
and were numerous, but, with the exception of a few of the larger 
vessels, they were not in any way abnormal. The larger vessels—the 
two median arteries from the anterior median fissure, with their 
immediate branches to the grey matter—had their muscular and 
outer fibrous coats somewhat hypertrophied. A few of the larger 
vessels in the posterior columns were similarly, though to a much less 
extent, affected. 

The cells of the grey matter in the lumbar region of the cord were 


m7) by Josepn Brown, MLB. 219 


slightly affected with commencing fuscous degeneration ; but this 
had not gone so far as to influence their shape and outline, nor were 
their processes broken. or atrophied; indeed, in one specimen I was 
able to trace the process of one cell running across the field of the 
microscope, and apparently communicating with that of another cell at 
some distance from it. In one or two specimens I met with a cell in 
the external group of the anterior horn of grey matter, so clouded 
with granular deposit as to obscure the nucleus, but this was extremely 
rare. The nerve fibres of both grey and white matter seemed normal, 
the axis cylinders, stained deeply with carmine and the white substance 
of Schwann, was clearly demonstrated, the whole presenting the 
appearance of the structure of a fairly healthy cord. The spinal 
canal could be distinctly seen, and was not dilated, as is the case when 
the cord is atrophied. 

In both the grey and white matter amyloid bodies were found 
irregularly scattered throughout. They were not numerous, and 
seemed to give rise to no displacement or atrophy of the surrounding 
nerve elements. They were seen more clearly in a longitudinal 
section of the cord, and were most frequently met with in the posterior 
columns. No deposits of hematoidin were found in any of the 
sections of the cord. 

The neuroglia seemed normal further than a slight increase in the 
posterior columns, where the amyloid bodies were more numerous. 

In the medulla, pons, cerebellum, corpus striatum, and optic thalami, 
nothing of note was found beyond occasional slight hypertrophy of | 
the vessels. 


Remarks.—We would first direct attention in this case 
to the pathogenesis. The patient was advanced in years, 
and naturally we would have expected to find the vessels of 
her brain more or less affected with atheromatous degenera- 
tion, which was clearly seen to be the case at the post- 
mortem examination, and still more so in the prepared 
sections. The vessels chiefly affected were not the minute 
arterioles, but the smaller arteries of the pia mater and 
brain substance proper, along with the larger vessels at 
the base of the brain. Atheroma is a slow and progressive 
disease, so I think I am right in presuming that the 
first structures atfected were the vessels; thus, when the 
sudden death of her daughter caused sleeplessness and 
anxiety, the cerebral circulation was readily interfered with, 
and the patient exhibited maniacal symptoms. Along with 
this condition of the vessels, we would also expect disease of 
the nerve cells in consequence of mai-nutrition, and this 
is precisely what we found, for the cells were seen to be de- 
generated, though not to an advanced stage. Indeed, the de- 


‘ fe 
— 


220 A Case of Transient Alternating Hemiplegia,  |July, | 


generation was chiefly in the first stage of the disease. 
When we further take into account the general and ad- 
vanced disease of the vessels in comparison with the slighter 
and decidedly recently diseased state of the cells, I think there 
is little doubt but that the disease of the vessels was the” 
commencing lesion in this case. As the pathological con- 
ditions became more extensive, we had the symptoms of 
insanity more pronounced, but we had no evidence of motor 
symptoms until the morning after admission to the asy- 
lum. These motor symptoms had many peculiarities—they 
almost always followed excitement, this being readily ex- 
plained by rupture of the diseased vessels from imcrease of 
blood-pressure, due to the excitement. They were tran- 
sient, and as sudden in their appearance as in their dis- 
appearance. They were not confined to one side, some- 
times attacking one side, sometimes another, and lasting 
seldom longer than three days at a time. The muscles 
of the tongue at the beginning were not involved in the 
paralysis, the leg and arm being chiefly affected, and 
there was a marked leaning of the body to the affected side, 
as if there was a general weakness of the whole side. No 
convulsions preceded these symptoms, and the sensibility was 
little affected. 

When we look for a pathological cause to account for 
these symptoms which differ considerably from an ordinary 
ease of hemiplegia, I think there can be but little doubt 
that the lesions of the convolutions explain them all. 
The slightly diseased condition of the cord was not suffi- 
cient to account either on physiological or pathological 
erounds for such symptoms, the motor tracts and ganglia 
at the base of the brain were heaithy, so that we are 
brought by exclusion to consider the lesions of the convo- 
lutions as the only cause. This, I think, is still further 
proved, when we recollect the experiments of Hitzig, Ferrier, 
Goltz, and others, on the brains of the lower animals. 
Though the last-named experimenter holds views somewhat 
different from the two former, yet they all agree in this—that 
when the grey matter of the convolutions, or a portion of it 
is destroyed, paralysis of the opposite side of the body follows, 
the sight is affected, and, according to Goltz, the sensation © 
always remains impaired ; and he also observes that the dis- 
turbance of motility, sight, and sensation corresponds to the 
amount of grey matter destroyed. We can readily under- 
stand in this case rupture of a diseased vessel occurring 


1877.] by Josspu Brown, M.B. 221 


either in the pia mater or brain-substance of the convolutions, 
and so causing destruction of the superficial layers of the 
grey matter, producing loss of function, not only of the sub- 
stance destroyed, but also of surrounding matter, from 
mere irritation, and so motor symptoms of the opposite 
side from that in which the lesion took place; but as the 
lesion was small, and not destroying the whole depth of 
grey matter, the recovery of the functions of the sur- 
rounding substance was rapid, hence the motor symptoms 
were markedly transient. This we know to be the case 
in lesions artificially produced on the convolutions of the 
lower animals, for Ferrier found the disorders of motility 
were often very severe for a day or two after the lesion had 
been made, but rapidly disappeared, and if there was*not total 
destruction of the grey matter, the motor power completely 
returned. 

The duration of the motor symptoms, varying, as it did in 
this case, from a day or less to four days, was, I think, entirely 
due to the size and depth of the hemorrhagic softening, and 
_ the alternating character resulting from the convolutions of 
one hemisphere, and at other times from those of the other 
being involved. The peculiar weakness generally over the 
side which was paralyzed, so thatthe patient inclined markedly | 
to it, is a feature which has been observed by all experimenters 
in cases of motor symptoms following lesions of the convolu- 
tions in the lower animals. i 

Owing to the extensive and diffused character of the lesions 
_ of the convolutions in this case, it is impossible to advance it 
as proving the localisation of the motor centres of the con- 
volutions, nor do the symptoms presented agree with all of the 
results brought forward by Goltz; still the fact remains that 
the lesions were most frequent and extensive on the convolu- 
tions bounding the fissure of Rolando, though there were 
lesions also of the frontal and occipital convolutions as well, and 
it is in this region that Ferrier has placed, by experimenta- 
tion, the chief motor centres of the convolutions. 

In conclusion, I think I am justified, from the symptoms 1n 
this case, in believing that lesions of the convolutions alone 
may give rise to disorders of motility, and that these are 
somewhat different when their symptoms are carefully noted 
from the symptoms of ordinary hemiplegia resulting from 
lesion of the brain lower down in the white matter, motor 
tracks, or ganglia at the base. 

The aphasic symptoms are to be accounted for by the. ex- 


922 A Case of Transient Alternating Hemiplegia. {July, 


tensive softening found in the third anterior frontal convolu- 
tion and the surrounding region of the left hemisphere. 


EXPLANATION OF PLATE. 


Fig. I. x 350. Transverse section of a vessel from the grey matter of a 


convolution, showing hypertrophy and splitting up of its coats. 

Fig. II. x 350. Section of grey matter of a convolution, showing an aneurism 
with compressed matter around it. 

Fig. III. X 150. Section through a softened spot of one of the convolutions, 
showing remains of apoplexies, with a vessel leading into one, and 
hzematoidin. 


On the Composition of the Urine of the Insane.* By Dr. 


Razsow. ‘Translated by Dr. T. W. McDowa tt. 


The urine of the insane has been hitherto comparatively 
seldom the subject of minute examination, because, indepen- 
dent of the numerous opposing difficulties, no special 
importance was attached to it. And yet, more exact obser- 
vations of the quantity of urine secreted by this class of 
patients should claim our interest on several grounds. 
This subject, moreover, cannot be ignored if we desire to 
penetrate the darkness which surrounds, especially in the 
insane, the complicated processes of chemical change; for it 
is in them that such peculiar and obscure phenomena of vital 
chemistry and nutrition occur. We see how other internal 
maladies, injuries, and wounds, without any treatment, are 
cured surprisingly quickly; how the insane, independent of 
the amount of food consumed, often undergo in a very short 
time, an astonishing increase or decrease of weight, and 
endure total abstinence from food incomparably longer than 
other individuals. Cases in point are recorded, which almost 
exceed belief. Thus, Wigand (Ueber Wahnsinn. Kempten, 
1839), relates the detailed history of a lunatic who ate 
nothing for 62 days, and died in the hospital at Kempten, 
on the 63rd of starvation. In Henke’s Medical Juris- 
prudence there is a similar case, where death occurred on the 
64th day under violent convulsions. 

Such remarkable phenomena very probably indicate that 
the laws, according to which the processes of chemical 
change occur under ordinary circumstances, may undergo 
very considerable modifications in cerebral affections. As 
we know that the most essential results of chemical change 


* From the Archiv fur Psychiatrie und Nervenkrankheiten. Band, vii, heft I. 


sig 
eat Pe 








1877.] On the Composition of the Urine of the Insane. 223 


are contained in the urine, we may expect many important 
results from a more minute examination of it. 

Moreover, numerous relations exist between the functions 
of the nervous system and the urinary secretion. We need 
only mention the well-known effects produced upon the 
urinary apparatus by unusual mental. emotions. A definite 
connection between the central nervous system and the 
urinary organs is sufficiently proved by experiment—that 
one may observe increased secretion of urine, and _ the 
appearance of various substances not ordinarily present, 
following irritation of certain portions of the brain. If, in 
ordinary circumstances, every psychical emotion, a slight 
change in food and drink, repose or motion, are capable of 
influencing the urine quantitively and qualitatively, then the 
question appears reasonable, what properties does it possess in 
the insane in whom the above-mentioned more or less transi- 
tory conditions occur in their extreme forms. We might 
a@ priort expect that the urine, like a sensitive barometer, 
would show the varying conditions of the organism through 
changes in its quantity and composition. 

In more recent times, Lombroso, professor in Padua, has 
been engaged in examining the urine of the insane. He 
made observations on maniacs, epileptics, pellagrous patients, | 
idiots, and dements, and found that the quantity of urine in 
24 hours was less, except in the pellagrous patients, in 
whom it was greater than normal. In regard to specific 
gravity, his observations showed that it was diminished in 
pellagra and melancholia, almost normal in mania, and 
increased in dementia previous to an attack of excitement. 
According to him, urea, chloride of sodium, and phosphoric 
acid are diminished in maniacs during their periods of 
freedom from excitement, and also in melancholics. These 
results, to which a certain value must be accorded, lose 
somewhat in importance, as Lombroso seldom made minute 
analyses, but generally contented himself with approximations. 

Laillier has specially examined the urine of the insane for 
sugar. (Annales Medico-Psychologiques, 1869). He arrived 
at the conclusion that diabetes mellitus occurs more fre- 
quently in the insane than the sane, and that it stands in 
an etiological relation with the neuropathic diseases of the 
former ; an assertion which has not, hitherto, received any 
support, and very probably never will, for it is certain that 
diabetes is very seldom observed in asylums. 

Connected with this subject is a most interesting work by 


224, On the Composition of the Urine of the Insane, [July, 


EKbstein (Ueber die Beziehungen des Diabetes insipidus 
(Polyurie) zu Erkrankungen des Nervensystems.—Deutches — 
Archiv fur klinische Medicin. Bd. xi. 1878), who has col- 
lected a series of cases from medical literature and his own 
practice, in which polyuria was developed, in connection with 
primary disease of the brain, or in consequence of the same. 

Mendel has more recently added an important contribu- 
tion to our knowledge of the urine in brain disease. (Die 
Phosphorsaure im Urin von Gehirnkranken. Archiv fir 
Psychiatrie und Nervenkrankheiten, Band i11.). He has paid 
special attention to phosphoric acid, and arrived at valuable 
results. However, I cannot at present specify them, but 
must refer to his original work. 

For some time, 1 have directed my attention to the 
constitution of the urine in mental diseases, and have 
specially observed the quantities of urea and chlorides in 
different circumstances. Although I am far from consider- 
ing these investigations as completed, I have been induced 
to publish them, because circumstances compel me to discon- 
tinue them, and very probably I shall not be able to resume | 
them for some time. Iam aware that only a comparatively 
small value can be attached to the following series of obser- 
vations, and that they are liable to the objections that at the 
same time other important matters, as the chemical examin- 
ation of the intestinal evacuations, &c., have not been 
sufficiently attended to. It is my intention, at some future 
time, to work at this subject more completely, and to take 
into account other important relative matters.* 

I determined the quantity of urea by nitrate of mercury ; 
the chlorides by nitrate of silver, and followed exactly the 
methods recommended by Professor Hoppe-Seyler. (Hand- 
buch der chemischen Analyse.) 

I take this opportunity of again expressing my special 
thanks to Professor Meyer, who kindly placed at my disposal — 
the materials for this paper, and aided me in its prosecu- 
tion. 


I. Constitution of the Urine in Melancholics. 


In almost every case of mental depression, I found the 
quantity of urine passed in 24 hours considerably diminished, 


* IT wish to remark that I have always observed the greatest care, and have 
only employed cases for my purpose in which I was certain that I obtained the 
whole urine passed in 24hours. I suppose it need not be specially mentioned, 
that in such observations, so frequently beset by difficulties, much patience 
and perseverance are required, 


1877. | translated by Dr. T. W. McDowa tt. 225 


the specific gravity—contrary to the statement of Lombroso— 
increased, the urea more or less diminished, and the chlorides 
reduced to a minimum. 

The following refers to a robust lady of average stature, 
02 years of age, who has suffered from folie circulaire for the 
last ten years. During one of the melancholic stages, she 
lay in bed for three months silent and apathetic. It was 
with difficulty that she was compelled to take even a small 
quantity of food, and her bodily weight decreased remark- 
ably rapidly. The temperature was normal (36-37); the 
pulse small and weak. The bowels were moved only every 
three or four days by the administration of medicine. The 
patient exhibited all the complex symptoms described by 
Professor Meyer as characteristic of this psychosis. From 
11th November, 1875, to 11th February, 1876, she remained 
in bed in about the same state; then awoke from her melan- 
cholic apathy, and gradually taking her food better, passed 
into another usual stage,in which she, if we may judgefrom the 
course of this disease, will soon assume a perfectly different 
and youthful appearance, increase 20 kilogr. in bodily weight, — 
enjoy greatly increased bien étre, and through her frolicsome 
and teasing conduct continually occasion disturbances. 


The following table shows the course of the urinary secre- 
tion of this patient, observed during six months. Of special 
interest is the enormously diminished quantities of chlorides 
and urea secreted in 24 hours, and their increase keeping 
pace with her gradual improvement. 















Quantity Chlorides. Urea. 
Date. in pease and a. G Observations 
24 hours, | C@t10R. SP-OT-/5,. Ot,] Total. Pr. Ct.| Total. 
1875. 
14 Nov. 700 dk, yellow : 
and acid. | 1013 | 1°6 | 11°2 1°8 12°6 Daily ave- 
1D ,, 400 |straw-col.| 1020} 12 | 48 | 83 | 182 |rage amount 
Die 55 500 do. | 1024} 1° 50 | 4° 20° ~— lof food :-— 
ES >, 460 do. 1021 | 09 4°14) — — Breakfast— 
25 4, 380 do. 1020 | 06 | 2:28} 4:1 | 15°58 | Small cup of 
26 ,, 500 do. 1020 | 04 | 2° 36 | 18° coffee (about 
oy 55 400 do. 10201 04 | 16 | — — | (90-—160°0). 
BO, 650 do. 1018 | O° | 3°25} 31 | 20°15 
1 Dee. 330 do. 1018 | 0°7 2°31) — — Lunch : —Bf. 
9 700 do. 1015 | 0% | 35 | 24 14°7 .| tea, about 
5s 500 do. 1020 | 0-4 | 20 | — | 11°16 | 20°0-30°0, 
Cie ly. . 860 do. 1020} 06 | 216} 3-1 = sometimes 
oe 45 650 do. 1020 | O55 | 3°57] 2°8 18°2 10:0-15.0. 
Wheat bread 


226 On the Composition of the Urine of the Insane, [July, 





; Chlorides, Urea, 
Quanity Colour and ; ia es 


























| Date : r. Observations 
24 hours, | #eaction. Pr. Ct.| Total.|Pr, Ot,| Total. 
1875, 
12 Dec 700 do. 1020 | 06 | 42 | 34 | 23:8 
es 320 do. 1022 | O09 | 288) 35 | 11°2 
AG: 280 do. 1020 | 0°8 2°24) — = 
: 450 do. 1022 | 0.7-| 315): 13:5._ | Dinners= 
iS 200 do. 1022-09 | 18") 3 6° Soup, 30 
20: ;, 260 do. 1021 | 11 | .2°86| 398 8°58 Meat, 
Oe 240 do. L020. Fo EO Bea ee — 10 0-20°0 
ols 4, 600 do. 1021 | 0°8-| 48 | 34 186 | Hungarian 
1876 wine, ¢ glass. 
2 Jan. 400 do. 1020 | 14 | 56 | 30 | 120 | Afternoon 
e 510 do. 1020 | 11 | 561) 30 | 15:3 meal :— 
rie 480 do. 1021) oF 2:.1°-8°76 1-39 15°36 | About 90:0 
Dt 2 500 do. 2021-), 14 |. ¢ 0.1.33.) 165 coffee. 
je 350 do. 1020 | 11 | 3°85} 2:4 | 84 
13 ” 450 do. 1020 1°4 63 26 yab-74 Supper — 
15 ,, 320 do. 1020 | 14 | 448} 25 | 80 | 380soup, oc- 
16 ,, 360 do. 1022 | 14 dt | 28 1008 | casionally 
18° ., 420 do. 1020 | 18 | 756) 25 105 10:0-20°0 
20 ,, 520 do. 1015 | 13 | 676) 14 | 728 meat. 
2d 400 do, 1020 | ll | 4:4 | 2-4 96 
26s 600 do. LOTS | PS 9:0) 155 90 
Fis ae 260 do. 1014 | 10 | 286] 1°6 4°16 
28 710 do. 1014} 10 | 71 | 14 | 98 
2 Feb. 480 do. 1014: | 10 1-48) [45 9-9 
= 560 do. £013 | 12 |. 6°72) 1:2 6°72 
ewe 660 do. 1013 | 12 | 792) 12 | 7-92 
i ae 760 do. 1013 | 1°6 | 12°12; 1-4 10°64 | 11th Feb.— 
18° =, 900 do. 1013 -| 13 | 117 |. 1°38 | “11-7 ~| Out of bed. 
19 ,, 800 do. 1013 | 15 |12.0 | 1:25} 10°0 | From this 
20 ,, 1100 straw-col. date goes 
and acid.| 10138 | 14 |15°4 | 09 99  |aboutalittle, 
1 oan 880 do. 1013 | 14 | 13°32] 1°4 12°32 | and gra- 
22 4, 1320 neutral, | 1012 | 1:0 |132 | 1°90 13°2 |dually begins 
25 i, 1150 acid. 1013 | 15 | 17°25) 1:1 | 12°65 |to take more 
i eae 1100 = jdk. yellow, food. 
very acid.| 1015 | 14 |15°4 | 1°0 11°0 
28... 95 1020 do. 1015 | 15 |153 | 1:22) 19°44 
1 Mar. 1100 |straw-col.| 1015 | 14 |15°4 | 1°12] 12:32 
Ores 1300 do. 1012 | 12 |156 | 1-15] 44°95 
Bess 1300 straw-co].| 1012 | 1°2 |15°6 115] 1495 
7 tage 1160 do. 1012} 2-0 1116.1" — je 
B55 1000 do. 1016.) 1:2 | 120 | 4-051 39-5 
Gy wis 1250 do. 1010 | 09 | 1125) 0:87) 10°87 
/ ee 960 darker, | 1014 | 1:4 | 13°44) 1°97} 12:19 |\ Good appe- 
D3 1150. | straw-col.| 1013 | 13 | 1495) 0:93] 10°69 | | tite. Is con- 
1005 1300 do. 1012 | 1:2 | 15°6 1°15| 1495 | | valescent ; 
On . 1200 do. 1017 | 15 |180 | 1:42] 17-42 increased 
BO. ans 1400 _|pale yellow; 1013 | 12 | 168 115| 161 || in bodily 
25! 35 1600 = |gold yellow weight ; 
and acid. | 10138 | 1:0 | 16°0 1:42 22-72 f mental 
11 April} 1400 do. 1017 | 17 | 238 | 1:5 21:0 condition 
: still some- 
what de- 
J pressed. 





2. The following table refers also to a case of folie circu- 


1877.) translated by Dr. T. W. McDowatt. 227 


faire in a@ woman 69 years of age, whose symptoms and 
progress were exactly like those of the previous patient. 
The melancholic stage was, however, always shorter. I 
succeeded several times in collecting the 24 hours’ urine, 
during the periods of excitement and depression. 


Oa a a 
| 


Quan- | Chlorides. Urea. 
tity in| Colour. | Re- anne 

Date. 24 action./Sp.Gr.|— Me oe Observations. 
hours. | Cc Totwh| Go: Votal, 


es ee | ee | ns eee 
| 











1 Jan. | 1800 |pale yel- 
low and 


























clear. | acid | 1015 | 1°5 | 27:0 16 | 288 

16 ,, |/2100| do. | do. | 1012] 09 | 189 | 1:2 | 252 7 
i; , # 1800+ ° do. do. | 1016 | 09 | 162 / 22 | 396 || f 
1s _., ' | 2100.) ‘do: do. | 1012; 11 | 231 | 14 | 29.4 |} 5 ee ©: ; 
8 Feb. | 2000| do. dos. | 1013) 511. 280.) (8 | 86°03) | ~*etemoRe: 
Pie .|°1650:| do, do. | 1015:| 11 | 1895) 18 | 21-45/J 
28 April} 800 |dark yel- 

We low do. | 1020 | 1°3 ae 19 | 15:2 
2, do. o.- | LOIS OLS 7S |) 94° | 126 5 
20° .. moti do. | do. |'19022 | =i = «|. 23) | 40.85 ; ipuaee of 
15 May | 570| do. do. | 1023 | 1°34 7.41 | 29 | 1653 es 





3. P., a forester, tall and powerful, has been melancholic 
for four months; he les continually in bed, groaning and 
lamenting. Five days ago he made a determined attempt at 





Chlorides. |. Urea. 


Date, |2922-| Colour. | _ Be- Sp.Gr. Observations 
ee ees Per | rotal.| Pe | Total. 


14 April| 640 dark 
brown & 


clear (strongly 
acid 1031 | 19 | 12°16] 3°4 | 21:76 








iS: yy 1250 | pale 
brown, I 
brick red| sedi- 
ment f 
acid 1016 | 12 | 15°0 | 1°65 | 20°62] Bleeding at 
i a 550 | dark the nose, 
brown 
turbid acid 10384 | 2°2 | 123 | 3°88) 21:34 
20 ,, 530 do. do, 1030 | 271 | 11°15) 3°39 17:96 Nos albu: 
122 ,, 500 | dark Beis LOSE certs | armen [lm BAe: 17404 EPs 
11°6 r No sugar, 

















228 On the Composition of the Urine of the Insane, [July, 


suicide. Patient eats little; requires to be fed; becomes 
emaciated. Bowels constipated. 


During the following fourteen days the amount of urine 
varied between 400-500 Cm., Sp. Gr. 1025-1032. 


4, Melancholia stupida.—W., a big man, 28 years of age, 
has lain motionless in bed for six months, has uttered no 
sound; remains in the most astonishing positions. Tem- 
perature, 36°5-37°1, Radial artery contracted, pulse small, 
easily compressible, 60-80 per minute. Generally takes his 
food badly. Bowels operate every three or four days after 
medicine. Patient has become gradually a but he 
still has a moderate layer of adipose tissue. 


























Chlorides. Urea. 
Date. ne Colour. cae Sp.Gr. Per 2 Pars hae Observations. 
Cent. Gas Cent. Das 
9 Feb. 400 | dark 
brown & 
clear | very 
acid | 1030 | 1°5 | 6°0 4°9 | 19°6 |) Food taken : 
10 55 400 do. do. | 1080 | 14 | 56 4°6 | 184 || Milk, 600-0; 
1 555 420 do. do. |} 1030. 127) atta Pb 4 18°9 |! Beef tea, 
12, 590 do. do. | 10380} 1°8 | 10°62] 4°5 | 26°55 ro 250'0 ; Hun- 
ieee 300| do, | do. | 1030) 17 | 52 | 44 | 13:2 || garian wine, 
Bh 50°0. 
14 55 425 do. do. | 1031 |; 2:0 | 8°5 4'5 1912 > Milk,1000°0; 
10? 4; ' 400 de. do. | 1028; 1°7 | 6g 40 | 16:0 beef tea, 300; 
16, | 480 don | ero too] (17 | Bie | 40 | 18 | wheaien 
ly cae 670 do. do. | 1024) (13 | S71: | S:8 | 25°46 i bread, 20°0; 
18>, 5001 --ndo, <4) doe | 10800) SEC.) 020-0 doe ode 2 glass of 
19°. | 400-1 dent ao. | 962741 19% 10. 4) eee | Hungarian 
j Wine ; water 
20 ,, ABO dois): de.+ OUOB84) A 16:8 eee 50 0. 
Se. 570-1... dos |) dos.) 2021 | 115.) 85 fee ee 
22) 5; 300 do. do. | 1030 | 1°6 | 4°8 4°0 | 120 
7 ae 275 do. do. | 10380 | 16 | 4°4 3°4 | 935 | Occasionally 
24 =,, 675 do. do. | 1080) 1° | 10°02] 3°5 | 23°62) slavers much. 
2D. Uys 550 do. do. | 1031 | 1°5 | 825 | 3°3 18°15 
ZO a, 250 do. do. | 1025] 14 | 35 2°8 70 
7s aa 500 do. = |do, “| 1030 | 14° 147-0 36 | 180 
28) sy 880 do. do, | 10381 | 1°8 | 15°84] 4°1 | 86°08| For some time 
29 550 do. do. | 1080 | 2°1 | 11°55] 3°7 20°35| eaten more, 
18 Mar. | 1300 gold 
yellow & 
clear | acid | 1025 | 13 | 169 | 3:1 | 40°3 | Mental state 








| unchanged. 


1877.] translated by Dr. T. W. McDowatt. 229 


5. Melancholia with refusal of food.—J., 89 years of age, 
strongly built, tall—a farmer. In consequence of melan- 
cholic delusions, he had for some time taken only a small 
quantity of food occasionally, and during the last 14 days 
had entirely refused it. He was brought to the asylum, 
much reduced, but not completely emaciated, and died a 
few days after his admission. His urine was examined 
during the last three days of his life, and showed the follow- 
‘ing composition :— 





























Urea, 
Quan- : 
Date. wae Colour. ee Sp.G Per Remarks. 
Total. 
Cent. 
1110 April] 650| dark ) 
F brown, | 
5 ced \! acid 1080 | 5°6 ae } Considerable quantity 
i, | 550 | deposit ! \ pe aimee. 
of | | No casts or blood cor- 
| urates J 1029 | 54 | 29.7 |J puscles. 

} 12 ,, Nourine secreted during the last 24 hours. Bladder empty at the post- 
| mortem. 





II. The Urine in Cases of Excitement. 


The examinations of urine in mania and states of excite- 
}ment have not as yet led me to even approximately definite 
jresults. I, therefore, content myself with simply narrating 
the three following allied cases which possess many remark- 
jable features. 


1. Mania with short intermissions.—During the period 
|of noisy excitement I generally observed in the following 
}case a smaller quantity of urine and of its solid constituents, 
jthan on the days ot complete quiet. He is a well-nourished 
jman, 22 years of age—mining apprentice. After being 
‘maniacal ‘and incessantly noisy for two months, he had an 
interval of eight days of perfect calm, and again relapsed. 
‘Appetite always good; no emaciation. (For Table see 


page 230.) 


230 On the Composition of the Urine of the Insane, [J uly,. 
















Chlorides. Urea. 


Quan- “a 


Date.| tity. | Colour. | oo, |[SP-Gr} po) | Observations, 


Per Per 
@ink. ‘Total. Cant. Total. 


16 Mar) 1150 | golden 
yellow & 
clear. | slightly 





ferences | 























acid. | 1018 | 1°4 |. 16'F<] 1:13 1129990 

» | 800 | straw : 
colored, f 
turbid. | neutral.| 1015 | 1°4 | 11°2 | 1°13 | 904 i 

Con- 

»>{ 900 do, do. 1028 | 21 | 189 | 1°67 | 1503 tinuous ex= 

| 1100 | golden citement. 
yellow, Traces of | 
clear. acid. | 1023 | 21 | 23:1 | 2°2 | 242 albumen 

in the 

»,| 1050 | straw urine. § 

colored, 


clear. | strongly m 

acid. | 1013 | 1°6 | 16°8 | 1°15 | 12°08 ; q 
| 850) do. do. | 1024! 2°0 | 17-0 | 1°68 | 14°28 
» | 1750 straw 
colored, q 
turbid. | acid. | 1014] 1:4 | 245 | 1°83 | 23:27 | Quiet to-day. § 


do. do. OL: | 17 | A Od 365 15:0 | Again very } 


3, | 1000 
| excited. 


99 1600 | =, = 1012 = — = =< 


i 


1 Ap.| 1550 golden 
colored, ‘ 

clear. | do. | 1015 | 1°1 | 17:05] 1°87 | 28°98 |} 
yo | 950! - do. do. | 1020} 1:7 | 1615] 1°81 | 17-19 
re 1800 straw 
colored, | 
clear. | do. | 1015] 1:5 | 270 | 1°32 | 23-76 ‘ 
,| 2050 | do, | doo. | 1014] 16 | 828 | 111 | 29-75 || Nosbumigs 
>| 2150 do. do. | 1014] 1:4 | 301 | 1:18 | 24°39 | 
»»| 1850 | do. do. | 1015 | 175 | 8287; — | — || 

] 

,» | 2800 | do. dog >t FROIS 1s ae || Seah) ee Selo 
5» | 2200 | do. do. | 1015| 1:5 | 330 | 1:3 | 286 Lively. 
| 2300 | do. do. | 1011 | 1:2 | 27°6 | 1°04 | 28°92 


»| 1450 | golden 


colored, | Noisy. 








Quiet. 











turbid. do. 1011 | 1°6 | 23°2 | 1°62 | 238°5 


12 ,,! 1150 | darker.| do. | 1028] 19 | 2185|1:8 | 207 a 


1877. translated by Dr. T. W. McDowatt. 231 


2. Mania with grandiose ideas.—V., a well-nourished, 
powerful man, 58 years of age, weighing 75 kilogr. Con- 
tinually restless and excited, but harmless and amiable ; says 
he is Christ, Emperor George, and ruler of the whole world. 
Capital appetite. Patient notes down carefully what he eats, 
and hands the account to the Doctor daily. : 




















Chlorides. Urea. 
Quan- Re 
Date. | tity in lour. oe niaes. bservations 
— 24 hours © action. ape Per Total Per Total CPegiye 
Cent.| 7"? Cent. |= e8Fr 
17 Mar. | 2700 | golden | 
yellow & | 
clear. | acid.| 1017 | 1:4 | 378 | 1:18 | 3051 
18 ,, 2000 do. do. | 1016) 17 | 840.| 1:4 | 28:00 
no, 1850 do. do. | 1023 | 23 | 4255!) 175 | 32.07 
pO ,, 2050 do. do. | 1016 | 1°3 | 26°65] 1°75 | 35°87 
Zl ,, 1730 do. do. | 1018 | 17 | 2941) 1°6 | 2768 
m2 ,; 1350 — do. | 1021 | 1:8 | 24°81] 271 28°35 
ZO 55 2600 — do. , 1013 10 | 26°0 | 1:27 | 33°02 
24 ,, 1500 — do. ' 1022 | Q-1 | 81°56 | 21 | 31:5 





In regard to the food he took, the patient handed me the fol- 
lowing record: “His Majesty, Emperor George I., has, during 
his residence here from 4th September, 1875, enjoyed an excel- 
lent appetite, one day excepted. On this, the 17th Mar., 1876, 
he has eaten and drunk the following: 1.—3 mug of water 
(Imug contains 400 cem.) ; 2.—2 mugs of coffee ; 3.—2 pieces 

of wheaten bread; 4.—4 pieces of rye bread, + spread with 
lard; 5.—4 plates of soup; 6.—3 kilogr. of beef. On 
18 March, 4 mug of water (1 mug contains 400 ccm.); 
2 mugs coffee; 2 pieces of wheaten bread; 2 pieces of rye 
bread (one piece spread with lard, } with jam); a plate of 
potatoes; 4 plate of sauerkraut; 3 kilogr. of pork; 2 plates 
of soup. Gottingen, 19 Mar.,10 a.m. George I.” 


8. State of excitement with polyuria.—The following table 
refers to a feeble man of the better class, 36 years of age. 
Always a little peculiar; latterly he has exhibited a remark- 
able form of excitement, evidently dependent upon sexual 
causes. All ladies who dressed in violet gave him to under- 
stand by means of that colour that they wished to marry 
‘him. Suddenly he desires to devote his native place to 
destruction. The patient is aware that his health is bad, and 
says that he has felt a greatly increased necessity to urinate 
XXIII, 16 





232 On the Composition of the Urine of the Insane, [July, 


since the beginning of his excitement. Moderate appetite ; 
habitual constipation. 





Chlorides. Urea. 


Gantt 
Date. oe Colour. | . per Sp.Gr. CE iol. gale Tl Observations, 
hours. Gent. Total. Cant. Total. 








ee ee ee Fe 











11 Ap.| 3600 | golden 
yellow & 
quite 
clear. | acid. | 1009 | 0:9 | 382°4 | 0°87 | 31°32 Very excited 
and confused. 
12 ,, | 1900 | straw 
coloured 
and 

slightly 
turbid. | feebly 











alkaline.| 1013 | 1:1 | 20°9 | 1°46 | 27°74 | Much quieter. 
18 ,,.| 2600 |: os deiknlined 1ON0: | yaa) eel beg 
18 ,, | 8000 | golden 
yellow & | ; 
clear. | acid. | 1010) 07 | 21:0 | 1°2 | 860 |} Tg excited, 
+ | andex- | 
| 3 
19 ,,| 3200) do. | ao, | 1008] 07 | 224 | 0-89 Joss | gbreere 
| hypoea 
dri 
20 ,,| 8500] do, | ao. | 1008] 088 308/08 |280 | gumions, 





From 21-28th the quantity excreted in 24 hours varies from | Nosugar or 
3200-3600 ; the Sp. Gr. from 1007-1010. ' albumen, — 








Jil. The Urine in General Paralysis. 


Paralytics usually secrete in the so-called first stage, 
whilst a certain amount of mind and psychical euphoria 
remain, an increased quantity of urea, and, taking into 
account the greater consumption of food, more urea and 
chlorides than healthy individuals. With advancing 
dementia, the quantity of urine diminishes, as well as the 
absolute amount of urea and chlorides, whilst the Sp. Gr. 
appears increased, and a turbidity due to urates seldom fails 
to be present. When removed by a catheter, though at first 
acid, it rapidly becomes alkaline. | 

As to the occurrence of albumen, which von Rabenat | 
(Vorlaufize Mitteilung von Dr. Rabenau; Arch. von Psych, | 
und Nervenkr. Bd. iv. p. 787.) has observed in many cases | 
of paralysis at some time or another, I must agree with 
Richter’s statement (Ueber das Vorkommen von Hiweiss 1m} 
Urin paralytisch erkrankter Irren; Arch. von Psych, und} 


1877. | translated by Dr. T. W. McDowatt. 233 


Nervenkr, Bd. vi.) that this pathological constituent ig 
not frequently present, and, if it is, is not connected with 
the cerebral disease. 


1. R., a strong man, et 47, weighs 83 kilogr. Paralytic 
for a year. Marked psychical euphoria. 





Chlorides. Urea. 


Quan- 
Date, |tity.in ig 2108 DES See a ; 
ate. |" 54 | Colour. jaction./Sp.Gr. Observations. 
Per Per 
hours. Cent. | Lotal. Conn Total. 














28 Mar. | 2200 | golden 

yellow & 

clear, | acid. | 1020} 1°9 | 41°8 | 17 | 874 1/) 
29 4, | 2500/ do. | do. | 1015 | 15 | 87°5 | 1:22] 380% | See? al 
30, | 2000} do. | do. | 1017| 17 | 340 | 15 | 300 hae Be 
J 


gence, 
3 2200 do. do. | 1016 | 1°5 | 83°0 | 14 | 380°8 ; 





2. B., a middle-sized, powerful man et. 50, very fat. 
Paralytic for two years, with rather advanced dementia; 
always smiling and contented ; takes his food well. 





Chlorides. Urea. 


Quan- Re- ce uhge ee. or 21 Sv Oy ak a es ei aa 
Date. tity. Colour. aon: Sp.Gr. Ba Per | Observations 
Chak. Total. Cont. Total. 


eee comes | ees ees | ee ne ee eeS—Oe 





—eees oe | ee oe 





2 Ap.| 700 |gold yel- 
low and 
clear. acid, | 1025 | 2°6 | 18°2 | 2°34 | 16°38)) 








= ,, | 1450 do. do. | 1014| 1°4 | 20°31] 1°33 | 19:28 
15 | 25°5 | 132 | 22:44 Rather 

4 ,, |1700| do. do. | 1615 ee 

6 ,, | 1400) straw dementia. 


coloured 
&turbid.| do. 1020 | 22 | 30°] 1'8 = 

















47 ,, | 1450 do. _— 1015 | = | = = | a7 


8. Z., a short, powerful gentleman, 48, very stout. Since 
last autumn, all the symptoms of general paralysis. With 
the exception of a few transient attacks of bad humour and 
outbursts of anger, he is always happy, merry, and contented. 
Capital appetite. 

(Iwo months after the conclusion of the examination of 


234, On the Composition of the Urine of the Insane, (July, 


his urine, the patient became completely demented ; I there- 
fore resumed it. The decrease in the total quantities of urine 
and urea is very striking.) 


nema) 





Chlorides. Urea. 
Quan- Re- 
Date, eyes Colour. |, ation Sp.Gr. Observations. 
D . 
hours, oe Total. eo Total. 
23 Feb) 2850 | straw 
coloured 
& clear,| acid. | 1013 | 1°2 | 842 | 1°2 | 342 | Quiet and con- 


tented. 
24 ,,| 1150 | golden 
yellow & 
clear. | do. | 1022 | 1°8 | 207] 2°6 | 29°9 /) Cross: game 


another 
Hie ke ee patient a box 
carbid. | do. | 1025 | -2°3 | 800 | 26 | 82 |). CPt eee 


26 ,, | 1850 | golden 
yellow & 
clear. | do. | 1022 | 2°5 | 425] 2:3 | 42°5 | Again pleased. 

Attended a | 

concert to day ; 
ate and drank 
heartily. 

27 ~,, | 2000 do. do. | 1015 | 1°4 | 280] 1°7 | 340 


28 ,,| 1900 do. do. | 1015 | 1°1 | 20°99 | 2°09] 39°71 


29 ,,| 1400 do. do. | 1019 | 1°3 | 182) 2°27| 81:78] In low spirits 
because no news 

have arrived 

1 Mar! 2200]! straw from home. 


coloured 
& clear.| do. | 1018 | 1°6 | 35°2 | 2°14) 47°08| Again merry ~ 


| 2000! do. | do. | 1017] 1°0 |-200] 2:0 | 40-0 and Cea 
| 17501 do. | do. | 1021 | 16 | 280] 224| 392 
1900 | do. | do. | 1020) 17 | 806] 2:1 | 37°8 
| 20001 do, | do. | 1016] 1:6 | 820] 1:86] 872 


», | 1850 |dark co- 
loured & 
clear, | do | 1017 | 174 | 189 | 1°7 | 23:49| Very angry: 
scolded the 
whole day. _— 
because he did 
not receive an 
expected visit 
from his wife. 


8 ,, | 1300 do. do. | 1024] 1°8 | 234] 256] 8276] Received the - 
visit to-day. 





N OQ oO BP W 


SES ES RP SS 2 SST SSS SS IN SS tS 





8/7. | translated by Dr. T. W. McDowatu. 235 
——————  eeeeseeeeeeSSs—=*CN 





























Quan- Chlorides. Urea. 
tity in Re- 
Date.| 24 | Colour. - Sp.Gr. iho Observations. 
Roaes action. Per Total Per Total , 
Cent. al. Cent. otal. 
9Mar} 2400 | golden 
yellow & 
clear. | acid. | 1018} 1°6 | 384 | 1:82 | 4368) Very much 
pleased at 
the news that 
>he has won a 
| picture. 
Spoke all 
10 _,, | 2400 do. do. 1014 | 09 | 21°6 | 1°58 | 37-92 |J day about it. 
at ,, |-2000 do. do. 1017 | 1:3 | 260 | 1°75 | 35:0 
12 ,,| 2400 do. do. 1015 | 15 | 36:0 | 1°52 | 36:48 





413 =,, | 2100 do, do. 1015 | 1:1 | 2371 | 1:56 | 82°76 
14 _,, | 1800 do. do. |-1018 | 1:5 | 27:0 | 1°65 | 29°7 
15 ,,| 2300 do. do. 1017 | 14 | 32°2 | 1°85 | 4255 Changed : wept 




















because he 
feels getting 
m6 ,,| 2000| do, do. | 1015 | 1:1 | 22°0 | 1:46 [292 | 1 ea an 
bed, 
17 ,,| 1500) do. | do. | 1025| 1°5 | 995 | 9°75 | 41°25! Again cheer- 
ful, and_out of 
i8 ,, | 2000 do. do. 1021 | 2:0 | 400 | 1:8 | 36:0 bed. 
19 ,,/ 2850} do. do. | 1016| 1:3 | 3055] 1°65 | 38°77 
20 ,, | 1900 do. do. 1017 | — — = —~ Rigg Home. 
day. Home- 
mt ,,| 1550 | do. do. | 1021 | 1:7 | 26°35] 2°32 | 8596 sick. 
|) _ Cheerful. 
22 ~,, | 2450 do. do. 1013 | 09 | 22:05} 1:28 | 31°36| | Drank wine 
| and pro- 
| > posed the 
23 ,,| 1750 | darker do. 1022 | 17 | 2975| 2°22 | 3885/| Emperor’s 
| health, 
25 ,,| 2000 | golden |) Birthday, 
yellow & 
clear. do. 1020 | 1°8 | 86:0 | 2’1 Et de 
Two months later, Advanced dementia. 
18My.| 750| dark 
pore 
turbid. | stronely 
By s,| 820| do. | acid. | 1025/ -- | — | 2°6 21'32$ ar 








A, Br., et. 52, astrong and stout gentleman, paralytic for 
five years. Mind completely ruined. The patient sits always 


236 


a 


On the Composition of the Urme of the Insane, (July, 


in one place, seldom speaks a word, must be dressed and 
undressed ; excellent appetite. 

















Chlorides. 
Quan- Re- 
Date. | f.. o Colour, aetion, \oPOe Por ; 
Gent Total. 
6Mar| 800 brown red, 
turbid. | strongly 
: acid. | 10380] 17 | 136 
8 ,,| 825 |golden yel- 
low,turbid.| acid. | 1022] 1°6 | 13:2 
9 ,,| 800| do. do. | 1026] 1:9 | 152 
12 ,,| 950 dark 
golden yel- 
low. Brick- 
red sedi- 
ment. do. 1024 | 1°6 | 15°2 
13 5,1 650 do. do. 1024; — =— 
14 sf 1000 | golden 
yellow. do. 1017 | 1°6 | 16°0 
15 ,,| 575 |dk. brown 
turbid. do. | 1031 | 1°9 | 10°92 
16 ,,| 1050] do. do. | 1023| 16 | 168 
17 ,,| 900 lak. golden 
| yellow, do. 1021 | 1°6 | 14°4 
18 1100 do. do. 10238 | 1:5 | 16°5 


99 








Urea. 


Per 
Cent. 


38 
2°14, 
2°81 


2°8 
ol 


1°95 


2'3 


Total. 





30°4 
17°65 
22°48 


26°6 
| 20°15 


19°15 


20°7 
2°75 | 80 25 


Observation 


) 
| 
| 





dementia. 








5. B.,a male, much reduced, et. 53, paralysed for three 
years. Hxtreme degree of dementia and helplessness. 





Re- 


Quan- 
Date. Colour. acthow: 


tity. 


eee came | came eee 


11 Ap.| 975 | reddish 
brown & 


turbid. | acid. 


6. In a very far advanced case of general paralysis, | 


Chlorides. 


Sp.Gr. Per 


Cent. 


Total. 


Se 


1024 | 2°2 | 21.45 | 


1023 | 2:2 | 19°8 








Per 
Cent, 


2°28 | 22°21 


2°17 | 19°53 


Urea, 


Total. 


Observations. 


ee 


) ‘Fair con- 
| sumption of 
food. 





1 
Extreme de- 
gree of 
dementia. . 





377. | translated by Dr. T. W. McDowatt. 237 


succeeded by pressure on the bladder in obtaining all the 
urine secreted in 24 hours. On the last day of his life he 
took no food, and very little during the few previous days. 
During the last 24 hours, the thermometer continually indi- 
eated 30° in the axilla, and 31° in the rectum; the pulse 
was imperceptible. 











Chlorides. Urea. 
Quan- _ 
tity. Colour. action, |SP Gr: Per |p tat Pet She Observations, 
Cont.) "Cent. | °°" 
600 | golden 
yellow, ; 
quite clear| acid. | 1020 | 1°5 | 90 | 19 | 11:4 | Noalbumen or 
sugar. 





IV. Constitution of the Urine in Epileptic Lunatics. 


_ For a long time, much attention has been directed to the 
urine of epileptics. Quantitive and qualitative alterations - 
were discovered, and it was repeatedly stated that sugar and 
albumen occur immediately after the fits. The sugar 
question is now settled, since all recent works on this subject 
agree that urine passed after epileptic attacks is free from it. 
On the contrary, in regard to albumen, Huppert has quite 
recently stated (Virchow’s Archiv. Bd. 59) that a certain 
amount is found after every attack. If this statement prove 
true, it may become of great importance in forensic cases, 
where simulation of epilepsy is suspected. 

In ten epileptic lunatics, I have examined the urine 
immediately after the fits. The test for sugar gave negative 
results, but the statement by Huppert as to the presence of 
albumen proved correct in eight cases. Sometimes, how- 
ever, the reaction appeared so feebly and slowly, that it 
might be easily overlooked. In two cases, in spite of the 
fits being exceedingly severe and frequent, I could find no 
trace of albumen. ee ie 

_ The very frequent occurrence of polyuria in epileptics has 
struck me as remarkable. After each fit, an increased 
quantity of urine was passed, which was richer in chlorides, 
and more deficient in urea than a corresponding volume 
taken from the total quantity in 24 hours. When the fits 
occur at greater intervals, the quantity excreted in 24 hours 
is usually markedly reduced after each one. The quantity of 
urea, is, asa rule, not great, and occasionally there 1s an 
increase of xanthin. 


. 


8 


238 On the Composition of the Urine of the Insane, [July, 


The following cases were observed some time ago :— 

1. L., male, et. 20, feeble; weighs 53 kilogr.; is in a state 
of advanced dementia. Several severe fits daily. Is fre- 
quently in a state of ecstacy, and sees the Virgin Mary and 
Child. Usually says that he is very well. Appetite good. 





Chlorides. Urea. 


tity. tion. Per Observations. 


Date. Onan: Colour. Reac- Sp.Gr. 
| Cent. 


Per | 
Total. Cou: Total, 





epee | emcee: | eee | 











9 Jan. | 3600 |pale yel- 
low and 


clear, | acid. ' 1005 | 0:25 90 | 06 | 21°6 


27 Mar, | 2800 | straw 
yellow & 
clear. | do. | 1011 | 1°4 | 39:2 | 08 | 22°46 | Soon after a fit 

patient passed 
500 Cm. Sp. Gr. 
1011. Chlorides 
28°", 4000 do. do. | 1010} 12 | 48°0 | 0°84 | 83°4 | 16 per cent., 
Urea 6 per cent. 
Some albumen 


ao is 3500 do. do. | 1009 | 1:0 | 85:0 | 0°75 | 26:25 |Three fits. Afte 
the last he 
passed 500 Cm. 
urine, which 
BO: «5 2000 do. do. | 1012 | 1°4 | 280 | 0°82 | 16°4 | contained 11) 
per cent. — 
chlorides, 5°4 
per cent. urea, 
ol 55 2100 do. do | 1012 | 1°4 29°4 | 0°92 | 19°32 and some 


albumen. 
During the next 14 days the total quantity varied from 
2900-3800, the Sp. Gr. from 1005-1009. 


.2. B., a small powerful man, et. 52, epileptic since he was 
18. Moderate dementia, with frequent attacks of excite-_ 
ment. Regular digestion. Latterly the fits have been less — 
often, and their occurrence concealed by the patient. ) 





















{ 


Chlorides. Urea. 
Date. | 2224- Colour, | Reac Sp.Gr.| p Observations. 
tity. | P sede s er | Per 
1ty tion | Cent, Petal. Cent. Total 


—— 





ee | ee Oe 











eS 








29 Mar. | 3000 straw 
coloured 


'& clear.| acid. 1007 | 0°5 | 150 | 07 | 21:0 : 
30 ,, | 8000} do. do. | 1009 | 07 | 21°0 | 0°74 | 22:2 

SEER O50) do. | 1010 | 0°85 1912 | 0:88 | 198 /\ 
1 April] 2300; — do. 1010 | 0°85 19°55 | 0°88 | 20:24 | | 
2 ,, |2900! — | do. | 1008! 0-9 | 261 | 0-66 |1914]J 





No fit. | 

















po77.] translated by Dr. T. W. McDowatt. 239 

















| Chlorides. Urea. | 
Date. &"8™| Colour, | Reac: g Gul wp, Observations. 
- | tity, . t p.Ur., Per Per 
y , wen Cent. Total. Cont Total. 

3 April 1650 | dark = i ¥ 
yellow, ‘) Fit at mid 
turbid. | do | 1012) 11 /1815) 1°05 | 17°32/ | day. Distinct 

| trace of albu 
eT 55 1850 | straw- ‘men in urine 
yellow.| do. | 1009 | 10 |185 | 086 |15°91|| and abun- 





| dant earthy 
J phosphates. 


2050 — do. | 1010 | 1:1 | 22°55} 0°85 | 17°42} Fit. Trace of 


albumen, 
1600 |} dark - 
yellow.| do. | 1010! 10 16°0 | 0°95 | 152 |) | 


4 99 3200 straw- | 
yellow.| do. 1006) — — —_ oe 


oO oo 
v3 S 








8 , | 2200; — do. | 10083) = | — | — | — 
| 
9 , | 2600}; — do. 1006.) | SS 





| 
| 
| } No fit. 


. | 

3. W.., a big, powerful man, zt. 30, epileptic for 16 years; 
demented, and inclined to violence; takes food well. One 
or two fits in 14 days. 



























Chlorides. Urea. 


Date Quan Colour. |Sp.Gr. Reac- Observations. 
; tity. tion. Per Per 
Gent, | 1 otal. Gent, | Potal. 








mr | re | ,, 


BeSiar.| 1260 |straw- 























yellow & 
turbid. | 1016 | acid. | 1°2 | 14°4 | 166 | 1992) A fit the day 
my ,; 1720 |dark yel- before. 
low and 
clear. | 1015 | do. 13 | 22°36; 1°25 | 21°4 
22 ,, | 1800 dost | 1016z|" de. {|) 1:4 | 25:2) | 1:23 | 22-14 
Zo ,, 2000 do. Eotsado..) £2 |) 220 | 116 1232 
24, 2000 do. 1615 | do. 15 | 30°99 | 1°12 | 224 
2 ,, 2100 do, L105: |'* do: Pott she iP: 2st 
nO ,, 1750 do. LOZ |. do. £8 | 31% 1°19 20 62 
Be 4, 2000 do. | 1016] do. | 15 | 800 | 1:22 | 24-4 
ZS ,, 1600 do, 1017 | do. M7 27°2 ) 14 20-4 
mes, | 2100 | -do, | 1014| do. | 15 | 815 | 11. | 2381 
1 April! 1230 | pale 
yellow & : 
turbid. | 1020 | do. 1:8 | 22:14} 1°49 | 18°32) A fit at mid- 
@ », 950 | golden day. 
yellow & : 
clear. | 1024 do. DD Ni 2O9. 1 187 7°76 The urine 
3, 2500 do. 10138 | do. | 1'4 | 85°0 | 0°92 | 23:05! passed four 
4 ,, 2100 — 1014 _ — — _ — hours after- 
—;, 2100 _ 1015 — — _ _ _ wards con- 
S 2300 ~ 1012; — — _ _ — | tained albu- 


men, 





q 


24.0 On the Composition of the Ure of the Insane, [July, 


In the last two cases it is interesting to note, that immedi- 
ately after the epileptic attack a marked diminution in the 
24 hours’ quantity of urine, chlorides and urea occurred, and 
continued 2 days. 


V. Constitution of the Urine in Dementia, Idiocy. 


1. R., et. 58, law student, stout and powerful, enormously 
fat; weighs 106? kilogr. The patient has lived 380 years in 
an asylum, quite demented; sits all day quietly and 
uninterested in the same place; eats readily an abundant 
supply of food; bowels regular. 
































Chlorides. Urea. 
Date. ae Colour. nie Sp.Gr. Per | i Per a Observations. 
Cent. | * 9%"! Cent. otal. 
13 April} 1500 | golden 
yellow & 
clear. | acid. | 1012 | 1°5 | 22°5 | 0°81 | 12°15 
tact, 1950 do. do. | 1011 | 1:7 | 8335] 0°69 | 1845 
1D + 555 2000 do. do. | 1010 | 1% | 300 1.067. | 182 
16 ,; 2000 do. do. | 1014] 16 | 82:0 {1:0 | 20°0 
sy ease 1900 do. dose L018 4" 4-9 BEL 11°33} 25°27 
13) °,, 1760 do. do. |lOf44)- 5. | 264 | 102 117-77 
TO! 3 1850 do. | do. | 1011 | 2°3./ 24°05} 0.93 | 17°2 
20 55 2200 do. do. | 1018 | 1°5 | 83:0 | 0°91 | 2002 
ot eae 2000 do. do. | 1010} — — | 086 /17°2 
Ze! 55 2000 do. do. | 1010; — — — =_ 








2. An idiot, et. 40, of average stature, and strongly built. 
No trace of intelligence, cannot speak, only utters inarticu- 
late sounds. Restless and uneasy ; enormous appetite. 
















Chlorides. Urea. 


Quan- . |Reac- ae Se ees Speed [eels Sgt 
Date. tity. Colour. a, Sp.Gr. Per Per Observations. 
Cont. Total Giut. Total. 








23 Mar, | 1000 | straw 
coloured 
& turbid acid. | 1020 | 1°7 | 17°0 1°81 | 18°1 
24.55 1025 do. do. | 1021 | 1:5 | 15°37 2°03 | 20°8 
25 ,, 950°}. \do,. 21. doe (aloes) Sct) Eat ee me 


1050 do. 19 =| 19°95 
































99 





28.77. | translated by Dr. T. W. McDowatu. 241 


3. A delicate man, et 30, of average stature, strongly 
built, well nourished, weighs 60 kilogr. Became melan- 
cholic 5 years ago, and for the last 3 years has been com- - 
pletely demented. He remains motionless as a ‘statue 
where he is placed,. never speaks a word, or moves a muscle 
of his face. Of his own accord, he takes nothing, but when 
the morsel is put into his mouth, he chews it; in this manner 
he takes a sufficient quantity of food. He voids his urine 
twice in the 24 hours, and must, morning and evening, be 
led to the appointed place to empty his bladder. Bowels 
operate every three or four days. Temperature 36°5-37'1. 
- Pulse 60-70. 





| Chlorides. Urea. 


Date. ye Colour. ou Sp.Gr. 





Observations. 


Per Per 
Cink. Total. Cant. Total, 


| rr cr cr cr | cfc | | eee | Oe 


27 Feb| 580 |golden and 
clear. | acid.| 1022 | 2°2 | 11°66} 2:1 | 11:13 | Average quan- 
tity of food :— 

















428 ,,| 1000 |pale yellow Breakfast: 
andturbid.| do. | 1015 | 1:2 |12°0 | 1°64 | 16°64) allowance of 
; coffee and bread. 
429 ,,| 750 do. do. | 1010} 08 | 6:0 1°18 | 8°85 
: Dinner: A plate 
1Mar| 580 |golden and of soup and 
clear. do. | 1024) 1°9 |10:07| 2°41 | 12°77 meat. 
12 ,,| 640 do. do. | 1024| 2:0 |12°8 | 2:3 |1472| Afternoon: 3 
allowance of 
3 5, | 1200 |pale yellow coffee and bread. 





and clear.| do. | 1016 | 1°5 |18°0 | 1°42 | 17°04 
Supper: A plate 











74 ;,| 850' ‘€o. do. | 1017 | 14 |11°9 | 1:74 | 14°79 | of soup and $ 
piece of bread. 
5 ,,| 1050] do. do. | 1016} 1:4 |14°7 | 1:53 | 16:06 
6 .,'| 901 “ao, do. | 1015 | 1:0 [9:5 | 1:47 | 18°96 
17 900 |golden and 
= > dear. | do. | 10is') 11 |o9 | 1-86 |14'04 
8 ,,| 1100 do. do. | 1014] 1:1 {12:1 | 1:4 | 15-4 
9 950 le yel- 
_ Peiow: | do. | 1016 | 16 | 18°25) 1-42 | 18-49 
19 ,, | 1050 |dk. yellow, 
slightly 


turbid. do. | 1017 | 1°6 | 168 | 1°41 | 149 











These three cases, all in the last stage of dementia, 


4 
: 


242 On the Composition of the Urine of the Insane.  [July, 


possessed the common feature, that, considering the large 
amount of food consumed, a corresponding quantity of 
chlorides and urea was not excreted; an evidence of slow 
chemical change. In the last two cases, the amount of urine 
in 24 hours was less than normal. 





CLINICAL NOTES AND CASES. 





Notes of a Case of Monomania with Self-Mutilation and a 
Suicidal Tendency—fecovery. By Wiitiam J. Brown, 
M.B., Assistant Medical Officer, Borough Lunatic 
Asylum, Newcastle-upon-Tyne. (Onder the care of Mr. 
Wickham.) 


W.H.8. Reg. No. 801. Admitted 6th January, 1876. The 
statement which accompanied the medical certificate contained the 
following particulars: Alt. 25 years, single, poor, a boot-riveter. 
The existing attack, which had lasted one day, was not the first. He 
was 24 years of age when the first attack occurred. Never previously 
under treatment. Supposed cause unknown. Not subject to epilepsy, 
but suicidal, and dangerous to others. 

‘6 Medical Certificate—Found him in bed with the left testicle 
removed, and mutilation of right one. Said they were offensive to 
him, and that it was his duty to remove them. Complained that he 
could not sleep at night, and that he heard noises. Suddenly became 
taciturn. 

‘2nd. Informed by his mother that he had threatened upon many 
occasions to cut her throat, and that he had made an attempt this 
morning. Had threatened to make away with them all.” 

On admission, he was placed in a single room in the Infirmary 
Ward, and special attendants were detailed to watch him. The 
patient appeared to be very weak, from loss of blood, and the wound | 
having been only temporarily dressed, the hemorrhage, which ap-— 
peared to be arterial, had not ceased. Upon removing the dressings, ; 
the left side of the scrotum was seen to have been mutilated, and a | 
mass of coagulated blood and vascular tissue was found lying upon 
the right side. This mass appeared to be composed of the left | 
testicle and the greater portion of its appendages. During the cleans- 
ing of the wound with a solution of carbolic acid and water (1 to 40), a 
sudden jet of bright red blood sprang from the mass, and, in searching 
for the vessel which had caused it, the mass became detached and the | 
jet ceased, but considerable arterial oozing continued for some time. j 
This was almost entirely overcome by elevating the scrotum and apply- } 
ing lint, steeped in the lotion, over the wound, with compresses upon | 
either side, the parts being supported witha T bandage. Anirregular | 





187 ake Clinical Notes and Cases. 243 


wound was observed upon the upper portion of the right side of the 
scrotum, which had laid bare the right testicle, without, however, 
entering that organ. The septum scroti also appeared to have been 
injured, and the perineum was ecchymosed extensively. Before the 
wound was interfered with the patient passed water, and the urine was 
clear, and of a pale straw colour. He did not complain of pain, 
except when the wound was touched. His pulse was very variable, 
ranging from 90 to 108 before the wound was dressed, and from 78 to 
90 afterwards. His skin was moist and clammy, and he trembled 
shghtly. The pupils were normal, and no paralysis was observed. 
The tongue was readily protruded and slightly furred. He answered 
questions rationally, and stated that he had mutilated himself with a 
table knife, and that, in consequence of it being blunt, he had made 
four or five cuts before effecting his purpose. He stated that he 
considered it proper to remove the organ, and asked reporter if he 
was going to remove the other testicle. As he appeared faint, after 
the dressing, he was given a small quantity of brandy and water, which 
seemed to revive him. A bed having been prepared with four pieces 
of wood projecting from it, two on each side, and a polka having been 
placed upon him, he was put in a recumbent position, with a pillow 
under the perineum, and a hot jar to his feet. Two sheets were laid 
across his legs, and attached to the pieces of wood, to prevent him 
from moving and bringing on hemorrhage, or disturbing the dressings, 
and a wire cradle was placed over his pelvis to keep the weight of the 
clothes off the parts. He appeared to be much relieved and comfort- 
able, but said the polka cramped him. Having complained of hunger 
and thirst, saying that he had not eaten food that day, and having 
expressed a wish for tea, he was supplied with cold tea, beef 
tea and custard, which he seemed to enjoy very much. He requested 
permission to smoke, but it was not considered advisable to permit 
him to do so. In consequence of his weak state, and the presence of 
the polka, the thorax was not examined. He is above the average 
height, well made, and his muscular system well developed. His hair 
is dark, and his complexion sallow. He was quiet in his manner, 
but his eye had a suspicious look, and he appeared at times to be 
taciturn, 

7th January.—Last night he received, at bed-time, the following 
draught. Rlig. morph. mur. m XL; Aque. ad, Zi, Mit. haust, 
but was reported to have vomited it soon afterwards. During the 
night he was restless and sleepless, but his bowels were freely moved, 
and he passed water which had a smoky appearance. In the morning 
he was much better as regards his bodily condition, but more taciturn. 
His pulse was 60. It was not considered advisable to interfere with 
the dressings, lest the hemorrhage might recur. He informed 
reporter that something had told him to do what he had done, and 
‘said that some time ago, when playing with some lads, one of them 
had struck him with his knee in the groin, since which time his left 


244 Clinical Notes and Cases. [July, 


testicle had never been well; and that he also had, or feared he had, 
contracted syphilis a short time ago. His father and the relieving 
officer had previously informed reporter that the patient had been 
under treatment for syphilis. In the afternoon he informed the 


medical superintendent that he fancied he could see friends in his 
room, whom he knew to be far away, and complained of noises in his. 


ears, and of voices telling him something. The sheets which bound ~ 


him were removed, as was also the pillow from beneath the perineum. 
He was put on beef tea and the ordinary diet. 


8th January.— Received a draught at bed-time last night, containing — 


K Chloral hydratis, 38; Aque Zii., andslept part of the night. He 
refused to take both this and the former draught until told that he 
would be compelled to do so. Upon dressing the wound, which 
appeared to have a very healthy appearance, it was found that he had 
only removed the left side of the scrotum, with the greater portion of 


the centre of the left testicle, and a small portion of its upper and — 


lower surface, leaving an irregular and extensive wound. His 
urine was still smoky, and his pulse was from 75 to 80 through- 
out the day. He was able to sit up and read a book. | 
9th January.—Continues to improve as regards his bodily condition, 
Slept part of last night. Pulse 75 throughout the day. His father 


called, and told reporter that his son had generally been a sober, © 


steady working man, but that some time ago he had been under 
medical treatment, and had requested the doctor, who attended him, to 
remove his left testicle, which that gentleman had refused to do. He 
said also, that he had lately taken to drinking wine every day, and 
studying his Bible very intently, and seemed to have been seriously 
affected by conversations with various clergymen. 

10th January.—Slept well last night. Spat up some blood mixed 
with mucus. His urine has assumed its normal colour. His appetite 
continues good. He has expressed a desire for new milk, and is 
receiving it ad libitum. The wound is suppurating freely, and the 
dressings are stained with blood. His pulse throughout the day was 
75, and towards evening he had a slight headache. He appeared to 
sleep at intervals during the day. . 

11th January.—Slept well last night. Morning pulse 84, temp. 
100° Fahr. Wound has a healthy appearance. The parts were 
drawn together with diachylon and compresses of lint, and the lotion 
applied as before. He received half an ounce of castor oil, which 


operated freely. His appetite is good, and he appears to be progress- 


ing favourably. Was ordered whisky, 3ii., during the day. Evening 
pulse 72, temp. 98° Fahr. 
12th January.—Slept most of last night. Pulse 78, temp. 98° 
Fahr, Surface of wound healthy. Custard substituted for beef-tea. 
13th January.—Slept most of last night. His hair was cut close 
yesterday, at his own request, as he stated that he was accustomed to 
keep it close, and that when it was not cut he suffered from headache. 





1877.| Clinical Notes and Cases. 245 


The wounded surface is granulating well, and he seems to suffer more 
pain when the wound is being dressed. His urine is quite normal : 
his appetite is good, and he is cheerful. Morning pulse 84, temp. 
98°8° Fahr. Evening pulse 84, temp. 98:2° Fahr. | 

14th January.—Slept well last night. Morning pulse 93, temp. 
99° Fakr. Wounded surface healthy, small slough upon the upper 
and outer portion of the left testicle. Evening pulse 78, temp. 98° 

Fahr. . 

15th January.—Slept well last night. Progressing favourably as 
regards the wound. Morning pulse 78, temp. 98° Fahr. Evening 
pulse 78, temp. 96° Fahr. Said that he felt “ perplexed in his mind 
and body, and that he had imagined last night that he had seen per- 
sons who were not present, and had held converse with them. Said 
that it was a sudden impulse that had actuated him to injure himself, 
but that he would not do so again.” 

17th January—Morning pulse 78, temp. 98° Fahr. Wound 
progressing favourably. 
19th January.— Wound progressing favourably. Extras discon- 
tinued. | 
_ 22nd January.—Bread poultices were substituted yesterday in lieu 
of the plaster and lotion, but the lotion is sprinkled over the poultice 
before it is applied. The wound is clean, and has a healthy appear- 
ance, 

24th January.—Yesterday zinc ointment was substituted for the 
poultices, and lint steeped in carbolic oil (1 to 380) was applied over 
the lint which had the ointment upon it. The wound, which is rapidly 
filling up, is washed every morning with tepid water, containing a 
small quantity of carbolie acid. 

31st January.—The wound is progressing favourably, The granula- 
tions are occasionally touched with the nitrate of silver. He is getting 
a pint of porter daily, and a mixture containing Quin., sulph. Dj -; Tinct. 
ferri mur. 3j.; aquam, ad Zviij. m. 3{3. ter die, and the polka is to be 
| taken off for two hours daily. On the evening of the 28th he was 
| placed in the infirmary dormitory, but at 2.15 a.m., shortly after 
‘Teporter and the night attendant had visited him, he became restless, 
and was found standing at the dormitory door. Reporter had him 
removed to a single room and an attendant was placed with him. He 
associates with the other patients during the day, and sleeps mm a 
single room at night. 

_ Ast February.—Progressing favourably as regards the wound. He 
told reporter that he had not got any medicine, and, upon inquiry, it 
was found that he had refused the medicine and said that it made him 
sick, 

2nd February.— While he was being exercised, with the polka off, 
he induced one of the attendants to go for an orange and when 
| he had gone he sprang through a window sash before the other 
| attendant could intercept him, but he was seized before he could 


246 - Clinical Notes and Cases. [July, 


extricate himself from the window. Upon examination, superficial 
incised wounds of the finger, cheek, and leg were discovered. Those 
upon the finger were dressed with carbolic oil (1 to 30), but the others 
did not require any treatment. | 

4th February.—Wound progressing favourably. Has a very rest- 
less and suspicious look about the eyes. 

6th February.—No sleep, and very restless last night. 

7th February.—Little sleep last night. Extras and medicine dis- 
continued, 

8th February.— Reported to have had little sleep last night and to 
have had suicidal delusions. He asked the attendant to cut his 
throat. The wound is very nearly healed. The polka is now removed 
for one hour daily. 

12th February.—Polka removed for two hours. 

13th February.—Polka removed for three hours. 

15th February.—Polka removed for four hours. Wound touched 
with sulphate of copper and strapped with diachylon. 

16th February.—The wound is nearly healed, and the patient 
appears much better in every respect. Polka removed for six hours. 
Slept well last night, placed in a dormitory and special night watch- 
ing discontinued. 

17th February.—Polka removed for ten hours. 

18th February.—Slept most of last night. Wound healing. 

20th February.—The polka has been off for thirteen hours on each 
of the last three days, and the new cuticle has formed over the wound, 
but the diachylon strapping is continued to prevent the clothes from 
coming in contact with it. 

21st February.—Complaining of being in an unsettled state, and of 
constipation. RK Ol ricini 3{3. Restraint discontinued. 

22nd February—Wound healed. Dressings discontinued and a 
warm bath prescribed. At 1am. he complained of the castor oil 
having acted too freely. After receiving a draught containing Tinct. 
opii 383, he slept the remainder of the night. 

23rd February.—Permitted to take exercise in the airing court. 

28th February.—Appears to be much improved. Assists the 
attendants usefully. 

4th March.—Improvement still continued. 

13th March.—Improved both as to his bodily health and mental 
condition. 

2ist March.—There is no change in his case, but he is anxious to 
be allowed to work in the grounds. 

7th April.—No change has taken place since the last entry was 
made. 

7th May.—Escaped from a walking party at 4.35 p.m., and was 
brought back at 5.20 p.m. 

15th May.—There is no visible change in his mental state, and his 
bodily condition continues to be fair. 


F877. Clinical Notes and Cases. DAY. 


_ 19th June.—His mental state and bodily health appear to be im- 
proved. 

14th July.—The improvement is still maintained. 

21st July.—No change has occurred since the last entry. 

26th July.—His mental state and bodily health appear to be good. 

28th July.—Liberated, on trial, until the 20th December, 1876. 

27th September.—Came to the Asylum and stated that he felt 
worse ; that he did not feel comfortable when at home, although they 
treated him well; that he had been unable to obtain work, and that 
he should like to be taken back again. He was therefore placed in 
the second ward under special supervision and slept in the infirmary 
dormitory. ‘The following were the results of the physical examina- 
tion: Heart’s action, regular; radial pulse (lying down), 53; 
respirations, 20 ; temperature, 97°5° Fahr.; intelligence good. No 
headache, but has suffered much lately from headaches, and had a 
severe one yesterday. Lumbar pains. No irregularity in his gait, 
Pupils equal and apparently normal; speech coherent. Tongue 
readily and evenly protruded, moist, flabby, and slightly furred. Left 
testicle absent from the scrotum. Urine of a light straw colour, its 
specific gravity 1912°, and acid reaction. No change was observed 
upon applying heat to the urine, nor upon adding nitric acid, but a 
slight crystalline deposit was formed upon continuing the application 
of heat. There was a small vaccination cicatrix upon the right 
shoulder, and a small cicatrix upon the left elbow. No cicatrix could 
be observed upon the scrotum, the hair having grown over it. Suffer- 
ing from slight conjunctivitis. Skin cool. 

2nd October.—Sleeps and eats well, but has a restless, suspicious - 
look, and trembles. 
_ 13th October.—Removed to the first ward. 

29th October.—He was employed in the grounds for some time after 
his removal to the first ward, but he now assists the engineer, as a 
‘stoker. 

14th November.—Escaped at 1.30 p.m. 

28th November.—No information concerning his whereabouts 
having been received since the last entry was made, he was this day 
discharged. ; 

29th December.—Information was received that the above patient 
had joined a cavalry regiment, stationed at Leeds, as a recruit, but 
that, in consequence of his mutilation, he was not considered by the ~ 
regimental surgeon to be fit for service, and steps were being taken 
to have him inyalided. 


This case appears to have terminated in a complete re- 
covery, both from the wound and from the mental disorder. 
When the patient returned from leave of absence he was 
naturally somewhat depressed, having travelled on foot 
through Northumberland, Durham, Yorkshire, ae Lanca- 

XXIII, 


248 Clinical Notes and Cases. [July, 


shire, in search of work, and finding none, owing to the slack 
state of trade. He was half-starved when re-admitted, but 
soon grew stout and cheerful. He made his escape while 
steps were being taken to have him discharged in the usual 
manner. He asked reporter once or twice if he could pass 
for a recruit, and was informed that it would altogether 
depend upon whether he was examined closely or not, he 
having, notwithstanding the rude weapon which he had 
employed, performed a very neat operation. The deprivation 
of one testicle has evidently not deprived him of sexual 
desire, for he appears very anxious to know if he would be 
able to marry. This case is rather remarkable, both as 
regards the nature of the wound, and the fact of the patient 
having recovered so perfectly from so determined a desire to 
injure himself, and the retaining of his mental faculties, not- 
withstanding the adverse circumstances into which he was 
thrown on both occasions, after leaving the Asylum ; for there 
is little doubt that it was only want of work that drove him 
back again. 





Two Cases of Delusion as a Premonitory Symptom—in the 
one case not followed by Insanity, and in the other 
followed by Symptoms necessitating the Detention of the 
Patient m an Asylum. By Henry Sutuertanp, M.D. 


H. N., et. 26, clerk to a bank, consulted me in December. 

No history of hereditary insanity, but the patient had been 
much addicted to self-abuse. } 

Chief Symptoms.—Loss of sleep, constipation, headache confined to 
one spot, on the vertex, “the size of a penny piece,” and one delusion. 

He was calling at a house where there were two children; one, a 
boy, had a bottle of some poisonous chemical compound; the other 
child, a girl, died soon after from a fever. The patient believed that 
this child died of poisoning, and that it was his fault, because he did 
not tell the parents that the boy possessed a poisonous mixture. 
There was no doubt, however, that the girl met her death from 
natural causes, and there were no grounds for the patient’s supposition 
that the girl had been poisoned. This idea, however, became fixed in 
his memory. He could not forget it. He was in the habit of 
obliging his mother to repeat over to him twenty times in an evening 
the fact that he was not to blame in the matter, and, of course, even 
then he was not satisfied. 

Latterly he had become very much depressed, and had stated that 
he wished to make away with himself. He had, however, taken no 
steps which could excite any alarm. | 


£377. Clinical Notes and Cases. 249 


The question the relatives were most anxious about was whether 
or no the patient should be sent to an asylum. If he were, he would 
probably lose his situation for ever, as it was not likely he would be 
taken back to business on his discharge. If he were not, there was a 
risk of the suicidal threat being carried out. In this case, it was 
thought better that the patient should remain at home, the brother 
undertaking to sleep in the same room with him, and to watch care-. 
fully for further symptoms. 

Sleeping draughts and aperients were ordered, and plenty of exer- 
cise in the open air, with much benefit. No further symptoms of 
mental disorder were developed. 

B. R., et. 42, a grocer’s assistant. 3 

For six months he was under treatment for nervousness and 
debility. He then had an apoplectic attack, from which he recovered 
and went on for another six months, in all a year, without any 
decided mental symptoms being observed. 

Suicidal tendencies were then developed, the patient attempting on 
one occasion to strangle himself with a pocket handkerchief. He 
then became odd in manner and irritable, and quarrelled with his: 
master, who had been very kind to him, without cause. 

_ At the same time a somewhat curious delusion was developed. 
He believed that everybody and everything combined to present the 
number five continually before him, with the object of teazing and 
worrying him. Everything appeared to be arranged in fives. Several 
times in the day he had been asked to change a five pound note ; | 
customers had bought five pots of preserved meat at one time, and 
had continually purchased a pound of sugar, which cost five pence ; 
bills for articles supplied had frequently amounted to five shillings. 
In his own home he was not secure, as the first things which met his 
eye on going into his sitting room were the five ornaments on the 
mantle-piece. Even outside his house people would not leave him 
alone, as they had actually taken up five heavy stones in front of his 
door. 

Soon after this he became violent and unmanageable, and was sent 
to an asylum. 


The two cases above described are placed together as a 
contrast. In the first the mental aberration proceeded to the 
point where a delusion was formed, and there stopped. It 
appears to be somewhat unusual for this stage to be arrived 
at without the symptoms goiag so far beyond it that the 
patient is obliged to be detained in an asylum. In the 
_ Second, other mental symptoms were developed in addition 
to the delusion, but not until the patient had been for a year 
under medical treatment. 


250 [July, 


OCCASIONAL NOTES OF THE QUARTER. 





Concerning Habitual Drunkards. 


In the Scotsman of January 19th and 28rd are two long 
communications treating in a very full, clear, and impartial 
manner of the proposed legislation for the cure and control 
of habitual drunkards. The writer, speaking of the joint 
petition of the British Medical and Social Science Associa- 
tions to Parliament, very properly describes it as altogether 
wanting in precision, sensational in its philanthropy, as ex-— 
hibiting a stupendous credulity, and as presenting in various 
other respects objectionable features which are calculated to 
defeat its object. From the beginning an evil genius seems 
to have inspired the advocates of measures to control so- 
called habitual drunkards ; and we cannot call to mind any 
other cause which has suffered so much from the utterly in- 
discreet zeal of those who have supported it. Mr Dalrymple, 
who worked so hard to induce the legislature to grant him an 
Act, cared only, in collecting and presenting his data, to 
obtain evidence that was favourable to his views, and ignored 
all suggestions that did not chime with them. The proposed 
title of his Bill was as great a blunder as it was possible to 
make. It was not likely that the House of Commons would 
pass an Act authorising the locking up of drunkards, but a 
more discreet person than Mr. Dalrymple, possessed of his 
zeal and energy, might, perhaps, have induced it to make 
such an addition to the Lunacy Acts as would have allowed 
genuine cases of dipsomania to be certified and kept under 
control for a certain time. Those who have taken up Mr. 
Dalrymple’s mantle seem to have taken up with it his want 
of knowledge and his want of discretion; for we regret to 
observe that they are going on his lines, and using the discre- 
dited evidence which he used; following which course, they 
will, though they are calling for a remedy for a real evil, do 
no good whatever, but advertise their incapacity to deal with 
the subject. 

The writer in the Scotsman, after pointing out that, while 
there can be no real intention to interfere with ordinary 
drunkards, the provisions of the present law are adequate to 
reach cases of delirium tremens and mania a potu, goes on to- 
make the following temperate and sensible remarks concern- 
ing dipsomania :— 





1877.] Occasional Notes of the Quarter. - 251 


- Taking for granted, then, that there are persons with this uncon- 
trollable craving for intoxicants—persons who, in the words of the 
resolution, labour under a special form of insanity, which has excessive 
intemperance for a symptom—do they require any special treatment ? 
what is that treatment? and is it not attainable under the laws as 
they stand ? 

- In answering these questions we have at once to point out that such 
persons cannot be received into ordinary asylums as lunatics, for the 
very good reason that they cannot be certified to be lunatics. Their 
insanity is not held to be of the ordinary, but to be of a special form, 
and to be beyond the scope of the existing lunacy laws. It is true 
they may enter asylums as voluntary patients, but this would not con- 
fer any power of detaining them, and the craving when it appeared, 
being beyond control, would drive them out. Itis stated, indeed, that 
not many of those who enter asylums voluntarily remain in them 
longer than a few weeks. In no way, therefore, is their treatment in 
asylums possible, even if it were thought that the organisation of 


_ asylums, and the kind of life which is led in them, supplied a treat- 


ment suitable to such cases. The reverse of this, however, is 
the opjnion held. It is said that the dipsomaniac requires a treatment 
of a special character. In what this special character would consist 
we scarcely know, and opinions might differ on the subject; but there 
can be no doubt of this, that its essential feature would be prolonged 
and compulsory detention, with enforced abstinence from intoxicants. 
Whatever he might gain, the insane drink-craver would certainly lose 
his personal liberty, and be forced to submit to a discipline which 
would in all probability be irksome. In other words, a person labour- 
ing under a disease, which is not lunacy, though said to be in alliance 


with lunacy—which is described as a special form of lunacy—would be 


liable to a prolonged incarceration. It is alleged, of course, that this 
would be done for his good, that his recovery would be the chief 
object ; but, though still legally a sane man, he would not be con- 
sulted as to whether he wished or did not wish to be cured, nor could 


he interrupt a treatment which after trial he might greatly dislike. 


But more than this is alleged—it is also argued, though less promi- 
nently, that the seclusion of such persons is desirable in the interests 
of society—that the convenience and comfort of society are consulted 


in the matter—and that it is intended by it to save families from ruin 


and misery. These are excellent objects, and it would certainly not 
be dishonest to bring them in a clearer way to the front. Perhaps it 
would even be more honest. They are not motives to be ashamed of. 
They are, indeed, exactly those which lead to the seclusion in asylums 


of a large number of ordinary lunatics. And it is certain that their 


attainment may be much more confidently reckoned on than the re- 
covery of the secluded. So far, indeed as experience teaches, there is 
little evidence that prolonged detention and abstinence would result in 
many cures. This is a damaging fact, and the only good answer that 


252 Occasional Notes of the Quarter. (July, 


can be given to it is that as yet we have possessed no means of acquir- 
ing experience, and that we cannot acquire it without the assistance of 
legislation, We have indeed little to go on but the reports which 
come to us from America. These, however, are generally regarded as 
too good to be true, and it does not appear that practical men in this 
country place much confidence in them. In short, we cannot, as yet, 
tell whether the insane drink-craver can be cured by any sort of treat- 
ment, and there are certainly more things to make us despair than 
there are to make us hope. On the other hand, it is beyond doubt 
that the comfort and well-being of many families would be greatly 
promoted by an enforced withdrawal of some member who is unfortu- 
nately in the condition of those persons in regard to whom this reso- 
lution desires legislation. Whatever prolonged incarceration might 
do for the drink-craver himself, it would often by universal consent 
confer something very like a heavenly blessing on the family to which 
he belongs, and it does not seem unfair that the law should be made 
to protect the healthy and well-doing against the diseased and ill- 
doing. We use the double words here to meet any theory which may 
be adopted regarding the condition of the so-called dipsomaniac. 
With no theory, however, except that which involves the idea of 
disease, do we see how Parliament can ever be successfully approached ; 
and in making a demand for fresh and special legislation, it must be 
shown that we are only now recognising the special form ofdisease 
under which some drunkards labour, and the necessity for a mode of 
treating it which cannot be pursued without legal authority. We 
must define and specify the class of habitual drunkards, for whose 
cure and control we desire to legislate. We can scarcely ask that the 
law should set in motion a scheme for curing and controlling every 
one who could, perhaps properly enough, be called an habitual 
drunkard, because the term is loose, and in its wide embrace includes a 
multitude of persons who could not all be treated in one way. The 
law’s dealing with drunkards generally can only be in the way of 
punishment or of preventing and regulating the sale of drink. ‘The 


resolution of the 7,000 doctors does not touch that aspect of the great — 


drink question. It confines itself to asking legislation for a certain 


specified class of drunkards, and it starts wisely by declaring that an | 


alliance exists between the condition of that class and the condition of 
the insane, in regard to whom the law already and largely concerns 
itself. It thus appears to be only asking an extension of existing 
legislation in a new and narrow direction, without change of principle 
or policy. Whetber this will ever be obtained is doubtful. The diffi- 
culties and obstacles are great and numerous. It is not easy, indeed, 
to see by what machinery the views embodied in the resolution could 
be safely worked out, and as yet we have not been furnished with the 
details of any plan. Among the hindrances will certainly be the 
vague, ill-defined, and unpractical views which direct the action and 
inspire the sensational missives of the friendly society to which we 


1877.] Occasional Notes of the Quarter. 253 


alluded at the outset of this discussion. There is a fact, too, relating 
to insane drink-cravers themselves which may prove both a help and 
a hindrance. It is this: —The majority of them belong to the better 
class of society—to the educated class, that is, from the superior 
artisan upwards, who live in comfort and perhaps in affluence, and 
their whole number, great as it is, is not so great as is often supposed. 
There may be doubts as to the accuracy of this opinion, but careful 
inquiry will cause their disappearance. We refer, of course, exclusively 
to those persons of whom it could be certified that they labour under a 
special form of insanity which has excessive intemperance as one of 
its symptoms. Not a few of these people could thus defray the cost 
of a legalised detention out of their own pockets, and no aid from the 
Consolidated Fund, or from rates of any kind, would be needed 
either to establish or to maintain the institutions in which their 
detention would take place. Such institutions would be the outcome 
of private adventure, under State supervision and control, and Parlia- 
ment might be asked to do nothing more than sanction (with limita- 
tions) the compulsory detention in institutions licensed and supervised 
_ by the State, of persons found after legal inquest of some prescribed 
kind to be in the condition which the resolution defines. If no such 
persons presented themselves, and no such institutions were created, 
then the law would be a dead letter. Such legislation would be in the 
fullest sense permissive. It would permit those to take advantage of 
its provisions who could themselves afford the cost, or who could do so 
through help from charitable and public organisations. At the same 
time it would, in a certain sense, be tentative, since it would yield that — 
experience which is so much needed, 


Conscience in Animals. 


In a paper on “Conscience in Animals,” which Mr. G. J. 
Romanes has reprinted from the ‘Quarterly Journal of 
Science,’ he tells the following story of a monkey’s sym- 
pathy :— 

Many cases of sympathy in monkeys might be given, but I shall 
confine myself to stating one which | myself witnessed at the Zoolo- 
gical Gardens. A year or two ago there was an Arabian baboon and 
an Anubis baboon confined in one cage, adjoining that which contained 
a dog-headed baboon. The Anubis baboon passed its hand through the 
wires of the partition, in order to purloin a nut which the large dog- 
headed baboon had left within reach,—expressly, I believe, that it 
might act as a bait, The Anubis baboon very well knew the danger 
he ran, for he waited until his bulky neighbour had turned his back 
upon the nut with the appearance of having forgotten all about it. 
The dog-headed baboon, however, was all the time slyly looking round 
the corner of his eye, and no sooner was the arm of his victim well 


254 Occasional Notes of the Quarter. [July, » 


within his cage, than he sprang with astonishing rapidity and caught 
the retreating hand in his mouth. The cries of the Anubis baboon 
quickly brought the keeper to the rescue, when, by dint of a good 
deal of physical persuasion, the dog-headed baboon was induced to 
leave go his hold. The Anubis baboon then retired to the middle of 
his cage, moaning piteously, and holding the injured hand against his 
chest while he rubbed it with the other one. The Arabian baboon now 
approached him from the top part of the cage, and, while making a 
soothing sound very expressive of sympathy, folded the sufferer in its 
arms—exactly as a mother would herchild under similar circumstances. 
It must be stated, also, that this expression of sympathy had a de- 
cidedly quieting effect upon the sufferer, his moans becoming less 
piteous so soon as he was enfolded in the arms of his comforter; and 
the manner in which he laid his cheek upon the bosom of his friend 
was as expressive as anything could be of sympathy appreciated. 
This really affecting spectacle lasted a considerable time, and while 
watching it I felt that, even had it stood alone, it would in itself have 


been sufficient to prove the essential identity of some of the noblest 


among human emotions with those of the lower animals. 


In the same paper he relates the following stories of an 
intelligent terrier :— 


The terrier used to be very fond of catching flies upon the window- 
panes, andif ridiculed when unsuccessful, was evidently much annoyed. 
On one occasion, in order to see what he would do, I purposely laughed 
immoderately every time he failed. It so happened that he did so 


several times in succession—partly, I believe, in consequence of my 


laughing—and eventually he became so distressed that he positively 
pretended to catch the fly, going through all the appropriate actions 
with his lips and tongue, and afterwards rubbing the ground with his 
neck as if to kill the victim: he then looked up at me with a trium- 
phant air of success. So well was the whole process simulated that I 
should have been quite deceived, had I not seen that the fly was still 


upon the window. Accordingly I drew his attention to this fact, as - 


well as to the absence of anything upon the floor; and when he saw 
that his hypocrisy had been detected, he slunk away under some fur- 
niture, evidently very much ashamed of himself. 

For a long time this terrier was the only canine pet I had. One 
day, however, I brought home a large dog, and chained him up out- 
side. The jealousy of the terrier towards the new-comer was extreme. 
Indeed, I never before knew that jealousy in an animal could arrive 
at such a pitch; but as it would occupy too much space to enter into 
details, it will be enough to say that I really think nothing that could 
have befallen this terrier would have pleased him so much as would 
any happy accident by which he might get well rid of his rival, Well, 
a few nights after the new dog had arrived, the terrier was, as usual, 
sleeping in my bedroom. About one o’clock in the morning he began 


| 
| 


1877. | Occasional Notes of the Quarter. 255 


to bark and scream very loudly, and upon my waking up and telling 
him to be quiet, he ran between the bed and the window in a most 
excited manner, jumping on and off the toilette-table after each 
journey, as much as to say—‘‘Get up quickly ; you have no idea of 
what shocking things are going on outside.’ Accordingly I got up, 
and was surprised to see the large dog careering down the road: he 
had broken loose, and, being wild with fear at finding himself alone in 
a strange place, was running he knew not whither. Of course I went 
out as soon as possible, and after about half-an-hour’s work succeeded 
in capturing the runaway. I then brought him into the house and 
chained him up in the hall; after which I fed and caressed him with 
the view of restoring his peace of mind. During all this time the 
terrier had remained in my bedroom, and, although he heard the. 
feeding and caressing process going on downstairs, this was the only 
time I ever knew him fail to attack the large dog when it was taken 
into the house. Upon my re-entering the bedroom, and before I 
said anything, the terrier met me with certain indescribable grinnings 
and prancings, which he always used to perform when conscious of 
having been a particularly good dog. Now I consider the whole of 
this episode a very remarkable instancein an animal of action prompted 
by a sense of duty. No other motive than the voice of conscience can 
here be assigned for what the terrier did: even his strong jealousy of 
the large dog gave way before the yet stronger dread he had of the 
remorse he knew he should have to suffer, if next day he saw me dis- 
tressed at a loss which it had been in his power to prevent. What 
makes the case more striking is, that this was the only occasion during 
the many years he slept in my bedroom that the terrier disturbed me 
in the night-time. Indeed the scrupulous care with which he avoided 

making the least noise while I was asleep, or pretending to be asleep, 
_ was quite touching—even the sight of a cat outside, which at any 
other time rendered him frantic, only causing him to tremble violently 
with suppressed emotion when he had reason to suppose that I was 
not awake. If I overslept myself, however, he used to jump upon 
_ the bed and push my shoulder gently with his paw. 

The following instance is likewise very instructive. I must premise 
that the terrier in question far surpassed any animal or human being 
I ever knew in the keen sensitiveness of his feelings, and that he was 
never beaten in his life.* Well, one day he was shut up in a room by 

* A reproachful word or look from me, when it seemed to him that occasion 
required it, was enough to make this dog miserable for a whole day. I do not 
know what would have happened had I ventured to strike him; but once when 
I was away from home a friend used to take him out every day for a walk in 
_ the park. He always enjoyed his walks very much, and was now wholly de- 
pendent upon this gentlemen for obtaining them. (He was once stolen in 
London through the complicity of my servants, and never after that would he 
go out by himself, or with any one he knew to be a servant.) Nevertheless, one 
day while he was amusing himself with another dog in the park, my friend, in 


order to persuade him to follow, struck him with a glove. The terrier looked 
up at his face with an astonished and indignant gaze, deliberately turned round, 


256 Occasional Notes of the Quarter. [July, 


himself, while everybody in the house where he was went out. Seeing 


his friends from the window as they departed, the terrier appears to 
have been overcome by a paroxysm of rage; for when I returned I 
found that he had torn all the bottoms of the window-curtains to 
shreds. When I first opened the door he jumped about as dogs in 
general do under similar circumstances, having apparently forgotten, 
in his joy at seeing me, the damage he had done. But when, without 
speaking, I picked up one of the torn shreds of the curtains, the 
terrier gave a howl, and rushing out of the room, ran up stairs scream- 
ing as loudly as he was able. ‘The only interpretation I can assign to 
this conduct is, that his former fit of passion having subsided, the dog 
was sorry at having done what he knew would annoy me; and not 
being able to endure in my presence the remorse of his smitten con- 
science, he ran to the farthest corner of the house crying peccavi in 
the language of his nature. 

I could give several other cases of conscientious action on the part 
of this terrier, but as the present article is already too long, I shall 
confine myself to giving but one other case. This, however, is the 
most unequivocal instance I have ever known of conscience being 
manifested by an animal. 

I had had this dog for several years, and had never—even in his 
puppyhood—known him to steal. On the contrary, he used to make 
an excellent guard to protect property from other animals, servants 
&c., even though these were his best friends.t Nevertheless, on one 
occasion he was very hungry, and in the room where I was reading 
and he was sitting, there was, within easy reach, a savory mutton 
chop. I was greatly surprised to see him stealthily remove this chop 
and take it under a sofa. However, I pretended not to observe what 
had occurred, and waited to see what would happen next. For fully 


and trotted home. Next day he went out with my friend as before, but after 
he had gone a short distance he looked up at his face significantly, and again 
trotted home witha dignified air. After this my friend could never induce the 
terrier to go out with him again, It is remarkable, also, that this animal’s 
sensitiveness was not only of a selfish kind, but extended itself in sympathy for 
others. Whenever he saw a man striking a dog, whether in the house or out- 
side, near at hand or at a distance, he used to rush to the protectionof his fellow 
snarling and snapping in a most threatening way. Again, when driving with 
me in a dog-cart, he always used to seize the sleeve of my coat every time I 
touched the horse with the whip. 

+ I have seen this dog escort a donkey which had baskets on its back filled 
with apples. Although the dog did not know that he was being observed by 
anybody, he did his duty with the utmost faithfulness; for every time the 
donkey turned back its head to take an apple out of the baskets, the dog 
snapped at its nose; and such was his watchfulness, that, although his com- 
panion was keenly desirous of tasting some of the fruit, he never allowed him 
to get a single apple during the half-hour they were left together. I have 
also seen this terrier protecting meat from other terriers (his sons), which lived 
in the same house with him, and with which he was on the very best of terms. 
More curious still, I have seen him seize my wristbands while they were being 
worn by a friend to whom I had temporarily lent them. 


me7 7. | Occasional Notes of the Quarter. 207 


aquarter of an hour this terrier remained under the sofa without 
making a sound, but doubtless enduring an agony of contending feel- 
ings. Eventually, however, conscience came off victorious, for, emerg- 
ing from his place of concealment, and carrying in his mouth the stolen 
chop, he came across the room and laid the tempting morsel at my 
feet. The moment he dropped the stolen property he bolted again 
under the sofa, and from this retreat no coaxing could charm him for 
several hours afterwards. Moreover, when during that time he was 
spoken to or patted, he always turned away his head in a ludicrously 
conscience-stricken manner. Altogether I do not think it would be 
possible to imagine a more satisfactory exhibition of conscience by an 
animal than this; for it must be remembered, as already stated, that 
the particular animal in question was never beaten in its life. 


The Theory of Vision. 


The following extract is from an article on the Theory of 
Vision in the “ Revue Scientifique” of March, 1877 :— 


The rarer the instances are of the cure of those born blind, the 
more is it to the interests of science to record them, and to study 
them carefully; and it is a fortunate occurrence for science when an 
operation of this kind is made by a skilful operator, and one who is at 
the same time an intelligent, well informed, and attentive observer. 
This combination has been twice fulfilled within some years, at the 
Ophthalmic Hospital, Lausanne. A born-blind was cured in 1852, 
by Dr. Recordon, and another twenty-three years later by his colleague, 
Dr. Mare Dufour. Here are the particulars of the second case. 

A young Savoyard, Noé M., was born blind in the village of Con- 

tamine, on the road Du Col du Bonhomme (Haute Savoie). He grew 
up in this secluded part of the Alps, in the midst of a population 
who had probably no idea that his cure was possible. Dr. Martin, of 
Saint Gervais les Bains, met him one day, perceived the curability of 
his malady, and sent him to Lausanne; he was then twenty years of 

age. Noé M. was afflicted with a congenital cataract of both eyes, 
he had besides a corneal opacity, more particularly of the left eye, 
and a marked movement of nystagmus or spasmodic winking. His 
right eye was operated upon on the 14th of June, 1875. The 
Operation did not present any remarkable incident, and succeeded well. 
The cure was normal. As soon as it became possible, M. Dufour 
carried on a series of observations and experiments, employing convex 
glasses adapted to obtain retinal images as distinct as possible. In 
order to appreciate the results of these observations and experiments 
from a psychological point of view, it is necessary to enter into some 
considerations on the general state of the question. 

Numerous observations and easy experiments show that the object 

of the direct perception of sight is, and always remains, a simple surface 


258 Occasional Notes of the Quarter. [July, 


upon which forms are determined according to the different degrees 
of light and shades of colours. Sight does not perceive directly the 
relief of bodies, nor their distance beyond a surface; their relief is 
only perceived in a secondary and acquired manner when the person 
who sees has learned the signification of shades and of light; it is a 
judgment of habit resulting from experience. This judgment, from 
the very fact that it does not result from the immediate and direct 
action of the sense of sight, is liable to be deceived ; itis the essential 
source of the ordinary illusions of sight, illusions so frequent, and 
which are not properly speaking errors of the visual perception; but 
errors of the judgment occurring on the occasion of this perception. 
The facts in support of the preceding theory are numerous, It 
is difficult, and sometimes impossible, to distinguish on a lofty ceiling 
carvings in relief, from those which are designed on a smooth surface 
by a skilful artist. It is very difficult, even for a practiced eye, to 
discern in a good theatre decoration the point where the side scenes 
end from that at which the drop scene commences. Habit and a 
practical judgment are necessary for that. J remember to have seen 
in a picture gallery the works of a clever painter who had made it his 
speciality to deceive the eye by paintings in relief; the illusion was so 
great that to recognise it, it was necessary to bring the eye close to 

the painting, and the moment one withdrew a step or two the illusion 
was reproduced as vividly asever. The eye, however, becomes able to 
perceive, and in the greater number of cases without error, the relief 
of bodies, and in a certain degree their relative distance in a direction 

perpendicular to the surface which is the object of direct perception ; 

this is the result of the education of one sense by means of another. 

The relief of a body which can be taken in the hand is established 

primitively by the touch; their distance, when known objects are. 
concerned, is calculated by their distinctness, and above all by their 
apparent dimensions. JInielligence intervenes in the end, armed by 

the processes of science, in the first instance to extend the uses of 

sight, and then to rectify its persistent illusions. La Fontaine writes, 


“¢ Si Peau courbe un baton ma raison le redresse.”’ 


In the case supposed in the fable, the intervention of reason is not 
necessary, because the sense of touch could rectify the false judgment 
occasioned by the visual perceptions ; but it is to science alone that 
it appertains to establish the true dimensions of bodies placed beyond 
our reach, to give us the idea of the size of the sun, to set at an 
enormous distance, sometimes to relegate to an incommensurable 
distance, stars which will remain always to the direct perception of 
sight as luminous fixed points on the uniform surface of the heavens. | 

In relation with the necessary education of the sight by touch, the | 
experiments made upon the born-blind confirm the results of the | 
observation of ordinary facts. Cheselden has operated upon many 
born-blind; he has given an account of what he considered the most ji 


1877.) | Occasional Notes of the Quarter. 259 


important of his observations; this was the case of a boy of thirteen 
years of age, upon whom he operated in 1728. When this child re- 
covered its sight, everything appeared to him as a smooth surface, 
which seemed close to his eye. . The blind person upon whom M. 
Recordon operated in the autumn of 1852, judged two houses to be 
equally distant, which were far apart from each other. It very evi- 
dently results from the observations of M. Dufour that Moé M. did 
not, in the first instance, judge in any degree of the relief of bodies 
by the impressions of sight. He beheld, without recognising them, 
objects which were the most familiar to him, but he knew them the 
instant he could touch them; and it is beyond doubt that it was after 
a series of experiences that he learnt to translate his visual impres- 
sions into perceptions of relief. He touched everything, as little 
children do when allowed to follow the instincts of their nature. His 
attendant remarked that when he thought himself unobserved he 
handled all the objects around him, and examined them on every side, 
at the same time passing his hand all about them. The education of 
the sight by touch is not less striking in the other cases that have 
been observed. The boy operated upon by Cheselden could not at 
first distinguish by sight the dog and the cat belonging to the house. 
He was seen one day to catch the cat, which he recognised by touch, 
and after having regarded it attentively, while he felt it, he let it go, 
saying, “Go, Minet, I shall recognise you in future.” The lady 
operated upon by Wardrop, before having made sufficient trials, 
stretched her arm to grasp an object close to her eyes, or, on the con-_ 
trary, searched near her for objects that were at some considerable 
distance. Noé M. was brought before the Société Vaudoise de Méde- 
cine, at its séance of the 5th August, 1875, that is to say nearly two 
months after the operation. At this epoch he no longer made mis- 
takes as to the relief of objects which he knew, nor in his apprecia- 
tion of their distance. He understood then the signification of the 
diminution in the size of an image which results from the distance of 
an object; but when he had to do with considerable distances, and with 
objects which he did not know, his notions were still excessively con- 
fused, and the sight of a landscape seemed to bewilder all his ideas. 
We can then affirm, whether on the grounds of observations and 
experiments easy to be made at any time, or upon the observations of - 
born-blind who have been cured, that the object of the direct percep- 
tion of sight is only a coloured surface. The fact being held for 
established, and the question whether sight perceives directly relief 
and distance being resolved negatively, a second question ¢presents 
itself, Does sight perceive directly forms not in relief? The 
_ problem was propounded by Molyneux, an Irish savant of the end of 
the seventeenth century, specially devoted to the study of mathe- 
matics and optics. Madame Molyneux became blind shortly after 
her marriage. This circumstance, combined with the nature of her 
husband’s studies, contributed probably to direct his attention to 


260 Occasional Notes of the Quarter. [ July, 


questions relating to blindness. After having reflected upon the 
subject, he put the following question to his friend Locke—‘ Suppose 
a man blind from his birth, and now grown up, who had been taught 
to distinguish by touch a cube and a globe of the same metal and 
nearly of the same size, so that when he touched the one or the other. 
he could say which was the cube and which was the globe; suppose 
that the cube and the globe being placed upon a table, this blind 
person became able to see, the question is asked whether on seeing 
without touching them, he would be able to distinguish them, and to 
say which is the globe and which is the cube ?” 

This question appears in the annals of science under the title of 
Problem of Molyneux. This savant himself replies in these terms: 
‘‘ No, for although this blind person has learnt by experience in what 
manner the globe and the cube affect his touch, he nevertheless does 
not yet know that what affects his touch in such or such a manner 
must produce such and such an impression upon his sight.” Locke 
accepted his friend’s solution of the problem. The question thus 
propounded became the occasion of Cheselden’s experiments. ‘The 
relation of this surgeon does not appear to me nevertheless to estab- 
lish experimentally quite certainly that his cured patient did not 
discern forms not in relief, while it establishes, in the most positive 
manner, that he had not any primitive perception of relief, and 
consequently did not recognise objects until he had touched them, 
Condillac accepted and simplified the theory of Locke and Molyneux. 
He affirmed that sight only furnishes us directly with pure sensations 
which do not bring with them any objective perception, no more of 
objects not in relief than of those in relief. Under the combined in- 
fluence of Locke and of Condillac, the prevailing opinion of the 
seventeenth century was that all knowledge of forms in visual 
perception rests on experience and on comparison with touch. This 
theory was energetically opposed by John Miller, not as to what con- 
cerned relief (with regard to that the discussion appears closed), but 
as regarded smooth surfaces. Muller is so resolved in his opinion that, 
not content with having declared himself for the direct perception of 
objects not in relief, he declares himself unable to understand how 
Locke and Molyneux could have pronounced in the negative. In this 
state of the scientific controversy, the observations made upon Woé 
M. are of great interest. It is necessary to state that M. Dufour’s 
remarks upon them are not favourable to the theory of Miller, and 
seem to confirm that of Molyneux. 

In fact, the operation having been successfully accomplished, Nod M. 
continued to move like a blind person; so much so, that Dr. Dufour 
thought for a moment that the cure was not effected. The second 
day of experiments, after having proved by the opthalmoscope the 
integrity of the bottom of the eye, the doctor made his patient sit 
down, and held his watch before him, turning the face towards him, 
at about a stepfrom him. Noé said without hesitating : ‘“ J see some- 


a : 
i 


moo77.| Occasional Notes of the Quarter. 261 


thing white.’ The visual sensation was then established, but how 
much of it was perception? ‘To the question, “ Js ct something round 
or square?’ Noé made no reply. He was asked “ Do you know what 
a square is?” He showed by a movement of his hands that he un- 
derstood very well the meaning of the question. He replied in a 
“similar manner to the question if he knew what was a round by form- 
ing a ring with his hand. He had then, as far as concerned tangible 
form, a clear idea of square and round; but sight did not enable him 
to recognise whether the objects placed before him had the one or the 
other of these shapes. He looked steadily, however, at the watch. 
The next day, that is to say the third day after the operation, the 
experiment was renewed with precisely the same result; but this 
time, which had not been done on the previous day, Noé M. was made 
to touch the watch. As soon as he had grasped it with his hand, 
he said: ‘Jt is round; tt ts a watch.” To recognise the form of the 
watch by the simple use of sight, it was then necessary for him to in- 
terpret a visual sensation by the aid of touch. 

This belief was strongly confirmed by the following experiment, 
which Dr. Dufour relates in these terms; ‘‘I showed him two pieces 
of very white paper like paste-board. These two pieces formed two 
elongated rectangles; the one about ten centimetres long, the other 
twenty centimetres, of the same breadth. ‘ What do you see ?— 
Some white vbjects.—Are they of the same size?” He replied with 
hesitation: No. Is one longer than the other?” A pause. ‘ Which 
is the longest?” No reply. Pressed by me, he declared that he 
could not tell. He touched it,and passing his hand along the longest — 
rectangle, he indicated immediately which was of the largest dimen- 
sions, and then looked attentively at the one and the other. He was 
then given two pieces of the same white paper, the one square, the 
other somewhat oval. ‘ Do yousee a difference between these papers ? 
—Yes. ‘What difference?” Noreply. ‘‘ Well, one of these papers 
is square, and the other is round.—Which is square?’ Noé M. did 
not reply for a moment, and ended by saying that he was unable to 
designate it. I told him to put out his hands and touch them. He 
touched the square piece first, and feeling one of the angles in his 
hand, he said with a vivacity to which his replies had not accustomed 

us: This is the square. He afterwards touched the round piece, then 
examined them both, and from that moment he has always been capa- 
ble of distinguishing round objects by visual sensation alone. It will 
be remembered, indeed, that in a preceding experiment, in examining 
the face of the watch, the patient had already seen a round object, and 
had verified this sensation by touch. But whether the form was not im- 
printed on his memory, or that the experiment had been too short, 
and that, not having the contrast of any other than the round shape 
at the time that he felt the watch, the difference of the outlines ap- 
peared less striking to him, that first experiment was not sufficient to 
impress on Noé M.’s mind the particular visual sensation that affects 


262 Occasional Notes of the Quarter. [July, 


us when we see something round. The experiment of the two papers, 
on the contrary, completely sufficed to give him the knowledge of these 
simple forms. The round paper was about 10 centimetres in diameter. 

The unequal length of the two papers, the difference in the outline 
of a square and of a round shape, are manifested independently of all 
relief. Noé M. did not then distinguish forms not in relief, simply 
by vision, before the experience in which touch intervened. 

Here is a third question: Does the eye perceive primitively and 
before any experience surface movement? To the question thus pro- 
posed, Condillac had given theoretically an entirely negative reply ; 
he had insisted that knowledge of movement does not belong naturally 
to sight, and demands the exercise of touch. The experimental verifi- 
cation of this hypothesis has seldom engaged the attention of 
observers; this gives special importance to the experiments of M. 
Dufour. The question is to learn whether the displacement of visual 
impressions on the retina immediately gives rise to the idea of the 
displacement of objects. In the case of Nog M., the reply is in the 
negative. One of the experiments tried on the first day was this : 
the doctor made the patient sit down, with his back to the window ; 
then placing himself at a distance of two steps from him, he told him 
to look, and made with his hand, which wasin a strong light, oscilla- 
tions of about 40 centimetres against a black coat. To the question : 
“ Do you see anything?” WNoé replied: I see something light. It will 
be remembered, that in his blind state, he distinguished a bright light 
from darkness; he possessed thus the notion of light, and even some 
notion of colours, as we shall see later. ‘To the question : ‘* Do you 
not see something which moves?” He could not reply, although the 
movement was several times stopped and then renewed. Pressed 
with questions, he never arrived at any other answer than this: “ Jé 
is something light.” 

The third day the doctor swung about a watch chain in front of 
him. He said, “ Jt is yellow, it moves.” He had seen the movement. 
What had occurred between these two experiments? Dr. Dufour 
acknowledges that he has no precise data with regard to this; he can- 
not seize upon the exact moment when Moé M. learnt to distinguish 
movement from rest, nor consequently determine the conditions of the 
progress; therefore, with the prudence of a true scientific spirit, he 
offers the following conclusions :—“ The examination of Noé MW. has 
not the character of a definitive experiment. . . . Ihave re- 
tained from his examination the impression that the distinction of rest 
from movement by the means of vision is something which must be 
learned. Evidently the image of the body which moves is displaced 
upon the retina of the observer ; but this displacement, or the succes- 
sive irritation of the different retinal elements, does not give at the — 
first outset the notion of movement. If the patient looked fixedly, he | 
would be obliged, in order to follow a moving body, to move his eyes; | 

and the consciousness he would have of this ocular movement would | 


1877.] Occasional Notes of the Quarter. 263 


perhaps give him the notion of the mobility of the observed body. 
Excepting in this way, I see only co-ordination with touch which could 
give this knowledge, or it may be a known sound with the help of 
other knowledge previously acquired by experience. It was not pos- 
sible to know how Noe M. had acquired the knowledge of movement.” 

To sum up: theobservation of Dr. Dufour confirms previous obser- 
vations made in analogous cases, completes and extends them. It 
establishes that, in many cases at least, when a born-blind acquires 
the use of sight, he acquires the sensation of colours, but that the 
use of sight alone does not furnish him immediately with any element 
of localisation, that is to say, of distances, of forms, and of move- 
ments. Such are the facts. 

The following are references to cases of cures of born-blind ; indi- 
cating the date of the operation, and who was the operator, and the 
special malady of the patient; also the source from whence the par- 
ticulars are derived :— 


i728. Cheselden.—Enfant de treize ans, cataracte congénitale. 
Philosophical Transactions, année 1728, page 
447, 
1806. Home.—Enfant de douze ans, cataracte congénitale. Philo- 
sophical Transactions, 1807, page 838. 
as? id: Enfant de douze ans. Id.,id. 
1826. Wardrop.—Dame de quarante-six ans, adhérences iritiques 
obstruant la pupille. Philosophical Transac- 
tions, 1826, page 529. . 
1840. Franz.—Jeune homme de, dix-sept ans, cataracte congénitale. 
Philosophical Transactions, 1841, page 59. 
(?) Trinchinetti.—IEnfant de dix ans, cataracte congénitale. 
Archives des Sciences Physiques et Naturelle 
de la Bibliotheque Universelle, 1847, page 336. 
(?) ie Enfant de onze ans, 1d., id. 
1852. Recordon.—Jeune homme de dix-huits ans, cataracte congé- 
nitale. Bulletin de la Société Médicale de la 
Suisse romande, 1876. 
1874. Hirschberg.—Enfant de sept ans, cataracte congénitale. 
zs Archives de Graefe, xxi, 1. 
1874. Hippel—Enfant de quatre ans, cataracte congénitale, 
. Archives de Graefe, Xxi, 2. 
1875. Dufour.—Jeune-homme de vingt ans, cataracte congénitale. 
Bulletin de la Société Médicale de la Suisse 
romande, 1876. 
1876. Hirschberg.—Enfant de quatre ans, occlusion pupillaire. 
Archives de Graefe, xxii, 4, 
En 1801, Ware a opéré la cataracte d’un enfant de sept ans (Philo- 
 sophical Transactions, 1801, page 382) ; mais la cataracte était pro- 
bablement acquise. . 


Dex F, 18 


264 (July, 


PART IL—REVIEWS. 





On Idiocy and Imbecility. By Witt1am W. Iretanp, M.D., 
Edin., Medical Superintendent of the Scottish National 
Institution for the Education of Imbecile Children at Lar- 
bert, Stirlingshire; Author of the “ History of the Siege 
of Delhi,” “Studies of a Wandering Observer,” ete. 

_ London: J.and A. Churchill, New Burlington Street, 1877. 


It is safe to prophesy a high reputation and an ultimate 
position, as a standard work, for the volume now under 
notice. Fitly crowning a large amount of good work in his 
special department, extending over several years, Dr. Ireland 
has now collected the fruits of his own labours, and of his 
study of the labours of others, into one compact volume, the 
result being a work valuable alike to the purely scientific 
student and to the practical man, whose daily occupation is 
the care and treatment of idiots and imbeciles. 


Starting with the definitions of idiocy and imbecility, Dr. 


Ireland gives as his own, ‘Idiocy is mental deficiency, or 
extreme stupidity, depending upon mal-nutrition or disease 
of the nervous centres, occurring either before birth, or before 
the evolution of the mental faculties in childhood.” ‘The 
word imbecility is generally used to denote a less decided 
degree of mental incapacity. Thus, when a man distinguishes 
between an idiot and an imbecile, he means that the mental 
capacity of the former is inferior to that of the latter.” 

Thechapter on the “Statistics of Idiocy” showsa large amount 
of careful and laborious work, and that next to it on the 
““ Causes of Idiocy” is exceedingly interesting, and remark- 
able for the common sense views enunciated. The influ- 
ence of heredity, of consanguine marriages, of drunkenness 
in the parents, and of the many other commonly assigned 
causes, are all examined, and the vagueness which surrounds 
many of these and the readiness with which post hoc is 
assumed to mean propter hoc by some observers are indicated. 
The thoughtful views in this chapter are well worthy of 
attention. 

Dr. Ireland’s classification of idiocy is well known, and is 
here given at length, with the substitution of “ Genetous ” 
for his former Congenital Idiocy. 


Some authors have divided idiocy into congenital and acquired—a 


| 


£4877.] Reviews. 265 


distinetion which appears to me of little value where the pathological 
causes are the same. Most of the diseases which produce idiocy may 
occur before birth as well as after it, and we do not require a double 
pathological classification, without any sufficient difference either in 
the nature of the lesion or its results. Coming to the study of idiocy 
after having gained some experience in medicine, I have from the 
beginning viewed it from the standpoint of pathology ; and my idea 
of idiocy is compounded of the following classes, which are generalised 
from individual existing idiots, who resemble one another by having 
the same or similar diseases, as they resemble the type of idiocy by 
having mental deficiency along with a corporeal disease. 


1. Genetous Idiocy. 
Microcephalic Idiocy. 
EKclampsic Idiocy. 
Kpileptic Idiocy. 

. Hydrocephalic Idiocy. 
. Paralytic Idiocy. 
Cretinism. 

Traumatic Idiocy. 

9. Inflammatory Idiocy. 
10. Idiocy by Deprivation. 


DN a nH oo 


The only way to prove the worth of this classification is to exhibit 
the general characteristics of the different groups, and to show in what 
respect they vary from one another. 


Each of these is dealt with at length ; and, in the case of — 
some of the most interesting, such as the epileptic and micro- 
cephalic varieties, the entire subject is entered into in the 
most exhaustive and painstaking manner. 

The probability of a complete cure of idiocy is greater in the 
epileptic form than in any of the other classes save that of idiocy of 
deprivation, 

_ In addition to the chapters on the different varieties, there 
1g one on insanity in children and insane idiots, which will 
be read with great interest. 

Insanity in children is generally connected with tubercular menin- 
gitis, hyperemia of the brain, or the exhausted state of the constitu- 
tion following fevers. It is averred that Indian hemp has been found 
very useful in treating the restlessness which accompanies the mental 


disorder, The associated chorea is often successfully treated ; but, as 


a general rule, insanity in childhood, when it lasts for any time, is 
seldom completely cured. It either ends in death or imbecility, the 
morbid processes having a tendency to injure the nutrition of the 


growing brain. The most frequent forms of insanity are mania and 
“%nelancholia; but cases exhibiting the other mental forms generally 


described have been found, save perhaps insanity with fixed delusions, 


266 Reviews. [July, 


Insanity in children is a rare affection. According to Boutteville, 
the proportion of insane children to insane adults is from five to nine 
years old as 0:9 per cent, from ten to fourteen, 3°5, and from fifteen to 
nineteen, 20 per cent. Out of 21,333 recorded cases of insanity, eight 
were under ten years of age, The distinctive diagnosis between in- 
sanity in children and idiocy presents no difficulty ; the intellectual 
hebetude of the idiot is wanting, and the insane child shows energy 
and passion quite different from the sluggish feeble cast of idiocy. 

Most original of the whole book, and altogether excellent, 
are the long and exhaustive remarks on the best method of 
education in idiots. From them we quote the following, only 
remarking that, besides these, each sentence contains some 
interesting fact, or practical suggestion. 


The Treatment should be both Mental and Physical. 


Nowhere is the maxim of Pestalozzi truer than in the training of 


idiots: “ Nicht Kunst, nicht Buch, das Leben selber ist das Fundament 
der Erziehung und des Unterrichts.” Neither art nor book, but life 
itself, is the groundwork of education and teaching. ‘To produce im- 
provement we must act upon the whole being, upon the body as well 
as the mind, for idiocy or imbecility is not simply mental deficiency 
or inertness, to be removed or improved by a special course of teaching 
adapted to a low mental state, but a deficiency of nervous functional 
power, the result of various diseases of the brain and nervous system, 
and often associated with, and in some measure dependent upon, a 
feeble constitution. A deficiency of mental power, though the most 
important symptom, is far from being the only one. Though no doubt 
the mental faculties in uneducated idiots frequently suffer from want 
of exercise, teaching alone, in many instances, would be attended with 
little or no benefit. In the feeble the tone of health is to be raised; 
in the scrofulous the constitutional defect is to be treated; in the 
epileptic we try to diminish the number of fits, or to make them cease 
entirely. Hach case must be separately studied and treated by 
hygiene and medicine as it seems to demand. In all, the bodily frame 
is to be invigorated by exercise. While this is being done the work 
of the teacher may go on parallel with that of the physician. 


What Pupils benefit most. 


In general it will be found of no use to try to teach idiots to speak 
who have never voluntarily uttered a sound; but when they begin to 
say a few words the process can be much accelerated by the per- 
severing efforts of the teacher. Great benefit is also derived from 
giving vocal exercises to those children who are deficient in pronuncia- 
tion. When speech has fairly begun, a change of scene for a few 
weeks has sometimes a good effect in hastening progress, as it gives 
the mind new perceptions, new feelings, and something new to com- 
municate. When the child has fairly begun to emit sounds, the best 


1877. | Reviews. _ 267 


plan is to teach monosyllabic names of familiar objects, which ought 
always to be shown to him at the same time. When he is able to 
combine words he may be asked simple questions, or taught nursery 
rhymes. The progress the child makes will, of course, depend very 
much on the extent of his mental faculties, and the subsequent 
cultivation given to them. 


There are many other quotations we would willingly make 
from this book, but it will be fairer to our readers and to the 
author to leave them to make each other’s acquaintance. 
We have said enough to bear out the statement that a sub- 
stantial and valuable addition has been made to the medical 
_ literature of the time. 





On Alcoholism, the Various Forms of Alcoholic Delirium, and 
ther Treatment. By Dr. V. Maanan, Physician to St. 
Anne Asylum, Paris, &c. Translated by W. 8. Green- 
FIELD, M.D., M.R.C.P. 


“The Bureau d’Admission of the department of the Seine, 
at the St. Anne Asylum in Paris, of which Dr. Magnan is 
one of the two physicians, is an institution to which no 
parallel exists in England. To it are brought all the cases 
of insanity previous to their admission to the various public — 
asylums, and all cases of acute delirium and mania which 
fall under the care of the police in Paris.” The physician with 
such experience must have gained much new and valuable 
information, which Dr. Magnan has systematised in regard to 
Alcoholism in this book. 

Dr. Magnan first describes the phenomena of intoxication 
and the results of a prolonged administration of alcohol and 
‘absinthe in intoxicating doses in the case ofthe dog. The deli- 
rium, halluciations, motor restlessness, and convulsive move- 
ments closely resemble alcoholism in man, and the modes of 
death are precisely the same as that seen in drunkards. The 
post-mortem appearances, consisting of meningeal hemor- 
rhages and pachymeningitis, the presence of alcohol chiefly in 
the nervous centres and liver, the fatty degeneration of the 
latter organ, the sclerosis are all of the same kind as those 
- found inthe human subject. In England we are not so much 
interested in the account which follows of the action of ab- 
sinthe on man and dogs. The author points out that the 
hallucinations in the alcoholic delirium of man are always of a 
‘painful kind, but he divides the general mental state into the 


268 Reviews. [July, 


maniacal, melancholic, and stupid forms; a distinction without 


any sort of reason we think, the forms being all melancholic 
with different degrees of motor excitement. He classifies in 
another way the patients who labour under alcoholic delirium. 
He divides them into three groups according to the clinical 
facts and terminations. The first group consists of “ patients 


affected with alcoholic delirium, with easy, complete and — 


rapid convalescence,” the second of “ patients with slow con- 
valescence and with bad relapses,’ and the third of 
“patients specially predisposed, who, when suffering from 
alcoholic delirium, have frequent relapses and a con- 
valescence often interrupted by delirious ideas, assuming 


more or less the form of partial delusions.’ The author 


does not think any medical treatment but the simplest 
necessary for alcoholic delirium, and he is_ evidently 
against sending any but the patients in the third group 
to asylums. | 

A distinct class of cases is separated and described as 
those who suffer from “ febrile delirium tremens,” when the 


temperature rises in the first few days from 102° to 105°. 
In such patients the prognosis is less favourable. The author 


points out that alcohol can only be detected in the organs, 
when a case has died within seven days after drinking; he 
also shows that the epileptiform attacks have no relation to 
the muscular tremblings. He gives some instructive diagrams 
showing the diminished sensibility both absolutely and re- 
latively, in the two sides of the body. Jn the treatment of 
such case Dr. Magnan does not use the camisole, which he 
says asphyxiates the patient, but uses a dress of his own in- 
vention which he calls the maillot, and which is so effectual for 
its purpose, that he says in it “our alcoholic may struggle, 
ery, dash himself against the walls, or throw himself on the 
ground, and no accident need be feared.” This seems only 
too good to be true. He urges the use of diluent drinks, 
diaphoretics, and diuretics, and support of all kinds in the 
febrile delirium, which is the only alcoholic delirium that 


would be generally recognised as delirium tremens proper 


in this country. He uses opium in moderate doses, but en- 
tirely abjures chloral. The author, it seems to us, scarcely 
dwells enough on the danger of suicide in simple and febrile 


alcoholic delirium, and on the importance of the suicidal — 


impulse, as a complication of these diseases. 


There is an excellent chapter on chronic alcoholism, its | 
mental and bodily symptoms, and the sclerosis, steatosis, | 


: 


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1877. | Reviews, 269 


atheroma and diffuse myelitis found aftér death in those 
cases. The variety in the mental, motor, and sensory symp- 
toms during life are, he thinks, explained by the varying 
extent and position of these changes in the brain. He 
criticises Huss’ classification of the cases, and we think with 
justice. The first class of cases he describes are those 
“with a tendency to dementia,” and of these, as of all his 
varieties, he gives many clinical cases in detail. The first 
part of the book where we should be disposed to differ en- 
tirely from Dr. Magnan, is where he describes a class of 
cases of “chronic alcoholism terminating in general 
paralysis,” and implies that the latter disease is one of the 
natural terminations of the former. That general paralysis 
is sometimes caused by excess in alcohol, especially if this is 
combined with other excesses, we believe to be true, but in 
such a case, a new disease quite different from any of the 
ordinary and direct effects of alcohol has arisen, a disease no 
doubt that in some of its symptoms is so like some cases of 
alcoholism that it is impossible to distinguish them without 
careful study, but still that is pathologically and clinically 
distinct from it. Dr. Magnan gives two interesting pulse 
tracings, the one from an alcoholic paralytic, and the other 
from a case of general paralysis without alcoholic antece- 
dents, which strongly contrast with each other, the difference - 
arising, he explains, from the presence of atheroma and 
diminution of the elasticity of the arteries in the former. The 
hemi-anesthetic and hemiplegic forms of chronic alcoholism 
are well described and illustrated. The coldness of the 
insensible limbs, sometimes by two or three degrees, the 
anesthesia of all the mucous surfaces, while the reflex 
action remains, e.g., tears flowing after irritation of an eye 
- whose cornea was perfectly insensible to touch, are most in- 
teresting phenomena. In speaking of the treatment of 
chronic alcoholism, he advocates confinement. ‘Tonics of 
all kinds, open air and hygiene, dieting and therapeutic 
agents must furnish the basis of medical treatment.” He 
recommends arsenic in this disease, as also in the first stages 
of general paralysis. 

If all the cases of “ Dipsomania ” were as distinct and 
well marked as the two given in this book, we should be re- 
lieved of much difficulty, but unfortunately we do not find 
them to be so. His chapter on general paralysis is the 
weakest in the book. We think that Dr. Maenan has a 
totally wrong conception of this disease, though it is one to 


270 Reviews. July, 


which he has devoted very special attention. The book is 
well translated by Dr. Greenfield. 





System of Positive Polity. By Avcusts Comrr. Fourth 
Volume, containing the Theory of the Future of Man. 
Longmans, Green, and Co., 1877. 


This is the concluding volume of the “ System of Positive 
Polity,” the whole of which Comte’s disciples have now given 
to the English public. The translation is by Mr. Richard 
Congreve, and whether it be that the matter is less interesting, 
or the style more prolix, or that the translation has been less 
clearly done, we must confess to having found the volume 
more difficult to read than the preceding volumes. There is 
an appendix containing all the early essays of Comte on 
Social Philosophy, which has been translated by Mr. Henry 
Dix Hutton. Marginal notes to the text, and a full table of 
contents, add to the usefulness and the value of the work. 
After the great labour which his disciples have undertaken 
in placing the “ Positive Polity’ in the hands of English 
readers, it may appear somewhat ungracious to express a wish 
that they will set to work to produce a condensation of it 
similar to that which Harriet Martineau made of the “ Positive 
Philosophy ;”” but we feel sure that if they were to do so 
they would do a great service to many who will never succeed 
in mastering, even if they are not discouraged from trying 
to master, the contents of four large and diffusely written 
volumes. 

In this volume Comte, in order to give definiteness to his 
conception of the independence of woman, propounds a 
daring hypothesis, which we do do not remember to have 
seen quoted and commented upon anywhere, either by his 
disciples or by others, but which is “ possibly destined,” 
he says, ‘‘to become a reality in the course of our advance, 
though at what time, or even in what manner, is not for me 
to enquire.” 

“Tf in human production the man contributes merely a 
stimulus, one that is but an incidental accompaniment of the 
real office of his generative system, then it is conceivable that 
we might substitute for this stimulus one or more which 
should be at women’s free disposal. The non-existence of 
such a power in the animal races nearest to man is no 
sufficient reason for refusing it to man, as the most eminent 





1877. | Reviews. 271 


race, and the most susceptible of modification. In man the 
privilege would be in accordance with other peculiarities of 
the same function, with menstration for instance, which is a 
decided advance on the rudimentary form of it found among 
the higher animals, an advance due solely to our civilized 
condition. — 

“JT need not dwell further upon this hypothesis, the sole 
object of which is to implant a presentiment, as it were, of 
the degree in which woman, even in her physical functions, 
may become independent of man. . . . Supposing the 
independence of woman ever to attain this limit, as a conse- 
quence of the sum of human progress, moral, intellectual, and 
even physical, then her action on society would be increased 
in an eminent measure. We should then no longer hesitate 
_ between the coarse view now prevalent and the noble doctrine 
to which Positivism gives its systematic form. The highest 
species of production would no longer be at the mercy of a 
capricious and unruly instinct, the proper restraint of which 
has hitherto been the chief stumbling-block in the way of 
human discipline. The function, and all the responsibilities 
it involves, would then be vested as it should be, in its 
highest organs, in those who alone can overcome the weak- 
ness of impulse; and the object of the transfer would be the | 
accomplishment of all attainable amelioration.” 

Whether this be a necessary part of the scheme which is to 
“present the Utopia of the Virgin-Mother as the synthetical 
condensation of the Positive religion,” we know not; but it 
is certainly a novel suggestion, which had never occurred to 
‘the present writer, that mankind would ever reach a stage of 
high development at which woman would contrive to fertilize 
herself in some mysterious way. No doubt the change would 
get rid of a great deal that is coarse and repugnant to a 
- refined sensibility, for many persons must have sympathised 
with Sir Thomas Browne, when he says: ‘ I could be content 
that we might procreate like trees, without conjunction, or 
that there were any way to perpetuate the world without this 

trivial and vulgar way of coition ; it is the foolishest act a 
wise man commits in all his life; nor is there anything that 
will more deject his cooled imagination, when he shall con- 
sider what an odd and unworthy piece of folly he hath com- 
mitted.” But it may be hoped that if nature ever goes so far 
in improving the scheme of human propagation as to do 
without the help of man, it will go still farther, and will get 
rid of all that is objectionable in it; that it will be as Goéthe 


272 Reviews. [July, 


thought would be so much prettier—Es wiire doch immer 


htibscher wenn man die Kinder von den Baumen schiittelte. 
This volume contains the exposition of the fundamental 
theory of Humanity as the Great Being; a general view of 
the affective life, or the definite systematisation of the Posi- 
tive System of Worship; a general view of the intellectual 


existence of man, or the definite systematisation of the 


Positive doctrine; a general view of man’s active existence, 
or the definite systematisation of the Positive life; and a 
general view of the last phase of the transition—a philosophi- 
cal estimate of the present in its relation to the future and 


the past. It ends with a final invocation of “‘ the noble and_ 


tender-hearted lady, my patroness and exemplar,” to whose 
sacred memory he offered what he calls justly “‘an excep- 
tional dedication,” at the commencement of the first volume. 
Nothing is so distasteful to us in Comte’s writings as these 
sentimental ebullitions concerning the divine Clotilda. And 
we know nothing so suggestive of the organisation and 
machinery of Roman Catholicism as his systematisation of the 
Positive System of Worship; he has taken its scaffolding to 
build up Positivism in place of Christianity. 





Essai de Psychologie: La Béte et VHomme. Par le Dr. 
Hpovarp Fournré. Paris: Didier et C™ 1877, 


This essay is intended to form the first part of a work which, 
when completed, is to have the ambitious title of “ A Philo- 
sophy of the Sciences ;” the second part of it being entitled 
* science.”” Because the same word is often used in psycho- 
logy by different authors in different senses, and thereby 
obscurities, confusion, and sterile criticism are occasioned, 
the author begins with a chapter in which he defines, with 
laborious care, and at considerable leneth, the meaning of the 
expressions which he makes use of in his psychological voca- 
bulary. We set ourselves to study these elaborate definitions 
with an earnest desire to profit by them, but we must confess 
that we were sadly disappointed, for they are extremely vague, 
and do not seem to show so much understanding of his sub- 
ject as the author’s pretensions entitle us to look for. For 
these pretensions are by no means humble: throughout the 
book we find him discussing his conviction that he has cleared 
up obscurities and settled difficulties which have troubled 
philosophers ever since philosophy began. And the mis- 


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1877.) Reviews, 273 


fortune is that when we try our best to understand the ser- 
vice which he claims to have done, we often fail to do so; 
words of learned sound and vague. meaning doing duty for 
explanations of things. His idea of simplifying obscure 
facts is to slide confidently over them on vague and somewhat 
dogmatic assertions, We attempted honestly to read the 
book by beginning at the beginning, and going steadily on, 
but our attention wandered so frequently that the attemp 
was abandoned, ' 

One of the author’s dogmata which has surprised us is, 
that ‘‘ animals do not understand ”—that intelligence is ex- 
elusively human. The elephant, the dog, and the monkey 
entirely destitute of intelligence! The way in which he 
supports this opinion certainly seems to show that, whether 
such animals have understanding or not, he does not under- 
stand them, and warrants a grave doubt whether he under- 
stands the subject which he writes about. We should like 
him to explain by what faculty the Arctic fox, which sees 
comparatively little of man, and cannot therefore benefit by 
the collision of intelligence, achieves such a clever trick as the 
following :—When several of its companions have been 
trapped it gets cunning and will not come near the traps, 
and the hunter is then obliged to devise a new method to. 
kill it. He suspends a loaded gun between two poles stuck 
in the snow, and attaches to the trigger a long string, one 
end of which he carries forward under the snow in a line 
with the gun, fastening the bait to its other end in such 
a position that when the fox seizes the bait and so fires the 
oun it is shot. When this fate has befallen a few foxes, 
the animal executes a clever turning movement, and attacks 
the enemy in the flank; for it digs a trench in the snow at 
right angles to the bait, lies down in it, and, seizing the bait, 
fires the gun, whereupon it trots off unharmed with its prize. 
‘If that clever trick does not show understanding, it is hard 
to say what understanding is. 

Dr. Fournié is medical officer to the National Institution 
for the Deaf and Dumb, and we have been not a little sur- 
prised to find that he thinks very little of the method of 
teaching the deaf and dumb to speak and to read speech 
by observation of the motions of the lips, and that he rele- 
gates it to a very subordinate position in the education of 
them. Hedeclares that the basis of education should be to 
develop their intelligence by its natural instrument, which 
‘he considers to be gesture-language, and to have translated 


274 Reviews. [July, 


into this language all the ideas conveyed by writing. The 
articulation of sounds may be cultivated, as a sort of crown 
of instruction in those who show an aptitude to that sort of 
exercise. 


A 


Théorie du Fatalisme (Essai de Philosophie Materialiste.) Par 
B. Comra, Professeur de droit civil 4 I Université de 
Jassy. 1877. 


We welcome this essay, which comes to us from Roumania, 
where they are doubtless thinking now of other things than 
philosophy. Init the author attempts to prove that all the 
phenomena of the world, whether physical, moral or intel- 
lectual, are governed by fixed natural laws; that, conse- 


quently there is no such thing as so-called free-will, human . 


or divine, and no such thing as chance; and that in this 
world, so far as we know, there is nothing but matter, which 
obeys fixed laws in all its infinite movements and transfor- 
mations. In order to carry out his purpose, he proposes to 
pass in review successively—(1) Physical and physiological 
phenomena; (2) Social phenomena; and (3) Psychological 
phenomena. Certainly he does pass very rapidly over the 
first class of phenomena, devoting to them a short chapter 
which consists of exactly seventeen lines and one-third of a 
line, and containing 127 words! His reason for this brevity 
is, that the phenomena present no difficulties in the way of 
the theory which he upholds, and that he thinks it better to 
discuss at length the phenomena of the second and third 
orders, which do present difficulties. The second class, how- 
ever, does not occupy him long, being disposed of in a chapter 


of ten short pages. The bulk of the essay is devoted to the - 


consideration of psychological phenomena. 
In this psychological part the author’s aim is to explain 
through the play of mechanical forces, physical and physio- 


logical, all the faculties of the mind, not excepting the highest — 


creative imagination and the consciousness of self. It will 
not excite surprise that he claims the right to use hypotheses 
in the accomplishment of his aim. Many of his readers will 
be apt to think that, with such license as he has taken in this 


respect, it is possible to-explain anything, however difficult, — 


and at the end of all to be no nearer an explanation than at 
the beginning. He seems to us to be suffering a little from 
Herbert Spencer on the brain, and to have carried the method 
of explanations that explain nothing to something like a 
reductio ad absurdum. 


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#977; | Reviews. 275 


Psychiatrische Studien aus den Klinik des Professor Lepus- 
porF. Vienna. 1877. 


This is a foreign equivalent of the West Riding Asylum 
Reports, and is another indication of a determination to 
utilize, for the advancement of medical science, the material 
so abundantly provided in all asylums. Another very im- 
portant object is gained in the preparation of such volumes. 
The papers are mostly the productions of young men; and 


_ although they may not show great power and originality in 


the writers, they do indicate a certain amount of good work. 

Professor Leidesdorf has succeeded in establishing a very 
efficient system of clinical instruction in the mental diseases 
at Vienna, and to this fact we owe the present volume. It 
contains eleven papers, all of which we have read, and of each 
of which we at first intended to give an abstract, but that 
would have necessitated a very long notice. We therefore 


- content ourselves with giving the titles of the papers. 1. 


General and Statistical about the Psychiatric Clinique in the 
Lower Austrian District Asylum. 2. Psychical Epilepsy. 
3. On Electrical experiments in Paralytic Dementia. 4. On 
Convulsions due to Alcoholic Intoxication. 5. Atropine and 
its use in Epilepsy. 6. On the Influence of the Sympathetic 
on the Circulation of the Retina. 7. On Wet Packing in » 
Maniacal Excitement. 8. Ophthalmoscopic Observations in 


the Insane. 9. On Primary Dementia. 10. Paralytic Myel- 


itics. 11. A Case of Hematomyelitis. 
lt may be seen from the titles of the papers that they 


all refer to subjects which have already been more or less 


under notice, and we cannot say that we have encountered 


much that is original. Some of the conclusions may be 


questioned; but those who are engaged in similar studies 


~ will find it useful.to refer to many of the observations con- 


” tained in this volume. 





Contribution to the Pathologic Anatomy of the Blood 
Vessels of the Brain. By Dr. OBERSTEINER (Vienna). 


In this small work we have an attempt to describe the 


natural and morbid microscopical appearances that are seen 


in the vessels of the brain. It is very evident, however, that 
Dr. Obersteiner’s observations are not without many serious 
errors, which only a more careful and more extended. study 


will remove, but it is not easy to point out the faults with- 


276 Reviews. [July, 


out reference to the original preparations. He has, however, © 


endeavoured to reduce these errors to a minimum, and hence 
his results are on the whole fairly trustworthy. In the study 
of the state of the vessels there is certainly a good founda- 
tion for understanding something of the pathology of the 
brain itself; and hence its importance. 

Dr. Obersteiner first enters into a description of the 
normal structure of the vessels; this differs little from that 
of the text books. In all but the very smallest, there are 
from within outwards Endothelium, Membrana fenestrata, 
Tunica muscularis, and the Lymph sheath. The lymph 
sheath surrounds the whole of the blood vessels of the brain 
like a mantle, which in no place is united to the underlying 
layer. This sheath encloses a space called the adventitial 
lymph space. Between the lymph sheath and the brain sub- 
stance there is another space, also belonging to the lymphatic 
system, the perivascular lymph path. This has no proper 
outer wall, but is separated from the brain by very fine 
tissue processes forming the pericellular space. 

Dr. Obersteiner enters very fully into the views of various 
authors on the nature of this lymph sheath and the space. 
He then gives the result of his observations on the blood 
vessels of ninety-one persons, ranging inage from one month 
to 70 years. 

A. The Adventitia—1. Fatty Infiltration—The seat of this 
is either in the inside of the lymph sheath—which, instead 
of being a bright, clear, transparent membrane, becomes dull 
and opaque (diffuse fatty infiltration)—or else the fat is 
deposited as several large drops (granular fatty infiltration). 
The fat corpuscles may be in such numbers as to present a 


speckled appearance, under a low power; or they may run — 


together and enclose the vessel in a kind of ring, or there 
may be several layers of fat, giving rise to a bulging of the 
vessels. | 

Dr. Obersteiner does not think that fatty infiltration 1s 
entirely pathologic, for he did not find a brain in which the 
vessels throughout were free from fat in the adventitia. He 
believes that infiltration in the form of fat drops or corpus- 
cles is for the most part the remains of the embryonic state, 
or of early childhood. The rarer form of fine fat granules 
evenly distributed in the adventitia may, however, be a sign 
of pathologic change ; it is seen especially in drunkards. 

2. Pigmentary deposition.—l. As true heematoidin either 
in the form of rhombic crystals, or amorphous granules, both 


1877. | Reviews. 277 


may not infrequently be enclosed in a fat corpuscle cell: they 
are found in the neighbourhood of blood extravasation and 
old apoplectic clots. 

2, As dark brown finely granular pigment enclosed in 
peculiar pigment cells; found mostly in meninges and espe- 
cially at edge of medulla. They are elongated cells, with 
thick processes and a most distinct nucleus; their long axis 
is parallel to the course of the vessel. 

3. As a black, very finely granular pigment scattered in 
the adventitia ; this resists many chemical re-agents. 

4, Most frequent form, that of roundish granules, the 
largest of which is probably only 0-005 mm. in diameter. 
They frequently collect together, and take on a mulberry 
form. The colour varies from bright yellow to a brown; it is 
lighter in children. It is probably without pathologic signi- 
ficance, being produced by a higher oxidation of the fat 
collected in the vessels. This is proved by their chemical 
reaction. 

3. Calcareous degeneration.—This commences as bright, 
very refractive points, something like fat drops; these blend 
together and form globular or glandular enlargements. The 
adventitia after a time may become changed into a calcareous 

_ cylinder. , 
4, Hypertrophy, Proliferation of Nuclet.—In hypertrophy — 
the adventitia becomes spindle-shaped, of a streaky wavy 
_ appearance, longitudinally ; sometimes long processes extend 
from the adventitia into the brain substance. The prolifera- 
tion of nuclei takes place into the adventitial lymph space. 

do. Dilatation of the Adventitia.—This is a dilatation of 
the lymph channels without any communication with the 
Inner wall taking place. The space so formed is frequently 
beset with fat corpuscles and pigment. Sometimes the dila- 
tation is in the form of bulle, at others retention cysts are 
produced, in which various elements collect and obstruct the 
lymph stream. 

B. The Adventitial Lymph Space.—This may be obstructed 
by adhesion of the adventitia to the media. Jt may contain 
excess of lymph corpuscles, fat globules or pigment or amy- 
loid bodies ; frequently various anomalous bodies, which are 
possibly metamorphosed lymph corpuscles. Other deposits 
may be met with as cells of tubercle, sarcoma, cancer, 
Syphilis, etc. A dissecting aneurism is formed by weaken- 
ing and bursting of the inner layers of the walls of the blood 
vessel and escape of blood into this space. In purulent 


278 Reviews. [July, | 


meningitis pus may be traced along the vessels from the 
periphery into the interior of the brain substance. 


C. The Media—1. Fatty imfiltration.—This is first seen in 


_ the muscular fasciculi as bright, refractile fat drops; these 
coalesce, and so a dull yellowish colour tube is formed. Itis 
uncertain how far this condition is abnormal, as Dr. Ober- 
steiner has found it as often in the sane as the insane. 

2. Pseudo-Hypertrophy.—This affects small portions of the 
muscular tissue of the arteries, its nuclei disappear and the 
cells change their shape and become granular. ‘The nature 
and significance of this is uncertain. 

3. Calcification.—In two forms, either as small, clobular, 


refractile bodies, or diffused and forming a dull granular 


cylinder. This may easily be mistaken for fatty degenera- 
tion, but is distinguished from it by the action of chemical 
re-agents. 

A, Hypertrophy of the Connective Tissue.—The media in 
this case has a streaky appearance, as the normal elements 
are replaced by connective-tissue processes. 

5. Other Changes.—Amyloid and colloid degeneration. Dr. 
Obersteiner met with the latter in a case of hydrophobia. 
The vessels may be bent; this is almost always a sign of 
congestion, and is due to some abnormal state of the media. 
Circumscribed dilatation of the vessels is often seen, espe- 
cially in the pons and medulla; this may be spindle-shaped. 
The blood effused from a rupture vessel may take two forms, 
either as an irregular shaped mass, sometimes like the 
branches of a tree, or as numerous roundish puncta. 

D. Membrana Fenestrata and Intima.—There is not much 
to remark in these; they are the most seldom diseased, and 
the last to become so. There may be shrinking of the endo- 
thial nuclei, and the endothelium may become detached from 


the basement membrane and form folds in the interior of the © 
vessel, which on superficial examination may be mistaken for | 


coagulation products. 


H. Contents of the Vessels—Blood. This depends on ‘the , 
state of the brain before death. Lymph embolism has been | 


met with in leucemia; this is a collection of white cor- 
puscles ; it is most likely post-mortem, or at least produced 


immediately before death, the white corpuscles having a | 


tendency to cohere, and not being so mobile as the red, 
collect in the course of the vessel. Fat embolism may 
occur; it must not be confounded with that formed in or 
from the walls of the vessels. 


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1877.] Reviews. - 299 


_ After all, Dr. Obersteiner has not been able to draw very 
positive conclusions from his observations; he has certainly 
not shown that any special peculiarity of the vessels is con- 
nected with the various forms of insanity. Nor will this 
ever be accomplished, if it is possible, till workers will unite 
together for the purpose of settling how and what to observe ; 
for in spite of the immense amount of time and labour that 
has been bestowed on the histology of the brain, the subject 
is still in a most unsettled and unsatisfactory state. It will 
continue to be so, so long as microscopists are only anxious 
to find out something “ fresh,” so long as they work indepen- 
dently, and, as they do, in opposition to one another. 








PART IIl—PSYCHOLOGICAL RETROSPECT, 





1. American Psychological Literature. 


By A. R. Turneuuzt, M.B., Assistant Physician Royal Edinburgh 
Asylum. 


American Journal of Insanity. 


Vol, 32. 

January, 1876. No. 8.—Proceedings of the Association of Medical 
Superintendents. Case of Hrastus Hotchkiss, by Dr. Joseph Work- 
man. Reviews, &c., &. 

April, 1876. No. 4.—Case of Jacob Standermann, by Dr. John 
Ordronaux. Probationary Leave of Absence, by Dr. Henry Landor, 
Reparation of Brain Tissue after Injury, by Dr. John P. Gray. The 
Examination and Commitment of the Insane, by Dr. A. E. Macdonald. 
Reviews, &c., &e. 





Viole3de >. 

July, 1876. No. 1.—History and Description of the Connecticut 
Hospital for the Insane, by Dr. Abram Marvin Shew. Notes on 
Asylums for the Insane in America, by Dr. John Charles Bucknill. 
Asylum Periodicals, by Dr. Judson B. Andrews. Preparation of 
‘Tissues for Microscopical Examination, by ‘Theodore Deecke. 
Reviews, &c., &c. 

October, 1876. No. 2—Notes on Asylums for the Insane in 
America. Proceedings of the Association of Medical Superinten- 
dents. Summary, &c. 

_ The Journal of Nervous and Mental Diseases. New Series. Vol. 1. 

_ January, 1876. No. 1.—The Brain not the Sole Organ of the 

Mind, by Dr. W. A. Hammond. <A Contribution to the Study of 

Syphilis of the Nervous System, by Dr. R. W. Taylor, The Patho- 

logy of Tetanus, by Dr. H. M. Bannister. Notes on the Pathology 
XXIII. 1 


280 Psychological Retrospect. [July, 


of the Sympathetic Nervous System, by Dr, T. E. Clark. What is 
Needed for the Successful Treatment of Inebriates? by Dr. H. 5. 
Davis. On Cerebral Anemia, by Dr. J. L. Teed. The New York 
Neurological Society. Reviews, &c., &. 

April, 1876. No. 2.—General Structure and Modes of Action of 
the Nervous System, by Dr. J. S. Jewell. Lesions of the Infacial 
(especially Facial Neuralgia) resulting from Disease of the Dental 
Organs and other parts, by Dr. D. H. Goodwillie. The Intra- 
cranial and Intra-ocular Circulation, by Dr. J. C. Shaw. On the 
Plea of Insanity as an Excuse for the Commission of Crime, by Dr. 
Walter Hay. A Contribution to the Pathology and Therapeutics of 
Pertussus, by Dr. 8. D. Powell. On Migraine, by Dr. J. L. Teed. 
A Discussion of the Relation of the Nervous System to the Uterus, 
with special reference to the phenomena of Parturition, by Dr. Henry 
M. Lyman. Cases of Infantile Paralysis, Paraplegia by Rheumatic 
Metastasis ending in Hemiplegia and Recovery, and Cerebral 
Paralysis, by Dr. J. J. Caldwell. Reviews, &., &c. 

July, 1876. No 8.—Facial Paralysis of Cerebral Origin, occur- 
ring in Infancy, by Dr. 8. G. Webber. Note on the Physiology of 
the Respiratory Apparatus, by Dr. Isaac Ott. The Lesions in 
Paralysis Agitans, by Dr, Lantenbach. Note on the Structure and 
Arrangement of the Medullated Nerve Fibres in the Ganglia of the 
Posterior Roots of Spinal Nerves, by R. W. Amidon. The Nature 
and Treatment of Epilepsy, by Prof. Dr. M. Benedikt. On Mental 
Vertigo, by Professor Laséque. A Case of Poisoning by Coal Gas, 
by Dr. Ransom Dexter. The American Neurological Association. 
Reviews, &., &e. 


The Quarterly Journal of Inebriety. 


Vol. 1. 

December, 1876. No. 1.—President’s Address, by Theodore L. 
Mason. Causes of the Increase of Inebriety in America, by George 
M. Beard. Proceedings of the American Association for the Cure of 
Inebriates. Clinical Notes, &c., &e. . 

March, 1877. No. 2.—Duration, Mortality, and Prognosis of In- 
ebriety, by Dr. T. D. Crothers. The Relation and Hereditary Ten- 
dency between Inebriety and Epilepsy, by Dr. E. C. Mann. 
Reviews, &c., &e. 

Pamphlets. 


Transactions of the American Neurological Association for 1875. 

On Masturbation and Hysteria in Young Children, by Dr. A. 
Jacobi. 

Association of Medical Superintendents—In the report of the 
proceedings of this Association (meeting at Auburn), interesting in- 
formation is furnished in regard to the progress of various asylums 
in different States of the Union; and notes are given of the discus- 
sions which took place on different points of importance brought up 





1877.] Psychological Retrospect. 281 


at the meetings. In regard to the liberation of patients from asylums 
on parole, the opinion of American Superintendents seems in general 
to be opposed to the system, as being attended with too great respon- 
sibility and risk, and unsuitable for the class of patients to whom it 
is usually applied (unrecovered or only partially recovered patients) ; 
but a few advocate and practise the system. A discussion took place 
‘upon the proper method of treatment of inebriates; and the Associa- 
tion adopted resolutions stating that, in its opinion, it is the duty of 
each of the provinces of the United States “to establish and main- 
tain a State or public institution for the treatment of inebriates, on 
substantially the same footing in respect to organization and support 
as that upon which the generality of State and provincial institutions 
for the insane are organized and supported ;” that the voluntary 
system when applied to inebriates must in most cases prove entirely 
futile, and that, therefore, statutory power should be given for the 
compulsory detention of such persons when required ; and further, 
that inebriates ought to be treated, not in ordinary institutions for the 
insane, but in separate institutions. 

Discussions also took place on the responsibility of insane persons 
for criminal actions, on some of the predisposing causes of insanity, 
and on other matters. 

Case of Erastus Hotchkiss, and Case of Jacob Standermann.— 
These are records of two cases in which the persons were brought to 
trial on the charge of murder, found guilty, and sentenced to death, 
and in which insanity was afterwards proved. The former seems to 
have been a case of acute recurrent mania; while the latter was that 
of a young man, with a strong hereditary tendency to insanity, 
Subject to epilepsy, and much enfeebled in mental power. In both 
cases a careful medical examination proved that the criminal action 
was performed while the person was under the influence of an insane 
impulse, | 

Probationary Leave of Absence.—In this paper Dr, Landor advo- 
cates the system of granting probationary leave of absence, prior to 
‘discharge from the asylum, to suitable patients, and shows that when 

the cases are judiciously selected, the results are very satisfactory. 
He gives a tabular history of 114 cases, in which he had liberated the 
patient on probation, and sums up his results in the following sen- 
 tences:—‘‘ It will be seen from the recapitulation of the table that 
fifteen were returned to the asylum out of the total of one hundred 
and fourteen. This must be regarded as a very small proportion, and 
‘it shows that the selection of cases for probation was carefully 
made. The fifteen discharged, after the termination of the proba- 
tionary period, improved, but not cured, cannot be said to be failures, 
for it is probable that there would not have been fifteen improved had 
they all been retained in the asylum. But seventy-eight were 
reported well at the end of the time of probation. It does not admit 
of more than a guess as to how many of these would have recovered 


282 Psychological Retrospect. [July, 


if detained in the asylum. I am sure that a considerable number 
suffered from the disciplinary rules of a large asylum, and I think I 
put it very moderately, when I assert that at least five per cent. would 
have turned out incurable. I am strongly of the opinion that 
results which can be put at that rate justify the system of probation. 
previous to discharge.’ 

Reparation of Brain Tissue after Injury. —Dr. Gray gives an 
account of two cases of injury to the cranium, with injury and 
destruction of the adjacent brain matter, m which reparation of the 
brain-tissue afterwards took place with more or less completeness. In 
the first of these cases the patient recovered from the injury, but was 
deaf. The second was that of a soldier struck in the head by a ball, 
which crushed in the posterior part of the right parietal bone, 
leaving a large opening in the skull, and becoming imbedded in the 
substance of the brain. The ball was removed ten days after. The 
patient’s death took place eleven years afterwards ; and at the post- 
mortem examination an elliptical opening was found in the right 
parietal bone, corresponding to the wound caused by the ball. No 
attempt at bone reparation had been made; the dura mater extended 
over the opening, and was firmly adherent to the scalp; the arach- 
noid and pia mater were so completely renewed that no trace of the 
injury could be detected in their structure or by the presence of 
cicatrices. The convolutions were fully outlined, and resembled in 
appearance the other convolutions of the right hemisphere. Vertical 
sections through these repaired convolutions showed the normal pro- 
portion of grey and white matter. Dr. Gray concludes from these 
cases, and two others previously published, which he quotes, that just 
as nerve fibres can be re-united and reproduced in the healing of 
wounds and fractures, so the brain-tissue can be reproduced after 
injury. 

Notes on Asylums for the Insane in America.—This is a reprint in 
the “‘ American Journal” of the articles published by Dr. Bucknill, 
in the “ Lancet’? of March 18th, 1876, and subsequent dates. The 
republication shows, at all events, that our American brethren are not 
afraid to hear what others say of them, especially if it is an eminent 
authority who speaks. 

Association of Medical Superintendents — At the meeting of thie 
Association at Philadelphia, the reports relative to the care and treat 
ment of the insane in the United States were continued; and dis- 
cussions took place on matters of more or less importance. Dr. 
Baldwin made reference to the value of blood-letting in some few cases 
of insanity—cases in which there was great determination of blood to 
the brain, with symptoms premonitory of apoplexy. Dr. Kempster 
stated that in every case of localized softening of the brain that he 
bad examined, he had found the remains of a ruptured miliary aneur- 
ism in the softened spot. A discussion took place upon the action 
and use of chloral hydrate, some of the members of the Association 


1877.) Psychological Retrospect. 283 


considering it to be an excellent hypnotic, and capable of being freely 
used in larged oses without untoward effects, while others deprecated its 
regular use, as producing symptoms of cerebral congestion and other 
morbid phenomena. Dr. Smith found chloral of service in cases of 
epilepsy, where high mental excitement and sleepless nights had 
followed the seizures. Dr. Smith had also used nitrite of amyl with 
seemingly good results in epilepsy, and regarded it as especially appl- 
cable to that class of cases where the paroxysms occur in rapid suc- 
cession, and continue one, two, or three days. The inhalation of 
chloroform in similar cases had been found very beneficial. 

Several of the papers in the ‘“‘Journal of Nervous and Mental 
Diseases”’ do not call for detailed notice, some of them being syste- 
matic lectures, and others translations, 

Syphilis of the Nervous System.—Dyr. Taylor gives an account of 
three cases of syphilis, in which a certain train of symptoms came on 
among the secondary affections. These symptoms were a sensation of 
great weakness, frontal headache, vertigo, restlessness at night and 
sleeplessness, confusion of thought and impairment of memory, some- 
times followed by delirium at night, and accompanied by febrile re- 
action—elevation of temperature, and increased rapidity of pulse. 
The delirium may sometimes mount up to moderate, or even severe, 
mania. Paralysis of various kinds, and epileptic convulsions may 
occur. Dr. Taylor considers these symptoms to be due to a subacute 
syphilitic inflammation of the meninges of the brain. ‘The prognosis 
ds generally good, and the treatment anti-syphilitic and tonic. An 
account is given of another case in which nervous symptoms and 
hemiplegia came on, and death took place; and in which the lesion 
was probably an inflammation and infiltration of the vessels, beginning 
first in the inner tunic, and then gradually involving the other coats. 

The Pathology of Tetanus.—Dr. Bannister believes that the course 
of the great majority of cases of tetanus may be stated as follows :— 

1. A peripheral wound involving the sensitive nervous fibres, and 
causing an irritative local lesion or neuritis. 

2, Transmission of this irritation, either simply as such or as actual 
inflammation, through the nerve trunk and the grey matter of the 
cord to the medulla and pons, and possibly to the higher reflex centres 
in the optic thalamus and corpora quadrigemina, or perhaps even to 
_the cortical motor centres of the brain. 

3. Reflection of this irritation along motor nerves, at first only the 
trigeminus and accessory, then gradually involving other and spinal 

nerves, and producing tonic contraction of nearly all the muscles of 
the trunk. 

In a few cases tetanus may be purely central in its origin, and in 
some cases, the reflex centres of the cord may be affected before those 
of the medulla. 

The Intra-cranial and Inter-ocular Circulation.— From observations 

made after the administration of large doses of quinia, atropia, and 


284 Psychological Retrospect. [July, 


other drugs, Dr. Shaw concludes that marked changes may take place 
in the cerebral circulation without any alteration in the retinal and 
choroidal circulation, and that, therefore, we cannot place much reliance 
upon ophthalmoscopic appearances in the diagnosis of the simple func- 
tional diseases of the brain, such as cerebral anemia and hyperemia. 

Case of Infantile Paralysis, §c.—Dr. Caldwell gives a short account 
of cases of infantile paralysis, paraplegia by rheumatic metastasis, and 
cerebral paralysis, in the treatment of all of which, in addition to 
other methods, galvanism was employed with benefit. 

The Lesions in Paralysis Agitans.—Dr. Lautenbach believes that 
the symptoms of paralysis agitans are due to an irritation of the 
regulating or co-ordinating fibres in the voluntary motor tract of the 
brain, which fibres pass from the peripheral grey matter of the cere- 
brum through the motor ganglia (probably through the nucleus cau- 
datus) and the pedunculi cerebri to the cerebellum. 

Medullated Nerve-fibres in the ganglia of the posterior roots of 
Spinal Nerves.—Mr. Amidon, in examining the spinal ganglia of the 
frog, cat, and dog, has observed the large-sized medullated nerve 
suddenly lose its myelinic coat, and then its axis cylinder becomes 
‘divided into two branches. He believes that the cells on the spinal 
ganglion are unipolar, and that the cell process becomes a medullated 
nerve-fibre, which in its peripheral course, either joins a sensitive 
fibre of the posterior root, or bifurcates, one-half going to the cord, 
and another to the nerve. The ganglion on the posterior root of a 
spinal nerve would appear to exercise a trophic influence over the 
sensory nerve fibres. | 

Neurological Association. On the Retinal Circulation in Epilepsy. 
—F rom observations made in 95 cases, Dr. Cross is of opinion that 
there is no change in the intra-ocular circulation in the interval 
between the paroxysms, and that there might be congestion of the 
retinal vessels after a fit, but it soon disappeared. 

The Quarterly Journal of Inebriety—The “Quarterly Journal of 
Inebriety ” is the Organ of the American Association for the cure of 
inebriates. Starting with the doctrine that “ Intemperance is a 
disease,” this Association advocates the establishment of hospitals 
for the exclusive treatment of inebriates. Dr. Beard endeavours to 
show that drunkenness, as a disease (inebriety), is closely allied to 
the neuroses—this connection being more especially seen in its here- 
ditary character and in its periodicity—and that it has of late increased 
for the same reasons that other nervous diseases have increased, and 
part passu with them. 





2. Lnglish Asylum Reports.—1876. 


The reports by the Commissioners indicate two important improve~ 
ments in most English asylums. The continuous night supervision 
of epileptic and suicidal patients has been almost universally adopted, 


1877, | Psychological Retrospect. : 285 


and has been found to work well. Detached hospitals for the treat- 
ment of infectious diseases have been erected in several places, and 
proved of service on more than one occasion. 

Brrmincuam.—Dr. Green’s opinion is that “under some circum- 
stances, mechanical restraint is not only justifiable, but preferable to 
manual restraint, and may be used with decided advantage to the 
patient.” He cites three instances which occurred during the year, in 
which restraints for very short periods had a good effect. A very 
destructive patient wore a strait waistcoat for two and a-half hours; 
a ean patients were restrained during one night with permanent 

enefit. 

It is stated that in 25 per cent. of the admissions intemperance was 
clearly the exciting cause of mental disease. 

Joist Counties: Carmartuen.—Through a defect in a main 
sewage pipe typhoid fever attacked six patients, two of whom died, 
both epileptics. Plans have been prepared for the extension of the 
building, as, especially on the female side, the accommodation is in- 
sufficient. Concerning the night supervision of epileptics, Dr. 
Hearder says—‘‘ While very much may be said in favour of this 
arrangement for special cases, all theoretical objections to the scheme 
have disappeared before the practical working of the system.” 
Dent’s tell-tale clocks are in use to check the punctuality of the 
night attendants. 

CUMBERLAND AND WEsSTMORELAND.—The buildings at Garlands 
are now inadequate for the population. The wards are crowded ; the 
kitchen, laundry, and workshops are too small. It is, therefore, pro- 
posed to build blocks for patients working in the laundry and on the 
farm; avery good plan. No detached hospital for infectious cases 
has yet been built, but the epileptics are now under special super- 
vision during the night, though the structural arrangements of the 
wards are not the best possible for that purpose. 

Fifteen of the patients admitted during the year were Irish; on 
which Dr. Campbell remarks—“ I firmly believe that if the patients 
were as comfortably kept in the Irish District Asylums as they are in 
the English County Asylums, the asylums on the West Coast of 
England would not require such frequent enlargements.” Of course 
Dr. Campbell does not mean that the Irish, of malice prepense, 
swarm over to England to enjoy the luxuries of a pauper lunatic 
asylum. If he suggests that they should be sent back to their native 
country when they become insane, various objections to his proposal at 
once become evident. For example: A man and his family come 
from Limerick and settle in Whitehaven; in three months his wife 
‘becomes insane, and is placed in Garlands Asylum, where she can be 
visited by her relatives. Whether she recovers or not, it would be a 
hardship to insist on her removal to Limerick. If she recovers, a long 
double journey has been undertaken at a possible risk to her life or her 
ultimate recovery, and at great expense. If she becomes a chronic 


286 So oes Retrospect. (July, 


lunatic, she is vias beyond the reach of her friends; a cruelty to all 
concerned. 

GLAMORGAN.—This asylum is so full that ‘‘ every available place 
has been utilised for sleeping accommodation ; beds are made up 
nightly in one of the day rooms, and the committee room is used for 
the same purpose.” Of 148 admissions no fewer than 27 males and 
40 females were suicidal, and the prevailing form of mental disease 
was melancholia. 

Dr. Pringle’s remarks on intemperance are worthy of notice :— 

With the view of determining what proportion of cases due to intemperance 
has been admitted to this asylum since its opening, I have carefully examined 
the tables bearing on this point, with the following result :—Hxcluding old 
cases received from other asylums, there have been 748 males admitted during 
the past twelve years, and of these 174, or 23 per cent., were ascribed to in- 
temperance. During the same period, and again excluding all old cases, there 
have been 636 females admitted, and of these 31, or 4°8 per cent., were due to 
the same cause. Taking both sexes together, the percentage is 14°8. But the 
above calculation is made without any allowance for cases in which the cause 
could not be ascertained, and during the twelve years these amounted to 202 
males and 141 females. A proportion of those cases was no doubt due to in- 
temperance, and would add of course to the above percentages. Now, if to all 
the above be added the idiots and imbeciles born of drunken parents, and the 
wives and other relatives made insane by the want and misery generally found 
in the homes of the intemperate, I do not think I at all exaggerate when I say 
that at least one-fourth of the isons) in Glamorganshire springs directly or 
indirectly from this habit. 

Guoucester.—The asylum is quite full, and the Committee of 
Visitors appear undecided as to the best form i in which to supply 
further accommodation. That most dreadful of all accidents, a fire, 
occurred in the roof of the building; but as it happened during the 
day it was speedily got under, and but slight damage resulted. : 

Herrzrorp.—Two cottages for workmen have been built upon the 
asylum property. This is an arrangement which exists in many 
asylums, and should in all. For married attendants and artisans 
nothing could be better calculated to attach them to the service of the 
asylum than having their homes on the estate. 

The Commissioners remark :— 

During our inspection we also found 11 menand 13 women in bed; one of the 
former and three of the latter were kept there on account of excitement and 
violent propensities. We greatly regret the resort to.such a system for such 
reasons, and for the long periods during which it has been continued in these 
cases. One of the women has been so treated continuously during the last 
year. She had, no doubt, previously exhibited much and dangerous violence, 
but we cannot regard this mode of avoiding the difficulties that attend the 
proper treatment “of cases of this kind as satisfactory, and if she cannot be 
managed here, except in this manner, we should recommend trying the effect 
of removing elsewhere, as for instance to Fisherton House. 


It must be admitted that a year is a very long time indeed for a 
person to be confined to bed for refractory conduct. No doubt the 
case was an unusual one which was subjected to such very exceptional 
treatment, and it would be interesting to know what forms of treat- 


©1877} Psychological Retrospect. 287 


ment were attempted in the first instance. Simple rest in bed is an 
undoubtedly valuable method of treatment in various forms of in- 
sanity, especially in transient attacks of mania so frequently seen in 
chronic cases during the menstrual periods. If we are to understand 
the remarks of the Commissioners as condemning. rest in bed in any 
case, it is very certain that no person of experience will agree with 
- them. 

Dr. Chapman records a decided increase in the number resident, and 
attributes it to the action of the Government subsidy, It is perhaps 
right to mention that he is one of the few Superintendents who have 
professed to trace a connection between the Government grant and the 
increase to asylum population. In 1874 he admitted 14 incurable 
cases of more than a year’s duration; in 1875, eighteen; last year 
the number rose to 28. He says :— 


It is a matter having so many practical bearings that it is probably well 
again to state that all close analyses of the increase constantly going on in the 
registered number of the insane show the increase to be due, not to an increase 
of fresh cases, i.e., to a greater tendency to send to the asylum cases that used 
not to be so accommodated, and of whom a majority remained with their 
friends, and were never statistically heard of. This tendency is due, as a 
constant element, to the increasing knowledge of what asylums really are,and 
an increasing objection amongst the people generally to associate with, and 
retain amongst them, insane persons. The occasional elements are especially 
relief to the monetary pressure of asylum accommodation due, now to a 
Union Chargeability Act, now to a Government subsidy. This is of course an 
. evil in so far as that it implies increased expenditure, but the same argument 
might obviously be brought against the existence of asylums at all, and the 
real question as to whether sending into the asylum patients who might, and, 
apart from such special circumstances as the Government subsidy, certainly 
_ would have been otherwise accommodated, be desirable or not, is a much wider 
and more difficult one. 


Dr. Chapman encourages the discharge of chronic cases deemed 
harmless. That some of them have returned in a deteriorated condi- 
tion is only what might have been expected. 

Here is a paragraph which will be gratifying to all the temperance 
newspapers :— 


On the great question of the use and abuse of alcohol, it is not perhaps right 
that a person holding such a position as mine should hold his peace as I have 
hitherto done. Iam quite satisfied that alcohol is absolutely unnecessary as 
an ordinary article of diet. That most people, however, can take a moderate 
allowance without evil result is certain, but it is equally certain that the 
moderate allowance is very apt tobe exceeded whilst still going by that name, 
and that the sense of satisfaction and comfort it produces is no indication of 
its being beneficial, perhaps rather the reverse. As a medicine it has no doubt 
great power, but the cases in which that power is exerted for good are compara- 
_ tively few, very much fewer than is usually supposed by the public, at least, 
if not by the medical profession, and are chiefly to be found among acute 
diseases. A glance at the financial statement will show that very little alcohol 
ds prescribed in this asylum, and I am rather disposed to believe that a small 
Share in the lowness of our death rate, and our satisfactory proportion of 
recoveries, may be fairly attributed to the comparative absence of this 
medicine. om 


288 Psychological Retrospect. [July, 


LancasHinE (LANCASTER).—Several cases of typhoid fever, dis- 
tinctly due to poisoning by gas from a sewer, occurred in the autumn, 
and a nurse and domestic servant died. As a means of diminishing 
the number of chronic cases in the asylum, 57 patients were sent to 
workhouses during the year. Dr. Strange and others have declined 
to certify that any pauper lunatic was fit for workhouse treatment. 
The Committee of Visitors having declined to adopt the night super- 
vision of epileptic and suicidal patients, the Commissioners absolve 
themselves from further responsibility, . 


LANCASHIRE (Prestwicu).—During summer a limited epidemic of 
small-pox occurred; six patients were attacked and one died. The 
asylum continues so crowded that it was necessary to refuse admission 
to 48 chronic and incurable cases. We are glad to find Mr. Ley re- 
turning to the charge in reference to the objectionable system of filter- 
ing the patients through workhouses. He says :— 


One hundred and eighteen patients were received from their own homes, and 
249 others passed through the workhouses on their way to the asylum. The 
duration of residence of these latter cases in the workhouse varied from afew 
days to many months. The advantages of early treatment and the injurious 
effects of delay, have been often pointed out in previous Reports, but the large 
number of cases that year by year are brought to the asylum, after months of 
unnecessary detention at their own homes or in workhouses, prove how little 
understood these well-established principles are by the relatives of patients or 
even by Poor Law officials. It is difficult to impress public opinion with the 
fact that mental disorders, like morbid changes in other parts of the body, are 
the results of inherited or acquired constitutional disease, and, like other 
diseases, are curable with proper treatment in proportion to the promptitude 
with which we set about the restoration. When so delicate and so susceptible 
an organ as the brain is the seat of evil, it is as unreasonable to expect that it 
can be restored to its healthy functions without treatment as to expect that a 
broken leg can be made whole and serviceable without the treatment and rest 
proper for such an injury. As the splint is to the broken limb, so is the asylum 
to the insane. The best experience confirms the opinion that persons afflicted 
with mental disorders cannot be successfully treated at their own homes as 
those can who suffer from other diseases. In this respect the rich and poor are 
on the same level; both are compelled to leave their families and friends, and 
seek rest, safe custody, and treatment in special institutions, where alone such 
maladies can be dealt with with any chance of success. In every other serious 
disease people, even very moderately endowed with sense, agree in one respect, 
and that is to procure at once the best advice they can, and to follow it im- 
plicitly ; but in insanity the almost invariable practice is to ignore the symp- 
toms until they can no longer be denied, and then to dally with them or try to 
hide them until the disease asserts itself in some unmistakable form, and re- 
covery is imperilled and delayed. . . . . In addition to this high per- 
centage of recoveries [53 per cent. |, 87 patients have been enabled to leave the 
asylum relieved, transferred either to the workhouses or placed under the care 
of their friends. The pressure for accommodation is so great that chronic 
eases who are quiet and orderly, and who can be accommodated in the lunatic 
wards of the different workhouses, cannot remain here very long; they are re- 
quired to make way as speedily as possible for the admission of new cases. 
From every point of view the maintenance of lunatics in workhouses is an evil 
to be deplored, but it is a necessity, and under the present system is un- 
doubtedly the lesser of two evils, for as only a certain portion of the insane 


1877.) Psychological Retrospect. 289 


can be cared for in asylums, it is better that incurables should make way for 
new cases, and thus afford to the latter class the surest means of restoration. 


As the result of this process of elimination of chronic cases, it has 
been found necessary to improve the classification and increase the 
accommodation for the acute. 

Lancasuire (Wuirrincguam).—Dr. Holland objects to tell-tale 
clocks, believing them to be useless in checking the regularity of 
night attendants. If he is right, how deluded and misguided must 
be his confréres. He naturally refers to the serious fire which 
occurred in one of the blocks in February, 1877. Great presence of 
- mind appears to have been exhibited by the staff, and to this is attri- 
buted a narrow escape from a desperate misfortune. 

Leicester, BoroveH or.—It has been determined to build 
detached hospitals for infectious diseases, but operations have not 
yet been commenced. A cottage situate near the asylum property 
has been rented, and is occupied by a few quiet patients employed on 
the farm. The mortality has been unusually low, and the rate of 
recoveries exceptionally high. The night supervision of epileptics has 
been introduced, and is found to work well. 

MippLesex (Hanwey).—‘ The incessant demand for asylum 
accommodation is best illustrated by the fact that during the past 
twelve months no less than 1,341 applications have been received 
from the unions and parishes of the county for beds, and of these only 
397 patients have been able to be received. 

‘¢ Much of this demand for accommodation can be hardly considered 
‘of a legitimate character. It is within the knowledge of the com- 
Iittee that patients are occasionally sent by the parishes as paupers 
who do not come legally within that denomination, but are sent by 
the parish, who have made an arrangement with the friends of the 
patients for a portion of the maintenance rate, and in some instances 
the payment exacted by the parish, supplemented by the Government 
grant of 4s. per week per head, may exceed the maintenance rate 
charged by the asylum.” 

Many important improvements have been carried out during the 
year, about which the visitors appear very well pleased with them- 
selves, if we may judge from the tone of their report to Quarter 

Sessions. The tour of inspection to other asylums made some two 

or three years ago appears to have had a beneficial effect, for we have 

the Commissioners congratulating “ the Committee onthe marked suc- 
cess of their efforts during the last few years in improving the asylum 
and adding to its efficiency for the proper treatment of the patients.” 

Dr. Richards believes that in 111 cases he obtained more or less 

reliable information concerning the causation of insanity. He finds 
that hereditary tendency is the most frequent. In 27 per cent. 
mental anxiety, in 14 per cent. grief and poverty, in 10 per cent. 
intemperance, in 8 per cent. domestic troubles, and in 22 per cent. 
previous attacks were considered responsible for the illness. 


290 Psychological Retrospect. [July, 


An hospital for infectious diseases has been built for each division ; 
so has a post-mortem room, together with a male and female mortuary, 

Monmovuts, Brecon, anp Rapnor.—Various works have been 
lately completed, or are in progress, for the improvement and 
enlargement of this asylum. Some remarks made by the Com- 
missioners in connection with a suicide, evidently due to the careless- 
ness of an under attendant, suggests the possibility of making the 
rules so numerous and apparently so complete that attendants may 
think they have done their whole duty if they observe them, But 
rules may be multiplied indefinitely and yet fail to meet every possible 
occurrence. Whether is it better to have a few leading rules, supple- 
mented by careful instructions by the superior officers, and by common 
sense, or a large volume of directions which may be never read, are 
probably not clearly understood, are susceptible of various interpreta- 
tions, and cannot be absolutely complete at the best? 

The occurrence of phthisis among the insane has occupied so 
much attention that we reproduce the following paragraph by Di 
McCullough :— 

On a previous occasion I referred to the frequency with which consumption 
originated in the asylum, and my fear that it might, to some extent at least, 
arise from overcrowding. In the seven years ending with 1875, 36 male 
patients died from this disease, three being the smallest number in any of these 
years, and the number being as high as eight at the time the wards were most 
overcrowded. By the opening of the new buildings, in the latter part of 1875, 
the overcrowding on the male side was relieved. No death from consumption 
occurred amongst the males during the past year, nor is there at present any 
male patients labouring under consumption which originated in the asylum. 
Although it is unsafe to draw inferences from the exemption of a single year, 
yet the facts agree so well with what is known of the causes of consumption 
that it can scarcely be considered a mere coincidence. 

NortH, Waues (Denpieu).—The quality of the water supplied 
having been improved, there was an almost total absence of diarrhoea 
during the year. The asylum is full; to avoid overcrowding, chronic 
and harmless cases have been sent to workhouses or handed over to 
the care of their friends. Special supervision of epileptic and suicidal 
patients exists on the male side, and is reported to work admirably. 

Oxrorp.—Dr. Sankey complains, as do many other superinten- 
dents, that the wages offered by the visitors are not sufficient to retain 
the services of good attendants. This is a subject which might, as 
has been suggested, be taken up by the association, for it is second 
to none in importance. Liberal wages, regulated according to the 
district in which an asylum may be placed, and a kind, judicious 
treatment, are wonderfully powerful in attaching attendants to their 
work. 

Sanop AnD MontcomEery.—In the report of this committee to 
Quarter Sessions the following paragraph occurs :— 


The Commissioners in Lunacy visited the asylum on May 29th. Their report 
has been printed, and was read to the Court at the June Sessions. In this 
report they state—“ There is here, as in many other county asylums, a vast 


eh 


377. Psychological Retrospect. 291 


number of chronic cases, in which cure is hopeless; but they require proper 
diet and some personal supervision. Dr. Strange, however, assures us that he 
could not conscientiously send them to workhouses, as they are now regulated 
in this part of the country. If no relief can be obtained by eliminating a 
sufficient number of the patients in that way, or by placing them with their 
friends, carefully selected, and from time to time visited, the only course 
seems to be some enlargement of this building, much opposed as our Board is 


_ to that course, where the number for care and treatment had already exceeded 


500.” 


Now, mark the very next sentence :—“ The visitors have during 
the last year given their best endeavours to carry out the discharge 
of patieuts to the workhouses ’—that is, the visitors have given their 
best endeavours to do what their superintendent advises them not to 


do. Instead, therefore, of the visitors hoping “ that in future in this 


matter there will be more co-operation between the visitors and the 
Board of Guardians,” it would be better perhaps for the visitors to pay 
more attention to the opinion of their superintendent. 

Dr. Strange records a good illustration of the power of epileptics 


_ to survive severe accidents. ‘‘ A male epileptic sustained a compound 


comminuted fracture of the humerus; he was violently thrown down 
by another epileptic. From the nature of the case, the greatest 
difficulty was experienced in obtaining union of the bone, and several 
months elapsed ere he was able to dispense with the apparatus made 
to secure the arm in position. The patient had barely recovered 
from the above accident when he received a severe fracture of the 


skull, caused by a blow given by another very violent epileptic ; 


happily no bad symptoms resulted, and he was soon again con- 
valescent.” 
SoMERSET.—The visitors justly object to criminal lunatics being 
placed under their care, and remark—“ There is no proper means of 
keeping them safe; they make the place seem to be a gaol, and they 
contaminate the other patients.” 
_ Contrary to the usual practice of other asylums, the report by the 
Commissioners is not given, which is, under the circumstances, 
strange, as we have Dr. Medlicott saying—‘‘ The greater, therefore, 
the publicity given (as regards the internal management of hospitals 


for the insane), the greater the chances of removing popular sus- 


picions about them.’”’ Some remarks are made on medical treatment. 

Starrorp (Burntwoop).—It would appear from the Commis- 
Sioners’ report that extensive alterations and repairs of the building 
are necessary before it can be considered in proper condition. No 
arrangement exists for the continuous supervision at night of 
epileptic and suicidal patients, though there were on the 8th December 
no fewer than 74 males and 48 females of the former class. As it is 
reported that ‘in almost every part of the asylum the necessity for 
painting, whitewashing, and repairs, and repair of the walls and 
ceilings, is strikingly apparent, and the kitchens and washhouse 
require early attention,” it is not to be wondered at that it is recom- 


292, Psychological Retrospect. [July, 


mended that the work should be undertaken on a comprehensive 
scale, and thus the patients be saved the annoyance of the constant 
presence of workmen in the wards. 

Starrorp (Starrorp).—The want of a convenient post-mortem 
room is much felt here. It is reported that in 96 deaths an exami- 
nation was only made in seven cases. Twenty-seven deaths were 
attributed to exhaustion and 10 to senile decay. 

Dr. Pater’s report is short. The type of insanity seen at Stafford 
is very unfavourable, organic brain diseases of various kinds, general 
paralysis, and chronic epilepsy. Dr. Pater ascribes the freedom 
from serious accidents enjoyed during 1876 to the practice of 
secluding patients, especially dangerous epileptics. 

SurrotK —During the 45 years Dr, Kirkman had charge of 
this asylum he must have observed a remarkable series of changes in 
the popular and professional mind in reference to many matters 
relating to lunatics and their treatment. ‘To these we do not refer, 
but proceed to give the kind remarks made by the Commis- 
sioners on their last visit:—‘ After forty-five years of valuable 
service as superintendent of this asylum, Dr. Kirkman has recently 
tendered his resignation, but remains until his successor is appointed. 
We feel pleasure on the present occasion in recording our opinion 
of the zeal and devotion which have characterised his management, 
and of the kindness and benevolent solicitude with which he has 
always watched over those placed under his care. These qualities have 
deservedly given him a high place in the estimation of the visitors, 
whilst they have won for him the affectionate regard both of the 
patients and all others with whom he has been brought in contact.” 

And now Dr. Hager reigns in his stead, At last a night attendant 
has been appointed to each side, and “the good effects are already 
evident.” On account of the low rate of wages, persons suitable as 
attendants are procured with difficulty, As quarterly payments of 
the inferior staff exists, some persons decline to enter the service, 
being unable to wait so long for their money. This is an evil which 
prevails in many asylums, and is an undoubted grievance. All male 
attendants should be paid monthly, as a large proportion are married 
or belong to some benefit society. It is quite evident that extensive 
structural alterations are urgently required, and Dr. Eager is anxious 
that the visitors should see their necessity. In the meantime, 
the laundry improvements have been knocked on the head. 
Indeed, the present building appears to be allowed to go to decay 
whilst the visitors make up their minds how they are to provide 
adequate accommodation for the increasing number of lunatics. 
Surely it is possible to make suitable additions to an asylum which 
had only an average number of 430 patients last year. Dr. Hager 
seems to indicate a way out of all difficulties when he says—‘‘ I 
venture to question whether it is advisable to treat this house as a 
temporary one, as additions might be made on the present ground 


1877. | Psychological Retrospect. 293 


which would satisfy the demands for many years to come, and with a 
small and gradual outlay the buildings now standing might be put into 
thorough repair and efficiency.” We are, however, puzzled as to the 
meaning of the following :—“ The desirability of attempting to keep the 
chronically insane patients in the workhouse should be urged upon 
the Guardians and those in authority, as by the judicious transfer to 
the workhouse of such cases as are cleanly, healthy, quiet, and harm- 
less, vacancies have occurred as fast as new patients have arrived, and 
absolute pressure for room has been warded off; but no doubt in 
time the want of medicine, management, regular exercise, and 
sufficient dietary will necessitate the removal of the majority who 
are still alive.’ We cannot imagine Dr. Eager as recommending it ; 
but is it right to send helpless creatures where they will be deprived 
of what is essential to their life, on the score of economy ? 
Sussex.—As an example of what may be done in the way of reliev- 
ing asylums of chronic cases, the experience of Haywards Heath is most 
satisfactory. During the last six years Dr. Williams has handed over 
to the care of their friends no fewer than 200 patients, and only about 
10 per cent. have returned. A hospital for the treatment of infectious 
diseases is in course of erection. Continuous night supervision of 
epileptic and suicidal patients has been in use for some time, and is 
said to be most satisfactory. It has been necessary to improve the 
wages of attendants and nurses ; they now appear to be fairly liberal. 

Schools for the patients are continued ; “the numbers attending are 

Increased, now amounting to about sixty of each sex, and the effect of 
the system is found to be very beneficial. Many patients, who upon 
admission could neither read nor write, have, when discharged, been 
able to do both.” 

Lancasuire (Rartnnitit).—The Commissioners “ are glad to learn 
from the medical journal that during the last two years there has been 

@ gradual reduction in the amount of seclusion employed; and that 
there has been a marked diminution in this mode of treatment during 
the last six months.” Here, as elsewhere, earth closets have not 
proved satisfactory. The habits of the patients put these useful 
articles to a severe test. Used as night stools they appear to answer 
excellently, but that is all that can be said in their favour. 

_ The accommodation at Rainhill is not sufficient for the district, and 
the question now presses urgently, how is it to be provided? Matters 
have been made worse by the transfer to the asylum of bedridden and: 
incurable patients from Workhouses. Dr. Rogers’ remarks on this 

subject are important, and we, therefore, reproduce them :— 


But, pending some other solution of the difficulty, there is no just reason 
why the limited capabilities of this asylum should not be employed to the 
‘greatest advantage, and it is to the disregard of this principle that I now wish 
to draw attention. 

Of ninety-one patients admitted from one particular union, 11 were idiots 
and imbeciles, and 20 were cases of dementia, for the most part the result of 
long-standing disease of the brain, or of the decay of old age. Of these four. 


, a 


294, Psychological Retrospect. [July, 


teen appeared to have been taken from their beds to be brought to the asylum, 
and remained in bed during the time that they lived; twelve out of the number 
having died, the two remaining being helpless idiots. 

Under existing law no power of selection rests with the Medical Superinten- 
dent of an asylum, excepting when the statutory reservation of beds is made by 
the Committee, the decision as to the fitness of patients for removal to an 
asylum resting solely with the medical officer of the parish, checked, to a cer- 
tain extent, by the magistrate who signs the order. Hence it follows that, 
provided the order and certificate are in due form, the medical officer of an 
asylum has no power to refuse to admit a patient, excepting in the case of 
infectious disease, even supposing he should be quite sane, or should be suffer- 
ing from some bodily disease, quite distinct from insanity ;- and the only way in 
which he can act is by reporting the case to the Commissioners in Lunacy, or 
to the Committee of Visitors at their next meeting, who can order the patient's 
discharge; but in the case of bedridden patients, who have but a short time to 
live, and who have already made the journey to the asylum, it would appear 
opposed to feelings of humanity to turn them out merely because they were not 
fit cases to be sent. In the case of this particular Union to which I refer, the 
reason given for transferring all these invalids to the asylum was, that there 
was no room in the Workhouse. Granting this, however, it may yet be assumed 
that the capitation grant from Government holds out an inducement to guar- 
dians to transfer cages to asylums, without regard to their fitness. 

I cannot, however, conceive that it was contemplated by the Government to 
relieve the medical wards of Workhouses of all cases in which the mind decays 
from old age, or bodily disease, by transferring them to lunatic asylums. If it 
were so, an immense increase would have to be made in the number and size of 
our asylums, for it is a matter of every day observation that mental failure is a 
very frequent accompaniment of decay of the bodily powers, whether from 
chronic disease, or from old age. 

I do not, however, mean to assert that cases of senile mania, or dementia, 
are not sometimes properly sent to asylums, nor other chronic brain diseases, 
in which mental aberration is a prominent symptom; but I contend that every 
case should be judged on its own merits, and I would suggest that in any future 
addition or alteration of the lunacy laws the grant from the Treasury should 
only be allowed on a certificate being given by the Visiting Justices of an 
asylum that the patients, on whose account the grant is payable, are fit and 
proper cases to be sent to an asylum. 

Had such a provision been in force during the past year, one-fourth of the 
patients sent from the Union referred to would not, in my estimation, have 
been certified for payment of this allowance. 


NortHuMBERLAND.—The admissions during the year were fewer 
than in 1875. Referring to this Dr. McDowall remarks :-— | 


This fact is the more peculiar and gratifying, as it was generally feared that | 
the allowance of 4s. per week, made to the Unions by the Government, for 
every patient in an asylum, would lead to a large inerease in the number sent 
there, and in some counties this has really occurred. So far as my knowledge 
extends the decrease to which I have referred cannot be attributed to the 
detention of lunatics in the wards of workhouses in acute and curable cases. 
This is an evil which prevails largely in some districts of England, against 
which, all having any knowledge of it, strongly protest. In their report for 
1876 it is specially referred to by the Commissioners in Lunacy, and as the 
Blue Book may not be accessible to many interested in thig subject, I have 
appended their remarks to this report. 


It ig not necessary at present to direct further notice to this | 
subject beyond noticing the small attention which has been excited by | 





1877.) Psychological Retrospect. 295 


this portion of the Commissioners’ report. It is quite evident that 
something is far wrong in the present system by which patients are 
treated in Workhouses. Had the tragedies which they narrate 
occurred in asylums, we should certainly have heard more about them. 

In relation to the discharge of unrecovered patients, the following 
paragraph may be reproduced :— 


_ Hleven unrecovered patients were handed over to the custody of their 
friends. Some went home to die; but most were harmless lunatics in good 
health, who should be able, if properly treated, to support themselves wholly or 
partly, and who, in their own homes, should enjoy those domestic comforts 
which cannot be provided in a large institution. In two or three instances, 
you have deemed it prudent to refuse applications for the discharge of unre- 
covered patients, although the relatives undertook to protect the patients and 
the public against any evil consequences. It must be confessed that itis difficult 
to know how to act in these circumstances. If a suicidal or homicidal patient 
is discharged, at the request of his relatives, and some accident follows, per- 
haps. through the relatives neglecting the duties they undertook to perform, the 
asylnm authorities might feel inclined to question the wisdom of having allowed 
the patient to go. But so long as such cases are kindly treated at home, and 
are not a nuisance to their neighbours, the law does not compel their removal ; 
and it is a notorious fact that deplorable accidents are of too frequent occurrence 
through their not being placed under care in an asylum at all. But, once they 
have been placed under care, they cannot be removed with the same facilities in 
all cases, for the law determines their-future treatment, and to a great extent 
takes it out of the hands of the relatives, and vests it in the Medical Officer 
and Visiting Justices of the asylum. Such being the case, it is easily seen that 
collisions must occur between the relatives, who consider themselves. the cus- 
todians of the patient by nature, and the asylum authorities, who are so by 
law. That this is an evil cannot be doubted, and its continuance is chiefly due 


_ to the diversity of opinion as to the proper manner in which it should be met. 


Some desire that, notwithstanding the condition, all patients should be re- 
movable on demand, as in ordinary hospitals. Others, knowing the occasional 
unreasonableness of relatives, and the numerous evils which follow premature 
discharge, would have the matter settled by a medical certificate, as is the 
practice here. The more familiar one is with the question, the clearer become 
the advantages and disadvantages of each system. It therefore appears 
desirable, in the meantime, to judge each case on its merits, and to interpret 
liberally that portion of the Act which gives a discretionary power to the 


‘Visiting Magistrates. 


It is unnecessary to give Dr. McDowall’s remarks on the so-called 
“ open-door” system. He seems to approve its principle, but to be 
afraid to adopt it. 

Norrotx.—The present building being full, it is proposed to erect 
a separate block for 250 chronic lunatics, imbeciles, and idiots. The 


leading idea in carrying out this extension is cheapness. Should it 


be determined to run up a building at a minimum cost, a few years 
will show the short-sightedness of this, for the annual outlay for 
repairs will prove disagreeably heavy. 
Brrxs.—Although this asylum has been open only a little above 
six years, it has been found necessary to prepare plans for additions, 
to accommodate fully 200 patients. 
Dr. Gilland’s report is very long, and on some matters most 
XXIII. | 20 


296 Psychological Retrospect. . (July, 


minute. The case of puerperal fever might have been omit- 
ted; also the pathological appearances found in a case of pul- 
monary apoplexy. Nearly a page is devoted to an account of the 
rather sudden death of an attendant, from pulmonary hemorrhage, in 
his own home. He appears to have been a decent man; but 
who is benefited by the publication of the following in an official 
report ?—“ It is, however, a matter of universal regret that no 
memorial stone has been erected to mark the last resting-place of this 
unfortunate man, so suddenly cut off in the prime of life, who, for 
nearly two years, was a valuable, well-conducted, amiable, and highly- 
respected attendant in this asylum.” 

Witts.—No fewer than five patients were admitted during the 
year in whom no insanity could be discovered, The largeness of the 
number is most unusual. 

What with repairs and improvements of the old building, and the 
necessity of erecting large additional accommodation for the ever in- 
creasing number of patients, the Visitors appear rather driven to 
despair. When will it end? they seem to ask. The whole of the 
arrangements for the extinction of fire have been put on a new basis, 
which has received the approval of Captain Shaw, of the London Fire 
Brigade. 

From Dr. Burman’s report it is evident that the overcrowding of 
the wards has exerted a disastrous effect upon the health of the 
patients. A serious outbreak of erysipelas carried off seven ; pulmon- 
ary consumption proved fatal in eight; and, although diarrhea pre- 
vailed, it proved fatal in but one case. A patient, whose foot had 
been amputated, died on the 11th day from blood poisoning, caused 
by his bad hygienic surroundings. 

Various improvements have been carried out, but the Commissioners 
indicate others in the diet, the number of attendants, &c. 

SurREY (WanpswortH).—Various structural improvements have 
been effected during the year; the night watching has been made 
more complete, and the weekly charge for patients has been slightly 
raised. The Committee reported to Quarter Sessions: ‘In March 
last we received a circular from the Commissioners in Lunacy, re- 
questing certain complicated statistical returns for the year. As 


these would have entailed an undue amount of labour, out of all pro-. 
portion to any value which could attach to them, the information | 


sought being already supplied under the Lunacy Acts, we declined to 


accede to the request of the Commissioners; but, upon a personal — 


application being subsequently made by one of them to Dr, Biggs, 


we allowed him to furnish the returns, and we understand that he has — 


done so for this year, but that the Commissioners do. not propose to 
ask for them again.” If this paragraph refers to the statistics asked 
for by the Commissioners from all asylum superintendents last year, 
we believe that Wandsworth was the only asylum in England which 
declined to prepare them. 


1877. ] Psychological Retrospect. 297 


A serious explosion of gas occurred by which several patients were 
injured, one seriously. As it has been determined to build a third 
asylum for the county, it is very properly suggested that some pro- 
vision should be made for idiots, especially children. Such cases, 
grouped with adults in the usual way, learn nothing but bad habits, 

NortHampton Geyerat Luyatic Asytum.—All paupers have now 
been removed; there is now accommodation for 300 private patients, 
and it is almost completely taken up. Owing to defective drainage, 
typhoid fever continued to appear, and caused two deaths. 

Mr. Bayley is justly sensitive as to the reputation of the insti- 
_ tution of which he has charge, for he remarks—* I have been told 
that some observations have been made upon the use of restraint in 
this asylum. I wish, therefore, to state that during the time I have 
held my appointment, now more than eleven years, no patients have 
ever been restrained except those (very few in number) who have 
refused to allow necessary surgical appliances to be used. In such 
cases I think restraint is both necessary and justifiable, but as a 
means of controlling violent, destructive, or dangerous patients, I 
look upon it as very objectionable and quite unnecessary.” 

Omacu District.—The asylum was visited by a severe epidemic of 
erysipelas, resulting in several deaths, and due, according to Dr. West, 
to the defective disposal of the sewage, so that during dry weather 
the stench was unbearable in the front of the building. It should also 
be noted that the asylum is overcrowded. A fatal case of diphtheria 
occurred. ‘The table giving the causes of death is of very little value 
from want of details. To givean instance—eight deaths are recorded 
as due to ‘fever and other diseases.” 

Perhaps we may here allude to one or two things that have struck 
us in the Irish reports. The Inspectors appear to visit the asylum 
very frequently in the course of a year, and, it seems, have become so 
_ familiar with the structural and other defects that they pay remarkably 
little attention to them. What would an English or Scotch Commis- 
sioner say or do if phlegmonous erysipelas were epidemic in an over- 
crowded asylum? Here is what the Irish Inspector says :—“ The 
general sanitary state of the house is satisfactory, with the exception 
of a few cases of erysipelas, which I have recommended to be sent to 
the hospital, so as to separate them from the main building.” Another 
example will suffice for the present. Inspector No. 1, reports “very 
favourably ” of the general condition of the Omagh Asylum in March. 
In less than two months it is visited by Inspector No. 2. He also 
reports that the sanitary and general condition of the asylum is “ very 
satisfactory, with the exception of a few remaining cases of erysipelas, 
which for some time had been rather frequent”’—a very offhand way 
of dismissing so serious a subject. Itis said that the bedding is good 
and ample, and, in the same sentence, “many, however, of the bed- 
steads (iron) are worn ricketty, and being easily broken, might be 
converted into dangerous implements by refractory or violent patients, 


298 Psychological Retrospect. [July, 


It does sound strange to find official approbation bestowed on an 
asylum, and in the same page to have it stated that “ in some of the 
divisions there is a want of homely, comfortable furniture, while the 
walls are blank and cheerless.” be 

Marysoroven Disrrict.—Farm and other outdoor work appears ° 
to be in much favour in Irish asylums, and most rightly so ; but what 
must be the character of the patients when it is necessary to have the — 
whole asylum property surrounded by ahigh stone wall? Dr. Nugent 
says — 


The land recently purchased, as I am informed, is turning ont (as I ever said 
would be the case) most remunerative, although a portion only is cultivated. 
Tt has, up to the present, been much improved by drainage. The steward states 
he could and would employ a greater number of patients on it, so as to render 
it more productive, but from an apprehension of attempts at escape ; while for 
the same reason Dr. Hatchell is unwilling to avail himself of it as a place for 
exercise. Having no doubt that ultimately, for security sake, the land in 
question will have to be properly enclosed, I think the sooner it is done the 
better. The gloomy restricting wall in the immediate rere [sic] of the buildings, 
when thrown down would afford a considerable amount of available material 
for a proper protecting fence. : 


If this advice is right, then nearly every English and Scotch super- 
intendent must be wrong. Some very few old asylums may have a 
wall round their estate, but most have nothing, not even a wire fence, 
and some have no airing court walls. What is the result? A dimi- 
nution in the number of escapes. In airing courts, and such supposed 
places of security, attendants will be careless, and whilst they light 
their pipes the patients climb over the wall. In one Scotch asylum 
the escapes from the airing courts averaged one per month. The 
walls were pulled down; the patients exercised in an open field, and 
there was only one escape in eighteen months. In another the super- 
intendent had a good ladder put up against the wall of the airing 
court to keep his attendants up to the mark. 

Ennis Distrrict.—It says little for the liberality of the Visitors of 
this asylum, that Dr. Nugent should be able to report as follows :— 


The various day-rooms, corridors, and dormitories, the bedding in which last 
appears to be good and plentiful, are fresh and well ventilated, with a whole- 
some temperature, but the walls, as a rule, are cold and cheerless, very unlike 
what obtains in most similar institutions in this country, where more attention 
is paid to a little cheap domestic ornamentation, of itself indicative of comfort. 
At the female side some improvements have been effected during the past year, 
which may be well extended to the male divisions. The grounds immediately 
around the buildings are in a neglected state, as well as some of the airing 
courts, which are rough and stony. I deem it my duty to notice deficiencies [sic], 
and the more so as the yery liberal rate in aid accorded by Government to public 
establishments for the insane, and of which last year the Ennis Asylum par- 
ticipated to the extent of fully £2,400, was intended to meet those expenses 
which are greater in lunatic institutions than other public charities. I have ~ 
requested Dr. Daxon, who has always practically shown his anxiety to improve 
the house, and with adue regard to economy, to bring certain subjects before 
the Board at a seasonable opportunity. mt 


1877.] Psychological Retrospect. 299 


As the result of this protest, Dr. Nugent was able, at his next visit, 
six months afterwards, to report some improvement in the day rooms, 
“but still, like the corridors, they are nude, cheerless, and totally 
_ devoid of ornamentation, a deficiency, it may be said, peculiar to the 
institution, and which could be so well obviated at a very trivial 
expense.” Surely something might have been done in the direction 
indicated during the nine years the asylum has been occupied. 

Monacuan District.—It says much for the management of this 
asylum that Dr. Robertson is able to report that during 1876 no 
attendant was discharged or fined for misconduct. One of the In- 
spectors reports a new plan of compelling patients to be tidy, as far 
as refers to their boots :— 


The patients on both sides of the house appear to be taken great care of, 
being clean and tidy in their persons, having their shoes blacked every day, and 
kept tied by means of knotted twine, which prevents the patients taking them 
off during the day; at night the warders cut the laces—being common twine 
used, the expense is nothing—(four shillings a year). 


_ Extensive structural repairs are under consideration. 


Enniscortay.—Dr. Edmundson argues against the modern doctrine 
that alcohol is useless and even injurious in the treatment of disease. 
He is convinced that it is in many casesindispensable Among those 
discharged was one woman found “not insane.” Her history is as 
follows :— 

She was admitted on a justice’s warrant on 28th Nov., represented as being 
two days ill and suicidal. On enquiry I found she had always been a very 
temperate girl; that three days previous to admission a number of persons 
were employed by her master thrashing; that porter went freely round, of 
which she partook beyond the bounds of moderation. At 8.30 p.m. her master 
sent her for a fiddle across the country; she was obliged to cross a river, into 
which she fell both going and returning, and being drunk, she with difficulty 
saved herself. Next day her stomach was deranged, and her head sympa- 
thetically affected, accompanied with a cloudy state of the intellect. By the 
time she arrived here all trace of her dissipation had disappeared, and not 
being insane, I procured her discharge at the next Board, after a lock-up of 
twenty-four days among the insane. 


Kititarney District.—Typhus appeared during the year, causing 
the death of one patient and the gardener. Dr. Woods reports that 
only three escapes occurred, and evidently unwittingly strongly sup- 
ports the system by which airing courts and boundary walls are 
abolished, for he says—‘ I am somewhat surprised that more escapes 
did not take place, as owing to the loss of our airing courts, the 
patients have been obliged to take exercise on the walk round the 
farm, quite close to the boundary wall, which is by no means high.” 
It is also important to remark that, so far as can be gathered from 
Dr. Woods’ report, the patients who did escape did not get away 
through the extended liberty accorded by the force of circumstances. 
The asylum has been open since 1858, and is not yet properly furnished. 
Dr. Nugent reports that, though certain improvements are being 


300 Peusholoatods Retrospect. (July, 4 


carried out, he “cannot avoid referring to the noticeable want of © 
common domestic furniture in many of the day rooms, and to their 
naked, cheerless, appearance.” When it is stated that the asylum 
derives about two-fifths of its total outlay from Government to meet 
extra expenditure, one feels puzzled to know how the money has been 
spent. 
: Crry or Lonnon.—A detached building, capable of containing 20 
patients and their requisite attendants, is about to be built for the 
accommodation of cases of contagious diseases. ‘The Committee of — 
Visitors prosecuted a nurse for illtreating a female patient, by cutting — 
her finger-nails below the quick. The vixen was fined £5, with the © 
alternative of one month’s imprisonment. Here, as in other asylums, 
great difficulty is experienced in the disposal of the sewage. | 
West Ripine.—Dr. Major’s remarks on the causation of insanity 
are so judicious that we reproduce them in extenso. It cannot be said 
that his views are absolutely original, but they are specially worthy 
of attention at the present time. | 


With regard to the cause or causes inducing insanity in the patients admitted, 
the part played by alcoholic excess should be specially noted, as being that 
which above all others is preventible. Adopting a somewhat novel, but, in my ~ 
opinion, the most accurate classification, it may be stated that, in the year 1876 
91 cases were admitted which resulted from alcoholic excesses, either alone or 


in combination with other adverse conditions. In 58 of these cases, alcoholism 


appeared to stand alone as the causative agency. In 8 cases there was, in 
addition, hereditary tendency to insanity; in 15 cases adverse physical con- 
ditions were combined with alcoholic excess as the causative agencies; and in 
10 cases adverse moral conditions. These numbers, collectively, give a percent- 
age of 17°84 of the admissions as the proportion of cases attributable to 
alcoholic excess in combination with other influences, from which in many cases 
it is found impossible to disassociate it. Taken separately, the proportion for 
the male admissions was 31°2 per cent., that for the females being as low as 
4°98 per cent. It is needless to add that these results must not be taken as 
indicating more than those derived from a consideration of the cases admitted 
in the year 1876, Doubtless, even in the same district, the proportion of cases 
chargeable to alcoholic excess will be found, within certain limits, to be con- 
stantly varying, but a careful annual record cannot fail to convey valuable and 
reliable information. 

With respect to other causes operating in producing insanity, no classification 
has been attempted in the present Report. If it be true, as I think it is almost 
universally admitted to be, that in the large majority of instances we have not 
to do with a single cause in any given case, but with several causes, all of which 
ought to receive consideration, it must follow that the method of tabulation 
which usually obtains, and in which one cause is assigned for each case, i$ mis- 
leading, and ought to be abandoned. And. having made this statement, it may 
not be out of place to give an indication of a method of tabulation, the adop- 
tion of which in asylum reports might, it appears to me, with advantage be 
considered. My suggestion is shortly this—that in every case the conditions, | 
however numerous, which, on full enquiry, would appear to have taken part in 
its production, should be recorded, and the results finally tabulated by adding 
together and classifying all the causative influences assigned in all the cases. 
under consideration. ‘lhus, to take three hypothetical cases, the first might be _ 
caused by intemperance and cranial injury; the second attributable to here- 
ditary tendency, childbirth, and grief ; the third to grief, starvation, and intem- " 


1877.] Psychological Retrospect. 301 


perance.- Now, on adding and classifying the causative agencies as stated in 
the above examples, it is found that the result is as follows :— 


Intemperance (took part in the causation of)... ... .. 2 cages. 
Cranial injury : if Me Donia ten lr te, 
Childbirth “3 3 ip t 3 
Hereditary tendency _,, ae Pie. 
Starvation = i c Bie 
Grief 99 2 ”9 


Ey Meat oe eis nan 
Such a table might seem at first less satisfactory than those ordinarily drawn 
up. In it no attempt is made to give the exact number of cases attributable 
to any individual cause—that I believe to be impossible—but from it would be 
gathered the number of cases, out of the total admissions, which a given cause 
contributed to produce, the most frequent cause being still represented by the 
highest figure, and the cause least often occurring by the lowest. In this way 
_then, it appears to me, no causative influence would be left out of consideration, 
_but to each would, in the result, be assigned its amount of influence, so to 
speak, which would depend on the frequency of its occurrence in relation with 
other causes ; and this, if I mistake not, is what it is important to arrive at. 


As the asylum at Wakefield continues full, and the demand for the 
accommodation of acute cases undiminished, it has been proposed to 
send out suitable cases to live with their relatives. On this subject Dr. 
Major remarks— 


The practice of returning to the care of their relatives patients who have 
become quiet and harmless, whose cases do uot call for special treatment, and 
more especially when they have passed the procreative period of life, has, I 
think, much to recommend it, and may not unfrequently be carried out with 
satisfactory results. Whether the practice could with advantage be extended 
by making a money allowance to those able and willing to become, with such 
assistance, the guardians of their insane relatives, is a question on which there 
is room for much difference of opinion, for the reason that weighty arguments 
may be adduced both in favour of and against such a system. Without enter- 
ing on a discussion which would be unsuitable in the present report, I may say 
that, in my opinion something might with advantage be done in this direction, 
_ while, at the same time, I am disposed to think that the so-called “ family care” 

of the insane, so extensively carried out in Scotland, and in which patients are 
boarded, not only with relatives but with non-relatives, who become in name 
and position their guardians, would be unsuited to our thickly populated dis- 
tricts. It must be borne in mind also that the number of patients in asylums 
suitable for home care could hardly be very large, and that when any system of 
payment is adopted, even in the case of relatives, thorough inspection would 
have to follow, or the door would be open to grave abuses, 


Hants.—The changes occurring in the staff of attendants and 
nurses is perhaps the most embarrassing of the experiences of a super- 
intendent. Dr. Manley, therefore, is entitled to considerable commis- 
seration whenit is known that, in 1876, twelve attendants left after an 
ayerage service of only four months, 15 nurses after an average ser- 
vice of only six months ; the twoassistant medical officers resigned ; so 
did the storekeeper and housekeeper, and the office of clerk became 
vacant. 

Drvon. —The population cf this asylum continues to increase, so 
that at no very distant date it will be necessary to extend the present 
buildings, build another asylum, or combine with adjoining counties 


302 Psychological Retrospect. [July, 


for the erection of an asylum for imbeciles and harmless lunatics. A 
very complete hospital has been built. A detached chapel is now in 
use, and is capable of accommodating 420 persons. It has cost 
£2,600. The water supply has been made somewhat more satisfactory, 


and hydrants have been placed round the building as a provi 


against fire. 

Cuesurre.—(Upton). In order that the attendants, when off duty 
in the evenings, may remain in the building, and not spend their time 
in public houses, Dr. Davidson has provided for them a reading and 


recreation room, containing a billiard table, &c. Such a step is in the 


right direction, and worthy of imitation. 
Cunsutre (Parxsipr).—The more effectual protection of the 
buildings from fire has been under consideration by the Visitors. 
Concerning intemperance, Dr. Deas says :— 


It is a fact worth mentioning, though it may only be a coincidence, that in the 
years when the male admissions rose so high, the proportion of cases where in- 
temperance was believed to be the cause was very much greater than in the 


other years ; and this was most markedly so in 1876, when the number of male 


admissions was also most greatly in excess. That intemperance is one of the 
great factors, at any rate, which accounts for the increasing incidence of 
insanity among the male population of our district, as compared with the 
female, is, 1 think, undoubted ; and these fluctuations in particular years may 
not improbably be due to varying states of trade, &c. Opinion, I think, is 


rather divided as to whether ‘‘bad times” or ‘‘ good times” cause most drink- 
ing; but I am inclined to think that in “bad times” drinking is, at all events, 
attended with more injurious results from being associated with other depress- 


ing influences, such as deficient food, mental anxiety, &c. 


Among those discharged in 1876 were no fewer than five patients 


who exhibited no symptom of insanity during their residence in the 


asylum. 


Two of these had been drinking; but any symptoms which may have been 
due to the effects of drink had passed off before they came here. One of 
these, a woman, was brought in the middle of a most inclement night, having 


been driven several milesinacab. She was most scantily clothed, and was - 


half dead with cold, from the effects of which she did not recover for two or 


three days. Perhaps this powerful sedative dispelled any excitement caused 
by drink. Another case was a decent respectable old woman, who apparently 
had been bothered a little by some family dispute, but in whom we could find 


nothing amiss during the two or three weeks she was here. She was an old 


woman, it istrue; but more sensible and collected than most of her age and 


class. Another case was a woman, a mill hand, who had lived by herself, and 
not been getting enough to eat. She was naturally nervous, and not being 
strong, had been upset by a fright she received. Was said to have been quite 


out of her mind; but showed no indicatiou of anything wrong after admission. 


The last case was a woman of a low moral type, who had been in a workhouse 
for some time. She was said to have broken out and become unmanageable. 
She said herself that she had wanted to leave; and on being refused, she would 


not work any more ; and thenthey sent her here. However it was, she behaved — 


quite well the short time she was here, and showed no symptoms of insanity. 


Two cases of general paralysis were discharged, one as “ recovered,” 
the other as “relieved.” It is somewhat amusing to find Dr. Deas 


1877.] Psychological Retrospect. 308 


informing his Committee in one paragraph of these “two rather re- 
markable instances of what may fairly be termed recovery from that 
fatal and incurable disease” [that is a fairly successful attempt at a 
bull]; and in the next “ that they are, in all probability, only greater 
developments of the slighter remissions in the course of the symp- 
toms, which is a common characteristic of the disease; and, on this 
account, the permanence of the improvement cannot be too 
confidently counted upon.” ‘It is no doubt such cases as_ these, 
which have from time to time been the basis of the so-called 
cures effected in the hands of sanguine and enthusiastic adminis- 
trators, by particular drugs. The last ‘notable’ discovery of the 
kind was the Ordeal Bean of Calabar, which was confidently put 
forward as a specific in this disease, on the strength of two cures 
effected by it. It seems almost a pity that our two cases had not been 
treated with Calabar Bean too.” 

DunprE.—Arrangements are in progress for building an asylum in 
amore suitable locality. Dr. Rorie makes a short reference to the 
treatment of various forms of insanity by placing the patients in 
rooms of various colours, as first proposed by Dr. Ponza; but he is 
unable to state his opinion as to the value of the process. The 
majority of the speciality will be astonished to hear that during 
seventeen years he has found it necessary to have recourse to forcible 
feeding in only one case. 

Montrost.—Dr. Howden directs attention to the different types of 
insanity which prevail in Scotch and English asylums, and is inclined 
to attribute the much larger proportion of organic brain disease found 
in the latter to the greater prevalence of drunkenness among the 
population. He is “ disposel to think that though instances of in- 
toxication may be seen more frequently among Scotch than English 
working men, there is a more constant use of stimulants with the 
latter, and that the constant daily soaking, within bounds of apparent 
sobriety, is far more injurious to the brain than an occasional outbnrst 
of intoxication.” | 

Concerning bodily nutrition during attacks of insanity, he says— 


A reference to Table 16, showing the weight on admission and on discharge, 
of those who have recovered, proves how closely mental improvement is asso- 
ciated with improvement in the physical condition. In only two cases had 
there been a loss of weight, while in the remainder there was an average gain 
of 12lbs. The gain in some cases was remarkable. Thus, one man gained 
—82ibs. in eight months, another 28 in four months, another 23 in five months, 
while a fourth, who laboured under acute mania on admission, gained no less 
than 38lbs. in four and a half months. Of the women, again, seven had gained 
between 28lbs. and 30]bs., whilst one gained 33lbs. in 13 months, and another 
34lbs. in 10 months. Some years ago (report for 1873), I pointed out what 
seemed to be the usual change in weight in the course of an attack of acute 
mania. At first there is a rapid loss of weight. In this stage the patient is 
‘in constant excitement day and night, and rarely sleeps; the lungs, and in 
Many cases the skin, give off more than the usual amount of waste, which is 

| hot repaired by the somewhat irregular and insufficient amount of food taken. 


304. Psychological Retrospect. [July, 


It is worth noting that at this stage, even when the appetite is good, and the 
quantity of food taken as great, or even greater, than normal, the patient still 
loses weight, owing in part, probably, to malassimilation, but mainly to undue 
waste. It might be supposed that in these circumstances the production of © 
artificial sleep by narcotics would tend toshorten the wasting period of mania. — 
As arule, however, this does not seem to be the case; what is gained in one way 
is lost. in another, and the injury to the digestive and nervous system by 
narcotics appears rather to retard recovery. If the disease is allowed to run 
its natural course the increase of weight is found to be simultaneous with the 
gradual return of natural sleep, and once the patient has turned the corner, it 
is remarkahle how rapid the increase is. The sameobservations apply, though 
in a less marked degree, to melancholia. 

Then follows an illustrative case. 

Roxsureu, &c.—Ground has been purchased for the erection of 
cottages for married attendants with whom will be boarded a number 
of female patients. It is thus hoped that the services of good 
attendants may be retained, and that no immediate necessity will arise 
for the extension of the main building. 

EpinspureH Royat Asytum.—The important and extensive struc- 
tural alterations begun some considerable time ago approach comple-. 
tion, and promise to be most satisfactory. 

In his report Dr. Clouston touches on various subjects relating to 
the increase of asylum population throughout the country, and dis-- 
cusses those circumstances which should | be taken into consideration © 
when it is a question whether a patient should be sent to an asylum 
or not. 

Ayzr.—This asylum is now completely full, and it is feared that it: 
may be soon necessary to add to the accommodation. Here, as in- 
other Scotch asylums, the ‘‘ open door”’ system is in use in a more or 
less complete fashion. We are surprised that Dr. Skae does not use 
the tables of the Medico-Psychological Association in preference to 
the disjointed and antiquated ones in his report. 

Inverness.—The asylum is now crowded, and it is proposed to 
erect two detached buildings, each capable of receiving fifty patients 
behind and in close proximity to the existing house. The dietary 
having been improved some time ago, there has been a notable 
diminution in the mortality, but cases of typhoid still occur, and 
the amount of phthisis is relatively large. The clothing has been 
much improved in condition and fit, but it is still light, a complete - 
suit of male clothing weighing only 8lbs. 100z. It is stated that 
“the chief difficulty under which the administration of the asylum is 
conducted is that connected with the staff, and as all the inducements 
hitherto tried to secure and retain the services of efficient attendants 
have failed, it is suggested that more success might attend arrange- 
ments for securing retiring allowances to persons who have passed @ 
certain number of years in the service of the institution. Instead of 
raising present wages, a scheme of future advantage might be devel- 
oped which would not prove more costly, and which affords grounds for 
hesitation before renouncing the benefits which the time already. served 


1877.] Psychological Retrospect. 305 


has conferred.” The proposal is reasonable, for one cannot see why 
eC asylum officials should be in a worse position than English and 
rish 

_ Cricuton Royatu Institution.—“ The recreations and amusement 
lists for the year (1875) afford the usual numbers and variety. The 
number of parties specially arranged for the patients amount to two 
hundred and forty-nine. . . . Ordinary in-door and out-door 
amusements generally, but not specially arranged, as bowling, croquet, 
&c., are not included in the above numbers.” We like to see a man 
push his ideas to their utmost limits in practice, though some 
might ask, “Is all this amusement rational, wholesome treatment 
for the mind diseased?’ ‘There is probably great truth in what has 
been said by a well-known authority, that the ultimate result of 
constant amusement is to enfeeble and deprave the mind of both 
officers and patients. A patient is placed in an asylum not only to 
recover from a present malady, but to be subjected to mental disci- 
pline and hygiene, so that he may be the better able to face those 
difficulties which he will encounter/on his return to the outside world. 
Such an incessant whirl of gaieties, a London season in the North, 
must be dreadful to quiet, sedate, contemplative people, if any such 
now live at Dumfries. But, of course,it must be remembered that most 
of the patients are of the private class, and cannot be got to work. 
Dr. Gilchrist says—“ It has been our ambition to provide some 
special recreation for each day, or evening in the year, a high 
standard which has not yet been reached.” In Sabdbath-observing 
Scotland some ingenuity will be necessary to invent asuitable amuse- 
ment for Sundays. 


PART IV.-NOTES AND NEWS. 


CURE OF INSANITY BY STRANGULATION. 


Dr. Dz Wotr relates the following case in the Report of the Nova Scotia 
Hospital for the Insane for 1875 :— 
_ “Another unexpected and far more sudden recovery occurred here many 
_ years ago, which has never been reported. The case is by no means devoid of 
interest, the more especially as the restoration has proved permanent. 
aes , No. 296, wt, 25, single, was admitted 7th May, 1864. She had 
been for a ahort time engaged in school-teaching, and was six weeks insane. 
She manifested determined suicidal propensities, and had refused food for 
several days prior to admission. 

“The immediate cause of her insanity was a failure on her part to master the 
science of algebra, which, without sufficient thought, she had promised to teach 
one of her scholars. Night after night she pondered over the works on algebra 
within her reach, but all to no purpose. Loss of sleep, intense disappointment, 
and chagrin at being unable to fulfil her promise, soon preyed upon her mind to 
fuch an extent as to compel her to abandon her school, and shortly after resulted 
in an outbreak of melancholia. 








306 Notes and News. [J uly, 


“Her suicidal propensities were traceable to hereditary predisposition—even 
the mode was similar. Her first attempt, which was made at home, was by 
hanging ; a process which her mother had carried out effectually two years 
before. The fine brass wire used for this purpose left a deep dark indentation, 
which remained visible for more than two months after admission. 

“Not only did she refuse ordinary food, but she eagerly caught up and 
swallowed cinders, buttons, and small stones; and finding these did not destroy 
life, she secretly stuffed the throat with a bunch of horse-hair and flannel, equal 
to a good-sized hen’s egg. 

“In this condition she was admitted. The obstruction was apparent, andshe 
was at once removed by tickling the fauces, and thus bringing on an effort at 
vomiting. Finding that even after this the blandest liquids were immediately 
rejected, the stomach tube was used, when a coin or similar substance was 
pushed forward, and she was enabled toswallow whatever food was given to 
her. She would take no nourishment voluntarily, and offered no great resist- 
ance when it was administered. She kept up a constant moaning day after 
day, and her unceasing cry was that she was eternally lost. In failing to keep 
her promise to her pupil, she supposed she had committed ‘the unpardonable 
sin. 

“Occupying a dormitory with five others, in the fourth storey of the building, 
and watching an opportunity one night soon after admission, she raised the 
window-sash six inches—it was checked to that height, but could be strained to 
a quarter of an inch more on one side—she forced herself through this narrow 
opening, taking with her a blanket, with a knotin one corner. Resting herfeet 
upon the granite belt-course, and closing the window so as to leave the knot 
inside, she made a spring, and landed on all fours about six feet from the build- 
ing. Rebounding, she fell on her back, and was immediately picked up by the 
watchman, who was within sight at the time. : 

“The injury resulting from this heroic leap was comparatively very slight, 
and was limited to a sprained ankle and a bruised back, with scratches on the 
hands and feet, caused by the hard ground where she landed in falling.- These 
were soon healed, and she went about as before, moaning and lamenting inces- 
santly. The shock of the fall had failed to restore her mental equilibrium, or 
to change the character of her delusions. 

‘““From this period she was under close surveillance day and night, and so 
resolute were her attempts to thrust buttons and pieces of glass down her 
throat, that hers was made an exceptional case, and the occasional use of a thin 
cotton camisole was sanctioned, the long sleeves of which terminated in a point, 
and were secured behind her back, her arms being crossed over her chest. 

‘‘Late in the autumn of 1864, a marriage took place between two of the 
attendants, and the ceremony was celebrated in the ward in which the patient 
was domiciled. From this the bridal party and guests adjourned to one of the 
upper wards to engage in the customary festivities. The attendant in charge, - 
depending on the camisole as security, ventured to leave her duty at 8.45 p.m, | 
to join in the merry-making. Precisely at 9 o’clock the watchwoman came to | 
take charge, and found the patient suspended by the neck, with a sheet which | 
she had fastened to the window-guard; although one hand only had been | 
released from the camisole by gnawing through the cotton. | 

“The night-watch, with the most commendable presence of mind, gently | 
raised the body in her arms, and untied the knot. She then quietly summoned | 
assistance, and the senior attendants, with the superintendent, were imme- | 
diately at work endeavouring to restore animation. ‘Artificial respiration was } 
kept up persistently, and at last a faint gasp was heard, showing that life was | 
not wholly extinct. Vigorous means were now resorted to to restore the circula- | 
tion, and these were not abated for a period of nine hours. At six the following | 
morning it was considered the immediate danger was over. The tongue, how- } 
ever, was still protruded, the face deeply suffused, and convulsions recurred at | 


1877.] Notes and News. 307 


uncertain intervals. This continued for forty-eight hours, the patient apparently 
vibrating between life and death, when suddenly her countenance assumed its 
natural aspect; her eyes opened, and she recognised us all; she awoke as it 
‘were from a dream, and her reason was perfectly restored. She had no relapse 
from that day to this,” 


Appointments. 


Avan, W. J., M.B. and C.M., has been appointed Assistant Medical Officer to 
the Somerset County Lunatic Asylum, vice Dutt, resigned. _ 


Barron, J., M.A., M.B., C.M., has been appointed Assistant Medical Officer to 
the Berks County Lunatic Asylum, Moulsford, vice Harvey, resigned. 


Danisu, J., L.R.C.P.Hd., L.R.C.S.Hd., has been appointed Assistant Medical 
Officer to the Derbyshire Lunatic Asylum, Mickleover, vice Daly, resigned. 


Jacos, D., L.R.C.P and L.R.C.S.Hd., has been appointed Assistant Medical 
Officer to the Derby County Lunatic Asylum. 


Lawson, R., M.B., C.M., has been appointed Senior Assistant Medical 
Officer to the Third Middlesex Asylum, Banstead Downs, Surrey. 
Levinas, EH. G., A.B., M.B., L.R.C.S8.1., has been appointed Assistant Medical 
Superintendent of the Bristol Lunatic Asylum, vice De Denne, resigned. 
' MacMuny, J., L.R.C.S.L, L.K.Q.C.P.1., and L.M., has been appointed Assis- 
tant to the Resident Medical Superintendent of the Slgo District Lunatic 
Asylum. 
- Praxton, J. W., M.R.C.S.E., L.S.A.L., has been appointed Assistant Medical 
- Officer to the West Riding Lunatic Asylum, Wakefield, vice Lawson, appointed 
- Agsistant Medical Officer to the Middlesex Lunatic Asylum, Banstead. 
Russevt, A.P., M.B., C.M., has been appointed Assistant-Physician to the 
Crichton Royal Institution, Dumfries, vice Murchison, appointed an Assistant 
| Medical Officer to the Middlesex Lunatic Asylum, Banstead Downs. 





THE MEDICO-PSYCHOLOGICAL ASSOCIATION. 


THE THIRTY-SECOND ANNUAL GENERAL MEETING will be held at | 
Tur Roya Cotnece or Puysicians, Patt Mat, Lonpon (by permission of the | 
President and Fellows), on THURSDAY, Aveust 2, 1877, under the Presidency of | 
G. Fre,pine@ Buanprorp, M.D., F.R.C.P. 


AGENDA : 


T.—Meeting of the Council, at 10.30 a.m. 
IIl.—Meeting of the Association, at 11 a.m. 


1. Dr. Parsey will resign the Chair. 
2. Appointment of Officers. 
3. General business of the Association. 





AFTERNOON MEETING, AT TWO O’CLOCK. 


1. Address by Dr. G. Fielding Blandford. 
2. Discussion on the President’s Address. 


Notice of Resolutions to be proposed, or Papers to be Read, should be | 
sent at once to the Hon. Secretary. 


The Members of the Association and their Friends will dine together after | 
the Meeting. 





Members of the Profession, desirous of admission into the Association, are} 
requested to communicate with the GENERAL Honorary SECRETARY (W. REYs| 
Wiu1aMs, M.D.), Bethlem Royal Hospital, London, S.H. 


THE JOURNAL OF MENTAL SCIENCE. 


[ Published by Authority of the Medico-Psychological Association] 











Bo 13.) ares. OCTOBER, 1877; Vou. XXITTI. 














PART 1,.-ORIGINAL ARTICLES, 


President’s Address, read at the Annual Meeting of the Medico- 
Psychological Association, held at the Royal College of 
Physicians, London, August 2nd, 1877. By G. Freipine 
BuanprorpD, M.D., F.R.C.P. 


GrentLEmEN,—At various times since you did me the honour 
to elect me your President for the coming year, I have con- 
sidered what should be the subject of the address which 
custom demands that I should this day deliver. You have 
listened to addresses on the prevention of insanity, the treat- 
ment of insanity, the care of the insane whether recent or 
chronic—in fact, as every year brings its address, I felt that 
it was difficult to choose a theme that had not already engaged 
the attention of far abler and more experienced Presidents. 
When, however, the Parliamentary Committee, which has 
so long been sitting, commenced its labours, and heard the 
evidence of so many witnesses on the various points which 
they have brought before it, it seemed to me impossible that 
I could pass over such an event without notice, and I deter- 
mined to lay before you some remarks on the Report of that 
Committee, and the evidence there received. Yet, although 
the Committee commenced its sittings in the beginning of 
March, it has not yet presented its report, consequently I am 
not able to lay any portion of the latter before you on this 
2nd of August. | 

However, it occurred to me that there have been Parlia- 
mentary Committees in former times to investigate the 
subject, and that it might be interesting to note the points 
which chiefly engaged the attention of those Committees, 
and contrast them with the topics on which the present 
one has been seeking information. Such an investigation 
will also bring before you the growth and progress of lunacy 
legislation, which has been, to a certain extent, the outcome 
of these committees. I think it possible that some at any 

XXIII. 21 


8310 The President’s Address, [Oct., 


rate of my hearers may not be aware of the comparatively 
modern constitution of the machinery for the care and pro- 
tection of lunatics under which the subjects of her Majesty 
live, and with which those of her Majesty’s subjects whom I 
am now addressing are so closely concerned. Do not fear 
that, when I propose to be historical, I am going to take you 
through endless Acts of Parliament from the Middle Ages to 
our own. Intricate as lunacy legislation appears, the chief 
Acts of Parliament to which I shall call your attention are 
few in number, and the Parliamentary Committees of modern 
times prior to that of 1877 were but two. Of these Acts and 
Committees I propose to say something, chiefly with reference 
to that portion of the subject with which the Committee of 
1877 is concerned, viz., the liberty of the subject. This, as 
_ you are aware, is the point which this Committee is enjoined 
specially to consider, it being alleged that the present lunacy 
laws are insufficient to protect sane people from being wrong- 
fully shut up as lunatics. My intention is to point out how 
the present lunacy laws were developed and evolved out of 
the statutes of former times, and how our forefathers’ liberties 
were protected in the good old days when George the Third 
was Kine. 

The Act of Parliament “for regulating mad houses,” 
which continued in force till comparatively modern times, 
and under which our elder brethren lived, was that com- 
monly known as the fourteenth of the King, passed that 
is, in 1774, the fourteenth year of George the Third’s reign. 
What Acts existed before that I will not here stop to inquire. 
Practically there were none. By this it was enacted that 
five fellows of the College of Physicians should be annually 
elected Commissioners in Lunacy for the granting licenses in 
London and Westminster and seven miles round, and in the 
county of Middlesex. Of these five, two must not have 
served in the preceding year, and no one could serve more 
than three years. If no fellows of the College would accept 
the office, the Commissioners might be chosen out of the 
licentiates. They were to elect a secretary, and to meet 
in the College hall at such times as would not interfere with 
the censors or the other business of the College. The Secre-— 
tary was to keep a box in which to place the papers con- 
nected with the commission, and this box he was to hand | 
_over to his successor at the expiration of his office. The | 
Commissioners were to license houses annually in the metro- | 
politan district, and visit them at least once a year, between | 


877.| by G. Fretpine Bianprorp, M.D. 311 


the hours of eight and five o’clock. At such visits they were 
to make minutes, which, within a week were to be entered 
by the Secretary in a register kept at the College, and were 
to be read to the Commissioners at their next meeting. No 
minute which impeached the character of an asylum was to 
be so entered unless it was signed by three or more Commis- 
sioners. Any censure passed on a house was to be hung up 
in the censors’ room at the College, to be perused or inspected 
by any person who should apply for that purpose. One guinea 
was to be paid to each Commissioner for every visitation of a 
licensed house, together with his expenses. 
For the admission of a patient into a licensed house, %.e., 
a house containing more than one patient, there were neces- 
sary an order or direction of some one or other, whose name 
and address had to be given, and also an order in writing 
uncer the hand and seal of some physician, surgeon, or apothe- 
cary. A return of the admission and the name and addresses 
of the parties signing the direction and medical certificate 
was to be left with the beadle of the College of Physicians in 
London within three days, and it was the beadle’s duty to 
deliver it within two days to the Secretary of the Commis- 
sioners. 
In the provinces houses were licensed by the justices of 
the peace, and two justices and a physician were chosen for 
each county, who were to visit and inspect asylums as “ often 
as they shall think fit.” They might also, “if necessary,” 
Make minutes in writing, which were to be entered in a 
register by the Clerk of the Peace, and a copy was to be sent 
to the Secretary of the Commissioners. Notice of the admis- 
sion of a patient to a provincial asylum was to be sent to the 
- Commissioners within fourteen days. 
_ This Act did not extend to public hospitals or to pauper 
patients. 
- We learn something of the working of this Act from the 
evidence taken before the Select Committee appointed to 
eonsider “of Provisions being made for the better Regula- 
| tion of Madhouses in England.” This Committee commenced 
its sittings on the first day of May, 1815, and ended them for 
_ that year on the ninth of June. It must have been an excit- 
| Ing six weeks in this country, and people’s minds were exer- 
| ised about wars which were far nearer home than Armenia 
| and the Danube. On the first of May Wellington was at 
| Brussels watching his foe. Napoleon’s troops commenced 
| their march on June 6th; he himself left Paris on the 12th, 








312 The President's Address, [Oct# 


and the rest you know. In 1816 the Committee recom- 
menced its sittings. 

I will not weary you by attempting to give even the shortest 
summary of this evidence. It related almost wholly to the 
treatment of the insane, which, as I need not remind you, 
was of a character now happily altogether obsolete and past. 
We are not concerned with such questions now-a-days, and 
the Committee of this year has not gone into them at all. 
In 1815 a great discussion was raised on such questions as 
these—the comparative advantages of strait-waistcoats and 
handcuffs ; whether it was advisable that there should be a 
pump in every airing court ; whether the patients should be 
regularly purged, vomited and bled; whether it is advisable 
that they should or should not sleep two in a bed, concern- 
ing which the Secretary of the Commissioners says, that 
such a practice is a wrong thing, but it cannot be expected 
that a man who pays only ten shillings a week should have a 
separate bed. I wish, however, to draw your attention to 
the evidence concerning the Act of Parliament, so far as it 
affected the liberty of the subject. Dr. Richard Powell, 
the Secretary of the Commissioners, throws some light on 
this. “ The Commissioners,” he says, “‘ visited all the metropo- 
litan houses once a year, and, where there appeared a neces- 
sity, more than once. Their censures of a house were seldom 
hung up in the censors’ room, because such hanging up in a 
private room was completely inefficient, so they adopted the 
more sensible plan of writing to the proprietor and informing 
him of the circumstance.”? The Act of Parliament, though 
requiring a medical certificate, does not specify any particular 
form in which it is to be given. The Commissioners drew up 
a form of their own, which was “ mostly used, but not always, 
as they have no power to compel it.””, They did not, however, 
compare the number of persons in a house with the number 
of certificates. That was impossible. A file was brought, 
“with the certificates jumbled together upon that file; 
patients have gone out of the house, and the certificates 
remain on the file; in short, we only take some of the papers 
and collate them, to see that they accord with our registers 
and returns; we do not attempt to go through the whole, 
but take one indiscriminately and see that it is correct, and 
from finding three or four so, we rather infer that the whole 
are so.” Being asked if they could not make the proprietor 
furnish a list, he says that it would be a very good provision. 
His practice was this—“I take a memorandum book and 


1877. ] by G. Fieytpine Buanproro, M.D. 313 


enter the names as the keeper gives them to me, and,” he 
says, “if we come within a few names of the number, we 
think ourselves very well off. When any patient complains 
to the Commissioners that he is improperly confined, or they 
see reason from his manner to think him go, into that case 
they then more particularly examine: but supposing they 
find the patient’s conversation correct, they know better than 
to infer immediately that he is well, and that his conduct will 
also be so; and if they did, they have no power under the 
Act to liberate him. They usually, in such case, direct the 
Secretary to write to the friends of the patient, and say— 
‘We require, that if his confinement be longer protracted, 
the propriety of such confinement be justified by a more 
repeated and particular examination of some medical prac- 
titioner.’ For it is obvious to the Committee that the Com- 
- Inissioners cannot, on their visitations, have time enough to 
examine into individual cases of lunacy; for doubtful ones 
may require many hours and repeated visits; and if the 
Commissioners were to act from the impulse of the moment, 
or barely to judge from the propriety of temporary conver- 
_ sation, they might let half the lunatics they see loose, though 
they were very unfit to be at large.” Itis clear from the Act 
of Parliament, and the evidence taken before the Committee, 
that the liberty of the subject was a secondary consideration. 
_ The primary one was the regulation of madhouses and the pro- 
viding better treatment for those placed therein. If a single 
patient was confined in a house where only one was taken, no 
order or certificate was necessary, and by the subsequent Acts 
we shall see that though certificates were required, there was 
no visitation of such patients till comparatively modern times. 
The Committee of 1815, in their report say, that one of the 
subjects which had engaged their attention was the detention 
of persons, the state of whose minds did not require confine- 
ment; and they say that, on this ground of complaint, the 
Committee had very slender means of information. With 
this remark the whole matter is passed by. 

How the provincial asylums were inspected appears from 
the evidence of various persons. One proprietor stated that 
he had kept a licensed house for six years and a half, and 
during that time it had never been visited by two magistrates 
and a physician together, as the Act directed, though a neigh- 
bouring magistrate frequently called on him, and other 
Magistrates more or less frequently. The Secretary of the 
Commissioners stated that they had no power under the Act 


314 The President's Address, [Oct., 


to call upon Clerks of the Peace for returns from the country, 
so that they were in absolute ignorance of what licensed 
houses there were. Difficulties occurred in corresponding 
with the Clerks of the Peace, who would not pay the postage 
of the letters. On the Secretary writing to one clerk, the 
answer ran as follows :—‘“‘ Worcester, Sept. 10th, 1813.—No 
step whatever has been taken in this county respecting 
lunatic asylums, nor has any account of Mr. Rickett’s house 
at Droitwich been made to the Sessions or the Clerk of the 
Peace, or any license been taken out by him. I have laid 
accounts of postages, &c., for these kinds of business before 
the magistrates, who are so very particular in their allow- 
ances in this county, that they have told me they cannot 
allow them, and have advised me when I receive such appli- 
cations, not to attend to them.’”’ It is not to be wondered at 
that returns of admission from provincial licensed houses 
were extremely irregular. Of one asylum we are told that 
no notices were ever sent to the college. 

Such were the provisions for the liberty of the subject in 
1815, under the Act of 1774. <A private patient was sent to 
a licensed house on one medical certificate—a pauper was 
sent without any at all. Of visitation and inspection there 
was next to none, and the visitors had no power of release. 
That all this called loudly for alteration, I need not say, but 
the disclosures of illtreatment revealed a state of things 
which called still louder. You might have thought that 
such evidence, together with the report of the Committee, 
would have speedily brought about a new statute. In their 
report the Committee lament that in consequence of the 
length of the inquiry it is too late to pass an Act in that 
Session to remedy the state of things. You may be surprised 
to hear that no less than thirteen years elapsed before such 
an Act was passed. The Committee sat again in 1816, and 
in 1817 a very good Bill was brought in, but it did not 
become law. I suppose at that particular time lunacy was 
not avery welcome topic in the Houses of Parliament. Be 
that as it may, it was not till 1828, the ninth year of Geo. 
1V., that a radical alteration of the law took place. In this 
year an Act was at length passed to remedy the defects of 
that of 1774. By it not less than fifteen persons were to be 
appointed Commissioners in Lunacy for the metropolitan 
district by the Home Secretary. They were appointed for 
one year; five were to be physicians, and their remuneration 
was to be £1 per hour, They were to meet quarterly for the 





1877.] by G. Frecpine Buanprorp, M.D. 315 


- granting of licenses. These in the provinces were to be 
_ granted at Quarter Sessions, where three or more justices 
were to be elected to visit the provincial licensed houses, 
together with one or more medical men. The licensed houses 
were to be visited by three Commissioners, or two Justices, 
with their medical visitor, four times a year, between the 
hours of eight and six in winter, and six and eight in 
summer. They might also be visited at night if informa- 
‘tion, on oath, of malpractices was laid before the Commis- 
sioners. ‘The visitors were to make minutes at their visits, 
which were to be transcribed by the clerk ina register. The 
clerk of the visitors in the provinces was to transmit a copy 
of these minutes to the clerk of the Commissioners. An 
annual report was to be made to the Secretary of State. 
_ Patients were to be admitted upon the certificate of two 
medical men who must have visited the lunatic separately, 
and an order based on the authority of the certificate. The 
medical men were to state the Christian name and surname, 
residence and occupation of the person or persons by 
whom the patient was brought to the asylum, or by whose 
authority he was examined, also the patient’s name, age, 
residence, occupation, and the former asylum, if any, in 
which he had been ; also if he had been found lunatic by in- 
quisition, and the special circumstances, if any, which pre- 
vented his being examined by two practitioners. Such 
medical men were not to have any interest in the asylum. 
This certificate was in force fourteen days after date. Inthe 
case of a pauper one certificate was necessary, together 
with the order of two justices, or an overseer and clerey- 
man. The proprietor of the asylum was to transmit within 
seven days a copy of this order and certificate to the Clerk of 
_ the Commissioners or Visiting Justices, to be entered in a 
register. Also notice of discharge, or death, was to be sent 
within three days. Any inquiry as toa person supposed to be 
in confinement might be made toa Commissioner or Justice, 
who, if he thought it reasonable, might make an order that 
the Clerk should search the register. Patients were to be 
visited every six months by the person who had made the 
order for their confinement, or a deputy. ‘The Commissioners 
might release a patient improperly confined after three 
separate and distinct visits of three Commissioners, who 
must be physicians or surgeons—twenty-one days to elapse 
between each visit. Such release was to be granted at one 
of the quarterly meetings of the Commissioners, or at a 


316 The President’s Address, [Oct., 


special meeting summoned at three days’ notice. Single 
patients were to be received on a like order and certificates, 
and a copy of them was to be sent to the Commissioners 
within five days, marked “ Private Return,” and on Jan. Ist a 
certificate of two physicians as to the patient’s state was to 
be forwarded. This “ Private Return” was kept in a private 
register, open to the inspection of the Secretary of State and 
the Lord Chancellor, or Lord Keeper, or the Commissioners of 
the Great Seal. The name of any single patient might, after 
his discharge or death, be wholly erased from the register 
by the Secretary of State. The Lord Chancellor might 
require the Commissioners to visit patients in charge of their 
relations, but no regular visitation of single patients was 
instituted. 

In 1832 another Act was passed—2 and 3 Wm. IV., cap. 
107. This did not differ materially from the last. The 
Lord Chancellor, not the Home Secretary, was to appoint 


not less than fifteen, nor more than twenty persons, to be. 


- Commissioners of the metropolitan district for one year, of 
whom not less than four, or more than five, were to be 
physicians, and two barristers. The order was to be signed 
by a relative or other, and two medical certificates were to 
be signed by medical men who had seen the patient within 
seven days. 

There was, however, one singular alteration in the law 
enacted by this statute, which illustrates the state of public 
feeling at that time. By the Act of 1828 notice of the ad- 
mission of a single patient, with copy of the order and 
certificates was to be sent to the Commissioners within five 
days, the notice being marked “ Private Return.” By the 
Act of 1832 the person receiving a single patient was not 
bound to make any return of the order and medical certifi- 
cates, though these were necessary, unless the patient should 
not have returned to his usual place of abode at the end of 
twelve months. This notice was also to be marked “ Private 
Return,” and was not to be inspected by any person, except 
by the said Clerk or other person authorised by the Lord 
Chancellor or the Home Secretary. 

Then came the Act of 1842, the 5 and 6 Vict., cap. 87. 
The number of physicians was by this increased to six or 
seven, and that of the barristers tofour. A patient might by 
this be set at liberty after two visits, instead of three, and, what 
was of far more importance, the provincial houses were to be 
visited twice a year by the Metropolitan Commissioners, in 


| 
, 
| 
| 





Se 1: | by G. Fietpine Buanprorp, M.D. 317 


addition to the visits of the Justices. A return was to be 
made of patients escaping. The Commissioners were to 
report as to whether any system of non-coercion was in prac- 
tice in any asylum, the classification or non-classification, 
the number of attendants, and the amusements and occupa- 
tions of the patients. 

The result of this Act was that for the first time the whole 
of the asylums in England and Wales, whether public or 
private, except Bethlem Hospital, were subject to the visits 
of the Commissioners in Lunacy—the Metropolitan Com- 
missioners, as they were then called. Inthe year 1844 these 
Commissioners presented a report to the Lord Chancellor of 
avery voluminous character, comprising the result of their 
enquiries and visits at the county asylums, the naval and 
military hospitals, the public hospitals, and the licensed 
houses. As regards the question of the liberty of the subject, 
this report points out a curious defect in the existing law. 
For admission to a licensed house two medical certificates 
and an order were requisite; for admission to a county | 
asylum one medical certificate was necessary, as at present, 
but a patient could be admitted to a public hospital without 
any order and certificates whatever, these institutions having 
been exempted by the Act of 1832. The Commissioners 
state that all the hospitals, by their own private regulations, 
require them, but the Act of Parliament did not make it 
compulsory. Moreover, private patients in the county 
asylums could be received on one certificate only, and 
various irregularities grew out of the lax state of the law on 
this point, the visiting physician of one asylum signing 
certificates of admission. The Commissioners also complain 
that the law is much evaded, which enacts that copies of the 
order and certificates must be sent to them in the case of 
single patients. In the case of single pauper patients no 
orders or certificates were ever sent, and those relating to 
private patients were so few in number that it was manifest 
that the most culpable negligence existed. 

The result of this report of the Metropolitan Commissioners 
was the great Act of 1845, the Act which is in force at the 
present time, of which subsequent Acts are mere modifica- 
tions, and which was brought in by the present Chairman of 
the Lunacy Board, and passed through his exertions. This 
is the Act which is at the present time on its trial, for the 
modifications enacted by the Acts of 1853 and 1862 are, in 
my opinion, so slight that the liberty of the subject is not 


318 The President’s Address, [Oct., 


materially influenced by them, though they are doubtless 
right and proper. 

If I were asked what was the greatest. advance made by 
this Act for the safety of the subject, I should be inclined to 
say that it was the obligation that the medical men signing 
the certificates should state the “ facts indicating insanity 
observed by themselves.” You know what it is that we look 
to chiefly when we receive a patient’s papers. There are the 
dates of the order and certificates. These were not altered 
by the Act of 1845. The medical certificates were before 
that time limited to seven days; the month in which the 
order must be signed was part of the Act of 1862. But the 
reasons for the opinion of the medical men certifying were 
demanded for the first time in 1845. I think you will agree 
with me that herein is a great safeguard. We may have a 
strong feeling that a man is insane, we may be strongly dis- 
posed, on the representations of friends, to think that he 
requires restraint, we may by general observation and know- 
ledge of him extending over years have a firm belief that he 
is insane. But this, as you know, avails us nought. We 
have to state that which indicates insanity on a particular 
day ; and you also know how difficult it is to do this in many 
cases, and how the alleged lunatic gets the benefit of the 
difficulty. I think you will agree with me that these certifi- 
cates are far more rigidly examined and rejected than formerly 
was the case, and that herein lies the great security which 
the public enjoys, and which practically is sufficient; so that 
cases of persons falsely and maliciously certificated as 
lunatics are, | may say, unknown. No machinery that I can 
conceive practicable can ensure that a patient shall be seen 
by an official before or immediately upon his admission, but 
if his certificates are subjected to inspection within twenty- 
four hours, it is not difficult for skilled officials to say that 
this or that certificate is one which does not contain any 
statement of facts indicating insanity, and to demand further 
proof of the alleged unsoundness of mind. It is said by 
some that the duties of the Commissioners are imperfectly 
carried out, that their office is overwhelmed with the amount 
of work which has to be done, and that the greatest laxity 
prevails. I have not found it so, and I will take this parti- 
cular instance of the examination of certificates and contrast 
it with the practice of the office thirty years ago. JI opened 
at random some certificates of 1846, and here are the certi- 
ficates of the insanity of two gentlemen. I may mention that 





1877.]| by G. Frenpine Buanprorp, M.D. 319 


at this time there was no space for the facts indicating 
insanity communicated by others; the medical man stated 
what he had himself observed. The first certificate runs— 
‘“‘ His conversation, account of himself, and my previous 
knowledge of him.” The second is as follows :—“ Having 
previously been his medical attendant under similar cireum- 
stances, and perceiving that he is now becoming in a similar 
state.” In the other case the first certificate ran thus— 
‘Personal violence—excessive indulgence in the use of 
spirituous liquors and in women;” and the second was even 
’ shorter, *“‘ Personal and unreasonable violence.” Ithink you 
will agree with me that these certificates would not now be 
considered conclusively indicative of insanity, and would 
certainly come back again with a good deal of red ink upon 
them. 

I need not go through the various provisions of the Act of 
1845. An important alteration was made in the constitution 
of the Visiting Commissioners ; whereas formerly they were 
gentlemen practising in the ordinary course of their profes- 
sion, those now appointed were debarred from taking any 
other office or duty, or any profession or employment, from 
which any gain or profit might be derived. 

In 1853 this Act was amended by another—the 16 and 17 
Vict., c. 96. By this persons who had been patients might 
be received in an asylum as boarders. The facts indicating 
insanity observed by the certifying medical men were to be 
distinguished from those communicated by others. Notice 
_ of death was to be sentto the Coroner. Transfers of patients 
were instituted, and various regulations were made with re- 
gard to single patients, and Bethlem Hospital was exempted 
no longer. 

In 1859, after great excitement and agitation concerning 
private asylums and the Lunacy Laws, a Bill was brought 
in by Mr. Walpole to amend the latter, and a Select Com- 
mittee was appointed, which sat in 1859 and again in 1860, 
and issued a report in the latter year. The result of this 
long enquiry was the Act of 1862, under which we now are. 
- The alterations made by this were very trifling; the copies of 
the order and certificates were to be sent in within twenty- 
four hours, instead of seven days; the order must be signed 
by some one who had seen the patient within a month, and 
the Commissioners visits were increased in number. I pass 
over the various alterations in the laws affecting pauper 
patients -and county asylums, and also those relating to 


320 The President’s Address, [Oct., 


Chancery patients as not bearing directly on the subject I am 
considering. And now we come to the year 1877, when, as 
you know, another Committee has been sitting—the third of 
this century—to consider not the management of mad 
houses, or the condition of lunatics, but the Lunacy Laws 
as they affect the liberty of the subject. What the report 
of this Committee will be we as yet know not; but we may 
look for afew moments at some, at any rate, of the questions 
which have occupied its attention, and some of the 
remedies which have been proposed for the alleged defects of 


the law and its administration. And, first of all, what has ~ 


led to this Committee being called together? There has been 
no public agitation on the subject. No alleged lunatics have 
been found sane by juries asin 1859. Such agitation as there 
has been has, I believe, proceeded from a very few individuals, 
who have themselves been the inmates of asylums, having 
been, as they themselves think, unjustly shut up while sane. 
From the accounts we have read of these individuals inthe penny 
and halfpenny papers during the last year or two, I thought 
that a very considerable number would have come forward 
and made their complaints. But I believe Iam right in stat- 
ing that not half a dozen have been found, who, even on their 
own showing, may be supposed to be victims of an unjust 
law. This is a very striking fact, and I doubt if any insti- 
tution in our land, or any land, can be adduced against which 
so little can be said. Since the last Committee sat, in the seven- 


teen years, 1859 to 1875 inclusive, rather more than 185,000 - 


persons have been placed under restraint. Yet those who 
think themselves wronged are but the few I have mentioned, 
and we have yet to learn whether in the opinion of the 
Committee they have proved their case. Besides the lunatics 
themselves, or I suppose I must say, the alleged lunatics, who 


are the others who are dissatisfied with the existing ‘Taw 2 


There is a class of persons who rail against all laws which 
put any restriction upon those who wish to do exactly what 
they like, who rail at magistrates, at the police, at the treat- 
ment of prisoners, persons who would like to aid a lunatic to 
escape as they would a pickpocket. Then there is a class 
who are profoundly ignorant of the whole matter, and never 
Saw a lunatic in their lives—would much rather not see one, 
much less go over an asylum—yet who are entirely convinced 
that patients are still barbarously illtreated in asylums, and 
for that reason wish the latter to be swept away. If youask 
these people what they would substitute in their place they 


1877.] by G. Frenpine Buanprorp, M.D. 321 


have nothing to suggest; but nothing can shake their belief, 
founded as it is on the high authority of sensation novels. 
There is yet another class who go about in the perpetual de- 
lusion that vast numbers of perfectly sane people are shut up 
every day by interested relatives for the sake of their pro- 
perty, and that doctors can be had, in any quantity, and at 
the shortest notice, to accomplish this. These are the same 
sort of persons as those who still believe in “ the unhappy 
nobleman now languishing at Dartmoor,” and they who still 
believe in that individual are only the residue, recollect, of a 
very large number of persons who firmly believed in that 
audacious and vulgar swindler. Arguments avail as little on 
the one subject as the other, and if I were addressing a body 
of such persons instead of you, gentlemen, [ should be merely 
wasting time, were I to bestow arguments upon them. There 
is one more class of persons who would like to see alterations 
in the existing law; these are they who think that in the 
universal reconstruction of all things, some pleasant little 
office may, perchance, fall to their lot. They would like to 
see sixteen Commissioners instead of six, officials in every 
county, private asylums managed by public superintendents, 
and soon. Itis curious how the recommendations of all such 
individuals tally with their respective positions and wants. 
There is one class who are not to be enumerated among 
them. They are the persons who have the interest of the 
insane at heart, who recognise the inevitable truth that some 
thousands of our fellow-subjects are every year stricken with 
this disorder, and depend upon their sane brethren for care 
and cure. They believe us when we tell them that the most 
important step of all towards cure is early treatment, which 
means early restraint, and they give us that credit for wishing 
to cure those committed to our care, which every medical 
man in this land is thought worthy of except the lunacy 
doctor. I believe that of such people there are not a few. 
Thanks to our excellent county asylums and the gentlemen 
who form the Committees of them, many of them members 
of both Houses of the Legislature, the knowledge of this 
subject has increased and is still increasing, and I have con- 
fidencethat we shall not see any retrograde legislation brought 
about by the classes I have mentioned before. 

Finally, I would say one word upon the remedies proposed 
for the alleged defects in the law, the defects by which both 
in public and in private asylums sane persons are said to be 
shut up annually, or kept long after they have recovered 


322 The President’s Address, [Oct., 


their sanity. For, bear in mind, the accusation is not 
only directed against private asylums. Three flagrant cases, 
which before the commencement of the inquiry were 
paraded in the newspapers, were those of persons confined 
in public asylums: two out of these turee have, I think, 
been mentioned to the Committee. Of the other, a man, 
whom I myself saw several times, I have seen no notice. All 
kinds of devices have been proposed, one that every patient 
should be tried by a jury before admission; another, that 
he should be taken before a magistrate; a third that the 
order and certificates should be inspected by a magistrate; 
a fourth, that some official person, as a medical officer 
of health, should sign the certificates. One person thinks 
that no lunacy doctor should sign them; another complains 
that the bulk of medical men signing have no knowledge of 
lunacy. Some wish that the first certificates signed should 
be valid for a limited period only—three, six, or twelve 
months—and then that every patient should be recertified. I 
shall not waste the time of this meeting by discussing seri- 
atum these recommendations. Those who demand a jury for 
every patient do so not from any desire to benefit patients, 
but because, knowing the nature and constitution of juries, 
and the glorious uncertainty which attends the decision of a 
jury led hither and thither by the evidence of conflicting 
witnesses and the speeches of contending counsel, they think 
that there is a strong probability that a lunatic will escape, 
and that friends will not run the risk of this, and so will 
abstain from interfering with those who require care and 
treatment. ‘The suggestion that every one should be taken 
before a magistrate was made to the Committee of 1859-60, 
and I cannot do better than read to you their remarks upon 
it: ‘“ Insanity, under any shape, is so fearful a malady, that 
the desire to withdraw it from the observation of the world 
is both natural and commendable. The reverse of this would, 
in all instances, be painful, and in many it would be cruel. 
A man in business may become affected by temporary in- 
sanity, brought on by over-exertion, mental anxiety, or 
physical ailment ; but if he is early and properly treated, his 
recovery may be as quick as his seizure was sudden. What 
could be more injurious than a public inquiry in such cases 
as these? Where the insanity was undisputed, the inquiry 
could lead to no useful result, though the knowledge of the 
malady might be seriously prejudicial to the future prospects 
of the patient and his family. But when it was disputed, it 


| 


1877.] by G. Fretpine Buanprorp, M.D. 323 


is unnecessary to dwell on the various mischiefs which would 
instantly result from it; such, for instance, as the agitations 
caused to the patient’s mind just at the moment when it was 
trembling in the balance, the injurious comments which 
might be made on his character and conduct, the unneces- 
sary exposure of which need not and ought not to be brought 
before the public gaze; the stigma or prejudice which might 
permanently attach to him and his children in the event of 
recovery; and frequently, it may be added, the grievous 
expense which such enquiries would entail. Norshould it be 
forgotten that the delay caused by reference to a magistrate, 
with a possible inquiry, might prevent or retard that immedi- 
ate aa which is so requisite for the patient.” [ Report, 
p. vill. : 

As to the verification of the documents before a magistrate, 
he would be a bold magistrate, I think, who refused to sanc- 
tion the admission of a patient into an asylum when two 
medical men had certified it was necessary. And as regards 
the mere formal filling up of the certificates, that inspection is 
performed now by skilled persons in the Commissioners’ 
office, and performed necessarily better than it could be by 
an unskilled justice of the peace, who, perhaps, has never 
seen such a paper before in his life. The other recommen- 
dations are hardly worth notice. Re-certification at the end 
of a twelvemonth would not affect the great bulk of patients, 
and those who have not recovered in that time are most of 
them chronic patients not likely to recover at all, and obvi- 
ously insane. Re-certification at a very early period, just 
when a patient is beginning to lose his delusions, would be a 
measure, in my opinion, of very doubtful propriety. 

There is one more suggestion which is constantly made, 
that is the abolition of private asylums. It is so easy to say 
that patients are kept therein for profit only, that no means 
of cure are tried, that, once in, they never come out, that 
the wonder is that we do not hear it oftener than we do. I 
will give you the figures quoted by the noble Chairman of the 
Commissioners to the Select Committee a week or two back. 
In the 17 years, 1859-1875 inclusive, of the 185,000 patients 
admitted into asylums, 90,000 were restored to liberty; of 
these 90,000 about 22,000 were private patients and the rest 
pauper. The paupers admitted were 150,000, the private 
_ patients, 35,000. So that 62 per cent. of the private patients 
were discharged, and only 45 per cent. of the paupers. 

- The Report of the Committee of 1877 is not yet before us. 


324 The President’s Address. [Oct., 


What it will be, and what alterations will be proposed, we 
cannot say, or what bill may be brought in ata future session 
of Parliament for the amendment of the present law. But of 
this I am certain, that no persons in this realm have such 
intimate and special knowledge of that which is necessary 
for the welfare of the insane as the members of this Asso- 
ciation. Some of us have the care of private patients, some 
of paupers; but the knowledge of. the one is at the service 
of the other, and we all contribute to the study of insanity, 
and the benefit of theinsane. And.I would ask each member, 
according to his opportunities, to try to bring about such 
legislative changes, if changes there are to be, as shall 
promote, and not retard, the restoration and well-being of 
all who are lunatics, idiots, or persons of unsound mind. 


On the Best Means of Providing for the Care and Maintenance 


of Pawper Lunatics of the Demented and Imbecile Class. By 


Tuomas L. Rocers, M.D., Medical Superintendent, County 
Asylum, Rainhill.* 

I feel that an apology is almost needed for introducing the 

subject that I bring before you to-day—that of the best 


means of providing for the care and maintenance of the large 


and constantly increasing number of pauper lunatics of the 
demented and imbecile class, which gradually accumulates 
and fills up the available space in our County Asylums; often 
to the exclusion of recent cases requiring immediate medical 
care and attention. 

The subject has been often referred to in presidential 
addresses, but discussion has been generally led on some 
other point, and thus the opinion of members has never 
been fairly elicited on this particular question—how provi- 
sion can best be made for this class. 

Meanwhile an influential Committee of the Charity 
Organisation Society have discussed the subject fully, and 
have arrived at certain conclusions; and it may be asked 
why, in face of their report, I need re-introduce the sub- 
ject before the present meeting. 

My answer is, that on a question so closely concerning our- 
selves, and on which we might be expected to have formed a 
definite judgment, it does not become us to maintain silence, 
and to allow the opinion of others, however influential, to go 
unsupported if we agree with them, or to pass unchallenged 
if we dissent from them. 

For although several members of our Association were 


* Read at the Annual Meeting, August 2nd, 1877. 





1877.] The Care and Maintenance of Pauper Lunatics. 3825 


present and took part in the discussions, and in the report 

which resulted from the discussions of this Committee, this 
Association, as a body, has not committed itself to any one 
view, and it may be that opinions in antagonism to the report 
referred to are held by some of our members. 

It is for the purpose of taking the sense of this. meeting 
on the subject that I introduce it now; and, following the 
example of a distinguished authority in another place, I 
propose to do so by way of resolution. 

The first resolution has reference to the practice of board- 
ing out harmless and chronic patients with families in their 
own sphere of life, but aliens in blood. 

We know that this practice has many advocates among 
our associates North of the Tweed, and also many theoretical 
admirers in this and other countries for whom the title of 
“family life’ has apparently something very attractive. 

Let us inguire if such a system can be carried out to any 
extent in England. 

I have read more than once the address of our retiring 
President, and that portion which alluded to the subject now 
under consideration appears to me to have left little unsaid ; 
but the discussion which followed the address was immediately 
led away to the cause of our American brethren, and to the 
hard usage they had received both in their own and in this 
country, and the rest of the address was passed by without 
comment. 

Yet I think it deserved better treatment than this. In read- 
ing Dr. Parsey’s address, which was a model of impartiality, 
his position strongly reminded me of that of a barrister who 
holds a brief in a cause which he feels cannot be sustained, 
but for which he is anxious to do his best, whilst determined 
at the same time not to give up any principles which he con- 
scientiously holds. 

The question whether any tangible number of our pauper 
lunatics can be disposed of by placing them out to board in 
private families is, after all, a pecuniary one—.e., whether 
it is worth while for the families of our working classes to 
board and lodge lunatics for the sake of the remuneration 
they would receive. The further question, whether amongst 
our working-class population there are to be found cottagers 
with the necessary qualifications of patience, kindness, and 
devotion towards their charges, such as we hear of amongst 
the “‘gardiens” of the lunatic colony of Gheel, merges itself 
in the former one, of remuneration, for it may be assumed 

XX. 


.826 The Care and Maintenance of Pawper Lunatics, [Oct., 


without wrongine these worthy people, that if they did not 
derive some temporal benefit from taking charge of lunatics 
they would not do so, and also that if our cottagers derived 
a corresponding advantage from undertaking the same duty 
they would be glad to undertake it. 

I speak not without some experience on the subject, for I 
was at one time much more sanguine about it myself, and 
tried the experiment of boarding out patients with the 
families of some of my attendants, and in building some 
new cottages for them this object was kept in view; but I 
must confess that the experiment was a failure. I never had 
more than three patients at a time so boarded out, and at the 
present time I have only one. 

It may be objected that my experiment was on too small a 
scale to entitle me to generalize on the subject, but my reply 
to that would be that the very reluctance of my attendants 
to apply for patients to live with them indicated their unwill- 
ingness to receive them, as my intentions were well known, 
and it was not to be expected that I should ask them as a 


favour to receive patients. In fact, I did on one occasion ask 


an attendant, whose wife had previously for some time 
taken charge of a patient, if he would take in a man whom 
I did not wish to send to a workhouse, and whom it was 
unnecessary to detain in an asylum. I offered him 10s. a 
week ; but his reply was, that the man had a large appetite, 
and that he could not afford to board him at the price. I 
afterwards gave the patient leave to try amongst the neigh- 
bouring cottagers tor himself, but he came back to me with 
tears in his eyes, saying no one would take him for the money. 

Within the present year one of the paid labourers employed 
on the estate, in the receipt of 18s.a week wages, left his 
employment and the neighbourhood because he could not get 
decent board and lodging under 18s. a week. 

Now, if a householder would not take in a sober, steady, 
working man of sound mind for less than 13s. a week, how 
could any one be expected to take charge of a lunatic for 10s.5 


for it cannot be assumed that the value of the lunatic’s | 


labour would be equivalent to the difference. Neither 
can we suppose that Boards of Guardians would consent to 


pay more for lunatics boarded out than for those maintained — 


in asylums. 

I think that this may be taken as a fair exposition of the state 
of affairs in Lancashire, and I do not imagine that it varies 
much from that in other urban populations. 


| 
| 
| 


| 


1877.) by Tuomas L. Roars, M.D. 327 


In rural districts no doubt it might pay the cottagers to 
have lunatics to board with them, but as our largest and 
most crowded asylums are those appropriated to our large 
towns, the facility of boarding out a few lunatics in rural 
districts does but touch the fringe of the subject. 

I might allude to the disadvantages as regards the patients 
themselves in placing them out to board in our densely popu- 
lated districts, as compared with a sparsely inhabited 
country, such as the Scottish Highlands, for instance; but 
if I have shown that people in the same class of life are 
unwilling to receive them, it is unnecessary to occupy time 
in multiplying objections. 

I therefore submit the following resolution :—“ That, 
although the system of boarding out quiet and harmless 
pauper lunatics with families in their own station of life 
may be advantageous in districts where it is practicable, the 
proportion of cases in which such a system could be 
carried out is so limited, that it does not practically affect 
the question of future provision for the insane poor of the 
chronic and imbecile class.” 

The other alternative is the plan recommended by the 
Charity Organisation Committee, and this has been so fully 
discussed, and so warmly taken up and brought under the 
notice of the Government by Sir Charles Trevelyan and other 
influential men, that there would appear but little occasion 
for further discussion of the subject. 

My own opinion is entirely in accordance with that of this 
Committee, and I may be excused for re-calling to the 
memory of the members of this Association a resolution 
that I proposed in my address in 1874, which was :—“ ‘That, 
besides institutions for idiots who are capable of training, and 
hospitals and asylums for recent and curable cases of mental 
disease (to which there should be generally attached a 
medical school), further provision should be made for chronic 
and harmless lunatics, imbeciles, and idiots, upon the plan of 
the Metropolitan Asylums for Imbeciles, and for Criminal 
Lunatics, by establishing district asylums, especially for this 
class.” 

I believe, however, that there are differences of opinion 
amongst our members on this point. I have heard it said 
that “the stamp of chronicity” (I think that is the phrase) 
being fixed on these institutions would have an injurious 
effect upon the inmates, as implying that they were past hope 
of recovery ; and the constant association of the same class 


398 The Care and Maintenance of Pauper Lunatics, [Oct., 


would have a deteriorating effect on the general body. I 
believe this to be entirely a fanciful objection. A certain 
proportion even of these chronic cases recover ; supposing 
the recoveries did not exceed one per cent. in the total number 
under treatment, many of our county asylums which are 
supposed to receive recent and acute cases are 80 crowded 
with incurables that they do not send out more than ten per 
cent., so that the difference after all is only one of degree and 
not of kind. 

As regards the name, the title of chronic asylum is surely 
not more offensive than that of pauper asylum. Many patients 
feel it an indignity to be considered pauper lunatics, and in 
my opinion not without reason, seeing that a considerable 
proportion of them never were paupers until they became 
mentally afflicted, and that the cost of maintenance of many 
is either wholly or in part defrayed by their relations. 

A second objection I have heard urged is that these chronic 
cases are liable to exacerbations of maniacal excitement, 
which would require their re-transfer to county asylums. 
The same objection applies in a still greater degree to the 
practice of sending out un-recovered lunatics to workhouses, 
which is now adopted to a great extent in many counties. 

In the county of Lancashire, for instance, it often happens 
that no sooner are patients discharged from one asylum to a 
workhouse, than they are almost immediately sent under fresh 
certificates to another. The re-transfer from a chronic asy- 
lum to one for acute cases would certainly not be so frequent 
nor more difficult to effect than from a workhouse to an 
asylum. 

Another, though unacknowledged, objection, I believe also 
arises from a personal feeling on the part of some medical 
superintendents that, as they would not like to have charge of 
a chronic asylum themselves, they entertain a prejudice 
against them generally. 

My view is, that lunatics are altogether out of place in 
workhouses. Moreover, the capitation grant for lunatics who 
are in asylums not being extended to those who remain in 
workhouses, certainly has the tendency to make the Boards 
of Guardians more unwilling to retain them. There is nov 
only an indisposition on the part of Guardians to erect new | 
lunatic wards, but those who have already gone to consider- | 
able expense in this direction complain that they are unfairly | 
treated, because, by keeping their own lunatics, they lose the | 
Government grant, which those who have provided no accom | 

| 


| 


1877. | by ‘Tuomas L. Rogers, M.D. 329 


modation of their own avail themselves of to the fullest 
extent. 

In fact, the manner in which this capitation grant is at 
present applied, requires a complete revision, for there can be 
no valid reason why the grant should not be allowed for 
lunatics who are not in county or borough asylums, as wellas 
for those who are, and the present system is a direct en- 
couragement to parish officers to send persons to asylums 
whose condition does not render removal at all necessary. 
This fact was strongly impressed on my mind by an analysis 
of the cases admitted into Rainhill last year. I do not, how- 
ever, propose to occupy any more time by enlarging on this 
subject at present, especially as I believe it has already been 
brought under the notice of the Government in consequence 
of my report thereon, but I will at once propose my second 
resolution, which is :— 

“That this meeting cordially concurs in the resolution of the 
Committee of the Charity Organisation Society :—‘ That the 
arrangement which has been made for Idiots, Imbeciles, and 
‘Harmless Lunatics in the Metropolitan Asylums District, is 
applicable, in its main principles, to the rest of England, viz., 
that Idiots, Imbeciles, and Harmless Lunatics should be re- 
moved from Workhouses and County Lunatic Asylums into 
separate Asylums, and that young persons of the first two 
classes should be suitably educated and trained.’ ” 


Morison Lectures on Insanity for 1877.* By Joun SrpBaxp, 
M.D., F.R.C.P.E., Deputy Commissioner in Lunacy for 
Scotland. 


Lecture Il.—Insanity 1x THE Mippie AGEs. 


The fall of the Roman empire was followed by a lengthened 
period of political confusion and social anarchy, during which 
the ideas that had been developed by the action of Greek and 
Roman culture were lost sight of, and seemed for a time to 
have been lost altogether. The epoch which thus followed 
the disintegration of the Roman power, and which lasted till 
the social and political elements began again to exhibit 
symptoms of stable organisation and vigorous life, has become 
known as the Middle Ages. As limited by Hallam, it com- 
prises about a thousand years, dating from the invasion of 


* These lectures were delivered before the Royal College of Physicians of 
Edinburgh. 


330 Morison Lectures on Insanity for 1877, [Oct., | 


France by Clovis at the end of the fifth century, to the 
invasion of Naples by Charles VIII. at the end of the 
fifteenth. We may regard these dates as broadly marking 
off the period of history which derives its characteristics 
from what is known as medievalism. But the features 
which marked the epoch did not show themselves in all 
countries at one time. In some they gave place to the 
features of the modern epoch earlier than in others. Nor 
did anywhere the whole medieval character die out at once. 
Some of its characteristics faded earlier, some later; and 
some remain with us to the present day. We must there- 
fore, in tracing their history, refrain from binding ourselves 
by too precise a demarcation of the limits of the period. 

As a preliminary to any enquiry into the condition of the 
insane or the conception which was formed of the nature of 
insanity, we must, as was pointed out in last lecture, glance 
for a moment at the general condition of society at the time, 
in regard to its intellectual and political life. During the 
first half of the epoch there seems indeed to have been 
scarcely any development worthy of such an appellation. 
The whole of Europe was almost without exception sunk in 
the darkest ignorance and the most wretched barbarism. 
But even at a later period, when the clouds began to lift, 
and signs of returning light were undoubtedly to be discerned, 
the culture, such as it was, affected merely a fraction of a 
special class. 

‘Whatever mention we find of learning and the learned 
during these dark ages,” says Hallam, ‘“‘must be understood 
only to relate to such as were within the pale of clergy, 
which was, however, pretty extensive, and comprehended 
many who did not exercise the offices of religious ministry. 
But even the clergy were for a long period not very materially 
superior, as a body, to the uninstructed laity. An incon- 
ceivable cloud of ignorance overspread the whole face of the 
church, hardly broken by a few glimmering lights who owe 
almost the whole of their distinction to the surrounding 
darkness. In the sixth century, the best writers in Latin 
were scarcely read; and perhaps from the middle of this 
century to the eleventh, there was in a general view of 
literature little difference to be discerned.”? The darkness, it 
is true, was not spread equally over the whole of Europe ; nor 
was the darkness at its thickest in every region at one time. 
“France reached her lowest point at the beginning of the 
eighth century ; but England was at that time more respect- 


1877] by Joun Stppatp, M.D. 331 


able, and did not fall into complete degradation till the 
muddle of the ninth, .....°. But of the prevailing ignorance, 
it is easy to produce abundant testimony. Contracts were 
made verbally for want of notaries capable of drawing up 
BRArters. 62). In almost every council the ignorance of the 
clergy forms a subject of reproach. It is asserted by one 
held in 992 that scarcely a single person was to be found in 
Rome itself who knew the first elements of letters. Not one 
priest in a thousand in Spain, about the age of Charlemagne, 
could address a common letter of salutation to another. In 
England, Alfred declares that he could not recollect a single 
priest south of the Thames (the most civilised part of Ene- 
land) at the time of his accession, who understood the ordi- 
nary prayers, or could translate Latin into his mother 
tongue.” 

The political condition during this period may be fitly 
described as one of incessant perturbation. The struggles 
of races for possession of the countries that had been loosed 
from the Roman yoke continued for centuries to make the 
state of war persistent and almost universal. And when 
these had resulted in the establishment of the states into 
which Europe became ultimately divided, the conflicts 
within themselves of factions and of princes striving for 
sovereign authority still prevented the development of stable 
political organisation. 

In such a state of society little thought could be bestowed 
on anything which did not directly relate to the. fierce 
struggle for very life in which every state and every indi- 
vidual was engaged. Questions relating to philanthropic or 
even social duty were scarcely mooted; and we have no 
satisfactory record of the views that may have been held 
regarding them. There were still preserved in the adminis- 
tration of justice, where it was possible to carry it out in any 
regular form, the traditions of the old Roman law ; and its 
provisions for dealing with dementes, fwriosi, and mente captr 
would probably influence the treatment of many cases. A 
ereat portion of the inhabitants of France and Spain, as well 
as Italy, were governed by the provisions of a body of law 
called the Theodosian code, which had been compiled soon 
after the establishment of Christianity. Harly in the twelfth 
century attention was directed to the systematic study of 
jurisprudence; and the comprekensive system of Justinian 
was adopted as the basis of teaching in the schools which 
arose in Bologna, Naples, Padua, and other places. And 


oo2 Morison Lectures on Insanity for 1877, ([Oct., 


though the canon law was for a time imposed upon a great 
portion of medieval Europe by the overwhelming influence 
of the church, the influence of the Justinian code was widely 
felt; and it is still to be traced in our modern legal systems, 
forming as it does the actual basis of French, German, and 
Scottish jurisprudence. 

But during the barbarous epoch of which we have just 
been speaking, the influence of Roman law upon the mind 
of the community in determining its treatment of the insane 
(either in regard to the modein which their care and treat- 
ment were provided for, or in regard to holding them re- 
sponsible for their acts,) can only, as in earlier times, have 
had any extensive application in the case of persons of great 
social importance. 

The most important change which took place during the 
Middle Ages in the constitution of society was the gradual 
abolition of slavery in southern and western Europe. ‘‘ The 
eleventh and twelfth centuries,’ says Hallam, “saw the 
number of slaves in Italy begin to decrease; early in the 
fifteenth, a writer quoted by Muratori speaks of them as no 
longer existing. The greater part of the peasants in some 
countries of Germany had acquired their liberty before the 
end of the thirteenth century. In other parts, as well as in 
all the northern and eastern regions of Europe, they re- 
mained in a sort of villenage till the present age. Some 
very few instances of predial servitude have been discovered 
in England so late as the time of Elizabeth, and perhaps 
they might be traced still lower.”” In France this condition 
was not entirely abolished till the time of the first revo- 
Jution. | 

This desirable social change was to a great extent due to 
the influence of the Christian church; and that influence 
was also exerted in other notable though widely divergent 
directions. The church rendered invaluable service by incul- 
cating the duty of caring for and protecting those sufferers 
from insanity whose condition was recognised as a result of 
disease. The story of the village asylum of Gheel which 
originated in the legend of St. Dymphna, shows that as early 
as the seventh century the custom had arisen of sending mad 
persons for cure to the shrines of saints. In the twelfth 
century we find madmen being taken to St. Bartholomew’s, 
in London, and wonderful cures are recorded in the monkish 
narratives as having taken place there. To some hospitals, 
long before they ceased to be altogether ecclesiastical estab- 


1877.] by Joun Sippatp, M.D. 333 


lishments, there were attached chambers, or cells, into which 
lunatics were received. But unless the provision which was 
thus made in these earlier times was much better than the 
condition in which these places were found in the eighteenth 
century would seem to indicate, the benefit of the charity 
was conferred more on the public which was relieved from 
the presence of the patients than upon the patients them- 
selves. And judging by the kind of structures which we 
know to have been devoted to this purpose, it is probable 
that such was really the view with which they were erected. 

But I think we should fail to do justice to the benefit con- 
ferred by the monastic establishments if we omitted to 
recognise their utility as sanctuaries in which persons of 
morbidly sensitive nature, or those suffering from religious 
excitement or depression, could find a refuge from the jarring 
influences of active life. It scarcely admits of doubt that 
many of those who devoted themselves to the practices of 
extreme asceticism were, like the emperor Charles V. at 
Yuste, subjects of mental disease, and that they often found 
in such asylums a protection and a sympathy which might 
have been sought in vain elsewhere. In connection with the 
benefits conferred upon the insane through the instrumen- 
tality of the medieval church, we must also recognise the 
truly noble work carried out by Vincent de Paul, who in ad- 
dition to his other labours for the relief of suffering humanity, 
strove successfully, though within a limited field, to amelio- 
rate the condition of the insane. 

But in the midst of the unstable social conditions of the 
medizeval period there was. little consideration or even 
tolerance extended to persons who exhibited anything excep- 
tional in their language or demeanour. The tendency of 
the human mind to regard with anxiety and terror all devia- 
tions from what was believed to be the natural order of 
events was then an overpowering force. ‘To excite apprehen- 
sion it was not necessary that the deviation should be so 
marked as would be shown in the behaviour of the insane. 
Even the acquisition of a little more knowledge than what is 
usual seems at some periods to have been sufficient to excite 
serious fears. The ingenious Gerbert, afterwards Pope 
Sylvester IT., who introduced the use of clocks, was suspected 
of necromancy and regarded with apprehension. Roger 
Bacon, the greatest natural philosopher of the Middle Ages, 
was imprisoned for ten years for practising magic. Vergilius, 
Bishop of Salzburg, having asserted the existence of the 


334 Morison Lectures on Insanity for 1877, [Oot 


Antipodes, the Archbishop of Metz declared him to be a 
heretic, and caused him to be burnt. And even Thomas 
Aquinas, “ the seraphic doctor,” did not escape the accusation 
of dealing in the black art. In the same spirit, there was a 
disposition to fear and persecute those who were afflicted 
with a form of disease which produced unusual kinds of 
behaviour. There can be no doubt that a large number of 
disorderly persons who would at the present day be treated 
as insane were unhesitatingly regarded at that period as 
merely criminal, and were punished accordingly. But 
besides this, an immense number of harmless persons were 
believed to be under demoniacal influence—witches or 
wizards—and were sacrificed in thousands to the ignorance 
and fears of those who should have protected them. That 
the cruelties which were thus perpetrated attained such 
remarkable dimensions was due to there being incidents of 
the struggle carried on during the last stages of medizevalism, 
when the classes which had previously held society in thrall 
became conscious that their power and influence were slipping 
from their grasp. It had been at a previous epoch when the 
fact was recognised by pagan and imperial Rome that neither 
was its power invincible, nor even its continuance assured, 
that the extravagance of reckless cruelty assumed the chronic 
form which disgraced the later pages of its history. 

And it was in like manner, “at the beginning of the 
end” of the medieval period, when its social and religious 
systems were threatening to give way, that every 
deviation from established rule was looked on with 
special alarm. Exceptional conduct was attributed to 
the worst conceivable causes, and every effort was used 
unsparingly to stamp it out. The sternness, or we may say 
the brutality, with which this determination to stamp out all 
such deviations was carried out, was a consequence of the fact 
that the efforts of civil government at the time were devoted 
almost exclusively to the preservation of the existence of the 
state. The political organisation had nowhere fully attained 
to a condition of consolidated stability, and society was, in 
many instances, still trembling near the verge of anarchy. 
It was almost inevitable, therefore, that persons, whether 
sane or insane, who committed breaches of public order, 
should, in most cases, be dealt with by the public execu- 
tioner. But it also resulted from this necessity, real.or sup- 
posed, of at once stamping out everything that was excep- 
tional, that many insane enthusiasts and others not guilty of 


1877.] by Joun Stppatp, M.D. 3395 


actual violence were also subjected to capital punishment. 
So late as the time of Queen Elizabeth we find an illustration 
of this. Three enthusiasts, named Arthington, Coppinger, 
and Hacket were accused of conspiracy against the Queen. 
Hacket was hanged, drawn, and quartered ; Coppinger died 
raving mad; and Arthington, recovering from his fanaticism 
and insanity, was pardoned. The circumstances are thus 
recorded :—“ On Friday, the 15th of July, Coppinger having 
sent for Arthington out of his bed, declared to him that he 
had had a revelation which assured him that he was prophet 
of mercy and Arthington prophet of judgment; that Hacket 
was king of Europe, and that they were to go before him and 
separate the sheep from the goats. Arthington the more 
readily credited this, because he found a mighty burning 
in himself, which he interpreted to be a commencement of the 
angelic nature.” ... ‘“‘Coppinger magnified Hacket as the 
holiest man that had ever lived, except Christ. A little after 
he was apprehended he ran absolutely distracted, and 
never recovered his senses, but obstinately refusing all 
nourishment, died of hunger the day after Hacket was 
executed.’”’* | 

We have evidence that the insane did not universally come 
to such tragic ends. Some must have been cared for in an 
intelligent manner. And we know that a considerable 
number who possessed a certain amount of shrewdness and 
drollery were received into the great houses and protected, 
partly from feelings of kindness, and partly because their 
eccentricities provided a source of amusement. 

But we cannot doubt that a large number were also to be 
found among the herds of outcast vagabonds who existed in 
a worse than savage condition, wandering about the out- 
skirts of the more civilised localities. These bands were 
truly sources of injury and danger to the community, and 
were, aS might be expected, subjected to severe treatment 
when brought within the power of the law. Just before the 
adoption of a more humane system in the time of Elizabeth, 
“we find the magistrates of Somersetshire capturing a gang 
of a hundred at a stroke, hanging fifty at once on the 
gallows, and complaining bitterly to the Council of the 
necessity for waiting till the Assizes before they could enjoy 
the spectacle of the fifty others hanging beside them.’’+ 

It seems impossible, also, to escape the conviction that a 


* Biograph. Britain, ed. 2nd, vol. i. 
t Green’s History of the English People, 1874, p. 385. 


336 Morison Lectures on Insanity for 1877, [Oct., 


very considerable number of lunatics were included in the 
multitude which, in accordance with the intolerance of the 
day, were hanged or burnt as heretics. Very slight occasion 
was sufficient to afford ground for an accusation of heresy ; 
and it is appalling to be reminded of the immensity of the 
number of those who fell victims of the charge. The motive 
which impelled society to adopt or to sanction the cruelties 
which were inflicted on heretics was no doubt, as in the other 
cases we have been considering, the fear with which they 
were regarded as sources of danger to the State. It seemed 
impossible for those charged with governing authority to 
understand that a man might refuse to give his support to 
the authorised doctrines of the church, without at the same 
time wishing to overturn the secular administration. It 
was not, for example, the mere theological aspect of his 
opinions which raised the storm of anger against Wiclif, but 
rather that he was looked. on as a raiser of sedition, and “a 
source of strife, who, by his serpent-like instigation, set the 
serf against his lord.” And the view which Henry IV. took 
of the Lollards was, as persons whose object was “to destroy 
himself, his brothers, and several of the spiritual and tem- 
poral lords.” The mere recognition of any social element as 
abnormal implied a belief in its dangerous character. To 
permit the continuance of anything like an unusual intel- 
lectual development was to admit the thin edge of a wedge 
which might rend asunder the imperfectly united members of 
the political body. Hence the burning of 31,000 persons by 
the Spanish Inquisition, as recorded by Llorente ; and hence 
the death “for Anabaptist errors’? of 30,000 persons in 
Holland and Friesland, mentioned in the official report of the 
Venetian ambassador at the Court of Charles V. And can 
any one acquainted with the tendency of persons suffering 
from early stages of insanity to be infected by surrounding 
enthusiasm or fanaticism, and to fasten with eagerness upon 
exceptional religious beliefs, doubt that many of those who 
then perished as heretics were really the victims of mental 
disease ? 

So late as 1761, in Portugal, we have evidence that the 
most obviously insane manifestations were treated as heresy, 
in the burning by the Inquisition of Gabriel Malagrida, an 
old man of seventy. No other charge was laid against him 
but the utterance of incoherent nonsense, the true signifi- 
cance of which it seems difficult to have ignored. “ Will 
posterity believe,’ asks Isaac Disraeli, in his notice of the 


£877. ] by Joun Sippatp, M.D. 337 


case,* “that in the eighteenth century an aged missionary 
was led to the stake for having said amongst other extrava- 
gancies, that ‘The holy Virgin having commanded him to 
write the life of Anti-Christ, told him that he, Malagrida, was 
a second John (but more clear than John the Evangelist); 
that there were to be three Anti-Christs, and that the last 
should be born at Milan, of a monk and a nun, in the year 
1920; and that he would marry Proserpina, one of the 
infernal furies.’”? Poor old man. He was one of the last 
of the poor lunatics who were admitted by the gate of 
fire into that asylum whose inmates remain for ever— 
which returns no patients, either cured or uncured, to cause 
anxieties, or to share them, in this busy world. 

But if we pursue our examination of the annals of those 
dark and troublous Middle Ages, we find ourselves driven 
more and more to the conviction that every one who ex- 
hibited any peculiarity, either physical or mental, and who 
could not be counted a criminal, a vagabond, or a heretic, 
ran imminent risk of being burnt as a wizard or a witch. 
The belief in witchcraft was not only inculcated by the 
church, but even the horrible ideas of the incubus and the 
succubus were sanctioned. ‘It has come to our ears,” so 
runs a Bull of Pope Innocent VIII., published 1488, ‘‘ that 
numbers of both sexes do not avoid to have intercourse with 
the infernal fiends, and that by their sorceries they afflict 
both man and beast. They blight the marriage bed; destroy 
the births of women, and the increase of cattle; they blast 
the corn on the ground, the grapes in the vineyard, the 
fruits of the trees, and the grass and herbs of the field.” 
And in order that criminals so atrocious might be destroyed, 
the Pope appointed inquisitors in every country armed with 
apostolic power to convict and punish. Stimulated by the 
church, the search for persons who ought to be punished for 
such crimes was only too successful. ‘To be noticed as more 
than ordinarily ugly was sufficient to excite suspicion in the 
ease of an old woman. And once suspicion was aroused, it 
was difficult to escape conviction. “ The trial of this offence,” 
said Bodin, “ must not be conducted like those for other 
crimes. Whoever adheres to the ordinary course of justice 
perverts the spirit of the law both divine and human. He 
who is accused of sorcery should never be acquitted, unless 
the malice of the prosecutor be clearer than the sun; for it 


* Disraeli, Cur. of Lit, 63. 


338 Morison Lectures on Insanity for 1877, [Oct., 7 


is so difficult to bring full proof of this secret crime that out of — 
a million of witches not one would be convicted, if the usual 

course were followed.” Now it is important that we should — 
remember the character of the man who thus seems deliber- 
ately to throw all semblance of fair dealing to the winds. It 
is important that we should recognise that he was no ignorant 
inquisitor who might be expected to exaggerate the intolerant 
and partial view of his era. He was a learned scholar— 
placed by Mr. Buckle above Comines as a historian, and ona 
level with Machiavelli. Hallam says he “ possessed a highly 
philosophical mind, united with the most ample stores of 
history and jurisprudence. No former writer on political 
philosophy had been either so comprehensive in his scheme, 
or so copious in his knowledge; none perhaps more original, 
more independent, and fearless in his enquiries; two men 
alone, indeed, could be compared with him—Aristotle and 
Machiavel.”? It is also well that we should note here that he 
was the direct controversial antagonist of John Wier, the 
physician of Cleves, who was the first to raise his voice with 
effect in making protest against the atrocious murders com- 
mitted in this infatuated crusade against witchcraft. Wier 
brings forward clear evidence to show that many of the 
victims of that crusade were undoubtedly suffering from 
mental disease. It is hardly necessary, indeed, to have 
detailed proof that many insane persons were believed to be 
witches, and were consequently driven to the dreadful stake. 
We have, however, in the discharge of fourteen persons by 
the Parliament of Paris, in the vear 1589, an interesting in- 
dication of what many cases must have been, in which the 
inquiry did not terminate so satisfactorily. The incident is 
also interesting as being one of the first instances in which 
medical evidence of insanity was permitted to prevent the 
infliction of punishment. ‘‘ Fourteen persons condemned to 
death for witchcraft appealed against the judgment to the 
Parliament of Paris, which for political reasons had been 
exiled to Tours. The Parliament named four commissioners 
—Pierre Pigray, the king’s surgeon, and Messieurs Leroi, 
Renard, and Falaiseau, the king’s physicians—to visit and 
examine these witches, and see whether they had the mark 
of the devil upon them.” Pigray, who relates the circum- 
stance in his work on Surgery (Book vii., chap. 10), says 
**the visit was made in presence of two counsellors of the 
court. The witches were all stripped naked, and the physi- 
cians examined their bodies very diligently, pricking them in 


1877. | by Joun Stppatp, M.D.- 339 


all the marks they could find, to see whether they were in- 
sensible to pain, which was always considered a certain proof 
of guilt. They were, however, very sensible of the pricking, 
and some of them called out very lustily when the pins were 
driven into them.” If any of them had been suffering under 
local anesthesia, so frequent in some diseases of the nervous 
system, how inevitable would have been their condemnation. 
Fortunately they had fallen into merciful hands. ‘“ We 
found them,’’ continues Pierre Pigray, “to be very poor, 
stupid people, and some of them insane. Many of them 
were quite indifferent about life; and one or two of them 
desired death as a relief from their sufferings. Our opinion 
was that they stood more in need of medicine than punish- 
ment; and so we reported to the Parliament. Their case 
was thereupon taken into further consideration; and the 
Parliament, after mature counsel amongst all the members, 
ordered the poor creatures to be sent to their homes, without 
inflicting any punishment upon them.” For a time the 
numbers who were executed for witchcraft were so great as 
almost to exceed belief. For many years Cologne burnt its 
three hundred witches annually ; the district of Bamberg its 
four hundred; Nuremberg, Geneva, Paris, Toulouse, Lyons, 
and other cities their two hundred. In Great Britain this 
form of persecution did not commence so early as in some 
other countries; but it continued longer than most of them, 
and seems to have been carried out with vigour. Every 
record that has been preserved mentions that the witches 
were hanged and burnt, or burnt without the previous hang- 
ing—“ alive and quick.” During the whole of James’s reign, 
amid the civil wars of his successor, the sway of the Long 
Parliament, the usurpation of Cromwell, and the reign of 
Charles IJ., there was no abatement of the persecution. If 
at any time it raged with less virulence it was when Crom- 
well and the Independents were masters. During the first 
eighty years of the seventeenth century the number executed 
has been estimated at five hundred annually—making the 
frichtful total of forty thousand. 

These numbers are probably to be regarded as only a 
rough estimate of the facts. But if we suppose that a large 
proportion of the annual five hundred were, as we have 
reason to believe, persons of unsound mind, it becomes inter~ 
esting, if not important, to reflect for a moment on the 
bearing of such a fact on the proportion of insanity in the 
country. According to the proportions which are furnished 


340 Morison Lectures on Insanity for 1877, [Oct., 


by the statistics of insanity at the present day, a population 
such as that of England in the seventeenth century would 
have furnished about two thousand persons annually who 
would, according to our present views, have been placed in 
asylums. The terrible deduction which an acceptance of 
such a statement would force upon us is that under the rule 
of the Stuart kings, a proportion of nearly one out of every 
four persons who would with our present views have been 
sent to an asylum was actually sent to the stake and burnt as 
a witch. It was so far a terrible solution of problems re- 
garded at the present day as of the utmost importance—how 
to deal with patients so as to prevent recurrence of their 
malady, and how to prevent them from propagating an 
insane predisposition to a succeeding generation. 

Towards the end of the medieval period, and when social 
organisation began to exhibit symptoms of strength and 
stability, there still existed a sensitive intolerance of excep- 
tional conduct. But we find existing along with this a 
dawning consciousness in the public mind, that the commu- 
nity has a duty to perform towards its abnormal members, 
beyond merely keeping them out of sight or stamping them 
out of existence. In England, it was in the reign of Eliza- 
beth that the first legislative recognition of this duty is 
recorded. It was then that the Act was passed which laid 
the foundation of the English poor-law, and which established 
the system that was in force till a comparatively recent 
period. Under this law a distinction was for the first time 
drawn between mere idle vagrants and those impotent and 
destitute persons who are proper objects of charity; each 
town and parish being for the future held responsible for the 
relief of its indigent and disabled inhabitants. 

In 1547, at the close of the preceding reign, was established 
the first lunatic asylum in England unconnected with eccle- 
siastical administration. This took place when the monas- 
teries were suppressed, by the transfer to the authorities of 
the City of London of a monastic establishment which for a 
century and a half had afforded accommodation to mente 
captt. This institution, which was then situated in St. 
Botolph’s without Bishopsgate, was originally a priory for the 
order of St. Mary of Bethlem; but at the time of the 
transfer it had already acquired the name of Bedlam—a 
word which had even then been incorporated into the English 
language. The change from ecclesiastical to lay manage- 
ment does not seem to have been any advantage to the un- 


F377. | by Joun Srppautp, M.D. 341 


fortunate inmates, whatever disadvantage may have resulted 
from it; for we find it reported fifty years after the change 
that the condition of the hospital was too loathsome for any 
one to enter. The place was really a horrible prison and not 
a hospital in any sense of the word. Up to the year 1770 
the patients were exhibited to the public like wild beasts in 
cages, on payment of a penny; and they are said to have 
afforded much sport to the visitors, who flocked to see them, 
in numbers estimated at not less than 48,000 annually. 
A wretched privilege was granted to some whose condition 
had undergone such modification that they were no longer 
considered dangerous to the public. They were “ licentiated 
to goa begging.” On their left arm was placed an armilla— 
an iron ring for the arm about four inches long, which they 
could not get off. “They wore about their necks,” says 
Aubrey, as quoted by Disraeli, ‘‘a great horn of an ox in a 
string or bawdry, which when they came to a house they did 
wind ; and they put the drink given to them into this horn 
whereto they puta stopple. Since the wars,” he continues, 
and I fear it indicates a melancholy fact, “I do not re- 
member to have seen any one of them.” It is probable, 
indeed, that most of them perished unheeded during the 
conflict. In the ‘“‘Tom a Bedlam” song, which dates as 
early as the first part of the seventeenth century, the com- 
forts of his asylum life are alluded to by the “ licentiated 
beggar ”’— 
“Tn the lovely lofts of Bedlam, 
In stubble soft and dainty, 
Brave bracelets strong, 


Sweet whips ding dong, 
And a wholesome hunger plenty.” 


The first unmistakable evidence of changing views in the 
public mind is the stoppage of the practice of licensing these 
Bedlam beggars in the year 1675. At the same period a 
large building, a new Bethlem, was erected in Moorfields, to 
accommodate the insane. The necessity for making provision 
in this manner for lunatics steadily increased as the country 
came more and more under systematic government and as 
the wholesale butchery of such unfortunate persons as 
wizards or witches died out. This hideous barbarity had 
almost ceased at the end of the seventeenth century, 
though a case of witch burning occurred in Germany 
in 1749, one in Scotland in 1722, and one in Eng- 
land in 1716. In the Scotch case, which happened 

XXIII. 23 


342 Morison Lectures on Insanity for 1877, [Oct., 


at Dornoch, the poor victim was undoubtedly insane, and 
laughed and clapped her hands at the sight of ‘‘ the bonnie 
fire’ that was destined to consume her. In 1736 the English 
law against witchcraft was repealed; and it is a notable fact 
that eight years afterwards we have the first legislative 
attempt to provide protection to lunatics; and it does not 
destroy the significance of the fact that it amounted to little 
more than a measure for chaining and locking up dangerous 
lunatics in secure places. ; 

In 1751 St. Luke’s Hospital was founded in London by 
voluntary subscription, and several institutions of a similar 
character were erected in other parts of the kingdom. There 
seems also to have sprung up about this time a very con- 
siderable number of private establishments for the safe 
custody of lunatics. But these, as well as the public institu- 
tions, seem to have been dens of misery and cruelty, where 
‘“‘chains, whips, darkness, and solitude” characterised the 
treatment. 

An interesting record of what was the popular view of the 
condition we now call harmless insanity, is contained in 
Addison’s description of Moll White, whose appearance, he 
says, reminded him of the lines of Ottway— 


‘A wrinkled Hag, with Age grown double, 
Picking dry sticks, and mumbling to herself ; 
Her eyes with scalding Rheum were galled and red, 
Cold Palsy shook her Head ; her Hands seemed withered, 
And on her crooked Shoulders she had wrap’d 
The tattered Remnants of an old striped Hanging, 
Which served to keep her Carcase from the Cold.” 


“He begged his friend Sir Roger,” he says, ‘to go with 
him into the old woman’s Hovel, which stood in a solitary 
Corner under the side of the Wood. Upon our first enter- 
ing,” says Mr. Spectator, “Sir Roger winked to me and 
pointed at something that stood behind the Door, which, 
upon looking that Way, I found to be an old Broomstaff. At 
the same time he whispered me in the Har to take notice of 
a Tabby Cat that sat in the Chimney-Corner, which, as the old 
Knight told me, lay under as bad a Report as Moll White 
her self; for besides that Moll is said often to accompany her 
in the same Shape, the Cat is reported to have spoken twice 
or thrice in her Life, and to have played several Pranks above 
the Capacity of an ordinary Cat. 


“T was secretly concerned to see Human Nature in SO 
much Wretchedness and Disgrace; but, at the same time, — 


bO 77. | by Joun Sippautp, M.D. 343 


could not forbear smiling to hear Sir Roger, who is a little 
puzzled about the old Woman, advising her as a Justice of 
Peace to avoid all communication with the Devil, and never 
to hurtany of her Neighbours’ Cattle. We concluded our 
Visit with a Bounty which was very acceptable.”” The whole 
paper is interesting and important as revealing, not only the 
condition of such persons as this miserable old woman, but 
also as showing that the philanthropic feeling was acquiring 
force in the public mind; though its practical expression was 
still inactive. ‘‘{f have been the more particular in this 
Account,’ says Addison, in concluding, “because I hear 
there is scarce a Village in England that has not a Moll 
White in it. When an old Woman begins to doat and grow 
chargeable to a Parish, she is generally turned into a 
Witch, and fills the whole Country with extravagant Fancies, 
imaginary Distempers, and terrifying Dreams. In the mean 
time the poor Wretch that is the innocent Cecasion of so 
many Evils begins to be frighted at her self, and sometimes 
confesses secret Commerce and Familiarities that her Imagi- 
nation forms in a delirious old Age.” 

The learned ideas of this period ran nearly in the same 
eroove as those which we found to exist among the philoso- 
phers of Greece and Rome. John Locke, who was a con- 
temporary of Addison, said, ‘‘ Opposition to reason deserves 
the name” of madness, “and is really madness; and there is 
scarce a man so free from it, but that, if he should always, 
on all occasions, argue or do as in some cases he constantly 
does, would not be thought fitter for Bedlam than civil con- 
versation.”” In this, and in the other better known passage 
in his “ Essay Concerning the Human Understanding,” 
where he unsuccessfully attempts to define madness, his 
reference to Bedlam is worthy of careful note. For it clearly 
indicates that whatever the philosophical theory might be, 
fitness for Bedlam, loathsome as it was, was in that day 
accepted as the popular criterion of what deserved to be 
called insanity. 

I shall now conclude this lecture with a quotation from 
Boileau, the French satirist of the same epoch, who cer- 
tainly adopts a sufficiently broad view of insanity :— 


‘‘ Tous les hommes sont fous, et malgré tous leurs soins 
Ne différent entre eux que du plus ou du moins.” 


‘* All men are mad, and spite of all their pother, 
Scant difference show: one is but madder than another.’’ 


344 [Oct., 


The Photochromatic Treatment of Insanity. By F. PritcHarp 
Davies, M.B., Medical Superintendent, Kent County 
Asylum, Maidstone. 


The term used above is, I believe, new to medicine, and J 
introduce it as convenient to denote the treatment of insanity, 
or, indeed, of nervous diseases generally, by the means of 
coloured light. 

I do not intend making any attempt to give the history of 
this line of treatment. Iam satisfied it is very old, and has 
doubtless been tried, forgotten, and re-introduced, as often as 
have most other things thought to benew. Recently, however, 
considerable attention has been directed to it by means of 
somewhat sensational articles in the daily papers, and not a 
few alienists have given it a serious trial. I, myself, have 
carefully watched and noted its effect for over a year and 
in a great diversity of cases ; for, with no reliable guide, every 
fresh case was an experiment, and I had to make up my mind, 
as I went on, what were, and what were not, suitable cases 
for the treatment, It is in the hope that my experience, 
including some success, and much failure, may be useful to 
my fellow-workers that I publish the results. 

First, let me describe the means used here to bring patients 
under the influence of coloured light. An ordinary “single 
room”’ is selected, and the window glazed with dark violet- 
blue glass, the walls and doors being coloured the same hue. 
This forms what I designate the ‘‘ Blue Room,” and is used to 
control nervous excitement. The “Red Room” is made in 
the same way, only substituting red for blue glass and colour, 
and is said to be beneficial in cases of nervous depression. For 
obvious reasons it 1s important to have a room with a due 
south aspect and a rather large window. 

From among the cases I have taken notes of, I select the 
following, as having benefited in a marked degree by this 
treatment :— 


E. B., female ; aged 33, Admitted June 18th, 1872, in a maniacal 
condition. At this time she had delusions about her husband, was 
very violent, and used threatening language towards him. The entries 
in the case book show her to have been of a most passionate temper ; 
several outbreaks of fury are recorded, and her language was generally 
of a most disgusting, licentious, and blasphemous character. The 
pharmacopxia seems to have been exhausted upon her and all to no | 
purpose; though as she obstinately refused to take physic, and | 


1877.) The Photochromatic Treatment of Insanity. 345 


each dose had to be almost forced upon her, it is more than 
probable that she did not take much of the medicine prescribed. 
Hypodermic injections set up such irritation of the skin, while 
they did not seem to have the least permanently beneficial effect, 
that they were discontinued. Counter irritation, leeches, and shower 
baths were tried in turn, but seemed to aggravate rather than 
allay her symptoms. All treatment seemed hopeless, and for a while 
I was at a loss to know what to do next. About this time, however, 
I began to try the photochromatic treatment, and, as she was in amost 
wildly excited state, threatening death and destruction to all around, 
she was, on October 1st, put into the “ Blue Room” for some hours, 
and the effect is mentioned in her case book as “ marvellous.” Strong 
as is this term, I think it is hardly too strong, when I remember how 
furious and ungovernable she was, and how rapidly she became tranquil. 
Complaining of frontal headache, she was removed in a few hours, but 
the next day the treatment was resumed and continued at intervals 
for about a week. From the very first there had been a constantly 
increasing dread of the blue room, and the tone of insolent defiance 
with which she was wont to greet the visit of the medical officer, rapidly 
changed into one of entreaty to be spared “ that horrid place.” The 
effect was permanent. She no longer gave way to violent impulses; her 
language changed at the same time, and ceased to be objectionable. 
Not only this, but she began to take an interest in her fellow patients, 
and was of great service in assisting to clean the ward. Keeping well, 
and her friends being very anxious to have her at home, she was dis- 
charged December 5th, and has remained in good physical and mental 
health ever since. 

Another case is that of— 

S. J., female; aged 18, Admitted August 26th, 1875. The 
medical certificate which aecompanied her order of admission, stated, 
«“ She informs me that she had very great pain in the head, and felt 
she must destroy herself by cutting her head off, and dashing her head 
against the wall, and sometimes by throwing herself into the water, 
and that it comes upon her suddenly, and she must do it. Constantly 
spreading curious untruths about the place, that people who are well 
and in health are dead or very ill—that her brother was drowned and 
his cap picked up.” 

The relieving officer who accompanied her to the asylum, 
stated that she had been examined by five medical men, and 
that they were three hours consulting as to whether they 
would send her to the Asylum or not. When brought here, 
considerable difficulty was felt in deciding whether it was a 
case of aggravated hysteria or mania, and it was not until 
she had been under notice fourteen days, that the return was 
made to the Commissioners in Lunacy as to her mental state. 
The records of her case show that she was frequently very 


346 The Photochromatic Treatment of Insanity, [Oct., 


excited, and often used to scream loudly without any known 
cause; several times her jaws were firmly locked for days 
together. Once when this trismus had persisted for about 
sixty hours, I gave her chloroform, and under its influence 
the muscles relaxed, but gradually as consciousness returned 
they stiffened, and when completely from under the anes- 
thetic the jaw was as firmly locked as before. Iron, quinine, 
nux vomica, valerian, and many other drugs were ad- 
ministered, and each in their turn gave promise of success, a 
promise, however, which was not fulfilled. Shower-baths of 
five seconds duration were then tried every morning, and 
under them the patient improved so much as to be discharged 
on trial May 27th, 1876. She was not away long though, 
and June 7th saw her once more a patient here, in a nervously 
agitated condition, with worn and dejected appearance. Her 
teeth had been closed for several days, and she had taken no 
food in consequence. The shower-baths were again tried, 
but this time failed entirely, and as she remained cold and 
shivering after them they were soon discontinued. 

When left untreated, her nervous excitement became very 
manifest, and seemed steadily increasing, so she was ordered 
to be put in the blue room for four hours. The effect was 
almost as marked in her case as in that of EH. B., and frontal 
headache was again complained of. ‘The treatment was con- 
tinued, and in all she was eight times in the room when the 
desired effect seemed secured. She steadily improved from 
then up to September Ist, when she was discharged recovered. 

There are several points of resemblance in these two cases. 
Both may be regarded as instances of moral insanity, plus a 
strong element of hysteria, while in neither was there any 
sign or symptom by which serious organic disease of the 
brain could be recognised. It was desirable, then, in each 
case, to find some means by which a powerful impression 
could be made upon the mind; something which would act 
as a tonic upon the latent will, and rouse its dormant energy 
to control the irregular nervous action. This the blue room 
certainly supplied. The complete fuilure of all other méans, 
and the rapid recovery after its employment, clearly denote 
its potency. 

The following cases will illustrate the power it gives us in 
more serious forms of disease :— 

R. B. T., male. Admitted October 18th, 1871, aged 33. From his 
case book we learn that he has frequently recurring attacks of acute 
mania, during which he is most homicidal. He can at no time be re- 


1877, | by F. Prrrcuarp Davies, M.B. 347 


garded as a safe man, for he is constantly on the look out for 
material with which to make weapons, and never loses a chance to 
secrete a knife. Under the usual treatment his attacks have lasted 
from two to three weeks, and have left him very much exhausted. 

April 6th, this year, he began to use very threatening language, 
break windows and destroy clothes, by which we knew he was about 
having another maniacal outburst. He was at onceremoved to the blue 
room and kept in it until night, when he returned to hisown room to 
sleep. ‘The first day he was very noisy; daubed the walls with feces 
and destroyed his clothes, At night the room was thoroughly cleansed, 
re-coloured, and the next day he was again put into it, and acted just 
as before. Towards evening, though, a change was noticed in him; 
he was quieter, and, upon being removed, asked not to be sent back 
there again. However, the room was again cleaned and properly 
prepared by the next day, when he was put into it for the third time. 
About noon he begged to be let out, complaining of severe frontal 
headache. Upon it being remarked that his room was not so clean as 
when he went into it, of his own accord he offered to wash it out, and, 
materials being provided, did so in a most thorough manner. From 
that time he has given us no trouble, and has exercised great control 
over himself. 

F. H., female, aged 83. Admitted July 25th, 1876. A most 
violent and destructive patient, tearmg bed-clothes with her teeth, 
and trying to bite any one who goes near her. She was brought to 
the Asylum firmly bound up in a strait waistcoat, and even though 
thus secured had managed to hurt one of the accompanying attend- 
ants. She is noted as being extremely filthy and disgusting in her 
habits, refusing food, and offering most violent opposition to the ad- 
ministration of medicines. While in this state a thorough examina- 
tion of her chest could not be made, but we were able to ascertain 
that she had severe valvular disease of the heart, which rather 
embarrassed us in the therapeutic treatment of her mental disorder. 
October 1st she was tried in’ the blue room for five hours, but the 
result was not encouraging. The next day, however, she was again 
put there, and at night, when taken out, asked not to be sent there in 
the morning, as it gave her the headache. I regarded this as a good 
sign, and the treatment was continued. After the fourth day a 
marked improvement was noticed, and she became gradually quite 
calm. Since then she has remained tranquil, and has quietly sub- 
mitted to treatment for her cardiac affection. 


It will be noticed in every instance I have mentioned of 
the treatment there has been complaint of frontal headache. 
This is not a constant effect, but in all, or nearly all of the 
cases I have met with, where the treatment was efficacious, 
it was present, and I therefore consider it a favourable sign. 

Tt must not be imagined that in all the cases on which I 


348 The Photochromatic Treatment of Insanity, [Oct., 


have tried this treatment I have met with success; on the 
contrary, the failures are very many, and far outnumber 
the cures. The list of those upon whom it had no effect 
whatever is a long one, and in very many the improvement 
was but slight. Still, [am convinced it has very materially 
benefited some, and those not slight cases, but cases which 
had resisted other treatment, and given great trouble. 

I believe the photochromatic treatment is most beneficial 
in hysteria, moral insanity, acute mania, and even in cases 
where, though the disease is of long standing, there are lucid 
intervals. Where there is serious organic disease of the 
brain, and the will is totally destroyed, [ have found it use- 
less. In County Asylums we meet with comparatively few 
cases likely to be influenced by it, as for the most part they 
remain in the hands of general practitioners, and only come 
under the notice of alienists when more advanced. Yet I 
do not think we can afford altogether to disregard it, as it is 
absolutely free from harm, interferes with no other line of 
treatment, and does good in some cases. 

All that I have hitherto said relates to the “‘ Blue room ;”’ of 
the “Red” I have but little to say, and that little is not favour- 
able. The first case in which I tried it was A. B., when in a 
state of acute melancholia. For five days she had been 
moaning and crying, imploring to be killed, and obsti- 
nately refusing food. Sleep could not be induced, even 
though drugs were administered, and several other means 
tried. At length she was put into the red room, and in half 
an hour she was fast asleep, and slept tranquilly for several 
hours. I was delighted, and thought my troubles at an end. 
Hope told a flattering tale. She awoke, was as bad as ever, 
and, ultimately, I was obliged to confess to myself that her 
sleep there was but a coincidence. Since then I have tried the 
red lightin many other cases, but with uniform result, and I 
cannot relate one single instance where I am convinced that 
good resulted from the treatment. Still, Jam not discouraged, 
nor do I feel disposed to abandon the use of the room. It is 
possible it may benefit some one yet to come. Iam not pre- 
pared at present to propound any theory to account for the 
modus operandi of the photochromatic treatment, but am 
rather inclined to regard it mainly asa moral influence. 


1877.] 349 


The Pathological Significance of False Membranes under the 
Dura Mater m Insanity. By T. 8S. Crousroy, M.D., 
F.R.S.E. 


Many of the well-known pathological appearances found in 
the brain in insanity will, I doubt not, be found to have 
much more significance than they are thought to have at 
present, when the general physiology and pathology of the 
organ is better understood. It cannot be that such serious 
and enduring marks of morbid action in the parts supplied 
by the internal carotid and vertebral arteries as thickened 
and condensed cranial bones, adherent and thickened mem- 
branes, congested and toughened vessels, pia mater adherent 
to convolutions, and atrophied convolutions ; all appearances, 
one or other of which are found in the majority of the insane, 
and treated almost as matters of course in the asylum dead 
house—could have arisen without intense disturbance in the 
working of the delicate neurine that those structures 
envelop and subserve. We as yet don’t fully know what 
those things mean, as regards the previous condition of 
the brain. We talk of over-action, congestions, and brain 
excitement, but such terms are but vague expressions 
when we closely analyse what they mean. I think we are 
entitled to conclude that if such things are the accom- 
paniments and effects of the storm on the bulwarks and 
sails of the vessel, the state of matters in the ship itself, 
while the tempest was at its height, must have . been 
disturbed enough, could we only have had the means to 
see it. I have scarcely any patience in arguing with those 
who will say that there are no pathological changes left in 
the brains of those who have died insane, when such things 
are commonly met with, and can be seen by any tyro. It 
is our capacity to draw conclusions from such things that 
is at fault; and our means of observation as to the real 
condition of the minute brain structure. Conceive what 
dynamical disturbances must have occurred in the working 
during life of a most highly organised, yet infinitely delicate, 
jelly-like convolution supplied by a twig of a meningeal 
artery, during the long period when that twig was becoming 
thickened in its coats, overstrained at one time by intense 
congestion, its perivascular space alternately blocked up by 
débris, and by the overloaded vessel, its blood current now 
rushing at twice its usual speed, and then in a state almost 


350 False Membranes under Dura Mater in Insanity, [Oct., 


of stasis. It is vain for anyone to say that such condi- 
tions can lead to an organic alteration in the coats of the 
vessel, and yet that the neurine may be left normal. The fact 
that all those vascular disturbances and changes. were, 
probably, the result of the morbid vital action in the nerve 
tissue, and not its cause, were the result of the mere 
straining of the supply pipe from the irregular demands of 
the part supplied, should make us realize very vividly the 
intensity of the pathological disturbance that goes on in the 
convolutions of a brain that is acutely maniacal. 

There is one pathological appearance very often found 
under the dura mater in those who have been acutely insane, 
the significance of which, I believe, to be most profound, 
IT mean the false membranes met with in 14 per cent. of 
the cases of general paralysis, in some epileptics, a few 
maniacs, a few cases of senile insanity, some cases of ordinary 
dementia, and a small number of the cases of organic 
dementia with hemiplegia or local paralysis. I need not 
particularly describe the appearance of those membranes. 
That has been done, but Ido not think that their import 
has been at all so carefully considered as might have been 
expected. 

They always occur over the arachnoid, and under the 
dura mater. They may cover both hemispheres, or only a 
part of one. They are generally confined to the region of 
the vertex, seldom being found on the base of the brain. 
They may vary in thickness, from a mere film to half an 
inch; in consistency from a gelatinous cedema to a fibrous 
membrane as tough as the dura mater; in colour from the 
merest opacity to that of blood clot. They may consist of 
one solid cake, or of many layers. Soon after their 
exudation, or formation, blood vessels are developed in many 
of them—blood-vessels with very delicate coats, and un- 
supported by solid tissue material, so that the slightest 
congestion in the brain causes ruptures and small apoplexies, 
often in hundreds of places at a time. In many cases they 
tend to become organised into fibrous material, and they 
become adherent to the dura mater, the subsequent accre- 
tions or exudations taking place on the inside next the 
arachnoid. To have a large mass of new material in such a 
position as this, in anything like the proportion of cases I 
have stated, undoubtedly implies that its formation is, in 
some way, essentially connected with the chief and primary 
change that is going on in the cerebral substance. When 


1377. | by T. S. Crouston, M.D. 351 


we find granulations deposited on the aortic valves in a 
certain fixed proportion of cases of acute rheumatism, we do 
not doubt that the essential conditions determining the de- 
position of these granulations are similar to those that 
determine the effusion or adherence in the pericardial sac. 
If we can make out the real condition under which such false 
membranes are formed, as regards the state of the blood- 
vessels, for instance, we go far to determine the state of the 
blood vessels in the brain during the acute attacks of maniacal 
excitement of general paralysis. How, then, are such mem- 
branes formed? They are not the product of ordinary in- 
flammation, for we know that meningitis is accompanied by 
the ordinary inflammatory products of fibrinous exudation 
and pus. The constitution of those membranes microscopi- 
cally is that of a very imperfectly organised fibrous material, 
usually, but not always, containing in it great quantities of 
neuclei and blood colouring matter. It is, in many cases, 
nearer the constitution of an old blood-clot that is in 
the process of being absorbed, than anything else; but 
still it differs from this in its consistence, in not hav- 
ing the amount of white fibrinous substance and the 
same amount of brown crystalline substance, and in 
some of the cases containing no blood at all. It is 
more highly organised, too, sooner acquires blood vessels 
of its own, and, unlike the blood-clot, its tendency is to 
increase in amount. We have no evidence of such mem- 
branes getting absorbed. We never find them in the half- 
way stages of that process. On the contrary, we nearly always 
find evidences that layer after layer is being added to the 
original membrane, each succeeding layer being marked by a 
ereater amount of blood colouring matter in it. This blood 
colouring matter does get partially absorbed, for, in the older 
and first formed portions of the membrane, the colour is much 
paler. Dr. Howden thinks they are formed by successive thin 
effusions of blood spreading themselves over the brain. I 
think they are sometimes accompanied in their formation 
by effusions of blood, but JI think that this is only 
one part of the process, and that a quite secondary one 
pathogenetically, and one element of their composition. 
There is something more than single or multiple apoplexies. 
If we look at such a membrane, we see that the apoplectic 
effusions are each very small in amount, and pretty equally 
scattered like pin heads over it. The whole of the small 
blood vessels over the surface of the brain had been affected 


352 False Membranes under Dura Mater m Insanity,  [Oct., 


at the same time and in the same way. And in addition to 
the rupture of many of them, there has been an exudation 
that is in its composition half-way between an inflammatory 
and an cedematous one. It is quite evident that there has 
been stasis of the blood in the blood vessels, but not the 
inflammatory stasis. 

The conditions of all pathological changes affecting the 
circulation are quite peculiar inside the cranium as compared 
with any other part of the body, from their taking place in a 
closed box, on the contents of which the atmospheric pressure 
acts only through the arterial and venous tubes that enter it. 
This, no doubt, makes the process of the formation of such a 
false membrane as we are discussing a difficult one to under- 
stand by comparison with any similar process elsewhere. 

Would the mere semi-mechanical process of obstruction of 
the vessels during the epileptiform fits and congestive attacks 
of general paralysis account for them? I think not; for why 
do we find them so very rarely in epileptics, some of whom 
take fits every day for years, and yet no such membrane is 
found? They are undoubtedly found most frequently in those 
general paralytics who have had frequent congestive attacks ; 
but then these are the worst cases of the disease, and they 
have been found where no such attacks had occurred, and 
even in a few cases of very acute mania. Let us consider 
what has taken place. In a closed cavity containing a mass” 
of soft, almost semi-fluid tissue, and an immense net-work of 
blood vessels, there has been effused a considerable quantity of 
a fibro-gelatinous material often mixed with blood, at the part 
where the contents and the box would lie in apposition to 
each other, but for the cerebro-spinal fluid. This effusion 
must have been a gradual one, for if anything like the amount 
found in some cases had been poured out at once within the 
skull there would have been coma and death. The room 
taken up by the membrane has been got at the expense of the 
space previously occupied by the brain. Does this imply a 
steady pressure for some time, or a sudden shrinkage of 
the brain? Why has this the most evident token of morbid 
brain-action located itself outside the brain-tissue altogether, 
and even outside the arachnoid? Out of what blood vessels 
was it effused ? Has it any analogy to any other effusions 
or membranes that form in the pleura, pericardium, or peri- 
toneum? ‘To answer the last question first, such membranes 
very,closely resemble some of the morbid effusions found in 
those cavities, where the inflammatory process has been of a 


Bol. | by T. 8. Croustoy, M.D. 353 


very ‘low type,’ and where there has been cedema along 
with it; the position of both is the same between two smooth 
serous moving surfaces. The mechanical effect of such a 
ready-made cavity where any effusion or exudation can be 
easily poured out is veryevident. Inall those cavities morbid 
exudations and cedematous fluids occur much more frequently 
than in the substance of the more solid tissues that surround 
them. ‘Their composition is apt to be quite different. It is 
always more fluid. Who has not met with gelatinous effusions 
into the pleura when the seat of the real disease was in the 
lungs? They are “symptomatic” of morbid activity else- 
where. In the case of the false membranes we are discussing, 
the actual effusion seems to take place chiefly from the net- 
work of loosely connected vessels comprising the pia mater, 
exuding through the arachnoid, and also in part from the 
eapillaries of the dura mater; at least I have seen small 
apoplexies, like pin points, scattered over the inside of this 
membrane in such cases. The tendency to actual effusions 
of blood in those small apoplexies chiefly distinguish such 
membranes from the common exudations in any of the other 
serous cavities; but then it must be remembered that there 
are five times more blood-vessels in the head than anywhere 
else, and that while they are well supported collectively by a 
strong bony case, yet that the blood-vessels and capillaries 
inside the cranium have less support from their surround- 
ing textures and the tissues they supply, than any blood- 
vessels in the body. 

Is there any reason to imagine that there is, during the 
varying conditions of intense morbid activity in the brain, 
during an attack of insanity, any tendency to sudden shrink- 
age of the organ from sudden vaso-motor stimulation partly 
closing up the lumen of the arteries, or any other cause? I 
think there are grounds for supposing this to be the case in 
some instances, but I don’t think this explains the occurrence 
of the false membranes. I never saw such membranes asa mere 
compensatory packing material to fill up the space left vacant 
in any of the numerous kinds of brain atrophy, except those 
that in the beginning had been accompanied by intense ex- 
citement and over-brain action of a morbid kind, | 

Dr. Hughlings Jackson has well pointed out that the 
actual neurine is free from the liability to syphilitic affections 
which attack the connective tissue and vessels, and damage the 
nerve-substance proper by pressure or irritation. Now, I main- 
tain that the grey and white nerve-elements proper that com- 


354 False Membranes under Dura Mater m Insanity, [Oct., 


posethe brain are also not subject to the ordinary inflammatory 
process. A few cases of so-called ‘‘cerebritis”’ have been 
described, but the occurrence of such a disease has not been 
confirmed. Inflammation, when it attacks the brain, attacks 
the packing tissue, the fibrous envelopes, or the blood vessels 
only. No doubtit damages the neurine secondarily. But acute 
insanity 1s a disease of the grey substance of the convolutions. 
It is,in fact, one of the kinds of “inflammation” to which 
those tissues are subject. During its existence we have intense 
congestion in the vessels and capillaries from the morbid 
demands made on them by the neurine. There is not only 
congestion, but,as inthe ordinary inflammatory process, stasis 
of the blood in the capillaries; and I have found fibrinous 
ante-mortem clots in the vessels of the pia mater in two very 
acute cases.* This blood stasis is accompanied by abundant 
exudation in the perivascular canals, and by rupture of many 
of the small vessels. No trained microscopist almost ever 
examines a brain in which there has recently been acute 
insanity without finding abundant blood-colouring matter. 
The white corpuscles adhere to the walls of the capillaries, 
obstruct them, and travel out of them as in ordinary inflam- 
mation. In such cases the morbid action is most 
intense; the tension of the vessels, the vaso-motor paralysis, 
the blood stasis, all tend to cause a morbid exudation from 
them, accompanied by rupture of many of them, and the 
position, where this naturally takes place, is where the two 
conditions are combined of the greatest abundance of vessels 
outside the outer layer of the convolutions, and a space 
ready to receive it; and that is where the arachnoid slides 
on the inner layer of the dura mater. 

I look on the state of things under which those false 
membranes are formed, not as a specific one but as the 
acme and representative condition of all the morbid states 
of the brain in insanity—the same in kind, but far greater 
in degree than most of the others. It is the extreme 
result of the morbid states of the grey neurine that cause 
those convolutional ‘ congestions” which are the universal 
accompaniments of acute insanity. 

In general paralysis and in those casesof epilepsy and demen- 
tia where the pia mater adheres to the convolutions the patho- 
logical disturbance of the nerve substance of the convolutions 
is no doubt also ofa special “inflammatory” kind, so far as the 


* « Jo. Ment; Sci.,”” Jan., 1875, p. 595. 


1877.] by T. S. Cuouston, M.D. 359 


brain tissue proper is capable of this process, but of a type 
per se, and affecting the outer layers of the grey matter only 
in great intensity. But this process does by no means explain 
the real nature of general paralysis. The necessarily pro- 
gressive character of that disease which is its most 
characteristic and essential feature, is not, as yet, explained. 
The crudest and most backward notion that has been lately 
broached as to the real pathological nature of general 
paralysis is that the local adhesions of the pia mater to the 
convolutions is the one “specific” pathological feature of 
the disease. Such a selection of one morbid appearance 
only as being the grand feature of a most complicated and 
subtle disease, carries its own refutation. What are we 
to make of the cases of epilepsy, &c., in which there is 
adhesion of the pia mater to the convolutions found after 
death? I had one such case the other day in which 
this was universal over one hemisphere. The unlikeli- 
hood of the adhesion theory reaches its climax when the 
further theory is tacked on to it, that the local spots, where 
those adhesions are so strong that portions of the brain 
tissue are removed with the membrane, are the only convo- 
lutions affected by the disease. It would not be a “ general,” 
but a local paralysis were this so. 


CLINICAL NOTES AND CASES. 





Pathological Notes. By A. Harsinsoy, M.D., M.R.C.S., 
Assistant Medical Officer Lancaster County Asylum. 


Multiple Apopleates.—The subject of these notes was a 
demented, undersized, ill-developed female epileptic, aged 36, 
subject to fits for a long time, but whose history is unknown. 

On April 18th she had two severe and protracted fits with 
a short interval between. She recovered consciousness slowly 
and imperfectly, answered questions reluctantly, refused 
milk, but allowed herself to be fed with it, and remained in 
a state of passivity and torpor contrasting with her previous 
querulousness and irritability. 

During the night and on the tollowing morning she had 
three more slight fits without any further mental change. 
She died on the afternoon of the 19th. ‘There is no doubt 
cerebral hcemorrhage occurred during the fits on the 18th; 
and although a suspicion of this arose at the time, yet 1t was 


356 Clinical Notes and Cases. [Oct., 


vot entertained, owing to the return of consciousness, the 
pupils being normal, deglutition possible, and the extremities 
capable of voluntary movement (the feet and ankles alone 
escaping observation). The altered look and collapsed con- 
dition were not cause for wonder, as independently of the 
accession of fits she could not have survived for many days 
the exhaustion due to diarrhea, tuberculous ulceration of the 
bowels, and perforation of the caput ccecum coli, with localised 
abscess in the peritoneum. The latter curiously found exit 
through the umbilicus, having previously destroyed the peri- 
toneum and tissues over the iliac bone, and exposed and 
isolated the cords of the lumbar plexus. 

On post-mortem examination the abdominal state was as 
described. In the lungs there were deposits of tubercle and 
slight excavation. There was no marked hypertrophy of the 
heart, renal degeneration or atheroma of the vessels. The 
brain was small, but heavy (502 oz.), the cerebrum being 
sclerosed in the posterior half. The membranes were 
thickened on the vertex and the dura mater adherent to the 
calvarium., The veins and sinuses were very full of blood 
and dense clots. The arteries were not atheromatous, but 
very tough and resistant, pulling out on slicing the brain. 

Symmetrically situated in each postero-parietal lobule was 
an apoplexy the size of a walnut, containing in its centre 
several separate and distinct, soft, recent clots (three on the 
left and five or six on the right side), from the size of a pea 
to that of a cherry. In the third left occipital convolution 
was another clot, the size and shape of an almond, splitting 
up the white fibres; and in the second left temporo- 
sphenoidal was a rather smaller one. For some distance 
round all these clots the brain substance, but particularly 
the grey matter, was broken down and mixed with blood, 
forming a soft red pulp. The convolution round the end of 
the left parieto-occipital fissure and the first right occipital 
convolution were similarly reddened and disorganised. Be- 
sides these six extravasations there were found three cal- 
careous tumours, on the left side. The largest, weighing 21 
erains, honeycombed, and irregular in shape, was situated in 
the ascending frontal convolution, half way up, and just 
reaching the surface in the fissure of Rolando. The second 
was in the tip of the occipital lobe, and the other in the 
first temporo-sphenoidal convolution. The left anterior cere- 
bral artery was only about half the size of the right, and they 
were connected by two communicating branches. 


1877. ] Clinical Notes and Cases. 857 


The points to which I may direct attention are— 

I. The number of extravasations. In Reynolds’ system of 
medicine, Dr. Hughlings Jackson states that “sometimes 
two or more recent clots, even large clots, are found in 
different parts of the brain.” He mentions a case of Mr. 
Llewellyn’s, in which there were two clots, one of Dr. 
Ogle’s, in which there were three, and one of Dr. Baiimler’s, 
in which four recent clots were found. Dr. W. A. Hammond 
says that “of 139 cases cited by Durand-Fardel twenty-one 
were multiple; eighteen of these were double and three 
triple. In my own experience two cases of triple lesions 
have occurred and two of double lesions.” According to 
Niemeyer “usually there is only one hemorrhagic effusion in 
the brain, rarely several.” 

II. The occurrence of apoplexy during an epileptic seizure. 
“ Apoplexy is so rare a sequence of epilepsy that it is men- 
tioned simply for the purpose of stating this fact” (Russell 
Reynolds). Niemeyer also refers to it as rare, and Hammond 
does not mention it. 

III. The absence of such grave symptoms, mental and 
otherwise, as might be expected from so extensive lesions. 
Is it possible that the indurated, sclerosed condition of the 
cerebrum, in whichall the extravasations occurred, neutralised 
to some extent the force of the blood in the ruptured vessels 
and prevented transmission of the pressure to more important 
parts, or had the brain become so habituated to epileptic con- 
gestion that the pressure was borne with comparative im- 
punity ? 

IV. The position of the hemorrhages. The upper surface 
of the hemispheres is not very frequently the seat of 
apoplexies. 

V. Regarding the motor centres, it is interesting to note, 
as the probable starting point of the epilepsy, the presence of 
an irregular, jagged, calcareous tumour in that part of the 
‘ascending frontal convolution which, according to Ferrier, 
produces action of the elevators of the angle of the mouth. 
‘Her fits mostly occurred at night, and unfortunately having 
never seen her in the very beginning of one, Iam unable to 
‘Say what the initial movements were. 

' The extravasations avoided Ferrier’s motor centres, except 

-as regards the postero parietal lobule, and excluding the latter 

the absence of paralysis was therefore to that extent corro- 

borative of his experiments. She was able to draw up her 

legs, but as already stated, it. was not observed whether the 
XXIII. 24 





358 Clinical Notes and Cases. [Oct., 


foot and ankle movements were affected by the hemorrhage 
into the postero-parietal lobule. 

As the following case bears some sort of resemblance to 
the foregoing, I may briefly mention the particulars :— 

Lydia S—, an epileptic, aged 49, on the 26th of April, 
1876, in a quarrel and violent passion, was in the act of 
whipping off her boot to strike another patient, when she 
suddenly fell forward on her face ina fit. She was turned 
over by the nurse, was severely convulsed, became very dark 
in the face, and died in a few minutes. Her fits had always 
been very severe, and without any warning. 

The following extracts are from the post-mortem record :— 
“The right side of the heart is almost entirely replaced by 
fat.’ ‘Blood effused beneath the membranes of the brain 
on the upper surface, about the cerebellum, Sylvian fissures, 
and indeed nearly all over.” Death was certified to result 
from apoplexy, but whether the apoplexy was preceded by an 
epileptic seizure must remain uncertain. My impression at 
the time was, and still is, that the sequence of events was 
first the violent mental perturbation and passion, second 
bi epileptic attack, and lastly the apoplexy and sudden 

eath. 

Tumour in Second Frontal Convolution of Brain.—Isabella 
B—, aged 40, died on June 1st from acute pulmonary tuber- 
culosis. On examining her brain, a cylindrical tumour—one 
line and a half in diameter by three long—was discovered in 
the superior posterior angle of the second left frontal convolu- | 
tion, one-third of an inch from its superior and posterior 
borders. It appeared to be of old standing, was soft, like | 
inspissated pus, and was easily enucleated. This woman had | 
a peculiar sort of squint from an early age, and when | 
eighteen years old was actually operated upon, but without | 
success. 

Ferrier, on stimulating the posterior extremities of the| 
first and second frontal convolutions, obtained lateral move-| 
ments of the head and eyes, elevation of the eyelids and} 
dilatation of the pupils. The tumour in this case was con-) 
fined to a small part of this region, and whether the squint-| 
ing condition of the eyes was due to the limited lesion, or} 
was merely a curious coincidence, I cannot pretend to say./ 
Perhaps in future experiments it would be worth while 
defining more exactly the effects produced by restricting the) 
stimulation to the particular spot referred to. 






1877. | Clinical Notes and Cases. 3059 


A Case of Typical Melancholia from Hereditary Predisposition. 


A.B., priest, zt. 53, a tall, well-made, strong man; head well- 
formed, above average size; intellect powerful, acute, logical ; 
imagination fertile; character diffident, undecided, scrupu- 
lous and hyper-conscientious. As a boy at school evinced 
high talents, was a good classic, but a still better mathema- 
tician. Could draw from nature very accurately, without any 
teaching, and with his left hand ; and was fond of illustrating, 
in this way, any subject upon which he was conversing ; a 
bone, a leaf, a flower, &c., he would sketch in an instant, and 
it would be quite true to nature. He had a most acute sense of 
hearing, but no ear whatever for music, the masses of Mozart 
or Beethoven being to him (he often said) the same as the Old 
Hundredth psalm—he perceived no difference. In short, 

‘it was totally Jost upon him, and he seemed utterly uncon- 
scious of a performance that was thrilling ordinary folk. His 
‘Memory and reasoning powers were marvellous; he weighed 
-@ question in all its bearings and sides so exhaustively that 
‘he was most undecided in action; and when he did act he 
always thought he ought to have acted differently ; he would, 
é.g., spend months in planning a holiday and, after taking it, 
would say he ought to have spent it elsewhere, or at some 
other time; after making a sick-call, he would bother himself 
and others as to whether he had done wrong in “ preparing,” 
or not “preparing,” the sick man “for death;” if he held 
a trusteeship, he felt he was wrong in holding it, and if he 
got released he was then equally wrong in doing so; so that, 
‘in all the little matters of daily life, he was always torturing 
his own mind and boring other people to death. Whenever 
he chose to apply his mind to any subject steadily, he would 
accomplish an extraordinary amount of work, whether in 
jlearning Arabic, translation, or solving mathematical prob- 
(lems; he would walk long distances without fatigue, and his 
jappetite was voracious ; but he often ate largely, simply 
|because unaware of what he was about; and (quite automa- 
| tically) he would continue the operation as long as other and 
slower feeders remained at the table; he was most careless 
jand untidy in dress, but most particular as to personal clean- 
jliness. He never brushed hat or clothes, would put on Roman 
\collars and coats anyhow, and go out in the streets and walk 
with head bent and on one side, and eyes downcast and full 
|0f thought, quite unconscious of his grotesque “ get-up ; ’ 








360 Clinical Notes and Cases. [Oct., 


he never scraped his boots, or used a door-mat, but carried the 
mud into his rooms, and he would run up and downstairs, 
holding his candle at an angle of 45° to 90°, dropping grease 
on carpets and floors wherever he went. He was a gentleman, 
however, as well as a scholar, but so lost, so absent as to all 
these little matters that, when told of them, he would start, 
be very sorry, and beg pardon ad nauseam. This was his 
ordinary or normal state; but when any trouble came upon 
him, not only was all this aggravated, but new phenomena 
manifested themselves, e.g., strange sounds and fancies and 
whisperings in his ears, of doggerel lines; he would see 
devils on the altar, a black snake in his stomach, or think 
himself a bottle of West India pickles! The death of a 
relative or friend would induce this state, or even anxiety 
about a sick man; he would, at such times, present a most 
melancholy aspect, pace his room day and night, couldn’t read 
anything but his “ office ;” would be taciturn, and laugh at 
his thoughts and fancies at meal-times, when he would cut 
bread, cheese, &c., by sudden fits and starts, unaware of what 
he was doing, or the enormous amount he was consuming, 
and he would pour out and drink tumbler after tumbler of 
water in the same rapid way, to the number of six or seven 
atameal. His first great trouble was the death of his mother 
(a Protestant) soon after his conversion to the R. C. Church 
and his taking priest’s orders; he thought her soul was 
lost, and at her funeral he first showed signs of insanity ; 
after this he fancied, one day, that he was pursued by 
enemies, and he attempted to escape by jumping out of the 
window, but was prevented; he was then placed in an asylum, 
where he fancied his food was poison, and he was fed by the 
stomach- pump, resisting violently all the time. He was at- 
last discharged ‘‘ cured,” and he took priest’s duty, but never 
could do full duty; confessions and sick-calls were always 
bugbears with him; going to visit a sick or dying man, he 
said, was to him “like going to face-a regiment of armed 
soldiers!”” Hence he was allowed to work or be idle, as it 
pleased him. Some ten years after quitting the asylum he 
came to live with me, and he was with me some six years, 
often breaking down and requiring a holiday; but although 
‘very eccentric and a bore, and the subject of occasional 
hallucinations and delusions, still he did not act in accordance 
with them until after his eldest brother’s death (a year ago), | 
when, one day, in a boat with a brother, a niece (zt. 19), and | 
a boatman, he suddenly called out, “Tm in a boat with a | 


1877.] Clinical Notes and Cases. 361 


woman, pull me ashore,” in an excited way, and as soon as 
he landed he went to his confessor to confess his sin. His 
eldest brother’s death saddened and shook his mind fearfully. 
After it he was more easily than before disturbed by trifles ; 
e.g., he once presented a country cheque for his sister at her 
London banker’s, and because it was not then and there placed 
to her credit he thought he had done something very wrong 
and irregular, and involved his sister and himself in disgrace 
and endless law expenses; he felt (he said) as if, in showing 
a dear friend a pistol, he had, unintentionally, shot him dead. 
A few weeks before leaving me he began to be in great mental 
distress because he was a trustee for his eldest brother; he 
said that, being poor and a priest, he ought not to be trustee 
for anyone; his bishop therefore sent him to a Catholic 
lawyer to get released ; but, no sooner were the first legal 
steps taken with this object, than he became thoroughly 
insane! Now, he had “involved himself and his brother in 
endless law expenses;”’ he and the family ‘“‘would be beggars 
in three months.” He paced his room all day, crying “ woe! 
woe!” at meals seemed lost to everything, didn’t reply when 
spoken to, or said “yes” for “no,” and. “no” for “ yes,” 
or something irrelevant. One day at dinner he grasped his 
temples, sank gradually on to the floor, which he kept strik- 
ing with hands and feet, crying, “‘ Woe! woe! woe! I know 
I shall be a beggar.” From this time I felt sure I must no 
longer regard him as an ordinary boarder, but as a lunatic 
to be placed under proper supervision ; for his delusion as to— 
his beggary took such a deep hold of him that he now refused 
fire and food and clean linen, fancying he couldn’t afford to 
pay for them (although his income was amply sufficient) ; and 
he wore the oldest and most ragged things he had, leaving 
the good and new ones intact; he would sit up late, burning 
letters and papers, rummaging old boxes and desks, or get up 
at two or three a.m. and burn letters and papers, or write 
letters and go out to post them and return without posting 
them, knocking and ringing at the door, and on my letting 
him in, not appearing aware that he had disturbed me, nor 
apologising as he would have done at other times. His friends 
and the Bishop now wished an alienist physician to see 
him, and we at once decided that he should go to another 
asylum, and told him so; Now, it was this, and not the trustee- 
ship that was to be the ruin of himself and family—‘‘ Who was 
to pay for il?” ‘Where was the money to come from ? ” 
Insanity is strongly hereditary in his family; a sister was 


362 Clinical Notes and Cases. [Oct., 


in an asylum, and a father or grandfather attempted or com- 
mitted suicide. I have good reason to know that celibacy 
has always been a most painful trial to him, and that 
nocturnal emissions were very frequent ; but I have also 
every reason to believe he was free from the habit of mas- 
turbation, and led a chaste life. Be a IE 





OCCASIONAL NOTES OF THE QUARTER. 


Dr. Bucknill on Specialism, Confession, and the Physician v. 
the Priest. 


In his opening address as President of the Section of 
Psychology, at the Annual Meeting of the British Medical 
Association at Manchester this year, Dr. Bucknill thus treats 
of the above subjects :— 


There can be no doubt that all special employment leads to narrow- 
ness of mind, and that the learned professions suffer from this ten- 
dency most notably. This, indeed, was long ago pointed out by Arch- 
bishop Whately in his work on “ Rhetoric;” and there can be no doubt 
that there is a legist’s narrowness, and a priest’s narrowness, and a 
physicien’s narrowness. It will be very useful to ask ourselves whether, 
within the latter, there is not also a mental physician’s narrowness, 
tending to explain natural varieties of character and natural courses 
of conduct, upon the assumption of morbid deviations from an unknown 
standard of sanity. For, like the old king, who, when he heard of 
crime or misfortune among men, always asked “ Who is she?” are 
we not somewhat disposed, in all human follies and miseries, to ask 
“ What is the insanity ?” and are we not often tempted to parody 
Carlyle’s cynical description of this realm, as a fair country, contain- 
ing thirty millions of men, mostly lunatics? If this criticism be too 
wide and general, it is surely not wholly without foundation, and may 
well be taken by us as a warning voice against a danger incident to 
our very peculiar calling in life : for, if you think of it, the study and 
care of men with diseased minds is a very peculiar calling, distinguish- 
ing us from all the rest of the world, which carries on all the business 
of life on the assumption that men are reasonable beings. Society 
rubs along, believing in the rule of reason as it does in the law of 
gravitation ; and although we may enjoy vastly more credit than the 
levitating spiritualists, we scarcely stand on a less distinct foothold 
from the common faith which actuates the daily conduct of our fellow- 
men; and the greatest caution is needful that, as the companions of 
the insane, we do not become too much associated with them in their 
modes of thought. The learned author of the “ History of Civilisation” 


1877.) = ~~ Occasional Notes of the Quarter. 363 


maintained that the characters of men are developed from their objec- 
tive surroundings, so that the men of the mountain, of the plain, of 
the forest or the desert, differ from each other in consequence of the 
great features of nature by which their character is fashioned, and 
which they reflect in mental and bodily peculiarities, This, no doubt, 
is in great measure true; but it is even a more weighty truth that the 
individual man reflects his fellow-men, and that man is the creature of 
his social surroundings, and the due consideration of this most im- 
portant factor of mind is the-great addition which Mr. Herbert Spenser 
and his followers have added to modern philosophy. Mind as subject 
and nature as object does not explain, as used to be said, the whole 
field of thought and things to be thought of, of feelings and things 
to be felt. There is an addition to this: the minds of other men, the 
manifestations of which are objects, but which in themselves are not 
objects, but what Professor Clifford, with his keenest insight and 
appreciation, proposes to call ejects; and these minds of other men it 
is which really and effectually mould us to what we are. To be 
moulded by the best minds is the greatest happiness, to be fashioned 
by the worst is the greatest misfortune which a human being can 
endure. To be warped by the dishonesty or to be soiled by the im- 
purity of other minds, is bad enough; but, if it be possible that the 
sound mind can be made to vibrate the discords of unreason by asso- 
ciation with the unsound, that, indeed, would be a misery worse than 
any which the imagination of Dante dared to invent. And who shall 
say that it is not possible, and even probable? Nay, who shall say 
that it is not a dreadful fact, dimly revealed in the traditions of our 
specialty 2. How long Gulliver among the Yahoos could have retained 
his human attributes, is as uncertain as the resistance which a sound 
mind, without suspense or relief, could offer to insane surroundings ; 
but that such resistance would gradually come to an end, there can, I 
think, be little doubt. It is not, however, from any complete fall, but 
of those touches of imperfection from the contagion of surroundings, 
the danger of which is imminent and perhaps unavoidable, against 
which I most desire to exhort you to employ the antiseptics of fre- 
quent recreation of mind and body, combined with the tonics of sane 
companionship and sound-minded occupation and study. I wish to 
insist upon the great need of the mental physician to breathe much of 
the pure air of rational life, for the sake both of himself and of his 
patients ; and of the greater need the more he is of a true mental 
physician, understanding incoherence and delusion, and sympathising 
with morbid feeling. If the oculist were to abide long in his dark 
room, he would soon be worth little as an oculist; and if there be one 
man more than another who ought to be a man of the world, it is the 
physician who has the care of the insane; for if he allow himself to 
become ignorant of the outside world, he will be able to make no com-~ 
parisons of the sane with the insane; and, therefore, liable to con- 
sider opinions and conduct morbid which are only strange, a danger of 


364 Occasional Notes of the Quarter. [Oct., 


which I could give you amusing examples. An instance of it was, I 
think, given by Lord Shaftesbury, in certain physicians who considered 
a lady insane because she carried a small dagger in her dress; carry- 
ing such daggers at that time being a common freak of fashionable 
dressmaking, unknown to these innocent doctors. 


¥ se % % % % 


There is indeed another important calling between whose profes- 
sional work and this work a great gulf is fixed; namely, the immea- 
surable difference between the supernatural and the natural. And yet 
the priests of some creeds make the singular mistake of ilustrating 
their duties by comparing them to ours; nay, they go beyond com- 
parison in declaring positively that sin is spiritual disease, and that 
they are physicians of the soul. It behoves us to look to this ; for it 
cannot be said that the priest and the physician are very much alike, 
especially the priest. Comparisons are commensurate, and by as 
much as the priest is like the physician by so much is the physician 
like the priest. If sin is disease, disease is sin; and if the priest is a 
physician, the physician is a priest. I desire punctiliously to guard 
myself, in the following remarks, from the expression of any theo- 
logical opinion whatever, and especially from any opinion which may 
‘give offence to our most respected fellow-members who belong to the 
communion of the Roman Catholic Church. | I believe that they will be 
among the first to agree with me that the functions of the physician 
and those of the priest are essentially unlike, and that it is most 
‘desirable to avoid any misleading analogies between them. The 
‘Roman Catholic honestly expresses his belief that the functions of 
the priest are divine, and that confession is a sacrament ordained by 
God. That is a definite position which we can understand, and which 
in this place it would be improper to dispute. But within the Protes- 
tant Church of this country a very different position has been assumed, 
against which I think the medical profession will do well to protest. 
I well remember that, at the meeting of this Association which was 
-held at Torquay, the Chancellor of the Diocese presented himself as 
the ambassador of his Bishop, with the proposal that priests should 
be admitted within the ranks of the medical profession, in order that 
they might practice medicine in conjunction with their clerical duties ; 
and I now observe that a certain school or sect of divines within the 
State Church of this country are diligently employed in the dissem- 
ination of the doctrine that the priest is a physician; that sin is 
disease, and that the confession of sin to the priest is as natural and 
necessary as the communication of the causes, history, and symptoms 
of disease made by a patient to his medical attendant. If we allow 
this doctrine to pass unquestioned, there may perhaps be little danger 
‘that priests will really seek to practice as physicians; but there is a 
‘likelihood that the public estimate of the functions of the physician 
-will be unsettled and confused, and that the avowal of the history and 
causes of disease will not escape from that suspicion and repugnance 


Lec? Occasional Notes of the Quarter. 365 


which, in this country, is so widely attached to the confession of sins 
to the priest. JI have found the doctrine to which I refer expressed 
in many works of English divines. Often, no doubt, it is used ora- 
torically as a mere metaphor, as by Bishop Hooker, who says that 
‘priests are spiritual and ghostly physicians in the private particular 
case of diseased minds ;” but of late, in that sect of the English 
Church which mimics the Church of Rome, the doctrine seems to be 
definitely taught that sin is disease and the priest a physician; and, 
under cover of this doctrine, so-called patients or penitents are ex- 
horted to the confession of their symptoms or sins in order that they 
may be cured and absolved. To establish this assertion, I shall only 
quote from one book, which, however, is the accepted manual of con- 
fession among our mimic priesthood. 

The author of ‘The Priest in Absolution” speaks of the subject of 
his manual as ‘‘his subject of spiritual pathology.” Hesays: ‘“ The 
qualification of a priest binds him to the acquisition of sound morality 
as a judge, and of great skill as a physician” (Part i. p.4). He 
speaks of “the duty which devolves upon a priest, in his character of 
a physician, to probe the spiritual wounds of his patients” (p. 5). 
‘‘ The priest must have the knowledge of a physician, in order to 
direct the moral knowledge of which it is the strength” (p. 10). 
“For the priest as a judge punishes offences, but as a physician heals 
the sick so far as he can prevent a relapse” (p.41). “ HeJ thepriest | 
is nevertheless, as a physician, obliged to warn them and rebuke them 
according to their needs” (p. 49). In the second part, he says: “A 
surgeon may do many things else indecent for the sake of curing dis- 
ease; a confessor may study cases of conscience’’ (p. 20). In his 
directions, ‘‘ How to deal with shame-faced penitents,” he says: “The 
priest should kindly remind them that they do not shrink from reveal- 
ing their bodily diseases to friends and physicians ; and that, as the 
soul is of more consequence than the body, they should not shrink 
from disclosing the diseases of the soul to its physicians ” (p. 189), 
-He says that it is sometimes the priest’s duty to delay absolution, 
“advising him [the penitent or patient] to come back on a fixed day, 
within eight or ten days, adding that any relapse within that period 
should cause no discouragement, but rather urge him all the more to 
resort to the physician” (p. 195). “If absolution be delayed, — 
Tt is good for the patient who is very ill to see his doctor frequently 
(p. 255). “A priest is said to have cured one patient by telling him 
to come to him for confession as soon as he had fallen into sin, and 
not to wait fora second fall. By absolving him and giving him the 
‘same penance, he was cured in a few months” (p. 236). “ We must 
distinguish between what is a proper disposition to receive absolution 
and what is its fruit; else we may act like doctors who content them- 
selves with purges without ordering the supports needful to sustain 
the effects thereof, and so kill the patient weipeze.). “Like medi- 
cines after which the patient seems to be better, though the fever recur 
afterwards, so with confession, which, though it blots out all sins of 


366 Occasional Notes of the Quarter. [Oct., 


which a person accuses himself with sincere grief, does not remove all 
subsequent evils” (p. 240). ‘ Different people require different treat- 
ment. The phlegmatic, the melancholy, the choleric, and the san- 
guine, must not be dealt with in the same manner” (p. 268). This 
work, “ The Priest in Absolution,” has been severely criticised both in 
Parliament and the Press on account of its: obscenities; and it has 
been defended from the pulpit of this very city by the Rev. Knox 
Little, from whose sermon I quote a passage from the ‘Pall Mall 
Gazette” which directly affects us: “There are,’’ says this priest, 
‘Cmany books of medical science just as bad; but they are not flung 
into society from the House of Peers, nor are their authors called 
corruptors of society.’ J am not aware whether the books of medical 
science referred to by this reverend gentleman are the poisonous 
pamphlets of the manly-vigour quacks ; but, with regard to books of 
real medical science, his comparison invites the obvious retort that 
the badness or goodness of anything is relative; and that the shrewd 
saying of Lord Palmerston, that dirt is matter in the wrong place, 
which applies with undiminished force to thoughts and words, so that 
language which may be wise and good and pure in a medical treatise 
may be dirt in its worst sense elsewhere. Let us pass, however, this 
comparison with our books, to follow that drawn with ourselves. Is 
the priest a physician? Is sin disease? Is sacramental confession 
the avowal of symptoms, penance treatment, and absolution cure? In 
the interests of society and our profession, I must emphatically deny 
not only the identity of these things, but that there is any real 
analogy between them. I assert that the physician is a naturalist, 
the priest a super-naturalist ; that no sopbistry can bridge the abyss 
between them. ‘he physician works by natural means upon natural 
conditions to produce natural effects within and upon the bodily orga- 
nisation. In the pursuit of his calling, he only differs from other 
men by the possession of superior knowledge and skill acquired by 
Jabour. He is the successor of Hippocrates and Harvey, but only in 
the same sense that Whitworth and the village blacksmith are suc- 
cessors of Tubal Cain. He pretends to no supernatural power 
acquired by mystic ceremonial, and he is content to do that which 
any other human being can do who has taken the trouble to learn bis 
art. That art is the correction of deviations in the organism of men’s 
bodies, which disturb the ease with which it works in health; that is, 
to cause the removal of bodily disease, which in itself has no necessary 
connection with disobedience of God’s laws, and is no more sin than 
health is virtue. To the physician’s idea of disease, an organisation 
—that is to say, a complication of parts—is essential, and is dia- 
metrically opposed to the theologian’s idea of sin as an affection of 
the immaterial soul, which has no parts. Hamlet sees this when he 
exclaims— 
“TIT do not set my life at a pin’s fee; 


And for my soul, what can it do to that, 
Being a thing immortal, as itself ?” 


1877.] Occasional Notes of the Quarter. 367 


For the removal of disease, the physician employs the forces of 
nature aided by abstention from its causes. Beyond such curative 
abstention, he asks for no repentance and he imposes no penance. Nor 
does he postpone his beneficent action as we have heard that the priest 
is instructed to do, telling his patient to come again in eight or ten 
days ; nor when he has alleviated disease, or even removed it, does he 
perform any incantation or ceremonious declaration of health. There 
is absolutely nothing in medical practice corresponding to absolution, 
which is the very essence and acme of the priest’s proceedings. With 
this profound difference between the function of the priest and that of 
the physician, it would, indeed, be surprising if we found that the 
questioning of a penitent, which is called confession, bore any real 
resemblance to the questioning of a patient as to the history and 
symptoms of disease. ‘The first obvious difference is that the physician 
does not assume that all men are diseased, needing his recurring aid 
and imprimatur of recovery, while all men are said or known to be 
sinners whose peril can only be averted by periodical confession and 
absolution. The second is that in avast number of instances the 
doctor’s patient makes no confession whatever, the physician seeing, 
or hearing, or feeling the symptoms, and proceeding with his remedies ; 
while without confession the penitent receives no priestly benefit and 
no taste of absolution. A third difference is, that the confessions of 
patients to their medical men are purely voluntary, and the omission 
of them in no way penal, whereas absolution from priestly confession 
is in itself an offence only to be condoned by special repentance and 
penance. The physician looks upon confession as a painful necessity, 
and avoids it to the utmost of his power; he recognises the danger 
which lurks in spoken thought reacting upon bodily function, his 
experience telling him that the surest method of avoiding many 
symptoms of disease is not to think of them, and that the best means 
of escape from the thought of them is to avoid speaking of them. 
Therefore, the physician will often endeavour to obtain the history of 
those diseases of the nervous system which most seem to justify con- 
fession from a near relative rather than from the patient himself, and 
the history having once been obtained, he will discourage its repeti- 
tion, and thus he will avoid incurring the mischief of that hypochon- 
driasis of sentiment to which patients and penitents are alike liable. 

‘“‘ Whatever hypocrites austerely talk 
Of purity, and place, and innocence, 


Defaming as impure what God declares 
Pure, and commands to some, leaves free to all,’ 


the physician believes sexual pleasure within rational and legal bounds 
to be wholesome and right, but that to think of it unreasonably, and 
far more to converse about it, leads to excess, debility, and disease ; 
and, therefore, he is most chary in encouraging the confidences of his 
patients in this protean subject of priestly confession. e 
Finally, the physician restricts his attention to the present condition 


368 Occasional Notes of the Quarter. [Oet., 


of his patient, and whatever inquiries he may make as to the past 
history of the case are directed solely to such facts as bear upon the 
present. The attention of the priestly confessor, on the other hand, 
is directed mainly to past time, when the soul of his penitent was ina 
sinful state, but which has already changed to a condition of repent- 
ance or he would not be at the confessional. I have little more to 
add, except that the aim and results of the priest’s and physician’s 
activity are as different, nay, as antagonistic, as possible. The guid- 
ance of the physician, and especially of the mental physician, is 
towards reticence and yestfulness, and the repression of that self- 
examination which leads to hyperesthesia of sentiment. The guid- 
ance of the confessor, if we stili follow ‘The Priest in Absolution,” is 
towards what he calls “‘ supernaturai recollection,” and three kinds of 
union with the Lord, namely, 1st, Simple union; 2nd, The union of 
espousals, which is preceded by substantial dryness; and 8rd, The 
union of consummation, called spiritual marriage. In these unions 
there are three degrees, those of EKecstacy, Ravishment, and Spiritual 
Flight. “In the simple union, the soul’s powers are suspended, but 
not the body’s.” ‘*In Kestacy, the body is lost. One sees not, hears 
not, feels not.” ‘ In Ravishment, the soul is carried away suddenly 
and violently.’ “ In Spiritual Flight, the soul seems carried out of 
the body and Ecstacy and Ravishment are included” (p. 319). I 
think that now, if not before, mental physicians will be disposed to take 
a lively interest in the seven hundred clergymen of our State Church 
who are the believers and followers of this “ Priest in Absolution.” 

I have only one word further to say, namely, that however the above 
remarks may apply to general physicians, they apply still more em- 
phatically to us as mental physicians, seeing that the peculiarities of 
our speciality compel us, far more than our brethren, to inquire into 
the state of men’s minds, and into the hidden circumstances and con- 
ditions which lead to them. The symptoms of the diseases with which 
we deal being far less obvious to the senses than the symptoms of 
other diseases, we are correspondingly compelled to occupy a position 
which carries with it a greater danger that we shall be compared with 
spiritual confessors, and which needs the greater caution that we 
should walk with prudence and circumspection in the well-trod paths 
of medical reticence, forbearance, and wisdom. — British Medical 
Journal, 





Dr. Lawson on the Treatment of Certain Cases of Insanity by 
Hyoscyanune. 


There is one condition associated with mania, and not unfrequently 
with senile dementia with excitement, which is most annoying—the 
propensity to the tearing of wearing apparel, blankets, &c. When 
appearing as a symptom of chronic mania it is frequently wilful, and 
is effectually put a stop to by single large doses of hyoscyamine. _ In 


Pen | Occasional Notes of the Quarter. 369 


one case in the asylum this mode of treatment is, when occasion re- 
quires it, particularly successful. The patient, either in wanton mis- 
chief, or in retaliation for some imagined slight or necessary exercise 
of discipline, either tears blankets or rugs to shreds, or cunningly strips 
off narrow pieces from their edges, so that for a time his ravages may 
go on unobserved. ‘Three-quarters of a grain of hyoscyamine in- 
variably put a stop to the intense and aggressive excitement, to which 
follows the detection of his wantonness, and the dose keeps him under 
control for about a month or six weeks, when the memory of his 
prostration requires to be revived by a repetition of it. 

But in cases of extreme dementia the circumstances are different. 
The patient may be absolutely unconscious that he is doing wrong, 
and he demolishes his apparel and bedding in an automatic manner, and 
apparently as the result of a constant impulse. When remonstrated 
with he can scarcely apprehend the nature of the offence, and when 
roused to a sense of it, expresses and manifests great contrition ; yet 
us soon as the remonstrance is over the destructive tendency again 
shows itself. One of the best examples of this variety is at present a 
resident in the asylum. He is an old soldier, and shows symptoms of 
advanced brain-wasting and arterial disease. Night and day his only 
tendency seems to be to tear. Though very old and feeble, and nearly 
toothless, he demolishes rugs, which appear sufficiently strong to resist 
the destructive tendencies of a powerful man; and while under obser- 
vation during the day he attempts at every opportunity to carry his 
fingers towards the most obscure region of his apparel in the endea- 
vour to carry out his propensities. These movements are performed 
in an automatic half-surreptitious manner. MHalf-drachm doses of 
chloral were at first administered to this patient, night and morning, 
without effect. Every night he destroyed one or more strong rugs. 
On April 30 he was ordered 5}, gr. of hyoscyamine every two hours 
night and day, and very shortly the physiological action was induced, 
and his tearing was stopped. After the full effect of the medicine 
was established, two days were allowed to intervene, and then he had 
jg gr. every night. The good result was kept up as long as the 
medicine was given, but when it was stopped, and when instead of it 
5 gr. doses of chloral were given every three hours, or after the action 
of that drug had been established by a single and much larger dose, 
he commenced to tear, as the attendant said, “as ravenously as ever.” 
When, however, he had had his ,'g of a gr. nightly for three months 
the drug was stopped, and he was not destructive for about three 
weeks. During the operation of the drug he was able to take exer- 
cise in the airing court, and showed little or no muscular weakness ; 
he took his food well, and his tongue and throat were quite moist. When 
in the ward he constantly sat in one position, but was not drowsy, and 
could speak rationally as far as the substance went, but was stammer- 
ing in utterance and demented in manner. He slept well. 

In speaking first of the employment of hyoscyamine in the treat- 


370 Occasional Notes of the Quarter. [Oct., 


ment of the epileptic status, it is necessary to observe that under 
ordinary circumstances, and in the great majority of instances, hydrate 
of chloral is so absolutcly certain to arrest the progress of the fits 
which in the aggregate make up the status, that hyoscyamine is rarely 
required for the production of that happy result. In the actual prac- 
tice of this asylum chloral has been found to be so free from disadvan- 
tages (and it has been used here to an extent and in such doses as has 
perhaps not been equalled in any other public institution), that it 
demands priority over all other drugs in the treatment of the status. 
But in cases where, on the presumption that some other remedy might 
produce even more striking results, hyoscyamine has been used, it has 
been found to be almost equal to chloral in the arrest of fast-recurring 
fits. This was well seen in the instance of a female patient, who had 
a monthly attack of the status, and in whom chloral stopped the fits 
for a period exactly proportionate to the dose. Thus half a drachm 
would ward off the fits for about an hour at atime, and one drachm 
for about three hours, and so on. In this case hyoscyamine was 
equally effective in producing the required immunity. In rare cases 
also, where chloral has been pushed to the greatest extent compatible 
with safety but unsuccessfully, hyoscyamine has been employed with 
marvellous results, as will be seen in the following case :— 


J. B. was admitted October 24, 1868. He was 24 years old on admission, 
and appears to have taken fits for 10 years previously. He was almost abso- 
lutely demented, could not tell his own name, and was incoherent and fatuous 
in his conversation. He had two or three fits daily, and as many in the night ; 
and, over and above these regular seizures, had occasional attacks of the status, 
in which the fits were severe, and followed each other in rapid succession. 
Thirty grains of bromide of potass, given three times a day for a whole year, 
did not diminish the fits either in number or severity. In fact, they became 
worse, and at times were so severe and frequent that he lost his sight for two or 
three days ata time. ‘This blindness has since then frequently recurred under 
the same conditions, and is associated with nystagmus, which prevents ophthal- 
moscopic examination. It may be added incidentally that another patient, who 
lived in the same ward, had a similar attack of blindness following upon re- 
peated epileptic seizures. J. B. now took sulphate of atropia for eight months, 
but without benefit. The subsequent record of his case is made up of a series 
of notes regarding attacks of the status, followed by blindness and prolonged 
stupor, in which he frequently had to be fed with the stomach-tube. Latterly 
the fits were arrested by repeated drachm doses of chloral. In the first week 
of July, 1876, he began to have every night six, seven, or eight fits, notwith- 
standing the liberal use of chloral, 30 grs. being at first given once or twice a 
night, and subsequently increased to much larger doses. This, for him, large 
number of fits was occurring nightly up to July 5, when one-sixteenth of a gr. 
of hyoscyamine three times a day, and a supplementary dose of the same size 
at 11 p.m. were prescribed. Next night he had one fit, and on the following 
night none; but this success was again interrupted by the occurrence of five 
fits on the third night after the first administration of the drug. The physio- 
logical action had not been induced, and the medicine was ordered night and 
day, and the full action of the hyoscyamine was developed on July 8. After 
that date he had only one fit. The physiological action was sustained till the 
12th by occasional doses, after which the drug was discontinued. For a period 
of 35 days and nights he was completely free from fits—an exemption such as 


1877.] Occasional Notes of the Quarter, 371 


he had never experienced or approached to during the whole period of his 
residence. Both his physical and mental state improved very much, and he 
could answer questions with more readiness and talk more coherently. His 
dementia, however, was so deep, that only a slight improvement—that directly 
due to the absence of fits—could be expected. He gained weight, and was 
more cheerful. On August 13 he again began to take fits, but at first they were 
fewer in number than his daily average. During 18 days and nights he had 
only 17 fits, whereas his common number averaged about three per night, the 
seizures during the day being much less regular and constant. From August 
13 onwards he fell into his usual condition, and continues to occupy his place 
as a confirmed epileptic for whom nothing but temporary alleviation can be 
looked for. Still, there can be little doubt that, by inducing at a critical period 
the physiological actions of hyoscyamine, this patient was delivered from the 
epileptic status, freed from fits for a period of 35 days, and subsequently for 
nearly three weeks was saved from two-thirds of the seizures which, judging 
from prolonged observation, he would otherwise have had. 


Tt may not be out of place here to mention the treatment of the 
excitement of general paralysis by repeated large doses of hyoscyamine 
given on two or three successive or alternate nights. I have recently 
had several instances of the value of the medicines in this condition. 
The most recent case is that of a general paralytic, who was 


Admitted on August 27,1876. Fora whole month he was exceedingly ex- 
cited and restless, and, notwithstanding the measures employed to subdue him, 
had only short snatches of sleep. In the intervals he was employed in tossing 
about, re-arranging and tearing his bedclothes, and in smearing the walls and 
in swabbing the floor with his exeretions. After three repetitions of three- 
quarter-grain doses of hyoscyamine onalternate nights, his excitement was com- 
pletely removed. He also became clean in his habits, has since then remained 
well, and has been transferred to a ward where he may have the privilege of 
enjoying for a time, at least, such advantages as would have been impossible 
had his degraded habits remained unchecked. 


Amongst general paralytics I have had three or four opportunities 
of observing a condition which is apt to be troublesome in treatment. 
Suddenly, perhaps, the urine which has been passing in a free stream 
is retained, and no effort can procure its expulsion. This state appears 
to be due to aspasmodic affection of the sphincter vesice. A large 
catheter passes freely till the sphincter is reached, and after a little 
pressure enters the bladder with a jerk. But repeated catheterisation 
seems to make matters worse, and rest and soothing suppositories are 
rather tedious in their action, more especially as mental excitement 
generally accompanies the retention. In such cases one ? gr. dose of 
hyoscyamine, followed by a repeated 2 or + gr, dose every three hours 
(night and day if possible), soon produced marked benefit. A case of 
this sort was treated quite recently. The patient had had his urine 
drawn two or three times a day for nearly a week. He was passing 
through an attack of excitement, incidental to general paralysis, On 
September 29 he had 3 grs. of hyoscyamine, Next morning, the 
medicine having produced sleep, he was much subdued and passed water 
freely, and in a good forcible stream. Small continuous doses were 
now given, and he went on passing water readily and abundantly. 


372 Occasional Notes of the Quarter. [ Oct, 


After four days the medicine was stopped, his excitement having 
abated, and his urination having been established. Next morning the 
water had again to be drawn, the medicine was resumed, and on the 
same day he again began to pass water in abundance and with ease. 
Small doses were given for about twelve days, but the physiological 
action was never fully established. He could walk about, and was 
free from excitement. The drug was then struck off, the patient 
being rational and industrious. Since then he has had no difficulty 
with his urine, and has been subdued, and anxious to make himself 
useful, 

One thing is particularly noticeable in the prolonged use of hyos- 
cyamine in suitable cases, and the detection of it removed one of the 
most formidable objections to the drug. The tongue, mouth, lips, and 
throat do not become dry; the appetite, instead of .being impaired, 
improves wonderfully ; and mental improvement is marked on the 
establishment of the physiological action of the drug, as shown by the 
wide dilatation of the pupil, the ataxic pronunciation, and the totter- 
ing walk. It is needless to state that similar observations have been 
made with regard to the prolonged and judicious use of belladonna 
and opium ; and the fact is interesting, as indicating how much the 
apparently specific actions of a drug are dependent on, or capable of 
being modified by, variations in the constitutional conditions which the 
drug has to overcome.— West Riding Reports for 1877. 





Dr. Shuttleworth on Intemperance as a Cause of Idiocy. 


At the Manchester meeting of the British Medica] Asso- 
ciation, Dr. Shuttleworth of the Royal Albert Asylum, 
Lancaster, read the following paper :— 


The relations of drink and insanity have of late occupied a some- 
what large share both of popular and professional attention. Recent 
Parliamentary enquiries in connection with proposed legislation for 
habitual drunkards have served to attract to the subject the interest 
of the intelligent lay public ; while a more logical mode of estimating 
the drink-etiology of insanity (the suggestion of which was due to 
their worthy President, Dr. Bucknill) had engaged the notice of pro- 
fessional specialists. Some discriminating statistics which have 
recently appeared, based upon the experience of large asylums, would 
no doubt lead to increased scientific accuracy in determining the rela- 
‘tive activity of intemperance and other causes in the evolution of 
mental diseases; and as aconsequence we might hope for less random 
assertions upon the subject than those sometimes to be met with in 
total abstinerce literature. The more direct result of excessive 
drinking as affecting the mental soundness of the individual guilty of 
the vice, naturally called for the first. share of attention; but there 


1377. | Occasional Notes of the Quarter. 373 


were certain secondary and hereditarily transmitted consequences 
which were no less worthy of careful investigation. It was to the 
consideration of the connection between intemperance in the parent 
and idiocy in the offspring that he desired to invite their notice. 
There was no doubt a widely-spread notion that idiocy was, in a large 
number of cases, the special mode in which the sin of the drunkard 
was visited upon the next generation. In the Report of Mr. Dal- 
rymple’s Committee on Habitual: Drunkards, it was remarked that in 
the United States ‘nearly one-half of the idiots are stated to be the 
offspring of intemperate parents.” British opinion on the subject 
having been largely influenced by statements and statistics emanating 
from American sources, it might be worth while to examine these 
latter a little in detail. The paragraph in the Report quoted seemed 
to be based upon a two-fold authority. First there was the oft- 
quoted calculation attributed to the late Dr. Howe, of Boston, U.S., 
that “out of 300 idiots, 145 had drunken parents.” Secondly, there 
was the evidence of Dr. James Parrish, of Philadelphia, that a very 
large proportion of the inmates of American idiot institutions (nearly 
50 per cent., according to the testimony of those connected with 
them) were eases attributable to drunkenness. The calculation attri- 
buted to Dr. Howe would appear to be in fact derived from an article 
in the thirty-fourth number of the “ American Journal of Medical 
Science,”’ by Dr. Jarvis, of Massachusetts, upon the Report on Idiocy 
presented in 1848 to the Legislature of that State. The figures 
given by Dr. Jarvis differed somewhat from those of Dr. Howe him- 
self, who, in his treatise on “The Causes of Idiocy,” asserts that out 
of 859 idiots, the condition of whose progenitors was ascertained, 
99 were the children of drunkards. Both statements were doubtless 
based upon the same documents—the oft-cited “ Report of the Com- 
missioners on Idiocy appointed to enquire into the condition of Idiots 
within the Commonwealth of Massachusetts.” The statistics tabu- 
lated by these Commissioners were so much relied upon as to deserve 
a somewhat detailed examination. 
The Massachusetts statistics were drawn up in 1848 by a Commis- 

sion of three, of whom the Jeading spirit was the late Dr. Howe. 
They were based upon an examination of 574 cases of idiocy, selected 
from 755 of such cases discovered by the Commissioners to exist 1n- 
the 82 towns of Massachusetts, containing in the aggregate nearly 
400,000 inhabitants. Mr. Enos Stephens—who, he had been in- 
formed, was a phrenologist, not a physician—was employed in the 
enumeration, at their own houses, of the greater number of the cases, 
with their attendant conditions. Tables showing the physical and 
mental condition of 574 cases were published by the Commission ; 
and in the Edinburgh reprint (which alone is now accessible for 
reference) they found, besides summary of results, a specimen m full 
of the tabulation of 45 of the cases. With regard to 11 of these, it 
was stated that the parents were of intemperate habits ; but it was 


XXIII. 20 


374 Occasional Notes of the Quarter. [Oct., 


significant that in 10 of these they were also described as ‘‘not being 
in a normal state of health,” and in every one of these ten cases the 
offspring were described as scrofulous as well as idiotic, The Massa~ 
chusetts tables did not give specific information as to hereditary 
tendencies to disease, consanguinity, &c., which might tell as contri- 
butary causes; but in the Connecticut tables, arrauged on a similar 
plan, and collected by State Commissioners in 1856, information was 
furnished on these points. The Connecticut enquiry embraced in all 
531 cases, and in 235 of these information was given with reference 
to the habits of parents. Of these 235 cases there were 75 in which 
intemperance was noted. He would refer to the Table of Causes of 
30 cases printed in full detail, and they would have an example of the 
general mode of tabulation. There they would find that out of 30 
cases, 7 were said to be the children of intemperate parents ; but (let 
it be remarked) in two of these cases it was added that the parents 
were consumptive, in one that they were cousins, in two they were 
described as below the average of intelligence, in one as being in 
feeble health, whilst in the seventh case the existence of idiotic 
cousins was noted. Surely there was thus exhibited an array of con- 
current causes which should make them chary of assigning drink as 
the chief cause of idiocy on the strength of American statistics ! 
He (Dr. Shuttleworth) had recently had the opportunity of visiting 
all the more important institutions for the training of idiots in the 
United States, and he was bound to say that the impression left upon 
his mind, after methodical conference on the subject with the respec- 
tive superintendents of these institutions, was that parental drunken- 
ness was generally regarded as occupying by no means a prominent 
place in the causation of idiocy. In one institution only—that at 
Frankfort, Kentucky—was he told that any considerable proportion of 
the inmates were children of intemperate parents. Wherever in the 
Institution Reports a table of probable causes was given, the per- 
centage ascribed to intemperance was extremely small. Thus, Dr. C. 
T. Wilbur, of the Illinois State Idiot Asylum, spoke of only 8 cases 
resulting from abuse of drink by parents out of 365 in which the 
supposed cause of the idiocy was recorded. American statistics were, 
however, not now the only data for the scientific estimation of the 
subject. During the last quarter of a century much has been done in 
this country for the idiot class, and particulars of the history of such 
cases have been obtained and noted. Several large institutions for the 
care and treatment of idiots now existed in Great Britain. Dr. Grab- 
ham, the superintendent of the oldest and largest of these institu- 
tions—he meant Harlswood—said that in 6 cases only out of 800 
tabulated by him is intemperance assigned as the probable cause, and 
in two of these there was also hereditary insanity. At the Royal 
Albert Asylum a persevering attempt had been made to ascertain 
whether the parents of candidates for admission were temperate or 
otherwise. This was one of the questions in the schedule filled up in | 


1877.] Occasional Notes of the Quarter. 379 


each case by the medical referee ; and collateral information was often 
derived through the medium of local committees, The general 
result of such inquiries was entered in the case- books, and from a 
scrutiny of the history of 200 male and 100 female congenital or 
presumably congenital idiots, the following statistics were derived : — 

Of the 200 males, 9 had intemperate parents, classed thus—7, in- 
temperate fathers; one, intemperate mother; and one, both parents 
intemperate. 

Of the 100 females, 7 had intemperate parents—in two of these 
cases the mothers were intemperate, and in five the fathers were in- 
temperate. 

Of the 300 patients, 16 had intemperate parents, eight of tions 
are described as habitual, and eight as occasional drunkards. 

These cases might be arranged j in the following classes :— 


Males. Females. Total. 

Parental intemperance the direct or only 

ascertained cause, Bit sods!) On Gaesey 
Parental intemperance complicated by here- 

ditary tendency to insanity or nervous 

disease. Zits hes OG Oa eee eae 
Parental intemperance complicated by ad- 

verse physical circumstances affecting 

parents (¢.g., ill-health, phthisis, and 

consanguinity ) di is aa" 2a ee ane 
Parental intemperance complicated by ad- 

verse mental circumstances (¢.g., emo- 

tion or anxiety of the mother while 

pregnant, &c.) ‘ : : He” ore a | eee a. 


— _— —— 


Total : ‘ ‘ eR! Behe oo 


The 800 cases considered were congenital cases, or cases in which 
idiocy was observed as an early consequence of fits during dentition, 
the predisposition to which may often be considered as practically con- 
genital ; cases resulting from falls and other clearly accidental causes 
being excluded, it was right to add that they were non-epileptic 
cases, and above the rank of paupers. He had himself been unable 
to recognise any distinctive type of idiocy in the cases attributed to 
drink. Considering the intimate and prolonged dependence of the 
child upon the mother, one would suppose @ priori that maternal 
rather than paternal intemperance would count most in the production 
of idiocy. Yet in the cases tabulated drunken fathers were in the 
majority of thirteen to four. Possibly the mental anxiety entailed by 
a drenken husband upon a wife during the impressionable period of 
pregnancy might 1 in part explain that discrepancy. With respect to 
Vicious nursing, he had little doubt that such nursing as a child was 
likely to derive from a drunken mother would intensify any predispo- 


376 Occasional Notes of the Quarter. © [ Oct., 


sition to mental defect. The baneful effects of giving infants alco- 
holic drinks was well illustrated in Sweden and Norway. In the 
latter country, they were told, babes were quieted by giving 
them linen soaked in whisky to suck, and such practices might in 
part account for the extensive prevalence of idiocy and juvenile 
insanity in Scandinavia. In conclusion there were two questions 
which might be useful in enabling them to form an opinion on the 
subject which he had endeavoured to elucidate. First—Are an un- 
usually large proportion of the immediate progenitors of idiot 
children intemperate people? Secondly—Are an unusually large 
proportion of the children of drunkards idiots? In the light of such 
British statistics as they possessed, and judging from personal obser- 
vation of a large number of parents afflicted with idiot children, he 
would hesitate to answer in the affirmative the first question. With 
regard to the second, an affirmative answer would, he thought, only 
apply when the subject was considered broadly. Congenital idiocy 
was probably not, as a rule, the immediate legacy of the drunkard to 
his offsprmg. Doubtless, however, physical and mental degeneracy, 
in diverse but correlated forms, was the entailed inheritance of the 
drunkard’s posterity, and perhaps scrofulous disease, epilepsy, nervous 
instability, and moral obliquity were the more direct bequests. It 
needed, however, but one step more, especially if the conditions con- 
tinued unfavourable, to arrive at idiocy; and in this way, no doubt, 
the sins of the fathers were sometimes literally visited upon the 
children ‘unto the third and fourth generation.” —Lancaster Guardian. 
In the discussion which followed the reading of this paper, the 
president (Dr. J. C. Bucknill) remarked that althongh personally he 
felt a great regard for the late Dr. Howe, he had for some time sus- 
pected the absolute scientific accuracy of the conclusions drawn from 
the Massachusetts tables. Dr. Seguin (of New York) confirmed the 
statement of Dr. Shuttleworth with regard to American observations 
on the subject, and expressed his approval of the discriminating way 
in which the figures had been handled in the statistics laid before 
them. He mentioned that recently, as president of the Association 
of Medical Officers of American Idiot Institutions, he bad sent out to 
all practising physicians in the United States queries with regard to 
their experience ag to the causation of idiocy. Dr. Langdon Down 
generally approved the conclusions arrived at by Dr. Shuttleworth, 
although from long experience he knew the immense practical diffi- 
culty in arriving at the truth with regard to the existence of vicious 
habits on the part of parents of idiots admitted to public institutions. 
He had, however, detected and described one or two remarkable cases 
in which the idiocy of the offspring seemed to be the direct conse- 
quence of parental intemperance. Dr. Hack Tuke thought that the 
American statistics, if not entirely accurate, might nevertheless have 
served a useful purpose, and on that ground were entitled to respect | 
Dr. Shuttleworth, in replying, said (in answer to the last speaker) | 


1S77. | Occasional Notes of the Quarter. 377 


that their first object as scientific men must be to arrive as closely as 
possible to the truth, without fear of consequences; but that he 
might add that one of his objects in placing his conclusions before the 
Section was a benevolent one, inasmuch as he felt it was not fair that 
parents afflicted with idiot children should without good reason have 
also affixed to them the stigma of intemperance. He thanked Drs. 
Seguin and Down for their kindly criticisms, and mentioned that an 
examination of the Massachusetts Tables in extenso, a copy of which 
had within the last few days been placed in his hands, quite confirmed 
the conclusions arrived at in his paper, viz., that etiologically con- 
sidered they abounded in mixed causes.—Brit. Med. Journal. 











PART I1.—REVIEWS., 





The West Riding Lunatic Asylum Medical Reports, Vol. Vt. 
1876. Edited by J. Cricuton Browne, M.D., F.R.S.E., 
and Herspert C. Masor, M.D. 


This volume, like its predecessors, is in part the work of 
gentlemen who are not connected with the West Riding 
Asylum. The space at disposal will only permit of a short 
notice of some of the papers, which will be referred to in the 
order in which they appear. 

The Histology of the Island of Reil._—The functions of 
this part of the brain are unknown, although aphasia, and, 
again, certain disorders of speech in general paralysis have 
been attributed by some to diseased conditions of its sub- 
stance. Hidden in the depth of the Sylvian Fissure, there 
can be no doubt that the Insula is often unnoticed or 
forgotten in pathological examinations. Its approximation 
to the lenticular nucleus of the striate body; its relations 
with the commissural fibres of the fasciculus uncinatus con- 
necting the temporo-sphenoidal and orbitar convolutions ; the 
arrangement of its fibres, which seem to be independent of 
the corona radiata; its greater development in man corres- 
ponding with the greater development and complexity of his 
frontal lobes as compared with those of the apes, as long 
known to anatomists; its inverse proportion, in_ those 
animals in which it exists, to the adjoining perforated area ; 
in a word, its position, relations, and peculiarities conspire 
to surround it with interest, and merit the careful investiga- 
tions of histologists and pathologists. _ aie 

At the beginning of the paper on this subject, it is stated 


378 Reviews. | [Oct., 


of the Insula that “It is that part of the brain which 
appears earliest both in the human fceetus and in the animal 
series. It appears to be peculiar to man and the higher 
apes; with the exception of the makis, no indication of its 
presence being observed in other animals.”’ There appears 
to be a want of agreement between these two sentences. 
For the statement in the latter of them, the work of Leuret 
and Gratiolet is correctly quoted. Being peculiar to man 
and the higher apes, the Insula cannot well be that part of 
the brain which appears earliest in the animal series, unless 
we reverse the order of nature and make the animal series a 
descending one. Nor are we aware upon what grounds is 
based the statement that itis the part of the brain which 
appears earliest in the human feetus. It would seem, rather, 
that following the formation of the encephalic vesicles and 
of the central ganglia is the outgrowth and development of the 
mantles of embryonic nervous tissue representing the future 
cerebral hemispheres, upon the external surface of which an 
incipient plication first appears, representing the future con- 
volutions of the surface; and further development proceeds 
from before backwards. 

From Dr. Lockhart Clarke’s statement in the last edition 
of Dr. Maudsley’s work, and from what Meynert has 
written on the cortex, one would have been prepared to hear 
that greater differences existed between the cortical grey 
matter of the Insula and that of other parts of the hemi- 
sphere than has been found by Dr. Major. As the result, 
however, of his careful micrometrical and other observations, 
he arrives at the following conclusions :— 

1. The cortical layers of the Insula agree in number, order, and 
general arrangement with those of the vertex, but the cells of the 
third layer are in the Insula generally smaller than at the vertex. 
The vessels and neuroglia present no peculiarity. 

2. The various gyri forming the Insula present similar structure. 

3. No difference of structure can be detected in the right as com- 
pared with the left Insula. 

4. The method of union of the white matter with the cortex is in 
the Insula similar to that observed in other lobes. 


The Weight of the Brain in the Insane is the continuation 
of a previous paper by Mr. Crochley Clapham. The results 
tabulated at the end of the paper are very laborious, and are 
based upon so large a number of cases as to be reliable and 
useful for reference. The author finds that the brain weight 
is lowest in idiocy, gradually rising through brain wasting, | 


nor. | Reviews. 379 


general paralysis, senile dementia, simple dementia, recent 
insanity up to chronic mania, in which it is highest. In 
all sorts of brain atrophy he finds that the cerebrum wastes 
much faster than the cerebellum. An error appears to have 
crept into the commentary, as far as relates to the male 
cases, where it is said that the “cerebellum, pons, and 
medulla, as compared with the entire brain, are proportion- 
ately larger in the Church of England cases than in the 
Roman Catholics.” 

On Classification and Nomenclature in Nervous Disorders. 
—Rightly premising that before laying down a system of 
classification it is necessary that some of the descriptive 
terms now in use should be modified, Dr. Rabagliati proceeds 
to suggest what several of the alterations should be. The 
word acute, as now applied to disease, covers two very 
different notions: one, the severity of the malady; the 
other, its shortness and rapid course. To remedy the 
anomaly, it is proposed to confine the use of the term acute 
to disorders which run a severe course, the opposite of which 
would be mild, while sub-acute would describe an intermediate 
group. Hach of these terms would correspond to a certain 
fixed range of body-temperature. For diseases of short 
duration, the proposal is to use the term brachychronic, the 
opposite of which would be chronic, descriptive, as now, of 
diseases of long duration. With the spirit of these sugges- 
tions most would agree, for some subdivision of the kind 
would be an undoubted gain. But Dr. Rabagliati is 
not so felicitous in reference to other terms. He proposes to 
confine the word Constitution to the set of facts, or inter- 
relations between the organism and external nature, from 
birth until the present time; the term Diathesis he would 
confine to the fasts of the intra-uterine life, and that of 
heredity to those of the family history. But so much contfu- 
sion arises from the technical use of the same word with 
dissimilar applications that the proposed restriction in the 
meaning of these established terms is undesirable. Consti- 
tution, for example, as now used in medicine, embraces facts 
belonging to all three of the groups just referred to. | 

The key-note of the article is the view that a scientific 
classification must be etiological—a view which has long had 
its adherents. He says :— 

After a good deal of consideration, I have come to the conclusion 
that such a classification as will prove of permanent value must be 
etiological; and although I am aware that high authority may be 


380 | Reviews. [Oct., 


cited against this method, I shall not here do more than suggest the 
general considerations which seem to require that a truly scientific 
classification must be founded on causes. Firstly, the problem of 
science in general-is the investigation of causes; the attempt to 
include a large number of phenomena under a general expression, or 
to discover the laws of phenomena, is only another way of making 
this statement, and this is the universally admitted scope and aim of 
science. Secondly, a large number of conditions known under the 
name of disease are indistinguishable from each other if their causes 
are not known; yet their effects and causes are entirely different. 
For instance, the group of diseases known as Pyrexiz include the 
widely differing disorders known as Fevers, as Inflammations, and as 
Specific Inflammations. Unless the observer has time given him he 
cannot by inspection differentiate these conditions from one another, 
but if he knows the causes then he can do so. 


It seems, after all, that there are other people than the 
late Dr. Skae who believe in etiology, but it is amusing to 
hear its praises sounded from Wakefield. 

Hight orders of disease are defined, according as they are 
due either to external causes, %.e., matter inorganic or 
organic, or to internal causes. Genera are to be determined 
by various considerations, such as the part affected; and 
species by the characters of the disorder, whether acute or 
mild, brachychronic or chronic. We think that the most 
truly scientific method of classifying diseases is the anato- 
mico-pathological. 

The paper concludes with a proposition which is too 
sweeping. It is that three stages are common to all dis- 
orders whatever: first, a stage of depression of nervous © 
power; second, a congestive stage with high temperature ; 
and third, a stage of subnormal temperature. 

Calorimetric Observations upon the Influence of various 
Alkaloids on the Generation of Animal Heat. By W. Bevan 
Lewis, L.R.C.P. Lond. In these elaborate and interesting 
investigations, it is stated that when there is an elevation of 
animal heat the thermometer gives us ‘no clue as to 
whether the elevation is due to increased heat formation, 
decreased heat discharge, or both conditions.” The ealori- 
meter, dealing with the new formation of heat, affords the 
desired information. Taking, as an example, the calori- 
metric observations on the administration of large doses of 
chloral to rabbits, Mr. Bevan Lewis finds that there is a 
primary condition of deficient heat-production, which is not 
merely apparent and due to retention of heat by the body of 
the animal, inasmuch as at the same time the temperature of 


1877.] Reviews. 381 


the body had fallen. This is succeeded by the more charac- 
teristic action of the drug—a great increase of heat-forma- 
tion, accompanied by a considerable fall in the animal’s 
temperature, the latter being due to escape of heat from the 
exposed surface of the body during general vascular dilata- 
tion. Here the calorimeter supplements our knowledge, as 
without its testimony the fall in temperature, so often 
observed after large doses of chloral, might be attributed to 
diminished heat-production, or to increased escape of heat 
with ordinary production. Mr. Lewis appears to have carried 
out these experiments carefully. 

Hyoscyamine wm the Treatment of some Diseases of the 
Insane.—Dr. Lawson’s experience is that— 


Hyoscyamine appears to possess great value in the treatment of 
cases in which aggressive and destructive excitement is the leading 
symptom of insanity, in cases of chronic mania with special delusions 
of suspicion, mania of asubacute or recurrent form, and simple mania, 
characterised from the first more by agitation than excitement, and 
due to the existence of obscure delusions and hallucinations. In the 
treatment of the excitement of general paralysis, in the epileptiform 
seizures of the same disease, and in the epileptic status, it is also of 
use. . . . . But perhaps the most striking results from the use 
of the drug occur in the treatment of such patients as wilfully or im- 
pulsively destroy large quantities of clothes and bedding. 


He reports some very striking cases in exemplification of 
these views. We have seen moderate doses of the drug 
act well in cases similar to some of those he describes, and 
are inclined to believe that asylum physicians will find it 
useful in certain cases, carefully selected for its administra- 
tion. But we would deprecate a rash or a too extensive use 
of this deliriant. 

Dr. Lawson’s conclusions are as follows :— 


That hyoscyamine rarely causes a decided exanthematous eruption. 

That very rarely (in two cases out of many hundreds of adminis- 
trations) it causes hamatemesis. 

That in small continuous doses it does not produce, in suitable 
cases, dryness of the throat or tongue, and does not interfere with the 
appetite or induce nocturnal restlessness. 

That in cases of retention of urine occurring in the progress of 
central nervous diseases, and due evidently to a spasmodic affection of 
the sphincter of the bladder, hyoscyamine produces free and voluntary 
diuresis. 

That small doses act powerfully in cases of locomotor ataxy, and 
other conditions characterised by frequent interrupted nervous dis- 
charges, and generally considered to be associated with sclerosis. 


382 Reviews. [OCh, 


That a certain tolerance is established in man, as in the lower 
animals, by the frequent administration of the drug. 

The following cautions may also be useful, viz. :— 

That in the aged and in patients showing marked signs of arterial 
disease, the drug should be administered with great caution. 

That it should be freely diluted. 

That it should be avoided in cases of furious mania, when great ex- 
citement exists, and artificial feeding is likely to be required for some 
time. 

That the extractive hyoscyamine should be prepared in small 
quantities, and kept in a small stoppered bottle to lessen the danger 
of change from oxidation and other influences, 

If these precautions are kept in view, the drug can be extensively 
employed as a valuable therapeutic agent, and one capable of in- 
creasing the recoveries in, and diminishing the expenditure of, lunatic 
asylums. 


Dr. Merson deals with the climacteric period in relation to 
insanity. He confirms the existence of a climacteric insanity, 
and says :— 


Looking to the symptoms displayed at the time of admission by 
the cases whose history was investigated, it seems to me that, 
excluding cases complicated with organic disease of the brain, they 
might be all referred to three classes, characterised by the prominence 
of different groups of symptoms. i 

The first class was characterised by simple depression without 
hallucinations of the senses or intellectual arrangment. In some 
cases there was extreme nervous irritability and hyperesthesia of 
sensation almost amounting to hallucination. 

In the second class, also, depression was the prevailing mental con- 
dition, but along with this there was great emotional and intellectual 
disturbance. Hallucinations of the senses were not uncommon, and 
some vague delusions of a depressing kind were nearly always 
present. 

The third class of cases presented delusions of suspicion and perse- 
cution as the most prominent symptom. In most cases hallucinations 
of the senses were present, and outbursts of excitement not unusual. 


Dr. Sutherland describes some interesting cases on the 
Borderland of Insanity. 

In certain “ clinical notes,” it is stated that great benefits 
have been derived from the treatment of dirty habits in the 
insane by tannin suppositories at night. 

From another paper it appears that at Wakefield the 
generality of the insane presented nothing essentially pecu- 
liar in their skull-shapes, and “ that in fact their skulls were 
not nearly so twisted as their wits ;” that the exception, the 


aor Te .| Reviews. 383 


insane type, is the skull-shape in which the greatest transverse 
diameter is placed in the anterior third of the skull, and that 
the insane have larger head measurements than the sane in 
all directions, save that of the transverse arch. The conclu- 
sion as to the “insane type” of skull is vitiated by the fact 
that the comparison was made with criminals. 

Notes on the Pathology of General Paralysis. By Dr. 
Crichton Browne. The view that general paralysis of the 
insane is of inflammatory origin, that its symptoms are due 
to an insidious, slow, chronic, or occasionally to a subacute 
form of inflammation, either of the cerebral substance or of 
the meninges, or of both, has never been without its sup- 
porters since the disease was first differentiated by Bayle, 
and by him called chronic meningitis ; and since Calmeil, 
more than fifty years ago, deemed the morbid lesion to be a 
chronic inflammation of the cerebral pulp predominating at 
its circumference. This inflammatory view is still, perhaps, 
the most popular one on the subject, and Dr. Crichton 
Browne avows himself as an adherent toit. That so many 
other views have been held as to the pathological lesion 
proper is evidence of the difficulty in deciding as to whether 
the well-known changes necessarily imply an inflammatory 
process or not, and as to how far the inflammatory process is 
essential in those cases in which there is supposed to be 
stronger indications of its presence. Certainly, all the 
usual lesions can be plausibly accounted for without in- 
voking the aid of an inflammation. It would, however, 
require much space to re-state the arguments which for 
many years have been adduced both for and against the 
inflammatory view of general paralysis, and we pass to the 
most interesting feature in the article now under notice. 

The assertion therein that ‘all authorities are agreed that 
there is no appearance that is constant, and that can there- 
fore surely guide us to the pathological starting-point and 
nature of the malady; and most authorities are agreed that 
there is no appearance, nor group of appearances, that is so 
pre-eminently frequent as to be entitled to paramount atten- 
tion,” in general paralysis, is certainly inconsistent with the 
literature of the subject, which teems with illustrations of 
the fact that observer after observer has indicated what he 
deemed to be the constant, essential, or characteristic lesion. 
Following these, Dr. Browne expresses the view that 
{he one appearance which is “so frequent as to be specific” 
in general paralysis is the adhesion of the pia mater to the 


384 Reviews. [Oct., 


cortical substance. These adhesions were carefully examined 
by the very earliest investigators, some of whom assigned 
considerable importance to them. Agreeing that they are 
caused by a chronic adhesive inflammatory process, he adds 
that, speaking generally, they represent the course and dis- 
tribution of the morbid processes in which the disease essen- 
tially consists. In holding this view he has grasped only a part 
of what we believe to bea more general truth as to the patho- 
logy of general paralysis—a truth of which various writers 
have given indications. He was not the first to examine 
minutely the distribution of the adhesions in general para- 
lysis with the object of applying the knowledge thus gained 
to an explanation of its various symptoms. Nearly two 
years ago, for example, in an article on a case of general 
paralysis in these columns, the distribution of the adhesions 
to the cerebral cortex was minutely described, and the 
attempt was made to show how far the localisation of these 
adhesions could be brought to bear upon the explanation of 
the localisation of symptoms observed during life. But to 
Dr. Browne is due, we believe, the credit of being the first to 
publish an attempt to explain all of the leading symptoms of 
general paralysis in this way. 

With much that he writes about these adhesions we 
cordially agree; from much, however, we dissent. We 
cannot accept adhesions of the nature described as being so 
extremely constant and characteristic in general paralysis as 
he imagines. He only claims them in 80 per cent. of his 
cases; but then he tries to explain away the remaining 20 
per cent., partly on the ground of difficulty in the diagnosis - 
and partly on the theory that the cases in which they are 
absent are protracted cases, that in them the disease has 
been of the slow degenerative type, hence that there has been 
wasting of brain before active hyperemia set in, and, there- 
fore, that the surface of the brain, bathed in serum, is not 
subjected to that friction or pressure against the skull which 
he supposes to increase the irritation and lead up to the ad- 
hesions, Yet this theory is evidently felt to be weak, and is 
reinforced by another to the effect that the adhesions may 
have been formed, but may have undergone absorption. 
But of these three roads of escape, none are open. 
Especially the absorptive theory is contrary to all we know 
of the progressive nature of the disease. In proof 
of this, we would prefer to adduce the autopsies 
furnished by accepted authorities on the subject, in the 


1877.] Reviews. 385 


records of which is so often found the distinct statement 
that in this or that case, dying at different stages, adhesions 
were entirely absent. It would quite suffice to bring forward 
the testimony of Bayle, who, more than fifty years ago, eV1- 
dently made careful search for these adhesions ; or that of 
Calmeil, as to this point. Kven if the objection should be 
raised that the necropsies on record were imperfectly made 
with reference to this point, which we do not admit, we 
would then refer to our own experience. During several 
years past we have removed the whole of the meninges from 
the brain of every general paralytic dying under our care 
with the most scrupulous care and exactitude, and have 
minutely noted the localisation of every adhesion. As one 
result of these tedious investigations, we can say that the 
brain may be absolutely free from the adhesions in question 
in typical cases of general paralysis running either a short, 
a medium, or a protracted course; but would anyone say 
that in these cases there was no disease of the cortex? The 
fact is that these adhesions merely represent the points 
where the disease has been most marked. And we do so the 
more readily, inasmuch as we have found them in a larger per- 
centage of cases than is at first claimed by Dr. Browne, 
and have long considered these adhesions and their locali- 
sation of extreme importance in the morbid anatomy and 
pathology of general paralysis ; hence, indeed, the investiga- 
tions just referred to. The stripping must be most carefully 
done, and is wearisome, but it has the great advantage that 
one can then proceed to examine the entire brain in the 
fresh state, and to select portions for microscopical examina- 
tion in the usual way. 

We also cannot admit the analogy which it is attempted 
to draw between the occasional absence of these adhesions 
and the occasional absence of the characteristic lesions of 
such affections as fulminant cerebro-spinal meningitis, variola, 
or scarlatina. 

This able and interesting article displays, we think, rather 
too great a tendency to accept the conclusions of recent 
experimenters as to the real bearing of their observations on 
the effects of excitation and destruction of the cerebral 
cortices of the lower animals —a tendency which leads the 
writer of it, for example, to attribute the occasional complete 
blindness of general paralytics to involvement of both 
angular gyri in the morbid process, which, although perhaps 
true in some instances, is a conclusion opposed to several 


386 Reviews. ROGts 


cases on record, and also to one which recently came under 
our own observation. 

Dr. Milner Fothergill writes on the therapeutics of some 
affections of the nervous system, and Dr. Hughlings Jackson 
on epilepsy—a subject with which his name is so much 
associated. 

Altogether this volume of Reports is a very interesting 
and able one, extending the boundaries of our knowledge 
and leaving mental disease its debtor. We shall look foward 
with pleasure to the next volume. We hope that a rumour 
of their discontinuance is unfounded. 





Pessimism : a History and a Criticism. By James Svutty, 
M.A. King and Co. 1877. 


Not until the close of his self-sufficing lfe did Schopen- 
hauer gain the attention and enjoy the reputation which, 
during long years of neglect, he had the full assurance he 
ought to have and would one day have; but if he could come 
to life again now, and see what a commotion he had made in 
magazine philosophy, he would probably be not a little 
eratified, in spite of the indifference which he always pro- 
fessed alike to the applause and to the censure of men. He 
is considered to be the apostle of Pessimism, which has been 
raised to the dignity of a philosophical system, and Mr. 
Sully has been at the pains to write a considerable treatise, 
in whick he deals with the subject elaborately from a 
historical and a critical standpoint. Schopenhauer’s notion 
was that the world was nearly as badas it could be, consistently 
with its continued existence: others before him have, without 
going quite so far as he did, denied the happiness and asserted 
the inherent misery of life; and Mr. Sully has accordingly 
begun his work with a historical sketch of instinctive and 
reasoned optimism and pessimism. A long time ago a certain 
ereat Preacher put the whole matter very concisely and forcibly 
when he cried—“ Vanity of vanities, all is vanity. What 
profit hath a man of all his Jabour which he taketh under 
the sun? . . . For that which befalleth the sons of men 
befalleth beasts; as the one dieth so dieth the other; yea, 
they have all one breath.”? Those who are minded to write 
pessimistic essays on life might well, feeling it impossible to 
improve upon these words of the Preacher, ‘relinquish their 
designs, and let the world be happy or miserable in peace. 


1877.] Reviews. 387 


“Not to be born is the most reasonable, but having seen the 
light the next best thing is to go thither whence one came as 
soon as possible.” A reasoned exposition of the pessimistic 
theory of life must be a very doubtful benefit to the mass of 
mankind, being an opening of their eyes to a knowledge of 
good and evil, which the experience of Hden would seem to 
show that they are better without. For, if all men were 
truly wise, and all equally so, it is a question whether they 
might not conspire together to perpetrate one great 
act of felo-de-se ; “true wisdom consisting in a perception 
of the nothingness of all things, and in a desire to become 
nothing, to be blown out, to enter into nirwina.” 

Having finished his historical sketch, which strikes us as 
fragmentary and unsystematic, being rather a collection of 
unconnected individual utterances than a study and exposition 
of lines of thought, Mr. Sully devotes a chapter to an account 
of the life and doctrines of Schopenhauer, and another chapter 
to his German successors, especially Hartmann, the author of 
the singularly famous “ Philosophy of the Unconscious.” 
One might wish Schopenhauer were alive now in order to 
hear what he would say of the “‘Philosophy of the Uncon- 
scious ”’ and its offshoots; we suspect that it would provoke 
from him no little vigorous criticism and trenchant scorn. 

Now what is optimism, and what is pessimism? Accord- 
ing to Mr. Sully, optimism is the theory that the world is on 
the whole good, or conducive to happiness, and so better than 
non-existence. If we made any criticism, we should be in- 
clined to say of this definition that it is not optimistic 
enough; and in like manner it might be said of his defini- 
tion of pessimism—namely, that the world is on the whole 
_ bad, or productive of misery, and so worse than non-exist- 
ence—that it is hardly pessimistic enough. However, taking 
these doctrines as he has enunciated them, is it worth while 
to discuss which of them is true? Will any good come of 
the discussion? Would it not be equally easy and equally 
unprofitable to write an elaborate book on one side or on the 
other? For, when all has been said, does not the matter 
remain just where it was? Suppose one writer sets forth the 
seemingly tough argument that men, as aruie, do desire 
eagerly to go on living, in proof that on the whole happiness 
does predominate over misery in the world ; what is to hinder 
another writer from bringing forward the supposition of a life 
in heaven after death as proof that man has felt this world 
to be on the whole so productive of misery that he has been 


388 Reviews. [Oct., 


driven, on the condition of continuing to live in it, to invent 
a future life to outweigh and to redress the miseries of this ? 
However, Mr. Sully does not agree that the discussion is 
valueless ; on the contrary, he thinks that “a knowledge of 
the real felicific value of life would have a worth for our 
feelings,” and that the question of the value of life is 
intimately connected with the whole of practical science or 
the theory of conduct. 

Acting on this conviction, he proceeds to consider and 
discuss the scientific basis of pessimism under the two heads 
of (a) The pessimist’s interpretation of physical nature, and 
(b) The pessimist’s interpretation of mind. His first heading 
would, we think, have more correctly indicated the contents 
of the chapter had it stood as—‘“ Hartmann’s Interpretation 
of Physical Nature,” for it is really a criticism of the 
doctrines of that writer. But there were pessimists before 
Hartmann, and there are pessimists now probably who do not 
accept the philosophy of the unconscious. Have they no 
interpretation of physical nature as a scientific basis of their 
doctrine ? Moreover, it is somewhat strange to set up and 
knock down Hartmann as the representative of the scientific 
basis of pessimism, who is really without the least basis in 
science, being more metaphysical than metaphysicians them- 
selves. Putting aside Schopenhauer’s and Hartmann’s 
peculiar doctrines, what has the conception of will as the 
reality of the world, the theory that it extends through the 
whole region of phenomena, which Mr. Sully elaborately 
confutes, to do with the basis of pessimism? Philosophy 
does not begin nor end with the latest writers about whom 
magazines make a stir. 

In the same way, when he treats in a subsequent chapter 
of the second division of his subject, namely, the pessimist’s 
interpretation of mind, he is still solely occupied with 
Schopenhauer and Hartmann. We have read the chapter 
with some surprise, for Mr. Sully takes these writers to task 
in a pragmatical way, flinging at them with supreme com- 
placency the tritest psychological doctrines. Surely a little 
reflection might have suggested to him that it was very 
unlikely either of them would be ignorant of doctrines which | 
they might have learned in any textbook of psychology, and 
possible that in supposing them so ignorant he might himself 
be failing in apprehension of their philosophy. His 
criticism would have been more profitable for instruction, 
had he striven to understand their terms in the sense in 


4 


£377. | Reviews. 389 


which they used them, and to enter heartily into their thoughts, 
and forborne to fail foul of them because they did not pack 
their doctrines, duly parcelled and labelled, in the proper 
psychological compartments, as these are arranged in the text- 
books of the schools. Mr. Sully seems to feel assured that 
his somewhat diffused psychological disquisitions, into which 
_ he never fails to enter when an occasion offers, and which 
read like magazine articles, have an important bearing upon 
the subject-matter of his book, but we do not see so clearly 
what particular concern such questions as whether all mental 
states are conscious states, whether Schopenhauer’s way of 
talking of will in nature is psychologically correct, how far. 
will is separable from desire, and the like, have with the 
question whether happiness or misery preponderates in the 
world—a question which will never be settled by elaborate 
a priort speculations. No doubt many of the psychological 
criticisms are acute, but it isa pitythat they were not embodied 
methodically in a psychological treatise, instead of being 
scattered in a book where they are apt sometimes to distract 
and provoke the reader. The book being mainly a criticism 
of Schopenhauer’s and Hartmann’s doctrines of pessimism, 
not truly a history and criticism of pessimism, would more 
properly have been so called; but, regarded in that light, 
the disquisitions may not perhaps be so much out of place. 
Anyhow, Mr. Sully is well satisfied with his achievements ; 
for he says, after completing his examination of the pessimist’s 
arguments, by way of summing up— 


First of all, the metaphysical portico, so to speak, of this dark and 
gloomy edifice was found, after a slight inspection, to contain 
numerous cracks and flaws, and to offer anything but a certain and 
safe approach to the pessimist’s desired resting-place. Again, the 
physical groundwork of the structure has proved itself, on a close 
scrutiny, to be essentially unstable, being built of nothing but purely 
fanciful hypotheses, and what is more, of hypotheses which frequently 
run directly counter to experience, and which involve incoherent and 
self-contradictory conceptions, Once more, the psychology of pessimism, 
when its tangle of unexamined ideas is unravelled, shows itself to be 
radically erroneous. Lastly, the attempt to prove pessimism directly 
by an appeal to observation must be regarded as a signal failure, since 
the method of observation pursued is wanting in those conditions of 
completeness, impartiality, and precision, which can alone give to a 
method a scientific value. 


Schopenhauer and Hartmann are utterly routed then at all 
points—beaten, pursued, almost annihilated. For Mr. Sully 
XXIII. 26 


390 Reviews. [ Oct., 


goes on ruthlessly to show that will, instead of being the 
root of pessimism, as they would have it, is the possible basis 
of a preponderance of happiness—‘‘ Whereas the pessimist 
finds his world-misery rooted in will, this same will has 
supplied us with the one possible basis of a life which must 
satisfy by a sure preponderance of pleasure.” Does not that 
assertion prove how easy it is to find a multitude of argu- 
ments in support of either side of the question, how idle the 
discussion is, and how difficult it always will be to convincea 
man of melancholic temperament that this is the best of all 
possible worlds, or a man of gay and sanguine temperament 
that it is nearly as bad a world as it could possibly be? Mr. 
Sully concludes with a chapter in which he argues that the 
basis of a pessimistic or of an optimistic view of life re- 
spectively is mental temperament. No doubt of it; all the 
world has known that from the days of Adam almost unto 
the present day; but how does the recognition of the truth 
bring us any nearer to answering satisfactorily the question 
whether happiness or misery preponderates in the world? 
Those who, differing from us, think it worth while to go 
into all the arguments, and to try to answer it, should 
certainly read Mr. Sully’s book, which they will find to 
contain a great deal of acute analysis and valuable criticism, 
and to be both instructive and suggestive. 





Der Mensch als Selbstzweck: eine positive Kritik des Unbe- 
wussten. Von B. Carnerr. Wien, 1877. 


We have here another elaborate criticism of the unconscious. 
The book is divided into five chapters, the first of which is 
introductory ; the second treats of the Unconscious; the third, 
of the Individual and the World; the fourth, of Causality ; 
the fifth, of One’s proper Aim, and Intelligence; the sixth, of 
Love. Schopenhauer and Hartmann are the main subjects 
of the criticism. Buta glance at its pages shows the vast 
influence which our great countryman, Darwin, has had upon 
German thought. 

The concluding paragraph of the introductory chapter will 
serve to exhibit the author’s philosophical standpoint :— 


There is no other way to ideas than the way of science. Our 
Idealism does not hinder us from subscribing to the assertion that the 
work of a materialist, who explains to us the activity of the smallest 
nerve-fibres, is more valuable than that of an idealist, who puts forth a 
complete philosophical system. But each can labour only in the field 
which is open to him, and happily mankind has no need of the philo- 


1877. ] Reviews. 391 


sopher in order to attain to ideas and ideals. It is the lesson of 
philosophy to make the ideal clear, to separate from it everything that 
is in contradiction to the results of science ; for clearness is the stamp 
of adequate ideas, and knowledge alone leads to clearness. 


The remarks which follow conclude the chapter on the 
Unconscious. For the arguments which support them, we 
must refer our readers to the book itself. 


The world is here, and mortal man must take it as it is presented 
tohim. But against all his sorrows are counted joys enough, all 
illuminated by the exalted feeling of the solidarity and unity of the 
human race. We have yet before us so glorious a period of time, 
and so honest a piece of work, that we can fitly leave all care about 
the end of the world to a later generation. If we provide first of all 
for the well-being of our children, and endeavour that our Will may 
go on to live in them—if each one has a clear conception of that— 
then he has all the world which he needs. Jn the incarnation (human- 
ization) of consciousness, not in the detfication of the unconscious, lies the 
deliverance. 

There are a good many persons who could not well set before 
themselves a worse aim than that their wills should go on to 
live in their children. One would fain see the curse of a 
mean and sneaking nature end with the individual, and hope 
that a coarse mass of vulgarity and vanity may not come to 
life again in any posterity. 

We must say that after the learned disquisitions of his 
chapters, in which there is much that is put in a fresh and 
original fashion, the author’s conclusions of the whole matter 
sometimes strike us as very modest, if not mean. They may 
be perfectly well-founded, but they are not very inspiring. 
Thus, after discussing the relations of the individual and the 
world, he tells us that “ work was our beginning, work is our 
reward, and work will be our redemption. Love of work are 
the words of words for man in the struggle of life. A sudden 
end to our planet is not probable; rather a gradual cooling 
of it, the consequences of which may be of a very rough 
nature. Man, who was equal to his beginning, will also be 
equal to the ending which life offers to him. To be conscious 
of which and, holding clearly to this consciousness, to take 
upon him the burden of life and to be master of it, 1s accord- 
ing to our ethical notions the noblest Life-ideal.” ‘The 
human race will one day go out for ever like a burnt-out 
candle, or rather be cooled out like a jet of steam on a frosty 
day, and all that the individual has got to do is to keep 
that clearly in mind, and to bear the burden of life with 
steady patience—“Travaillons sans raisonner,” says Mart:n in 


392 Reviews. [Oct..% 


Voltaire’s Candide, “c’est le seul moyen de rendre la vie 
supportable ;” and to all demonstrations either of the worth 
or of the worthlessness of life let us reply with Martin in 
the same story—‘“‘Cela est bien dit, mais il faut cultiver 
notre jardin.” : 

The general purport of the chapter on Causality will 
appear from the conclusion which is reached, that “the con- 
viction of the universal and unchangeable reign of law in 
everything that happens, psychical not less than physical, is 
the most precious achievement of clear thought, won by 
experience, established by experience. Causality is the iron 
yoke at which mankind drags heavily, but at the same time 
the iron testimony that it reckons safely when it reckons 
with experience.” 

In the last chapter the author sets himself to combat the 
low and unworthy ideas of woman and of love which have 
been promulgated by Schopenhauer and Hartmann, and rises 
to a certain pitch of enthusiasm as he descants on the high 
and noble nature of true and pure love. Against those 
authorities he quotes John Stuart Mill, whom he believes to 
have described a far nobler ideal of what woman should and 
may be. Love isa theme which admits of any amount of 
rapturous writing, and we shall not attempt to make a critical 
estimate of our author’s cpinions, but we can imagine a 
cynical disciple of Schopenhauer saying at the end of a 
glowing discourse upon the glories of love—“ That is very well, 
friend, but what if you subtract the fundamental organic pola- 
rities ?’? And if we are to look forward to a time when the 
world-cooling process has gone so far that only a few degraded 
remnants of mankind, buried in snow huts near the equator, 
are dragging on a miserable existence, on the eve of human 
extinction, and all the high feelings and great achievements 
of the human race are as if they had never been, what room 
is there for enthusiasm? “Il faut cultiver notre jardin.” 





Hints on Insanity and Signing Certificates. By Joun Mitiar, 
L.R.C.P. Ed. Second edition. Renshaw, 1877. 


This is a second edition of Mr. Millar’s excellent “ Hints 
on Insanity.” In it he gives not only all the necessary in- 
formation concerning the proper statutory forms to be com- 
plied with in order to place an insane person under care and 
treatment, and the fullest advice with regard to filling up 
certificates, but a great deal of practical information concern- 
ing the different varieties of insanity and the best course to 


1877.) Reviews. 393 


be pursued in dealing with them. The general practitioner 
will find it a book most useful to him. If he attends care- 
fully to the full and explicit directions which Mr. Millar gives 
in the clearest language, he can hardly go wrong. If he does 
eo wrong, then it is difficult to believe that instruction will 
avail to make him go right. 





The Care and Cure of the Insane. Being the Reports of the 
‘* Lancet” Commission on Lunatic Asyluwms, 1875-6-7. 


By J. Mortimer Granvitie, M.D., F.L.S. 2 vols. 


The “ Lancet” instituted an enquiry, or ‘‘ commission,” in 
1875; 1. To ascertain the general character and efficiency of 
the provisions made for the insane in asylums, and the condi- 
tions of their daily life; 2. To discover the measures, and, as 
far as may be possible, to formulate the system of treatment 
adopted for the cure of remediable or recent, and the relief of 
incurable or chronic cases; and thirdly, to collect and collate 
statistics of cases occurring within the last ten years at the 
asylums visited, with a view to estimate the results. The 
two bulky volumes we have to notice are the results of this 
enquiry. We shall not a say a word as to the necessity for 
such an enquiry conducted by an irresponsible newspaper in 
regard to great public institutions, with a Government Com- 
mission for their inspection long in existence, and which are 
already so inspected, suspected, and watched, that their 
medical officers, if they possess any sensibility at all, are 
kept in perpetual worry, their minds diverted from their 
proper duties through the work entailed by such enquiries, 
and their courage and nerve broken long before they arrive 
at old age through such things combined with the harassing 
nature of their professional employment. Weare convinced 
that vigour of administration and honesty of management 
are often sacrificed now-a-days through such nagging, while 
the concentration of mind needed for studying and treating 
individual cases of the most obscure of all diseases cannot be 
attained. The life of an asylum doctor is not a bed of roses 
at the best, and the profession generally has been singularly 
unmindful of the status and interests of the men engaged in 
this branch of medicine ; while the general medical press 
has often been flagrantly unjust towards it, combining 
real ignorance and popular prejudice with a lofty affectation 
of knowledge in its hostile criticism in a way that we never 
remember to have seen exhibited towards any other de- 
partment of the profession. Such a state of matters tends 


0A Reviews. [Oct., 


to limit and lower the class of men who take to practical 
medical psychology, while the great hope for asylum manage- 
ment as well as the elucidation of the problems of diseased 
mental phenomena lies in attracting the best thinkers and 
workers into this speciality. To aggravate, if possible, still 
further the evils of which we complain, the teaching of 
mental diseases is most scandalously neglected in our 
medical schools, and in no way encouraged by the majority of 
our licensing corporations. 

But what are the results achieved by the “ Lancet’? Com- 
mission? It is somewhat difficult to get at them on account 
of the extreme prolixity of the book. To show this, take 
the account of Brookwood Asylum, Surrey, with which the 
first volume begins. It occupies seventy pages, most of them 
of close print. Itis full of information, mixed up with all 
sorts of admirable but commonplace and second-hand 
opinions and reflections as to the right treatment of the 
insane. There is scarcely an opinion expressed that any in- 
telligent asylum medical officer would differ from. It bears 
the impress of a mind of small grasp anxious to get at the 
truth, much concerned about the right treatment of the 
insane in asylums, and with most benevolent intentions 
towards them, but evidently new to the questions to be dis- 
cussed, and inexperienced in practical insight. The conse- 
quence is that we have the account of the asylum mixed up 
with the author’s thoughts in a confusing way; as the pro- 
blems he had to treat of came before him in a practical shape 
in the asylum wards, he is led on to page after page of 
general principles, which, no doubt, were quite new to him, 
but which are simply Conolly’s teachings and spirit in a 
diluted form, tinctured by the sound and judicious practical 
sense of Dr. Brushfield, evidently instilled into the 
Commissioner without stint in conversation. That 
Brookwood Asylum is an admirably managed institution, and 
most successful, practically, was the result of the visit. 
There is nothing new in the account of it to asylum physi- 
cians who had read the reports of the institution, while 
no general physician would care to read so long a 
statement in regard to any special hospital. In regard to 
the statistical tables, we think that “deemed curable” 
is an utterly unreliable basis on which to found statistics. 
It is a fact that may be merely a fancy—a kind of fact 
always to be avoided in statistics. | 

A very interesting historical account of Hanwell and of 
Conolly’s. immortal work there follows the account of 


1877.] Reviews. 395 


Brookwood, and the other asylum for the county is thus 
introduced to the notice of the reader—“The Middlesex 
County Asylum at Colney Hatch is a colossal mistake ”—an 
opinion in which, toa certain extent, most asylum physicians 
will concur. The author strongly advocates the separate 
treatment of the curable and incurable cases, and most 
readers will, therefore, turn with great interest to the 
chapter on the Metropolitan District Asylums of Leavesden, 
Caterham, and Hampstead, those first great experiments in 
this country in massing together the mentally afflicted of the 
mildly incurable type. It is clear that the practical realisa- 
tions of his views as to the advantage of separately treating 
the incurables did not bear out his theoretical opinions on the 
subject. He was not satisfied, and his report is not an 
enthusiastic one. Bethlem, we think, though it gets an 
admirable report, is scarcely done justice to as a hospital 
for the curable insane. It deserves more commendation than 
it gets. The historical account of this hospital and St. Luke’s 
will be found well worthy of perusal. 

The second volume is by far the most interesting. After 
the special reports on some of the London private licensed 
houses, all of a somewhat favourable character, the author 
goes on to give summaries and general results, with a short 
treatise embodying his own opinions at the end. Our 
opinion of him and of his work, of his fairness, intelligence, 
and breadth rises, on the whole, as we go on. His visi- 
tation of asylums and his experience of the treatment 
of the insane, its difficulties and peculiar characteristics, 
had not been without effect on his own education. He 
clearly did his best to think out some of the problems 
before him. The recoveries at the five asylums visited 
for the ten years 1865-74 were at the rate of 30°5 per cent. 
on the admissions, and the deaths 36-9 per cent. of the 
total admissions, 27°8 per cent. of those under treatment, 
and 9°38 per cent. of the average number resident. “It 
is an important and weighty fact that the percentages of 
recoveries obtained in the ten years 1865-74, which formed 
the subject of the enquiry, do not show any notable advance 
on those reached in the years 1845-54, while the deaths are 
relatively more numerous now than then.” The explanation 
of this, we believe, to be entirely due to the character of the 
cases sent into asylums which have altered of late years. 
The standard of what constitutes lunacy suitable for asylum 
treatment has changed and immensely widened. All who 
have experience are agreed on this point. Far more mild 


396 Reviews. [Oct., 


cases, far more congenital imbeciles, far more eccentrically- 
behaved monomaniacs and contorted harmless specimens of 
humanity, and—as explaining the death-rate—very many 
more senile dotards and hemiplegic wrecks are now sent to 
asylums than formerly. The trouble taken by the author in 
the manipulation of his figures compels respect ; an interest- 
ing fact is thus brought out: ‘The probability of life at 
38:4, the average age of 12,539 patients admitted at Colney 
Hatch in twenty-five years being 27°8, 4,407 or 35°15 per 
cent. died at an average age of 45°6. The proportional loss 
of probable life, or the measure of failure to reach the 
standard of expected life at the age estimated was equal to 
26-0 per cent. on the total years likely to be lived by the 
ageregate number of patients admitted. In other words, 
26°0 per cent. of expected life was lost at Colney Hatch.” 

Dr. Granville thinks in regard to the clinical observation 
and study of mental disease that ‘‘ this department of study 
has first been neglected, then investigated with preconceived 
opinions which misled observers, and now it is the 
scene of wild intellectual excitement in which the under- 
mining of faiths and the uprooting of moral principles 
engross a larger share of attention than the calm elucidation 
of disease and the patient search for remedies.”’ His remarks 
about the evileffects of nearly all narcotics are far too sweeping, 
and the result of practical inexperience. He desires in some 
places to be so very knowing and judicious that he blows hot 
and cold in the same breath, discouraging the experimenters, 
and saying that research is very much needed. The tables 
showing the real scientific value in calorific and work 
equivalents of the dietaries are novel, most valuable, and 
should be imitated in all Asylum Reports. They show that 
most asylum dietaries are too meagre. At times the author 
seems to forget himself completely, and gives way to a, psycho- 
logically, very curious state of mind, closely resembling that 
of certain pragmatical monomaniacs, as when he says, “I 
am only strengthened in the persuasion that the received 
methods of asylum management, so far as treatment is con- 
cerned, rest on an entire misconception of the nature and 
indications of mental disease, the possibilities of remedy, and 
the aids most likely to further and expedite recovery.” If we 
are thus all wrong on every line, God help us; the sooner 
those of us who are asylum medical officers leave the field, 
and betake ourselves to such other pursuits as we are 
capable of, the better for ourselves and our patients. 


1377.) Reviews. 397 


The Vagabond Papers. Sketches of Melbourne Iafe in Light 
and Shade. Melbourne, 1876. 


This book is written by one of those facile-penned gentle- 
men, who, having a talent and no money, wanted to put the 
former to usury, and the latter into his pocket, and so went - 
into model lodging-houses, emigrant’s homes, hospitals, and, 
finally, as an attendant into. the Kew and Yarra Bend 
Asylums, for the purpose of amusing and enlightening the 
readers of the “ Melbourne Argus.” Most undoubtedly, 
Asylum Medical Officers should carefully read such books; 
they give an idea of the inner life of their institutions that 
itis difficult for the heads of those places to get. This book 
bears all the marks of truthfulness and honesty. The author 
seemed greatly to prefer the modified cottage system at the 
Yarra Bend Asylum to the palatial mansions elsewhere, and 
would like to see most harmless chronic lunatics placed in 
real cottages with the sane people who inhabit them. The 
book is very amusing reading. 





PART Ifl—PSYCHOLOGICAL RETROSPECT, 





1.—German Retrospect. 
By W. W. Ireanp, Larbert, Stirlingshire. 


The German Retrospect has been done from the following periodi- 
cals and papers :— : 

Archiv fur Psychiatrie und Nervenkrankheiten, Berlin, 1875-1876, 
Vie Band, 1 tes, 2 tes, and 3 tes, Heft. 

Allgemeine Zeitschrift fir Psychiatrie, Berlin, 1875, xxxii. Band, 
6 tes Heft. 1876, xxxiii. Band, 1, 2, 8, tes Heft. 

Medicinische Jahrbiicher herausgegeben, von der K. K. Gesells- 
chaft, der Aerzte, redigirt von 8. Stricker, Jahrgang, 1875, iv. tes 
Heft. 1876, 1 and 2 tes Heft, and 1877, 1 tes Heft. 

Psychiatrisches Centralblatt Vienna, numbers from January, 1876, 
to, May; 1877. 

Correspondenz—Blatt der Deutschen Gesellschaft fur Psychiatrie 
und Gerichtliche Psychologie, numbers from January, 1876, to July, 
STE. 

Der Irrenfreund, Coblenz, six irregular numbers from number 9, 
1875, to number 8, 1876. 

Verhandlungen der Berliner Medicinischen Gesellschaft als 
Separat-Abdruck aus der Berliner Klinischen Wochenschrift, 
Berlin, 1876. 

Die Luétischen Psychosen in Diagnostischer und Prognostischer 
Beziehung yon Dr. Albrecht Erlenmeyer, Neuwied, 1876. 


398 Psychological Retrospect. [Oct., 


Uebersicht der 6ffentlichen and Privaten Irren und _ Idioten 
Anstalten in Deutschland und Oesterreich zusammengestellt von Dr. 
A. Erlenmeyer, Neuwied and Leipzig, 1876. 

Zur Psychophysik des Moral und des Rechtes von Dr. Moriz 
Benedikt, Vienna, 1875. 

The Peripheral Nerve Cells.—Dr. Sigismund Mayer (“ Archiv” vi. Band, 
2 Heft.) has an article of nearly a hundred pages, which might well 
have been reduced to fifty, ‘“‘ On the Peripheral Nerve Cells and the 
Sympathetic System.’ He considers the white substance of Schwann 
to be composed of true cells of very minute size, having free nuclei. 
By an attentive study of histology he attempts to solve the difficult 
question of the function of the minute anatomical elements of the 
nerve fibre. He thinks it probable that the substance of Schwann, 
which is of a fatty composition, serves to keep up, to strengthen, and 
to favour the vegetative or nutritive processes going on in the nerve 
fibres, and that the functions peculiar to nervation are principally 
carried on by the axis-cylinders. In some nerves, the olfactory for 
example, the white substance is wanting; nor does it accompany to 
the end the nerves distributed amongst the fibres of both striped and 
unstriped muscular tissue to the skin and the glands. 

On a nerve being cut through, Dr. Mayer found that a change took 
place in the tissue of the distal end. The nerve tubes became filled 
with a homogeneous substance, rich in nuclei, in which the differen- 
tiation between the white substance and the axis-cylinder is impos- 
sible, though the homogeneous substance rather resembles that of 
Schwann than the composition of the axis-cylinder. A similar 
appearance is observed in the regeneration of nervous tissue and in 
various parts of the cerebro-spinal system during the sleep of hyber- 
nating animals. 

The author makes the histological distinction between the sympa- 
thetic and cerebro-spinal nervous system simply to consist in the 
predominance of the gelatinous over the tubular nerve fibres in the 
sympathetic. The gelatinous fibres are most numerous in the one; 
the tubular in the other. 

Dr. Mayer then considers the nature of the peripheral cells which 
he has carefully studied in the heart and bladder of the frog, toad, and 
salamander. 

He observes that cells and fibres accompany one another in many 
tissues besides those of the nervous system, for example in voluntary 
muscle and connective tissue. 

Peripheral nerve cells sometimes have processes, and sometimes 
have none. ‘The processes are different in structure from the ordinary 
nerve fibres. ‘They are of all lengths and shapes, and are often con- 
nected, or continuous, with the fibres, though not always. Sometimes 
the processes run amongst fibres, and end in a blind extremity. Some- 
times the cells are more numerous than the fibres, from which they 
seem to run, so that it is impossible that each cell should have its 
independent fibre. Moreover there is great variability in form and 


1877.] Psychological Retrospect. 399 


sizes of the cells and in their contents, whether pigmentary or fatty. 
The engravings of nervous cells in text book, each having its process 
ending in a nerve fibre, are too ‘‘ schematisch.” 

From a very careful study of the development of the tissues of the 
sympathetic system, and the changes induced in nerves by mechanical 
injuries, Dr. Mayer has arrived at the conclusion that the peripheral 
nerve cells are nothing else than arrested forms of nerve fibres or ele- 
ments, which, in some circumstances, pass into nerve fibres; but 
which, from some cause or other, have persisted in the form of nerve 
cells and nerve corpuscles. He also holds that although in the first 
development of nervous tissues the fibres are formed from cells, that 
afterwards new fibres and even new cells and free nuclei may be 
developed out of the old fibres. 

Dr. Mayer observes towards the end of his paper that though he 
cannot admit that the peripheral nerve cells possessed the so-called 
functions assigned to them, he does not think that they have no 
significance in the organism. Such a view would not agree with the 
constant occurrence of ganglia, and their wide diffusion in the peri- 
pheral nervous system. The great difficulty is that we cannot 
experiment upon the nerve cells without also acting upon the con- 
tiguous fibres. 

The Primary Convolutions.—Dr. C. Wernicke has a paper on the 
“ Primary Convolutions of the Human Brain,” in the “ Archiv.” vi. 
Band, 1 Heft. It is illustrated with twenty-three lithographs of the 
brains of monkeys, and of the human cerebrum in its different stages 
of development. The particulars given are incapable of reproduction 
in a shorter form. 

Dr. Wernicke says that he has often seen atrophied brains where 
the convolutions were narrow and curled, and lying close against one 
another, treated as finely developed brains. . He himself lays much 
stress upon the relative size of the frontal and temporal convolutions, 
and of the parietal and occipital lobes. He has seen great varieties 
in the size of the gyrus fornicatus, of the precuneus, and of the lobulus 
lingualis. He considers such appearances should be carefully studied 
in cases where there is a hereditary tendency to insanity. He notices the 
resemblance which the brain of the Ateles monkey bears to that of 
man. Amongst other particulars he specifies that the brain of the 
Ateles is the only simian brain which has a cuneus analogous to that 
in the human brain, and in which the calcarine fissure 1s separated as 
in man from the fissura hippocampi. ae 

The Structure of the Cerebellum—At a Scientific Congress at 
Graz (Zeitschrift xxxiii. er Band, 2 tes Heft), Dr. B. Stilling made 
a demonstration of the finer structure of the cerebellum. He pointed 
out three new grey nuclei in this organ, though anatomists have only 
indicated one. His method of preparation was to cut slices of 1-15 
mm. thick from a cerebellum hardened in alcohol, to put them in a 
watery solution of carmine for three days, then to wash them with 
alcohol, steep them some hours in turpentine, and then set them 


400 Psychological Retrospect. [Oct., 


between two plates of glass with Canada balsam. The carmine gives 
adeep red colour to the white substance of the cerebellum, and leaves 
almost uncoloured the corpus dentatum and Stilling’s three new 
ganglia, which he has named the Dachkern, the Pfropfkern, and the 
Kugelkern. 

Electrical Excitation of the Brain——Dr. C. Furstner (‘ Archiv.” 
vi. Band, 2 Heft), in conjunction with the late Dr. Samt, undertook a 
series of experiments to test the different questions raised by the dis- 
coveries of Fritsch, Hitzig, Ferrier and others. It was intended that 
the experimental demonstration of the so-called motor centres for the 
different muscles should be accompanied by excision of these parts, as 
has already been done by Hitzig* and Carville, with somewhat un- 
satisfactory results, for where something like paralysis did follow, it 
very soon disappeared. It was suggested that another part took up 
the function of the extirpated motor centre, and Dr. Furstner intended 
making a search for this vicarious region. Unfortunately, owing to 
the death of Dr. Samt, all the experiments were not carried out, and 
the results of the vivisections made were of too uncertain a character 
to be given to the public. For the electrical excitation of the hemi- 
spheres, Dr. Furstner used the induced current as practised by Ferrier, 
instead of the continuous current generally used by Hitzig. His 
experiments agree with Hitzig’s results as to the situation of the 
different centres. He found circumscribed points of excitation for the 
muscles of the trunk and the arm and leg, and for both together, for 
the tail, for the movements and protection of the eye, for the tongue, 
for the opening and shutting of the jaws, and for the movements of 
the ears; but he found that the reaction of the muscles of the trunk, 
of the tail, and of the ear were not constant, and that very variable 
degrees of electricity were required for their production. He found 
the points given by Ferrier beyond Hitzig’s motor zone not excitable 
by weak currents. 

Dr. Furstner remarks that to excite given motions by excitation of 
defined parts of the cortex, it is often necessary to raise the strength 
of the electrical stream in different animals. 

There are also cases where, although every condition of the experi- 
ment seems to be properly fulfilled, no muscular contractions whatever 
canbe caused. In one case he laid bare the left hemisphere in a healthy 
dog, and found the centre for the orbicularis palpebrarum, for the fore 
and hind leg, for the tail, the muscles of the trunk and of the ear. 
The appropriate muscular contractions were excited in all the groups 
save that supplied by the facial nerve. After an interval, Dr. Furst- 
ner laid bare the right hemisphere, but here also the missing centre 
could not be found. 

Dr. Furstner supposes that some of the centres for groups of 
muscles may be farther from the superficies of the cerebral cortex than 
others. 

Abscess of the Brain and Motor Centres.—Dr. Anton Frey (“Archiy.” 


* See “German Retrospect,” Oct., 1876, p. 465 


3774 Psychological Retrospect. 401 


vi. Band 1 Heft), gives the case of a man who lost, to a great extent, 
the power of the left arm and the power of moving the left corner 
of the mouth. The speech was also somewhat embarrassed. He 
died in the hospital of erysipelas, when a small abscess was found in 
the white matter of the right hemisphere, at a point which must have 
been crossed by the fibres for the innervation of the whole left arm, the 
left angle of the lips, and perhaps of the tongue, otherwise the embar- 
rassment of speech might be explained by the loss of power of the lips. 
There is no doubt that the clinical study of abscesses, hemorrhages, 
and tumours of the brain, forms a very useful test of localisations of 
muscular motions in the cortex, but of course we ought to have all 
the cases recorded, and not an observation here and there published 
because it confirms or throws doubt upon a theory. 

Low Temperature in the Insane.—Zenker (‘ Zeitschrift fir Psychi- 
atrie,”’ xxxill, Band, 1 Heft), has studied nine cases of lunatics where 
the bodily heat was found easily to sink ; it fell in three cases as low as 
32,2°, and in one as low as 30°6. In some of these instances there was 
maniacal excitement, but the sinking of the temperature was always 
accompanied by a tendency to lethargy and somnolence. He compares 
this with the drowsiness which overpowers men starving from cold, and 
the winter sleep of animals which also follows diminished temperature. 

The cases he describes were all emaciated, or wanting the layer of 
fat under the skin which is so efficacious in preventing the body from 
cooling rapidly. Five of these cases are given at large, as also the 
case of an insane man who was discharged from an asylum on a very 
cold day, thinly clad. About a hundred steps beyond the house he 
sat down, his head sank upon his breast, and he died as if struck by 
lightning. Whether it resulted from hyperemia of the lungs, or the 
reflex emptying of the vessels of the brain, the effect was the instant 
death of the man. The lungs were found dull-brown and injected ; 
the air-passages filled with bloody foam, otherwise healthy. The 
venous sinuses were filled with blood, brain-substance without san- 
guineous points, white as wax, and empty of blood. 

Dr. Zenker’s paper illustrates the danger in some cases of allowing 
the bodily heat to sink very low, which it is apt to do with lunatics 
who tear or throw off their clothes. 

Rise of Temperature on Section of Spinal Cord.—Dr. Carl Schroff, 
jun. (“ Medicinisches Jahrbuch,” 1877, 1 Heft), has made a number 
of experiments to settle the question whether the bodily heat in the 
dog is increased by section of the spinal cord, as asserted by Quincke 
and Naunyn, and denied by others. Scbroff’s experiments confiim 
the rise of temperature, which amounts to about one degree centi- 
grade, but do not tend to support the existence of a regulating centre. 
There seems some reason for Rosenthal’s view, that the rise of tem- 
perature is but the consequence of the fever following a wound. Dr, 
Schroff’s method of experimentation is simple enough ; he divides the 
spinal cord of the poor animal, and then reads off and notes the tem- 
perature from a thermometer half inserted into the rectum. 


402 Psychological Retrospect. fOcrs 


In the “Jahrbuch,” for 1876, 1 Heft, there are some experiments 
by Nicolai Bohtling, on the effects of section of the spinal cord and 
ischiatic nerve upon the temperature, but the results seem to me to be 
too contradictory to justify any conclusion being based upon them. 

The Lesions in Epilepsy.—Dr. Snell (“ Zeitschrift,” xxxii. Band, 
6 Heft) has examined the bodies of a hundred insane epileptics in 
order to obtain some generalizations, which, on the whole, he does not 
seem to have reached. Of the hundred cases, forty-seven died in a 
fit or in the comatose state following it, the most common cause of 
death being failure of the respiratory process. In only two of these 
did Dr. Snell find fresh extravasations of blood in the pia mater or 
arachnoid. Hardening of the cornua ammonis is noted in three 
cases, and in another the cornu was absorbed by a tumour pressing 
upon it. In four instances there was adhesion of the pia mater to 
the surface of the brain. In the discussion which followed the 
reading of Dr. Snell’s paper, Dr. Wiedemeister stated his opinion that 
the hardening and alteration of the cornua ammonis were not a 
specific pathological result of epilepsy. 

A Difficult Diagnosis.—Dr.C. E. Hostermann (“ Centralblatt,” 30th 
April, 1876) describes a case in which the diagnosis was not made 
till after death. The patient was a woman of twenty-three years of 
age. In May, 1875, she had an attack of unconsciousness with con- 
vulsions, which passed over without any return until the end of 
November, when the epileptic fits came back. In December, after 
partaking freely of wine, she had violent headache, swimming in the 
head, and sleeplessness. ‘These symptoms increased, and she had four 
epileptic attacks, and a slight exopthalmos, which had existed from 
childhood, became much increased. On the 9th of January she could 
not leave her bed, and complained of seeing double. On admission 
to the hospital the head measured 22 inches in circumference; there 
was great tremulousness in the hands and tongue ; the eyes were 
prominent, their axis converging owing to paralysis of the external 
rectus muscles. There was a slight paralysis of the right side of the 
face ; the thymus gland was increased; the heart’s action strong, 
with an apex blowing murmur to the first sound, the pulse varying 
between 100 and 186. The headache and giddiness, with occasional 
vomiting and singultus, persexered to the end, but the seeing double 
disappeared. There was failure of the function of the fifth pair on the 
right side, both in the sensory and motor branches, and diminution 
of the power of the muscles of the face. She died on the 27th 
January. The diagnosis made in Meynert’s Clinik was a tumour or 
abscess of the pons Varolii, which would explain the pressure upon 
the cerebral nerves near their origin. Nevertheless, the pressure was 
that of the whole brain upon the floor of the skull, for on examina- 
tion there was found a hypertrophy of the brain with all the charac- 
teristic symptoms as described by Rokitansky, the inner surface of 
the skull rough, the membranes anemic, the foramina narrowed, the 


1377. Psychological Retrospect. 403 


convolutions flattened, the brain increased in density of consistence, 
and weighing 1508 grammes. 

A Theory of Aphasia.—In studying and recording cases of 
aphasia much confusion has arisen from observers neglecting to 
analyse the different mental processes connected with the faculty of 
speech, and even supposing the theory proposed by Dr. D. C. Spamer, 
of Giessen, be not adopted, a perusal of his paper will be useful in 
helping one to carry out such an analysis. Scarcely any two observers 
have agreed in adopting a common classification of the variations of 
aphasia. Several reject all classification whatever, preferring to 
describe each case separately. The terms amnemonic, aphasia, 
aphamia, alalia, aphonia, asymbolia, agraphia, and alexia indicate so 
many attempts to include different failures of speech under a common 
definition. Dr. Spamer, who has evidently applied his mind intensely 
to the subject, proposes a theory by which he thinks this variety of 
symptoms may be explained in accordance with received notions 
about the functions of the nervous system. 

Dr. Spamer, in his paper, which occupies 46 pages of the “Archiv.”’ 
vi. Band, 2 Heft, takes a comprehensive view of the whole subject, 
but the necessary limits of space prevent us from doing more than 
reproduce the main features of his theory, with such illustrations 
as seem necessary to its being understood. 

In order to understand his theory one must study the diagram 
which is here reproduced. 


WRITING. | SPEE CH. 





FAR. EYE. 


a 


404 Psychological Retrospect. fOete 


The circle in the middle of Figure V delineates the paths of 
the representations. The impressions proceed from the sensory 
nerves into the brain. NA is the auditory; NO is the optic nerve. 
P and P! represent the places where the apprehension of hearing K, 
and sight G, are received. When the impressions have reached these 
points, they are simple apprehensions of sensual objects, but when 
they reach B they become ideas or comprehensions (Begriff). From 
this we may suppose that they are conducted to C, C1, and Cl, the 
centres of co-ordination of speech, writing, and gestures. Motions 
N! and N"™ are the motor nerves through which the symbolic commu- 
nications of speech and gesture are. maintained in activity. The 
feathery prolongations at the ends represent the distribution of the 
nerves to the different muscles. 

The integrity of the process of language through words and 
writing is dependent upon the exact relation between the co-ordinating 
groups of cells with the muscles of the vocal apparatus. Dr. Spamer 
thinks that the greater facility in the execution of mental processes 
and motor actions attained by practice may be due to the diminished 
resistance opposed to the conveyance of excitations from cell to cell. 
In the diagram this connection is indicated by the line from B to C, 
the co-ordinating centre for speech, and from B to C1, the co-ordi- 
nating centre for writing. . 

Besides these paths there must be separate tracts for the effects of 
the representations or behests of the will to the same muscles through 
which the ordinary actions of the throat, arms, and other actions are 
directed. This is proved by the fact that the process of swallowing, 
&c., are not suspended in aphasia. The complication of aphasia with 
paralysis of the muscles of the pharynx, tongue, and lips is very 
rare, only occurring with extensive destruction of brain substance. 

On the contrary, aphasia is often accompanied with hemiplegia. 
In this case the non-paralysed hand can do everything but write, 
save in the rare instances. where there is no agraphia with .the 
aphasia; but if the aphasia be not complicated with hemiplegia, the 
distinction between the symbolic and non-symbolic motor tracts can 
be clearly shown: the person can execute fine work with the hand, 
only he cannot write. 

In order not to complicate the diagram, the second path to the 
muscles for non-symbolic motion is not drawn. As with writing we 
learn the meaning of what we write, an enduring connection is drawn 
with B, the centre of ideas or comprehensions; but words may be 
learned without their names, so the connection is not a necessary one. 
The way from P, the place of perception of the verbal symbol K1, to 
C, the centre of co-ordination for the utterance of the words, does not 
inevitably pass B, the seat of the idea of the word, but may go by 
another and more direct way. 

From Meynert’s researches it appears that there are in the medulla ~ 
oblongata and the pons large multipolar gauglionary cells in connec- 


1877.] Psychological Retrospect. A05 


tion with the extensive origin of the auditory nerve, and that these 
multipolar cells are also connected with the motor nerve cells of the 
facial vagus and hypoglossal nerves. 

The integrity of the medulla oblongata and the pons is sufficient for 
the movements of the throat and lips which are put in action in crying. 

Wernicke gives two cases where children cried after craniotomy, 
although the medulla oblongata alone was left intact. The incitation 
to the movements causing speech assuredly do not come by this short 
way, as is proved by numerous cases of aphasia with inability to speak 
or to repeat words which are found to be attended with injury of the 
third (left) frontal convolution. Through this gyrus the speech tract 
passes, but we may suppose that in its centrifugal, and perhaps in its 
centripetal course, it goes through the medulla. The paths B C and 
IK C must meet at the third frontal gyrus, for both these ways are 
almost always interrupted by lesions of this convolution. Neverthe- 
less one of these paths may remain intact when the other is occluded. 

Eisenmann had, as early as the year 1864, collected twenty-one 
cases in whom the patients could neither express themselves by writ- 
ing nor speaking, but could repeat words said to them. ‘The inter- 
ruption must have lain between B and C, while K C, the direct 
line, lay open. Spontaneous powers of speech, without the power of 
repeating speech heard, would be only possible when the understand- 
ing of words spoken failed. The path would here be interrupted both 
at K Cand K B. There is a path both from P and P! direct to C 
without passing through B. This explains how we can read aloud or 
copy print or manuscript without understanding its meaning. An 
interruption of the path from P or P! to B, while the path from C or 
C1 to B is maintained, would explain cases like the one given by 
Broadbent (‘‘ Med. Chir. Trans.,” Vol. lv., p. 146). 

A very intelligent man lost, after symptoms of brain disease, the 
- power of reading print or manuscript, while he could both easily and 
correctly dictate and write himself. His conversation was intelligent, 
and his stock of words waslarge. Dr. Spamer cites other cases where 
patients could copy writing or print from sight, but could not do so 
from dictation. Others connect wrong ideas with words, or use words 
which do not correctly express their ideas, or they substitute one word 
for another in copying (paralexia). Some notice the false symbols 
for their thoughts, others blunder away apparently without being 
aware of it. Dr. Spamer has noticed some cases where the patients 
failed to recognise their blunders in speech and writing, and yet could 
understand correctly what they heard or read. I have seen this 
exemplified in a case of eclampsic idiocy. How can one recognise the 
true symbol received in a passive form.and fail to recognise the 
utterance of a false one in an active form ? 

It is singular that so acute a physician as Trousseau, and so learned 
a philologist as Max Miller, should have taken up the fallacy that our 
thoughts are inseparable from words. Dr. Spamer, considering that 


XXIII. 27 


406 Psychological Retrospect. [Oct., 


the expression of our ideas is often conveyed through other ways than 
that of verbal symbols, proposes the name Asymbolia, instead of 
aphasia, to include all the disturbances of the faculty of language 
which have been described by medical observers as following disease 
of the brain. His analysis of the different perversions of language 
will be found useful in guiding the study of newcases. The inquirer 
should find out whether the patient both uses and understands symbols 
correctly, the nature of the perversion of speech, how many words 
he uses, and of what class, and whether he can repeat words said to 
him. Jn tike manner the various perversions in writing should be 
studied, whether he can write at all, or write false words or senseless 
combinations of letters, or can write to dictation or copy correctly. 
It ought to be noted whether gestures or signs are used correctly or 
incorrectly, As the understanding of symbols may be affected in a 
degree unequal to the expression of them, the inquirer should ascer- 
tain whether the patients knows the letters, understands what he 
reads, knows numeral figures and chemical or algebraic symbols, or 
connects ordinary sounds with their real associations. 

In a postscript the author refers to a case reported by Westphal, of 
an intelligent man who was afflicted with hemiplegia along with in- 
complete aphasia. He spoke fluently, but could not find for himself 
or understand single words. He could write to dictation, but could 
not read a short time after what he had himself written. He suc- 
ceeded after a time in accomplishing this, but, as he himself explained 
by means of a special contrivance, he followed with the finger the 
single letters of the written word, and read while he was writing (so 
schreibend las), that is, I suppose, he traced the written letters again 
with his finger as if re-writing them, and thus read. 

This play of lines and centres seems an easy play, but there is a 
complexity both in the ordinary processes and perversions of human 
thought which can hardly be reduced to figurative explanations. 

Temporary Aphasia.—Dr. Schlangenhausen (“‘ Centralblatt,”’ April, 
1876), records the case of a young woman, who, on learning she was 
deserted by her lover, became insensible for a quarter of an,hour, and 
on regaining consciousness, found that she could not speak. In place 
of the desired words, she repeated, ti, te, to. She understood every- 
thing which was going on around her, and could express her meaning 
in writing, but not without much delay over particular words. The 
aphasia passed away in about five hours. Dr. Schlangenhausen thinks 
that the series of changes which went on in the brain were sudden 
contraction of the vessels causing loss of consciousness, succeeded by 
dilatation and hyperemia, which were greatest in the regions supplied 
by the arteria fosse Sylvii. 


L877. | Psychological Retrospect. 407 


English Psychological Retrospect. 


1. Intra-cranial Syphilis and Insanity. 
2. Resumé of Cases of Insanity with Syphilis, in Relation to 
the so-called “ Varieties of Syphilitic Insanity.” 
Acute Forms of Insanity Intercurrent in Secondary Syphilis. 
3. The Distinctions between Syphilitic Disease of the Encephaton 
and General Paralysis. 


By W. Juuius Micxin, M.D., Medical Superintendent, 
Grove Hall Asylum, London. 


(“ Brit. and For. Medico-Chirurgical Review,’ July and Oct. 1876, 
and April 1877).* 


The following is a short abstract of this series of papers, 
and consists mainly of quotations from the original text on 
the points of greater interest, omitting, for the sake of space, 
the various references to the literature of the subject. The 
large number of insane soldiers under his care has afforded 
Dr. Mickle a rich field for the study of syphilitic affections of 
the nervous system, and of the question of the causation of 
insanity by syphilis :— 

I.—The first paper of the series deals with cases in which there 
were intra-cranial syphilis and insanity, and in several of which the 
former stood to the latter in the relation of cause to effect. The 
first and second of these cases are of special interest, owing to the 
very marked syphilitic disease of the cerebral arteries and arterioles 
present in each, and to the relation they bear to the differential 
diagnosis between general paralysis and the syphilitic diseases of the 
encephalon which simulate it. 

The first case was that of a soldier, aged 41, whose mental derange- 
ment had come on insidiously several months before admission, an 
alteration of manner haying been succeeded by very great defect of 
memory, incoherence in conversation, confusion of thought and failing 
comprehension, together with headache, nocturnal restlessness and 
hallucinations, and habits inclined to be destructive and degraded. 
With the exception of the cranial pain, these symptoms continued at 
the time of his admission, and were associated with some emotional 
facility, with physical signs simulating those of general paralysis to 
some extent, and with slight paralysis of the left lower extremity. 
There was external evidence, and later a history, of syphilis. Under 
specific treatment his mental condition improved very greatly, a 
certain degree of dementia alone remaining. The physical condition 
also improved, but there were several convulsive seizures, followed by 

* These papers were published some time before the appearance in this 
country of Heubner’s recent contribution on the same subject; and 1 and 2 
before the discussion on Visceral Syphilis Path. Soc. 


408 Psychological Retrospect. [Oct., 


temporary spasm of the right side of the face. He remained in the 
improved condition, and, after a course of five anda half months, 
specific treatment was omitted, the patient having then been free from 
fits for four months. Four weeks later he was suddenly found to be 
confused and stupid, the articulation was impaired and mumbling, and 
there was incomplete left hemiplegia, especially of the face and upper 
extremity. The treatment was resumed, but epileptic seizures 
recurred now and then for the next few days; the patient was con- 
fused, impatient, and obstinate, and at last sank after a series of fright- 
ful epileptic convulsions, beginning on the right side. 

Autopsy.—All the arteries at the base of the brain stood out like 
rather firm cords, their walls being much thickened. This thickening 
also involved the walls of the various branches of the main cerebral 
arteries, and was well seen in the vessels overlying the corpus 
callosum, and on the walls of the great longitudinal fissure. Besides 
this, there were circumscribed growths in the walls of several arteries, 
and at these points the coats were very greatly thickened and 
nodulated. One was found in the walls of the right middle cerebral 
artery, about an inch from its commencement, diminishing the calibre 
of the vessel internally, and projecting externally in the form of a pair 
of small flattened buds. In the interior of the vessel a dark clot was 
rather firmly adherent at this point. A similar nodulation was ob- 
served in several of the smaller branches of this artery. In the left 
middle cerebral artery a somewhat similar change existed just external 
to the anterior perforated space.’ But in this vessel the adventitious 
material affected the inner coats more than the outer, and formed a 
plate of whitish fibrous-like tissue encircling the interior of the vessel 
for the length of about half an inch, and lessening its calibre. The 
smooth internal lining membrane of the artery continued unbroken 
over the inner surface of the morbid material. The branches of this 
vessel also presented little nodules. Nodular or more flattened patches 
were found also in the upper part of the basilar artery ; in both 
posterior cerebral, and both anterior cerebral arteries, especially in 
that of the right side. Where nodulated or bulbous, the vascular walls 
were firm, and had either a whitish or a yellowish-white colour. Some 
thickening and slight opacity and edema of the soft meninges existed 
in the fronto-parietal region. Over the front border and under 
surface of the corpus callosum, at and near the genu, and extending to 
the convolutions on both sides, but especially on the right, an area of 
marked gummatous disease was found. It affected part of the median 
surface, and part of the orbital surface of the right frontal lobe. The 
anterior portion and median surface of the first frontal gyrus was the 
part mainly affected, also the front of the gyrus fornicatus, and, on the 
orbital surfece, the gyrus rectus. The membranes covering this area 
were extremely thick, tough, and adherent to the cerebrum ; whilst the 
grey cortical matter was mostly replaced by a firm yellowish exudation, 
which was closely adherent to the membranes on one side, and to the 


1877. ] Psychological Retrospect. 409 


medullary matter on the other. In fact the material was continued 
into the medullary matter, invading it irregularly, and producing an 
indurated yellow layer. The induration of the medullary substance 
was particularly marked in front of the base line of the lateral 
ventricle, and in the portions adjoining the median surface of the 
frontal lobe. All these changes were less decided, and occurred over 
a much smaller area in the corresponding portions of the left hemis- 
phere, the areas of disease being continuous with each other over the 
corpus callosum. ‘The right corpus striatum was atrophied and 
collapsed on part of its upper surface, the alteration commencing 
about a third of an inch from the inner border, and being situated 
mostly at the external aspect. On section, the whole thickness of the 
striate body was found to be diffluent in the portion underlying the 
change mentioned on its upper surface. The right temporo-sphenoidal 
lobe was softened, and became diffluent on pressure, except on its 
inferior surface and at its posterior termination. Here, also, were a 
few adhesions. The spleen weighed 9oz.; upon it were seen several 
starred cicatrices near the upper end, one at the lower end, and one 
on the anterior border. The cicatricial material penetrated into the 
parenchyma. On the upper surface of the right lobe of the liver were 
five depressed white cicatrices, and the cicatricial fibrous tissue 
extended from some of these to the depth of one and two inches into 
the glandular substance; while beneath the others were found firm 
yellow gummata, Syphilitic changes were found in the skin and 
right testis. 

Under the microscope the gummatous infiltration showed products 
of declining action and decay. The walls of the minute arteries at 
this part were thickened, some of them greatly, were unduly opaque, 
exhibited a granular infiltration, and in parts an indistinct cellular 
proliferation in the inner coats. The external surface of some was 
pigmented. The brain substance, beneath the gummatous material, 
stained badly, and showed some colloid bodies; the walls of its 
arteriules were enormously thickened, and were in much the same 
condition as those just described. The vessels of the overlying 
meninges were thick-walled. In the left first frontal gyrus the 
vessels were thick-walled, some were shrunken in their sheaths, or 
were occluded. In the left ascending parietal convolution the 
vascular coats were thickened, the angles of the nerve-cells rounded, 
their nuclei indistinct, and some of the cells moderately granular. In 
the right temporo-sphenoidal gyri was fuscous degeneration of the 
large nerve-cells, and the vessels were altered much as described 
above, but, in addition, had bright (fatty-like) particles strewn 
throughout the adventitia. The growth in the right middle cerebral 
artery was mainly of fibrous tissue, with yellow opaque patches, small 
bright round molecules, numerous indistinct cells, molecular masses 
and granules. That of the exterior of the left middle cerebral artery 
was much the same. 


410 Psychological Retrospect. [Oct., 


In the above case severe syphilitic disease is found to affect the 
surface and the arteries of the brain. Affecting the cortical grey 
substance, both directly, and also indirectly through the medium of 
vascular disease, it gives rise more particularly to mental derange- 
ment and to convulsion ; affecting the arteries, it increases the gravity 
and multiplicity of the symptoms, and undermines the nutrition of 
various encephalic districts. The former lesion assumed, in this case, 
the character of a local gummatous infiltration and encephalitis, in- 
vading and indurating the medullary substance, destroying the cortical 
grey matter, rendering the soft membranes at that part thick and 
tough, and binding them firmly to the subjacent sclerosed white 
substance. The second morbid change—the extensive thickening and 
gummatous nodulation of all the large arteries at the base of the 
brain, partially occluding some, and impairing the adaptive elasticity 
of all—no doubt disordered the cerebral circulation, and finally led, 
by the way of thrombosis, to local ramollissement of the cerebral 
substance. But not only were the vessels at the base thus affected, 
their branches also partook of the same change ; nor did the thicken- 
ing stop at the earlier arterial subdivisions, but extended to the 
arterioles, and was seen in the minute microscopic vessels of most of 
the sections made. Looking at these, no surprise could be felt at the 
mental deterioration which had occurred, and they suggested an 
auxiliary cause of the convulsive phenomena. This syphilitic arterial 
lesion is one of great interest, and was found in the next case also. 

The importance of the syphilitic lesions of the arteries of the brain 
is now claiming more general recognition. Thrombosis, local soften- 
ing of brain, and cerebral hemorrhage often follow in their train, and 
when the morbid change is extensive the termination is probably 
always fatal. The vessels at the base may be affected indirectly ; a 
syphiloma or a gummatous infiltration pressing upon them, occluding 
them partially or completely, and leading to thrombosis, to softening, 
&c. But in the lesions now specially under consideration the arteries 
are affected directly and primarily by syphilitic disease, and not by 
the mere external pressure of syphilomata. 

In some there are nodular masses, gummatous patches, embedded 
hard grains, or circumscribed local thickenings, in the walls of the 
larger cerebral arteries. Of this kind are cases detailed by Wilks, 
Hughlings Jackson, Lancereaux, Moxon, Broadbent, and Heubner. 
Frequently clots are adherent to the internal walls of the vessels at 
these points, usually softish, but sometimes so firm and large as to 
form tough, adherent cylinders obliterating the channel, as appears to 
have occurred in Bristowe’s case. 

In others there is found a general extreme thickening of the walls 
of all the arteries at the base of the brain, from infiltration and ad- 
ventitious material, and this, in several cases at least, has been found 
to extend more or less throughout the subdivisions of the arterial 
trees to their most minnte ramifications, and not only in the cerebral 


O77. | Psychological Retrospect. A11 


substance, but in the meninges also. Examples of this are described 
by Clifford Allbutt and by Heubner. The surface of the basal 
vessels is more or less irregular in these cases. 

Not unfrequently the marked nodulation of these more or less 
universally thickened basal vessels, or the presence of gummatous 
patches in their walls, gives rise to a combination of the two con- 
ditions above described. Of this nature are the instances given by 
Batty Tuke, by Buzzard, and my own two cases. 

‘To whichever variety the vessels pertain, their conditions are totally 
distinct from atheroma on the one hand, and, on the other, from the 
hypertrophy found where the circulation of imperfectly depurated blood 
has produced habitual over-action, and consequent overgrowth of the 
arteriolar tubes. Neither the naked eye nor the microscopical ap- 
pearances are those of the former—atheroma—and as for the latter 
change it is different in its appearance and distribution, and is associated 
with disease of the principal emunctory organs. It will be noticed 
that the arterial lesions partake of the diversity of appearances 
observed in every organ and tissue which is lable to syphilitic 
changes. Here, as elsewhere, the lesions may be diffused or circum- 
scribed, and their concomitance with syphilitic deposit or growth in 
other organs, or with other evidence of syphilis in or about the brain, 
shows that they are originated by the venereal lues. 

In the above case it was seen that the minute vessels of the men- 
inges and of the cerebral convolutions had their walls considerably 
increased in thickness, though not in an entirely uniform manner. All 
the coats of the minute arteries seemed to be implicated. The nodules 
in the walls of some of the large arteries at the base bulged from the 
exterior like little flattened buds. But at the same point, in one, was 
also an annular fibrous-like material, lying in the inner coats, 
occluding the lumen, and covered by, at least, the bright smooth 
epithelial surface of the intima. On making sections it was slightly 
separable from the coats by teasing. But only so at the edge, where 
it was thin and in process of being bevelled off—the main portion of 
the adventitious material was intimately bound up with the coats of 
the vessel. fees 

When widespread, the condition seems to be a chronic arteritis of 
syphilitic origin ; when circumscribed, it often appears to partake of 
the nature of ordinary syphiloma. Lorca: 

The symptoms which arise from extensive syphilitic disease of the 
arteries of the brain are of great variety, and are usually complicated 
by the symptoms dependent upon the presence of other intra-cranial 
syphilitic lesions. Taking a number of cases, however, Just as they 
occur, and with all their complexity, the order of relative frequency 
of the symptoms is as follows :—(1), convulsive symptoms of various 
kinds; (2 and 8), dementia and hemiplegia ; (4), apoplectic symp- 
toms—or coma, drowsiness, somnolence, especially in the latter 
periods; whilea great variety of mental symptoms occur in the earlier 


412 Psychological Retrospect. [Oct., 


periods. Headache, aphasia, difficulty of articulation, palsies of 
cranial nerves are often found; and vomiting, blindness, and optic 
neuritis are not infrequent. In case 1 the arterial disease and its 
secondary effects were complicated by the presence of gummatous 
disease of the cerebral surface and of the soft meninges. In a group 
of cases presenting lesions of the latter kind (cortical and meningeal), 
the order of frequency (excluding the affection of the nerves at the 
base) is, headache and convulsive seizures of the nature of hemi- 
spasm; tremor; partial, incomplete, or transitory hemiplegia; con- 
traction, or anesthesia of a limb; mental symptoms: optic neuritis, 
&c. In case 1, complicated as it was in the manner just adverted to, 
the order of succession of the symptoms was—dementia, the earlier 
course of which was chequered by restlessness, destructiveness, and 
uritability; early headache; epileptiform attacks ; transient hemi- 
plegia; impairment of motor energy; recurring epileptiform seizures, 
with mental confusion; and a lethal attack of furious convulsions. 

The principal lesions of the brain were on the same side as that on 
which the convulsions which proved fatal began, and it is pointed out 
that in other respects, also, the case affords no support to recent 
views, based upon experiment, as to the cerebral localisation of move- 
ments. 

The above remarks apply, in part, to the second case in the paper, 
of which the following is a brief summary :— 

A soldier, aged 33 years, who had contracted syphilis some years pre- 
viously, was suddenly seized with difficulty of articulation and of 
deglutition, and incomplete dextral hemiplegia. This was followed 
by angry and confused excitement, by intellectual and moral deteriora- 
tion, and by recurring temporary attacks of great dysphagia, with 
vaso-motor disturbance, Subsequently, there were dementia ; incom- 
plete right hemiplegia ; speechlessness ; dysphagia ; drowsiness by day 
and sleeplessness by night; much moaning, with constant and in- 
creasing contraction of the limbs, especially of the cold and purplish 
right limbs. 

Autopsy.—Calvarium thick and dense. All the arteries at the 
base of the brains were extremely thickened, and stood out like 
firm cords, ‘They were slightly irregular on the exterior, but the 
thickening was uniform, and seemed to arise from new material, the 
naked eye appearance of which had become assimilated to that of the 
normal coats. There was a brownish-yellow gummous-like swelling, 
about one-third of an inch in length, on the left middle cerebral artery, 
immediately external to the substantia perforata. The walls were 
greatly thickened at this point, the calibre of the vessel lessened, and 
the coats readily separable from each other. The microscope showed 
the walls of the minute arteries in the third left frontal convolution to 
be considerably thickened, and some of the smaller ones were occluded. 
The adventitia of some was granular. The same increased thickness 
of the walls of the arteries was found in and about the left corpus 


ahey a Og Psychological Retrospect. 413 


striatum, with a concentric appearance. A few collections of fine cells 
also were seen in the walls. The minute appearances of the middle 
cerebral artery were much as those described in the first case. The 
intra-ventricular aspect of the left corpus striatum was sunken and 
discoloured over a large area, and the greater part of the ganglion 
was replaced by a firm, tough, yellowish, gummatous mass. On the 
upper surface of the diver was a large, brownish-yellow gumma. The 
kidneys were healthy, and the heart fairly healthy. 

The third case, although an instance of syphilitic disease of the 
meninges and brain-surface, was mainly interesting for the syphilitic 
cardiac disease which gave rise to excessive feebleness of the heart’s 
action, of the circulation generally, and of the reparative powers, as 
well as to cardiac dyspneea; and, finally, to death by cardiac failure. 
Mental impairment, especially loss of memory, and occasional emo- 
tional depression were the principal mental symptoms. The syphilitic 
disease of the heart in this case was more extensive than in any of the 
heart-cases quoted in the paper, and its clinical features bore a close 
resemblance to some of those recorded by the late Dr. John Morgan, 
of Dublin. 

In the fourth case the patient had frequently been in hospital for 
syphilitic affections. Intense cranial pain was followed by restless- 
ness, excitement, hallucinations of hearing and delusions. Nocturnal 
syphilitic pain continued, he became irrational and childish in demean- 
our and language, and showed great impairment of general mental 
power with apparent incipient general paralysis. After admission, 
were dementia, then some bzen-étre; simulation of general paralysis ; 
symptomatic paralysis agitans; disturbed innervation of the heart ; 
impairment of deglutition ; extreme general motor paresis; inability 
to walk ; incomplete left hemiplegia; impaired speech. Mental and 
physical recovery under specific treatment. 

In the next case there were some severe cranial pains for a pro- 
longed period, vertigo, convulsive seizures and transitory paralysis. 
Subsequently dementia; hemiplegia of some months duration ; 
amaurosis from extreme double optic neuritis; impaired taste and 
smell ; much (right) unilateral impairment of hearing ; incomplete 
and partial (left) hemianesthesia; recurring epileptiform attacks : 
intestinal torpor, and paroxysmal epigastiic pain. Great improve- 
ment under specific treatment. 

Passing by the rest of the cases, the following summary of all is 
given in the second paper. me 

Three clinical features are worthy of notice in these, and similar cases. 

The first is the marked tendency to mental impairment or failure ; 
the predominance of negative intellectual symptoms, often with weak- 
ness or loss of the moral sense and an inclination to a degraded state 
of feeling as evidenced by the habits of the patients. In some, early 
or intercurrent outbreaks of maniacal symptoms occurred ; in a few 
there was causeless depression, or fear, or undue emotional facility. 


414 Psychological Retrospect. [Oct:, 


The second broad clinical aspect of importance in the above cases is 
that almost invariably there were motor symptoms, either of the 
paralytic or of the convulsive type. In the former—the paralytic— 
type, motor failure was in the form of hemiplegia, or palsies of cranial 
nerves, or impairment of articulation, or motor paresis and inco- 
ordination of a wide-spread kind. The latter—the convulsive—type of 
symptom showed itself more particularly in epileptic attacks, hemi- 
spasm, tremors, or symptomatic paralysis agitans. 

The third general feature is that sensory symptoms were frequent. 
Of these the most striking was intense nocturnal pain, especially 
cranial pain; while anesthesia was far less frequent. Impairment of 
sight, blindness, or unilateral deafness, as well as hallucinations of the 
senses were occasionally found. 

I1.—The second paper is mainly occupied with the discussion of the 
so-called “ varieties of syphilitic insanity.” 

Even where intra-cranial syphilis is found in the insane it is only by 
a close and accurate study of each case that it can be decided as to 
whether the constitutional syphilis is the cause of the mental symp- 
toms; or modifies, without having in the first place originated 
them; or, on the other hand, is merely a chance accompaniment. 
When, therefore, cases differmg extremely in their histories and 
clinical features are grouped together under the name of ‘ Syphilitic 
insanity,” and nosological varieties of this are described, it is fitting 
to inquire upon what bases the descriptions of these varieties really 
rest, That a patient may contract syphilis, and that insanity may 
occur some weeks, months, or years afterwards, surely tells us nothing 
as to the etiology of the mental affection. It is stated that syphilis 
may originate insanity at periods of its duration varying from a few 
weeks to many years; that in the early stages mental disorder may 
be induced by the anemia and blood changes of syphilis ; and, later 
on, by inflammations or congestions originated by syphilis; or, again, 
by syphilitic neoplasms either affecting or invading the brain from 
without, or developing within it. I cannot but think that many of 
the cases described as of the first and second of these kinds were in 
reality due to other causes than syphilis. Where no intra-cranial 
syphilitic processes are developed, the origin of insanity can rarely be 
attributable to syphilis with scientific accuracy. In a series of such 
insane and syphilitic patients, the clinical features and general course 
of the mental disorder seem to be the same as those in an equal 
number of their non-syphilitic fellow-patients, when the other circum- 
stances and influences are alike. That there is good ground for this 
statement will be evident from an examination of the tabular summary, 
forming an appendix to this, the second, paper, and containing 26 in- 
stances in which insanity and syphilis co-existed, but in which there 
was no evidence of organic intra-cranial syphilitic lesions such as existed 
in the cases detailed in the first paper. In the tabulated cases now 
referred to, insanity, of course, occurred at a period subsequent to the 


1377, | Psychological Retrospect. 415 | 


syphilitic infection. On examining the summary of these cases a 
great variety of symptomatological forms of mental disease are found 
supervening in syphilitic persons. There is no evidence of character- 
istic clinical features in them—nothing that marks them off from the 
ordinary ran of cases—and the connection between their syphilis and 
their insanity seems, for the most part, to have been but a casual one. 
Therefore, when cases are described as examples of ‘“ Syphilitic in- 
sanity” in which the clinical features are the same as those in ordinary 
insanity, where at death no syphilitic lesions are found in or about the 
nervous centres, and where the only evidence suggestive of syphilis as 
a cause is an infection occurring previously to the onset of insanity 
or the appearance of syphilitic diseases, it is evident that some more 
stringent proof of a causal relationship must be exacted before such 
cases can be admitted into the category in question. 

The so-called varieties of syphilitic insanity described by Drs. 
Wille, Stewart, and Clouston, are next noticed at some length. The 
first variety mentioned by the last of the writers just named is ac- 
cepted as presenting symptoms which often arise from gross intra- 
cranial syphilitic disease. But the second variety meets with some 
criticism. Itis that in which insanity of an acute maniacal or delirious 
form breaks out almost immediately, or not long, after primary 
syphilitic infection in a patient whose history is one of pre-existing 
disease of brain, or of previous attacks of insanity, or of hereditary 
neurosis. Nor is the third variety without objection; it is that in 
which ‘Syphilitic insanity follows distinct syphilitic epilepsy or 
apoplectiform attacks, and in this way partakes of the character of 
ordinary epileptic insanity.’ Of the several varieties referred to, only 
the first seems to maintain its place as a frequent and distinct form of 
disease. I think the occurrence of the second and third varieties to 
be far less frequent than has been asserted or implied in some quarters ; 
that in the majority of the cases assigned to these varieties, syphilis 
was not the real cause of insanity; and that those in which it was 
are undeserving of being placed in the same pathological niche as the 
cases included under the first variety. 

The paper closes with the consideration of cases in which acute forms 
of insanity have been attributed to the evolution of the secondary stage 
of syphilis. It seems that the frequency of these cases has been ex~- 
aggerated, that upon closer examination many appear to have had no 
actual dependence upon syphilis. In some of the few real cases the 
blood-change produced by the specific virus probably acts much as a 
dram of spirits acts upon the hereditarily weak brain in producing a 
temporary mania a potu. That early mental disease may be produced 
is, moreover, rendered likely by the occasional occurrence, in the early 
secondary stage of syphilis, of other nervous symptoms such as head- 
ache, insomnia, anesthesia, neuralgia, or hemiplegia and facial palsy. 
I have no clear undoubted cases to offer of acute mental disease caused 
by syphilis in its earlier secondary stage, although acute insanity 


416 Psychological Retrospect. | [Oets; 


occurred at that period of the evolution of the specific malady in 
several patients under my care. In one or two of these the mental 
aberration had been attributed to the effects of syphilis by those who 
sent the patients here. Abstracts of several of these cases are given, 
and show that clear proof of their actual dependence upon syphilis is 
wanting, and that there is nothing special to distinguish them from 
acute attacks of insanity occurring in non-syphilitic persons who are 
under the same general influences. 

IlI.—The Third paper is devoted to a detailed consideration of the 
differential diagnosis between syphilitic disease of the encephalon and 
general paralysis. 

(1.) The form of general paralysis most frequently simulated by 
syphilitic disease of the encephalon, is that in which dementia is the 
leading symptom from the first, and these two affections are contrasted 
at length, firstly as relates to their mode of onset and the earlier symp- 
toms, and secondly as regards thé fully-developed affection. The mode 
of onset and the earlier symptoms of the two diseases are contrasted, 
after a description of the early symptoms of several instances of the 
dementia form of general paralysis, not unlike certain cases of brain- 
syphilis at the same period. Compare them with the mode of onset 
and earlier symptoms of the form of mental disorder from brain-syphilis 
which simulates general paralysis most frequently and closely. While 
there is much that is similar in the syphilitic vases, yet we may find 
in them an early hypochondria or temporary acute mania or delirium, 
and the mental symptoms are often preceded by marked motor or sen- 
sory disorders. Harly paralysis of some of the cranial nerves with 
ocular troubles, early optic neuritis, or local anesthesiz, often charac- 
terise the syphilitic cases. Headache, nocturnal, deeply-seated, and 
increased by pressure or warmth, is usually a striking phenomenon, 
and is more urgent and persistent than is the prodromal headache 
observed in some cases of general paralysis. Convulsions and local 
spasms are more frequent in the first periods than in the correspond- 
ing periods of general paralysis. Early insomnia, common in some 
instances to both, is, as arule, more severe in the syphilitic cases, and 
the same remark apples to rheumatoid_pains in the extremities, and to 
the various neuralgiz at the same period. Aphasia, too, occasionally 
occurs at the onset of the syphilitic malady in question, and so do 
grave apoplectiform seizures. A fitful appearance, changeableness, 
temporary character, and capricious association and succession of the 
several symptoms, and their frequent alternations, are features more 
evident in the syphilitic cases. Anemia is frequent, and a sallow 
cachectic hue, not usual to general paralytics at this stage. The early 
or rapid decline of memory sometimes insisted upon is, however, 
common to both ; nor is there any very marked difference between the 
occasional early convulsive phenomena of the two diseases, which in 
both are commonly unilateral, and often without loss of consciousness, 
though possibly more often of this type in the syphilitic cases, The 


SZC. | Psychological Retrospect. 417 


impaired articulation and tremors of lips, face, and tongue may be 
absent or but imperfectly marked ; but on the other hand, they may 
be imperfectly marked in the dementia form of general paralysis also. 
Early well-marked apoplectiform attacks, severe nocturnal cranial 
pain, paralysis of individual cranial nerves, local muscular contraction 
and rigidity, optic neuritis and vertigo, failure of special senses, and 
local anesthesiw, are the most important distinguishing features of 
(intra-cranial) syphilitic cases in the incipient stages ; and these, 
when present, greatly facilitate the differential diagnosis between the 
particular class of cases of intra-cranial syphilis now under discussion, 
and general paralysis-dementia. On the other hand, the characteristic 
condition of the articulation, facial and labial muscles, tongue, velum 
and pharynx, when fully developed at this early stage, often suffice to 
establish the diagnosis of general paralysis. ie ae 

Referring next to the affections when fully developed, although the 
mental symptoms are often very similar, yet a few points of difference 
may usually be traced. For, in the syphilitic cases, as compared with 
the dementia form of general paralysis— 

1. Hypochondriacal feeling and idea are more often noticed at the 
very first yielding gradually to dementia. 

2. Prior to severe apoplectiform and other attacks, the loss of 
memory, confusion of thought, and tendency to fatuity are less marked, 
advanced, and fixed, than in general paralysis-dementia ; there is more 
an obscuration than a destruction of mind. 

3. Paroxysmal outbreaks of excitement in action and language are 
rather more frequent in the syphilitic cases. 

4. The course of the mental affection is a more chequered and 
irregular one in syphilis, and is more frequently complicated by symp- 
toms such as convulsions, spasms, paralyses, and sensorial disorders. 

5. Insomnia and irritability of temper are more frequent and marked 
in the syphilitic cases, but to this there are exceptions on both sides. 

The pbysical symptoms are then reviewed and differentiated in detail ; 
particularly the various paretic, paralytic, convulsive and spasmodic 
affections; the ocular and electro-muscular conditions ; the apoplectic 
and sensory symptoms. Jor these the original paper must be re- 
ferred to. ri 

(2.) The maniacal seizures of general paralysis are next distin-. 
guished from those sometimes accompanying encephalic syphilis. 

But even the most typical symptomatological form of general para- 
lysis, that with grandiose delirium, is occasionally simulated more or 
less by intra-cranial syphilis. For in the latter gaiety of feeling and 
exalted notions may be found, together with a tottermg gait, 1mpair- 
ment of speech and of writing, inability to dress, and a blurring of 
the lines of facial expression, These syphilitic cases with exaltation 
are distinguished from the general paralytic— a 

(1.) By the distinct history or symptoms of syphilis. (2.) By the 
preceding cranial pains, nocturnal and intense. (3.) The exaltation is 


418 Psychological Retrospect. [Oct., 


less marked and perhaps less associated with general maniacal rest- 
lessness and excitement, (4.) Sometimes by palsies of one or several 
cranial nerves, or hemiplegia, paraplegia, &c., having the character 
and course of syphilitic palsies, as previously described. (5.) By the 
greater frequency of optic neuritis, early amaurosis, deafness, local 
anesthesie, vertigo, or local rigid contraction. (6.) The affection of 
articulation is often paralytic rather than spasmodic and paretic, and 
usually speech is not accompanied by marked facial or labial tremors. 
(7.) By cerebral or spinal meningitis, or pachymeningitis. (8.) By 
the variety of the motor and sensory symptoms, and sometimes by 
their capricious association or succession. . . . . . (9.) By the 
effect of anti-syphilitic treatment. 

(3.) Reference is made in the third place to the diagnosis between 
certain cases of syphilis and those cases of general paralysis in which, 
mingled with the ever-present and characteristic psychical weakness, 
the most prominent mental symptoms are those of a hypochondriacal 
or of a melancholic type. 

Finally, the temperature, the condition of the pulse and heart, and 
the morbid anatomy are adverted to. 


The Treatment of Habitual Drunkards. 


At the meeting of the British Medical Association, at 
Manchester, Mr. G. W. Mould, M.R.C.S., read a paper on this 
subject in the psychological section in which he advocated 
the establishment of retreats where habitual drunkards 
might be placed under some control for stated periods. It 
was followed by a discussion, of which this is an abstract. 
This, together with the abstract of the succeeding four 
papers, read at the Section, are extracted from the “ British 
Medical Journal.” 


Dr. Moors (Belfast) thought habitual drunkards should be com- 
mitted to prison for an indefinite period, and not discharged until 
they were cured.—Mr, Parker (Liverpool) thought that reformatory 
institutions should supplement gaols, and that, after serving a period 
of imprisonment, drunkards should be sent to the institutions until 
cured. Until such steps were taken he thought no manifest improve- 
ment could be effected.—Several other speakers supported this 
opinion, and urged that such reformatory institutions might be made 
self-supporting.— Dr. Rogers (Rainhill) thought there was a great 
deal of hypocrisy running through the discussion. Was it right for 
the members of the Association, after enjoying the good things of 
this life, to advocate so coolly sending many poor people to prison? 
He thought the law as it stood was sufficient to put down drunken- 
ness, if it were fully enforced, and thought it was unjust to punish 
the drunkards whilst the sellers of the drink were allowed to go free. 
In opposition to what one gentleman said, he thought the granting 


1377. | Psychological Retrospect. | 419 


of grocers’ licenses a very beneficent measure.—Dr. Brappon (Man- 

chester), Dr. Brates (Congleton), Dr. Harrineroy Tuxe (London), 
the PresipEnt, and other members took part in the discussion.—Mr. 
Moutp (Cheadle) proposed, Dr. Eastwoop (Darlington) seconded, 
and it was resolved: “That itis the opinion of the Psychological 
Section of the British Medical Association that legislative action is 
imperatively necessary for the treatment of habitual drunkards, and 
that this object would be best effected by the establishment of district 
institutions for their treatment.’—Mr. Parker (Liverpool) proposed, 
Dr. Moors (Belfast) seconded, and it was resolved: ‘ That it is the 
opinion of this meeting that the establishment of reformatory insti- 
tutions for the confinement of drunken offenders during lengthened 
periods ought to be urged upon the Government.” 


A Case of General Paralysis at the age of Sixteen. By T. S. 
Crouston, M.D. (Edinburgh).—General paralysis has hitherto been 
supposed not to occur before the age of twenty, and is seldom met with 
before twenty-five. J. M. was first seen on March 10th, 1876. He 
was then nineteen years of age. He was admitted as a patient into 
the Royal [Edinburgh Asylum on September 22nd, 1876. His 
maternal grandfather had died of softening of the brain at sixty- 
three; a maternal uncle of the same disease at fifty; a half-brother 
(maternal) is paralytic. He was an illegitimate child, and, during 
ber pregnancy, his mother suffered great emotional disturbance, and 
was almost barbarously treated by her father, being locked up in a 
room for months. He was a dull boy. There was no history of 
sexual excess or masturbation. His walk was first noticed to be slow 
and peculiar at the age of sixteen. ‘This increased. His speech soon 
became affected. He could not do anything that required nicety of 
movement with his hands. He became forgetful, sluggish in his 
intellect, and his power of attention was almost lost. When first 
seen, the speech and walk of general paralysis were very marked. He 
had unequal pupils, and the mental condition was that of the disease 
in the second stage. He was very facile, but had no delusions of 
grandeur, and never had any. All his symptoms, mental and bodily, 
became gradually worse. He had a congestive attack, with conyul- 
sions, after which he was quite paralysed, speechless, and devoid of 
mind. He had large sloughing bed-sores before death, in spite of all 
precautions againt them. His sensibility was almost abolished before 
death. After death the skull cap was found condensed, the dura 
mater adherent and slightly thickened, The convolutions were 
atrophied. There was much compensatory fluid. The pia mater was 
thickened, and adhered strongly to the convolutions over the anterior 
lobes, both over the apex and base of the brain ; the anterior lobes of 

the two sides adhered to each other. The lining membranes of the 
ventricles were very much thickened and covered with large granula- 
tions. The spinal cord was also found to be atrophied and otherwise 
abnormal, On a microscopic examination, the coats of the vessels 


420 Psychological Retrospect. [Oct., 


were found thickened with, in many places, blood-colouring matter 
surrounding them. The whole of the outer layers of the convolu- 
tions of the anterior lobe of the cerebrum were filled with proliferated 
nuclei and masses of granular matter. 


Pathological Illustration of the Localisation of the Motor Functions 
of the Brain By Rinerose Arrxriys, M.D. (Cork).—This paper 
contained the record of six cases illustrating the occurrence of local- 
ised cortical lesions in the non-motor and motor areas of the brain, 
accompanied with the negative and positive symptoms accordingly. 
The cases en résumé were as follows :—Case 1. Glio-sarcomatous 
tumour growing from the left temporo-sphenoidal lobe; softening of - 
the middle part of the three tiers of convolutions of this lobe; circum- 
scribed hemorrhage into softened tissue; no motor symptoms. Case 11. 
Localised deposit of lymph attached to the dura mater over a portion 
of the postero-parietal lobule of the left hemisphere; superficial 
erosion of cortex; no motor symptoms.—Case 111. Softening of the 
gyrus supramarginalis and portion of the occipital convolutions of the 
right hemisphere; no motor disturbance of the left side; lesion of 
the left hemisphere, causing motor disturbance at the right side (in 
motor area).—Case 1v. Meningeal hemorrhage; pressure on the left 
ascending frontal and ascending parietal convolutions, and on the 
edge of the inferior parietal lobule; right hemiplegia.—Case v. 
Adhesion of membranes to, and softening of the middle third of, the 
left ascending parietal and portion of the ascending frontal, with 
edges of gyrus supramarginalis and gyrus angularis; paralysis of the 
right hand and arm.—Case vi. Softening of the lower two-thirds of 
the left ascending parietal convolution ; fucus of softening in the 
centrum ovale of the same hemisphere; right hemiplegia. Brain 
charts and specimens were exhibited, showing the exact topography 
of the lesions in these cases. 


Morbid Histology of the Spinal Chord in Five Cases of Insanity. 
By Riyerosz Arxiys, M.D. (Cork)—Dr. Atkins recorded the 
appearances observed by him in the spinal cords taken from the 
bodies of five persons dying insane.—Case 1. General Melancholia 
following on previous Maniacal Excitement. Male, aged 29. Mental 
Symptoms: Persistent depression and restlessness, delusions of perse- 
cution, and suicidal tendency. Physical Conditions: Gradual and 
progressive emaciation, general debility; finally tubercular disease of 
lungs and marasmus; death three years and nine months after first 
attack. Summary of Histological Changes in Spinal Cord: Moderate 
fibrosis of vessels; atrophy and degeneration of grey cornua, espe- 
cially in upper dorsal regions ; partial atrophy, and disappearance of 
nerve-fibres in external lamine of white columns in all regions ; over- 
growth and molecular degeneration of connective tissue matrix 
(sclerotic) ; and, as a special condition, a central sclerosis displacing 
laterally the grey cornua confined to the upper dorsal and sacral 


1877.] Psychological Retrospect. 421 


regions.—CasEr 11. Senile Dementia. Male, age 76. Mental 
Symptoms: Dulness; loss of memory; incoherence ; with occasional 
excitement ; and, finally, complete hebetude. Physical Conditions : 
Weakness of lower limbs, with a tendency to fall if not watched ; loss 
of power over sphincters ; emaciation; general lowering of sensibi- 
lity ; rapid formation of bed-sores ; death from marasmus two months 
after admission. Summary of Histological Changes: Marked fibrosis 
of vessels; pigment atrophy of ganglion-cells; atrophy of nerve- 
fibres in white columns; overgrowth and degeneration of connective 
tissue ; obliteration of central canal by proliferated nuclei ; formation 
of great numbers of amyloid bodies in posterior’ and portion of 
- postero-lateral columns throughout entire cord.—Oasx i. Secondary - 
Dementia (third attack of mental derangement), Male, age 24, 
Mental Symptoms: Deeply demented, stupid, dirty, destructive; 
occasionally irritable, and quite unconscious of his condition. Physical 
Conditions: Progressive emaciation; muscular weakness; loss of 
control over sphincters; dryness and roughness of skin; torpidity of 
circulation, diminished sensibility, and a tendency to the rapid forma- 
tion of superficial sores. Death from general decay ten years after 
initial attack, three years from last admission. Summary of Histolo- 
gical Changes: Moderate fibrosis of vessels; partial degeneration of 
ganglion-cells of anterior cornua, and of nervous reticulum of posterior 
cornua; atrophy of nerve-fibres; overgrowth and molecular degene- 
ration of external lamina of connective tissue; obliteration of central 
canal by proliferated nuclei; dilatation and erosion (especially in 
cervical region) of perivascular spaces (?) in vicinity of latter—Cass 
Iv. Paretic Dementia. Male, age 88. Mental Symptoms: Loss of 
memory, stupidity, partial incoherence, vivid visual hallucinations ; 
progressive dementia; and, finally, complete mental fatuity. Physical 
Conditions: Unsteadiness and uncertainty of speech; trembling of 
facial muscles; difficulty in protruding tongue, with spasmodic move- 
ments and atrophy of organ; uncertainty and irregularity of gait; 
twitchings of muscles; irregularity of pupils; progressive paresis ; 
finally, loss of motive power. Congestive attack ; paralysis of right 
arm; bed-sores’; diminution of sensation. Death six months after 
admission, fourteen months after initial symptoms. Summary of 
Histological Changes : Fibrosis of vessels, with vast nuclear prolife- 
ration on and in their walls; pigment-atrophy of ganglion-cells of 
hypoglossal, and, to a less extent, of vagi-glosso pharyngeal nucleéi; 
similar condition of cells in anterior cornua, the dorsal region being 
especially affected ; atrophy of nerve-fibres ; coarseness and molecu- 
lar degeneration of connective tissue, with nuclear proliferation 
throughout. Obliteration of central canal by similar proliferation ; 
wide dilatation, and erosion of perivascular spaces in vicinity of latter, 
and, as a special condition, ‘“ pools” of yellow exudation in both grey 
and white structures throughout the entire cord, encroaching on and 
involving the ganglion-cells, together with spots of miliary sclerosis. 


XXIII. | 28 


4.22 Psychological Retrospect. [Oct., 


—Case v. Paretic Dementia. Male, age 38. Mental Symptoms : 
Dulness, loss of memory, incoherence, and delusions; progressive 
mental enfeeblement, with temporary partial improvement. Conges- 
tive attack; dementia gradually deepening; finally, almost complete 
fatuity. Physical Conditions: Unsteadiness and irregularity of gait ; 
muscular tremors and weakness; slowness and indistinctness of 
speech ; loss of tone of voice; great difficulty in protruding tongue; 
marked jerkiness and spasmodic movements of this organ; loss of 
control over sphincters; diminution of sensibility. Othaematoma 
(left); formation of bed-sores; complete loss of motive power. Death 
from general decay four months after admission. Summary of Histologi- 
cal Changes: Fibrosis and dilatation of, with nuclear proliferation on, 
vessels, especially in medulla oblongata ; pigment-atrophy of nuclei of 
hypoglossal, vagi, and glosso-pharyngeal nerves, and cells of anterior 
cornua in cervical and dorsal regions (lumbar, sacral, and coccygeal 
regions grossly softened) ; atrophy of nerve- fibres in white columns; 
molecular degeneration of connective tissue; completely degenerated 
patch at bottom of posterior fissure of medulla oblongata, at centre 
part of decussation of anterior pyramids, with copious formation of 
amyloid bodies in that situation; scattered obliteration of central 
canal; dilatation of perivascular spaces in its vicinity. ‘lwo spots of 
central sclerosis (lower cervical region) in posterior white columns, 
just behind the grey commissure, pressing on and displacing the left 
posterior cornu. Dr. Atkins remarked that these appearances 
seemed to indicate primary vascularisation with subsequent growth of 
connective tissue, followed by sequential atrophy and degeneration of 
the nerve elements. It was a point of interest to determine whether, 
if such appearances are pathological at all, the degenerative lesions 
were of that secondary nature described by Turck, Charcot, and 
Bouchard as following on primary cerebral disease, or whether they 
were either the result of an extension of the morbid process from 
the brain by continuity of tissue, or a simultaneous implication of 
the vascular system in both centres, followed pari passu with 
sequential changes in the two together. The absence in several of 
the cases of gross disease in the brain (the microscope in all reveal- 
ing condition somewhat similar to those in the spinal cord), and of 
any muscular contractions such as are believed by Bouchard to 
depend on secondary degenerations, favour the latter view. ‘The loss 
of the volitional and perceptive powers of the mind in connection with 
degenerative changes in the cord suggest the possibility of the pos- 
session by that centre of such functions as has been recently ad- 
vanced by Hammond. There are also grounds for connecting the 
progressive emaciation, the muscular weakness, the loss of control 
over the sphincters, and the general marasmus with the conditions of 
the cord described. The occurrence of speech-defects in the paretic 
cases, with lesions of the bulbar nuclei, is also a point of interest. 
Very many more observations, however, must be made before the 


1877.] Psychological Retrospect. A283 


absolute significance (if any) of such changes in the spinal cord can 
be correctly determined, and these few cases are recorded ag a slight 
contribution to the subject. The paper was illustrated with micros- 
copical sections, specimens, and drawings. 


Hysteria and Insanity. By G. H. Savaen, M.D. (London).—The 
conditions implied in hysteria plus insanity are closely related, but 
difficult of separation and of the early diagnosis of such items as 
render them more amenable to treatment in asylums than in general 
practice. 1, EK. F., aged 17, was admitted into Bethlem Hospital 
from a general hospital, where she had been under treatment for 
amenorrhcea and hysterical paraplegia following a disappointment in 
“an affair of the heart.” The paralysis soon passed off, but new and 
formidable symtoms, in the shape of catalepsy, obscenity of action 
and expression, suicidal, homicidal, and general destructive tenden- 
cies, supervened, and rendered the patient actively maniacal for four 
months, at the expiration of which she became for a considerable 
‘period fairly intelligent and rational. Two paroxysms of maniacal 
excitement, however, soon followed, and as soon ceased. She has 
remained well for the last three years, but may at any time yield 
under physical or psychical causes, though the family history seems 
sufficiently free from ancestral taint. 2. A married woman, the 
mother of several children, and the subject of several miscarriages, 
had been in hospital for hysterical paraplegia associated with delu- 
sions and perverted sensations. On admission to the asylum her 
delusions were found to be of an emotional and suspicious kind, and 
her mental condition generally such as rendered her voluntarily 
helpless, unhappy, insanely religious, and highly exaggerative of her 
anomalous feelings and blunted sensibilities. Her belief in her own 
incapacity she could falsify at pleasure. When alone she could walk 
and perform such other physical acts as she believed herself incapable 
of when attentively watched. Her health was fairly good, but her 
weak and perverted will stamped her, in conjunction with her delu- 
sions and behaviour, as a hystero-maniacal patient. Hystero- 
epilepsy seems common enough in asylums, but it is a matter of 
doubt whether or not patients with a highly-developed faculty for 
deceit and imitation can perfect themselves in this distinct disease, 
of which the following cases are illustrative examples. 1} EG E., 
single, aged 27, a governess, with no known family failures, but having 
known neuralgia, amenorrhea, and h ysteria and various delusions, was 
depressed, religious, self-inflictive, and given to exaggeration and 
deceit. She ate and slept well, but remained unchanged until 
Seven months after admission, when she had an attack of convul- 
sions, which relaxed her sphincters, raised her temperature, and 
diminished her reflex sensibility. This was followed by marked 
depression and another fit, in which it was noticed that the patient 
kept admirable time in her spasms with a patient who played the 
piano. Treatment failed to do her any good, and at the end of a 


424, Psychological Retrospect. [Oct., 


year she was discharged “not improved.” 2. H. F., aged 25, a 
dressmaker, was admitted with a history of catalepsy, noisy behaviour, 
and destructive demeanour. On admission she was sleepless, restless, 
excitable, irascible, and liable to paroxysms of maniacal fury. She 
had controllable convulsions, during which she could grasp objects, 
inflict injury on attendants, and destroy whatever came in her way. 
After the convulsions she became cataleptic, and maintained a statue- 
like attitude for hours together. She went on gradually improving, 
however, until some bad news upset her, and rendered her again for a 
short time slightly cataleptic. She is now doing well, and gives fair 
hopes of a permanent recovery. 8. G. G., aged 13, phthisically 
predisposed and with a history of chorea and neuralgia, attempted to 
strangle herself, and became noisy and insubordinate. Although 
suicidal, she was in terror of death, and feared that people would 
drown her or bury her alive. On the near approach of a man she 
assumed a cataleptic condition, ground her teeth for some time, and 
then quietly resumed her occupation. Her fits were neither marked 
by pallor nor lividity. She had a habit of reading a book upside 
down, and, if corrected, would go into a fit. She was eminently 
hysterical ; but, under judicious care and moral influence, she 
was discharged ‘recovered.’ Hysterical insanity is sufficiently rare 
among men to entitle the following case to be added. William A., 
married, aged 34, well educated, sober and industrious, four weeks 
before his admission had been frightened, and thereby rendered sleep- 
less, restless, and melancholy. He was predisposed to insanity, and 
in his younger days he suffered from scrofulous lesions. On admis- 
sion he was suspicious, fidgety, and nervous. In a short time he 
became excited and gave himself up to immoderate laughter and 
absurd demeanour. All this passed off in a short time, and he made 
a rapid recovery. After his discharge he remained well for two 
months, and gave satisfaction to his employers. He, however, soon 
relapsed, and again became suspicious, jealous, delusional, and inco- 
herent. He had hallucinations of sight and sound, slept badly, and 
refused his food. He was fed artificially, and during the process 
behaved in a passive and heedless manner. Soon afterwards he had 
a “rash,” which was followed by a severe attack of erysipelas, from 
which in a short time he emerged in full possession of his mental 
faculties. His memory was perfect, and he could give a résumé of all 
that was done to him in his illness. This ‘‘lucid interval” did not 
last long; he again relapsed into his former apathy, and became 
more distrait than ever. If irritated, he laughed immoderately and 
behaved grotesquely. He could be roused at intervals to a conscious= 
ness of his condition, and to converse rationally with his wife. He 
remained still under treatment. 


Fleming on the Motions of the Brain. 


Mr. W. J. Fleming, Lecturer on Physiology at the Glasgow Royal | 
Infirmary, has contributed to the “ Glasgow Medical Journal, ” for | 


LS (7 .| Psychological Retrospect. A25 


July, an interesting paper on the Motions of the Brain. He had access 
to two men, each of whom had had portions of their skull caps removed 
by accident, and he took cardiographic tracings of the pulsations and 
respiratory motion of the brain under different circumstances, when 
the patients were awake, when asleep, after meals, after taking 
stimulants, and after mental exertion. He reproduces the tracings. 
He shows clearly that though the actual bulk of the contents of the 
cranium cannot vary, yet that they may greatly differ in the relative . 
_ amounts of the two flnids which are separated only by elastic and 

freely extensible membranes, viz., the cerebro-spinal fluid, and the 
~ blood contained in the vessels. When the volume of the latter is 
increased, part of the former passes down into the spinal canal, which 
is a yielding box. A tracing taken when the brain conditions are 
normal can scarcely be distinguished from one taken from the radial 
artery. Holding the breath, coughing, speaking, straining, all 
markedly affected the respiratory curves. Holding the breath had 
this effect :—“ After the moment at which breathing was suspended, 
we have for three pulsations no perceptible effect ; from this point the 
whole line shows a gradual elevation, corresponding to an increase of 
tension, and at the same time each pulsation becomes longer and 
stronger, and the dicrotic notch more marked, and generally doubled. 
A slight fall then takes place in the tension, probably owing to an 
effort of the thorax to inhale, immediately followed by a marked rise, 
culminating in what we may call a gigantic pulsation. The trace 
then gradually falls until breath was taken, when after two or three 
irregular pulsations, it returns to the normal.” Compression of the 
femorals and jugulars was followed by great increase in the cerebral 
bulk, while posture markedly affected it: such positions as recumbency, 
elevation of arms, &c., caused great increase of blood in the brain. 
After food there was a marked increase in the cardiac brain-pulsations, 
and after some beer the pulsations and respiratory curves were found 
gradually to increase, showing a diminution in the whole bulk of the 
encephalon, due to the amount of blood drained off for the performance 
of digestion. During sleep the curves pointed to acondition of con- 
gestion rather than of anemia of the brain. Anesthesia removed the 
respiratory curves and increased the cardiac, while, during mental 
exertion, the volume of the brain was increased. 


426 [Oct., 


PART IV.—NOTES AND NEWS. 


REPORT OF THE THIRTY-SECOND ANNUAL GENERAL MEETING 
OF THE MEDICO-PSYCHOLOGICAL ASSOCIATION. 


The Annual General Meeting of the Council took place at the Royal College 
of Physicians, Pall Mall, London, at half-past 10 on Thursday, August 2, and 
of the Association at 11. Dr. Parsry occupied the chair, and there were also 
present— 

Dr. Lalor, Dr. Blandford, Dr. Parsey, Dr. Rogers, Dr. Rhys Williams, Dr. 
Hack Tuke, Dr. Anderson, Dr. E. Sparshall Willett, Dr. Harrington Tuke, Mr. 
Frank K. Dickson, Dr: Yellowlees, Dr. J. Murray Lindsay, Dr. H. Maudsley, Dr. 
Wood(London), Dr. Campbell (Garlands), Mr. G. W. Mould, Dr. J. C. Bucknill, Dr. 
T. S. Clouston, Mr. Richard Greene, Dr. Edwards, Dr. G. Wilson, Dr. James 
Stewart (Bristol), Mr W. Arnold Thomson, Dr. W. Kitching, Dr. John A. Wallis, 
Dr. Herbert Major, Dr. Charles Fox, Dr. H. Sutherland, Mr. H. Clifford Gill, 
Dr. 8. Mitchell, Dr. Oscar T. Woods, Dr. Francis Jas. Wright, Dr. W. Orange, 
Dr. Guy, Dr. Hewson, Dr. J. Bayley, Dr. Sherlock, Dr. T. O. Wood, Dr. T. W. 
Freshfield, Mr. W. Clement Daniel, Mr. J. Tregelles Hingston, Mr. George Thom p- 
son, Mr. G. Henry Pedler, Dr. Boyd, Dr. Paul, Dr. George Mickley, Mr. H. 
Rooke Ley, Dr. D. Nicolson, Dr. W. Julius Mickle, Dr. Heurtley Sankey, Dr. 
Alonzo H. Stocker, Mr. J. Ansell Brown, Dr. H. Stilwell, Mr. Edward Thomas 
Hall, Dr. J. A. Philip, Dr. J. Langdon Down, Dr. H. Rayner, Mr. H. J. Manning, 
Dr, D. Munro, Dr. E. Walford. 

The Secrerary (Mr. W. Rhys Williams) called attention to the minutes of the 
last Annual General Meeting, reported in the Journal, and which were taken 
as read. 

The PresipENT—The next thing is that your late President must vacate the 
chair. I have great pleasure in doing so, and seeing myself replaced by a 
gentleman so well known amongst us all, so much respected, and who has been 
for so many years a member of the Association, I mean Dr. Blandford (hear, 
hear). 

Dr. G. FIELDING BLANDFORD then took the chair. He said—Gentlemen, I 
have to thank you sincerely once more for the honour that you have done me in 
electing me your President to-day. I shall not take up the time of the meeting ~ 
by making any remarks now—probably you will hear quite enough of me before 
the day is over. We will now, if you please, proceed to the business of the 
morning. 

The SrcRETARY—The next business is our next 


PLACE OF MEETING. 


The PREsSIDENT—Have you any proposition to make with regard to the next 
place of meeting? 

Dr, Maupstey—lI propose that the next place of meeting be London. 

Dr. Paut—I beg to second that. 

Dr. Srewart—I would not for the world offer any suggestion in opposition to 
the majority of the members of the Association, but as.a provincial member I 
would suggest that, perhaps, if we want to avoid the reproach that has been 
thrown upon the British Medical Association of being too much in the way of 
centralisation, ib would be better for ug to avoid, if possible, meeting too often 
in London, for fear it might be looked upon as a Metropolitan Association. 
I don’t think it would be wise to let it be thought that we are going to meet at 
all events three years in succession in London. I believe it is pretty likely that 
the British Medical Association will meet in my part of the world. I putina 
plea for Bristol. It might be considered that Bristol is a little bit out of the 


1877. ] Notes and News. 427 


world, but it is not sufficiently out of the world for us to muster 200 members 
as the Bath and Bristol Branch, whichis a nuclens of a great number of others. 
I know it would be astimulug, at all events, to those connected with the Asso- 
ciation who are in the West of England to be once and awhile favoured with 
the presence of an annual meeting. I don’t presume at all to make a proposi- 
tion in opposition to that of Dr. Maudsley, but I throw out the hint that it 
would be well to bear in mind that the idea is abroad amongst provincial mem. 
bers of the Association that too often meeting in London would tend to bring 
the Association into disrepute, and the idea would be fostered in the minds of 
some that it is wished to be a Metropolitan Association more than a Provincial. 

The PrestpENt—Have you, gentlemen, any other proposition to make with 
regard tothat? If gentlemen have no other proposition to make, I will put the 
motion to the meeting. 

The motion was carried nem. con. 


THH ELECTION OF OFFICERS. 

The PrestpENt—The first officer that we proceed to elect is the President 
for the ensuing year—the President elect. 

Dr, Murray Lrypsay—lI have the honour to propose a gentleman to fill the 
office of President for the ensuing year. In doing so Iam aware of the im- 
portance of the office, to which any member of the Association might well 
aspire, and of the advisability of appointing to this honourable position a gentle- 
man of experience, ability, energy, aud position. I consider it all the more 
necessary at the present time to appoint a gentleman to this honourable position 
possessing these qualifications. I look upon it that the ensuing year will be 
probably one of the most important, if not the most important, year in the 
history of the Association, for it may be expected that the resolutions of the 
Committee on the Lunacy Laws may bring to our notice some very important 
questions affecting the care and treatment of the insane, and will, at the same 
time, affect our interests. I have, therefore, very great pleasure in proposing 
a gentleman, and I hope that he will meet with your acceptance. I therefore 
feel it both an honour and pleasure in proposing that Dr. Crichton Browne be 
appointed for the office of President for the ensuing year, feeling assured that 
the true interests of the Association are safe in his hands (applause). 

Dr. Bucknint—I have great pleasure in seconding the nomination of Dr, 
Crichton Browne as President of the Association for the ensuing year. I fully 
endorse everything that has been said by Dr. Murray Lindsay, and from my 
long knowledge of Dr. Crichton Browne, I am sure that he will discharge the 
duties of his office in such a manner as will be to the interest of the Associa- 
tion (hear, hear). Therefore I have great pleasure in seconding the proposition. 

The PrestpEnt—lI have great pleasure in putting this motion to the meeting, 
the election of such a distinguished member of the Association as Dr. Crichton 
Browne. Those in favour— 

Dr. Harrineton Tuke—I think we must ballot. 

Dr. CampBELL—I think it is only necessary to resort to the ballot when 
there is a difference of opinion. If unanimous we need not ballot. 

Dr. Rays Wittams (the Secretary) read the rule, which stated that the 
election must be by ballot. , 

Dr. Paut—I have much pleasure in moving that that rule be suspended on 
this occasion. ‘ . 

The resolution was then put to the vote, and carried unanimously. 

Dr. Mounp —Dr. Lindsay has spoken very highly of the necessity of having 
a good man at the head of affairs. I am sure he wants his right hand man 
thoroughly accustomed to his work, and we cannot have a better than Dr. Rhys 
‘Williams. I propose Dr. Rhys Williams’ re-election as Secretary, who, I hope, 
will do as well as he has done, or, perhaps, even better (hear, hear). 

Dr. Wittetr—lI have very great pleasure in seconding, 

The motion was carried unanimously. 


428 Notes and News. [Oct., 


Dr. RocErs—It clearly needs no words to recommend Dr. Paul’s re-election 
as Treasurer. There will be no dissentient voice, nor any necessity to send 
round the ballot box on his account. He has hitherto been the right man, I hope 
he will so continue, and we cannot wish for a better. I propose his re-election. 

Dr. Hack Tuxr—I beg to second that. Having audited the accounts this 
morning, and seen that they are in a very satisfactory condition, I think Iam 
as suitable as any one else to second the proposition for his re-election. 

The motion was carried unanimously. 

Dr. Rogrrs—I beg to propose to the meeting that the present Editors of the 
Journal be reappointed. I think the conducting and the editorship of the Journal 
has given general satisfaction—I would say universal, only to expect that is 
something superhuman. After all, the management of the Journal is in the 
hands of the Association at large, and if anybody has had any reason to be dis- 
satisfied it rested with themselves for their suggestions to be carried out. I 
propose that Dr. Maudsley and Dr. Clouston be re-elected editors. 

Dr, LawLEer—I have very. great pleasure inseconding that. In Ireland there 
has been universal satisfaction at the mode in which the Journal has 
hitherto been conducted. 

Dr. Harrineron TuKE.—There is, I think, a letter in the hands of the Secre- 
tary from a very distinguished member of our Association, which I should like 
very much before we proceed to vote this office, should be read. It is a letter 
from Dr. Bucknill. 

The SecretTaRy—lI have not brought it with me; I took itto be a private letter. 

Dr. Harrineton TuxeE—The purport of the letter might be put. It isa 
proposition of Dr. Bucknill to offer himself as Editor of the Journal in the 
event of the resignation of Dr. Maudsley. There are several gentlemen—I am 
asked by one—who are very anxious to put upon record their earnest wish to 
see Dr. Bucknill in harness again at the head of the Journal which has 
done so much, and which has been of so much advantage to the Association. 
I should like very much, therefore, that the intention of Dr. Bucknill to come 
forward as the editor of the Journal should be placed upon record. And while 
I now move that the letter should be read and put upon the minutes later on, 
I shall do a little more. JI am not myself personally entirely satisfied with the 
way the Journal is at present conducted. The great literary abilities of the 
editors are unquestionable: I think no one could say the Journal could be 
better edited, or be done with greater pains, and perhaps better success, but 
there are certain doctrines taught there, certain tenets, which are contrary and 
“ repugnant to me, and I may say, some others here. I think it wonld be an 
advantage year by year to let them see that the Association is watching their 
proceedings quite prepared to let other fresh men in, or, at all events, not to 
submit their judgment entirely to the hands of the editors. I venture to say 
that the present editor or editors of the Journal in their doctrines do not 
represent the majority of the Association. I shall end by a motion, and I 
shall ask for the ballot in thiscase. I shall move that Dr. Bucknill, Dr. Clouston, 
and Dr. Hack Tuke, if he will allow himself to be nominated, should be the 
editors of the Journal for the ensuing year. I understand that Dr. 
Maudsley proposes to resign next January, and that will at once raise the 
question. The result of the ballot will show you how just I amin the observa- 
tions I have made. 

Dr. Murray Linpsay—I have much pleasure in seconding Dr. Harrington 
Tuke’s resolution, for the reasons he has stated in addition to others. I endorse 
every word he has said with regard to the ability of the present editors; that, 
I think, is beyond dispute. But, as a member of the Association, I have long 
felt—and I don’t stand alone, because there has been a pretty general feeling 
for some time past—that the Journal has not done for the Association 
what it might have done, what it ought to have done, and what it was expected 
to have done, It has not advanced our interests, and not been of that practical 


1c 7. | Notes and News. 429 


use we have looked for. As Thave said, I think it ig most important that this 
year, which will be a most important one, we should have ag editors gentlemen 
of high position and influence, who will be able to make the voice of the Agsso- 
ciation felt—its weight felt—for I regret to say its weight has not been very 
much felt in high quarters, if we may judge from the results. I have there- 
fore very great pleasure in seconding Dr. Harrington Tuke’s amendment. 

Dr. SHERLOCK—May I be allowed to make one remark. Though a very old 
member of the Association, I regret I have not been able to attend so often as 
I could have wished. We are rather placed, according to my mind, ina diffi- 
culty. It occurs tome that Dr. Maudsley, who is sitting here, should be asked 
as to whether he really wishes to retire—that seems to be the first thing—and 
then it will be open for the Association generally to express their feelings as to 
who should be elected to continue the very responsible duties, and undertake 
the very serious work. Dr. Maudsley no doubt will be ready to state what he 
feels on the matter, and that will clear the ground. 

Dr. Rogzrs—Hxcuse me, but | think this discussion is introducing a matter 
not before the meeting. I should like to know how Dr. Harrington Tuke 
becomes aware of Dr. Maudsley’s intention to resign inJanuary. If it ig true, 
Dr. Maudsley has acted in rather a strange manner not to have first communi- 
cated it tous. His resignation is not before the meeting, and I cannot see how 
we can act at all on a thing which is not before the meeting. Dr. Harrington 
Tuke’s motion has placed this meeting in a most invidious position. Probably 
no one would oppose the election of Dr. Bucknill, whom we may consider, if not 
the founder, one of the earliest members of this Association; he was one of 
the few Superintendents at that time who banded themselves together for the 
purpose of founding this Association, and who has returned to us again as an 
ordinary member, after having filled high and important office under the 
Government. If he would undertake the duties of Editor again, I don’t think 
there is any one in this room who would oppose him, were it an open question. 
But are we to reject our present editors, simply because he will return? I 
think such a proceeding is entirely opposed to English feeling at all events. 
But the point I rise to is one of order. Is any member in order in speaking to 
a motion not before the meeting ? 

The Prestpent—As to a point of order, I think Dr. Harrington Tuke is 
right. Two gentlemen have been proposed and seconded as editors, and it is 
within order for anybody else to propose other gentlemen. 

Dr. Rogers—I think I don’t make myself clearly understood. The point of 
order I rose to was not proposing the election of certain members, but intro- 
ducing matter only known to himself and not before the meeting—Dr. Maud- 
sley’s intended resignation. 

Dr. SHeRLocK—I still think that if Dr. Maudsley would be good enough to 
explain, it would clear the ground. 

Dr. MaupstEy—It has been well known privately to some members of the 
Association for some time that I have felt desirous to be relieved of the burden 
of the editorship, which I have had the honour of holding for something like 
fifteen or sixteen years. I had announced too my intention to resign, and had 
determined to place my resignation in the hands of the Secretary on this occa- 
sion. But I may say, I am not aware that I have ever expressed any intention 
of resigningin January. The first information that I have had on that subject 
has been from Dr. Harrington Tuke; but probably he knows my mind better 
than I do myself on that matter (laughter). Since I came to that resolution 
to place my resignation in the hands of the Secretary, an unexpected difficulty 
has arisen with regard to my successors, and several members of this Associa- 
tion—very influential members of the Association—with whom I have been in 
the habit of acting for many years past, pressed upon me the desirability of 
continuing the editorship for a time—at any rate for another year. And in 
answer to that appeal, I finally consented to do so, if it would be at all for the 


430 Notes and News. [Oct., 


convenience of the Association. JI am perfectly prepared to abide by that 
decision. I am entirely in the hands of the Association. If they think it 
better that I should retire now, as I had intended doing, that I should place my 
resignation, which I have here, in the hands of the Secretary, I shall be very 
happy to do so. If not, and they elect me as they have done for fifteen 
years, I will go on with the work of the Journal for another year, at any rate. 

Dr. Harrineton Tuxe—I rise for a personal explanation. The reason why 
I mentioned January was simply this: I was informed—and I am sure you 
must see from the tone of this discussion nothing is more absent from my mind 
than to say anything disagreeable in this matter—I was informed that Dr. 
Maudsley had expressed his intention to resign. I know he had written an 
official letter to the Secretary on the subject. I was also informed that he 
wished to retain the editorship until January, in order to finish the present 
volume of the Association, whether that is January or April I cannot say. 

Dr. Crouston—I have merely to say that so far as I am concerned, and the 
very little work I have done and am able to do, I am entirely in the hands of 
the Association; but Dr. Maudsley and I necessarily stand or fall together. 
If the Association choose to elect us—if the Association thinks we have done 
its work to the satisfaction of the majority, I shall be most happy to act as I 
hitherto have done with Dr. Maudsley; but if the meeting thinks that Dr. 
Maudsley should retire now, it necessarily, causes me to retire also—to 
place my resignation in the hands of the Association. I beg, therefore, 
that Dr. Harrington Tuke will withdraw my name from the trio of editors 
which he has in his motion. I yield to no one in my profound admiration for 
Dr. Bucknill and Dr. Hack Tuke, and the work they have done in this depart- 
ment of medicine, and I count them both as honoured friends; but under the 
circumstances I hope Dr. Harrington Tuke will be good enough to withdraw my 
name.* 

Dr. CAMPBELL—May I ask what motion is before the meeting P Will Dr. 
Tuke put his remarks in the form of a motion or an amendment ? 

The PREsSIDENT—As an amendment. 

Dr. SHERLOcCK—Another solution occurs to my mind—the ground being 
cleared to a considerable extent, would the gentlemen now in office be inclined 
to continue the work they have discharged so zealously and effectively ? In 
the minds of each one of ug there may be some difference of opinion, and in a 
public journal this is rather better than otherwise, because gentlemen have an 
opportunity of replying and ventilating their opinions. I should be very sorry 
to see the Journal advocating a one-sided opinion, and, therefore, with that 
view, if it could be so arranged, I would beg to supplement Dr. Harrington 
Tuke’s proposition if possible. There seems to be a feeling in the minds of 
some that some other gentlemen should be introduced. I should hail with 
great pleasure the advent of Dr. Bucknill, an old friend of mine, into the ranks 
of the Journal again, and, if possible, to elect him and also Dr. Hack Tuke, 
who we are all well acquainted with; that, if possible, the Journal should be 
edited by four instead of two. It would be only adding greater strength. 

Dr. MaupsLteY—Two are one too many. 

~ Dr. SHERLOCcK—I am afraid my proposition will fail, then. 





* In order to prevent any misunderstanding as to my remarks or intentions, I may state 
that I was one of those who had strongly urged Dr Maudsley to continue his services to this 
Journal and Association; but if he had not consented to do so, while I should have felt very 
highly honoured in becoming connected with Dr. Bucknill and Dr. Hack Tuke had the Associa- 
tion so willed it, and should have most cordially co-operated with them; yet, as I stated to 
Dr. Maudsley and tomany of our associates who spoke to me on the subject, I could only 
have consented to attain that honour by attaining also the promotion to the Senior Editorship 
of the Journal. This seemed to medueto the position of Junior Hiitor and to those who 
might in the future be elected to that office. Dr. Maudsley, in allowing himself to be re- 
nominated, yield2d to my own strongly expressed desire, and that of many other members of 
the As ociation, t» save the meeting from the unpleasantness of any discussion of the question 
at all.—T. 8S. Clouston. 


1877. | Notes and News. 431 


Dr. Harrineton TuxkE—All I wish is to ask you to go to the ballot on the 
amendment. 

After some further remarks, Dr. Harrinaton TuKE said if you will allow me, 
I will propose Dr. Bucknill, Dr. Hack Tuke, and Dr. Maudsley (laughter). 

Dr. Lator—I quite agree with Dr. Sherlock’s last proposition. If the 
gentlemen would kindly consent to waive any difficulties they may see in their 
own minds, and the four gentlemen would accept the office, I think they would 
be unanimously elected. It would be a conciliation of the difficulty. 

Dr. Maupstry—I think it would be exceedingly unwise to appoint four 
editors. According to my experience two editors are one too many. It adds 
to the difficulties in the management to have to send things backwards and 
forwards, and it increases the responsibility, for you are responsible for your 
colleague. He may put things in perhaps which you would not like. Very often 
I put things in Dr. Clouston does not care to be responsible for, I dare say; some- 
times he puts things in which I do not like. We have to give and take a good 
deal inthis matter. Jam gure of this, that the Association would not find a 
plurality of editors to be any advantage whatever to the Journal. However, 
as I say, 1 am entirely in the hands of the Association in this matter; Iam not 
in the least anxious to continue the Journal; and I am perfectly willing to hand 
in my resignation, if you can make a satisfactory arrangement without me. 
But that does not seem to be very readily made on the present occasion. If it 
will conduce to the advantage of the Association, and ultimately to settling 
the question in a satisfactory manner, | am willing to continue my services 
with Dr. Clouston for the present, but not with more editors. 

The PrEsIDENT—I wish to leave this entirely to the meeting, but I would 
Say one word. I don’t think we can go beyond two editors very well. I have 
always felt myself that one editor is better than two. Dr. Clouston having 
withdrawn his name from the names that were proposed by Dr. Harrington 
Tuke, do I understand Dr. Harrington Take to propose that Dr. Bucknill and 
Dr. Hack Tuke should be editors ? 

Dr. Hack TuxE—I rise to make the same request that Dr. Clouston has 
made, under these circumstances, that my name should be withdrawn. Had 
Dr. Maudsley sent in a formal resignation, I should have placed myself in the 
hands of the Association; but under these circumstances, I at once request 
Dr. Harrington Tuke to withdraw my name from his motion. ie ae 

Dr. Harrineron TukE—Now, sir, I think the course of the Association is 
made plain. I cordially agree with Dr. Maudsley that two editors spoil— 
excuse the vulgar simile—spoil the Journal. I think it would be very material 
if we could get one good strong leadership. That Dr. Maudsley’s leader- 
ship would be eminently useful no one could deny; but as I said before, 
though I stand alone, I must enter my protest against the doctrines laid down 
in that Journal, and against some of the writings. I won’t enter into the 
reason, because it is apparent to what I allude. Ag, therefore, it is considered 
best to have one editor, I propose therefore now, that Dr. Bucknill should be 
again elected editor of this Journal. I propose to go to the ballot on that 
subject. At all events, it may be a lesson to the present editors, if I don’t 
succeed in my object, to amend the future as to some of its writings and some 
of the opinions expressed there. (Oh, oh). Iam perfectly sure the Association 
will see that I do this with the utmost possible courtesy. z. 

Dr. Lrnpsay—I have great pleasure in seconding this amended proposition. 
It must be evident to us all that within a very short time this matter 
must come up before us again. We have Dr. Maudsley’s admission that he 
does not intend to retain the editorship for any length of time. Within a very 
short time we shall be called upon for some discussion on this question. 

Dr. YELLOWLEES—I think this is a matter much to be regretted. We cannot 
vote against the present editors with anything like comfort. I think Dr. 
Harrington Tuke has done very wrong. I wish if it were possible in some way 


432 Notes and News. [Oct., 


to get this matter settled. How could any of us vote against Dr. Bucknill P 
I think it is a matter of extreme regret that Dr. Bucknill should be used 
simply as a cudgel to give a lesson to the present editors. I am sorry’ Dr. 
Harrington Tuke should put it in that way, or compel us to put it that way. 

Dr. SH#RLOCK—In all kindness I beg Dr. Harrington Tuke to reconsider this 
proposal and to withdraw his proposition. It will be putting us ina very 
awkward position indeed. Hach one will regret deeply to record a vote. I 
myself shall. 

Dr. Harrineton Tuxe—I think that this Association has a right to ask from 
me some explanation, and I do it most kindly. It will be seen immediately 
that I have already proposed that Dr. Maudsley and Dr. Clouston, each of them 
separately and together, should be editors, and I have proposed Dr. Bucknill. 
This was forced upon me by the fact that Dr. Maudsley had expressed his 
wish to resign. That being absolutely so, it seemed to me to be competent to 
propose somebody else. I shall certainly press this to the meeting. I shall 
first propose that it is advisable there should be one editor; secondly, that Dr. 
Bucknill should be elected. 

The Presipent—Your amendment is at present before the meeting, and 
seconded. 

Dr. Lator—I feel Dr. Sherlock only expresses the general feeling—lI may say 
the unanimous feeling—that every member here will be put in an exceedingly 
painful position by this ballot. Iam informed that by moving the previous 
question things will remain just as they are. Under the difficulties we are in 
at present, and if that will save us from getting into such a disagreeable 
ballot ag this, I beg to move the previous question. 

The PrestpENt—That will not get us out of the difficulty, because we must 
elect somebody. 

Dr. Stewart—It may be within our power to get out of the difficulty, if, 
before proceeding to the election, the Chairman would call upon Dr. Bucknill to 
express his wish whether or not it should be put to the ballot. 

Mr. Tuompson—lIl propose that there should be one editor. Then it will be 
competent for any one to propose anybody they like for the post of editor 
afterwards. 

Dr, WiLtt1AM Woop—lI propose for the ensuing year there be two editors of 
the Journal. 

Dr. SHeRLocK—T’ll second that. 

Dr. Stewart—It will avoid the personalities which are unfortunately getting 
into this discussion, if we vote on that question. I will second the amendment 
of Mr. Thompson, that for the ensuing year there shall be but one editor. I 
dare say everyone will be glad of expressing an opinion which really strikes at 
the root of the matter. 

The PrestpENtT—I will now put to the meeting the amendment proposed by 
Mr. Thompson, and seconded by Dr. Stewart, that there should be one editor 
of the Journal. It seems to me that that will bring the matter to an isgue, 
and that I think you can take by a show of hands without the ballot. 

Dr. Harrineton TukE—No, no—the ballot. 

Dr. ORANGE—Supposing the majority of votes are in favour of one editor of 
the Journal, does that mean Dr. Bucknill? (Voices: No, no.) I understand 
this was to be the most courteous mode of voting on what is a most painful 
thing—that if one it meant Dr. Bucknill, and, if not, Dr. Maudsley and Dr. 
Clouston. 

The PRESIDENT—I cannot answer you that. 

Dr. Orance—lIt seems to be an abstract proposition. If we carry the 
motion for one editor, it is distinctly cashiering one editor. 

The PrestpENt—No doubt that was the intention of the gentleman who 
proposed the motion. 

_ Dr. Stewart—lI disclaim it, sir, as the seconder (laughter). My distinct 
object was to avoid anything in the way of personality. 


1S? | Notes and News. 433 


The ballot was then taken, when there were 24 votes in favour of two éditors 
and 13 in favour of one. 

The PrestDENT declared the amendment lost. 

Dr. Harrincton TuKE—I now propose that Dr. Bucknill be elected one of 
the editors of the Journal. I ask for the ballot. 

Dr. StEwart—It is quite impossible for any amendment to be put now, the 
last amendment having been voted on. The original motion must now be put. 

Dr. Harrineton TukE—Then my original amendment will stand ? 

Dr. Stewart—Strictly in accordance with the House of Commons, when an 
amendment has been put and voted upon you cannot put another amendment. 
We are obliged to know something about the order of procedure now. 
When an amendment has been voted upon, any amendment between that and 
the original motion falls to the ground. 

The PresipENT—I think Dr. Stewart is right. We cannot interpolate any 
amendment; therefore the original motion must be put to the house. It hag 
been proposed by Dr. Rogers, and seconded by Dr. Lalor, that the present 
editors should be re-elected. Those who are in favour of that hold up their hands. 

Dr. StEwart—No, the ballot. 

_ The Ballot was then proceeded with, when the votes were— 


For the motion... os ons in 2S 
Against ... We mele wes Sea owe 
Majority for ax ee ie 10 


The PrEsIDENT—The present editors are re-elected (applause). 

Dr. CLouston—I propose that Dr. James Rutherford be re-elected Hon. 
Secretary for Scotland. He has done his work very well. 

Dr. YELLOWLEES—I beg to second that. 

The motion was carried unanimously. 

Dr. StEwART—I have great pleasure in proposing that Dr. Maziere Courtenay, 
Medical Superintendent Limerick County Asylum, be re-elected Hon. Secretary 
for Ireland. Though no longer connected with the sister country, I have heard 
from various members who are there that Dr. Courtenay has done all he can to 
increase the number of members, and further the objects of the Association. 

Dr. Linpsay—I have very great pleasure in seconding. Dr. Courtenay fully 
intended being present to-day, but he is engaged officially, as he expects the 
Lord-Lieutenant to visit his asylum. 

The motion was carried unanimously. 


THE COUNCIL. 


The PrestDENT—The next business is the election of members to serve on 
the Council. The four gentlemen retiring in rotation are, Dr. Wm. Wood, Dr. 
Batty Tuke, Dr. Willett, and Dr. Christie. It is for you to supply their 
places with four other gentlemen. ; 

The following gentlemen were then elected:—Dr. Orange, Dr. Harrington 
Tuke, Dr. Lush, M.P., and Mr. F. K. Dickson. 


THE AUDITOR. 


The Prustp—Nt—The next business is the election of auditor in the place 
of Dr. Harrington Tuke, who retires. 
Dr. THompson—I beg to propose that Dr. Lindsay be elected as Auditor 
for the ensuing year. 
Dr. Srewart—I beg to second that. 
The motion was carried unanimously. 
NEW MEMBERS AND THEIR MODE OF ELECTION. 


The SEcRETARY—The next business is the election of new members. It is 
an open question how these members should be elected. — I have a letter from 
a member in Ireland, stating that the present method is hardly satisfactory. 


434 Notes and News. [Oct., 


You generally take the whole ina mass. I have a long list of new members ; 
all of them very good ones. They are :— 


Bower, David, M.B.Aberd., Assistant Physician, Saughton Hall Private 
Asylum, nr. Edinburgh. 

Bowes, John Ireland, M.R.C.S.Eng., L.S.A., Assistant Medical Superinten- 
dent, Northampton County Asylum. 

Cremonini, John, M.R.C.S. and L.S.A.Eng., Camberwell House, Camberwell, 
Honan. S.H. 

Daniel, Jacob, L.R.C.P. and 8.Ed., Assistant Medical Officer, Derby County 
Asylum, Michelover. 

Duncan, J. M, M.D., LL.D., F.R.C.P.Ed., 30, Charlotte Square, Edinburgh. 

Hvans, Evan, M.R:C.S.Eng., Fulham House, Fulham, Middlesex. 

Fox, Edwin Churchill Pigott, M.B. and C.M.EHdin., Brislington, Bristol. . 

Green, R., M.D., Medical Superintendent, Public Asylum, British Guiana, 
Berbice. . 

Gower, R. Munday, M.R.C.P.Lond., Senior Medical Officer, Millbank, London. 

Hogg, Richard Bowen, M.R.C.S., L.S.A., Assistant Medical Officer, Kent 
County Asylum, Barming Heath. 

Hutson, H., M.D.Hd., Medical Superintendent, Lunatic Asylum, Barbadoes. 

James, Henry Godfrey, L.R.C.P.Hd., Assistant Medical Officer, East Riding 
Asylum, Beverley: 

Isaac, J. B., M.D., Queen’s Univ., Irel., Assistant Medical Officer, Broad- 
moor, nr. "Wokingham. 

Hewson, R. W., L.R.C.P.Hd., Assistant Medical Officer, Royal Asylum, 
Cheadle, Manchester. 

Liddell, W. A., M.D., Medical Superintendent, Govan Parochial Asylum, 
Glasgow. 

Lovett, Henry A., M.R.C.8., Worcester County and City Lunatic Asylum, 
Powick, Worcester. 

Merson, John, M.D.Aberd., Senior Assistant Medical Officer, West Riding 
Asylum, Wakefield. 

McIntosh, W.C., M.D., F.R.S.Hd., Medical Superintendent, Perth District 
Asylum, Murthly. 

Plaxton, Joseph Wm., M.R.C.S., L.8.A.Eng., West Riding Asylum, Wakefield. 

Russell, A. P., M.B.Hd., Assistant Medical Officer, Crichton Royal Institution, 
Dumfries. 

Sanders, W. Rutherford, M.D., F.R.C.P.Ed., Professor of Pathology Uni- 
versity of Hdinburgh, 11, Walker Street, Edinburgh. 

Shuttleworth, G. E., M.R.C.S. and L.S8.A.Engl., Medical Superintendent, 
Royal Albert Asylum, Lancaster. 

Saundby, Robert, M.B. and C.M.KHdin., General Hospital, Birmingham. 

Swanson, George I., M.D.Hdin., Lawrence House, York. 

Stewart, T. Grainger, M.D., F.R.C.P.Edin., Professor of the Practice of 
Physic University of Edinburgh, 20, Charlotte Square, Edinburgh. 

Turnbull, Adam Robert, M.B., C.M.Edin., Assistant Physician, Royal EHdin- 
burgh Asylum, Morningside, Edinburgh. 

Walford, Edward, M.R.C.S. and L.S.A.Engl., 2, Paragon, Ramsgate. 

Wallace, James, M.D., Medical Superintendent, Greenock Parochial Asylum, 
Greenock. 

Worthington, Thos. Blair, M.A., M.B., and M.C., Trin. Coll., Dublin, Senior 
Assistant Medical Officer, County Asylum, Haywards Heath. 


Dr. Srewart—I am informed that some members of the Association who are 
unable to be present, are not quite aware of the methodical way in which we 
do our business, and somewhat object to it. It does seem to me there would 
be a way out of the difficulty if we followed the example of kindred associations, 
and ask our Secretary to take a little extra labour, which I am sure he would 
not object to, and that is, a day or two previous, to ask those who have candi- 


23/7. Notes and News. 435 


dates to propose, that all those who were desirous to obtain admission into the 
Association should send in their names two or three days before, so that a 
printed list might be put upon the table. We might then proceed fairly, and 
in a systematic way. I think that would meet the objection that some of our 
Irish brethren have made. It is a mere suggestion with regard to the future. 

The PRESIDENT—It has been our mode to ballot for the members collectively. 
I think it is, at the same time, open to any one to demand a special ballot, if he 
chooses, respecting any one particular person. It is open toany one to demand 
that they should not be balloted for collectively, but separately. If you will 
allow me, I will first of all put the question whether they are to be balloted 
for collectively or separately. 

Dr. Wittt1ams—I have had seven or eight names handed to me this morning. 
Here is one just given me, Dr. Matthews Duncan, a most distinguished 
Physician, proposed by Dr. Clouston, and seconded by Dr. Yellowlees. 

The PRESIDENT—Of course, if we keep strictly to our rules, gentlemen wish- 
ing to join should send in a written or printed request to that effect to one of 
the Secretaries. But very few send in requests themselves. We have not 
kept to the rule in past years, and we cannot very well enforce it now. I will 
put it to the meeting now, that these gentlemen be balloted for collectively. 

The motion was agreed to, and the list was adopted in its entirety, Dr. Hack 
Tuke and others remarking that before the next meeting some alteration 
should be made. 


THE TREASURER’S STATEMENT. 

Dr. Paut—lI haye this year a very satisfactory account to render so far as 
your funds are concerned. He then read the the abstract of the accounts for 
the year (see p. 436). ; 

Dr. Witt1amMs—Last year a Committee of the Association took into con- 
sideration the question of the disposal of the surplus funds, and they were 
asked to report to this meeting. We had a meeting on the 25th July last, at 
Dr. Maudsley’s, and it was then recommended that Dr. Blandford’s offer to 
draw up a full, systematic, and classified catalogue of the contents of the 
Journal of Mental Science should be accepted, and that the catalogue should be 
published at the expense of the Association. The Committee now beg to sub- 
mit that resolution to the meeting. 

Dr. W. Woop—I shall have great pleasure in proposing that the resolution 
be adopted. 

Dr. ParstY—I beg to second that. 

The PresipENt—We have thought for some time that a catalogue would be 
very useful, and I shall be very glad to try and draw up such a one for the 
Association as a memento of my year of office as your President, if the Associa- 
tion will accept it, and devote a certain amount of money towards the printing 
of it (applause). 

The resolution was carried unanimously. 

Dr. WILLIAMS—We algo discussed the question of hiring a room in London 
for the purposes of the Association, with a view to forming a library ; but, 
after some discussion, no definite resolution was arrived at. 

Dr. Hack Tukr—I certainly was rather strongly in favour of the proposal, and 
I still see much to be said infavour of it. I think it would be very desirable that 
the Association should have ‘“‘a local habitation” as well as “a name,” and that we 
should have a library of works bearing upon psychological medicine. — At the 
same time, I believe there area good many members who don’t think it would 
be quite fair towards them to have such a room in London, and to use any of 
the funds for that purpose. It would rather be for the convenience of 
London members, and for those in the neighbourhood, than for those in the 
country. Therefore, I do not propose any resolution embodying that idea; 
at the same time, I retain my conviction that it would be for the good of 
the Association to carry it out. Of course 1b remains with the Association ; 


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Notes and News. 437 


if any member wishes to propose, and any one seconds that, it will be put to 
the meeting. I do not myself propose it, although I retain the opinion that it 
would be greatly to the advantage of the Association. 

Dr. StEwart—I am almost ashamed to rise on my legs so often, but as a 
country member, finding much difficulty to come up to London to consult the 
works, I would throw out the suggestion with regard to the use of some of 
our surplus money—would it not be possible to establish a circulating library P 

Dr. Lator—Has Dr. Stewart any motion to propose ? 

Dr. Stewart—I will put myself in order by moving that a portion of the 
surplus be used for the purpose of establishing the nucleus of a library, to be 
added to from year to year, of books dealing with psychological medicine; the 
said books to be circulated by post, or whatever way the committee to be 
formed for the purpose may consider advisable, amongst the members of the 
Association, a certain time being allowed for the reading of euch new work; 
the work to be returned in the sume way as adopted by Lewis’s and other lend- 
ing libraries. I quite contemplate that it would involve work which would 
have to be paid for, but a small salary paid to an assistant secretary, if he 
might be so called, or a librarian, or whatever it might be, would meet that 
difficulty. 

The PresipENtT—We must have a room to keep them in. 

Dr. Srewart—Certainly. I merely wish to ventilate it to meet the diffi- 
culty Dr. Hack Tuke has referred to with regard to the objection of country 
members. I find some difficulty in keeping myself au cowrant with psychologi- 
cal literature. 

Dr. CampBELL—I think Dr. Stewart’s proposal would be a most useful and 
beneficial one to country members. It is a matter of pounds, shillings, and 
pence, whether you can afford to keepa room and librarian. 

Dr. THompson.—I would suggest that the matter be referred to a Committee 
for consideration aud enquiry. 

The PrestpENt—The Treasurer gets richer and richer every year. I think 
the Committee may be re-appointed, even though they don’t come to any 

- decision now. 

Dr. Strwart—I shall be very happy to propose that the Committee should 
be asked to re-assemble and consider the question of appropriation of some of 
the extra funds towards the nucleus of a circulating library. I purposely put 
the word “circulating.” 

Dr. CaMPpBELL—I second that with pleasure. 

Dr. SUTHERLAND—Would it be possible for us to make some arrangement as 
to the library of the Medico-Chirurgical Society ? ; 

Dr. Srewart—I propose that a Committee of four members, together with 
the Secretaries, Treasurer, and Editors, be appointed, to consider whether any 
surplus funds, after the costs of the catalogue have been paid, could be devoted 
towards the establishment of a circulating library of psychological medicine. 

Dr. BucKNILL—How many members are there in the Association P 

Dr. Pavt—About two hundred in England, and about the same number in 
Treland and Scotland; about four hundred altogether. 

Dr. Bucknitt—Then if they have one volume a week, it will take about 
eight years to get round. ; ; 

Dr. Movtp—Independently of that, there is the question of expense. There 
is a room to be hired—that room must be large enough to contain a library— 
it must be in a convenient position, and you must have a man in charge of 
that room. This would cost at least £200 a year, without thinking of the pur- 

f books. 
Poe Pave The extreme amount that could be afforded would be about £30 
or £40 a year. I doubt whether that would not trespass too much on our funds. 

Dr. Woop—What is the good of appointing a Committee, and limiting them 
to the consideration of a scheme we know to be impracticable ? 


XXIII. 29 


438 Notes and News. [Oct., 


Dr. Stewart—In Birmingham, at present, there is a circulating library. 

The PrestDENT put the motion, which was carried unanimously. 

Dr. Stewart proposed Drs. Bucknill, Hack Tuke, Rogers and Major as the 
Committee. 

Dr. SHERLOCK—I should think that Dr. Wood’s name should be placed. It 
occurs to me Dr. Paul has struck at the root of the matter, when he tells us 
what we can afford. 

It was agreed that the Committee should consist of the above-named members, 


THE LUNACY LAW COMMITTEE OF THE HOUSE OF COMMONS. 

Dr. Harrineton TuKE—In view of some proposition in which we are in- 
terested being brought before the Lunacy Law Committee, I propose that a 
Committee of our Association should be appointed, who would, if necessary, 
call a general meeting of the Association, or take such steps as they may con- 
sider desirable to protect the interests of psychologists. It might be perfectly 
unnecessary that we should meet, but I think it would be very advisable that 
some of the heads of our Association, some of whom have been already 
examined before the Commission, should be able to communicate when neces- 
sity arises. Some propositions have been put forward repugnant to all of us, 
but an end has been put to the objectionable clauses. 

Dr. CAMPBELL—You have the power to call a meeting whenever you like. 

Dr. Parsty—I have great pleasure in seconding the proposition of Dr. Tuke. 
I think it is of the greatest importance to us as an Association, and as indivi- 
duals, that we should watch, that we should be informed of the legislative 
action which may be taken. Certainly from the evidence heard already, many 
of us may be rather seriously affected. There has been a proposition made by 
the Chairman of the Lunacy Commissioners which would most materially affect 
the position of all the Superintendents of county asylums. In their behalf I hope 
that Dr. Tuke’s motion will be adopted, and that some members of the county 
asylums will be put upon the Committee. I more particularly allude to the ques- 
tion of visiting physicians being appointed, which we thought was scotched 
25 years ago. It was then thought so objectionable that asylums should be under 
the guidance of non-resident physicians, and that superintendents should take 
the position of rather high-class house surgeons, that resistance was made to it. 
Now it is proposed by the Chairman of the Lunacy Commissioners that the 
physicians should be appointed to assure the public that no improper proceed- 
ings were going on, and that the medical officers performed their duties. Such 
a thing would have the effect of reducing our standard, and throwing open 
our appointments to men of inferior class. We ought to do all in our power 
to resist it for that reason. I take great interest in seconding Dr. Harring- 
ton Tuke’s proposal. There are many other matters which have come before 
this Committee that perhaps might be objectionable to us as abody. I won’t 
particularly refer to them now, but merely refer to those which affect the 
superintendents of asylums. 

Dr. Lator—The Duke of Richmond stated in the House of Lords, in answer 
to Lord O’Hagan, who introduced a Bill for the better care of imbeciles in 
Ireland, that there should be a commission of inquiry into the subject. I think 
it would be exceedingly desirable to have reports of such proceedings furnished 
to the Committee of our Association. I think it desirable that the same Com- 
mittee should consider the report of the proceedings of this Royal Commission 
with reference to imbeciles in Ireland. I beg to move that it be referred to that 
Committee to consider the Irish subject. 

The PREsIDENtT—The Committee have powers to inquire into the matters 
connected with legislation in Ireland, or in any part of Great Britain. 

Dr. Harrincton Tuxe—I mean legislation generally. 

Mr. Moutp—I agree most cordially with Dr. Harrington Tuke. The present 
members on the Committee of the House of Commons are most desirous of 
getting all information possible before sending in their report. A committee 


1877. | Notes and News. 439 


chosen from our body would be well received, and the sooner they meet the better. 
Dr. Harrineton Tuxe—Then I move that a Committee be appointed to watch 


the progress of legislation, or any report that may be likely to lead to legisla- 
tion for either Great Britain or Ireland. 


The motion was put and carried unanimously, 


Dr. BuCKNILL suggested that the Committee should be empowered to con- 
sider the evidence which has been given before the Select Committee, and make 
such communications as may seem desirable to the Chairman of the Associ- 
ation, who might assist them in the consideration of the report, and the inter- 
pretation of the meaning of the evidence. 

The PRESIDENT—It is very much better to take all these things in writing. 

Dr. BucknILL—I move “that a Committee be appointed with powers to take 
such steps as they may deem desirable in respect to the forthcoming report of 
the Select Committee of the House of Commons on the Lunacy Laws.” 

This motion was put to the vote and carried, and the meeting proceeded to 
elect the Committee. 

The SEcRETARY read over the names of the proposed Committee—Drs. Bland- 
ford, Bucknill, Crichton Browne, Parsey, Maudsley, Orange, Lindsay, Clouston, 
Lalor, Boyd, Munro and Harrington Tuke; and Dr. CLousron suggested that 
the name of Dr. Anderson should be substituted for his. 

The PRESIDENT suggested that it should not be a large Committee. 

Dr. CAMPBELL suggested that it should be a fully representative Committee. 
He suggested a Committee to consist of Drs. Boyd, Blandford, Parsey, Rogers, 
Brushfield, D. Williams, Anderson, Yellowlees and Mackintosh. 

_ Dr. Harrineton Tuxe—TI do hope we are so far a united body in this matter. 
The interest of the Association generally is what we look to. There is not a. 
single member but who will be most anxious to see to the interest of the general 
body. 

Dr. ParRsEY—Two such men as Dr. Bucknill and Dr. Crichton Browne ought 
not to be left off. They would be of the most material assistance to us. 

Dr. Harrineton TukE—I have tried to the best of my ability to make it a 
representative body. 

Dr. Srewart—I have a list of 17 members, and I think that will be repre- 
sentative of English County Asylum Superintendents. These are Drs. Rogers, 
Parsey, Duckworth Williams, Brushfield and Lindsay. Scotch—Drs. Anderson, 
Yellowlees and Mackintosh. Irish—Dr. Lalor. Private Asylums—Drs. Bland- 
ford, Boyd, Maudsley and Harrington Tuke. Registered Hospitals—Drs. 
Bayley and Orange; and Independent—Drs. Bucknill and Crichton Browne. 

Dr. CampBeLt—I’ll second Dr. Stewart’s Committee. 

Dr. Harrineton TuxE—I would prefer that this motion be withdrawn altos 
gether, and that we ourselves watch the progress. The resolution shows the 
list of members I propose has not the confidence of the Association, therefore 
I withdraw the proposition. : 

The PresipyNT—The resolution that there shall be a Committee has been 
put and carried, therefore it is for the Association to say whether they will 
annul that. 

Dr. Rocers thought 15 would be sufficient. 

Dr. Stewart—Then I propose that a Committee of 15 be appointed. 

Dr. Rocers—Then Il] second that. 

The motion was put and carried. 

Dr. Stewart then proposed his list, with the names of Drs. Maudsley and 
Mackintosh omitted, and this being seconded by Dr. Campbell, was carried. 

Dr. Lator—I propose that the Committee just appointed have power also to 
consider and act in the same manner in reference to any Royal Commission as 
regards lunatics and imbeciles in Ireland. — 

Dr. Oscar Woops seconded. I think it is absolutely necessary that Ireland 
should be ably represented on this Committee. I am sure Dr. Lalor will do 

well in the advocacy of our cause. 


440 Notes and News. [Oct., 


Dr. Lator—My proposition will read thus:—‘“ That the Committee have 
power also to consider and act in the same manner in reference to any Royal 
or other Commission that may be appointed on the subject of the laws regard- 
ing imbeciles or lunatics in Ireland.” 

The motion was carried. 


THE W. AND S. TUKE PRIZE ESSAY. 


The Secretary—lI have received from the examiners of the W. and 8S. Tuke 
Prize Hssay a notification that the winner of the prize has for his motto “The 
Brain is Always the Seat of Insanity, but it is Not Alwaysthe Seat of its Cause,” 
andis Edward C. Spitzka, M.D., 308, Hast 23 Street, New York City, U.S. 

Dr. Hack Tuxre—I would only just say for myself and the other members of 
my family that it is a great satisfaction to us to know that the prize has been 
awarded by the Committee for an essay of much worth and originality. 

The Presipent—I am sure, gentlemen, it is great a satisfaction to the feeling 
of the meeting to hear that statement made by Dr. Hack Tuke, and to feel that 
this paper to which the prize has been awarded has been awarded to one that 
has given him that satisfaction we all wish he should derive from it. 


STATISTICAL COMMITTEHR. 


Dr. CLouston—I may state that I communicated with all the members of 
this Committee, which was appointed last year, asking them for their informa- 
tion with regard to this matter of statistics. I have brought ina report from 
their suggestions, but as we have not had an opportunity of unitedly con- 
sidering this report, I would ask for leave of the Association to postpone it 
until after the afternoon meeting. Then I should propose that it should not be 
acted upon this year, but that it should be published in the Journal, and be 
considered during the year by the members of the Association, and finally 
settled at our next Annual Meeting. 

The proceedings were then adjourned at half-past one o’clock. 


THE AFTERNOON MEETING 


was held at half past 2 o’clock. The President delivered his address. (See Wo. 
1, Original Articles.) 

Dr. BuckNILL—I beg to propose that the thanks of the Association be 
given you for your most interesting, valuable, and instructive address. I have 
rarely listened to an address which has interested me more, and which I am 
sure will be read by the public outside this building with greater instruction. 
The abbreviated history of the Lunacy Laws which you have given us must 
be highly satisfactory to those who wish not to rush into inconsiderate and 
unnecessary changes. I think that you have very wisely, and very needfully 
drawn attention to the gradual development of the securities for personal 
liberty which have been taken during a long period of legislation under grave, 
serious and full inquiry. J am sure that every one will agree with your 
moderate judgment of the character of the recent investigation, which as 
far asI can see is very needless, and is likely not to be very fruitful of 
results. I beg to propose that the thanks of the Association be given to you 
for your excellent address. 

Dr. Guy—As an outsider Iam glad to second this vote of thanks, and I do 
desire to state how very much pleased I am with the address I have heard; 
how clearly you have expressed yourself, how impossible it is for anybody to 
misunderstand you, and what benefits will be conferred upon us by your address. 

The Prestpent—I am much obliged to you, gentlemen, for the kind things 
you have said of me. JI hope my paper may give rise: to something in the 
shape of a discussion, though I don’t think I have raised any point. 

Dr. BUCKNILL—Yes you have, in rather a bold manner, and it needs explana- 
tion. You have quoted Lord Shaftesbury, in saying that the discharges from 
private asylums were 65 and from public asylums 45 per cent. NowI maybe | 


' 


} 
| 


1877. | Notes and News. 441 


wrong, but I imagine that you wish us to infer from that that the curative 
operation is greater in private than in publicasylums. If not, I will sit down. 
The Presipent—l did not mean that. I merely quoted the figures, because 
it is constantly said—I don’t mean to say where, but by outsiders—that patients 
are never cured in private asylums. 

Dr. Bucknitti—Hxactly. My friend Dr. Harrington Tuke said the same 
thing before the Committee. I entirely disagree with him. He drew the 
inference—I hope you will be able to contradict me—but he drew the inference 
that a favourable comparison might be drawn between the private and public 
asylums, from the greater percentage of discharges fromthe former. I entirely 
demur from that. Not that there is much use in the comparison. I believe 
both classes of institutions have their special merits, very high and great 
merits. I am the last man to say one word against those institutions which 
send out 65 per cent, on admissions. When we consider that a patient cannot 
be sent out of a public asylum without being cured and prepared to earn his 
bread again, and when we consider that in private asylums patients are very 
frequently sent out not entirely cured—for when they get outside they are as 
arule not expected to earn their bread, the greater proportion having means 
to live upon—there is no fair comparison to be drawn between the percentage 
of patients discharged from the two classes of institutions. I think com- 
parisons between them might be drawn upon some important points; for 
instance, I should like to see a comparison made between the two classes of in- 
stitutions as to which provides the most efficient medical care; I should like to 
see a comparison made as to which provides the greatest amount of amusement 
and curative means of all kinds. The great aim and object of these institutions 
is to secure the restoration of their patients, and I should like to know 
whether these means result in a greater or less proportion with the cures. I 
think we should then acquire means of judging very different to those which 
you have placed before us. 

The PresipeENt—Dr. Bucknill will observe I said nothing at all about re- 
coveries or cures, but merely the number discharged. I was merely quoting 
as to the question of patients being retaied in larger numbers in private 
asylums. I quite agree that the reason is, that in public asylums they 
have to be kept there until cured. I very much wish, if it were possible, for 
private asylums to keep their patients until cured. I believe some semi-cured 
patients are discharged from private asylums, and probably that accounts for 
the fact that there is a larger percentage of cures returned. I was only 
speaking on the question of patients getting out from an outside point of view, 
because it is said that it is harder to get out of one than the other. 

Dr. Bucknitt—Your explanation has satisfied me. If the public wish to 
find patients unjustly detained in asylums, they would not look in private 
asylums, but in public ones. 

Dr. Hack TuKr—It seems to me that the great lesson which we ought to 
learn from the admirable address you have given, is the immense importance of 
pablicity in asylums, and also the very great importance of central supervision. 
I think the necessity of publicity—although we may sometimes be inclined to 
complain of the cehsorious remarks of the public—that the importance of pub- 
licity ought to be frankly admitted by us. ‘The necessity of it was certainly 
shown in regard to the old York Asylam, where secresy was the order of the day, 
and where visits to patients were scarcely permitted. That as we know broke 
it down, and the Superintendent of that asylum gave some most extraordinary 
evidence before that committee you refer to in 1815, both as regards that 
which I speak of, and the amount of restraint. I remember that he himself 
described to that committee the restraint used. Although wishing of course to 
make the best of it, he said his patients when violent were handcuffed, chains 
were placed on their ankles and another chain carried from the cuffs to the 
ankle chain. That was during the day, and at night it was necessary to place 


442 Notes and News. [Oct., 


the arms in a ring and so attach them to the crib, and another chain was 
placed from the ankles to the bottom of the crib. I may also add that with 
regard to the question of restraint, I think the President of this College, Dr. 
Latham, made the remark, that he considered it necessary in not a few cases 
to chain the patients to the wall. He said that he had on several occasions, 
with regard to strait waistcoats requested they should be removed from the 
patients, but he was always only too happy to have them put on again! With 
regard to central supervision, I think all that has happened since the legislation 
of 1845, as compared with the legislation which followed that of 1774, does 
show the immense importance of good central supervision; and we cannot but 
attribute a large amount of the amelioration of the condition of the insane, which 
has followed Lord Ashley’s Bill, to the action of the Commissioners in Lunacy. 
The old Commissioners, from the College of Physicians, were certainly a mere 
fiction, because, if I remember correctly, they were obliged to grant licenses; 
in no case could they revoke one. Their position, therefore, on that point, 
was of course quite futile. Then again they had no power, I believe, in liberat- 
ing patients from asylums. Again with regard to prosecutions, although they 
had the nominal power of setting prosecutions in motion, they had no funds to 
carry them out. At the same time it must be admitted that we cannot be very 
proud of the College of Physicians in their action as Commissioners—their own 
standard with regard to the condition of asylums was certainly very low. I 
think Dr. Latham, as President of this College, described Miles’s Asylum, at 
Hoxton, as in all respects highly satisfactory. It was at the same time proved 
that at least two slept in the same bed, that violent and quiet patients were 
huddled together, that dirty and clean patients were not in any way separated, 
and in fact it was proved that, with regard to this particular asylum, all was 
a chaos of confusion, Therefore, the standard of the College of Physicians 
was very low. The law was that they should stick up their animadversions 
upon asylums in the censors’ room. They did not carry it out for many years 
before the time of the committee of 1815. I think, therefore, with regard to 
the present inquiry, we ought to admit that it is very desirable the public 
should be alive to the condition of asylums, it having been proved by past 
experience that the action of the public, although very often unwise and 
fanatical, is still a very useful safeguard with respect to the conduct of these 
institutions, and also that central supervision, although it is most important 
that local authority should have full play, and not be cramped by excessive 
centralisation, has been and will be of the greatest benefit in regard to the 
condition of asylums for the insane. 

Dr. CLouston—I agree most fully, Mr. President, as to the interest and im- 
portance of your address, and I have just one word to say and one recom- 
mendation to make to my English brethren. If they wish these lunatic scares, 
Parliamentary committees, and enquiries generally, and disturbances of the 
public mind in regard to lunacy to cease, I should recommend them to adopt 
our Scotch system of having every insane person confined by an order from a 
public judicial functionary, with two medical certificates and a signed petition 
by a relative. Our experience in Scotland—and I have had experience in both 
countries—is eminently favourable to this system. If you once adopt. the 
principle that the liberty of the subject shall not be taken away without a 
judicial order, you simply and perfectly get rid of all suspicions on private 
asylums and everything objectionable to the English system. I can call my 
brethren to confirm me as to the excellence and the practical working of this 
system. In Scotland I think the practice is almost universal of allowing 
relatives of insane persons to visit them without any kind of restriction what- 
ever, My own experience has been that this has a wonderful effect in allaying 
suspicions, and a very soothing effect as regards the patients themselves. 

Dr. MaupsteY—I should be pleased if Dr. Clouston would tell the meeting 
what provision they have in Scotland for temporary cases. I believe if a 


1877. | Notes and News. 443 


patient is treated in a private house, it is quite sufficient for a notice signed 
by a medical man to be sent to the Commissioners. In England we have no 
such arrangement. If we take, say a young lady of eighteen, suffering from 
melancholia, we have to get two medical certificates and an order; in fact, to 
go through exactly the same forms as we go through for sending a patient to 
an asylum, The qaestion is whether it would be desirable to add to that the 
signature of the magistrate. One of the greatest difficulties is to get friends 
to take action, simply because they dislike these certificates, believing them 
to be public; and it is difficult to persuade them the procedure is not. You 
would put a very serious obstacle in the way of the early treatment of insanity, 
which would not be desirable unless you supplement it by some such provision 
as is in vogue in Scotland for recent cases. 

Dr. CLouston—My experience of that part of the Scotch law hag been very 
favourable as regards cases of mildly acute disease treated on the responsi- 
bility of friends in private houses—it must always be done on the direct 
responsibility of relations, and the ordinary certificate from the family medical 
man saying that such a treatment is necessary for the first six months for 
the cure of the patient. I may also direct attention to the provision of our 
Scotch law, which enables us to receive patients voluntarily into our asylums, 
which I conceive to be a very valuable provision, and which we find in Scotland 
works admirably. Any patient can place himself under my care by writing a 
letter to the Commissioners in Lunacy, saying he wishes so to place himself. 
They write me a letter allowing me to receive him, and he can go away by 
giving me three days’ notice. It suits well in certain cases on the border land. 
Those patients are not entered on our register of admissions; they are not 
counted by the Scotch law as lunatics, not counted in our number resident, or 
reckoned as insane. 

The Presipent—All I can say is I wish we had such provisions, or some of 
them, at any rate. I think we are a very long way off getting them. I think 
the outcry would be very great amongst certain classes of the community if 
we proposed that in this country persons should be shut up for six months in 
the way Dr. Clouston says. I would also remind Dr. Clouston that we have 
nobody in this country exactly analogous to the sheriff of Scotland. I take it 
there is a very great difference between the sheriff and the ordinary county 
magistrate, who may be a man entirely non-legal—he might be a clergyman, or 
anybody having no knowledge of law. I do not think we could put our magis- 
trates exactly on a par with Scotch sheriffs, or expect them to execute the 
same functions. Certainly there would be a very great deal of difficulty in 
the country to persuade friends to send their papers to their next door neigh- 
bour, who might be a magistrate: probably great objection would be made and 
difficulties added to those already existing of placing patients under treatment 
at an earlier and proper time. But the other modes of dealing with patients 
referred to by Dr. Maudsley are extremely desirable, and I only wish to see 
them pass into law. ; (ae ; 

Dr. Bucknint—lI should like to ask whether the action of the sheriff in this 
matter is perfunctory—whether, when he is requested to sign the order, he 
takes the trouble to see that patient, or make inquiries as to whether he is a 
proper person to be sent, or whether he merely signs the order as a matter of 
course? According to the English law, a person who signs the order takes a 
certain responsibility which he is liable to be called upon to answer for. I 
apprehend that if a magistrate were to sign the order of admission of a private 
patient into a private asylum without any communication with the patient he 
would perform the duty in the same perfunctory manner, In the same way 
as magistrates do now. On signing the order of admission of a pauper patient 
into a pauper asylum, he wants to know from the medical man whether he 
ig a proper person, and from the relieving officer whether it is a case that 
ought to be sent to the asylum. He signs it as a matter of course. It 


AAA Notes and News. [Oct., 


appears to me that if that is to be the change, it would be rather retrograde 
than otherwise. 

The PresipENT—I would also ask Dr. Clouston a question—whether the fact 
of the sheriff signing the order exempts the person signing, the medical man, 
from any legal responsibility P 

Dr. Crousron—In answer to Dr. Bucknill’s question, I can only say that I 
believe our Scotch sheriffs read the medical certificates which are placed before 
them before they sign the order of admission to the asylum. They never see 
the patient. They consider their function is merely to judge from the papers 
before them. I know that our sheriffs in Edinburgh constantly refuse to sign 
orders, because the facts stated in the certificates are not sufficiently strong. 
I have been asked by one of them to go in and make a personal explanation 
of a case where they considered the facts very weak. In answer to your 
question, sir, I believe that the sheriff's order does not altogether exempt 
the medical man from responsibility ; by the common law of Scotland they. are 
liable just the same as in England. But I believe it very greatly lessens the 
risk to medical men. 

Mr. Movtp—I have listened with some interest to this discussion. For some 
years I have been the Medical Superintendent of a large asylum for the upper 
and middle classes. I was strongly of opinion at one time it was very desirable 
that the certificates of private patients should be similar to those used for 
paupers, that every person confined should have an opportunity of being 
examined by some public official. A residence of some ten years in a large 
hospital to which I have admitted from 125 to 130 during the year, has satisfied 
me that any publicity of the kind would be simply ruin to half the persons 
admitted. I believe the present law works very well indeed. I have had 
patients who have placed themselves voluntarily under my care. The question 
is, when can they go out? According to Mr. Welby, if a patient places himself 
ina lunatic hospital, you can recover from him his board and residence; but 
the law says, if there is anything the matter with him, you ought to have 
certificates. Dr. Maudsley has quoted the case of a young lady, eighteen 
year old, placing herself under care. I have done that several times. I have 
received official censure, and I have borne it. Im one instance I certainly 
saved the young lady from the misery of being placed in a public asylum or 
public hospital. This young lady was very grateful, and the official said 
nothing more about it except that I ought not to have done it. 

The PrestpENr—Time goes on. I will now call upon Dr. Rogers to read 
his paper. 

Dr. Rogers read his paper ‘‘On the best means to provide for the care and 
maintenance of lunatics and imbeciles, with special reference to the reports of 
the Charity Organisation Association.” (See Original Articles, p. 324). He 
concluded by proposing the first resolution referred to in his paper:—‘‘ That 
although the system of boarding out quiet and harmless pauper lunatics with 
families in their own sphere of life may be advantageous in districts where 
practicable, the proportion of cases in which such a course can be carried out 
is so limited that it does not practically affect the provision for the insane poor 
of the chronic and imbecile classes.” 

Dr. Hack TuKE—I just wish to call the attention of the Association to a 
resolution upon this subject which I moved last year, and which was carried. 
I find it has escaped the attention of Dr. Rogers: ‘‘ That this Association 
having had the proceedings of the Charity Organisation Society in regard to 
idiots, imbeciles, and harmless lunatics brought under its notice, desires, with- 
out committing itself to the immediate line of action the above Society might 
think proper to take, to express its satisfaction that it has taken up the subject 
of educational and custodial establishments for this class.” That arose 
on a portion of the then President’s address. Dr. Rogers says that the 
Association had not come to any conclusion upon the Charity Organisation 


£877; | Notes and News. AAD5 


Society report, but it will be seen that in general terms it has done so. At the 
same time, perhaps the more definite resolution which Dr. Rogers has brought 
eae are worthy of being adopted, soas to strengthen still more the cae 
* oe ae ss ae most entirely with his paper, except in one remark 
: ouses are not fitted for lunatics. I believe that work- 
houses may still, to a certain extent, be made available. Whatever provisionis 
ea oe uate avouring to carry out the idea of the Charity Organisation 
ociety, it will very far fail to meet the wants of lunatics in England, and 
workhouses may be used with great advantage in certaincases. I have visited 
many myself, and in a large number of -houses chronic lunatics are very well 
cared for. As the proposed machinery will involve an enormous expense, and 
will be very difficult to carry through, it will be very well ‘to utilise oan 
Fo ae as much as we Can. I shall be willing to second the first resolution. 
r. CAMPBELL—I think it a great pity Hngland did not avail itself to the same 
extent as Scotland did, of the capitation grant where they get a grant for their 
lunatics whether they are in an asylum or not. England neglected to appl 

The PRESIDENT read the resolution proposed. e 

Dr. Buckxnitt—I don’t know whether Dr. Duckworth Williams ig here ? 

The PrEsIDENT—No, he is not. 

Dr. BuckniL~t—I am very sorry that this subject should be discussed in his 
absence, because I believe he is the only Superintendent in England who has 
systematically and on a large scale tried the experiment. He has given evi- 
dence before the Select Committee of the House of Commons, that he placed 
out a large number of lunatics to board with their friends—I believe between 
three and four hundred, and in no single instance has he had occasion to regret 
having done so. Now, if other Superintendents had taken the trouble to try 
the experiment with the zeal and energy he has shown, we should be perhaps in 
a different position, and be more able to come to a decision on this resolution. 
For my own part I should wish to withhold an expression of opinion on the 
matter. I think it would be premature, seeing we have not tried it, and in the 
face of what has taken place in the county of Sussex. 

Dr. SHERLocK—In many counties this system no doubt may be widely 
adopted. Speaking of my own county, Worcester, I frequently, by getting 
assistance from the different unions, or by calling in to my assistance friends, 
make provision for occasional cases. I quite agree with Dr. Rogers, it will not 
be an extensive system. It would be impossible, so closely populated as Eng- 
land is, to extend the system in such a way as in Scotland. Still, I think, as 
far as it goes, it is useful and desirable to be carried out. 

The PrestpENt—No doubt the price of living varies very much. In an 
agricultural county I think it possible to get patients kept at a lower rate. That 
may have something to do with the question of being more practicable. 

Dr. Bucknint—Wherever tried it has been successful. I tried it at Devon- 
shire; to some extent I have been successful. Dr. Williams tried it on a large 
scale, and he has been successful. I think before we come to a resolution like 
this we should have some further instances. 

Dr. Hack Tuxe—lIf it had condemned the system of boarding out, I would 
not have seconded it. 

The Presipent—The resolution is that although it may be advantageous in 
districts where it is practicable, the proportion of places in which such a course 
can be carried on is so limited that it does not practically affect the question. 
That is the question we have to discuss. Dr. Rogers has tried it and failed. 

Dr. CLouston—I should most strongly concur with what Dr. Bucknill has 
said in regard to this Association not comuuitting itself to any such opinion. In 
Scotland the system of boarding out has been adopted to a very considerable 
extent. The village of Kennoway we have utilised for something like 50 
patients in this way, and in Scotland generally we seem to think, especially our 
Commissioners in Lunacy, that this will be a most valuable means of relieving 


446 Notes and News. [Oct., 


the asylums of old chronic demented cases, and old imbeciles. At the Morning- 
side Asylum during the four years I have held the position of Superintendent 
there, I have striven very earnestly to keep down our numbers, and with an 
increasing number of admissions we have fewer pauper patients than at the 
beginning of that time. I would most earnestly express an opinion that this 
Association should not commit itself to the resolution. 

Dr. Rocers—Before Dr. Clouston sits down would you ask him to inform 
the meeting the amount paid jfor each pauper lunatic; for, as I say, it all 
depends upon that ? 

Dr. CLouston—Six and seven shillings a week is ordinarily paid for these 
cases. Clothing is provided by the Inspectors of Poor, who correspond with the 
Relieving Officer here. It may be reckoned at eight shillings at the very outside. 

Dr. Rogers—Perhaps Dr. Bucknill will say what he paid. Iam quite aware 
he carried out the same system in Devonshire ? 

Dr. Bucknint—I paid the same as in the asylum. I generally got two 
patients in one cottage, paying from eight to nine shillings each. Put it at 
eight shillings, that would be sixteen shillings for the two. 

Mr. Lev—Weall consider it, I think, as a questionof expense. If pauper patients 
can only be boarded out with their friends for eight shillings per week, I think 
they would be far better in the asylum. They would be kept there better. In 
populous places like Lancashire it would be impossible to board them out for 
the sum mentioned. Another thing, they are so crowded in every large town 
that to introduce a pauper relative upon families would be an incubus they 
would not stand. These persons go away from home all day, and the presence 
of an insane relative would necessitate one of the family remaining at home to 
look after him. I quite agree with what Dr. Rogers has said; it may act very 
well in Scotland, but in England it will not do. 

Dr. ParsEY—With regard to this question of the boarding out of paupers 
among their friends, I took some trouble last year to find out the relative 
number and expenses of these patients. I recollect well going through the 
statistics and noticing that there was at the time a larger proportion of patients 
in asylums in Scotland than in HEngland—nearly, I think, 10 per cent. more 
were treated in asylums in Scotland than in this country—that the system of 
boarding out in rural districts prevailed to a great extent, and particularly 
in Wales and that a very large proportion of the insane of Wales were well 
and comfortably boarded. I believe there is a feeling still they should not be 
interfered with, and not to increase the number of asylums in Wales. I believe 
the patients are exceedingly well managed and taken care of outside the pre- 
cincts of the asylum. Iam very strongly of opinion that in the rural districts 
generally in this country it may be carried out to a considerable extent. I still 
hold to the opinion that it would be far more efficiently done if the patients were 
placed in districts sufficiently near to the parent asylum that they may have 
the supervision of the officers of the asylum. If that were done, a good deal of 
the pressure would be relieved. I proposed that to the committee of my own 
asylum—I suggested it rather. They said “ Why, Dr. Parsey, you are not 
going to let loose all your lunatics among us!” They received it with great 
repugnance—l don’t say all, but they were opposed to the feeling that these 
people should be set at liberty in this manner. My own feeling was I should 
like to try the treatment in Warwickshire. I am still of opinion that the 
treatment is a most efficient one in rural districts, but in urban districts there 
should be an increase of asylums. I don’t myself believe that the patients 
would be maintained at a much lower, if any lower, rate. At the same time it 
seems to me there might be a certain amount of economy, because we should 
not require so large a staff. Such a system will eventually become necessary. 
Tt will not do to send them long distances, for the expense would be so great 
that it would be decidedly increasing the expenditure already thrown upon 
parishes, and of which they now complain so very much about. Dr. Rogers 


1877.] Notes and News. 447 


states in his paper that the view expressed was so undecided that I seemed like 
the pleader of a bad cause, but did not like to admit it in any way. Iam 
sorry that my address gave him that impression, because my feeling was 
very decided indeed. What I wanted was to advocate the plan in the rural 
districts of this country—boarding out chronic patients within a moderate 
radius, and of building chronic asylums in the urban districts. These, I think, 
are the most efficient measures we can adopt at the present time. They are in 
some measure opposed to the views of the Charity Organisation Society, but I 
don’t alter my views. ; 

Dr. CAMPBELIL—Are the patients boarded out as comfortably and as care- 
fully cared for as in asylums? : 

Dr, RayNer—We know that in urban districts a patient would be very soon 
teased, and if not troublesome would very soon become so. 

Dr. Hack Tuxe—An important point is the bad moral influence of such 
patients ina house. The language of some of these harmless patients is often 
so foul that it is extremely objectionable. 

Dr. Rogrers—Those would not be the ones you would place out. 

Dr. SHERLOcK—If the cases are properly selected they receive an undoubted 
benefit. I hold that such a patient as that referred to by Dr. Tuke would not 
be sent out to a private house. These cases should be reviewed with an infinite 
degree of care and pains. Dr. Rogers is correct in saying that it is only a 
limited class that can be transferred safely. Dr. Kiff tried it. One year he 
drafted about 40, another year considerably more, but in the course of that 
experiment three-fourths of them were returned back to him in a vastly dete- 
riorated condition. 

Dr. RogErRs—To what did he draft them ? 

Dr, SHERLOCK—To the workhouse. When he transferred them to the care 
of friends, they were still more so. I believe they want some supervision even 
more than an occasional visit. The more classes are classified the better. To 
a certain extent I differ with Dr. Parsey, that the expense will not be much 
lessened. I think it will be. The construction of asylums necessary for the 
reception of those so-called harmless patients, is very much less costly than 
those for receiving dangerous lunatics. The mere cost of food will probably 
be very much less as regards imbeciles, and also the cost of attendance. That 
ig shown in the case of the Caterham and Leavesden Asylums. ‘There are 
various things that may considerably lessen the cost of maintenance in a 
chronic asylum. I should say that probably the expense would be reduced by a 
fifth or sixth as compared with what it is in an asylum receiving both curable 
and dangerous patients. Dr. Parsey has spoken with much higher authority, 
but probably kept an account of the two departments so separate that he can 
say how much was the cost of one and how much the cost of the other. 

Dr. Parsey—I think I may say that last year the charge at one or other of 
the metropolitan asylums, either Caterham or Leavesden, was higher than at 
Worcester for all the cases. 

Dr. Rocers—After all that has been said, there appears to me very little 
real divergence of opinion, because all the speakers have spoken of its appli- 
cation to rural districts and Scotland. I excluded this from my paper. I 
regret Dr. Duckworth Williams is not here. I am quite aware—in fact, we are 
all aware—that he has pushed this thing to a great extent, but I was not aware 
that it was to the extent of 300 or 400. But the question comes in, as I said 
at first, that of cost. Now, Dr. Clouston says they pay 6s. or 7s. in Scotland. 
We cannot do it at that price here. Dr. Bucknill says 8s. in Devonshire. 
Those are rural districts. Dr. Parsey said, in his address, that it was not a per- 
manent case in point, and I dont think the zeal and energy of Dr. Duckworth 
Williams can be imitated very successfully in Lancashire. I have not carried 
it out as a man does a hobby. Some remarks were made when I first pro- 
posed the plan to the magistrates. The clergyman of the village said, “ Surely 


448 Notes and News. [Oct., 


you are not going to turn out all these people and plant them all about the 
place.” Idid. I think there is very little difference of opinion about it, but 
if anybody feels that the resolution is such that _ they cannot take it, I 
would alter it a little. 

Dr. BuckNILL—Why not alter it in this way, say it is of advantage where 
practicable. Say it may be practicable in agricultural districts, but not in 
populous districts hke Lancashire. 

Dr. Parsry—I stated that at one or other of the metropolitan asylums the 
cost was 9s. per head. The printed statement of the Charity Organisation 
Association puts it at 7s. 6d. or 7s. 64d., but they select the two cheap quarters 
of the year. It is the half-year ending Michaelmas, 1876. You see how mis. 
leading itis. We all know the least of all is in the two middle quarters. 

The PrestpENt—Dr. Duckworth Williams was coming here to-day, but he 
was prevented by his health. 

Dr. Rocrers—I have altered my resolution to the following: “ That although 
the system of boarding out quiet and harmless pauper lunatics with families 
in their own sphere of “life may be advantageous in agricultural districts, the 
advantages are almost entirely limited to those districts. Thus the system 
only partially affects the provision for the insane poor of the chronic and im- 
becile classes in urban districts.”’ 

The resolution was then put to the vote and carried unanimously. 

Dr. Rocers—The second resolution is ‘‘ That this meeting cordially concurs 
in the resolution of the Committee of the Charity Organisation Society that 
the arrangement which has been made for idiots, imbeciles, and harmless 
lunatics in the metropolitan asylum districts is applicable in its main principle 
to the rest of England, namely, that idiots, imbeciles, and harmless lunatics 
should be removed from workhouses and county lunatic asylums into separate 
asylums, and that young persons of the first two classes should be suitably 
educated and trained.” 

Dr. SHuRtock—I second that with great pleasure. 

The resolution was at once adopted. 

Dr. Bucknitt—lI beg leave to say that we commit ourselves to a very wide 
opinion. We ought to remember that this new question will not be under 
the magistracy, but under the control of Boards of Guardians. If we 
commit ourselves to the opinion that pauper lunatics should be left under 
the control of Boards of Guardians I should, for one, like to express my dis- 
agreement with it so far. 

Dr. Parsry—I think the resolution is so very widely worded that it does not 
commit itself to anything whatever. It does not say under whose jurisdiction 
the patients are to be. My opinion is still further that there should be the 
greatest facilities offered for removing patients from one asylum to another. 

Dr. Hack Tuxn—That resolution of the Charity Organisation Society has a 
very important saving clause in its main provisions which entirely covers all 
objections. To show that it means to include the magistracy it adds, ‘‘ The 
governing body shall be composed of representatives of the local magistrates, 
of the local guardians, and persons appointed by the Crown.” 

Dr. Bucknitt—Will Dr. Rogers tell us whether he means by his resolution 
that such institutions should be placed under the Board of Guardians P 

Dr. RocErs—I merely quote the words of the report. 

Paragraph read as above. 

The PreEstpDENT—That is yews open to meet your objection, Dr. 
Bucknill: the resolution has been carried. 

THANKS TO THE RETIRING PRESIDENT. 

Dr. BuckNn1tt I wish to recall the meeting to a duty which, in the hurry of 
business, has been postponed—certainly not forgotten—that is to return thanks 
to the retiring President. I have great pleasure in proposing that this meeting 
returns its sincere thanks for the impartiality, dignity, and efficiency with 


1877. | Notes and News. 4AQ 


which Dr. Parsey has discharged the duties of President during the past year. 
No one has a greater right than I have myself to express that opinion ; from 
knowing you so well, from my anxious feeling for the welfare of this Institu- 
tion, no one has a greater pleasure than I have; from my intimate knowledge 
of my old friend, and the pleasure it has given me on seeing him in that chair, 
comporting himself in the manver he has done to the satisfaction, complete 
and entire, of every one; and the feeling is, I am sure, participated in by every 
member of this Association (applause). 

The PrestpEnt—That, gentlemen, is a, motion which I need not put to you 
as a motion at all; it will be carried, I am sure, unanimously. 

Dr. Parsrey—Atter the very flattering way in which my poor services have 
been mentioned by Dr. Bucknill, I think it would be improper of me not to 
express thanks for the honour you have conferred upon me. I have looked 
upon it as one of the most pleasing periods of my life to find myself at the 
head of an Association which I have been mixed up with for such a large number 
of years. It is very flattering to any member of the Association to find bim- 
self placed by his compeers as their President. My duties have been slight. 
Being a country member, only on one occasion have I been called to London. 
Iam sorry to say that that was in a measure a failure. There was an attempt 
by application made through myself as President to the Secretaries of the 
Royal Society, to have this Association considered in the Government grants 
made for scientific purposes. During the past year our claims were pressed 
upon them as far as we could, and I have no doubt these claims received their 
consideration. But I am sorry the answer we received was that the funds were 
not very large, and that we could not be considered. We asked to have a 
portion given for the pursuit of scientific*”subjects in connection with lunacy. 
That was the only matter out of the ordinary routine in which I was concerned. 
That was a failure. At the same time I have to thank you for the cordial way 
in which you have accepted my services. 


THANKS TO THE PRESIDENT, &c., OF THE ROYAL COLLEGE OF 
PHYSICIANS. 


Mr. Moutp—I move that our most cordial thanks be given to the President 
- and Fellows of the Royal College of Physicians for the use of these rooms. 
We cordially express our thanks to them, and hope they will, year by year, 
continue to us the same favour (cheers). 

The proceedings then closed. 


THE WILLARD ASYLUM. 


The following extract from a letter of its correspondent at Albany, 
to the “ Springfield Republican,” of October 13, 1876, is interesting 
in itself, and as showing the interest taken in such matters, and 
the current views about asylums in America :— 


Within the last week I have seen the two largest collections of the chronic 
or incurable insane which are to be found anywhere in the United States, with 
perhaps the single exception of the New York City Lunatic Asylum on Black- 
well’s Island. I do not know the exact number maintained there, but suppose 
it to be thirteen or fourteen hundred. ‘he two other establishments which if 
have just visited are the insane departments of the Blockley Alms-housein Phila- 
delphia—where I found 1,175 chronic insane persons on the | 18th le artieane 
and the Willard Asylum, on the east shore of Seneca lake, in the township = 
Ovid, where I found just about the same number (1,178), on the 22nd 0 
September. In the Blockley Alms-house, where the insane department ne 
euphonically called the “ Philadelphia Hospital,” nearly 1,200 patients, chie 7 
paupers, are cooped up in huge buildings, with small yards, giving scarcely 


450 Notes and News. [Oct., 


space enough for drying their clothes on washing-day—and with little or no 
employment or amusement. They are kindly treated, and are under the care 
of a medical superintendent, as all the insane should be, but something more 
than 10 per cent. of them die in a year, and those who survive lead dull and 
stagnant lives, with far less comfort and freedom than they might enjoy in 
different surroundings. At the Willard Asylum, on the contrary, the buildings in 
which nearly 1,200 insane persons (chiefly paupers, and nearly all incurable) 
pass their lives, are scattered over a pleasant farm, a mile in length, in detached 
buildings, none containing more than 500, while the smallest contains about 150. 
Instead of being cooped up within stone walls or in narrow yards, they have 
the range of this farm of nearly 500 acres, and such of them as are able to 
work, assist in: cultivating the soil, gathering the crops, and performing the 
numberless tasks that belong to a great colony such as this’is. It isa colony, 
I mean in the French sense, that is, a rural community, living upon its own 
land, and cultivating that, and resembles in some degree, the famous ‘ colony of 
Fitz-James” at Clermont, in France, where between 1,000 and 2,000 pauper 
insane have long been supported, and have contributed almost the whole cost 
of their maintenance by their farm labour. It is quite probable that Dr. John 
B. Chapin, the real founder of the Willard Asylum (although it bears the name 
of another physician, now dead) had the Clermont colony in mind when planning 
the establishment which he now directs on the shore of Seneca lake. In many 
respects, however, it differs widely from its French prototype. It may also be 
called, as I believe it has been, “the American Gheel,” though it is much smaller 
than that famous “city of the simple” among the wastes of Belgium. It re- 
sembles Gheel more in its spirit and aim than in its circumstances; and it is,in 
fact, a well-managed hospital for the incurable insane on a new plan, and with 
“some remarkable advantages over the old system of hospital building and 
management. 

About a dozen years ago, several of the physicians and philanthropists of 
New York, scandalised at the condition of the insane poor in the county alms- 
houses of that State, began to agitate for their removal to a better place of 
treatment. The state medical society took up the question, andits secretary, 
Dr. Willard, a young man who had madea good reputation in the war, was 
authorised by the Legislature, in 1864, to investigate the whole subject. Dr. 
Willard’s report, presenting a mass of painful facts concerning the treatment 
of the insane in the New York poor-houses, was published in 1865, and led to the 
passage of a law called “ The Willard Act,’ by which a new asylum, specially 
designed for the chronic or incurable insane, was authorised, and the money for 
its commencement was appropriated. Dr. Chapin, at that time associated with 
the late Dr. Cooke in the management of aprivate lunatic asylum at Canandaigua, 
was appointed by Gov Fenton as one of the commissioners to build the new 
asylum. He had in his mind a distinct plan for it, which has been carried out 
during the past ten years, in the face of many obstacles of all kinds; and the 
Willard Asylum, as it now stands, must be regarded as the development of Dr. 
Chapin’s idea concerning the medical and economical care of the chronic insane 
poor. Since the problem presented in New York was in substance the same 
that we find in Massachusetts, Pennsylvania, and all the older States—the same 
that England, France, and Germany are now wrestling with—it will be well to 
take notice of the way in which Dr. Chapin has solved it. 

The law of 1865 consigned to the Willard Asylum only the chronic pauper 
insane. The recent cases, supposed to be curable, by the same law are directed 
to be sent to the State Lunatic Asylum, at Utica, and thence, if pronounced 
incurable, or after two years’ treatment, to this asylum. The intent of the 
law is clear; the poor-houses were to be emptied of insane persons, and under 
this law, hereafter, all the pauper insane, chronic and recent cases alike, are to 
be provided with proper homes and care by the State. Connected with the 
Willard Asylum is a farm of 475 acres. The buildings are located at different 
points on the farm; plain, substantial buildings adapted to the care of the 


1877. ] Notes and News. 451 


insane, and so arranged as to be comfortable, safe, and convenient. “We 
do not see,” said the trustees of the asylum, five years ago, “either the 
necessity or propriety of buildings, palatial in outside ornament and cost, 
for the use of the pauper insane. We recommend less expensive buildings, 
yet equally convenient, grouped in different localities, contiguous to the 
gardens and orchards, where many of the patients could be most profitably 
employed. We believe such an arrangement of detached buildings for the 
permanent homes of the pauper insane will be in all respects advantageous. 
It will prove economical by lessing the first cost of the buildings per capita. It 
will lead to a more perfect and better classification. It will more perfectly and 
efficiently utilize the labour and render it most productive. The aggregation 
of all the pauper insane now in the State here, and then their segregation into 
detached groups of branch buildings, is a practical measure. The adoption of 
this scheme offers these paramount advantages :— 

“First. The removal of all the pauper insane from the poor-houses. 

‘Second. Vastly better and most comfortable homes, care and treatment 
for this unfortunate class, than they could possibly have in the poor-house. 

“Third. A better classification of the insane, thereby increasing their com- 
fort, the chances of their cure, at the same time realising more fully the value 
of their labour. 

“Fourth. The bringing allunder a single responsible direction and control 
would ensure the best combination of experience, economy and skill in their 
care, treatment and support of the whole. 

“Fifth. The relieving the poor-houses of a burden, not to say a 
nuisance, it makes them better and safer. homes for the paupers who are 
not insane.” 

These results were undoubtedly in the mind of the founder of this charity ; 
and the plan was broad and comprehensive in design. The results, thus far, 
show that it was also practicable, for it has been so long in operation as to 
demonstrate its entire feasibility and its general success. The system of 
detached buildings, or wards outside of a main hospital building, is no longer a 
mere theory ; for at this moment more than 600 patients are comfortably cared 
for in such detached buildings at the Willard Asylum. This is more than can 
be taken care of in either of the two new Massachusetts hospitals, yet look at 
the difference in cost of construction. The Worcester hospital alone, finished 
and furnished, will have cost more than 1,800,000 dols., the Danvers hospital 
more than 1,700,000 dols—while these detached buildings have cost lest than 
350,000 dols. For an outlay of no more than 500 dols. per patient, the State of 
New York has thus provided, in groups of detached buildings, sufficient shelter 
and comfort, and all necessary medical and sanitary appliances, while at 
Worcester the cost of construction is more than 2,500 dols. per patient, and at 
Danvers nearly 3,500 dols. The interest money which Massachusetts pays on 
the superfluous cost of construction at Danvers (60,000 dols. a year) would pay 
the board at Willard of nearly as many patients as the Danvers hospital ought 
to contain. Yet the annual cost of maintaining 400 patients at Danvers or at 
Worcester in the new buildings will probably be as great as that of maintaining 
800 at Willard. 

Of the 1,173 patients whom I found at the Willard asylum, 679 were women 
—nearly three-fifths of the whole. Of the 500 men but a small minority are 
able to do a day’s work, and probably the majority of them can do little or 
nothing. The same is true of the women. Yet the whole farm is carried on 
chiefly by the labour of the men, while the women do most of the indoor work. 
The attendants are about as many in proportion to the patients as at Taunton, 
and the cost of maintaining the whole establishment will be, this year, less 
than 175,000 dols, for an average of about 1,050 patients. The counties pay 
8 dols, a week for the board of the patients—-about 30 cents a week for clothing 
and breakage, while the State keeps the buildings in repair, and pays a few 
thousand dollars for the salaries of the chief officers. The whole cost is about 


A52 Notes and News. [Oct., 


3°50 dols. for each patient, which is precisely what the State pays in Massa- 
chusetts for the board of the pauper patients at Northampton and elsewhere. The 
interest charge on the cost of the establishment is about one dol. a week for 
each patient; which is not far from the charge at Northampton. At the new 
Worcester hospital this interest charge will be nearly 3 dols. a week, and at 
the Danvers hospital it will be about 4 dols. a week for each patient. The 
State pays this charge both in Massachusetts and New York. In my opinion 
the Willard Asylum is too large, and J even doubt whether there is any economy 
in managing an establishment with more than 500 patients, but the usual evils 
of large institutions are not visible at. Willard—so well does Dr. Chapin keep 
his work in hand. There are, in fact, four separate establishments on this one 
estate, and when the new group of detached buildings is completed and occu- 
pied, next summer, there will be five separate buildings or groups, capable of 
containing 1,450 patients. The farm is, in fact, dotted with buildings, and 
looks like a manufacturing village rather than an insane asylum. The steward 
lives in a separate house, built of bricks, and costing less than 5,000 dols., but 
far better for a family than the quarters usually assigned to such an officer in 
the hospital-palaces which superintendents delight to build. Several of the 
medical officers and other officers of the higher grade live in the detached 
buildings, and the attendants take their meals among the patients. The farm, 
which was originally bought for a State agricultural college, is well cultivated, 
though much of it is still covered with wood. The location is exceedingly 
pleasant, close by Seneca lake, and the buildings are not perched on the top of 
steep hills, as is the expensive fashion in Massachusetts. What was paid for 
grading and road-building at “ Hawthorne hill’ in Danvers would have bought 
two or three farms like that at Willard, the cost of which was 50,000 dols. 
There is no city or large town near, and consequently no convenient market, so 
that the supplies of meat, poultry, etc., must be furnished on the spot, and 
there are large slaughter-houses and poultry-yards. The whole establishment 
has the air, except for its factory-like buildings, of a great inland farm, as it 
really is. 


HABITUAL DRUNKENNESS. 


We have received from Dr. Joseph Parrish, of New Jersey, U.S., an open 
letter to John Charles Bucknill, M.D., of London, on the subject of Habitual 
Drunkenness. The following are extracts from Dr. Parrish’s letter :— 

“ My dear Sir,—Reports of your speech at Rugby, before the Temperance 
Association, of your correspondence with Dr. Clouston, and your essay in the 
‘Contemporary Review for February last, on Habitual Drunkenness, etc., are 
before me. 

“You seem to have used these means of communicating with the medical 
profession, and to some extent with the general public of Great Britain, for the 
purpose of discrediting the testimony of witnesses from this country before 
what is popularly known as Dr. Dalrymple’s Parliamentary ‘Committee on 
Habitual Drunkards,’ in 1872, and of injuring the cause which they represented 
before said Committee. 

‘““As some of your statements are, to say the least, unguarded, and as the 
impression they are evidently meant to convey, must be false and injurious, I 
feel it to be due to my colleague and myself, who appeared before the Com- 
mittee above referred to, and to the Inebriate Asylums and Reformatories in 
this country, that your erroneous statements should be corrected. 

“On several occasions, both in your own land, and during your recent visit to 
America, you have publicly expressed your right to make open enquiry into the 
‘credibility’ of ‘ statements’ made by Dr. Dodge and myself before the Com- 
mittee of your own Parliament, in answer to important questions which were 
submitted to us by the Committee. You also accuse us of being ‘deputed to 
teach’ the English people ‘how to change the laws of your country,’ etc., and 


1877.] Notes and News, 453, 


of ‘vaunting the absolute cure of thirty-four per cent. of their (our) diseased 
drunkards, and pushing their (our) creed, and their (our) system, with unblush- 
ing propagandism,’ etc. 

“For this reason I shall address you by an open letter. I ghall spend no time, 
however, in attempting to prove the ‘credibility ’ of the American witnesses 
before the Committee of your House of Commons. That ig sufficiently recog- 
nized in this country, and as the Committee were abundantly satisfied of it, 
before they sent for the witnesses, and by intercourse with them were reassured 
of their position, your sneering reproach has no weight. As to our being ‘de- 
puted to teach,’ etc., I have only to refer you to the following official commu- 
nication, which was addressed both to Dr. Dodge and myself :— 


“* House of Commons, London, March 2, 1872. 
“«S1r,—T am directed by the Select Committee of the House of Commons, 
appointed to consider the best plan for the control and management of habitual 
drunkards, and of which Committee Dr. Dalrymple is chairman, to request your 
attendance before them for the purpose of giving evidence. The Committee would 
be glad if you could make it convenient to attend upon them during the week 
commencing the 15th of April. Should this be inconvenient, on as early date 
after as convenient to yourself, The days of meeting of the Committee are 

Tuesdays and Fridays. 
“¢Tam, Sir, your obedient servant, 
“*« ArntHuR F. Kinescorr, Committee Clerk.” 


“But for such a request, from such a source, we should not have left our own 
land, on such an errand, and I am quite sure that no member of the Committee 
will sustain you in your ill-natured reference to our testimony in this connec- 
tion, as the relation between the British Committee and the American witnesses 
was of the most agreeable and satisfactory nature. 

“But to your several statements. You assert that your observation of 
American Inebriate Asylums was, ‘that the gentlemen confined in them were 
generally rather proud of their position,’ etc., and that ‘they were there under 
a very lazy and shameful pretence of curing a disease which did not exist, by 
remedies which were not applied.’ In the very next sentence you refer to the 
absence of restraint and confinement, and of the perfect freedom of inmates to 
walk out, procure liquor and bring it in to their own rooms. The evidence 
which you offer for this is, what ‘a friend told’ you about being invited to take 
‘his choice of spirits,’ by four of these unfortunate inebriates, during a visit 
he made to one of these Asylums ‘for the City of New York.’ 

“But you have overlooked the fact that this interesting social interview 
between your friend and his friends, occurred at an institution that was never 
represented in the ‘American Association for the Cure of Inebriates,’ and 
hence the story has no place as evidence against the Association whose ‘creed’ 
and ‘system’ give you so much pain. You seem also to have forgotten that 
said ‘Asylum for the City of New York,’ as you term it in the Review article, 
is located on an island on the Hast River, where there is no saloon or other 
place where spirits are sold, or given away.” 

Dr. Parrish then goes on to discuss at length the vexed question whether 
intemperance is disease, coming to a distinct conclusion in the affirmative. He 
points out that the American Medical Association, a body of physicians repre- 
senting every State and different sections of all the States of the Union, has, 
like the British Medical Association, passed a resolution affirming the propriety 
of establishing institutions for the treatment of inebriates. The Association of 
Medical Superintendents of American Asylums has recently followed in the 
same track, and he quotes other resolutions to the same effect from other impor- 
tant public bodies. He concludes his letter as follows :— 

“T now proceed to notice your reference to what you call the change in the 
‘condition and position of Inebriate Asylums,’ in the United States, since Dr. 
Dalrymple’s visit in 1871. You speak with the coolest complacency of ‘the 


XXIII. 


AD5A Notes and News. [Oct., 


State Inebriate Asylum at Media,’ as ‘supported partly out of public funds,’ 
-and add, that it ‘had been suppressed because it was said to be a failure.’ 
In every word of this statement you are entirely at fault. The Sanitarium at 
Media was not a State Institution. It never received a shilling from the 
public treasury. It was never ‘suppressed.’ In my answer to question 
-2,586, before the House of Commons Committee, in 1872, I said distinctly, ‘It 
isa private Asylum; it has an Act of Incorporation by the State to give it 
legal position and recognition, but it is managed by a Board of Corporators, 
-purely as a private enterprise.’ If you consult your Blue Book and pursue 
-your investigations to other parts of the testimony, you will learn more about 
the institution than perhaps you care to know. It did not prove ‘a failure.’ 
On the other hand, it did discharge thirty-three per cent. of its inmates, most 
of whom are to-day living, and are honourable and productive citizens. Its 
Board of Directors hag never been dissolved, and it still holds its chartered 
rights. It was closed voluntarily, because it was expensive to maintain on a 
private basis, and it was the desire of its Directors to see it conducted under 
the auspices of the State. I was the President of its Board of Directors, from 
the time of its inception to its close, and knew personally every inmate. I 
frequently visited the Capitol during the sessions of the Legislature, had 
repeated interviews with the Governors and with the Committees on appropri- 
ations, and what I have said elsewhere, I repeat here, to wit: 

“The reason the Sanitarium and other valuable institutions in Pennsylvania 
have failed to receive the State aid that they deserved, is owing in great 
measure to the exacting demands for immense sums of money for the insane. 
You say, also, that the Asylum on Ward’s Island ‘had been ordered to be 
suppressed for the same reason,’ but my previous reference to that Institution 
is sufficient. It was never so far acknowledged as an Inebriate Asylum by its 
officers, as to induce them to affiliate with those who have believed in and 
promulgated the disease doctrine. You speak also of changes in the law, and 
refer especially to ‘the New York Statute’ as being declared ‘ unconstitutional, 
and it is, therefore, now never actedupon.’ In reply to this sweeping declaration, 
which conveys the impression that there is no law in New York on the subject, 
Icopy for your information the following extract from the comprehensive law, 
which may be found in the 


‘© REVISED STATUTES OF THE STATE OF NEW YORK IN RELATION TO THE CUSTODY 
AND DISPOSITION OF THE EsTaTES OF IpIoTs, LUNATICS, PERSONS OF UN. 
SOUND MIND, AND DRUNKARDS. 


“ “8 1. The supreme court shall have the care and custody of all idiots, lunatics, 
persons of unsound mind, and persons who shall be incapable of conducting 
their own affairs in consequence of habitual drunkenness, and of their real and 
personal estates, so that the same shall not be wasted or destroyed; and shall 
provide for their safe keeping and maintenance of their families and the educa- 
tion of their children, out of their personal estates, and the rents and profits 
of their real estates respectively. 

“*¢§ 2. Whenever the overseers of the poor of any city or town in this state 
discover any person, resident therein, to be an habitual drunkard, having pro- 
perty to the amount of two hundred and fifty dollars, which may be endan- 
gered by means of such drunkenness, it shall be their duty to make applica- 
tion to the supreme court for the exercise of its powers and jurisdiction. 

“8 3. If such drunkards have property to an amount less than two hundred 
and fifty dollars, the overseers may make such application to the county court of 
the county, which is hereby vested with the same powers in relation to the 
person and real and personal estate of such drunkard, as are by this title con- 
ferred on the supreme court, and shall in all respects proceed in the like 
manner subject to an appeal to the supreme court.’ 


“J might quote similar statutes from the law records of various States in the 


1377.| Notes and News. 455 


Union, but the limits of this letter will not permit a complete exhibition of the 
legal view of the case. 

fs It is very evident, my dear Doctor, that you did not visit our Institutions 
with the purpose of learning much about them. You did not see them in any 
Spirit of earnest enquiry and examination. You display a very discreditable 
ignorance of their polity, and of the laws by which they were created, and 
under which they exist. 

“You did not sit down as did Dr. Dalrymple, with the Officers and Directors 
of Asylums, examine their statistics and records, and converse freely and fairly 
about their work. I have yet to learn from a single Institution that you 
visited, that you made any real search into the facts concerning a single 
case, and that you made any medical or clinical enquiries, or gave yourself 
time to examine and study recorded facts. According to your own state. 
ments in the papers before me, you took what ‘the physician to a neighbouring 
hospital told’ you about the use of spirits, and ‘concluded that these American 
pene Asylums seemed in some way to be part of the great whiskey 
raud.’ 

“You also talked with some of the disaffected inmates of Asylums, who, 
according to your own expressed estimate of them, are unworthy of confi. 
dence, and took their testimony as conclusive. Your superficial and hasty view 
covered only six institutions, and the fact that since Dr. Dalrymple’s visit the 
number of them has increased, and that the preparations for the organization 
and construction of new ones have been commenced in several States, entirely 
escaped your notice. Under these circumstances you cannot censure us on 
this side of the water for calling to your mind, and to the mind of the public, 
your extraordinary, and as it seems to us, unpardonable oversight. 

“Had you visited this country, on your professed errand of enquiry after 
truth, in the same spirit and with the same genuine philanthropy that 
prompted the late Dr. Dalrymple, you would have pursued a similar course of 
enquiry, and returned to your country, doubtless, with a confirmation of the 
same views and experience that he conveyed to his Committee, and through it 
to the world. 

‘“‘ And now, in conclusion, permit me to say that the work among us, in this 
behalf, was not entered upon in any spirit of rivalry with ‘Lunacy Commis- 
sioners,’ in Scotland, or elsewhere. Nor did we place ourselves in antagonism 
with Lunatic Asylums and their management, in this or any other country. We 
realized in common with the whole world of philanthropy this dreadful 
scourge of intemperance. We were compelled to admit that all was not 
being done that might be done to mitigate its sorrows and reduce its burdens. 
We were willing to aid if we could. From the standpoint of medical men, we 
thought we saw a vulnerable point of attack. We believed, as I have 
endeavoured to show you, that there were morbid impulses, morbid conditions, 
and morbid results, in the chain of causation and consequence, which it was 
our duty to investigate, and, if possible, to relieve. We hail with pride and 
gratification every effort of every kind, from every source, that promises 
palliation or modification of the direful calamity with which mankind is 
scourged in this fact of inherited and acquired propensity to alcoholic excess, 
and count our instrumentality as but one among many that are being brought 


to bear upon the evil. With these views we think it strange that alienists, 


either abroad or at home, should be aggrieved because our efforts have been in 


a good degree successful, and are attracting favourable attention, and it is still 
a source of regret that this class of scientists remain In doubt as to facts 
which have been verified by all the known means of evidence within the range 
of our profession, and which the popular mind accepts as well established. 
‘“We shall continue our work in the same spirit of earnest and faithful 
enquiry, and shall, at all times, be ready to meet objections, and consider them 
fairly, from whatever quarter they may come. We congratulate ourselves that 
such men as Drs. Peddie, Clouston, Boddington, Playfair, and others, who are 


A456 Notes and News. 


distinguished for fairness and research on your side of the Atlantic, have 
already given their honourable names and their vast influence in support of 
this noble cause, and I feel assured that when you allow yourself time and 
reason to secure the removal from your own vision of the mist of prejudice, 
you will not be content to stand with a diminutive minority of the British 
Medical Association on this very important subject. 
“ Yours truly, 
“JOSEPH PARRISH. 
“ Burlington, New Jersey, U.S. A. 
“May 10, 1877.” 


KNAVERY AND SUPERSTITION. 


A very curious tragedy has lately occurred in the town of Cervera (5,000 
inhabitants), Province of Logrono. The details are given by a number of 
newspapers, but the following is an account translated from the “ Im. 
parcial :’—“ A rich proprietor, well known in the country for bis advanced 
opinions, refused on his death-bed to accept any spiritual help, notwith- 
standing the prayers of his family and the advice of his best friends. 
There was a moment, however, when it was thought that the patient had 
modified his determination; the priest of the parish presented himself by the 
side of the dying man, but, finding that he persisted in his refusal, he 
retired precipitately, saying aloud to those who were present that, after the 
death of the reprobate, the devil would come in ,person to take charge of 
his body and conduct him to hell. Two days after the family were watch- 
ing over the corpse of the relation they had lost, when the door of the 
mourning room was suddenly flung open, and an indefinable being dressed in 
scarlet, smelling (apestando) of burnt sulphur, and dragging an immense tail, 
presented himself before the moarners, who, full of terror, rushed away 
from the room. On hearing the screams of these people, a man-servant, 
who was in the next room, snatched up a revolver and entered the scene 
of the scandal. As may be supposed, he stood terrified at the sight of the 
devil; but thinking that it would be better to kill his infernal majesty than 
be killed by him, he fired three shots at him point blank (a boca de jarro). 
Shortly after the family of the deceased found themselves face to face with 
the sacristan of the parish, degwisé en diable, with three shots in his breast 
and the foam of death upon his lips. The authorities at once interfered, 
and took four priests into custody. On the following day the unhappy 
sacristan was buried.” 


Appointments. 


Crerty, R.W., M.R.C.S.H., L.S.A.L., has been appointed Assistant Medical 
Officer to the Haydock Lodge Lunatic Asylum, near Newton-le-Willows. 

LinueY, G. H., M.D., M.R.C.P.L., has been appointed Assistant Medical 
Officer to the Warwickshire Lunatic Asylum, Hatton, vice Jones, resigned. 

Murpocu, W.,M B., C.M., has been appointed Assistant Medical Officer to 
the Perth District Lunatic Asylum, Murthly, vice Daniel, appointed to the 
Derbyshire Lunatic Asylum, Mickleover. 

Ripvuey, J. H. W., M.R.C.S.E., has been appointed Medical Superintendent 
of the Dunston Lodge Lunatic Asylum, near Gateshead-on-Tyne, vice Blackett, 
deceased. 


Tyner, R. G., L.R.C.S.1., L.K.Q.C.P.1., and L.M., has been appointed 
Assistant Medical Officer to the Wiltshire Lunatic Asylum, Devizes, vice 
Masterton, resigned, ‘ 


THE JOURNAL OF MENTAL SCIENCE, 


[| Published by Authority of the Medico-P sychological Association] 








No. 104, "=¥,S5RES, JANUARY, 1878. Vou. XXIII. 








PART 1.—-ORIGINAL ARTICLES. 


The Evidence Given Before the Select Committee of the House 
of Commons on Lunacy Law, 1877. 


Most of our readers are aware that on the 12th February, 
1877, on the motion of Mr. Lewis L. Dillwyn, M.P. for 
Swansea, a Select Committee was appointed by the House 
of Commons, “ To enquire into the operation of the Lunacy 
Law, so far as regards the security afforded by it against 
violations of personal liberty.” That Committee consisted of 
Mr. Stephen Cave, chairman, Dr. Lush, Mr. Woodd, Mr. 
Ramsay, Mr. Leighton, Mr. Tremayne, Mr. Herschell, 
Mr. Goldney, Mr. Joseph Cowen, Mr. Kavanagh, Mr. Butt, 
Mr. Birley, Mr. Hopwood, Sir Trevor Lawrence and Mr. 
Dillwyn. It was generally understood at the time, and 
came out more clearly in the course of the enquiry, that the 
chief reason for the appointment of this Committee was the 
fact that strong statements as to the inefficiency of the 
present Lunacy Acts for the protection of the personal liberty 
of sane people had been confidently made and most indus- 
triously circulated among the public and Members of Par- 
liament by a few persons and a small society, who said they 
could produce facts in support of their statements. It was 
generally understood at the time, and came out also during 
the enquiry, that most of those persons had had personal 
experience of the deprivation of personal liberty authorised 
by these laws. It certainly could not be truthfully said that 
there was any kind of public excitement on the subject of 
lunacy, or any public demand for an enquiry, nor had any 
lunacy cause célebre occurred recently to draw attention to 
the subject. To most persons engaged in administering the 
Lunacy Laws, the appointment of the Committee came as a 
surprise, and most of them, at least in the provinces, did not 
look on it'in any kind of serious light. We fear they thought 
of it chiefly as a sop thrown to satisfy a few noisy impor- 
tunate lunatics who were at large, so that few of them offered 


XXIII. 31 


458 The Lunacy Laws, 1877. [Jan., 


their evidence, or made any preparation to lay the results of 
their experience before the public. To this is due the fact 
that the non-official persons who gave their evidence before the 
Committee seemed to have been taken quite at hap-hazard, 
and that there was no proper representation of the different 
classes of persons who administer the Lunacy Laws, or have to 
do with lunatics throughout the country. Far too many of 
certain kinds of people were examined by the Committee, 
and far too few of others. This is self-evident when, in looking 
over the list of witnesses, one finds that 17 out of the 59 
witnesses were Government officials; that out of the 26 
members of the medical profession examined, all but three 
were specialists, and 14 were London men. The medical 
profession in general, apart from the specialty of psychiatric 
medicine, were as nearly as possible unrepresented, for only 
one of the three of their body was examined on anything 
but special points connected with individuals. And this in an 
enquiry as to how the Lunacy Laws affect the liberty of the 
subject, when 180,000 people have been certified insane 
and their liberty taken from them by the general body of 
the profession, under the authority of the Lunacy Act of 1845 ! 
Of that great body of medical officers of unions who certify 
nearly all the pauper lunatics, not one was brought before 
the Committee. Out ofthat most intelligent, public-spirited 
and large minded body of country gentlemen who compose 
the Committees of Visitors of the County Asylums, and who 
have had the whole labour of carrying out the Lunacy Acts 
in the English Counties, only one was examined on any 
general question. Not a single Visitor of a provincial 
licensed house was called to be examined as to how their work 
was done. Nota single independent representative of the 
legal profession, which has practically so much to do in 
carrying out the Lunacy Acts and managing the property of 
the insane, was asked to give his evidence. The whole body 
of Poor Law Guardians, who levy the lunacy rates, and repre- 
sent the public as regards their expenditure, were conspicuous 
by their entire absence. One might have thought that a 
few really recovered lunatics could have been got to give a true 
and impartial account of their treatment while insane. As 
for Ireland, not a doctor but Inspector Nugent, not an 
official of any Asylum, public or private, not a governor of 
an Asylum, not even a half-cured Irish lunatic, appeared to 
tell how the insane of that country are treated. Scotland 
was represented by its two Medical Commissioners, and one — 


1878. ] The Lunacy Laws, 1877. 459 


asylum physician from the provinces. Surely one or two of the 
Sheriffs, those all important officials by whose signatures every 
lunatic in Scotland is deprived of his liberty, might have 
been got to speak for themselves as to whether they acted 
“ministerially ” or “judicially ;” and whether they read the 
aa certificates through or not, before they signed their 
orders. 

The enquiry was a most important one, and cannot be 
treated lightly bv any one interested in the administration of 
the Lunacy Laws or in the welfare of the insane. Its scope 
was at once enlarged by the Committee from the question of 
the personal liberty of British subjects, as affected by the 
present Lunacy Laws and practice, to that of the general 
treatment of persons of unsound mind throughout the 
country in all ranks of life, the modes in which their in- 
sanity is determined, their liberty abridged, their civil 
rights lost and restored, and their power of communicating 
with their friends by letter and visiting. The vast amount 
of most valuable information and experience put on record 
in the Report from the witnesses who were examined, only 
makes it the more to be regretted that it was not made 
complete by having a more representative class of witnesses ; 
but as it is, it will mark an epoch and form a landmark in the 
history of Lunacy in Britain. 

Who is to blame for the serious omissions in the list of 
witnesses? It seems, in looking over some parts of the 
report, as if the Committee had allowed every one with a 
erievance or a crotchet, or who had anything to gain, to come 
before them, but had taken no trouble to search out that class 
of witnesses who would not come to offer themselves, but 
whose testimony and experience would have been most 
valuable. aaet 

The Report forms a vast Blue Book of 582 pages, containing 
11,642 questions and answers. There is of course much re- 
petition, and it is an absolute chaos as to the order in which 
the subjects were taken up by each witness. The various 
members of the select committee were evidently most vari- 
ously qualified for their tasks. There is no doubt that the 
Committee was most fortunate in its Chairman. Mr. Cave 
showed a knowledge of the subject and a business-like mode 
of sticking to the essentials of the matter in hand, as well 
as a penetration in bringing out the less obvious 
aspects of a question, that were of most essential service in 
the inquiry. Next to him, Dr. Lush showed great ability, and. 


460 The Lunacy Laws, 1877. (Jan., 


a mastery of the subject. The medical profession had no 
reason to be ashamed of its representative on the Committee. 
Lis special knowledge was of great service, though, as might 
have been expected, he did some special pleading in his mode 
of putting some questions about licensed houses. Sir Trevor 
Lawrence, Mr. Leighton, Mr. Tremayne, and Mr. Ramsay, 
were the other members of the Committee who took the 
most active part in examining the witnesses. Mr. Dillwyn 
chiefly asked questions relating to improper detention in 
asylums, and to the possibility of the artificial production of 
insanity and “dementia” by drugs. 

The task of preparing a digest of the evidence for this 
Journal has been one of no slight labour, difficulty, and re- 
sponsibility. The members of the Medico-Psychological Asso- 
ciation were fairly entitled to expect such a digest, and this 
Journal would have failed in its duty had this not been at least 
attempted. No body of men in the kingdom are so directly 
interested in the working of the Lunacy Laws and the 
welfare of the insane as are the majority of our members, and 
no body of men would profit more in reputation and in the 
comfort of their daily work among the insane by wise 
Lunacy legislation and the public confidence engendered 
thereby. ‘Those who in the future, too, may have to refer to 
this Journal will expect to find a record of our Parliamentary 
Lunacy stock-taking of 1877, the first since 1859. 

In drawing up such a summary of the evidence as will be 
likely to be useful to medical men, two courses were open: 
the one was to extract or refer to the chief points in the 
evidence of each person examined, whose opinion or experi- - 
ence was entitled to consideration, the other to bring 
together the opinions or experience of all such persons on 
each question about which evidence was given. Both plans 
have their advantages, and to make a perfect summary of the 
evidence both would require to be carried out; that would 
extend this article beyond practicable hmits. On the whole 
we think the first plan is the best and the most likely to pre- 
sent the evidence in an interesting form. The personal 
experience and opinions of such veterans in Lunacy Law- 
making, administration and treatment as Lord Shaftesbury, 
Dr. Bucknill, Mr. Wilkes, Sir James Coxe, Dr. Nugent, Dr. 
Lockhart Robertson, Dr. Mitchell, and Dr. Blandford should 
not be broken up into fragments, but stand together as unities, 
no matter how wide the range of subjects on which each 
spoke. Such men have so connected their names with all 


1878.) The Lunacy Laws, 1877, 461 


that is good or distinctive in the treatment of the insane 
during the period of which this report is a review, that the 
future historian of the subject will wish much more to see 
what those men said, than any general sammary of evidence 
on most of the questions now uppermost. This must be our 
excuse for the length of the extracts and of the article. 

At the end we shall attempt to review the evidence as a 
whole, and endeavour to make out what matters are in need 
of being set to rights, and what suggestions can be made to- 
wards improving our Lunacy Laws. 

The first witness called was Mr. C. 8. Perceval, Secretary 
to the Commissioners in Lunacy. He gave a summary of the 
Lunacy Acts and of the work of the Commissioners. This and 
all his other evidence was most clear and business like. The 
Commissioners are without doubt fortunate in their Secretary. 
He brought out the fact of which so much was said after- 
wards, that a total stranger can give the “order” for the 
deprivation of liberty of a British subject who is insane— 
though only a very minute proportion of such orders are 
actually given—that this order does not need to be counter- 
signed by any public authority whatever (116-7*), and that it 
is no one’s duty at present to make any inquiry of this stranger 
why he has signed it (118). The witness thought there ought 
to be a provision against this. He also brought out the curious 
fact, that there is no statutory provision for taking a patient 
to an asylum (126), and that the police have no authority 
whatever in the case of a private patient; we believe he might 
have added of a pauper patient. In his opinion, the medical 
certificates are the most important safeguards to the per- 
sonal liberty of the subject (148), and the present forms 
are sufficient for that purpose. He said that the Commissioners 
are entitled to ask the amount of payment made for a private 
patient, and frequently do so (217). He declined to speak as 
to the profits made. He admitted that the Commissioners 
know of, and by implication approve of, the rough justice 
of higher payments in the case of some of the patients, main- 
taining in better circumstances those who pay less, both in 
hospitals and licensed houses. He lays the blame of a homi- 
cide or suicide by a patient on leave from an asylum on the 
medical attendant who advised the leave (257). He averred 
there never were any difficulties about “friends” visiting 
patients in licensed houses, unless for medical reasons (262). 


* The numbers always refer to the questions in the Blue Book. 


462 The Lunacy Laws, 1877. [Jan., 


316. In the case of outsiders, or in the case of societies, or persons 
like Admiral Saumarez, who made it their business to go and find 
out whether certain people were properly confined or not; how would 
the Commissioners in Lunacy act in such cases as those ?—The Com- 
missioners would probably refuse to make any order on the ground 
that the person had no /ocus standi at all. 


Dr. Fox in his evidence, as we shall see, gives a different 
account of the actual practice. The following extract brings 
out the Commissioners’ view as to what is sometimes called 
improper detention in asylums :— 


266. Nor have there been any complaints made, suggesting that 
patients have been improperly retained in the asylums ?—I do not 
know about-complaints made. The Commissioners, from their own 
observations, sometimes think that a patient ought to be allowed to 
go, and their friends sometimes think that it is not time that they 
should be discharged. It is more in the case of pauper patients that 
we hear these complaints, than in the case of private patients. <A 
near relation wishes to get the bread-winner of the family out of the 
asylum, or the husband wants to get his wife back, because he finds 
it very uncomfortable to be living without her, and he wishes her to be 
discharged, whether she is quite cured or not; those are the kind of 
complaints we get in much larger numbers than those relating to 
the undue detention of private patients. 

267. You do not think that there is any ground for believing that 
people- who are once received are improperly retained in these 
houses ?—There may be sometimes a question of degree, whether the 
patients might not have been discharged a short time sooner than 
they were discharged ; but with that qualification I should say not. 


The following extracts show his views as to a public officer 
signing the order of admission of a patient :— 


304. Are you of opinion that it would be desirable as to prevent- 
ing the evils complained of by Lord Shaftesbury, if in the case of a 
certificate warranting the owner of a house to receive a patient, that 
certificate or that order should be countersigned by some public 
officer ?—That is rather a large question; but it is one which, of 
course, I have been personally considering for some time, for I know 
it has been suggested, and I really do not quite see that it would be 
any protection to the patient. It is not so in Scotland. In Scotland, 
the sheriff sees the papers and signs the order, and if the Committee 
will refer to the evidence of 1859, they will find that it is no protection. 
I refer to the evidence given by Dr. Coxe, now Sir James Coxe, 
Commissioner in Lunacy in Scotland. 

_ 805. But still if there is an order from a public officer for his 
reception, he would be responsible in some respect ?—But the question 
is how far would he be responsible. 


1878.] The Lunacy Laws, 1877. 463 


306. Do you think the order of a public officer is a mere matter 
of form ?—I know this, that the magistrates in pauper cases will very 
often not take the responsibility upon themselves at all, and will give 
no order for the reception of a patient unless there are two medical 
certificates, in which case the magistrate is bound to make the order. 

307. In that case it is merely a ministerial act ?—It is merely a 
ministerial act; and then the question arises as to any signature that 
could be devised; how far it would be a responsible and judicial act, 
or how far it would be merely a ministerial act. 

308. That is a question as to how far a public officer should 
countersign those certificates; upon that perhaps you have not 
made up your mind ?—Yes, I have made up my mind that as far as 
any plan which I have heard suggested goes, I do not think it would 
be of any use. I do not think there would be any additional protec- 
tion to the patient at all; but there are, of course, two sides to every 
question, and you would interpose an additional difficulty no doubt, if 
that is your object, upon what is hard enough already. 

309. I wish to know whether you do not think that there should 
be some public officer or some public record of the incarceration of 
people against their will?—You have a public record, but I do not 
personally think the intervention of a public officer would be of any 
material value at all to the liberty of the subject; it would certainly 
not be a material guarantee, and it would oppose an additional diffi- 
culty to the earlier treatment of insanity, which is so very important. 


He described (333) how a new license is got, and the ques- 
tions to the applicant certainly seem sufficiently searching, 
and the provisions sufficiently stringent. In fact, the general 
impression produced on any one reading his evidence 
is that he would rather not be the proprietor of a licensed 
_ house in London. They seem, from first to last, the bond 
slaves of the Commissioners in Lunacy. He thought all 
licensed houses could be bought up, but would prefer to leave 
the public their choice of asylums as they have now (348). 

He brings out the important fact that the Commissioners 
have really no control at all over the 6,526 single pauper 
lunatics scattered throughout England. They can only visit 
(which they have no time to do) and advise. He thought 
two more Commissioners should be appointed (568), and that 
a statutory power should be given to appoint temporarily 
Commissioners in case of illness. 

Mr. Wilkes, Commissioner in Lunacy, and formerly 
medical superintendent of the Stafford County Asylum, was 
next examined. He thought the ownership of a licensed 
house apart from the medical superintendentship is not de- 
sirable except under proper regulations, and that attendants 


464 The Lunacy Laws, 1877, [Jan., 


in licensed houses are “not, as a class, what they should be ” 
(674) ; but that they areimproving. ‘‘ The question (of atten- 
dants) after all, is one of payment” (682). Believed that a 
training establishment for attendants would do much good. 
Clinical instruction should be given to all medical men in 
regard to insanity (708). Like every other medical man, he 
believed strongly in the early treatment of insanity, and gave 
an unhesitating opinion that asylum treatment does not 
retard the cure of the patients, but very much the reverse 
(693). He gave the following very weighty and fair evidence 
as the result of his large experience on the subject of the prin- 
ciple of private houses and public asylums :— 


737. You said just now that in the case of pauper asylums, super- 
intendents have no reason to keep them (patients) longer than they 
can help ?—Of course their object is to discharge them. 

738. In the case of private asylums there is a direct interest in 
retaining them ?—I do not think so. 

739. There may be?—I do not think so. I think the interest of 
the proprietors of private asylums generally is to discharge them, and 
to show their list of recoveries. 

740. Do you think it is invariably so?—I do not know that it 
would be in the case of a chronic patient, who is absolutely insane ; 
of course if a proprietor had a patient of that description he would not 
like the patient to be removed to another house; I think that is a 
natural feeling, but I do not think, as far as I can judge, that if the 
friends wished to remove that patient, any obstacle is placed in the 
way. 

741. You see no objection to having a proprietor of a private 
asylum pecuniarily interested in the asylum ?—I do not see how you 
could provide otherwise for it. 

742. You do not think it ought to be done by County Boards by 
keeping the place for the care of well-to-do patients separate, utilising 
possibly the present asylums, and keeping them under public control ?— 
I presume you mean to convert them into what is called a hospital ? 

743. Yes; into public asylums, under the control of some autho- 
rised body ?—That I think is, on principle, a very important matter. 
I think if it could be effected, it is most important that all insane per- 
sons, who are so much at the mercy of others, should be in public 
asylums, and public establishments, if it could be effected, but I can- 
not see exactly, at present, how it can. I had a great deal to do my- 
self with the promotion of the Coton Hill Asylum, which is a hospital, 
and there, I am sorry to say at present, though it has succeeded as 
far as the number of patients is concerned, they are still in debt, and 
they are unable to carry out the charitable principle to the extent 

‘desired. Still, as a principle, I think the erection of hospitals is a 
most important question. 


1878. ] The Lunacy Laws, 1877. 465 


He did not approve of the mixed system of private and 
pauper patients in the same building, but thought that if 
they were in separate buildings, under the same manage- 
ment, it would work well. 

Mr, Wilkes was very conservative in his views throughout, 
and was perfectly satisfied that the protections which the law 
at present provides ‘“‘are quite sufficient to protect the 
personal liberty of the people.” 

Dr. Lockhart Robertson was the next witness. He de- 
scribed the Lord Chancellor’s visitors as being entirely subor- 
dinate to the Masters in Lunacy (823-4)—a statement as 
nearly as possible flatly contradicted afterwards by Master 
Barlow (11054). He was not so satisfied with the treatment 
of the Chancery patients in asylums as in private houses :— 


876. _ What is your opinion with regard to the treatment of lunatics 
in these asylums ?—I am not so satisfied with that as I am with the 
patients in private houses, 

877. The nature of the asylums, I suppose, is the same as those 
in which ordinary lunatics are detained ?—They are the same asylums. 

878. And there is no difference in their treatment ?—No. 

879. The only difference being the amount paid, which is generally 
larger, I suppose, in the case of Chancery lunatics ?—I do not know 
that it is larger. The Chancery lunatics are not a rich class. No, I 
should think the payment was about the average. 

880. You say you are not so well satisfied with their treatment ; in 
what respect ?—I am not satisfied that they get their money’s worth. 

881. But as to their liberty and chance of discharge ?—They are 
not nearly so well off as regards their liberty as the patients in private 
dwellings. 

882. They have not as much freedom to move about ?—No, and 
_ they have not such enjoyment of life, I think. 

887. You think that in asylums they are generally not so well off 
with regard to liberty; with regard to detention after their recovery 
would warrant their being discharged, what is your opinion upon that 
point ?—I think we have to look very sharp to get patients who are 
getting better moved out of asylums into private dwellings. I think 
our visits are very important in that way as regards the patients, and 
I think they ought to be more frequent to the asylums than they are; 
I think once a year is not sufficient for a visit to asylum cases. 


He was opposed to the consolidation of the Commissioners’ 
and Lord Chancellor’s Visitors’ offices, but it will be noted 
that his opinion would have had far more weight if he had 
not given so very insufficient a reason for it. 


889. Would it not be an advantage if the two offices (of Lord 
Chancellor’s Visitor and Commissioner in Lunacy) were consolidated ; 


A66 The Lunacy Laws, 1877. [Jan., 


there seems to be rather a waste of power; the visits overlap one 
another ?—I do not think it could be done; the difficulty would be 
with regard to the Lord Chancellor, who, being responsible for the 
patient and for his property, and for his custody, could hardly under- 
take that responsibility if the visitors were not servants of his own, 
and liable to be sent at any moment where he pleased to send them. 


The following part of Dr. Robertson’s evidence as to the 
undue detention of many patients in asylums has been much 
commented on, so we give it in full :— 


890. Have you formed any opinion as to what proportion of 
patients are detained after they ought to be discharged?—Do you 
mean of the Chancery patients ? 

891. Yes.—I do not think there are any detained after they ought 
to be discharged. 

892. With reference to the lunatics generally, have you formed 
any opinion upon that point ?—I think lunatics are detained too long 
generally in asylums, and I think a large number of lunatics who 
are in asylums, probably one-third, might be out of asylums. 
I am speaking of private patients now. 


He gave the following evidence in favour of making the 
medical certificates terminable at a certain time, and on 
renewal that they should be given by specially educated 
medical men. We believe the certificates are terminable in 
Scotland after three years, and that all the Superintendents of 
Asylums there say that this provision is of no use whatever ; 
so that if this principle was introduced into England they 
would have to be made terminable within a shorter time, for 
the provision to be of any use. 


893. TL asked a question the other day, whether the medical cer- 
tificate might be made terminable at a certain time, and renewable, 
instead of being permanent; what is your opinion upon the point ?—I 
heard you ask the question, and it struck me at the time that it was 
a most admirable suggestion. I was much struck with the question 
at the time. 

894. The objection stated to it was, that it would be an unneces- 
sary expense to those who could not afford it?—I think it would 
be a very good investment for those who could. 

895. Your opinion is in favour of it ?—Decidedly. 

896. You think, I suppose, that a more minute examination of 
the case would take place, than at an ordinary visit ?—Yes, there 
would be such a special examination by some physician who would be 
supposed to have some special knowledge of the subject. 

897. You would add to that suggestion, this—that the persons 
who renewed the certificate should be a special class, and not simply 


1878.) | The Lunacy Laws, 1877. 467 


medical men taken from here, there, and everywhere?—Quite so. I 
think they ought to have some special evidence of their fitness for 
their difficult duty. 

898. You would have the ordinary certificate left as it is for the 
first confinement, but that when it is renewed, it should be by people 
possessing a special knowledge of lunacy ?—I think so; at least 
skilled physicians. Ido not think the special knowledge of lunacy 
is so important as being a well-educated physician. 

899. People in very considerable practice ?—Yes, the leading 
men in each district. 


He made the following very important suggestion as to the 
formation of Asylums for Chancery patients, the weak 
point of which is, that it assumes that the system of Chan- 
cery patients and Chancery visitors, and inquisitions, and a 
totally different mode of looking at patients by the law, 
whether they possessed property or not—that this system is 
to continue for ever. We should think that few people but 
a Chancery visitor of lunatics hold this view. 


900. Can you give any suggestion with regard to the formation 
of Asylums ?—I would say that with regard to the Chancery patients, 
I have more than once felt that instead of our patients being placed 
throughout the country in the private asylums, where we pay about 
£100,000 a year on the whole, we might very fairly have three 
asylums of our own, one in each district, which would show the public 
the advantage of a public asylum as contrasted with the private 
asylums; and I think, being under the control of the visitors, they 
would almost stand out as models to the country of what a public 
establishment for the upper classes should be. We are certain of 
the patients, so there could be no loss on the establishments ; we have 
the patients already. - 

901. They would be self-supporting after the first cost of the 
erection of the asylum was defrayed ?—Certainly. 

902. Would you extend that to all lunatics, or would you confine 
it to Chancery lunatics ?—The Chancery asylums would necessarily 
be confined to the Lord Chancellor’s wards. I should extend the 
system to all counties; I think the Justices ought to have the power 
in each county of building, on the credit of the rates, asylums for the 
upper classes, as well as for the pauper. At this moment, the paupers 
are much better put up in asylums than the upper classes, not only 
relatively, but absolutely better put up. I should rather be a pauper 
myself had I the misfortune to be in an asylum. 


He makes an admirable suggestion about legalising and 
encouraging what he might have called the domestic treat- 
ment of recent insanity and threatened insanity among the 
higher classes in the houses of medical men. 


468 The Lunacy Laws, 1877. . [Jan., 


905. You also have a suggestion with regard to a smaller class 
of asylums, I think ?—Yes, I think particularly for the upper classes, 
for the richer classes. For example, in the London district, if a medical 
man were allowed to receive two or three patients into his house, I 
think those patients, if recent cases, would be much more likely to get 
better than patients placed in a large asylum. I think it has a bad 
effect, in recent cases, sending them to an asylum. ‘Their arrange- 
ments are much inferior to the home from which they (the patients) 
are brought, they are so shocked and upset, that I think the treat- 
ment which may now be necessary for safe custody is not quite the 
best. If two or three were sent to the house of a medical man, to 
whom it would then be worth while to receive them, which it hardly 
is with one, I think they would be in much pleasanter and more 
hopeful circumstances for treatment. 

1021. Do you think there is no danger, in boarding out, of ill- 
treatment of patients; you say that they are visited, and you think 
that operates as a check, but do you think it a sufficient check ?—I 
think the public opinion is a great check; the opinion in the village, 
and in the district, and of the neighbours; I think the whole tone of 
public opinion is so raised with regard to the treatment of the 
insane, that each year there is more and more facility given to return- 
ing the insane to private life and removing them from that false posi- 
tion of incarceration which is abject misery for a period of years to any 
man who can possibly enjoy liberty, which is the greatest enjoyment 
that we all have. 

1058. With private patients as well as Chancery patients, so far 
as possible, you would hand the treatment of lunatics over to indi- 
viduals, and not, as a special profession, to persons who keep a licensed 
house ?—I would. I would spread it out among the medical profes- 
sion, and treat it as a disease, not as a specialty as it is now. 


Chronic patients of another class he seemed to think 
better off with other people than doctors. ‘‘ It is only a needy 
doctor who would trouble himself with a single patient living 
in his house” (985). We think we have heard of young doctors 
doing this who were not very needy if the pay was good, and 
old ones, too. We think this witness blew hot and cold 
about doctors taking in patients into their houses; or at all 
events, he was not explicit enough. His opinion as to the 
‘Chartered ” Scotch Asylums is given as follows :— 


908. Perhaps you will explain what is the nature of the chartered 
asylums in Scotland ?—Yes, 80 per cent. of the private patients are in 
the chartered asylums in Scotland, whereas in England we have only 
48 per cent. in public asylums of the private patients. 

909. In other respects is the Scotch system superior to the 
English ?—I think so. 


He differs in opinion from Mr. Wilkes as to the effect of 


1878.] The Lunacy Laws, 1877. 469 


removing many patients to an asylum. He thinks that 
effect is sometimes “antagonistic to cure,” and “a great 
source of irritation.” 

He most properly suggests that the power of the Com- 
mittee in Chancery cases should be controlled and regulated, 
and it seems evident that the relative powers and posi- 
tions of the Masters, Visitors, Commissioners, and Lord 
Chancellor are in urgent need of regulation and statutory 
definition, if all these are in future to have to do with the 
same set of over-officialed lunatics, which we don’t believe 
will be the case. 

His opinion as to the Scotch pauper lunatic colony of 
Kennoway is very favourable. He and Dr. Lush had some 
lively sparring as to some of the opinions quoted above, in 
which both parties showed much acuteness and tenacity of 
view. He was of opinion that private houses should be re- 
placed by public asylums (1180). There were some ques- 
tions put to him arid to others as to the Commissioners being 
on such intimate terms with the keepers of private asylums 
that they could not do their duty, which certainly showed 
a profound ignorance of the facts and a suspicion that was in 
its absurdity a mere superstition. He was of opinion, gener- 
ally, that the safeguards against improper detertion in 
asylums were sufficient, and that a more complicated system 
of checks would do more harm than good. 

Dr. Robertson has a very low opinion of some of the 
licensed houses in London and their proprietors. He cer- 
tainly made strong accusations against Sussex House and 
Dr. Winslow, from which house he admitted he had been 
the means of removing many Chancery patients. Dr. Buck- 
nill afterwards supported Dr. Robertson as to some of the 
facts. On a subsequent occasion the latter was recalled, and 
after rebutting some of Dr. Winslow’s evidence—it can serve 
no good purpose for us to go fully into these questions relating 
to individual patients—he made two very important sugges- 
tions to the Committee: one was, that a visiting physician 
should be appointed by the Commissioners to every licensed 
house. If something of the kind could be done, no doubt it 
would completely allay the unpleasant public suspicion as to 
those asylums, and thus be a source of the oreatest comfort 
to their proprietors. The second was, that all the letters of 
the patients not forwarded should be sent to the Commis- 
sioners. The objectionable effect of such an enactment was 
pointed out afterwards by Mr. Phillips. 

He defends the use of neurotics as follows :— 


470 The Lunacy Laws, 1877. [Jan., 


6867. Are you aware that there is what is called chemical 
restraint used in lunatic asylums ?—Yes, I have read of such state- 
ments by which the writers implied, as I understood, the use of 
narcotic and sedative medicines; that is what they call chemical re- 
straint. My own opinion is, that there is no treatment for recent 
lunacy so valuable as those narcotic and sedative remedies. 

6868. You are in favour of it?—Most decidedly I am in favour of 
the judicious use of them; I believe there are more patients become 
chronic lunatics from want of the proper use of those sedatives, than 
from any abuse of them, 

6869. You do not think the habitual use of chloral has a dele- 
terious effect upon the brain?—The habitual use would probably 
have such an effect; I am speaking of the judicious use of it. 

By habitual use, I mean constant use every day for a long period ? 
—I should imagine that was as prejudicial as the use of any narcotic 
habitually indulged in. 

6871. Is chloral more prejudicial than common stimulants ?—I 
should have thought less so; the habitual use of chloral is more dan- 
gerous to life than any narcotic, inasmuch as it apparently accumulates. 


Dr. J. Crichton Browne, when called, at once informed the 
Committee that he could not agree with much of his col- 
league Dr. Robertson’s evidence. Thought abuses much 
more likely to grow up in private houses than in private 
asylums (1222), and that the lunatics boarded out should be 
properly inspected (1268). This opinion is so entirely reason- 
able that we think no one can refuse assent to it; that those 
6,000 single poor patients should be left entirely without in- 
spection, while the 1,000 Chancery patients have three most 
able, energetic and highly paid visitors to themselves in ad- 
dition to the Commissioners, is one of the finest illustra- 
tions of British regard not to the man but to his 
possessions that it is possible to conceive. He agreed 
with the other witnesses that the present law is quite suffi- 
cient for the protection of the liberty of the subject (1283). 
His colleague had said that when sent to examine patients 
and report privately to the Lord Chancellor as to their capa- 
city to claim a jury, he was in the habit of giving them a 
broad hint that if they wished to get off, to claim a jury, 
while he, on the contrary, never advises on this point at all. 

He does not at all agree that one-third of the patients at 
present in asylums could be boarded out, and does not 
approve of two or three patients being boarded in the same 
private house at all, but would recommend much larger 
numbers, especially in the case of paupers (1314). Did not 
approve of a magistrate’s order for the admission of private 


1878.] The Lamecy. Laws, 1877. 471 


patients to asylums (1385), nor that the medical certificates 
should be terminable. About the only things in which this 
witness seemed to agree with his colleague were that asylums 
for Chancery patients alone should be built, and that his 
office should not be amalgamated with that of the Com- 
missioners. 

He made an admirable recommendation as to a post- 
mortem examination being compulsory in the case of every 
death in an asylum, and that a report thereof, signed by two 
medical men, should be sent to the Commissioners. 

He gives the following evidence in regard to the establish- 
ment of psychiatric dispensaries connected with asylums :— 


1515. You think there may be attached to asylums, or to hos- 
pitals, out-door departments ?—I think it would be of very great 
advantage if the law allowed that; a sort of dispensary might 
be attached to the county or borough asylums, just as there is to 
general hospitals, to which patients threatened with mental disease,or 
who are threatened with a return of the malady, might go and obtain 
the skilled advice of the medical officers of the asylums, the ordinary 
general practitioners being unfit to deal with a case of that kind. 
In that way a large number of patients might, I think, be prevented 
from coming back to the asylum. 


He thought asylums under-officered (1522), and made the 
following statement as to the criminal responsibility of the 
insane, which would be reckoned by most ‘medico-psycho- 
logists as a retrograde, and by some a cruel, dictum. 


1558. Are you of opinion that they (lunatics) should be relieved 
from responsibility to the laws of the land ?—Certainly not, except 
so far as any crime they may commit has been influenced by their 
insanity, or is the result of mental disease. 


He advocates a short course of study of mental disease 
for all medical men (1583). He makes a statement in the 
answer to 1612, that “asa rule” his patients at Wakefield 
had not been kindly treated by their friends before they were 
placed under his care, which we must take the liberty most 
strongly to doubt. Is the West Riding of Yorkshire so 
entirely backward that human affections are stamped out by 
mental disease “as arule?” We should have thought it 
some mistake had he not (in 1615) strengthened and exag- 
gerated the statement by saying that “cruelty and chastise- 
ment as if for an ordinary case of misconduct are the rule 
in the early stage of insanity.” It may be so in Yorkshire, 
but we most energetically protest against the applicability of 


472 The Lunacy Laws, 1877. | [Jan., 


this opinion to other parts of the country which we know, 
where cruelty is the rare exception and not the rule at all. 
Mismanagement from ignorance is common, cruelty rare. Is 
any case really strengthened by such exaggerations, especially 
if they are also libels on human nature? 

He said that 1,000 patients is the proper number for a pauper 
asylum (1664). Lord Shaftesbury, as we shall see, puts the 
figure at 300, and Sir James Coxe at 200. On this most im- 
portant question we are surprised that the opinion and ex- 
perience of more of the witnesses were not asked. 

Dr. Bucknill came next. He has had every kind of pro- 
fessional experience in regard to insanity, first practising in 
general medicine, then Superintendent of the Devon Asylum 
for eighteen years, Lord Chancellor’s Visitor of Lunatics for 
thirteen, now a consulting physician in lunacy, the joint 
author of the most comprehensive work on Psychological 
Medicine in the English language as well as many others on 
lunacy and its legal relations, the founder of this Journal, 
and altogether the head of this special branch of medicine. 
No man ever gave evidence before a Parliamentary Com- 
mittee on any subject who was better qualified to do so. 
He gave the following general account of the working of the 
statute under which he held his Visitor’s office, and the 
objections to its machinery :— 


1716. The Act of Will. IV., in the 8rd section, directs that 
the medical visitors shall superintend, inspect, and report direct 
to the Lord Chancellor on the care and treatment of the Chancery 
lunatics. The Act empowers the Lord Chancellor, in conjunction 
‘with the Lords Justices who act under the Sign Manual, to make cer- 
tain general orders, which supplement the Statute. In 1855, Lord 
Chancellor Cranworth, in conjunction with the Lords Justices, made 
certain General Orders which are really the acting directions for the 
Visitors of Lunatics up to the present day, and in those Orders they 
direct that all special reports, that is to say, all reports in which the 
treatment of lunatics is not satisfactory, shall be made to the Board 
of Visitors; that is to say, not to the Lord Chancellor, but to the 
Board of Visitors, and that Board, if they think fit, may refer it to 
the Masters. The Masters, if they think fit, may call before them 
any persons to give evidence upon these special reports, and they can 
make a report to the Lord Chancellor thereupon, if they think fit. 
The result of that is, that all the important reports made by the 
medical visitors are not made to the Lord Chancellor, but to the 
Board, and referred-to the Masters. Now the Masters are the persons 
who practically appoint the committees. These reports are in almost 
all cases complaints of the manner in which the committees discharge 


1878.] The Lunacy Laws, 1877. A73 


their duties. Therefore the reports of the Visitors are referred to 
the gentlemen who appoint the committees, and their determination is 


come to upon the sworn evidence of the committees themselves, 
namely, the persons accused. 


He lays down the following most important principle to go 
on in future legislation, in regard to the admission of patients 
into asylums and their discharge—“I think the principle 
should be to make the admission as easy as possible to 
provide for early treatment; for if there is a difficulty in 
getting patients out of asylums there will be a disinclination 
to send them in” (1232). He has strong objections to the 
power at present given by the statute to the person who 
signs the order for a patient’s admission to an asylum whom 
he describes ‘“‘to be put in possession of the field” (1742), 
and would have the original order only last for a certain 
time, and then a “ re-certification ”’ by a “ properly qualified 
medical man approved by the Commissioners in the Metro- 
_ politan district and by the Visitors of Asylums in the 
provinces.” The following is an extreme illustration of the 
absurdity of the present law :— 


1752. Is there no objection ever made to the status of the 
person who signs an order ?—I never heard of one. 

1753. In fact, a perfect stranger may make an order for the 
detention of a wife, contrary to the wish of her husband ?—Yes, 
clearly. 

1754. If he can only get two medical certificates ?—Yes, and 
make an agreement with the proprietor to receive her. 

1755. Do you consider that a state of things which ought to 
exist ?—Certainly not. 


He thought that there are persons detained too long in 
private asylums (1770), but that they are “very rarely” 
“admitted wrongfully.” He recommended amalgamation of 
the offices of Chancery Visitors and Commissioners. None of 
the actual holders of these appointments who were examined, 
nor Lord Shaftesbury, would hear of this; but we think that 
Dr. Bucknill’s arguments for are infinitely more cogent than 
theirs against such ascheme, and commend themselves to any 
unbiassed person of common sense. He says, “ I think that 
is much needed. It was recommended before the Com- 
mittee which sat in 1859. They are two costly offices. 
Combined they cost £25,000 a year, and two sets of visitors 
are travelling over the country on parallel lines, and I think 
if they were combined a much greater amount of ue 

XXIII. 


ATA The Lunacy Laws, 1877. [Jan., 


could be provided for all the lunatics in the kingdom at not 
any increase of expense. The Board would be much more 
powerful, at all events, than the Board of Visitors.’? As he 
says elsewhere (1854), the two Boards are not co-operative. 
No amount of official conservative prejudice should prevail 
against so great a benefit to be conferred on the insane. 
This increased visitation is one great desideratum at present, 
according to the evidence of most of the witnesses. 

He expressed a strong opinion as to increasing the medical 
ebaracter of all asylums, public and private, and making them 
more hospitals for cure and treatment and less of boarding- 
houses. Thought the “ general admission of visitors into 
asylums” was a good thing to correct abuses, and “to dis- 
abuse the public mind of its prejudices with regard to 
asylums.” He thought the Commissioners ought to have 
the power of ordering any patient out of an asylum to be 
under domestic care, but still under certificates. After 
having been a visitor specially appointed to see to the 
right treatment of lunatics with property for thirteen years, 
he said he had “no knowledge” of the unfortunate people 
whose property was under £1,000, who “escape all ob- 
servation.” Who can say after this that there is not 
one law for the rich and another for the poor in England, | 
when they become insane, at all events? He said, “I 
cannot express too high an opinion of the hospitals for the 
Eee and “I should be sorry to see (private asylums) got 
Tid OL.” 

It is clear that his official life has merely strengthened Dr. 
Bucknill’s former ideas of giving greater liberty to those of 
the insane who can enjoy it, those ideas which prompted him to 
devise and carry out at Exeter pavilions and cottages for his 
pauper patients ; for he says, “ I should like to see the quiet, 
tranquil, incurable cases in domestic life.” 

Sir James Coxe was the first witness called from beyond 
Hngland. He first gave an account of the Scotch lunacy 
law and its working. It differs notably from that of Eng- 
land in many respects, but especially in three points, viz. :— 
1. That private and pauper patients require the same form of 
order and the same number of medical certificates for admis- 
sion into an asylum; 2, that “Order” is given by a 
judicial officer of the State, the Sheriff; and, 38rdly, as to 
property, lunatics who have it, have no special visitors or 
peculiar legal treatment, get their property managed for 
them much more cheaply than in England, and the law 


1878.] | The Lunacy Laws, 1877. 475 


makes no distinction between those who have less than £1,000 
and those who have more. The witness pointed out, how- 
ever, that the Scotch law is as loose as the English in allow- 
ing a stranger to petition the Sheriff for an order to put a 
patient into an asylum (1941). This clearly needs remedy. 
Another point for statutory revision is that which allows the 
medical certificates to be six or twelve months old before 
being presented to the Sheriff with the petition. It is satis- 
factory to learn that, as a matter of fact, Scotch lunatics are 
not deprived of their liberty six months after being medi- 
cally certified to be insane, the Sheriff’s practice being better 
than the law. The witness says that he understands the 
practice of different Sheriffs varies in regard to judging 
whether the facts in the medical certificates are correct or 
not. The witness described the “ certificate of emergency ” 
under which a patient in Scotland can be taken to an asylum 
and kept there for three days, which is clearly an admirable 
provision which the profession in England should at once 
import. It conforms perfectly to Dr. Bucknill’s principle 
of easy access to suitable treatment. It does not appear, 
however, that the operation of this certificate is sufficiently 
ouarded. There is no provision thatit shall be signed on the 
day of the patient’s admission into the asylum. Fancy a 
medical “ certificate of emergency” being signed in the case 
of a patient who is not taken to the asylum for a month, 
and the Superintendent expected to receive him on this 
warrant! We have heard of something like that happening in 
Scotland. In such a case it is a “ certificate of convenience,” 

as Dr. Mitchell called it, of the worst and most objectionable 
kind. In Scotland the Commissioners make the Asylum 
Superintendent send them a statement as to the “ physical 
condition ” of the patient immediately on admission. This 
seems a good regulation, and might well become a statutory 
enactment; and if a thorough medical examination into all 
the organs and bodily symptoms, it would tend greatly to 
keep up the medical character of asylums. The witness 
described how the Sheriffs’ orders lapse after the patient has 
been three years in an asylum, unless the Superintendent 
certiries that the detention of the patient is necessary either 
for his own welfare or for the protection of the public. The 
witness would not allow the Superintendents of private 
asylums to give this renewal certificate. We should have 
liked to have had the witness asked what was the actual 
legal authority on which Scotch patients are detained in 


476 The Lunacy Laws, 1877. [Jan., 


asylums there after the first three years. Is it the Sheriff’s 
order or the asylum doctor’s renewal certificate ? He should 
also have been asked, as there were no Sheriffs called to 
speak for themselves, if there was any appeal from one kind 
of Sheriff to a superior one, or if there was any check or 
control over the Sheriffs at all in this matter? Supposing 
a Sheriff began to act capriciously and made an order when 
there was no proper petition or statement, or medical certifi- 
cate, would the Asylum Superintendent have to admit the 
patient ? If his order is in legal form, does it cover and pro- 
tect the illegality of every other part of the paper ? 

The single patients in Scotland are regularly visited once a 
year by “ Deputy Commissioners.” This is a most necessary 
work and a good provision for doing it. Those same single 
pauper patients get two visits a year from inspectors of poor 
and four from parish doctors, so that they are better off in 
regard to visitation than an Englishman with £20,000 a 
year. Sir James Coxe described the “ Fiscal case ”’ in Scot- 
land, which would seem to be a mild kind of criminal 
lunatic, whom the Fiscal and Sheriff send to an asylum 
on special authority for a few days until his friends or the 
inspector of poor make proper provision for him, when he 
ceases to be a criminal lunatic in any sense. This also 
seems a good means of dealing with a certain class of cases 
where mildly criminal acts have been done by lunatics in the 
initial stages of their disease,and as the result of that disease. 
The most objectionable thing about being a “ Fiscal case ”’ is 
that your name is publicly advertised in the papers of the 
district as a lunatic. That is an injurious and cruel thing 
to many respectable people, and should be stopped by 
statute. 

The witness described the process by which an unrecovered 
or doubtfully insane person gets out of an asylum in Scot- 
land. It appears that the law allows two doctors to be sent 
to any patient in that country, and if they say he is quite 
sane, the Commissioners have to order his discharge; 
but if they say he is not quite sane, but still well enough 
to leave the asylum, the omnipotent Sheriff alone has 
power to order his release. This latter plan costs so much, 
however, that it is never followed. Personal liberty, there- 
fore, in Scotland is guarded and tempered quoad lunacy laws 
by two doctors and a Sheriff who put you into an asylum 
and can take you out thence, the only difference being that 
Sir James Coxe says nothing about fees for doing the 


1878. ] The Lunacy Laws, 1877. AT7 


former, but expressly mentions the fees both to the doctor 
and the Sheriff as a barrier to your getting out. We have 
often heard that it was a more responsible thing to give a 
certificate of sanity than of insanity. In Scotland this 
seems to be acted on, and the fees fixed accordingly. It is 
no doubt right in principle that the same officials who have 
the power to put patients into asylums should have the 
power to take them out. In addition, though the Scotch 
Commissioners expressly say they don’t want this power 
given to them, beyond all doubt they should have the power 
of discharge of sane persons which is vested in their English 
brethren, and also that demanded by the latter of ordering 
the discharge of unrecovered harmless cases whom they 
might consider fit for domestic care when that could be 
got. Sir James Coxe is altogether against the idea of ex- 
perts in lunacy in any shape or form :— 


2067. You do not think it would be an additional protection to 
the patient, if all these dealings with lunatics, or alleged lunatics, 
were in the hands of specially educated medical men ?—No, I think 
the practice would be very apt to degenerate into a close guild of 
specialists, who would be regarded by the public with distrust. 
Besides, I do not see how such a proposal could be carried out 
without great inconvenience to the public. 


His opinion of attendants in Scotch asylums is un- 
favourable, and what is worse, he suggests no remedy, and 
throws cold water on schemes of training. We should like 
if he had been asked in what “different asylums” training 
schools had been tried, and failed. The fact is quite new to 
us, if it is a fact. He makes an excellent suggestion that the 
Sheriff, instead of the Court of Session, should have power to 
appoint a Curator Bons for patients of small means, under 
£1,000. The exact process of the appointment of this 
Curator Bonis and its cost was not described by any of the 
Scotch witnesses, and this was an important omission, for. 
every witness agreed that the English system of an in- 
quisition in such cases is a most cumbrous and expensive one. 
So far as we can ascertain, it is this. The nearest relative of 
the patient usually, soon after he becomes insane—for the 
property of patients in Scotland does not seem to be generally 
left uncared for till they become chronic lunatics—gets a 
solicitor to draw up a petition to the Court of Session, to 
the effect that A. B. is insane, and unable to manage his 
affairs. He sends along with this a statement of the means 


478 The Lunacy Laws, 1877. [Jan., 


of the patient, and the names of his nearest relatives, 
together with two medical certificates of his mental in- 
capacity. This is presented to one of the Judges, who 
orders it to be printed and stuck up in a public place in the 
Court, and copies served by an officer of the Court on the 
patient and his next of kin. In eight days, if the patient is in 
Scotland, and in 14 days if he is not there, the Judge issues 
an order for the appointment of some competent person, 
often of his own selection, as Curator Bonis, who then has 
to find heavy security to the Court, and proceeds to ad- 
minister the patient’s property for his benefit, rendering an 
account of his intromissions to the Court of Session every 
year. The cost of this proceeding varies from about £15 up 
to £30. There is one weak point in the process from a legal 
point of view, and that is that there is no provision for the 
patient’s communicating with an agent or friend or even 
the Judge after he gets the paper served on him. 

The witness next alluded to a matter which seems to have 
disquieted some of our weaker medical brethren very much. 
The Scotch law, like the English, allows asylums in which 
there are less than one hundred patients to be managed by a 
non-medical superintendent, a- doctor visiting every day, 
and it appears there are several such asylums in Scotland, 
one of which, that at Banff, is thus spoken of by him :— 


2093. Are those asylums under non-professional men as well 
managed, and are the patients as carefully treated as they are in 
asylums where medical men have charge ?—I think they are just as 
well. I think the Banff Asylum is a model asylum in every way. 

2094. Do you think, with reference to the curative treatment of 
patients, that the visit might be made by medical men resident in 
the district, without having medical men especially appointed as 
managers or superintendents of the asylums ?— Yes. Where you 
have a large asylum, of course as the members increase there is 
always a greater demand for medical visits. In a small asylum 
a resident medical man is not necessary; in a large asylum it 
becomes necessary from the frequency of calls which might be made 
upon him. 


Surely there is nothing wonderful in the above statement 
or opinion. We have never heard any one deny the fact that 
the Banff Asylum is a well managed asylum; whether it is a 
“model asylum ” is a mere matter of fancy. Surely it is 
possible for a layman, and it would not take much of 
a layman, to manage an institution with 100 pauper 
lunatics from a country district, with a doctor looking in and 


1878. | The Lunacy Laws, 1877. 479 


taking the medical charge. It afterwards came out that the 
work is so light, that even an inexperienced young doctor 
hadn’t enough to do, and it would appear that it was to save 
any youthful member of our profession from ennwi and the 
mental degeneration that results from idleness, that he was 
discontinued and a layman appointed; we presume the 
sort of man being selected who would take no harm from 
having too little to do, and had tastes for farming through 
which his health would be kept in order. 

In regard to the question of providing accommodation for 
the insane generally, the following are his views :— 

2102, I think if you would not put restrictions upon the means 
of providing accommodation, if there were a sort of free-trade in 
accommodation, that accommodation would soon adapt itself to the 
wants of the public. For instance, if you would begin with not 
restricting District Boards to the provision of accommodation for 
pauper patients, but give them permissive powers to assess the 
districts for private patients, I believe a good many of them would 
provide accommodation for that class. I believe a good many of them 
would assess themselves, and provide for private patients in that way. 
I think if you would do away with restrictions as much as possible 
upon the manner of making provision for the insane, and allow 
natural laws to take their full swing as it were, it would be better. 


We confess we should have liked Sir James cross-examined 
as to his exact meaning, when he spoke of “ free-trade in 
accommodation,” and the present “ restrictions” on that, 
whatever it may mean, and as to how he would formulate 
the “ natural laws” that regulate the making provision for the 
insane and what they would be likely to do when they took 
“ full swing.” We should scarcely have supposed a hard- 
headed official Scotchman capable of talking in this way, 
and before a Committee of the House of Commons too. 
“Natural laws” seemed to have been allowed to have pretty 
full swing in the times before the Commission of 1857, of 
which Sir James Coxe was secretary, and we should like to 
have had him asked how he liked their operation. 

The following are his views as to the effects of treatment 
and the early sending of cases of insanity to asylums, &c. 
There is no doubt some truth in what he says about the 
fallacy of claiming for asylums all the cures of recent cases 
sent there when we don’t know how many get well without 
being sent to asylums, or would have got well had they not 


been sent there :— 
2106. You think the sending of patients, at an early stage of 


480 The Lunacy Laws, 1877. [Jan., 


their disease, to an asylum, is not in all cases beneficial ?—No, I 
think in many cases it does harm. I think there is a great fallacy 
about the benefits of early treatment being restricted to asylums, 
I believe that if you take a hundred recent cases, a certain pro- 
portion of them recover, but I do not think you are authorised in 
arguing from that, that if old standing cases had come sooner into 
the asylums, the patients would have recovered under the asylum 
treatment. I think they are there as the residuum of a number of 
cases which have already recovered under outdoor treatment. 

2110. Do youconsider that mental disease is in a great respect 
like bodily disease ; you would, I suppose, consider the analogy 
would hold good as to the treatment, as well as to the disease, that 
mental disease might be treated anywhere in the same way as bodily 
disease ?—Yes, certainly. I think the asylum is simply a convenient 
hospital for treating them; after a time it becomes just a convenient 
prison. : 


Very much has been said about the last sentence, about 
the prison view of an asylum. Is an asyluma prison ? We 
have looked up “ prison” in one of the best English 
dictionaries, and find one meaning of it to be “ any place 
of confinement, or restraint.” The witness was right, 
therefore, strictly speaking, but still we confess it sounds 
harsh, and it is certainly not a medical view of asylums. It 
is well, however, to have all sides of a question brought out, 
and we could point to many cases of chronic insanity in 
asylums, where at all events the relatives look on them as 
just “‘ convenient prisons.” On the whole we believe he was 
right to bring out strongly this view. If a number of luna- 
tics from asylums had been examined by the Committee, most 
unquestionably many of them would have taken the same 
view and used the same expression. It was well to take a 
look at asylums from this point of view, considering that 
the other aspects of them were sure to be well brought for- 
ward. 

He thus dissipates a pleasant delusion of Dr. Bucknill’s :— 


2130. I think Dr. Bucknill said in his evidence, ‘In Scotland 
there is only one large private asylum, and in that the nursing in the 
ladies’ house is conducted entirely by ladies, and itis made to an extent 
which is surprising, like an ordinary residence; there are no locked 
doors in it, there is every egress and ingress for all the patients all 
the day through ; that is the adoption of a plan which was first carried 
outin the Fife and Kinross Asylum in which the Commissioners for 
Scotland are justly interested and proud of its results, which I have 
visited and been much delighted with ;” is that the only case in which 
there is lay nursing; are you acquainted with the circumstances to 


1878. | The, Lunacy Laws, 1877. 431 


which the witness refers ?—I do not know any private asylum to which 
this description is applicable. 


He here refers to the undoubted hardship of a life-long re- 
sidence in an asylum to many cases. 


2139. Have you been acquainted with any cases, and if so, how 
many, of patients having been improperly detained after their com- 
plete recovery ?—No, none. I have seen a great many cases which I 
thought might be perfectly well out. 

2140. That was not because they had completely recovered, but 
because you thought they might complete their recovery outdoors ?— 
No; because I thought it was a hardship to keep a man in an asylum 
so little insane that he was capable of being out of it. I think it is a 
very hard case for a man to be locked up in an asylum and kept there ; 
you may call it anything you like, but it is a prison. He is cut off 
from all associations of outdoor life. A man has his life only once, 
and itis a very hard thing to keep him in an asylum all his days. 


As regards the “ boarding-out system,” the following are 
his views :— 

2141. The boarding-out system, as I gather, is very strongly in 
your mind as the proper system to be extended ?—I think facilities 
should be given to get patients back into their families. 1 am not 
much an advocate for having what they call colonies, of having them 
all concentrated in villages. 

2147. I take it that such influence as you may yourself legiti- 
mately use as a Commissioner has been exercised in favour of the 
system ?—We have not fostered the boarding-out system at all; it has 
developed itself; it is a self-development. 

2185. I observe here that notwithstanding the bias, which, no 
doubt, isa very proper bias, felt by the authorities in Scotland in 
favour of boarding-out, the proportion is almost precisely the same as 
iu England, where there is no official bias in that direction ?— Yes ; 
I think there is a great deal of talk about the Scotch system of 
boarding-out, but in reality there is as much boarding-out in England, 
the only difference is that it is part of the Scotch system of lunacy to 
place every pauper lunatic under the jurisdiction of the Commissioners ; 
whereas in England this is not the case. 

2186. Taking English private patients and Scotch patients, I find 
that in England 94 per cent. are in asylums, and in Scotland, 93:8 
per cent. ?—That may be so. 


Mode of Discharge of Recovered Patients im Scotland. 

2219. In your experience of 20 years, how many times do you 
think you have had such a case that patients have been discharged 
from asylums by superintendents of their own proper action ?— They 
are always discharged by their own proper action, every patient that 
recovers. 


482 The Lunacy Laws, 1877. [Jan., 


2220. I mean without interference on the part of the Board, when 
the medical superintendent is satisfied that the patient need not be 
any longer detained, and discharges him without consulting you ?— 
Yes, he merely sends us notice that he has discharged him. 

2221. Suppose that instead of its being within a fortnight or 
three weeks of the admission that he comes to that opinion, it is a 
year, or two years, or five years afterwards, has he the same power of 
discharge ?— Yes. 


The discharge of recovered patients it would thus appear 
is not expressly provided for in the Scotch Acts at all. The 
medical superintendent does so by “drawing an inference 
thatis not expressed in the Act.’’ This is clearly an omission. 
In pauper cases, on their recovery in asylums distant from 
their homes, there is no provision at all for parish officers 
coming to remove vhem, and we have heard of them refusing 
to doso, saying, in fact, to the asylum doctor, when told a 
patient was recovered—“ Well, then, you have no right to keep 
him any longer 1 in the asylum, let him out, It is your busi- 
ness not mine.’ 

As regards Banff Asylum again, and his views of medical 
treatment and the medical element in asylums, we had better 
give his own words :— 


2233. Is that a case in which you would put strong pressure upon 
the proprietor, or the public authorities connected with that asylum, 
that a resident medical man should be appointed ?—There was a resi- 
dent medical man originally. He had so little to do that upon the 
petition of the District Board to try how it would work with the ap- 
pointment of a non-medical man as superintendent, we made the ex- 
periment, and the experiment has answered remarkably well. 

2234. Are you satisfied generally with the amount of super- 
vision in Scotch asylums, as to the quantity ?—Yes, I think so. I 
think there is a great deal in the management of asylums that is non- 
medical. I think the mode of management of this Banff Asylum, for 
instance, depends very much upon the natural qualities of the super- 
intendent, and his being a man who is well acquainted with the 
management of land. He employs the patients upon the land in a 
very satisfactory way. It is a small asylum ; it cannot exceed one 
hundred patients. They have got about 20 acres of land belonging to 
them originally, and they rent a farm of about 100 acres besides, which 
they cultivate. 

2243. Do TI understand you rather to lessen the importance of 
medical treatment in asylums ?—No; but I think a great deal of the 
supervision of a good asylum is not medical; I think it is like the 
management of a large hotel, or something of that kind, and medical 
men are not necessarily the best hotel or farm managers. 


1878.] The Lunacy Laws, 1877. AS8 


2246. You have not much faith in the medical treatment of in- 
sanity, looking upon insanity as a special thing ?—I have great faith 
in the medical treatment of insanity, by restoring the bodily functions 
to health ; but I think you cannot treat insanity as a special entity; 
I think you must set to work to restore the health of the body, and 
that the mind then rights itself. That is the view I take of it. 

2276. What in your opinion, is the best number for a well- 
managed lunatic asylum ?—My own view is in favour of small asylums. 
I think when you come to large asylums the patients are lost in them, 
and I do not think they are more economical. The rates of mainten- 

ance are lower generally in our smaller asylums than in our larger 
asylums. 

2277. Would you put the limit at 500?—I would rather not ex- 
ceed 200. I think the smaller an asyluin is the better, unless for pe- 
cuniary reasons. 


We think itis a pity that opinions as to the effects of 
drugs and medical treatment should not be confined to the 
practising physicians who use them, and who, therefore, are 
the only persons who have an opportunity of forming a cor- 
rect judgment on the matter. 

2329. Have you ever known of any cases in which they (drugs) have 
been administered in hospitals or asvlums ?—There are many cases in 
which chloral is administered, I think, that has a tendency to produce 
dementia; but it is not given for the purpose of producing dementia, 
but to soothe the patient. 

2330. You are of opinion that chloral is injurious ?—Yes, if its 
administration is prolonged. 

2331. Bromide of potassium ?—I do not think that bromide of 
potassium is so injurious. 

2332. Laudanum?—Any narcotic administered for a length of time 
would have a prejudicial effect, but I think chloral more prejudicial 
than laudanum and bromide of potassium. 


We think Dr. Lush, in his examination of this witness, 
showed too much of a bias, and tried somewhat unfairly to 
confuse the state of matters in Scotland in 1857 with the pre- 
sent state of things. And if Sir James Coxe had been incon- 
sistent in his opinions expressed then and now, it would rather 
tend to increase the value of his present views, they being 
the result of matured experience. | 

Dr. Harrington Tuke was the next witness. He thought 
that the proper system for all private asylums was to have a 
resident medical proprietor. He thus described the treat- 
ment in such an institution: “Ina private asylum, on the 
convalescence of a patient, he would at once be removed into 
the family” (2548). The great field of the future for our pri- 


484. The Lunacy Laws, 1877. [Jan., 


vate asylums is no doubt in the direction of such domestic 
management for suitable cases. But then he says of the 60 
medical officers of the London licensed houses, “ I suppose 
there must be some fools and some scoundrels,” and when then 
asked if it might not be a dangerous thing to commit any- 
body to the care of fools and scoundrels, he replied ‘“* No!” 
because such men were carefully supervised. On purely 
psychological grounds we differ from Dr. Tuke as to the possi- 
bility of making ‘fools and scoundrels” into suitable 
guardians of the insane by supervision, but we prefer to be- 
lieve that he spoke both uncharitably and unadvisedly of his” 
brethren. 

He was very strong as to the effect of suitable medical 
treatment early applied in a private asylum. The following 
extract will show his views as to the results :— 


2554. What is the rate of cure in private asylums as com- 
pared with public asylums; have you got any statistics in your 
mind ?—-Yes. The private asylum should be restricted to asylums 
governed by medical men ; and in those the rate of cure is much 
above the private asylums generally, and for this reason. Itis proved 
by this fact, that while the increase of insanity has been so enormous 
in the class of paupers, the increase of insanity in the higher classes 
has been checked, aud it is really almost stationary ; the reason being, 
I take it, that each medical superintendent of the higher class looks 
after 23 patients, whilst in the lower class each superintendent looks 
after about 800. Iam not counting the assistants to each superin- 
tendent. | 

2505. So that, on the whole, there is no doubt that the rate of 
cure is considerably higher in private asylums ?—-Undoubtedly; it is 
statistically so. 


We have taken the trouble to look into this matter. 
The Commissioners in Lunacy publish an annual return, in 
which all those matters that can be statistically put are to be 
seen,and we find in the report for 1876, p. 27, that the “ Pro- 
portion of stated Recoveries to the Admissions” have been 
for the 18 years, 1859-76, in County and Borough Asylums, 
30°67 cent.; in Metropolitan Licensed Houses, 27:04; and 
in Provincial Licensed Houses, 31:36. Dr. Tuke subse- 
quently said to the Committee (2620) about the registered 
hospitals :—“ The cures are much less, Bethlehem and St. 
Luke’s being excluded.” On turning to the same page of 
the Commissioners’ Blue Book, we find the percentage of the 
recoveries in the Registered Hospitals to be 38°32, against 
the 27:04 in the Metropolitan Licensed Houses. In the same 


7378.) The Lunacy Laws, 1877. A485 


- answer (2620), from which we have quoted, Dr. Tuke ven- 


tures on what would seem very tender ground indeed, and 
confidently makes this statement in regard to the registered 
hospitals and his professional brethren who superintend 
them :—‘“‘ The last report of the Commissioners of Lunacy 
contains records of mismanagement and coniplaints against 
these hospitals. There is not one of them whose medical 
man has any repute for treatment, or who has come at all to 
the front.” This, indeed, is a grave charge, and if not to be 
proved, Dr. Tuke should surely not have made it. In simple 
justice to those gentlemen and their institutions, we must - 
again turn to the report to which Dr. Tuke refers, the same 
from which we have been quoting, and carefully go over 
the Commissioners’ entries on all the registered hospitals in 
England (pp. 830-350). We find almost nothing but praise 
of their condition and management. Positively the only 
statements of the nature of complaints are that the patients 
at Wonford House are left for an hour without supervision 
after going to bed; that the windows of St. Luke’s are dirty ; 
that the “ Medical Journal ” at Warneford Hospital was not 
up to date; and that at York they used some old box beds. 
Turning to p. 108 of the same report, we find a page and a 
half in regard to the suicide of one of Dr. Tuke’s patients at 
Manor House, which most persons would say looks much 
more like a “record of mismanagement” than anything to be 
found in the Commissioners’ entries regarding the hospitals. 
By the way, in that entry we observe—we do not criticise or 
blame, but merely put on record the fact—that Dr. Bucknill’s 
American friend would have gained his famous non-restraint 
bet had he been admitted to Dr. Tuke’s Asylum, for in the 
case of this gentleman, we find in the Blue Book that it had 
been “‘deemed advisable to place him under restraint, by 
means of a straight waistcoat, for three or four nights.” 
Then, as to the facts about “‘ Cures.”” We find at p. 149 that 
the very lowest proportion of recoveries in any hospital (ex- 
cluding those for idiots) was 14:2 per cent., and the one next 
to the lowest was 22°5 per cent., while the highest was 58-9 
per cent. Turning to p. 150, we see there the results for the 
year in all the London private asylums, and we cannot be 
accused of unfairness if we take the two, one of which Dr. 
Tuke owns, and the other of which he visits, viz., Manor 
House and Northumberland House. There were admitted 
into Manor House, 16 ladies and gentlemen, and there were 
discharged, recovered, 2, being at the rate of 12°5 per cent. 


A86 The Lunacy Laws, 1877. | [Jan., 


The admissions into Northumberland House were 30, and the 
recoveries, 12; or at the rate of 40 per cent. Comment on 
these facts is unnecessary, as is any further reference to Dr. 
Tuke’s evidence, except to refresh his memory in regard to 
any hospital man not having “any repute for treatment,” 
or having “ come to the front,” by pointing out to him the 
names of Mr. Mould, of Cheadle, with his 59 per cent. of 
“ cures,’ and Dr. Thurman, of The Retreat, with his 
‘Statistics of Insanity,’ which, at all events, have been 
hitherto reckoned perfectly reliable as records of facts. 

Dr. Nugent, one of the two inspectors of lunatic asylums 
in Ireland, then gave the committee an account of the work- 
ing of the Lunacy Laws in that country. He began by claim- 
ing that the English Lunacy Act was founded on the Irish 
(2/00), a statement which Lord Shaftesbury afterwards 
corrected. In Ireland there are no local authorities that 
have anything to do with private asylums, which are, there- 
fore, dependant for their visitation and inspection entirely on 
the Inspectors. The following is his account of modes of 
admission and discharge of pauper lunatics to the District 
Asylums :— 


2705. You have three modes of adinission; one by a single 
medical man’s certificate alone ?—That is presented to the Board; 
the other is where a single medical man signs a certificate of 
insanity, and the patient is brought before the physician of the 
asylum, who, on his own authority, admits him, subject to the ap- 
proval of the Board at its next meeting. The third is where two 
magistrates sign the admission of a patient into the asylum, and that 
is mandatory under the Act. 

2706. You appear to think neither of those satisfactory except the 
first ?—I think the first is the most satisfactory. There are urgent cases. 
The best proof I can give you of the fact is this: That I was look- 
ing over and preparing, within the last fortnight, the report for Par- 
liament, and I find that the number of lunatics admitted in the ordi- 
nary or legitimate way was only 197; the number admitted by resi- 
dent physicians, about 798 ; and the number sent in by magis- 
trates, 1,239. 

2707. Do you think that under any of those forms of admission 
there is danger of a sane man being sent into an asylum ?—I think 
that very often magistrates do not exercise proper discretion, and 
that they send in patients that they ought not. They may be insane ; 
but they fix them in the asylum as dangerous lunatics, when bond fide 
they are not dangerous lunatics, when they are simply mentally affected. 

2708. What mode have you of getting patients who have 
recovered out of these pauper asylums ?—As soon as they are re- 


1878.] The Lunacy Laws, 1877. 487 


covered the cases are brought before the Board, and the Board order 
their discharge. 

2709. Who brings it before the Board ?—The resident physician, 
or he writes to the inspectors; or when the inspectors are seeing 
the asylum, if there are patients in it whom they think fit to be dis- 
charged, they order their removal. 


To any Englishman the fact would be utterly incompre- 
hensible, that only 197 out of the total of 2,234 of the unfortu- 
nate lunatics of the poorer class are admitted into asylums in 
“the ordinary (?) or legitimate way,” which seems also 
the easiest, while 1,239 are virtually sent as “dangerous 
lunatics,” with only ‘the form of having a medical certifi- 
cate.’ No wonder Dr. Nugent finds this “ very unsatis- 
factory,” and has “constantly spoken of it.” It urgently 
needs rectification in the interest of humanity. The in- 
spectors are more powerful as to the discharge of private 
patients than the Commissioners in England or Scotland. He 
apologetically defended the existence of visiting physicians 
to public asylums in Ireland, but made out no good case for 
them. 


He here describes what seems to be an admirable law and 
practice in regard to criminal lunatics that should certainly 
be copied in Great Britain. 

2891. What is the state of things with regard to criminal lunatics 
in Ireland ?—The first asylum that was opened, I believe, in Europe, 
of the kind regularly constituted, was that at Dundrum, which was 
placed immediately under the Inspectors, and left altogether to their 
control ; it has been in existence now about 24 or 25 years, and I 
cannot conceive any institution to have progressed in every respect 
more satisfactorily than that has done. The system adopted in Ireland 
with regard to criminal lunatics is this: the Government leave alto- 
gether the admission of these lunatics to the discretion of the inspector. 
There are numberless cases of persons acquitted on the score of 
insanity whom we never think of sending to the criminal asylum, be- 
cause very often minor offences are symptomatic of disease more than 
anything else. A man breaks a pane of glass, or hits his neighbour, 
or does something that brings him within the category of an offender ; 
we would never think of sending that man to a criminal asylum, except 
he had shown, previous to that, violent or dangerous tendencies. We 
then measure the crime, or offence, very much by the antecedent 
character of the parties. There are 166 now in the Criminal Asylum 
at Dundrum, of whom 66 have committed murder. Of course, when 
a party commits murder, or any violent outrage on the person, he is 
peremptorily sent to the asylum, and the rule invariably is this, that 
at the termination of the assizes all the cases that have been tried by 


488 The Lunacy Laws, 1877. | [Jan., 


the judge of assize are sent up to the inspectors, where the parties 
are acquitted, either on the score of insanity, or where they are 
found incompetent to plead by a jury empanneled to test their mental 
capabilities at the time they are arraigned. We then select and examine 
each individual case, in all cases of murder, cases of violent assaults 
on the person, any cases of crime that would involve transportation 
for seven or fourteen years. We consider those as the proper cases to 
be placed in the criminal asylum. But for minor cases, where the 
punishment would not exceed six or eight months’ imprisonment, or 
punishment of that kind, we really do not think it is worth while to 
send them to the criminal asylum, except the individual who commits 
the offence is of a very violent and dangerous character. If we find 
that he is a violent and dangerous person for the time being, that he 
has to be under penal servitude, we send him to the asylum, and 
when the period of his incarceration naturally would have terminated, 
he is removed back to the asylum to which he is naturally chargeable. 


The following suggestion of Dr. J. H. Bridges, one of the 
Local Government Board’s Inspectors, is well worthy of 
attention for London and the large cities of the kingdom. 
He had first described the present arrangements at the work- 
houses, which are confessedly most imperfect. The proposed 
plan works well in Paris, and is free from the objections 
Lord Shaftesbury afterwards urged against it; at all events 
it would be better than the present arrangement under which 
workhouses arranged for one purpose are used for quite 
another. 


2945. Could you suggest any modification or improvement in the 
present system beyond what you have already stated ?—I have sug- 
gested at times to the Local Government Board the possibility of 
having in London certain probationary wards, which would, in point 
of fact, be equivalent to workhouse lunatic wards, only that they 
would be fewer in number; for instance, instead of having 30—one 
to each workhouse, or one to each union—you might conceivably have 
four or five such receptacles, in which these persons would be under 
special and skilled inspection, with a proper staff of attendants to 
supervise them. 

2946. Do you mean belonging to all the workhouses ?—Belong- 
ing to all the workhouses. I mean, supposing they were placed under 
some such common authority in London as the Metropolitan Asylum 
District Board, or some other authority of the same kind were 
adopted,"it would be worth while for the authority to have a proper 
staff of attendants, a properly paid medical officer, and properly con- 
structed wards in which they could be specially under observation. 

2947. You would, in fact, advocate the construction and establish- 
ment of intermediate asylums between the workhouses and the actual 
metropolitan asylums ?—Yes. 


1878.] The Lunacy Laws, 1877. 489 


Dr. Bridges, who has had much experience of the Poor Law 
Medical Officers who sign the present single certificate, sug- 
gested that two certificates should be required for all pauper 
cases. He condemned the practice of some Guardians, who 
insist that all the pauper insane of their unions should pass 
through the workhouse first, before going to the asylum, no 
matter how urgent their cases may be. Anything more 
short-sighted and harsh cannot be imagined. He disclosed 
the startling fact that a lunatic may be detained for years in 
an English workhouse, without any sort of legal authority 
whatever, or even being certified to be insane! This state of 
matters needs remedy. 

Mr. W.G. Balfour, L.R.C.P., then gave evidence that he had 
known a son sent to an asylum in Scotland by his father 
when he was not insane; but it appeared that when his 
father procured his discharge he would not leave, but stayed 
on as a voluntary patient. ‘hat asylum must be a very nice 
place. The witness recommended that one of the medical 
certificates should always be signed by an expert in lunacy, 
and that a magistrate should attest the signatures of those 
who sign orders, and also of the relieving officers. He 
thought that ‘‘it is as easy to treat 5,000 lunatics as 500.” 
He would have the State buy up ail private asylums. He 
made an important suggestion, that all English patients in 
foreign asylums should be under the protection of English 
Ambassadors (3157). 


Mr. J. J. Henley, another of the Local Government Board’s. 
Inspectors, described thus how a lunatic is at present ad- 
mitted into a workhouse, and what is done to him— 


8405. What local supervision is there of these lunatic wards ?— 
As soon as a lunatic is admitted into a workhouse, an alleged lunatic 
or an imbecile, his case is entered in a special book which is recom- 
mended to be kept by the Commissioners in Lunacy, stating the con- 
dition of the person on admission. His name is then transferred to 
another book of which this is a sheet, which is examined every 
quarter by the Visiting Committee ; his name is then entered on the 
certificate, which I quoted before, of the medical officer, to say that 
he is a proper person to be kept in a workhouse, and that the wards 
are sufficient for the purpose ; and the medical officer also makes 
a quarterly return to the Commissioners in lunacy, and the Guardians 
whenever they visit the asylum, have to answer a special query in 
their visiting book with regard to the treatment of all lunatics in the 
workhouse; and another book is kept, which is called the work- 
house medical report book, which is laid before the Guardians from 

XXIII. 390 


490 The Lunacy Laws, 1877. [Jan., 


time to time by the medical officer, in which he is bound to report to 
them where he may see any deficiency in the nursing or treatment of 
any person in the workhouse. ‘That, 1 think, is as far as the local 
supervision is concerned. 


The futility of any mere permissive act to produce any- 
thing like solidarity of working among the various local 
authorities who have to do with lunatics he pointed out, is 
well illustrated by the failure of ‘‘ Lord Devon’s Act,” the 
provisions of which have never, in any one instance, been 
put in force since it was passed (38410). He thought well of 
the Scotch lunatic wards of poorhouses, and advocates an 
arrangement by which a number of half-filled workhouses 
in a county, should join and empty the inmates of one or 
two suitable ones, which are suitably placed and have land 
attached into the others, which could then be used for the re- 
ception of chronic, harmless, incurable lunatics, so utilising 
buildings already in existence. This suggestion will bear 
probably important fruit in relieving the now overpressed 
county asylums. He does not think that there is any incon- 
venience in having a small number of harmless lunatics in 
the ordinary wards of a workhouse. 

Dr. Rhys Williams, of Bethlem Hospital, was next exa- 
mined, He approved of the idea of psychriatric dispensaries 
attached to asylums (3617), thought that the position of 
physician to a public asylum was a more satisfactory one 
than that of a private asylum, did not believe that lunatic 
hospitals would suit the higher classes in England, thought 
that the Commissioners’ visits should be more frequent, and 
that private asylums could not be suddenly done away with, 
but be gradually absorbed by the public authorities. He did 
not think chloral or other drugs could produce insanity, but 
did not like chloral, and had almost given up its use. He 
gave a good account of his female attendants. Ifall the 
witnesses had said what they had to say as clearly and suc- 
cinctly as did Dr. Williams, how easy would have been the 
task of making a digest of their evidence for the readers 
of this Journal! 

Dr. Maudsley was next called in. He was strongly of 
opinion that the present forms for the admission of private 
patients into asylums or private houses were quite sufficient, 
and if made more stringent would operate injuriously on 
their early treatment and chances of recovery. In regard to 
other matters, he gave the following evidence :— 


1878, ] The Lunacy Laws, 1877. 491 


Present Unwillingness of Medical Men to Sign Certificates. 


_ 38754, And yet, all over the country, people are exposed to be sent 
to an asylum upon the certificates of two medical men, who really 
are not qualified to give an opinion ?—There is no doubt about that ; 
but I think the way in which that operates mostly, is that, feeling 
themselves not qualified, they shrink very much from giving certifi- 
cates. There are some medical men. who will not give certificates 
under any circumstances scarcely. The medical man of a family is 
often unwilling to do so, because, when the patient comes out from 
under care afterwards, he probably will have some feeling of hostility 
towards him; and I am sure the medical profession, as a body, would 
be extremely glad to be released from the necessity of certifying. 


Order by a Public Official. 


3756. Ifit is considered desirable, as I heard suggested, that the 
certificates should go before some public official before they were 
acted upon, it seems to me that no public official would be in a better 
qualified position to judge of the value of the certificates than the 
Commmissioners, to whom exact copies are sent within 24 hours; 
indeed, not nearly so much so. If he entered really into the matter 
in each case, it would be a very anxious responsibility—a formidable 
matter for him to undertake; and if he did not, it would simply 
become a mere matter of routine, which, adding to the publicity, and 
adding to the expense, and adding to the delay of getting a patient 
under care, would make the early treatment more difficult than it 1s. 


Psychiatric Dispensaries, but no Patvents. 


3748. Are there not cases of incipient lunacy which might be met 
by medical treatment, as an out-patient would be treated in other 
diseases ?—No doubt in some cases there might be, but the difficulty 
of the early treatment of lunacy arises very much from this, that a 
man does not himself recognize that he is becoming insane. Very 
few insane people do acknowledge that they are insane; it 1s quite 
the exception when they do, and in the early stages 1t 1s a most un- 
common thing for a man to suppose so; he rebels against all kinds 
of treatment then, will not see a doctor, thinks the idea that he is ill 
perfectly absurd. Just at the moment when it is most important that 
something should be done, at that. moment there is the greatest diffi- 
culty in doing what is desirable. 


Advisability of distinguishing between Forms of Admission to 
Asylums for Cure and for Safe Custody. 


3751 Then again, there are dangers of such a person as the young 
lady you mentioned being sent by mistake to an asylum, in which 
case the symptoms would be very much aggravated, would not they ? 
—J do not think it would be advisable to send her to an asylum, nor 


‘ 


492 The Lunacy Laws, 1877. (Jan., 


would I do so; but Ishould send her from home to some medical 
man’s house, or to the house of some suitable person. If I have to 
do that, I have to go through exactly the same forms as I do to send 
her to an asylum, and thereis thegreatest unwillingness on the part of 
friends to do that. All I desire to see done, if feasible, would be to 
distinguish with regard to the stringency of admission-forms between 
the early cases of insanity in which it is a question of treatment, and 
chronic cases of insanity, in which it has become rather a question of 
safe custody. 


Importance of Early Treatment. 


3744, You think that if there was more care taken, more delay 
in admitting or consigning patients to asylums, their cure would be 
more doubtful ?— Undoubtedly ; there are two great objects to be kept 
in view with regard to the detention of patients; they are put under 
care, not only for their own safe custody, because they are dangerous 
to themselves or others, but another, and most important object, 
if insanity is to be cured, is, that they be put under care for treat- 
ment, and early, because recoveries are entirely in proportion to the 
early stage at which treatment is adopted. If regulations are made 
more stringent than they are now, and, indeed the present regulations 
operate to some extent in that direction, the friends of patients -will, 
instead of sending them from home, as is almost essential in a case of 
insanity—unlike in this respect other disease—keep them at home 
under improper conditions, and so very much injure the chance of 
recovery, 


Dislike of Relatives to any Forms. 


3745, Would that early treatment necessarily involve sending 
them from home; could not they be treated to a certain extent as 
out- patients ?—If a patient is sent from the care of his own friends, 
even if itis to a private house, it is absolutely necessary to go through 
the same forms as you go through to place him under care in an 
asylum ; and my experience as a physician is that friends shrink very 
much from doing that. They dislike the supposed publicity of it; , 
they dislike the formally pronouncing him to be a lunatic; and they 
will not remove him from home in consequence. 


Harly Treatment in Private Houses. 


3761. Do you think the system of private houses a good one? 
—I think it is very important in the early treatment of insanity, in 
some cases, that they should not be sent to asylums, when it is still 
important that they should be placed under some kind of care. 


Sanity and Insanity: the Line between. 


8791. Do you agree in the opinion which was expressed by Dr. 
Williams, that the line of demarcation between sanity and insanity is 
by no means very distinct ?—It is like a line of demarcation between 
light and darkness, it is impossible to draw it. 


1878. | The Lunacy Laws, 1877. 493 


He recommended the abolition of that clause in the Lunacy 
Act under which the proprietor of a private asylum can certify 
that a patient is dangerous, and so prevent his removal. 
Along with all the other medical witnesses, he scouted the 
idea of there being any drugs that could produce insanity. 

Dr. Duckworth Williams would send all cases early to 
asylums, and after a time discharge them, or send them to 
their friends, or the workhouses, each of which should be 
thus equipped :— 


3876. My idea is that all workhouses might have a detached 
building, in which chronic lunatics might be detained, and in which 
they might be kept much cheaper and at much less cost to the rate- 
payers than in the county asylum. 


He described how in the last seven years he had so dis- 
charged 200 chronic harmless cases from the Sussex Asylum 
at Haywards Heath, only 10 per cent. of which had come back, 
and that in this way he had saved the county £30,000. 
Another effect of this he then described :— 


3884. It has done away with the prejudice against the asylums in 
the county of Sussex to a great extent. Friends now see that they 
can get their relatives out without any trouble. 

3942, It is a matter of humanity, rather than scientific opinion, 
that you would advise these discharges ?—I think they are more com- 
fortable with their friends; their friends are more satisfied; and the 
patients themselves are more satisfied. 


He thought such cases could do with less diet on the whole 
than those in asylums, chronic lunatics not needing more than 
other persons, while recent cases do. He did not suggest 
any scheme by which the various medical superintendents of 
asylums shall be enabled to see alike as to what constitutes a 
chronic, harmless, incurable case. It would be a great 
pecuniary gain to every county, wanting a superintendent, to 
make it a sine qué non in every eligible candidate to have 
most clear perceptions on this point, judging by the example 
of Sussex. He thought that it would be an advantage for 
local authorities to build for, and lodge patients of every class, 
but was against the idea of having pauper and private patients 
in the same building. He made a most positive statement 
that lunacy is on the increase in Sussex, but brought forward no 
reasons that the majority of persons would think sufficient. 
He also stated, as a fact known to him, that criminal luna- 
tics are most dissatisfied with the diet of the county 
asylums after the more sumptuous fare at Broadmoor, _ 

Dr. Gilchrist, of the Crichton Royal Asylum, Dumfries, 


AQ 4 The Lunacy Laws, 1877. [Jan., 


then explained to the Committee the case of a Mr. Wilson, 
whom he had detained in his asylum for a longer period than 
the Scotch “certificate of emergency” allowed him to do, and 
who thereupon brought an action against him, and got £150, 
the Board of Lunacy having told his agents about the fact 
six weeks after its occurrence. ‘The witness is clearly a kind- 
hearted, over-conscientious man, who thought that it was 
his duty to do as he did for the protection of the patient ; but 
good motivesdo not unfortunately in this wicked world protect 
public officials who are appointed under Acts of Parliament from 
the consequences of a deliberate violation of the provisions 
of such Acts. Dr. Gilchrist must be satisfied with the ap- 
proval of his conscience, the sympathy of his professional 
brethren, and the general impression which seemed to be 
produced that the Scotch Board of Lunacy did a shabby 
thing in telling tales of him out of school. If they have no 
power themselves to prosecute for such an illegal detention in 
an asylum, they ought not to have interfered. He thought the 
Scotch plan of letting patients out on probation a good one 
when they don’t go to their friends. But he did not-make a 
suggestion as to where else they should go; and he says that 
a considerable proportion of his ‘‘ probationers” come back. 
He thought the Scotch law quite sufficient to protect the 
liberty of the subject ; but if this is so, we consider it a most 
unfortunate circumstance that he should have had to come to 
tell the Committee about his own abuse of the certificate of 
emergency, a provision under which any urgent case in 
Scotland can be sent at once to an asylum, which is quite 
according to Dr. Bucknill’s and Dr. Maudsley’s ideas of mak- 
ing the forms most easy for placing an acute case of insanity 
under medical treatment without delay. We believe that 
the certificate is in Scotland the greatest comfort to the 
friends of patients and to the asylum physicians, and of the 
greatest value to the patients themselves, and we hope the 
Committee in its report will recommend its extension to 
England. We have reason to believe that Dr. Gilchrist’s 
cases, of which he and Dr. Mitchell told the Committee, are 
the only instances known of an illegal interference with the — 
liberty of the subject that could by possibility be attributed 
to this certificate. 

The witness described the Scotch system of allowing 
patients to enter asylums voluntarily, but does not think that 
this provision is of any use in cases of temporary insanity 
from drinking, or in the case of dipsomaniacs, who constantly 


1878. ] The Lunacy Laws, 1877. 495 


make use of it, but won’t stay long enough to do themselves 
any good. This is his experience of the treatment of private 


and pauper patients together in the same institution but not 
in the same building :— 


4326. Are you aware whether there is any feeling of discontent 
on the part of paupers at seeing the private patients treated better than 
themselves ?—I should say certainly not, so far as my experience goes. 


The two houses are so entirely separate from each other that it could 
hardly be possible. 


In the following quotation he makes a very grave statement 
as to the relations between the Scotch Board and the asylum 
physicians :— ; 

4197. I do not refer to the case in which you yourself were con- 
cerned ; but generally speaking, is the system of visiting, and the 
system of supervision of asylums in Scotland adopted by the Com- 
missioners, considered a satisfactory one by those who have the man- 
agement of asylums?—I think I am speaking the truth when I[ 
say it is not generally satisfactory to the profession, to the medical 
superintendents. 

4198. Is it satisfactory to the public?—I can hardly answer that ; 
I should say not always. 

4342-3. You state that the medical profession, generally, in 
Scotland, are, in your opinion, dissatisfied with the administration of 
the Lunacy Board; will you state the grounds on which they object 
to the present administration ?—-Perhaps it was not right for me to 
make the statement except with considerable qualifications, but it is, 
I think, generally the impression of the medical superintendents that 
the Board interferes a little more than they might do in special matters 
of detail, which should be left to the medical superintendent, who is 
supposed to have the skill and experience necessary to deal with them. 
I do not think I can say anything more definite than that ; I have 
heard them complained of by gentlemen speaking in ordinary conver- 
sation. 

4344, Hearsay complaint ?—Yes, I have no other ground for it. 


This must strike a stranger oddly, for if there is one thing 
more than another that seems characteristic of the Scotch 
Medical Commissioners and Superintendents, it is the friendly 
terms on which they seem to be when they meet on profes- 
sional platforms. Is it possible that his treatment by the 
Board in the Wilson case has rankled in Dr. Gilchrist’s 
mind and coloured his opinions regarding it? At all events, 
on this point we should have liked the evidence of other 
Scotch physicians. 

Dr. L. S. F. Winslow occupied himself chiefly before 
the Committee in rebuting the grave charges brought 


496 The Lunacy Laws, 1877. [Jan., 


against his house by Dr. Lockhart Robertson and Dr. 
Bucknill. 

Then came the cases of Mrs. Lowe, Mrs. Petschler, 
Anthony Stevens, Peter Chance, the Rev. W. A. O’Conor, 
the Rev. J. W. Thomas, and Mr. Walter Marshall, all 
of whom personally or through others gave evidence be- 
fore the Committee as to their wrongous detention in 
asylums. It perhaps would be improper to indicate an 
opinion on the merits of any of those cases before the 
Committee have given in their report to Parliament, but 
there can be no impropriety in saying that there was 
strong and abundant testimony in all the cases that 
mental disease had existed. In reading over those cases, it 
does strike one that if greater freedom of visitation and of 
sending letters had been allowed, and facilities offered for 
trying some of them out of asylums whenever the acute 
symptoms had passed off, or the patients had acquired a 
fair amount of self-control, we should never have heard 
of them before a Parliamentary Committee on Lunacy 
Law. By far the most satisfactory quietus to many very 
troublesome but not dangerous lunatics is to send them out 
of an asylum; the trouble they give to their friends and the 
asylum doctor when out and in getting them back again, is 
infinitesimal compared to that implied in keeping them in, 
and they are apt to be much more satisfied and easily 
managed thereafter. 

Mr. Wm. W. Parkinson, master of the Bermondsey 
Workhouse, formerly an attendant and afterward the chief 
attendant in an asylum, then gave evidence. He was the only 
man of that class who was called, and we are certain that 
this was a mistake. Intelligent attendants could have given 
the Committee most valuable information on points that 
doctors can’t speak with any authority upon. He thought 
there were too great facilities for sending patients to asylums. 
He would like to have two medical certificates in pauper 
cases, the one being given by an independent man, the parish 
medical officer being, in his opinion, often young and inex- 
perienced. He thought there is now a great tendency among 
people in the lower and middle class to put their friends into 
asylums. This is a very important point, which we believe 
to be true in large towns, and which was brought out by no 
other witness. He thought for the removal of the pauper 
cases to asylums the Guardians should appoint trained 
persons. This also is a point of some practical importance. 


1878.] The Lunacy Laws, 1877, 497 


This is his opinion of attendants in asylums, and he must 
have known them :— 


9808. What is your experience of attendantsin asylums ?—I think 
they are very much improved upon on what they were 20 years ago. 
My first experience was very bad indeed. I think that the attendants 
are very much what the medical superintendents make them, I think 
when they have an excellent medical superintendent at their head, 
they are (much more attentive) much more kind, courteous, and humane 
towards the patients than when the medical superintendent is lax and 
indifferent to his duties. 


He did not approve of mixing convalescent with new 
cases in asylums, this practice being very bad for the former. 
The Commissioners in Lunacy might well ponder this, and 
try to get quietude in asylums by some other plan than an 
absence of classification. 

We may say, without fear of any contradiction, that the 
cases of the “ Protestant Alliance” and the “ Lunacy Law 
Amendment” Society broke down completely. No evidence 
of any value was brought forward, nothing but second-hand 
or hearsay gossip. 

Dr. Blandford’s evidence was of a very weighty and well- 
considered kind, and will, no doubt, have much weight with 
the Committee, from his position, character, and experience. 
This is his opinion as to the appointment of independent men 
as visiting physicians to private asylums, a plan suggested 
by Dr. Robertson, and also as to the whole question of the 
existence and use of private asylums :— 


7415. Thenithas been further suggested that there should be an 
independent medical man attached to all private asylums who should be 
paid by the proprietor, but nominated by the Commissioners in Lunacy ? 
—That would be the creation of a class of deputy-commissioners or 
something of that sort. I can only say that it would be very difficult 
to get medical men of that class who knew anything about the sub- 
ject unless they were very highly paid ; and it would really be merely 
adding an additional number to the Commissioners in Lunacy. I have 
not the slightest objection to that being done, if it is thought expe- 
dient. I think the Commissioners in Lunacy are a very great safe- 
guard both to the patients and to the proprietors. 

7416. Neither of those four plans which have been suggested 
would in your opinion be beneficial to the patient, having strict 
regard to this Committee, which is as to the liberty of the subject ?— 
I have no objection to any number of medical men seeing the patients. 
I think there would be no objection to a medical man of that des- 
cription being appointed, if he were a man who knew his business. 


— 498 The Lunacy Laws, 1877. [Jan., 


7475. Would it not be an additional safeguard if one of the 
medical men signing the certificate were to be in some way responsible 
to the public, and recognised by the Commissioners ?—I myself think 
that the safety of the public really is the fact that medical men in 
general are not all experts in this matter. The genefal charge 
made against us lunacy doctors is that we are ready to shut up every- 
body, and that we think everybody insane. If the people signing cer- 
tificates were all more or less what are called lunacy doctors, I think 
the public would imagine they were going to be shut up a great deal 
more than they are now, when an ordinary medical man signs a 
certificate, really as one of the public, not as an an expert in lunacy. 

7510. I need not ask you, as you do not think the system could be 
improved, whether yon think it would also be an improvement that the 
superintendent of an asylum should not have any pecuniary interest 
in the detention or otherwise of the patient ?—For many years I was 
in that position ; it is only quite lately that Ihave become in any way 
or shape aproprietor. I confess that, personally, I very much prefer 
not being a proprietor ; but I think this, that I should keep patients a 
great deal longer, if I had no pecuniary interest in them, than I do 
when I have a pecuniary interest, and I think one lets many patients 
out of a private asylum on account of the pressure put upon us by 
friends, who would be benefited by being kept longer, and who, in a 
public asylum, certainly would be kept longer. 

7511. No doubt that is the case with aman of right feeling, but I 
am assuming the case of a person not of high moral feeling ?— 
Another witness, who was before you, said if one were to begin de 
novo, perhaps it would be better to begin in that way. I think many 
people would have a great objection to send their relatives to anything 
like a public asylum. 


He ridiculed the idea of there being any drugs that can 
cause insanity. He thought that the law should compel every 
person who put a patient into an asylum to visit him in 
person or by deputy every six months, as was the case in a 
former Act (7441). Believed the Commissioners were quite 
sufficient to secure the liberty of the subject. He approved 
of the Scotch plan of a certificate of emergency. 

Dr. C. H. Fox’s evidence was chiefly taken up with Mrs. 
Lowe’s case. It came out clearly, however, that even in the 
best private asylums in England “it is in the power of 
the person who placed the patient in the asylum to prevent 
any access to him or her without his wish.’ The witness 
thought that the power of regulating the visits of outsiders 
to patients should be left to the discretion of the medical 
superintendent. 

Dr. P. Maury Deas went very fully into the case of Mrs. 
Petschler, who had been under his care at the Macclesfield 


1878. ] The Lunacy Laws, 1877. 499 


Asylum. His opinion in regard to sending recent cases of 
insanity to workhouses is as follows :— 


7824, You have spoken rather strongly against lunatics being re- 
ceived in workhouses; are you aware that there are 15,000 lunatics in 
workhouses in England ?-- Yes. 

7825. Are you aware of any single case in which there has been 
wrongful detention in a workhouse ?—I consider it is all wrongful 
detention. 

7826. Are you aware of any single case where a sane person has 
been detained in a workhouse ?——No, I have no knowlege of such a 
case. 

7827. Your objection applies to the whole 15,000 ?—My objection 
goes to this : when asylums are provided by the county, and sup- 
ported by the rates for the proper treatment of insane patients of the 
poorer class, I object to their being received, without any legal 
formalities or medical certificates, into buildings where they cannot 
receive the same treatment, and where they are detained without any 
responsibility, for a period depending entirely upon the discretion of 
the medical officer of the workhouse. 


He advocated ‘strongly the sending of quiet chronic cases 
to workhouses. 

Mr. Richard Adams spoke of the great success of the 
Bodmin Asylum, Cornwall, of which he is superintendent, 
and which carries out the principle for that county of provid- 
ing forall the insane, private and pauper, in separate houses 
near each other, under the same management. This is how 
it works there :— 


7993. Is there any jealousy or inharmonious working arising 
between the private and pauper asylums at Bodmin ?—No, none what- 
ever. 

7994. There is no hitch in the machinery of management ?—Not 
the slightest. 

7995. Is there any jealousy on the part of the pauper patients 
against those on the other side?—No; on the contrary, 1t 1s an 
advantage, because there are many pauper patients who come down to 
work in the private asylum who will not work anywhere else. The 
place is much nicer, and they get little extras for working, and so on, 
so that in this it is a positive advantage. 


He thought that if private asylums were more frequently 
visited it would satisfy the public. 

Mr. Samuel Newington spoke of the case of the Rev. Mr. 
Thomas. 

Mr. J. H. Kimbell, Mr. E. A. Everitt, and Dr. Parsey 
spoke in regard to the case of a nun named Miss Wardell, 
sent to the Hatton Asylum from a convent. Dr. Parsey 


500 The Lunacy Laws, 1877. [Jan., 


thought there was nothing in any way unusual about a nun 
becoming insane in a convent, nor that she would be treated 
in any way differently there from a private house, medical 
men being sent for, &c. 

Col. Fletcher spoke of the case of Peter Chance. 

Dr. Cameron, M.P. for Glasgow, detailed very fully the 
difficulty he had had in getting a “ Fiscal case” out of the 
Royal Asylum at Glasgow before his complete recovery, but 
after such improvement in mind that he was quiet and could 
earn his own living. The necessary tees for getting up a 
petition to the Sheriff in due form, and to pay two indepen- 
dent doctors to examine him and report, were not easily got, 
and it appears they would have been thrown away if 
they had been got. Surely Dr. Cameron would not have a 
man who was actually very dangerous to the lieges go out 
of an asylum merely because his wife wished to have him. 
Let him devise a remedy for such cases as he described, he 
being a legislator. 

The Hon. Francis Scott, chairman of the Brookwood 
Asylum, the only member of a Committee of Visitors of a 
County Asylum examined by the Committee, gave most 
important evidence in regard to the way pauper patients 
are certified and sent to asylums in such great numbers, the 
state of those who now occupy those institutions, a layman’s 
view of large asylums, their visitation by the Commissioners, 
the confusion of authorities, and finally the treatment he 
favours. The following are his views :— 

8614. We have had evidence on the contrary that it would be a 
great advantage if the system of the two certificates, in the case of 
private asylums, were supplemented, or even exchanged for that of 
magistrates; that the intervention of a magistrate is a great safe- 
guard ?—I cannot pretend to say what it would be instead, or in lieu 
of the two; but I certainly should seek to have some more efficient 
medical certificate than is now adhibited. The parish doctor, a 
young man who has paid something for his practice, and perhaps 
never read a line, never saw a case, gives his opinion, which is not 
worth as much as yours, and the man goes to the asylum upon that. 

8633. They are treated in classes instead of being treated indi- 
vidually ?—They are classified; and medical gentlemen will tell you 
they can treat them up to 1,000, and 1,500, but they used not to say 
so. ‘Three hundred or four hundred was enough for them to manage in 
a curative establishment; they cease to be curative ; we do not cure; 
ours are large places of detention. In 1857 the number of lunatics 
“deemed curable’? in the county asylums of England and Wales 
amounted to 1,890 out of 15,154 patients, or 12-47 cent. (House of 


1878. | The Lunacy Laws, 1877. 501 


Commons paper, 1858, No. 299). Those “deemed curable” in 
1874 and 1875, throughout England and Wales, were 74 per cent. ; 
those deemed curable in the county of Surrey were 43 per cent. Ido 
not know anything more disheartening than that. 

8663. You referred to the fact that you thought the Lunacy 
Commissioners were not able to visit as much as they ought; would 
you suggest that their number should be increased ?—TIf it is to con- 
tinue as it is—two divisions, two departments of State—it is abso- 
lutely necessary that either the number should be increased, or that, as 
the Poor Law Department has done, they should have a great 
number of inspectors under them. I merely put it in this way: there 
used to be about 12,000 lunatics and now there are about 65,000. 

8664. Was the staff the same then ?—Just the same. 

8691. One of the points you have touched upon is the confusion 
of authorities which govern the cases of lunatics. There are six 
authorities, are there not—the Asylum Visitors, the Court of Quarter 
Sessions, the Board of Guardians, the Home Office, the Local 
Government Board, and the Lunacy Commissioners ?— Yes; the Home 
Office I supposed to be over the other two, but I may be in error. 

8752. Ihave seen the practice in England; 1 have seen it in 
Scotland, and in Norway, and in France; I have seen it at Gheel 
and in other places in Belgium; I have seen it in Germany and in 
Italy. You need not ask me whether I desire to see more or less 
liberty. I say more liberty and more work. 


Dr. Mortimer Granville expressed very sweeping views as 
to the insufficiency of the present Lunacy Laws. 


8819. I think the means taken to ascertain the sanity or insanity 
of persons before they are placed under treatment in asylums are 
insufficient both as to the method of taking the opinion and the 
character of the opinion given. 


- He thought that means should be taken to identify each 
patient to the Commissioners at their visits. He thought a 
cunning lunatic would have a “far greater” chance of 
liberation than a sane man, that the dietary was below what 
it should be in nutritive material in the London pauper 
asylums, and that there should be a register of the medical 
treatment and the medicines used. This is his idea as to how 
the patients should be visited :— | 
8872. You think that the Lunacy Commissioners ought to visit 
more frequently than they do ?—-I think the system of visitation is 
not likely to be more efficient because 1t 1s increased, but the mode of 
conducting the visitation should be altogether altered. The visits 
should be to individual patients; that is to say, when a case 1s 
admitted to an asylum, I think the best plan would be for a patient 
to be sent, under ordinary circumstances, as to an ordinary hospital, 


502 The Lunacy Laws, 1877. [Jan., 


immediate notice being given to the Commissioners in Lunacy, who 
would instruct some official on their behalf to visit and certify to them 
the condition of the patient and the expediency of retaining him; and 
that the patient so certified should be kept under the observation of 
an independent official, at any rate during such period as the disease 
was supposed to be curable. 


Here is a most heterodox opinion—what will some of our 
Scotch friends say to it ?— 


8882. I think that the employment of farm labour is by no means 
a suitable one for the great mass of lunatics. 


He was wrong in his statement to the Committee about 
there being more recoveries in private than in public asylums 
as we have pointed out. He is greatly against large asylums. 
He advocated individualisation of patients, and the making 
of their circumstances more in harmony with their state, 
changing as it changes. He thought private asylums should 
be done away with, and the doctors who take private patients 
should be paid by salary. On the whole, he thought well of 
asylums. There are no abuses in them. He stated that 
chloral and other narcotic and sedative medicines tend to 
make the patients ‘“‘ pass pleasantly into dementia.” 

Dr. Thorne Thorne and Dr. Lake defended Dr. Winslow 
energetically about the case of Mr. Morton. Unfortunately 
neither of them had seen the patient up to the time of his | 
removal. 

Mr. Charles Palmer Phillips, Commissioner in Lunacy and 
formerly Secretary to the Commissioners for seven years, then 
gave weighty evidence on a great number of questions. 
He first gave the facts as to the case of a Mr. Long. He 
thought the Commissioners and the Lord Chancellor’s 
Visitors did not clash at all; he did not say their duties did 
not overlap. This is his opinion in regard to undue deten- 
tion in Asylums. 


9544, You stated that within your twelve years’ experience, you 
had not known a case where a person being sane, had been improperly 
confined in an asylum ?—I think not; I cannot recollect the case. 

9545. What is your experience as to the undue detention of 
individuals, who, not being sane, have been detained in an asylum 
longer than was necessary, either with reference to their cure or the 
safety of the public ?—My opinion, for what it is worth, is this, that 
the tendency is rather to discharge prematurely than to detain un- 
necessarily. Of course opinions must always differ as to the right 
moment for discharge. 

Mr. J. D. Cleaton, another Commissioner, gave this 
evidence about Mrs. Petschler :— 


1878.] The Lunacy Laws, 1877. «608 


9859. I may say I held an enquiry jointly with one of my legal 
colleagues extending over four days, and we came to the conclusion 
that she was insane, and properly placed under treatment ; that she 
was kindly treated, and that her detention was not unduly prolonged. 


Dr. Arthur Mitchell, one of the Commissioners in Lunacy 
for Scotland, gave most elaborate evidence as to the 
working of the Scotch Lunacy Laws. He approved of the 
uniformity of procedure for the admission of private and 
pauper cases as being sound in law, and thought the Sheriff’s 
order the right thing. The Sheriff in Scotland is a high 
and important legal functionary, combining the duties of 
Stipendiary Magistrate, County Court Judge, and paid 
Chairman of Quarter Sessions. He admitted that the certi- 
ficate of emergency is now often used as one of convenience, 
and did not condemn this. He gave the Commissioners’ view 
of the case of Mr. Wilson at the Dumfries Asylum. He said 
that 10 or15 per cent. of all the admissions into Scotch asylums 
were on certificates of emergency. He did not approve of 
lunacy experts, but was very strongly in favour of the fuller 
study of mental diseases on the part of medical men. Here 
is what he said as to the reasons that influence friends and 
parish officers in sending patients to asylums :— 


9935. During my work as a deputy commissioner, I was led very 
largely to know the motives which influence people in sending relatives 
or friends toasylums. I frequently saw patients, during one visit to a 
county, at bome and provided for under private care. A year elapsed, 
and on going back, I found that those patients had been removed to 
asylums. The reasons I was interested in knowing. There might be 
a change in the patient’s condition ; but that seldom was the reason. 
It much more frequently happened, the cases being chronic cases, that 
the removal was due to some change which had occurred in the 
domestic arrangements, some one’s death, or perhaps the loss of 
money, or perhaps even the acquisition of money. The reasons were 
extremely various, but they were not generally reasons which related 
to the patient’s own condition or his insanity. They were often, I 
thought, good and sufficient reasons. I frequently thought that, on the 
whole, it was an advantage to the patient that he had been removed. 
At other times, I thought that with a little forbearance, and with a 
little effort to adapt the new circumstances to the patient's case, the 
old arrangement might have been left undisturbed. 


Good Lffects of Visits to Patients in Asylums. 


10062. What are the provisions made for securing access to 
patients in asylums ?—The clergyman of any parish in which an 
asylum is situated, or the clergyman of any church to which a patient 
belongs, or any relation of a patient, or when the patient is a pauper, 


504 The Lunacy Laws, 1877. [Jan., 


any member of the parochial Board liable for his maintenance has 
liberty to visit any such patient in an asylum, subject to such general 
conditions and regulations as the superintendent and medical officer ot 
the asylum may think it proper to impose. Such conditions and 
regulations must have the sanction of the Board. If permission to 
visit a patient is refused and complained of, the superintendent 
must intimate the refusal and the grounds of it to the Board, whose 
decision in the matter shall be final. Under a special instruction 
from the Board they must make this intimation, whether the refusal 
is complained of or not. In addition to this, the Board can at any 
time give an order for the admission to visit a patient of any relation 
or friend of any medical or other person whom any relation or friend 
may desire to be admitted. This may be either an order for a single 
admission, or for admission for a limited number of times, or for ad- 
mission generally at all reasonable times. If a patient wishes to see 
any relation or friend, the Board can give an order for the admission 
of that friend, but they cannot, of course, compel the friend to go. . 

; It is the policy of the Scotch Board to give free access to 
patients ; but it is a policy which they seldom require to exercise or 
urge, because I believe it also to be the policy of the superintendents 
of Scotch asylums. It is scarcely possible, in my opinion, to carry 
such a policy too far. The freer the access to patients the better. 
The errors from an over-freedom cannot, in my opinion, be either 
numerous or of a serious nature. The evils from an opposite course 
can scarcely fail to be numerous and grave. 

10068. As a general rule, in Scotland, everybody can have access 
to every lunatic, provided there is no medical objection on the part of 
the superintendent ?—Yes, we have done our best to make it known 
that we think a great guarantee against improper detention is afforded 
by freedom of access to patients. 


There is no restriction as to letters at all in Scotland, except 
that the superintendents have to send, unopened, those ad- 
dressed to the Commissioners in Lunacy, but they can do 
what they like with the rest. Asa matter of fact, those are 
sent that ought to be sent. The Commissioners sanction the 
discharge on probation of patients; 1,805 have been thus dis- 
charged, 1,508 of whom were able to stay out of asylums. 
The Commissioners do not wish to have the English power 
to order discharge on their own examination, but approve of 
the present procedure of two medical men seeing the patients, 
and reporting to them. 


10109. In England it is about one Commissioner to 10,000, and 
in Scotland about one to 4,400; do you think if your lunatics were 
trebled you could get through the work ?—I do not think it would be 
possible. 


1878.] The Lunacy Laws, 1877. 505 


The witness explained that in Scotland the Commissioners 
did the work of the Chancery Visitors, that they visited the 
poorhouses twice a year, and have much office work. He 
explained that the duties cof the Deputy Commissioners are to 
inspect and supervise the single patients, pauper and private, 
a duty not done in England at all. 


Boarding-out System in Scotland. 


10162. Those of them who are paupers are visited by the parochial 
medical officer at least once a quarter, by the inspector of poor at least 
twice a year, and by one of the Deputy Commissioners in Lunacy, as 
nearly as can be, once a year. In addition to this they are at large, and 
are constantly seen by theirneighbours. This last isa very important 
kind of inspection. All the visits of which I have spoken are recorded. 
Certain patients are visited more frequently than once a year by the 
Deputy Commissioners, some of them many times; others again are 
visited less frequently. Some might be quite safely left for years 
without being visited, their guardians being known to be trustworthy, 
and the arrangements for their comfort to be satisfactory. My opinion 
is that there are patients who are happier in private dwellings than 
they would bein asylums. That is so clearly my opinion, that it does 
not seem possible to me that any one can entertain a doubt regarding the 
matter. There are not only many lunatics who derive no benefit from 
being in asylums, and who do not need asylum appliances for their 
proper care and comfort, but there are also many lunatics of whom it 
is true that they are happier and saner out of asylums than they would 
bein them. It isnot a kind thing to send such people to asylums ; 
and it would not be a necessary or desirable thing, if comfortable 
homes and guardians could be found for them; but this is not always 
and everywhere easily done, and the difficulties are becoming greater 
than they were. The providing for patients in private dwellings is a 
scheme which, to a large extent, is settled by considerations of money 
and trouble. | 

As to the system of mixed asylums with two departments, 
one for the private and the other for the pauper class, he 
fully confirmed Mr. Adams’ Cornwall experience that it is a 
great success in Scotland. Such asylums, he says, are “ self- 
supporting, and the extension of the buildings has been mainly 
out of the profits.” We think it is possible that the exist- 
ence of these asylums in Scotland, which are popular, and 
with different rates of board suitable to all classes, accounts for 
the extraordinary fact that, in a poor country like that, there 
should be far more private patients in proportion to the popu- 
lation, and in proportion to the number of pauper patients as 
will be brought on in our Review of the Blue Book for 
1876. That in England there should be only 12 percent of 


XXITI. 


506 The Lunacy Laws, 1877. [Jan., 


private to pauper patients, while in Scotland there is 22 per 
cent. is a fact well worthy of attention by such a Committee 
as this. Whatever is its cause, the fact itself speaks volumes 
for the self-respect and feelings of independence of the 
Scottish people. 

10166. How does that answer in Scotland?—We have very few 
private asylums in Scotland. We have only six; and those which 
receive patients in affluent circumstances have an excellent character, 
Many of their inmates come from England and Ireland. We possess 
in Scotland a considerable number of high-class asylums with Royal 
charters, which furnish excellent accommodations to private patients ; 
of all the private patients in Scotland, on the 1st of January this 
year, 85 per cent. were in public asylums, and 15 per cent. in private 
asylums. 


A * Public Asylum” does Not Make Public the Names of its 
Patients. 

10180. One objection that has been taken to public asylums is, 
that people do not like their names to be known, and they think there 
would be more chance of their names becoming public in a public 
asylum than if they went to a private asylum ?—There is nothing 
more public about a public asylum than there is about a private asylum, 
the one is called a public asylum, the other a private asylum, but 
there is practically no greater publicity about the one than about the 
other. 

10181. Then you think if you turn the superintendent into a paid 
Government officer, there would be no greater chance of publicity in 
that sense than if he kept a private house ?—None whatever, and the 
confidence that exists in public asylums in Scotland is shown by the 
figures that I have given you ; 85 per cent. of all our private patients 
are in public asylums. 


He expressed the opinion that there should be no legisla- 
tion to suppress private asylums. He explains (10222) that 
in Scotland the number of single patients continues to de- 
crease year by year, just because the Deputy Commissioners 
try to confine the system to suitable cases, and have the 
unsuitable sent to asylums. 

oe You have no serious alteration in the Scotch law to suggest? 
UNO. 

Mr. Palmer Phillips was recalled, and added greatly to his 
first evidence. The following is evidently the deliberate 
opinion of the Lunacy Commissioners as to the order of 
admission of private patients, and therefore deserves being 
put on record. It will be observed that he takes no account 
of the general principle of giving one private person power to 


1878. ] The Lunacy Laws, 1877. 507 


deprive another person of his liberty. The English prac- 
tice is proved to work well on the whole, but when one 
thinks of it as existing in the freest state in Europe, one asks, 
Does such a practice exist elsewhere in Christendom? And has 
its existence here anything to do with the chronic suspicion 
of asylums in the public mind, and the periodic outbursts of 
ignorant prejudice against them ? 


10378. You do not think it would be a good plan to try to assimi- 
late the English system to the Scotch system, that the relation, or 
whoever the party was who wanted the patient shut.up, should petition 
some public authority for the order ?—My own idea is, that if you 
substitute any magistrate or official person as the party to sign the 
order, it will be most mischievous to the liberty of the subject, and 
very prejudicial to the alleged lunatic, for this reason—there is, I 
think, no greater safeguard for the due performance of a duty than 
individual personal responsibility. Such responsibility, if it is not 
duly exercised, a jury will visit with damages, and in cases of false 
imprisonment juries give very heavy damages. At the present time 
the responsibility is such that very many decline to take it upon them- 
selves for the benefit of the lunatic, even when his benefit loudly 
demands it. I think that this safeguard is very well supplemented by 
certificates and reports, and by visits by the Commissioners and others. 
If you allow a magistrate either to sign the order or to countersign 
the order, you will at once destroy all the responsibility of the relative 
or other person. If a person is falsely imprisoned under a magis- 
trate’s order, there can be no remedy. If the magistrate has acted 
bond fide he will be relieved from all responsibility; he cannot be 
visited with a verdict for damages, and there will be no remedy for the 
lunatic. Besides, the magistrate will become simply a ministerial 
officer in the matter, and will be guided, if not absolutely, to a very 
great extent, by the certificate, so that really it will come to this, that 
the only safeyuard will be the certificates. The great safeguard now 
is the responsibility of the individual who signs the order. 


Work of an English and Scotch Commissioner— 
Feelings of Former. 

10392. According to the namber given, the Scotch Buard bears 
the proportion of one Commissioner to 4,400 patients, and the 
English, considering that they must visit in twos, would be in the pro- 
portion of one to 21,000 ?—The Scotch Commissioners must have an 
easy berth ; I rather envy them. 


The above shows how almost anything can be proved by 
figures, for as the English Commissioners only visit public 
Asylums once a year whilst the Scotch visit them twice, this 
fact at once diminishes by one-half the apparent disparity. 


508 The Lunacy Laws, 1877. [Jan., 


Feelings of rich English Lunatics. 


10475. You are aware that that jealousy does not exist in Scotland, 
where, in the chartered lunatic asylums, the two classes are brought 
together ?—I have no knowledge of Scotch lunacy, or Scotch lunacy 
practice; but Ican easily imagine that, in Scotland, which is a less 
wealthy country than ours, those feelings might not arise which do 
exist in England. There is a very large wealthy class in this country 
who would not, I think, go into asylums in any way connected with 
pauper asylums. 


Transaction of Business by Lunatics. 


10507. To turn to the question of the transaction of business by 
lunatics, did I understand you to say that the idea of yourself and 
brother Commissioners is, that no business should be transacted by 
lunatics in an asylum ?—I would almost go that length, I think, 
for two reasons, the man is under duress, and he may raise that ob- 
jection when he is relieved from that duress, and say, “ I ought never 
to have been asked, when I was really not my own master, to trans- 
act a matter of business. Iam very dissatisfied with the result of that 
business—you were my guardian, and should not have allowed me to 
transact business when I was not able to form an opinion for myself.” 


The following state of matters surely calls for instant 
remedy in regard to lunatics in workhouses :— 


10668. With regard to the admission of lunatics into workhouse 
wards, that, I think, can be done without any certificates whatever? — 
Yes, that seems to mea very great blot in the present state of things; 
there is only a statutory authority by implication for taking a man to 
a workhouse, and yet it is done every day simply upon an order to 
admit him, and that is twisted into an order to bring him. 

10664. In fact, a man is brought into a workhouse as a pauper, 
and when there, he is treated as a lunatic ?— Yes. 


The following opinion, which it will be remembered was 
concurred in by several asylum superintendents, and was 
reiterated by Lord Shaftesbury, is no doubt the deliberate 
conviction of the Commissioners. It is a most important 
landmark in the medical opinion and the lunacy policy of 
the Kingdom—a new departure, in fact. Ten or even five 
years ago, the idea of setting up great chronic incurable 
asylums was denounced by the best men in this department 
of medicine on the score of humanity and of medical opinion. 


10574. ‘Take the case of a county which already possesses one or 
more general lunatic asylums, and that has insufficient accommoda- 
tion ; would you think it desirable, in such a case as that if it is 
necessary to build a new asylum, that an arrangement should be made 


1878. ] The Lunacy Laws, 1877. | 509 


for classifying the lunatics, so as to have a new asylum built at mode- 
rate expense, such as you have spoken of, of £100 a bed, in which all 
the incurable and chronic cases that are harmless should be placed, 
leaving the existing institutions for the treatment of the other Cases ; 
would such an arrangement recommend itself to you ?—Yes. 


The following conflict of common sense with official bias 
and prejudice, in regard to the rendering of mutual assistance 
by the Commissioners and Lord Chancellor’s visitors, is almost 
ludicrous :— 


10692. The effect upon my mind is this: there are two rather 
overworked departments, one is on the spot, and the other is not, and 
it is required that the other should make a special visit over the same 
ground in a special case ; I wish to ask you whether, by fresh legis- 
lation (if any such is recommended), there might not be additional 
powers given by which the two officers, if not actually amalgamated, 
might interchange their official functions to the benefit of both of 
them ?—I have rather misgivings as to whether two separate bodies 
of officers could work very harmoniously in that way, occasionally 
doing each other’s work. 


He makes the suggestion that the Commissioners should 
be allowed to substitute certain relatives as giving the order, 
instead of strangers, who may have had to give it on emer- 

ency. 
: Mr. C. N. Wilde, Registrar in Lunacy, then described how 
the property of a lunatic is cared for under the present law, 
and his whole evidence is a proof of the cumbersomeness, 
expense, and uncertainty of the present system of inquisi- 
tions, &e. . 

Mr. Francis Barlow, Master in Lunacy, then gave his evi- 
dence on the same subject. It appears that after the enor- 
mous trouble and expense of an inquisition to get a man 
appointed as a “ Committee” to manage the poor lunatic’s 
property, there is no provision for making him find security 
or be responsible for his intromissions ! 

10994. In fact, you have very little control over the expenditure 
of the money by the Committee of the person ?—No, none whatever. 
I take it, the Committee of the person is entirely responsible for the 
money placed in his hands. I always tell him it is a responsible posi- 
tion; he must do what is right, and if he does not, it will get to the 
Lord Chancellor’s ears or our ears, and we shail overhaul him. We 
do not make him account, but we appoint a new person unless he con- 
sents to account. 

Master Barlow is clearly a fatalist as to the necessary ex- 


penses of proceedings in his Court :— 


510 The Lunacy Laws, 1877. [Jan., 


11010. What I wanted to get at is this: we have heard of cases 
in which the expense has been very considerable ?—The expenses are 
very considerable of that kind. ‘They are cut down very considerably 
by the last Act of Parliament, by the facility given to business, but 
still in many cases they are excessive, but I believe you cannot re- 
duce then. 

We recommend any one who wants to see how a thing 
should not be done, to read from question 11032 to 11050, 
where a clear and charming notion can be obtained as to how 
a Chancery lunatic is protected by the combined authority 
of the Masters, Visitors, Commissioners, Committee of the 
person and the estate, “Solicitors to the family” (the 
lunatic can legally have no solicitor of his own), and the 
Lord Chancellor, each of those persons having by statute a 
most British independence of all the rest. 

Mr. Joseph Elmer, one of the “Report Clerks” to the 
Masters in Lunacy, amply confirmed Master Barlow’s state- 
ments as to the expense and complication of the proceedings 
in their office; but the opinion had evidently dawned on his 
mind that there were some cases of mental incapacity and 
disease in which the cumbrous farce which “is called an in- 
quisition ’”? might not be needed; and he went so far as to 
think that where “ £15 or £20 ” of the patient’s own property 
is needed “ to promote the comfort of the lunatic in some way 
or other,” somebody should have the power to order it to be 
so spent there and then, instead of having to go through the 
following process— 


11155. In the first instance, the parties have to go before the 
Masters to make that application; the Masters then have to make 
their report on the subject upon written evidence, and that report re- 
quires the confirmation of the Court, which is a very roundabout and 
expensive process. 


To an official steeped in such traditions, the simplicity 
of the law by which a man suffering from a severe disease 
urgently needing treatment, is placed under such treat- 
ment by two medical certificates, and the order of a relative 
is so dangerous to the liberty of the subject as to be “ open 
to a considerable amount of observation !” 

The Earl of Shaftesbury was the last witness, and we must 
heartily congratulate his lordship on the way in which the 
Act of 1845, his own handiwork, has passed through this ex- 
amination. His lordship spoke with such a thorough mastery 
of every lunacy question about which he was asked, that his 
replies are the admiration of all his younger fellow country- 


1878. ] The Lunacy Laws, 1877. 511 


men who are in any way interested in the welfare of the in- 
sane. In the following quotation is recorded, perhaps, one of 
the most beneficial changes to humanity which any man has 
ever had it in his power to describe as his own work :— 


11251. Those are the principal changes made by the Act of 
1845 ?— Those are the principal changes made by the Act of 1845. 

11252. What do you consider generally the result of those changes 
(made by the Act of 1845)?—The result of those changes has been most 
beneficial indeed upon the condition of lunatics in England and Wales, 
I really should like to have an opportunity of stating a few things to 
show the beneficial effects of legislation upon this matter, not that we 
have by any means attained perfection, far from it ; but I think it is 
very desirable that we should know what has been done by legislation, 
and the point we have reached, from which we may go a good deal 
further. Nearly half a century has elapsed since these efforts were 
first made, and the greater part of the people who lived at that time, 
and who could say exactly what the state of things was, have passed 
away. I ventured, when I was examined in 1859, to give as full 
a statement as I could of the state of things that had come under my 
own observation. I am happy to say that since 1859, nothing has 
occurred that would lead me to make such observations, and to say 
that the state of things required revision and superintendence in the 
way it did before; on the contrary, since 1859, we have been ina 
state of continued progress, and very great improvement. ‘The state 
of things I may just repeat, because many of the Committee may not 
have read the evidence at that time, nor have read the evidence 
before preceding committees. I may merely say that the state of 
things was such as would pass all belief, and I really believe that there 
are scarcely any people now alive who have seen it except myself. 
It is a matter of great thankfulness and very great hope, when I 
remember what the state of things was 50 years ago, and what it is 
now. I could hardly believe when I undertook that operation, that 
I should live to see such an issue. I say this not by any means 
stating that we have reached perfection; very far from it, but I only 
state this for the encouragement of those who wish to proceed in this 
course of legislation, and to show what may be done by legislation, 
and that we have a new starting point from which to go forward. 

11253. Do you refer specially now to the admission of lunatics 
into asylums, or their treatment while there ?—To both, the admis- 
sion of lunatics into asylums was very easy indeed, the mere opinon 
of medical men was quite enough, there was no inquiry; the medical 
man might see the patient, or he might not; they were admitted ; 
the supervision was nothing more than a Committee of the College of 
Physicians, who very seldom visited the houses, perhaps once a year ; 
but the treatment of every class of them passes all description. 
Mechanical restraint was not then abolished, everybody resorted to 


512 The Lunacy Laws, 1877. [Jan., 


mechanical restraint as the only way of keeping an asylum in order ; 
they were neglected in every possible way, physically and morally, 
and nothing could be more disgraceful and terrible than their position 
was. . 

In regard to the improper keeping of patients in asylums, 
after they are fit to go out, this is his opinion :— 

11257. Since 1859, I should very much modify the opinion I 
then gave. Public opinion has been so very active, so much more 
attention is paid, visitation is so much improved in a variety of ways, 
both by the provincial magistrates and by ourselves, that I should 
say in the licensed houses, and certainly in the county asylums, the 
tendency was rather to turn patients out too soon. 


How Asylums are filled up. 


11262. The fact is, that when asylums are opened, particularly 
the large county asylums, there is such a rush of old chronic cases, 
that the place is entirely filled up ; hundreds and hundreds are hunted 
up, to the exclusion of the recent cases. The chargeability to the union 
and the capitation grant of 4s per head have very much assisted that 
movement, and unless we can distinguish the recent from the 
chronic cases, we can give no estimate whatever of the increase 
of insanity, as compared with the population. But we have made a 
calculation, which may be taken for as much as it is worth, a 
calculation of the number of admissions to every 10,000 of the popu- 
lation in each year from 1866 to 1875; you will find there a gradual. 
increase shown, rising from 4°6 in 1866 to 5:9 in 1875; being 
an increase of one and three-tenths of admissions into hospitals, as 
compared with every 10,000 in those years. There was also a 
question, I think I saw in the evidence somewhere, by some gentleman 
‘as to what was the amount of insanity in Scotland as compared with 
England. I have a paper here—to be sure it is drawn up by a 
Scotchman—it is in favour of Scotland. I think there is a difference 
of about 3 per cent. in favour of Scotland. The ratio per 10,000, 
which is taken from the 1st January, 1875, in England and Wales, 
was 26°64, and in Scotland it was 23. 

11263. Was there any reason given ?—No, I do not suppose they 
can assign it to greater temperance, because, with all their virtues, _ 
‘Scotch are not famous for that one. 

The risks and dangers of insanity are sometimes over- 
looked now-a-days, but are well brought out by his Lordship 
here :— 

11270. I find that these 1,600 suicides were committed by persons 
at large, while the number of suicides committed by persons under 
care and confinement amounted only to 21. But the whole number 
of suicidal patients under confinement at present in the various 
asylums is 6,096. That return shows that unless they were under 
care and treatment, they would in all probability, or the greater pro- 


1878. ] The Lunacy Laws, 1877. 513 


portion of them, have indulged their propensity and would have 
committed suicide. Also, we must bear in mind that many of these 
suicidal cases have very strong homicidal tendencies. 


11271. On the 20th March, in 1877, there were 240 men and 87 
women, in all 327, charged with murder, attempts to murder, and 
manslaughter. Of those, 145 men are charged with murder, 98 with 
attempts at murder, 7 with manslaughter; 71 women were charged 
with murder, 12 with attempts at murder, 4 with manslaughter. Now 
this is the history of these cases, and very remarkable it is. There 
are 145 men charged with murder. In 75 cases the insanity was not 
recognised, before the commission of the crime; in 29 the insanity was 
recognised, but the persons were reputed harmless; in 38 the insanity 
was recognised, and the persons probably not regarded as being alto- 
gether harmless, but insufficient precautions were taken; in 8, the 
exact circumstances were not known. Then you come to those who 
are charged with attempts at murder, maiming, or stabbing; in 42 
the disease was not recognised before the corimission of the crime; 
in 29 they were reputed harmless; of 12 insufficient care was taken, 
and in 15 the exact circumstances were not hnown. When you come 
to the women, there are 71 women charged with murder; in 28 the 
insanity was not recognised before the commission of the crime; in 
13 the insanity was recognised, but the persons were reputed harm- 
less ; in 23 the insanity was recognised, and the persons probably not 
regarded as being altogether harmless, but insufficient precautions 
were taken. Then you come to the stabbing. In 4 the insanity was 
not recognised ; in 6 they were reputed harmless; in 2 sufficient pre- 
caution was not taken. Now this is avery important matter, because 
it shows the very large number of cases in which, through inatten- 
tion, the insanity is not detected until the overt act has been com- 
mitted. That is the evil way in which a large proportion of the 
public judge of sanity or insanity. They will never hold a person to 
be insane till some overt act has been committed, and that is always 
invariably the case before juries. Then the overt act having been 
committed, furnishes a proof that the disorder is very far advanced ; 
almost to be inveterate and consequently incurable. What I state 
shows the absolute necessity of great precautions; the absolute neces- 
sity of paying great attention to the earliest stage of the disorder, 
and though I could by no means render admission into the asylums 
more easy than it is, I most undoubtedly would not render it more 
difficult, because I am certain society isin great danger. We always 
have felt, as Commissioners, that we have a double duty. We havea 
duty to the patient, and we have a duty to society. 


Order of Admission. 


11340. What is your Lordship’s opinion as to the order of ad- 
mission; do you think there is any change necessary in that ?—The 
order of admission stands on a very singular footing, no doubt, because 


514 The Lunacy Laws, 1877. [Jan., 


any one person may sign the order, with the exception introduced in 
the 25 and 26 Vict, that no medical man having an interest in a 
lunatic asylum, and no person receiving a percentage should be allowed 
to sign the order; otherwise any person whatever has the power to 
do so. I will tell you how that arose. When we prepared the Bill, 
which passed as the Act of 1845, we were perfectly aware of the 
weakness of the provision in respect of the order of admission, but we 
could not determine to whom to assign the power ; we could not impose 
it on relations or friends, because we found that in so many instances 
there were poor medical students and poor law students, and a great 
many other people, who came up from the country and resided in inns 
or lodging houses, and who were suddenly taken ill, of whom no 
human being knew anything ; and yet an order must be signed, and 
therefore it was allowed that anybody should sign the order of admis- 
sion, because otherwise the patient would not have been admitted into 
any asylum. I have not the least doubt that we intended, as soon as 
we could, to make some better provision, but strange to say, notwith- 
standing the law is so wide, and apparently so capable of abuse, I have 
not heard a single instance of a protest against it, or of any mischief 
having arisen out of that. Your Right Honourable Chairman, I think, 
made some remarks about it in the examination of Dr. Tuke, and it is 
undoubtedly a blot, and ought to be amended, because, although it has 
not hitherto produced any mischief, it is clearly not on a proper foot- 
ing. What I should recommend would be this: that you should 
leave the law as it stands, with a view to meet the emergency of 
the case, but then give the Commissioners a power to substitute 
some person for the one who signed the original order. I think my 
colleague, Mr. Phillips, suggested that it should be confined to those 
who had the power of discharge in the case of the death of the person 
who signed the order. I think I should go a little further than 
that, and leave it to anybody that the family agreed upon, because 
where a family are not in harmony, many of them would agree upon 
a third person, and, if they did that, I should give to the Commissioners 
the power to substitute him. 


Soundness of Lunacy Certificates Generally. 


11345. It is very remarkable, taking it altogether, that the certifi- 
cates have been so sound, considering the great numbers that are given 
every year. Of course we must admit that they are signed by medical 
men who have no. very extensive knowledge of lunacy, but it is cer- 
tainly very remarkable that the number of certificates which have 
passed through our office since 1859, the date of the last Committee, 
amounts to more than 185,000, and yet of all those certificates I do 
not think so many as half-a-dozen have been found defective. It 
sounds very well to say that persons acquainted with lunacy should 
be the only persons to sign certificates, but the fact is, as matters 
now stand, that a great amount of scientific knowledge as to lunacy 


1878. | The Lunacy Laws, 1877, 515 


is not possessed by many people; there are a certain number who are 
well informed, but the great mass of the community know very little 
about it, and with the large numbers of insane, dispersed, as they are, 
all over the country, you must trust to the medical men of the several 
districts. 


We think his lordship should have stated how many of 
those 185,000 certificates had to be returned to their writers 
for amendment by order of the Commissioners, before they 
conformed to the law. We believe that 10 or 15 per cent. 
were really defective in this way. 


Education of Medical Men in Lunacy. 


11346. Therefore you would point to a time at which medical men 
should be sufficiently skilled to enable them at once to send initiatory 
cases to asylums ?—Yes; but then you see those men have not yet been 
trained. 


** Special Doctors.” 


113847. I confess to you that I have a very great fear of a special 
doctor. I should like to see how the Act of Parliament would 
define a special doctor, before I can give an opinion. I confess I 
should be very much alarmed if there were persons who kept them- 
selves exclusively confined to that study, without a constant 
experience of both, of all the various circumstances that beset lunacy 
at large and under confinement, moral as well as physical, that attend 
it; all the social circumstances, and the ten thousand other circum- 
stances; how many eccentricities are exhibited by men who are not 
mad and who never will be mad, and yet under the minute refinements 
and discriminations of science, would be put down as being in the way 
to become mad. I confess I should be very much alarmed if special 
doctors of that kind should be instituted. You cannot have better 
Opinions in the present day than those of such menas Dr. Bucknill, Dr. 
Maudsley, and Dr. Blandford, but erect them into special doctors, and I 
should be afraid of them altogether; they would so completely surrender 
everything to sciencethat they would almosttake leave of common sense. 
Thereisno doubt that if you probe every human mind and every human 
heart, and test them by the severest formulas of science, you will find 
such moral curiosities, that anybody might very safely affirm, upon scien- 
tific grounds, that this or that person has a tendency to go out of his 
mind ; it amounts almost toa superstition. [I remember the case very 
well of a medical man, a doctor, an excellent man, who thought that 
I had some influence in obtaining the appointment of medical men to 
the Commission. I knew him very well. He came to me and told 
me what he wished. To show his extraordinary knowledge of the 
subject, he gave me a sheet of paper as big as that, with a list of the 
forms of insanity; I counted them up, and they were 40 in number. 
“My dear sir,” I said, “this will never do; if you reduce your 


516 The Lunacy Laws, 1877. [Jan., | 


principles to practice, you will shut ap nine-tenths of the people of 
England.” And so they would. You may depend upon this—if ever 
you have special doctors, they will shut up people by the score. 


Would Not Abolish Licensed Houses. 


11352. To abolish such a house as Ticehurst, for instance, would 
be a positive loss to science and humanity. 


But all Asylums Need Looking After. 


11357. Ican speak in high terms of many licensed houses and 
proprietors, but I will also add, that if you relax your vigilance ever so 
little, whether it be of licensed houses or hospitals, or of county 
asylums, the whole thing will speedily go back to its former level. 


Argumentum ad judicium. 


11359. I am sure that the success we have had with the county 
asylums has been entirely because we have done everything by per- 
suasion, by the force of experience and constant observation, and we 
have never exercised any authority. 

11430. Ido not think that would in any wise have been altered 
had there been a central body, unless you had given that central body 
the absolute power of control, and if you had attempted so much, I 
am quite sure we should have made no progress at all. We have had 
great difficulty in bringing the country gentlemen to the point at which 
they have arrived, but if we attempted to coerce them, I am certain 
we should have made no progress at all. 


A Suggestion for Increasing Security. 


113860. You think the Visiting Justices are sufficient, and ought 
to have the control ?—I think so, and I think any increased visitation 
might be done in that way. I would increase the visitation of county 
asylums by the visitor resident in the neighbourhood, and increase the 
visitation of the licensed houses in the country by an additional visit of the 
medical visitor. An additional security might be given by depositing, at 
end of a month, after the reception of a patient, the certificate; the 
medical superintendent should send up to the Commissioners the full 
statement of the condition of the patient, entering into minute details, 
and to all intents and purposes making it equal to a fresh certificate ; 
were that done, it would be satisfactory to the friends and to the 
Commissioners, and to the patient himself, and it would be a very great 
security. 

No More Commissioners Wanted. The Work and Work- 

ing of the Commission. 

11367. If more visitation is absolutely demanded, I would rather 
have it under the form of an increased number of Commissioners 


than any other way, but I confess I do not wish to see any more Com- 
missioners if we can avoid it. One reason is this: in the first place 


1878. ] The Lunacy Laws, 1877. 517 


I think the House of Commons would grumble very much if we 
asked for so much more. We are now six paid Commissioners, and 
there is the chairman, who makes seven, and if we have any honorary 
Commissioners we amount to eight or nine. If we increase them, 
we should get to eleven; we should then be approximating to a 
Parliament, and you all know what can be done in Parliament. We 
should get into debates, and making motions and divisions, and ten 
thousand things of that sort. The present Commission has grown 
up in a very remarkable way; it has grown up by small steps, the 
members being added one by one, and we have fallen into each other’s 
habits. The result is that in nearly fifty years I can only remember 
one division, so much have we harmonised together. Nevertheless, 
when the Commission was much larger, before it was reduced in 1845, 
we sometimes met seventeen and eighteen together, and I have sat in 
the chair talking and debating and making motions, not in dividing, 
for we always avoided that, till sometimes six and seven o'clock at 
night. I have had to sit in the chair listening to all that talk, and I 
am afraid we should get into much the same sort of thing. We go 
on harmoniously now, because we perfectly understand each other. 


The Scotch superintendents, we believe, will agree with 
this :— 


11373. In Scotland, I believe, the Sheriffs’ order terminates in 
three years ?—I think the security that such an arrangement would 
give would be quite nominal. It would cause a great deal of trouble. 
I do not see anything to say for it and I see little to say against it. 
If you have a very respectable man or lady as the person who signs 
the order, I do not think he or she should be displaced. 


Chronic and Recent Cases to be kept separate in the same Asylum. 


11473. Do I understand you that you would not have them in the 
same asylum ?—I would not mind the separation so that they were 
within reasonable limits; the one should be within reach of the other, 
and possibly even under the same roof; but I would have it com- 
pletely divided, and that the recent part should be totally distinct 
from the chronic part, so that the medical men should not have their 
attention diverted from the recent cases to be everlastingly looking 
after chronic cases. Ihave no doubt that in that way avery great 
effect would be produced in the repression of lunacy. 


Intemperance and Insanity. 


11491. Ihave formed the opinion that intemperance is the cause of 
full two-thirds of the insanity that prevails, either in the drunkards 
themselves or in their children. 


Argumentum ad hominem. 


11537. LIrepeat what I said before, that if it should be my lot, 
either in my own case, if I were then able to give an opinion, or in 


518 The Lunacy Laws, 1877. [Jan., 


the case of any one of my family, I would rather, by far, go into a 
licensed house than be put under single care. 


English View of Scotch Sheriffs’ Orders. 


11605. The Scotch people and the English people are different in 
many respects. I have no doubt the Scotch system is admirably 
adapted to their tastes and feelings, but I am certain it would be most 
repugnant to our tastes and feelings to have the civil magistrate 
interposing in these matters, Just consider it in thisway. Supposing 
you called in the intervention of the magistrate, he must act either 
ministerially or judicially; if he acts ministerially, what earthly use 
is he? He merely signs his name to the documents, and what will 
be the result? People would become very much alarmed if it got 
wind that there was somemember of their family about to be placedina 
lunatic asylum. It would giveno protection whatever, because if the 
magistrate did it ministerially, in what way could he control the 
certificate, or the person who gives the order, or the person who 
receives the patient into the asylum? Itis a mere ministerial act, 
and it affords no assistance or security whatever; but supposing, on 
the other hand, he acts judicially, and is called to sit in judgment on 
the certificate, and then he signs his name at the foot of the docu- 
ment, and says it is good and sound, then see what he does. He 
exonerates the medical man from his great responsibility ; he exone- 
rates the man who signs the order; he exonerates the man who 
admits the patient into the asylum, because he has declared every- 
thing to be good and current; however bad it may be, it is 
endorsed by the judicial man, who has been called in by Act of 
Parliament to sit in judgment on that certificate. Then you take 
away from the patient all remedy, all right of prosecution when he 
obtains his liberty. He could not sue the medical man for damages 
because he had been inattentive with reference to the certificate 
which he had given, nor the person who signed the order for 
wrongful imprisonment. The whole thing was endorsed by the 
magistrate, and must pass as unquestionable. 

11606. What will be the condition of the Commissioners ?—They 
will receive a certificate endorsed by a magistrate; they look at that 
certificate, and they say this is most imperfect; the facts here are not 
facts that we can admit. Such a person as this ought to be set at 
liberty ; but it is endorsed by the magistrate. Can we overrule him? 
If you say that the magistrate is to overrule the Commissioners, 
what becomes of the Commissioners? If you say that the Commis- 
sioners are to overrule the magistrate, what becomes of the magis- 
trate? We might have the worst certificate in the world, and we 
should not be able to overrule it, because it was endorsed by the 
magistrate, and the man must be shut up. . 

11607. I think it would take away nine-tenths of the protection 
he now has; I cannot conceive anything which to my mind would be 


1878.) | The Lunacy Laws, 1877. 519 


worse. I will do anything that I can in the world to protect the patient ; 
but I know if I were to assent to do what is proposed, I should assent 
to that which would be doing him irreparable injury. 


There is nothing in the evidence to show that any of those 
results have followed the Scotch practice, but the Committee 
ought certainly to get further evidence on this point if they 
continue their investigations. 


A Misapprehension. Scotch Commissioners never visit ! 

11628. Yes, but then, so far as I understand it, the Commissioners 
in Scotland sit in Edinburgh, and never visit themselves. 

11629. Your Lordship is under a misapprehension as to that; 
they visit regularly and periodically. 

We are sorry to see that his Lordship does not approve of 
compulsory post-mortem examinations, though he sees fully 
their advantages. It appears that in 1859 he made the 
suggestion “ that all medical men having lunatic asylums 
should invite young men to come and spend a few months or 
weeks, and so acquire a general knowledge of lunacy.” He 
was certainly before his time when he made that most impor- 
tant suggestion. Finally, he suggests and recommends a con- 
solidation of the Lunacy Laws. 

In spite of the incompletely representative character of 
the witnesses examined, of the vast number of mere crotchets 
and prejudices that were aired and put on record, and of the 
many lunacy questions that were not referred to at all, the 
record of evidence in regard to Lunacy Law is valuable, and 
will produce fruits, both in legislation and popular enlighten- 
ment. 

The following may be regarded as the general result of the 
evidence, without going into the individual cases. 

That if mistakes, which affect the liberty of the subject in- 
juriously, occur in the working of the present Lunacy Laws, 
they are few and usually soon remedied. 

That the present system and forms of admission into 
asylums in England and Scotland have worked fairly well, 
but that there is great need for some change in Ireland, 
whereby the poor who are taken with mental disease shall 
not be treated as criminals and sent first to gaols and then to 
asylums by a criminal process. 

That the present mode of local inspection of lunatics in 
the United Kingdom is wonderfully thorough and effectual. 

That the Commissioners in Lunacy and Inspectors of 
asylums in the United Kingdom are most efficient guardians 


520 The Lunacy Laws, 1877. [Jan., 


both of the insane, and of the liberty of the subject, but 
that in England they are too few in number. 

That it is an urgent duty of the State to provide that the 
future members of the medical profession on whom rests the 
chief responsibility for the liberty of the subject as regards 
lunacy, shall be generally better educated in mental disease. 

That in England there is great need for a simpler, cheaper, 
and better process of protecting and managing the property 
of lunatics. 

That the public opinion of the present time, as well as the 
prevailing ideas of all the authorities who administer the 
Lunacy Laws, arein the direction of leniency and liberty in 
the treatment of lunacy, recognising it as a disease towards 
which the primary duty of the State and individuals is to 
place each case under proper treatment without delay. 

That there is great need of consolidation of the forty Acts 
of Parliament relating to the insane, of provision for solida- 
rity of action among the various central and local lunacy 
authorities, and of simplification of the general lunacy 
policy in the United Kingdom. 

That the suspicions and prejudice of the public in regard 
to asylums, and especially private asylums, are chiefly 
founded on ignorance, and that means should be taken to 
give additional confidence in the working of the Lunacy 
Laws. 

The chief points in regard to which a fairly good case was 
made out that there is room for improvement by legislation 
are, we think, the following :— 

For England :— 

1.—Consolidation of all the present lunacy statutes. 

2.—Definition of the relative powers and status of all the 
authorities, local and general. 

3.—Provisions for the compulsory adoption of a more 
uniform lunacy policy throughout the country—a solidarity 
in the working of the consolidated statutes. 

4.—Amalgamation of the Commissioners and Lord Chan- 
cellor’s Visitors, and more liberty for Commissioners to visit 
singly instead of in pairs. Power to appoint temporary 
Commissioners. 

5.—Abolition of inquisitions except in a very few cases ; 
in these a Judge of the High Court to preside. For the 
ordinary cases two medical certificates to be sufficient proof 
of the patient’s incapacity to manage his own affairs. Those 
to be sent up to one of the Lords Justices, who would order 


1878. | The Lunacy Laws, 1877. 521 


them to be served on the patient, and, if not opposed, would 
appoint a Committee. 

6.—Committees of the Estate to be made to give security, 
yearly accounts, and to be easily removable. 

7.—Two medical certificates to be required in all cases, 
pauper as well as private, before admission to asylum. 

8.—No medical man to be allowed to sign a certificate of 
lunacy, except he enters with the Registrar of the Medical 
Council a certificate of practical instruction in mental disease, 
or until he has been three years in practice. (A provision of 
this kind exists in New York State.) 

9.—No stranger in blood to give an order for any patient’s 
admission to an asylum. 

10.—To provide for cases where no relatives are near, let 
the Justices’ order, as in pauper cases, be an alternative for 
all private patients. 

11.—The signature and identity of every person who signs 
an order for a private patient’s admission into an asylum to 
be certified to by a justice, beneficed clergyman, police 
magistrate, solicitor, or medical man who holds any State 
appointment, within a fortnight of the patient’s admission. 
(This is a New York provision.) 

12.—Medical officers of asylums to make much more full 
medical reports than at present to the Commissioners, 
within the first month, and to be obliged to state facts in- 
dicating insanity, as in the certificates of admission. 

13,—A Medical “ Certificate of Emergency,” signed on the 
day of admission, to be sufficient authority for a patient’s 
detention in an asylum for three days. 

14.—Any two medical men to be allowed to see and ex- 
amine any patient in an asylum when requested by the Com- 
missioners, or a Justice of the Peace, or by any relative of 
the patient, and if they report that he is quite sane, the Com- 
missioners to order his immediate discharge. 

15.—The proper form being filled up, should entitle the 
person in possession of it to take the patient to the asylum 
and to re-take him, if he escapes, by statute law. 

-16.—The medical character of asylums for recent cases 
should be increased by the encouragement of their medical 
officers to give advice at their institutions, to attend dispensa- 
ries where they exist in their neighbourhood, to take con- 
sulting practice, and to take in medical students and young 
doctors as temporary residents. 

17.—In all cases of deaths in asylums a post-mortem exam- 

LXULE, 30 


522 The Lunacy Laws, 1877. [Jan., 


ination to be compulsory by medical officers, and a full report, 
signed by two medical men, to be sent to Commissioners. 

18.—Visiting physicians to large private asylums to be ap- 
pointed by Commissioners. 

19.—Permissive power should be given to committees of 
visitors to build for private patients small separate Institu- 
tions near the county asylums, under the same management, 
the rates of board to rise from the county rate for paupers, 
plus six per cent. interest on moneys expended, upwards. 

20.—Probationary “hospitals” for doubtfully insane cases 
to be established in large cities, instead of the present 
workhouse probation system. Patients should not stay there 
longer than a fortnight. Power might be given to general 
hospitals to treat suitable cases of insanity for three months. 

21.—A proper workhouse system for chronic cases should 
be organised, the Guardians in a county having power to 
employ one or two of the present half-empty workhouses 
that are suitable for that purpose. 

22.—Provisions for erection of asylums for chronic and 
quiet cases in the largest counties to be made, the mode of 
transfer from ordinary asylums to these, and vice versa, to be 
most simple, and to be in the hands of the medical superin- 
tendents alone. 

23.—Law against recent cases of obvious insanity being 
sent to workhouses first, to be made more stringent. 

24.—Power should be given for several counties to combine 
and build training schools for idiots and congenital imbe- 
ciles. 

25.—Commissioners to have power to order the discharge 
of harmless cases from asylums. 

26.—No medical officer of any asylum, private or public, 
should be compelled to retain any case, not a criminal lunatic, 
he thinks should be discharged, whether completely recovered 
or not. 

27.—A system of discharge on trial by the sanction of the 
Commissioners for long periods. 

28.—The transaction of business by lunatics should be ex- 
pressly allowed or’disallowed by statute law. | 

29.—Patients in private houses should be visited more fre- 
quently than cases in asylums. Assistant Commissioners 
might be appointed for that purpose, or local men appointed 
for,certain districts. 

30.—Statutory power should be given for large counties to 
get up training wards for attendants. 


1878. ] The Lunacy Laws, 1877. 523 


31.—The domestic elements of treatment in private asylums 
should be specially encouraged. 

32.—A certificate from a medical man, sent to Commis- 
sioners, saying it was desirable for the treatment of any case 
that it should be in a private house, to be sufficient authority 
for the case to be so treated for six months, before formal 
certificates of lunacy are needed at all. 

33.—Provision for sending really dangerous homicidal 
cases from county asylums to Broadmoor, and vice versd 
really harmless cases of ordinary lunacy from Broadmoor to 
their county asylums. The Irish practice might be adopted. 

34.—All medical certificates to be valid in all asylums 
throughout the United Kingdom. 

35.—All relatives should be allowed to visit patients in all 
asylums, and the person who signed the order should be com- 
pelled to do so every six months. 

36.—International agreements should be entered into, 
whereby English Ambassadors should have some charge of 
English lunatics resident abroad. (The case of Davis v. 
Nathan shows the urgent necessity for this.) 


For Ireland the following changes in the law seem called 
for, but the evidence brought before the Committee was 
utterly insufficient :— 


1.—More Inspectors of Lunatics. 

2.—The abolition of the criminal procedure for sending 
pauper lunatics to asylums, except in really criminal cases. 

3.—The medical certificates to be made uniform with the 
English and Scotch, stating ‘ facts.” 

4.—Provision for local inspection of private asylums by 
justices. 

5.—Abolition of Visiting Physicians for public asylums. 

6.— Certificate of emergency ” to be introduced. 

7.—A simple and inexpensive mode of managing all pro- 
perty to be devised. 

8.—Pensions may be given to officers after 15 years’ 
service. 





For Scotland the following changes seem called for, but the 
evidence was by no means so full as it might have been as to 
the state of the Scotch law and practice :— 


1.—No stranger should be allowed to petition the Sheriff for 
the admission of a patient without appearing personally 
before him to state his reasons for so doing. 


024 The Lunacy Laws, 1877. [Jan., 


2.—The signature of the petitioner when not a stranger 
should be before a witness. 

3.—The medical certificates should be made quite uniform 
with the English certificates by allowing them to be signed 
within seven days after the patient has been seen. 

4,—The petition should be presented to the Sheriff within 
a fortnight after date. 

5.—The certificate of emergency should be signed on the 
day of the patient’s admission to asylum and should not be 
repeated. 

6.—Sheriffs should by statute see that all the formal parts 
of the certificate are correct and the facts sufficient. 

7.—The Sheriff’s order, and practice in giving orders, 
should be subject to review by Court of Session on proper 
cause being shown. 

8.—The Commissioners should have power to discharge 
patients without medical certificates when they see no proper 
grounds of detention. 

9.—Special provision should be made that, when a copy of 
the petition and certificates for the appointment of a cwrator 
bones 18 served on a patient, he shall be allowed to commu- 
nicate with the Judge whose name is on the paper. 

10.—Sheriff should have the appointment of a curator bonis 
for all cases whose property does not exceed £1,000, the ex- 
pense not to exceed £5 or £10. 

11.—Proper statutory provision should be made for the 
discharge of recovered cases and harmless cases from asy- 
lums; the inspectors of poor being compelled to send for 
and remove the paupers, and their relatives the private cases. 

12.—Provision for pensions to officers and servants in the ~ 
district and parochial asylums. 

13.—Commissioners should have power to order discharge 
of all cases from asylums whom they consider harmless and 
whom they consider would be better out. 

14.—The present provision for the re-certification of 
patients in asylums after three years to be abolished. 

15.—The Commissioners should have power to let out all 
cases from asylums (Fiscal included) certified by two medical 
men to have recovered, or be harmless and fit for discharge. 

16.—The Sheriff should not advertise the names of Fiscal 
cases. 

17.—Permissive power should be given to make the 
Superintendent of the District Asylum local overseer of 
lunatics, so that he may know all the cases in the smaller 


1878. | The Lunacy Laws, 1877. 525 


Counties, and advise the local authorities as to cases suitable 
for removal to workhouses and to private houses from Asy- 
lum, and wice versa. 


All the general provisions we have mentioned as required 
for England to be made applicable to Ireland and Scotland. 
In the Lunacy Acts of all three countries there are inoper- 
ative and unused sections that should be got rid of. 


Te 


Apoplexy, Aphasia, and Mental Weakness. By G. H. Savaee, 
M.D. Lond., Assistant Medical Officer, Bethlem Royal 
_ Hospital. 


In asylums, we are used to find but small changes in the 
nervous centres in our dead patients, and these changes are 
often of so general a character, that no assistance is given 
towards clearing up the question of localisation of function 
in brain-centres. 

In epileptics and some other chronic cases, the symptoms 
during life may point to a centre in the brain that will be 
found diseased after death. That there is a definite separa- 
tion of centres of functions, most physicians are now pre- 
pared to admit, and, theoretically, the existence of such 
centres is rendered probable by the peculiar narrowness of 
some of the commoner delusions of the insane. If there 
be, for instance, a centre for organic visceral sensations, 
disease. of that centre would account for various hypochon- 
driacal cases, such as those who fancy they have “lost their 
intestines,” or that “nothing but a large cloaca exists in 
their abdomen.”” Again, diseases of this centre might result 
in delusions such as that the body is “ non-existent” or 
“dead,” there being a complete change in the organic sensa- 
tions, or, what is equivalent, in the centre receiving such im- 
pressions in such cases. 

The effect on the healthy mind of deprivation of one or 
more of the senses has been often considered, and the diffi- 
culty of building up a sound and powerful mind, when one or 
moreis wanting, is also well known. And, in this relation, 
Miss Martineau’s early struggles against her mental deficien- 
cies are instructive. But there is room for considering the 
effects on the mind of a lesion not only destroying a centre 
associated chiefly with expression and communication of 
ideas (like the “Island of Reil’’), but also breaking up 


526 Apoplexy, Aphasia, and Mental Weakness,  [Jan., 


other intellectual relationships by destruction of connecting 
fibres. My opportunities have not yet been large enough to 
warrant my generalising on the effects on the intellect 
generally of apoplexies in different parts of the brain. 

The subjoined case is of interest, from the amount of 
coarse disease found in the brain, and from the fact that a 
very large amount of brain-tissue had been destroyed; and 
yet the patient not only lived, but grew fat and strong. 
The question of the aphasia will be noticed more in detail 
later. 

The first remarkable fact in the case is, that there was a 
double inheritance of apoplexy, if I may use the term, both 
the parents having died of blood effusions from ruptured 
arteries in the brain. 

Certain diseases are already recognised as highly trans- 
missible, but I am sure that many others will have to be 
grouped together as governed by the same inherited condi- 
tions. I hope to be able, in my next paper, to show some 
connection between arterial changes and some forms of 
general paralysis of the insane. In both apoplexy and 
general paralysis, we may have a tendency to fibroid degen- 
eration transmitted, ending in one case in brain starvation, 
and in arterial rupture in the other. We know that some ~ 
diseases of infancy are inherited, or rather that certain 
latent tendencies in the parents may be passed on, and 
appear in another form in the offspring ; thus a phthisical 
parent may produce a strumous or hydrocephalic child. I 
have seen also in several cases both parent and child suffer- 
ing from similar mental ailments at similar ages, or under 
similar conditions. Thus I have known mother and daughter 
both subject to puerperal insanity. This is little more than 
one would expect, for we know that gout and phthisis may 
likewise be inherited. 

I would only add here, that we see cases degenerate in the 
same way, there being, as it were, a way of dying common 
in the family. One family has cancer for its bane, another 
Bright’s disease or apoplexy, and a third may have, in addi- 
tion to physical decay, mental break-down. JI have seen 
several well-marked cases in which the insanity of the family 
only showed itself when the patient was gradually sinking, 
worn out by some other disease. Thus a lady of 65 years 
became profoundly melancholy and full of dreads and appre- 
hensions, and I found that her mother had had similar 
mental symptoms before she died of age and general wearout. 


1878.] by G. H. Savacr, M.D. 527 


Without further preface, I add the case. 


A.A. Married. Aged 59. Professional man, sober, and 
of industrious habits, having a healthy family. His father 
was found dead, death resulting from a fit of apoplexy. 
His mother died in her third apoplectic fit. No other 
neuroses known to exist in the family. 

The history of the earlier attacks of apoplexy is imperfect, 
as no notes were kept by the medical man who attended him 
in them. 

The patient was first taken ill in January, 1875, being 
seized with right hemiplegia with complete aphasia. The 
aphasia was complete for a week, and then passed slowly 
away. ‘The hemiplegia lasted only a few days. 

(The transitory nature of the symptoms is noteworthy, and 
must be taken in connection with the unusual site of the 
lesion, and the inference will be that the symptoms were 
produced by pressure on and not destruction of the motor and 
other centres.) 

In six weeks from the attack of apoplexy the patient was 
well enough to resume his ordinary calling. 

The next attack was of a less severe nature, and was 
called “epileptic,” as it was of such short duration. This 
occurred in June or July, 1875, and lasted only a few hours, 
and he again resumed his work. 

In February, 1876, he had his third fit, which was very 
severe, affecting his left side. In this fit he was severely 
and continuously convulsed for many hours, was very sick; 
his respirations became shallow and laboured; mucus 
collected in the bronchial tubes, and he was thought to be 
moribund. He was in bed several weeks and then began 
slowly to regain his bodily strength, but was markedly weaker 
in mind. He got about again, but was no longer fit for his 
professional duties, though at times he essayed them. 

In October, 1876, he had another extremely severe fit, in 
which he was expected to die. This time he was speechless. 
During the next six months, he improved greatly in general 
health, ate, drank, and slept well, and was generally in a 
placid, weak-minded condition. He was, however, irascible, 
and at times noisy, and, as he regained power, was more 
difficult to manage and became restless. He was sent to 
Bethlem Hospital, May, 1877,* under certificates stating 
that he was weak-minded, at times violent, at others tearful 


* Reported by permission of Dr. Rhys Williams. 


528 Apoplexy, Aphasia, and Mental Weakness, [Jan., 


and emotional. He would shake hands with perfect strangers 
as if he knew them. 

On admission—and I may here say that I saw him before 
admission—he was in good general health, with fair power 
in his limbs, one not being weaker than the other. Common 
sensation perfect. He took food well. Bowels regular. 
Clean in habits. Always with a smile on his face. He only 
sald, “yes,” or “ yes, dear,” if questioned, and did not seem 
to understand much that was said to him. He would listen 
as if he understood, but we could never get him to do things 
by word of command. Thus, if shown an object which he 
seemed to want, and then taken some yards from it and 
asked to fetch it, he forgot the object before he got to it.. 
He had areus senilis of both eyes. On careful examination 
of optic disc, both were found pale, the small vessels on them 
in strong relief; one large vein on right eye beaded in 
appearance. In the left eye, the large vessels were sur- 
rounded with lymph or connective tissue here and there. 
Macula scarcely to be made out in either eye. The tem- 
poral arteries were prominent and tortuous. At the wrists 
he had no radials, but the ulnars were large and very 
tortuous, giving the appearance and feeling of a small 
aneurism. The pulse-tracing showed high tension, but this 
was rather the tension, or apparent tension, of a rigid tube 
than of a full one. 

For six weeks he improved greatly in general appearance, 
got quite stout, was always walking about, and seemed 
cheerful. He learnt no new words, and seemed weak-minded 
as ever. He seemed more pleased to see his friends than 
strangers, but was friendly with any one.* In July he had 
another fit of an epileptiform character, which affected his 
limbs generally; he could not articulate at all for an hour 
after this fit, but was soon himself again. From this time 
till September there was no fit, and he gained flesh, but 
otherwise was unchanged. 

On September 19th, at 9.30 p.m., he was found lying on 
his left side vomiting and quite unconscious. There was no 
convulsion, but his left arm and leg were quite powerless, 
unresisting, and relaxed. His right arm was by his side, 
the forearm across his chest, waving to and fro, as if to 
brush something from his mouth. If pinched on the right 
side, he resisted ; but did not flinch, if pinched or pricked 
on the left. He had sensibility in right conjunctiva, but 


* His writing before and after the attacks are seen in lithographic plate, 
No. 2. 











WS O BIA 


SZ 








0 


Dy 















MEN Vy 
pent 
a nol # 














1878. ] : by G. H. Savaar, M.D. 629 


none in left. When the right foot was touched, it was 
rapidly drawn up; not so the left. 

Pupils small and equal. Motions and water passed invol- 
untarily. Temperature in axilla 97°. Pulse 120. Respirations 
30. Both temporal arteries equally pulsating. The vomiting 
continued for two hours. Patient then slept. The next day 
he was unconscious and quite paralysed on the left side. 
Pulse and respirations increased in frequency, and mucous 
rales were developing. Temperature in left axilla 100°, with 
surface thermometer on forehead 94°. 

On the second and last day, temperature in right axilla 
100°, in left 98°, on forehead 89°. The right hand continued 
to move across the mouth. Patient died forty-eight hours 
after the last fit. 

Post-mortem examination within twenty hours after death. 
Left foot flexed and inverted. Calvarium unsymmetrical, 
right haif the larger. Dura mater adherent throughout. 
Excess of sub-arachnoid fluid. Convolutions flattened on 
both sides. Effusion of blood on surface of right side of 
cerebellum. Pia mater and arachnoid easily separable from 
brain. Left half of brain most wasted. Grey matter pale 
and thin. The lesions will be more fully described below. 
Brain weight 50 ounces. No other marked disease in the 
body, beyond fatty degeneration and atheroma of arteries. 


TABULAR VIEW OF Fits, PROBABLE SEAT. 
1. January, 1875...... Right Hemiplegia. Left Occipital region (a).* 
Aphasia of short dura- 
tion. 


2. June or July, 1875 ‘“ Epileptic.” 
( Left Hemiplegia. 


pe t No aphasia. Right occipital a great (b) 
Very severe. extent, affecting region 
round parieto-occipital 
sulcus. 
4, October, 1876...... Right Hemiplegia. Large excavation of supe- 
Aphasia (permanent). rior frontal convolution of 
Progressive Dementia. over an inch square (c). 
O Sty, USTE se cwencos Slight ‘“ epileptic.” (?) caused by superficial 
spot of softening (jf). 
6. Sept. 19,1877 ... Profound Hemiplegia and 
anesthesia. Destruction of corpus stri- 
Right arm jactitation. atum and thalamus opticus 


on right side (e). 

Small effusion in outer side 
of corpus striatum of left 
side (d). 


* The figures refer to the lithograph No. 1. 


530 Apopleay, Aphasia, and Mental Weakness,  [Jan., 


The point of most interest to us in cases of apoplexy is the 
effect of such attacks on the intellect. And first, it is rare 
in my experience for apoplectic patients to require detention 
in asylums. This is, of course, often a matter rather of money 
than of mental symptoms. In the upper and middle classes, 
a patient, who has had a stroke, and has become aphasic and 
weak minded, can be treated at home; but among the poor, 
or those who cannot pay for attendants, the patient is better 
under infirmary or asylum care. In some cases, doubtless, 
regular asylum care is required, for they are practically 
dements, and should be treated as such, requiring to be fed, 
clothed, kept warm and clean. 

Apoplexy may attack a person, and he may recover both 
his muscular and mental vigour entirely, but in very many 
cases there is some loss. This, doubtless, differs much accord- 
ing to the other conditions of the patient and the cause of 
the apoplexy. A man past middle life, with already degener- 
ating arteries, and an ill-nourished brain, will suffer much 
more than a younger and arterially healthy patient. In our 
patient there was general vascular decay. 

Avsingle fit of apoplexy often leaves less marked mental 
symptoms than a series of epileptic fits or fits in general 
paralysis. 

The effects of an apoplexy on the mind are various, accord- 
ing to the site of the disease. As a rule, the free anastomosis 
of arteries allows the brain to be freely nourished soon after 
the fit, but I have seen one case at leastin which many of the 
arteries supplying the cortex beyond the apoplexy were 
plugged, the blocking of the arteries seeming to have fol- 
lowed shortly on the fit. 

An attack of apoplexy may affect the mental state of a per- 
son already of unsound mind. 

Thus Mrs. W. had been a patient in the incurable estab- 
lishment of Bethlem for twenty years, suffering from chronic 
mania. She was perfectly uniform in her behaviour for years 
before her death, avoided all notice, and would be angry if 
spoken to. She kept almost constantly alone in her room, 
and would abuse people for conspiring against her. 

On November 16th, 1876, she had a fit, falling down insen- 
sible. She had loss of power over her left arm and leg, and 
never recovered the use of her arm but regained some in her 
leg. She kept her bed till her death on January 18th, 1877. 

From the time of the recovery of sensibility to her death, 
she was mentally unlike her old self. At first, she was cheer- 


1878.] by G. H. Savace, M.D. Bt 


ful and pleasant and would talk affably. Towards the end 
of her life, she became very noisy, shouting and shrieking, 
especially at night. She said “she had a feeling as if she 
were gong to sink through the bed and floor.” In her case 
there was a small clot occupying the outer part of the corpus 
striatum. 

We next pass on to notice some mental disturbances asso- 
ciated with aphasia. 

Several interesting cases have been recorded in the dis- 
cussion in France on Aphasia, reported in the “ Annales 
Medico-Psychologiques.” 

Thus a M. Lordat, an accomplished lecturer and teacher, 
after an attack of apoplexy that caused aphasia, recovered 
all power, but was no longer able to lecture without notes, 
whereas before he had been noted for his brilliant improvisa- 
tion. This may be said to be a very slight evidence of intel- 
lectual loss, because his most brilliant writings were made 
during the thirty years he survived his aphasic attack. It is 
maintained by some that the intellect is less affected in left 
than in right hemiplegia. In some cases the only permanent 
effect on the intellect has been increase of the emotional dis- 
plays. 

It is possible for persons having become aphasic to re-learn 
to speak, but this is not possible to all. Some show their 
mental weakness by inability to apply themselves steadily 
to the task. 

Persons who are aphasic may be perfectly competent to 
give evidence or to make a will. 

Aphasia must be looked upon only as a symptom that may 
have many causes. 

With aphasia, we may have agraphia and general amnesia ; 
the varieties of the affection, and its various relationships, 
are extraordinary. 

A man has been known to lose his native and retain his 
acquired language, or to lose his acquired language and regain 
the language of childhood. 

Every case of apoplexy must be considered on its own merits, 
it being borne in mind that moral or intellectual changes 
may occur after a fit, and remain permanently, but that per- 
fect rationality may exist with complete loss of power to use 
words. It will always be a difficult thing to decide on the 
mental state of one who is aphasic and amnesic. In our 
case we had considerable effusion of blood, destroying large 
areas of the brain, and yet the patient recovered enough 


532 Apoplexy, Aphasia, and Mental Weakness Jan., 


power to do something in his profession. The first attack of 
aphasia was transient, and, I believe, due to pressure. 

In the attack that left him permanently aphasic, a large 
clot destroyed an important part of his frontal convolutions, 
rather cutting off the connection with the ‘Island of Reil”’ 
than injuring it. | 

The dementia, I suppose, is to be considered rather as the 
result of general degeneration than of a spreading of inflam- 
matory processes from local centres of degeneration. 


Morison Lectures on Insanity for 1877.*—By JouN SIBBALD, 
M.D., F.R.C.P.E., Deputy Commissioner in Lunacy for 
Scotland. 


Lecture II].—Insanitry 1x Moprrn Times. 


We have attempted in the previous lectures to obtain some 
idea of the way in which insanity was regarded, and the 
manner in which the insane were treated up to the beginning 
of the eighteenth century. We have found that a large 
number of those who would now be regarded as insane had 
been, up to this time, either disregarded altogether, or 
looked upon as exercising supernatural powers of evil, or as 
inspired with beliefs which were dangerous to the State. Three 
circumstances seem to have been the chief influences that 
tended to prevent persons labouring under mental disease 
from being treated with the consideration due to that afflic- 
tion, or often with any feeling that they were worthy of sym- 
pathy or requiring to be cared for. These were pointed out to 
be (1) the character of the social system in ancient times— 
powerfully affected as it was in every detail by the existence 
of slavery ; (2) the political exigencies of communities both 
in ancient and mediaeval times—so seldom in prolonged 
possession either of the external peace, or of the internal tran- 
quility necessary for the development of philanthropy in a 
government or a sense of social duty in a people; and (3) 
the superstitious ideas arising from ignorance—under which 
abnormalities of mental condition were attributed to self- 
induced possession by the devil or to other criminal conduct or 
supernatural association. In the beginning of the eighteenth 
century, however, these conditions had either been abolished 


* These Lectures were delivered before the Royal College of Physicians of 
Edinburgh. . 


e733. Morison Lectures on Insanity for 1877, 533, 


or had perceptibly diminished in power and importance. 
Slavery no longer existed in Western Hurope; civil adminis- 
tration appeared to have developed into stronger and more 
stable forms; and owing to the diffusion of knowledge that 
followed the invention of printing, the grosser kinds of super- 
stition were rapidly dying out. 

Under the changed conditions of the new epoch we accord- 
ingly find that a large number of persons whose condition 
or fate had formerly been disregarded, became objects of 
humane consideration, and that many others who had for- 
merly been regarded only with feelings of hatred or terror, 
were now being recognised as deserving and requiring both 
active sympathy and protective care. Two classes of 
people, therefore—one previously disregarded, and the other 
persecuted, and neither of which had been counted among 
the insane requiring care and treatment—were now recog- 
nised as objects of philanthropic regard, and as requiring to 
be provided for in a special manner. There arose a demand 
for places where these persons could be disposed of; and this 
was met by the establishment of a considerable number of 
asylums in various parts of the country, some being public 
institutions, but the larger number being provided by private 
enterprise. 

But at first the practical effect of the enlightenment of 
public sentiment was more a negative than a positive 
change in public action. The demented vagabonds were no 
longer to be hanged, and the maniacal witches were no. 
longer to be burnt; but short of the disuse of such inten- 
tional cruelty, the reformation at first made little progress. 
No public measure was adopted in this country for dealing 
comprehensively with the question till the year 1828, or it 
may, perhaps, be more accurately said, till the year 1845, 
when the Act was passed under which the present lunacy 
administration in England is carried on. The “ Vagrant 
Act,” passed in 1744, showed, indeed, that the community 
was becoming conscious that it was the duty of the State to 
deal with the matter in some way. By one of the sections 
of that Act, two Justices of the Peace were authorised to 
issue a warrant for the arrest of any person furiously mad, 
or so far mentally disordered as to be dangerous if left at 
large. He was then to be locked up im a secure place, and if 
it was found necessary, he was to be chained and confined in 
his own parish. The prevalent view of insanity still was, 
that the term could only be properly applied to such a con- 


534 Morison Lectures on Insanity for 1877, (Jan., 


dition as rendered a person dangerous to others ; and the 
necessity for combating the danger on behalf of the rest of 
the community was regarded as so important that every other 
consideration sank into insignificance. It was still the gene- 
ral idea of society which seems to have been expressed by 
Justice Tracy, when in 1723 he compared a “‘madman” to 
‘“‘a brute or a wild beast.” This date may, however, be 
accepted as marking in the history of our own country the 
perceptible rise of broader and juster views. It was about 
this time that it began to be recognised that among the 
members of the abnormal class which had now to be re- 
garded as insane, there were a large number who could not 
properly be left at large, and yet who were in no way brutish 
or wild. 

And here it is well that we should recall to our minds for a 
moment what was the kind of provision made at that time 
for the care and treatment of those insane persons who could 
not be left at large. We cannot obtain complete descriptions 
of the condition of asylums generally during last century, 
but we have evidence enough that they were mere prisons, 
and prisons of the most loathsome character. This is shown 
in the Report of a Committee of the House of Commons 
which sat in 1763. The disclosures which it contained led 
ten years afterwards to the passing of an imperfect measure 
intended to reform the administration of asylums; and this 
Act constituted the only authoritative regulator of the treat- 
ment of the insane till 1828, though it proved altogether 
inadequate to prevent the continuance of the most frightful 
abuses. 

We may obtain inferentially some idea of the state of things 
which had to be dealt with during last century by looking at 
the facts disclosed in the evidence taken by the Committee of 
the House of Commons on Madhouses, and reported to the 
House in the year 1815, Prominent among much that was 
calculated to awaken feelings of horror and of shame was 
the picture which is there presented of the Asylum at York. 
It had been known for many years to those who took the 
trouble to make careful inquiry, that the condition of the 
inmates of that institution was one of extreme wretchedness. 
Representations had been made to the Committee of Man- 
agement, asking for inquiry and reform. Butthese had been 
met with indignant denials that any abuses existed; and 
persons of the highest station came forward to certify to 
the excellence of the administration of the establishment. 


1878. | by JouN Srppautp, M.D. 535 


At last public feeling was roused to a degree sufficient to 
obtain in January, 1814, the appointment by the Court of 
Governors of a Committee of Inquiry. An important ob- 
stacie was, however, interposed to the carrying out of any 
complete investigation. A few days after the appointment 
of the committee the asylum was in flames, having, as was 
believed at the time, been set fire to for the purpose of frus- 
trating inquiry. And there can be little doubt, that as the 
pitiless fire ran along the walls ofthose miserable chambers 
it wiped out the tangible vestiges of many a deed as pitiless 
as itself, and incalculably more terrible, from the prolonged 
suffering that it had occasioned. Four, at least, of the in- 
mates were admitted to have perished in the fire, and the inves- 
tigation by the committee failed to show whether this ad- 
mission represented the whole truth as to the number of 
the victims of the conflagration. In spite, however, of all 
attempts to prevent investigation, sufficient evidence was ob- 
tained to show that the administration of the establish- 
ment had been a disgrace to the age, and to the people 
that had suffered it to exist. Those who had, amid much 
obloquy and against powerful opposition, ascertained the facts 
which had forced on the inquiry, were able to afford ample 
proof of much that the officials attempted to conceal; and 
many a damning admission was wrung from the unwilling 
lips of the officials themselves. Proof was obtained that many 
of the inmates had been kept huddled together in apart- 
ments miserably small for the number of inmates, and afford- 
ing no means of providing for the requirements of decency or 
cleanliness. In one filthy cell, twelve feet long by less than 
eight feet wide, 13 women slept, or passed the time which 
ought to have been allotted to sleep. Many patients were 
half-starved. Many died, of the date of whose death no 
record had been kept, and the cause of whose death might 
have been suspected, but could not be discovered. In the 
year 1813, according to the records of the institution, 11 
inmates had died. On inquiry it was found that 24 had 
actually died during that year; and it was ascertained that 
numbers of inmates who had died from unknown, or, per- 
haps, too well-known causes, were systematically represented 
in the annual statements as having been cured. ‘The use of 
chains and heavy irons seems to have been frequent. The 
committee of management, who had so angrily asserted the 
excellence of the treatment which the inmates received, were 
shown to have been ignorant, not only of the whole doings 


536 Morison Lectures on Insanity for 1877, [Jan., 


of the officers, but even of the existence of parts of the build- 
ing in which patients were constantly confined. ‘‘ The physi- 
cian had for many years past been the sole physician, sole 
visitor, and sole committee, and had the whole management 
of the institution.”* This physician, the steward, and the 
matron were all found to have fraudulently appropriated to 
their own use large portions of the funds that were paid for 
the maintenance of the patients. The steward burnt his books 
rather than allow them to be submitted to the committee. 

One would willingly refrain from giving, in detail, a record 
such as this, which must excite feelings of burning indignation 
and shame. But it is necessary that we should fully recognise 
the character of the institutions to which persons regarded as 
insane were consigned, if we would form a clear conception 
of the degree of mental disorder that must have been reached 
by patients in whose cases such treatment was possible. Before 
leaving this subject therefore, let us look for a moment at the 
state of things in the Royal Hospital of Bethlem, an institu- 
tion claiming at the time to be so circumstanced as to be 
properly exempt from any supervision by the State, and which 
had been held up to the admiration of France, in 1787, by 
Soulavic, in a pamphlet translated by the King’s chaplain. 
The following extract, from the evidence of Mr. Wakefield, 
before the Parliamentary Committee already mentioned, will 
indicate how far that institution deserved the exemption which 
it claimed : — 

“On Monday, the 2nd of May,” says Mr. Wakefield, ‘‘we 
revisited the Hospital, introduced by Robert Calvert, Esq., a 
governor, and accompanied by Charles Callis Western, Esq., 
Member of Parliament for Essex, and four other gentlemen.” 
(The first visit had been on 25th April, 1814.) ‘At this visit, 
attended by the Steward of the Hospital, and likewise by a 
female keeper, we first proceeded to visit the women’s galleries ; 
one of the side rooms contained about ten patients, each 
chained by one arm or leg to the wall; the chain allowing them 
merely to stand up by the bench or form fixed to the wall, or 
to sit down upon it. The nakedness of each patient was 
covered by a blanket-gown only; the blanket-gown is a 
blanket formed something like a dressing-gown, with nothing 
to fasten it with in front; this constituted the whole covering ; 
the feet even were naked. One female in this side-room, thus 
chained, was an object remarkably striking; she mentioned 


* Evidence of Mr. Godfrey Higgins, before the Committee on Madhouses, 1815. 


1878. ] by JoHn Srppatp, M.D. 537 


her maiden and married names, and stated that she had been 
a teacher of languages; the keepers described her as a very 
accomplished lady, mistress of many languages, and they cor- 
roborated her account of herself. The Committee can hardly 
imagine a human being in a more degraded and brutalising 
condition than that in which I found this female, who held a 
coherent conversation with us, and was, of course, fully sen- 
sible of the mental and bodily condition of those wretched 
beings, who, equally without clothing, were closely chained 
to the same wall with herself. Unaware of the necessities of 
nature, some of them, though they contained life, appeared 
totally inanimate and unconscious of existence.”* 

“In the men’s wing,” writes Dr. Conolly, in his abstract 
of the evidence, “six patients in the side-room were chained 
close to the wall, five were handcuffed, and one was locked to 
the wall by the right arm as well as by the rightleg. Except 
the blanket-gown these men had no clothing; the room had 
the appearance of a dog-kennel. Chains were universally 
substituted for the strait-waistcoat. Those who were not 
cleanly, and all who were disinclined to get up, were allowed 
to lie in bed; in what state may be imagined. In one cell 
they found a patient, a representation of whose condition is 
preserved in a plate published in Esquirol’s work. Not much 
to the honour of our English treatment. ‘This patient’s name 
was Norris. He had been a powerful and violent man. Having 
on one occasion resented what he considered some improper 
treatment by his keeper, he was fastened by a long chain 
which was ingeniously passed through a wall into the next 
room, where the victorious keeper, out of the patient’s reach, 
could drag the unfortunate man close to the wall whenever 
he pleased. To prevent this sort of outrage, poor Norris 
mufiied the chain with straw, but the savage inclinations of 
the keeper were either checked by no superintending eye, or 
the officers of the asylum partook of his cruelty and his fears ; 
for now a new and refined torture for the patient was in- 
vented, in the shape of an ingenious apparatus of iron.”’+ 

“A stout iron ring,’ as Mr. Wakefield describes it, ‘‘ was 
rivetted round his neck, from which a stout chain passed 
to a ring made to slide upwards or downwards on an upright 
massive iron bar, more than six feet high, inserted into the 
wall. Round his body a strong iron bar about two inches 
wide was rivetted; on each side of the bar was a circular 

* Hvidence of Mr. Wakefield, before the Committee on Madhouses, 1815. 

+ “Treatment of the Insane,” by Dr. Conolly. 

XXIII. 36 


538 Morison Lectures on Insanity for 1877, [Jan., 


projection which, being fastened to and enclosing each of his 
arms, pinioned them close to his sides.”* “ The effect of this 
apparatus was, that the patient could indeed raise himself up 
so as to stand against the wall, but could not stir one foot 
from it, could not walk one step, and could not even lie down 
except on his back; and in this thraldom he had lived for ~ 
twelve years. During much of that time he is reported to 
have been rational in his conversation. But, for him, in all 
those twelve years, there had been no variety of any kind ; 
no refreshing change ; no relief; no fresh air ; no exercise ; no 
sight of fields or gardens, or earth or heaven. Hach miser- 
able day was like another, and each night. At length release 
came, which he only lived about a year to enjoy.”t+ It is 
painful to have to add that this long-continued cruelty had 
the recorded approbation of the committee of management, 
the medical officers, and of all the authorities of the hospital. 

Such was the state of asylums in Britain. In Germany 
they were no better. “One is seized with horror,” says 
Franck,t ‘on entering these refuges of misfortune and afflic- 
tion ; one hears nothing there but cries of despair. It is 
frightful to be assailed by the miserable creatures, clothed in 
rags, and disgusting with filth; while others are prevented 
from approaching, by chains and ropes and the brutal treat- 
ment of the keepers.” In France the Salpétriére and the 
Bicétre were almost the only establishments to which the 
same sad description would not apply. ‘The cells, dens, or 
cages in which they were kept, writes Esquirol in 1818, 
‘‘were everywhere horrible: without air, without light, 
damp, narrow, paved like the street, often below the level 
of the ground, and sometimes underground. Chains, filth, 
and a supply of the coarsest food, often insufficient in quantity 
to support life!’|| Such throughout Europe, till within the 
last fifty years, was, with an exception, probably, for a short 
period in Italy, usually regarded as an appropriate provision 
for the class of persons to whose condition the term insanity 
was then commonly applied. 

But even so far back as the beginning of the eighteenth 
century, as I have already explained, the seeds of coming 
improvement had been sown. The feeling of terror, which had 
in ruder and more superstitious times overwhelmed every 


* Hvidence of Mr. Wakefield. 

tT Dr. Conolly, op. cit. 

{£ Quoted by Hsquirol, “ Maladies Mentales,” chap. xv. 
|| Loe. cit. 


_ 1878.) by Joun Srppatp, M.D. 539 


other sentiment that might have been excited by the presence 
of a lunatic, was now beginning in the minds of cultivated 
persons such as Addison to be replaced by a feeling of com- 
passionate consideration. The philanthropic reflections ex- 
cited in his mind by the spectacle of Moll White were the 
expression of a feeling that must have been shared by 
many others. But it is important to observe that the first 
effect of this feeling was to increase the number of persons 
regarded as insane rather than to improve their treatment. 
A large number of persons came to be regarded as insane 
whose mental overthrow was much less complete than had 
been thought necessary to make them so regarded a hun- 
dred years before. In the earlier period it had been only 
those who had passed into a condition which suggested 
Tracey’s ‘‘ wild beast” comparison, that were regarded as 
insane. Inthe later period such persons were beginning to 
be treated as lunatic as harboured perverse delusions or showed 
outrageous eccentricity of conduct. In the earlier period, 
therefore, by the time a person came to be regarded as fit 
to be sent to an asylum, the feelings of affection with which 
he had been regarded by those naturally bound to him had 
been blunted or perhaps destroyed. In the later period a con- 
siderable number of patients must have been in a condition 
that in no way prevented them from being followed into the 
cells of the asylum by the unstifled affection of their friends. 

We should fail, however, to fully comprehend the change 
that was taking place in the position of what relates to in- 
sanity, 1f we omitted to keep in view that during the latter 
half of last century social organisation generally was under- 
going rapid improvement, and acquiring year by year greater 
and greater stability. As a consequence of this, the humane 
sentiment of society becoming more and more developed, began 
to exhibit strength sufficient to exercise a powerful influence 
on every department of civil administration. It was in 1774 
that Howard began to direct public attention to the abuses in 
the administration of prisons. And itis impossible to believe 
that his efforts could have produced their happy result if public 
feeling had not arrived at a condition which made it willing 
to respond sympathetically to his appeal. When, therefore, we 
take into consideration the condition of asylums as they then 
were, and the fact that a number, continually increasing, of 
persons in whom their friends were deeply interested, were 
being placed in them, it is evident that some attempt to 
ameliorate the condition of the insane could not be long 


540 Morison Lectures on Insanity for 1877, [Jan., 


delayed. The first important step was taken in 1791. It was 
in that year that a female member of the Society of Friends 
was placed in the York Lunatic Asylum, whose terrible 
condition has been already alluded to. Her family, resid- 
ing at a considerable distance, requested some of their 
acquaintance in York to visit her. The visits of these 
friends were objected to by the superintendent of the asy- 
lum; and in a few weeks after, the unhappy patient died. 
This circumstance was regarded as a confirmation of sus- 
picions which had for some time existed. This feeling was 
believed by William Tuke to be so well founded that he 
resolved upon the establishment of an institution where 
members of the Society to which the patient and he himself 
belonged might receive judicious and humane treatment. 
In 1792, Tuke formally proposed his project; and in 1796, 
the Retreat near York, now so famous in the history of 
insanity, “was opened for the reception of patients, and 
commenced its career of usefulness and importance.” It 
was almost at the same moment, in 1792, that Cousin, 
Thouret, and Cabanis,being the administrators of the hospitals 
of Paris, appointed to be physician to the Bicétre the illus- 
trious Pinel, who there immediately released no less than 
eighty patients who had been kept in chains; and after sub- 
jecting them to milder and more humane treatment had the 
satisfaction of sending many of them in a state of sanity 
back to the outer world. 

Tuke and Pinel thus became the heroes of one portion of 
the struggle which was taking place between barbarism and 
civilisation—between darkness and light. And it in no way 
dims the glory which surrounds their names that we 
recognise the movement which they led as having become 
inevitable. Such systems as that of asylum administration 
which had grown up under the adverse influences of the 
middle ages were everywhere showing themselves unfitted 
for the requirements of modern life; and encumbered as 
they were with abuses that shocked the cultivated conscience 
of the community, their reformation or reorganisation must 
sooner or later have been undertaken. But those who were 
the first to probe the vices of the old administration, and to 
feel the necessity for their extirpation, must have been 
among the noblest spirits of the age; and none have 
deserved better than Pinel and Tuke to be placed high in the 
eae of those whom mankind should ever delight to 

onour. 


1878. ] by JouN Stppatp, M.D. 541 


The reform in the treatment of the insane which they so 
worthily began was destined, however, to proceed only by 
slow degrees. We have already seen how political embar- 
rassments and social disturbance could prevent the rise of 
philanthropic feeling in the community, and it is perhaps 
more than a mere coincidence that during the stormy period 
between the years 1792 and 1815, the reform of asylum 
administration made little progress. The political convul- 
sions which followed the outbreak of the French revolution 
shook every State in Europe to its foundation; and the 
almost incessant wars which blazed over the whole conti- 
nent and threatened to extend to our own shores, seriously 
damped the interest that had been excited in works of 
public benevolence. At first it seemed as if the results of a 
century of social development were to be completely sacri- 
ficed. ‘*The Habeas Corpus Act was suspended; a bill 
against seditious assemblies restricted the liberty of public 
meeting, and a wider scope was given to the Statute of 
Treasons. Prosecution after prosecution was directed 
against the Press; the sermons of some dissenting ministers 
were indicted as seditious; and the conventions of sympa- 
thisers with France were roughly broken up. The worst. 
excesses of the panic were witnessed in Scotland, where young 
Whigs whose only offence was an advocacy of Parliamentary 
reform were sentenced to transportation, and where a brutal 
judge openly expressed his regret that the practice of torture 
in seditious cases should have fallen into disuse.’’* 

After the first panic had passed off, the public feeling of 
the country did not immediately regain the elevation from 
which it had been rudely thrown. But even during those 
years of conflict with which the name of the first Napoleon 
has become inseparably associated, the philanthropic element 
in public sentiment did not altogether die out. The atten- 
tion of Parliament was directed to legislation for the benefit 
of the insane in the year 18138, two years before the re- 
establishment of peace. During this year and the following, 
two unsuccessful attempts were made to pass an act for the 
better regulation of asylums ; and in 1814, a Committee of 
the House of Commons was appointed to enquire into the 
condition of these institutions. ‘The report of that Com- 
mittee, as we have already seen, disclosed the existence of most 
terrible abuses ; but every bill for their reformation was rejec- 


* Green’s “ History of the English People,” p. 785. 


642 Morison Lectures on Insanity for 1877, [Jan., 


ted, tillthe gathering force of public opinion at last carried 
through the Act of 1828. This measure was brought forward by 
Mr. Gordon and Lord Ashley, and was a very important and 
beneficent enactment. It was an earnest, though imperfect, 
attempt to carry out the excellent principles which received 
fuller development in the Lunacy Act of 1845. The statute of 
1845 is that under which the treatment of the insane in Eng- 
land is at present regulated ; and for it the country is mainly 
indebted to the indefatigable efforts of Lord Ashley, who, now 
Karl of Shattesbury, presides over the administration which it 
is his glory to have established. A measure of the same kind 
was enacted for Scotland in 1857, and laws of similar character 
have come into force also in France, Germany, and other 
civilised countries. We may now, indeed, regard it as an 
established principle of all enlightened legislation, that it is 
the duty of the State to protect, and if need be, to succour 
all those whose mental condition renders them helpless or 
unfit to conduct themselves according to the requirements of 
public order. Henceforward, the secret horrors of the loath- 
some cell with its ponderous chains, and the irresponsible 
savage with his terrifying whip have been abolished, and 
their place is taken by the cheerfully-decorated asylum, fur- 
nished to serve as a comfortable home or fully-appointed 
hospital, carefully inspected by Government officials, and 
directed by officers carefully selected and held fully respon- 
sible. Henceforward, though occasional instances of neglect 
or harsh treatment may, or perhaps must occur, they cannot 
but be exceptional, and in direct opposition to the general 
spirit of the system. 

We have seen that one of the circumstances which acted 
most powerfully in creating the irresistible demand for the 
improvement of asylums was the broader conception of the 
nature of insanity which advancing civilisation had gener- 
ated in the public mind. Asylums, bad though they were, 
had been the only places to which the insane could be sent, 
and it followed that as soon as the inmates began to consist 
in a considerable proportion of persons suffering from the 
less violent forms of mental disorder, the uselessness and 
cruelty of the treatment to which they were subjected became 
greatly more obvious. But the history ofthe popular idea of 
insanity entered a new phase after the improvement of 
asylums had been effected. The existence of the improved 
institutions had a powerful influence on publie opinion. The 
broadened view of insanity had caused the improvement of 


1878.] by Joun Sippatp, M.D. 543 


asylums; the improved asylums were now in their turn to 
cause a further broadening of the view of insanity. It soon 
became apparent that asylums under the improved adminis- 
tration afforded suitable provision for many persons who had 
not previously been considered fit inmates for such establish- 
ments. formerly, asylums had only been thought of as 
places to which persons might be sent who were troublesome 
or dangerous to the public. Now they came to be looked 
upon more as hospitals for the treatment of mental disease. 
Instead of being places to which no one would be sent except 
when the interests of others made such a step imperative, 
they had become places to which many would be sent in the 
belief that their own interests would thus be best promoted. It 
is not difficult to understand, how, under these altered condi- 
tions, a large number of persons came to be sent to asylums 
whose degree of mental disorder was far short of what would 
have been thought necessary at a former period to justify 
their being branded with the then opprobrious name of luna- 
tic. The revolution in public sentiment which thus took place 
was both considerable and important; and that it was 
likely to occasion an extension of the limits of the popular 
idea of insanity will be at once apparent. That such an in- 
creased comprehensiveness of signification has actually been 
given to it must be within the personal knowledge of most 
of those whom I now address. 

I must now ask your attention to a circumstance which 
must be taken into consideration if we would fully under- 
stand the idea of insanity as it exists at present in the public 
mind. That circumstance is the rapidly increasing com- 
plexity of organisation in our modern social state. Mr. 
Spencer, in his work on Sociology, finds an analogy between 
the organization of animals and that of political bodies. He 
compares the ruder states of society to the simpler zoological 
organisms which consist of almost homogeneous elements ; 
and the highly civilised states he compares to the higher 
animals with their complex anatomies. With every advance 
in the scale of development, a correspondingly higher quality 
is attained in the performance of the several functions of the 
organism; and this results from the increased differentiation 
of the elements into organs, and from the more delicate 
adaptation of the structural machinery to the function to be 
performed. I believe that there is here a profound and in- 
structive analogy, which admits, as Mr. Spencer has shown, 
of being followed into considerable detail. And in no direc- 


O44 Morison Lectures on Insanity for 1877, [Jan., 


tion does the analogy appear more complete than in the 
direct proportion which intolerance of incongruous matter 
seems to bear to the degree of development of the organism. 
The contrast between the indifference which is displayed by 
the tissues of the amoeba or polyp to the nature of what may 
become involved in them, and the sensitive intolerance of 
any abnormal matter which is shown by the irritable tissues 
of the human body, is not more remarkable than the differ- 
ence between the effect of an abnormal element existing in 
a primitive and rudely organised community, and the effect 
of a similar abnormality when placed in a community whose 
civilisation is advanced and highly developed. Abnormalities 
of conduct that might be borne without difficulty in a dis- 
trict where the population is sparse and pastoral, and might 
even be compatible there with a capacity for useful work, 
cannot be tolerated in a busy city full of the complex opera- 
tions of a highly developed commerce. Persons whose 
eccentricities of conduct would scarcely have interfered with 
public order or private comfort, as they were understood in the 
time of Queen Anne, would be felt to be intolerable in the 
present state of society under Queen Victoria. In the former 
period they would have continued members of the household 
in which they were born; at present they would be regarded 
as Insane and sent to an asylum. 

But there is a collateral aspect of the relation of modern 
life to the mental constitution of the individual, which is also 
of considerable importance. The intellectual element enters 
so much into the labours of the present day, that persons 
suffering from feebleness or perversion of mind have much 
more difficulty in finding useful employment than was the case 
in the days of our fathers, when avocations were simpler and 
less intellectual. This is, therefore, a factor, whose influence 
must be recognised in the problem with which we have to 
deal. In London, in Edinburgh, and in every other locality 
where commerce, manufactures, and all forms of industry have 
undergone great and rapid development, there must necessarily 
from the comparatively high standard of capacity that is re- 
quired be a much larger number now than formerly of persons 
who are incapacitated by their mental condition from earning 
a livelihood, or from taking their places in any way as useful 
members of society. Such persons require to be regarded 
now as abnormal elements in the working mass; and as such 
they are extruded from it. A considerable proportion of 
these also come to be included in the number of persons now 
regarded as insane. 


1878.] by Joun Srppatp, M.D. 545 


We have now traced, though very imperfectly, the progress 
of the popular conception of insanity as it has been carried 
along the current of European history. We saw it at first 
dimly as it grew among the classic influences of ancient 
Greece and Rome. We caught transient glimpses of it amid 
the darkness and storms of the middle ages. And following 
it in its course during the more tranquil modern epoch, we 
have seen how the increase of enlightenment and the ad- 
vance of civilisation have permitted it to reach the position 
which it at present occupies. 

The method that we have adopted was to ascertain as far 
as possible what class of persons were, during the periods we 
have examined, treated as more or less irresponsible, or who 
on acconnt of mental abnormality were looked on as requir- 
ing to be dealt with in an exceptional manner. And if the 
inquiry has been satisfactorily carried out, we have found 
that the number and character of such persons has differed 
at different epochs and in different localities, according to 
the political cirewmstances of states, the moral and intellectual 
condition of peoples, and the social organisation of communities. 

We thus arrive at the conclusion that the idea of insanity 
in its popular and practical significance is essentially rela- 
tive; that in some circumstances it includes certain mental 
conditions which in other circumstances it does not include ; 
that in some states of society certain persons would be 
regarded as insane who would not be so regarded in other 
states of society. 

We have found that in recent times the idea has 
amongst ourselves acquired a greatly increased comprehen- 
siveness, and that this seems to be chiefly due to the following 
circumstances :— 

1.—Political: freedom from danger to the State either by 
attack of enemies from without, or from seditious tumult at 
home. 

2.—Moral and Intellectual: decrease of superstition and 
religious intolerance among the people, and. growth of the 
philanthropic sentiment; and— 

8.—Social: the extinction of slavery, the increased density 
of population in many districts, and the high development 
and complexity of our industrial and commercial organisa- 
tion. 

The question now suggests itself :—In what does insanity, 
in the popular and practical sense, consist at present? And 
whether we succeed in making the answers to this question 
definite we must at least endeavour to make it intelligent. 


546 Morison -Lectures on Insanity for 1877, [Jan., 


But it must, above all, be, if possible, accurate ; and the short 
time now at our disposal obliges us to dispose of the matter 
in as few words as possible. Let us then keep distinctly before 
our minds the special object of the inquiry. It is not what 
condition ought to be regarded as insanity, or what persons 
ought to be treated as insane, that we are expected to 
indicate, but what conditions are at present regarded by the 
public as constituting insanity, and what persons are wm 
actual fact treated as insane. 

So long as a man shows himself capable of managing his 
own affairs, and conducts himself in an orderly manner, 
neither injuring nor threatening to injure himself or others, 
we may be sure that he will not be regarded as insane by 
society. Let his mental condition be what it may, we are 
safe in affirming that so long as he shows ordinary capacity 
and conducts himself with ordinary propriety he will be no 
lunatic in public estimation. This does not imply, of course, 
that every one who does not come within this description is 
regarded as insane. Many incapable persons are incapable 
merely by reason of bodily infirmity, and many who conduct 
themselves improperly are properly regarded as vicious or 
criminal. These kinds of incapable and disorderly persons 
are obviously to be excluded from the number of those 
regarded as insane. ‘There are cases of incapables, however, 
in which the question whether an individual is to be regarded 
as insane, or his incapacity is to be attributed to bodily in- 
firmity, will depend on circumstances independent of the 
mere physical or mental state of the patient. It frequently, 
for example, depends on the kind of provision that is avail- 
able for beneficial treatment, whether a person is kept at 
home or placed in an hospital as a paralytic, or sent to an 
asylum as labouring under dementia. And in such cases it 
will only be when asylum treatment is resorted to, that the 
patient will be classed as a lunatic, either formally or in 
ordinary conversation. That such considerations have an 
appreciable effect upon the number of persons statistically 
regarded as insane, is perhaps well known to all who have 
been brought specially into contact with the treatment of 
insanity. But I may note, as an illustration of this and 
cognate facts, four of the five causes which Dr. Clouston, 
who may be regarded as likely to have the subject forced 
upon his attention from points of view somewhat dif- 
ferent from those with which 1 am most familiar, gives 
as producing the increase in the number of the patients 





1878. | by Joun Srppaup, M.D. 547 


gent during recent years to asylums. I quote them from 


the Report read at the meeting of contributors to the Royal 
Hdinburgh Asylum, on the 26th of last month :*—“< Short 
transient cases,” he says, “ especially those due to bouts 
of alcoholic excess, are now sent in greater numbers than 
formerly. Cases of slighter mental disturbance, the result 
of old age, of paralytic attacks, of bodily diseases affecting the 
brain and of general breaking down of the bodily powers, 
that formerly would not have been reckoned as insanity at all, 
are now sent to the asylum to be nursed and cared for. The 
country is richer and the parochial officers hesitate much less 
about charging the rates with the cost of providing for an 
insane person in an asylum. The capitation grant of four 
shillings a patient from the Imperial exchequer greatly aids 
the last reason.”” He remarks, in support of this, “ that the 
number of broken down cases sent here,” 7.e., to Morningside, 
“this year was more marked than had been the case before.” 

We have also to take into consideration that the kind 
of capacity which is required to enable a poor man to manage 
his own affairs is different from that which a rich man must 
possess. In the case of the poor man, it consists almost 
entirely in being able to earn sufficient to support himself and 
those dependent on him. In the case of the rich man, it often 
consists chiefly in being able to spend his money judiciously. 
And it is evident that a man may be able to do one of these 
duties who is wholly unable to perform the other. It there- 
fore depends so far upon his degree of wealth or poverty 
whether a man is to be regarded as insane. Difference of 
locality may also be an important element in determining the 
question of capacity. In the case of a poor man, he may be 
found capable of supporting himself in a locality where the 
ordinary means of earning a livelihood are the simpler avoca- 
tions characteristic of remote rural or insular districts ; while 
a man of similar capacity resident in a town would starve if 
left to subsist on his own earnings. ‘The effect of this 
difference is, that the man if resident in the country would be 
counted by society as sane, while the same man if resident in 
the town would have to receive parochial aid on account of 
mental incapacity, and would thus be constituted a pauper 
lunatic. In the case of a rich man, the question of capacity 
or incapacity will often depend even upon a circumstance 
apparently so extrinsic as the character of the friends with 


* April 26th, 1877. 


548 Morison Lectures on Insanity for 1877, [Jan., 


whom he is associated. If he is fortunate in having judi- 
cious friends who influence him fairly, he may manage his 
property in a most satisfactory manner ; while another man 
no more gifted, but subjected to unfair and injudicious in- 
fluence, may require to be placed under legal control and be 
regarded as a lunatic. 

Of the large! class of incapables between the extremes of 
wealth and poverty, the question of insanity is very largely 
determined by the conduct of friends and relatives. Every 
one must be able to call to mind instances where there is a 
member of a family who has a certain amount of weakness 
or eccentricity, but who passes through boyhood, looked on 
as a lad with odd tastes, and not clever, and who lives 
through manhood, known as the brother or the uncle who 
never took a very active part in business, but was the 
children’s favourite, and had the affection of all. In many 
such cases, the idea of applying the epithet imbecile or 
lunatic would perhaps never be suggested. But suppose 
such a person to be destitute of kindly relatives, or still 
worse to have unkindly relatives, and the history becomes 
sadly altered. The incapacity and the eccentricity become © 
much more obvious. Left to choose his own course of life, 
the unfortunate man becomes involved in countless difficulties, 
probably comes to be placed under legal guardianship, per- 
haps ultimately finding refuge in an asylum; and in that 
event the statistics of lunacy come to be affected by his being 
tabulated in the public records as one of the insane. 

It must be evident that an analogous series of considera- 
tions may affect the determination of the question of 
insanity even in regard to many of those who are dan- 
gerous to themselves or others. This is most obvious in 
the case of mental disorders of short duration. The 
transient delirium which is symptomatic of various acute 
diseases, is not of itself sufficient to constitute insanity, 
as the term is popularly understood, though it may 
undoubtedly be a manifestation of extreme disorder of the 
mental functions of the brain. Buta person suffering from 
such an affection may become technically a lunatic, if it be 
found necessary to place him in an asylum in order to 
obtain the treatment required. The delirium of meningitis 
may thus be regarded either as insanity, or not as insanity, 
according to circumstances independent of the nature of 
the mental disorder. The same may be said of delirium 
tremens, puerperal mania, mania & potti, and what has been 


1878. | by JoHN Sippatp, M.D. 549. 


called mania transitoria. Similar circumstances affect many 
of the more chronic conditions of mental perversion. But 
enough has been said to show that practically the fact of a 
man becoming a lunatic from a public point of view, depends 
greatly on whether the nature of his surroundings makes it 
necessary that he should be treated as one. And this again 
depends as much on the nature of the surroundings as on 
the condition of the individual himself. And, paradoxical 
as it may seem, in some cases it may be said with truth that 
the decision of the question whether a particular individual 
is or is not to be counted as a lunatic from the social point 
of view, depends more on the mental condition of his friends 
than on his own. 

If then we were to attempt to reply in one sentence to the 
question, What condition does society regard as insanity ? 
we should say, itis any mental abnormality recognised as a 
result of disease or defective development which renders an 
individual in the particular circumstances in which he is 
placed either dangerous to, or a disturber of order in, the com- 
munity, or incapable of performing the duties required of him 
in his position. The amount of abnormality here implied, 
will vary according to the time and place in which the indi- 
vidual lives, the duties he may be called upon to perform, 
and the condition of the community by which he is sur- 
rounded. 


Spurious Hydrophobiain Man. By W. Lavprer Linpsay, M.D., 
F.R.S.E., Physician to the Murray Royal Institution, 
Perth. | 


There is probably no disease to which human flesh is heir 
that attracts, every now and again, such a degree of public 
attention—that begets such a keenness of personal dread— 
that so frequently forms the subject of sensational narrative 
or comment in the public press—that causes to be exhibited so 
disgraceful an amount and kind of ignorance, superstition, 
credulity, and cruelty—as hydrophobia. Even cholera is not 
so formidable a disorder in the public esteem. Its cramps 
are not always present; and when -they are, they are not 
comparable with the convulsions of hydrophobia. Nor is 
there any terrifying mental disorder in the case of cholera ; 
whereas, in hydrophobia the morbid mental phenomena are 
more prominent, serious, and impressive than the motor 


550 Spurious Hydrophobia in Man, [Jan., 


ones. Moreover, cholera is not popularly believed to be 
necessarily and in all cases fatal; whereas it is currently 
supposed that there is no chance of escape from hydro- 
phobia. 

It is not, perhaps, surprising that, under such circum- 
stances, whenever two or three cases of hydrophobia—real or 
alleged—have occurred, or are said to have occurred, in a 
town or district, a popular panic is apt to arise. Such a 
panic may be said to exist at present in London; it did so in 
the same city in 1874 ;* it has done so there on several occa- 
sions of late years. Last year a similar panic occurred in 
Glasgow—one that led to such municipal errors, in the 
wholesale slaughter of poor inoffending dogs, as I have 
already elsewhere described.t And such panics have been 
common in Birmingham and other central county towns of 
England of late years. 

Of the nature and extent of the present hydrophobia 
panic in London let the “ Pall Mall Gazette’”’t testify. In an 
excellent common-sense article, entitled “The Mania for 
Hydrophobia,” it made the following statement in November 
last:—‘‘ An epidemic of nervous panic has been set up by 
hearing or reading sensational newspaper reports. If one 
case 1s reported in to-day’s paper, two or three more are sure 
to follow. And so it goes on, and may de until the panic has 
worn itself out, or the newspapers have something else to 
write about.” .... ‘In the present excited state of feel- 
ing, people write as if the very presence of dogs among us is 
incompatible with the welfare of civilised mankind.” 

In the “Illustrated London News,” too, of the same 
month,$ the versatile author, G. A. Saia, thus wrote :— 
“‘ A tide of cruelty toanimals seems to be steadily setting in, 
and it should be stemmed very sternly. The hydrophobia 
scare is leading to cruelty to dogs by unnecessary muzzling 
and confining them, and by assuming them to be mad, when it 
is only we who are half out of our wits with morbid dread of a 
malady, the prevalence of which I believe to be exaggerated. 
These epidemics of nervous affright seem to be recurrent. I 
remember a fearful hydrophobia scare when I was quite a 


* There was an epidemic both of canine rabies and human hydrophobia in 
London in the spring of 1874; the particulars of which were described in the 
“Daily Telegraph ” about the beginning of May of that year. 

+ In a paper on “The Pathology of Mind in the Lower Animals:” 
“Journal of Mental Science,” April, 1877, p. 18. 

t Of November 5, 1877, p. 10. 

§ For November 10, 1877, p. 450. 


1878.) by W. Lacprer Linpsay, M.D. 551 


little boy, and the grim stories that were told of Orders in 
Council authorising physicians to smother patients suffering 
from hydrophcbia between two feather beds.” I remember 
myself* the same sort of stories about smothering; and were 
only law, ethics, theology, and public opinion to agree with De 
(Juincey in regarding murder as one of the fine arts, there 
can be no question that so summary a process, or any equally 
efficient means of putting instant or speedy end to human 
life, would add to human happiness by terminating much use- 
less human suffering. 

We are constantly told that “ history repeats itself.” The 
same is true of certain forms at least of mental epidemics ; 
they recur from time to time, as Sala points out, and their 
phenomena do not differ much from age to age. In other 
words, the mental “epidemics of the middle ages,” as 
painted by Hecker, find their parallels in those of to-day. 
And of this fact there could scarcely be a better illustration 
than the hydrophobia panics of 1874, 1876, and 1877, which 
resemble in all essentials similar panics in 1760. Even at 
the present day—when we boast so much of our civilisation, 
education, culture, refinement, and so forth—and in the very 
midst of that highest civilisation, as it is represented in and 
by our great cities, we find as egregious a display of zgno- 
rance, superstition, credulity and cruelty in a hydrophobia 
panic as could have been found in a similar panic a century 
ago. These crude and base qualities of the public mind—so 
far as they are illustrated by hydrophobia scares or alarms— 
are to be found in the current belief among at least the 
lower orders of the community :— 


1. That all biting, wild, or eccentric dogs are rabietic. 

2. That their bite necessarily produces hydrophobia in 
man. 

3. That if this hydrophobia is not to be fatal in the man 
the dog must be killed at once. 

4, That all manners of quack specifics are to be relied on 
as CUreS. 


‘In 1760,” we are told, “there was quite a panic in 
London and its neighbourhood, owing to the number of dogs 


* But the belief on which such stories were founded has not by any means 
died out. So lately as 1871, I find the Unitarian clergyman of Mossley, whose 
case is mentioned in a subsequent part of the present paper, declaring, “I 
know that I shall have to be smothered” (vide “Narrative of Dr. Brum- 
well”), 


5o2 Spurious Hydrophobia m Man, [Jan., 


seized with madness.* Hundreds of dogs were destroyed, 
and none ever permitted to go about unmuzzled ; while the 
newspapers of the day abounded in numerous receipts for the 
cure of hydrophobia—all of them as useless as the remedies 
recommended now.t” .... ‘A dread of mad dogs,” says 
an essay published at the time (1760), “is the epidemic terror 
which now prevails, and the whole nation is at present 
actually groaning under the malignity of its influence. The 
people sally from their houses with that circumspection 
which is prudent in such as expect a mad dog at every 
turning. The physician publishes his prescription; the 
beadle prepares his halter; and a few (persons) of unusual 
bravery arm themselves with boots and buff gloves in order 
to face the enemy, if he should offer to attack them. In 
short, the whole people stand bravely on their defence, and 
seem by their present spirit to show a resolution of not being 
tamely bit by mad dogs any longer.’’t 

So far from having improved in public sense since 1760, the 
present hydrophobia panic (of 1877) shows that we have even 
retrograded. So far from there being “resolution,” or 
bravery, or a proper public spirit, there is a pusillanimous 
superstitious succumbing to what is supposed to be the in- 
evitable. “Just now,” says again the “ Pall Mall Gazette,’’$ 
‘bitten people, being frightened, lose courage and expect to 
die, whether they have been cauterised or no. One person 
bitten by a dog (supposed to bemad),and afterwards cauterised, 
has died—possibly from hydrophobia, assuming there is such 
a disease and that the dog was really mad; but, also, far 
more probably, from the natural consequences of a wound 
deeply burned by artificial means. Therefore people have 
lost jaith in a remedy which has hitherto hardly ever failed, 
and refuse to live under any circumstances.” Nor have 
hydrophobia-stricken patients acquired faith in any of the 
numerous other remedies—medical or surgical—that have 
been suggested as substitutes for cauterisation by hot iron or | 
caustic, notwithstanding that every now and then the lead- 
ing London newspapers open their columns to discussions 


* Here and generally elsewhere throughout the present paper (in quota- 
tions), the term madness is used as a synonym for rabies. But that it really 
includes a number of other and diverse morbid conditions, I pointed out in a 
paper on ‘“‘Madness in the Lower Animals,” in the “ Journal of Mental 
Science” for July, 1871. 

+ ‘‘ Pall Mall Gazette,’’ November 6, 1877, p. 5. 

- { Quoted in the “ Pall Mall Gazette,” November 6, 1877, p. 5. 

§ Of November 5, 1877, p. 10. 


1878. ] by W. Lauper Linpsay, M.D. 503 


regarding the merits of alleged specifics—sometimes 
narrating wonderful “cures” of the kind to which the 
reading public was much better accustomed a couple of 
centuries ago. And other journals—both medical and 
veterinary, scientific and literary—have followed suit. 
Within a few months—in 1874—the “Times” and “ Daily 
Telegraph,” the “Field ”’ and the “ British Medical Journal,” 
as well as the newspapers throughout the country generally, 
directed attention to the revival of what was in all proba- 
bility a so-called “specific” a couple of centuries old, 
namely, the “ Birling specific.’ And gentlemen of the 
highest social status took a public part in the resultant 
discussion as to its value ; for instance, the Honble. Grantley 
Berkeley, the Honble. and Rev. E. Bligh, the Rev. T. Cum- 
ming Macdona, the Vicar of Birling, and Dr. Prince, then 
of Uckfield, Sussex. The only demonstrable result of that 
public discussion on the curability of hydrophobia, and on 
the relative merits of specifics in general, and of the Birling 
one in particular, was the exposure it afforded of the 
wonderful amount of ignorance and superstition, prejudice 
and credulity, that still exists even among members of the 
best educated and highest ranks of English society regard- 
ing a disease that has been for ages only too familiar. And, 
if this be the case among the educated and refined, what are 
we to expect from or among the illiterate ana degraded, in 
whom for the most part hydrophobia itself is developed ? 

To the psychologist, hydrophobia is invested with the 
highest interest both of a scientific and practical kind; not 
only because— 


1. Its morbid mental phenomena are prominent and pecu- 
lar, forming a group by themselves; nor on account of :— 

2. Its giving rise to epidemics of fear, which in them- 
selves form a serious study ; but by reason of :— 
_ 8. Its furnishing one of the best examples that could be 

adduced of the wonderful influence of the mind over the body, 
and of morbid mental conditions in the generation of fatal 
physical disease. It does this in so far as many, I believe 
the majority, of the cases of hydrophobia are the direct fruit 
of morbid dread, which necessarily implies morbid wmagina- 
tion. And, further :-— 

4. It illustrates the influence of umitation, and, perhaps, 
also of sympathy, in the peculiar character of both the motor 
and mental phenomena in those forms of hydrophobia 

XXIII. 37 


554 Spurious Hydrophobia mn Man, ‘[Jan., 


which, having no connection with rabietic dogs—save an 
Imaginary — one—I have described and will speak of as 
‘* spurious.” 

To a consideration of these spurious or dubious cases of 
hydrophobia I propose devoting the present paper, because I 
believe that, in proportion as it becomes realised, first by the 
medical profession and then by the general public, that 
much—probably most—of man’s hydrophobia is produced by 
his own morbid groundless fears, operating in minds of a 
low development, or in impressionable, excitable, nervous 
constitutions, so will the tendency to hydrophobia panics 
diminish and disappear. I can best, I think, illustrate what 
I have to say by citing a series of cases of hydrophobia, sO- 
called—most of them fatal—in which 


1. Hither there was no dog bite whatever ; 

2. Or the dog that inflicted the wound was not proved to 
be rabietic ; 

3. Or was proved to be healthy ; 

4, Or where the bite produced no wound. 


I have never myself seen a case either of genuine rabies in 
the dog, or of hydrophobia in man. In Scotland, at least, 1 
believe both to be extremely rare. For various reasons, I had 
long been on the outlook for an instance, especially of 
human hydrophobia, in order that I might make my own 
investigations into its natural history. I had, however, 
despaired of meeting with such a case in Scotland, and still 
more so in my own neighbourhood, when, in June, 1876, an 
alleged case of hydrophobia was sent tothe Perth Infirmary. 
It was the cause of considerable excitement in town for 
some days—until indeed its real nature became apparent— 
for it proved to be a spurious case; and it formed the subject 
of comment in the local and Dundee newspapers of the 
day.* I lost no time in visiting the patient in the infirmary, 
in conferring there with Dr. Cameron, the then House Surgeon, 
and in inquiring, in my own way, into the history and 
nature of the man’s illness. The patient was a common 
labourer, an illiterate Irishman, who was said to have 
“ received a slight bite from a dog” about three weeks pre- 
viously. “'The affair so preyed upon his mind,” one newspaper 
account tells us, “that... . he appeared to be ina mani- 
acal state, and it was thought proper to remove him to the 
infirmary. He was quite quiet, however, shortly after his 


* Of June 13, 1876. 


1878. | by W. Lauper Linpsay, M.D. 555 


admission ;” * while another report assured us, very properly, 
“that there were no symptoms of hydrophobia.”” When 
visited by myself, in company with Dr. Cameron, there were 
neither mental nor motor, neither maniacal nor hydrophobic 
symptoms; and the case had all the aspect of malingering, 
such as is only too familiar to the house surgeons of general 
hospitals in all large cities. I found nothing but an indo- 
lent ulcer on one leg—an ulcer which the patient asserted 
was the immediate or direct result of the dog-bite. But 
other evidence collected by Dr. Cameron showed, or at least 
rendered it probable, that the ulcer in question was the 
result of the application of some chemical irritant, possibly 
applied with a view to destroy locally the effect of the bite ; 
but just as possibly and probably in order to the production 
of a demonstrable sore that might be made the ground of a 
claim for damages against the dog’s owner. Such a claim 
was in fact made by the patient’s wife, an Irish woman, who 
would appear to have worried and frightened her husband for 
the moment out of his wits by her asseverations about hydro- 
phobia and its results. This condition of ephemeral mama, 
however, subsided as soon as he was beyond his wife’s 
influence, viz., in the infirmary. When TI pointed out to the 
man himself, while in hospital— 


1. That possibly he had not been bitten at all, inasmuch 
as his trousers, stocking, and boot must have intervened 
between his skin and the dog’s tooth ; 

_ 2, While a dog-bite, even where a demonstrable wound is 
produced, is not necessarily dangerous, and still less neces- 
sarily productive of hydrophobia— 


he became much annoyed, and insisted that the immediate 
result of the bite was to make his leg black—an assertion 
quite sufficient to throw discredit on all his other statements. 
T came to the conclusion that neither his assertions nor his 
wife’s could be trusted, and that the case was not one worth 
further investigation. 

In this case popular superstition was pandered to by 
shooting the dog, which was never, by the way, accused of 
having been “mad;” the animal being destroyed not so 
much in order to prevent hydrophobia in others, through its 
bite, as to obviate a fatal termination in this particular case. 
That such a summary destruction of a merely suspected 


* ‘Dundee Courier,’ of June 13, 1876. 


556 Spurious Hydrophobia in Man, [Jan., - 


animal—of a dog that merely bites, perhaps in self-defence— 
or even of a dog that may prove to be mad, in one sense or 
other—is an egregious mistake I cannot stop here fully to 
explain. 

I found an Episcopal clergyman with the patient, admin- 
istering, it is to be presumed, religious consolation or 
offering condolence—a line of treatment that, in such cases, 
is calculated to confirm the fallacious belief in the reality of a 
patient’s illness. In such cases stern dealing, not gushing 
sympathy, is the sort of discipline required if we desire to 
repress and not to foster the tendency towards certain forms 
of spurious hydrophobia, and towards many forms of humbug 
that are far from being spurious. 

In this particular instance, the patient’s wife—a veritable 
Job’s comforter—appears to have been the producer of the 
patient’s whole illness, so far as there was any. 

In the autumn of 1876, three instructive cases of a very 
different kind occurred in Glasgow. They were all fatal in 
hospital. What were, for our present purpose, the most im- 
portant features of these cases, are contained in the following 
extracts from the newspapers of the day. Of one case, “ it 
is stated that the primary symptoms...... were brought on by 
reading accounts in the newspapers of the last case of hydro- 
phobia in Glasgow, a week or two ago. The particulars being 
brought to his recollection of the bite which he had received 
so long ago as the month of August, he allowed his mind to 
dwell on the circumstance, until he lapsed into a state of 
feverish and nervous irritability, followed by the symptoms ’’* 
of genuine hydrophobia, according to the authorities of the 
Glasgow Royal Infirmary. Another account says, “ The first 
indications of the disease appeared on his reading an account 
of death from hydrophobia.”+ It may be the same case to 
which Dr. Forrest, of Glasgow, referred, when he wrote some 
months subsequently :{ “In the interval between the bite 
and the first symptoms of the malady, he read in the news- 
papers the account of the case of hydrophobia in Falkirk, and 
that upset him very much. It was never off his mind...... 
He became excited, frightened and talkative...... For several 
days he was in a condition of acute mania.” 

Again Professor Macleod stated publicly, in Glasgow, that 
“the most extraordinary thing was the great effect the mind 
had upon the disease...... The first patient in the infirmary 

* “North British Daily Mail,” October 24, 1876. 


+“ Scotsman,” October 25, 1876. 
+ “ British Medical Journal,” January 27, 1877, p. 111. 


1878. ] by W. Lauper Lrypsay, M.D. 557 


had told him that he was perfectly well till one day he took 
up a newspaper and read of a man that had died from hydro- 
phobia, and he was never of any use POS ee moment. The 
second told him exactly the same things and poor —— in- 
formed him that his mind was haunted night and day 
ee Ge till at last he had those extraordinary symptoms, which 
seemed really as much mental as bodily.”* 

What has come to be called a hydrophobia mania, panic, or 
scare, would appear to be as common in America as England. 
General nervousness on the subject amounts, in special cases 
(individuals), to a morbid dread, which is produced and fos- 
tered by the sensational newspaper reports of every instance of 
alleged or supposed hydrophobia in man, or of rabies in beast. 
Hence it happens that persons bit by dogs believe themselves 
doomed to hydrophobia. And they even go the length of 
supposing that they have been bitten ;+ in other words, genuine 
delusions of suspicion or fear are engendered. 

Prominent in these cases in the causation of hydrophobia 
is the evil influence of the Press in publishing and dissemi- 
nating terrifying accounts of fatal cases, with all their accom- 
paniments. And the evil is a serious one, not confined to the 
single item of hydrophobia. It is notorious how by imita- 
tion, imagination and sympathy—all morbid in their cha- 
racter—the publication of murders and suicides—with all 
their sensational, pictorial or theatrical details—tends to 
multiply, not repress, such crimes against the body social or 
personal. But the evil is one of such magnitude that it de- 
mands a separate and special consideration. 

Another patient in the Glasgow Royal Infirmary did well 
till a dog accidentally passed through the ward. ‘“‘ Immediately 
thereafter he started up in bed, with his arms extended and 
his eyes staring, his whole countenance indicating intense 
horror<:.:. From that time he steadily grew worse.” We read 
of “convulsions caused by the appearance of the dog”’...... 
‘‘ Being breathed upon and fanned with a towel—operations 
which always seem to excite hydrophobic patients,’ he became 
“quite incoherent and maniacal.” <A bag of ice applied to 
his head had “ the effect of making him outrageously wild, 
tossing about in bed, and talking incoherently.”{ Amorg 


* “North British Daily Mail,’”? Dec. 14, 1876. <A fuller account of Prof. 
Macleod’s views was given in the “ British Medical Journal,” Dec. 23, 1876, 
p. 834. = 

t ‘Edinburgh Courant,” July 18, 1874. 

t “Spectator,” as quoted by .“ North British Daily Mail,” of Feb. 12, 1877, 
reviewing the Glasgow cases as recorded in the “‘ Lancet,” of Jan. 20 and 27, 1877. 


558 Spurious Hydrophobia m Man, [Jan., 


the many absurd remedies that were long ago proposed for use 
in hydrophobia, was the homeopathic one of taking a hair of 
the dog that bit you. But in the above case the mere sight 
of a dog—not of the dog that had bitten the patient, if he 
was bitten at all—by awaking painful associations, or 
dire imaginations, was enough to determine an attack of 
the dreaded disease. 

Hven in Glasgow—the second largest city of the empire— 
in its Royal Infirmary, which is connected with the second 
largest medical school in Scotland, and where the patients 
were submitted to the most careful examination by a whole 
series of physicians and surgeons—no proper decision appears 
to have been come to as to whether the so-called hydrophobia 
in the three cases above-mentioned was the genuine disease ; 
that is, a specific disorder arising from inoculation with the 
poisoned saliva of a rabietic dog. The Secretary of the 
Glasgow Royal Infirmary informed the alarmed public of 
that city, as regards two at least of the said patients, that 
they were “ thought to be suffering from hydrophobia,” but 
that “ grave doubts existed at the consultations held by the 
medical staff...... as to the true character of the disease...... 
The tests employed were entirely with a view of deciding the 
question in order to the adoption of the most appropriate 
treatment; and these tests were those recommended by the 
highest authorities.’’* 

In a fourth fatal instance in Glasgow, in the spring of 
1877—this time in a girl—we are told—‘‘ The case is, in 
many respects a peculiar and painful one, and leaves con- 
siderable dubiety in the minds of the medical men, who, how- 
ever, record death as the result of hydrophobia.”’+ 

Before passing on to English cases, which are abundant, 
there is still one Scotch case deserving of notice. It created 
a good deal of excitement in Ayrshire in the summer of 1876, 
as the West Kilbride case. The patient, a woman, from the 
date of a dog-bite (on 31st May) to the date of her death (in 
the end of June), “ had lived in nervous expectation of an 
attack of hydrophobia.” The dog was only “said to be 
rabid ;” but as usual in such cases, it was shot as speedily 
as possible.{ Though the wound inflicted by the dog healed, 
‘‘she was subject to a good deal of nervous excitement, pro- 
bably induced by injudicious people talking about it and its 


* Letter in the “ North British Daily Mail,” of Feb. 23, 1877. 
t+ Same newspaper, of March 17, 1877. 
{ “ Dundee Advertiser,” July 6, 1876. 


1878. ] by W. Lauper Linpsay, M.D. 559 


consequences.” She had gone to a railway station to meet a 
daughter, and “ having slightly over-heated herself, became 
unwell that night, and the hydrophobic symptoms of thirst 
and dislike of water at once set in. These were followed by 
oppression about the region of the heart, and ultimately by 
extreme nervous excitement and delirvum, final collapse” and 
death. “A blind husband was the object of much anxious 
consideration in her last moments.”’* 

Here, as in so many other cases, there was no diagnostic 
sign or symptom of hydrophobia. Thirst is one of the com- 
-monest of all indications of deranged health, especially when 
it is attended by or gives rise to the slightest febrile dis- 
turbance. And it has been shown over and over again 
that in the genuine disease, whether in man or other ani- 
mals, a dread of water is at least as frequently absent as 
present, so that it is, therefore, in no wise characteristic. 


To be continued. 


The Irish Lunatic Asylum Service. 


In the “ Journal of Mental Science” for April, 1876, a short 
account appeared of the present state of the Irish Lunatic Asy- 
lum Service and the action then being taken by Irish Medical 
Superintendents to obtain a more secure footing under Govern- 
ment, by ranking as Civil Servants. Inorder to gain this 
object, it would be necessary that the Executive should become 
their paymasters, and that their salaries, instead of coming from 
the rates, should be paid by the Treasury. Once secure of 
their position as Civil Servants, the rest would follow; their 
services would reckon, no matter how often changed from one 
asylum to another; they would no longer hold the anomalous 
position of men appointed by Government, responsible to 
central authority but paid by the ratepayers and as Civil Servants 
they would come under the Superannuation Act of 1859. 
Above all, they would become more closely connected with the 
Government, and obtain greater support and assistance in their 
official duties and in their attempts to further the study of 
mental disease in Ireland. 

It is necessary to repeat these various reasons for the course 
pursued by Irish Superintendents, in which they have acted 


* “North British Daily Mail,’ July 5, 1876, under the title, ‘Sad Case of 
Alleged Hydrophobia.”’ 


560 The Irish Lunatic Asylum Service. [Jan., 


alone, without consulting the interests of other Irish asylum 
officials, have formed a separate association, having for its 
object their interests only, and have forwarded a separate 
memorial to the Chief Secretary. By so doing they have 
brought down on themselves censure from all sides for their 
extremely Irish ideas of united action, their selfishness, the 
narrowness of their views, their vanity and stupidity in 
supposing that Government would pay any attention to so 
small and so powerless a body of men. ° 

Undoubtedly at first sight all this appears true; they are 
ready to admit that they have acted alone and for their own 
interest, have only partially jomed the general movement of 
Irish asylum officials in their petition to obtain more generous 
terms of superannuation, and may by this means have 
weakened the public cause. 

But a very little consideration will show that their apparently 
selfish course of action is rather the result of their present 
position, than of any wish to separate themselves from those 
associated with them in the working of District Asylums in 
Ireland. 

That Medical Superintendents in Ireland are on quite a 
distinct footing from the rest of the asylum staff, is a point 
which those accustomed to the working of English asylums 
cannot well understand. They are appointed by, and serve 
under different masters, so that it is impossible that the 
interests and objects of both can be in common except on the 
question of superannuation, and here it should be clearly 
understood that superannuation is not the chief end and 
object of the present movement amongst Irish Medical Super- 
intendents. ‘Iheir views embrace a much larger field ; a better 
scale of superannuation would be only one of the advantages 
obtained. To be made Civil Servants de facto by receiving 
their salaries from the Treasury, and to have the State who 
appoints them, and not the ratepayers who have no voice in 
their selection, as their paymaster, are the real objects of the 
movement. All will agree that the subject is one of vital 
importance not only to the future of Irish Medical Superinten- 
dents, but to that of District Asylums in that country. The 
present anomalous position cannot last; it must change either 
for better or worse—either the State must become the pay- 
master, or the appointment of Medical Superintendents will be 
handed over to the Local Board of Governors. Before many 
sessions have passed over, some enthusiastic member will call 
the attention of Parliament to the injustice of calling upon 


1878. ] The Irish Lunatic Asylum Service. 561 


the ratepayers to contribute to the salaries of men in whose 
appointment they have no share—a complaint which cannot 
fail to meet with the sympathies of all sides of the House ; 
and unless the Government are ready to pay their own servants, 
there is every fear that the appointment must pass to local 
selection, a result which all who take an interest in the con- 
dition of the insane in Ireland will consider most prejudicial to 
the wellbeing of District Asylums. 

In this movement the remainder of the staff of asylum 
officials had no object in joining ; they are entirely the servants 
of the Board of Governors, by whom they are appointed, 
dismissed and paid, the question was settled for them by Lord 
Mayo’s Act, which transferred their appomtments from the 
Lord Lieutenant to Local Boards, so that unless the Govern- 
ment were to undertake the entire management of these insti- 
tutions, there could be no pretext for demanding to have the 
entire staff made Civil Servants. 

In presenting their memorial to the Chief Secretary, the 
Superintendents of Irish asylums have counted the cost, and 
have taken into careful consideration the weakness of their 
party and the difficulty of men in their position with few friends 
in Parliament and very little party interest, being able to 
influence the Government to take any action on their behalf. 
But though they stand alone, their cause is one which will gain 
sympathy by being known. ‘They cannot expect to obtain 
this end at once, but when the question comes on for discussion, 
the Government will have before them the reasons why Medi- 
cal Superintendents in Ireland wish to become Civil Servants, 
will see that by granting the prayer of their memorial, they 
will have the means of retaining these appointments, which all 
sides agree should be left in the hands of the Hxecutive, and 
will at the same time be able to remove a cause of very just 
complaint from the Irish ratepayers. 

It may be urged, on the other hand, that a Government 
which has already acted in such a generous spirit toward public 
Asylums throughout the United Kingdom, is unlikely further 
to subsidise these institutions in Ireland by paying the salaries 
of the resident physicians; and, secondly, that if such a grant 
were made to Ireland, the same boon should be given to 
England and Scotland. 7 

But in answer to this it may be pointed out that without any 
further grant from the Treasury, the Government have two 
sources from which to obtain the amount required. Ist. Out of 
the money set apart for the rate in aid of 4s. per week for each 
pauper lunatic which every Pauper Asylum receives a sum 


562 The Irish Lunatic Asylum Service. * [Jan., 


might be deducted in lieu of the salary of Medical Superin- 
tendents in Ireland. This of course would not in any way benefit 
the ratepayers, but it would accomplish the desired object by 
removing any cause of complaint which the taxpayers have 
in being obliged to pay the salaries of men in whose appoint- 
ment they have no voice,and by giving to Irish Superin- 
tendents the rights of Civil Servants. 

2nd. I'he Government have at their disposal at the present 
time another source in Ireland in the surplus fund of the Dises- | 
tablished Church, which it is presumed must be utilised for the 
benefit of the Irish people, either by lessening the burthen of 
the existing public charities, or by affording means for further 
advancement in civilisation and knowledge. To what more 
charitable or greater end could it be converted than for the 
benefit of the insane poor, and in what way could it be utilised 
which would give so little cause for party or religious rancour ? 

Ireland is without comparison poorer than either England 
or Scotland. That the Government, therefore, should contri- 
bute somewhat more liberally to institutions for the insane in 
that country could not cause any dissatisfaction in other parts 
of the United Kingdom, whose local wealth has made their 
asylums to rank amongst the monuments of England’s great- 
ness and liberality. 

It must also be remembered that in Ireland the Government 
takes a much more paternal care of public Asylums than in 
other countries, the Treasury advance the money for their sup- 
port in the first instance, Government officials carry out their 
building, look after their enlargement and repairs, examine 
their financial accounts, and regulate their staff, and by so 
doing become to a very great degree responsible for their 
efficacy. It is therefore only right that the Executive should 
contribute liberally to raise these institutions, in whose man- 
agement it takes so great a share, to the standard of the 
requirements of the modern treatment of the insane. 

Irish Medical Superintendents have centred all their hopes 
on this one object—to become Civil Servants; they can only 
hope to succeed, standing alone as they do, by united action, 
by untiring energy, and by the aid and sympathy of their 
brethren in the sister countries. 

A subject of great importance to the specialty in Ireland— 
viz., the transfer of the management of District Asylums from 
the control of the Inspectors to the Irish Poor Law Board, 
has of late received much public attention ; a memorial praying 
the Government to take the matter into consideration having 
been circulated amongst Corporations and Boards of Guardians. 


£378,| °° The Irish Lunatic Asylum Service. 563 


- The question is said to have been previously under the con- 
sideration of the late Government, and to have been favourably 
received by Lord Spencer, when Lord Lieutenant, than whom 
none took a greater interest in the welfare of the insane. ‘The 
scheme is as yet so little known, that it is not easy to see the 
advantages to be gained by so sweeping a measure. It is not 
to be supposed that public opinion would allow asylums to be 
reduced to the standard of workhouses in Ireland. No saving 
could be made in the administration of these institutions, so 
long as any regard is had to the proper treatment of the 
insane. Nor is it likely that the Executive would permit 
the appointment of Boards of Governors to be taken out of 
their hands. Advantage might be taken of any change to 
arrange a more equitable distribution of the cost of maintenance 
of these institutions between landlord and tenant. 

But the chief cause of the favour with which the subject 
has been received, has been a desire to bring all local 
administration in Ireland under the Poor Law Board. To 
add to its labours could scarcely be advocated by any one 
on the ground that its field of responsibility was not 
already sufficiently large, considermg that it comprises the 
management of 163 unions, the whole dispensary system, 
almost all the public hospitals (as in Ireland the workhouses 
have now taken the place of the county infirmaries), and lastly 
the working of the Sanitary Act is carried out under its 
control. If to all this were to be added the additional labours 
and responsibility of the care of the insane, surely the burden 
would be beyond its capacity. But here the question 
arises, how far is it intended to transfer the care of the insane 
to the Local Government Board? Do the advocates of the 
scheme propose to do away with the lunacy office altogether, 
and to place all classes of the insane, whether rich or poor, 
pauper or Chancery patients, under the charge of the Poor 
Law? That a department instituted for the purpose of 
watching over the working of the Acts for the relief of 
pauperism, the cure of the sick poor, and the preservation of 
the public health should undertake the control of such of the 
insane who are the owners of large amounts of property, 
seems an anomalous state of things. ‘l'o separate the manage- 
ment of District Asylums in Ireland from that of the Private 
Asylums and the insane at large, would involve the 
carrying out of two separate systems, one for the poor and one 
for the rich, with different regulations, necessitating two 
offices and two sets of officials. 


564 [Jan., 


CLINICAL NOTES AND CASES. 


A Case of Disseminated Cerebral Sclerosis. By W. Buvan 
Lewis, L.R.C.P. Lond., West Riding Asylum. 


J. H., xt. 33, widower, admitted into West Riding Asylum, 
August 6th, 1877. 

It was stated by his friends that he had exhibited great depression 
of spirits for about twelve months subsequent to the death of a 
favourite child of his, but there was no evidence of decided mental 
aberration until a week ago, when he became restless, excited, and 
eventually outrageous in conduct. These outbursts of excitement 
have been increasing in frequency and violence up to the date of 
admission, and were characterised by noisy incoherent raving and 
shouting, aggressive behaviour, and dangerous and destructive pro- 
pensities. The facts of his history prior to this attack, as given by 
his friends and the Relieving Officer, were too conflicting to be closely 
relied upon. There was good reason, however, to suspect that for 
some years past he had been living a somewhat loose and dissolute 
life, and lately had become very intemperate in his habits. There 
was no history of cranial injury, or of any severe illness prior to the 
attack; a distant relative was said to have been insane. 

Such were the facts given on his admission. He was at this period 
greatly agitated, throat dry and husky from incessant raving, restless, 
gesticulating, and obstinately refused his food. He remained in a 
state of acute delirious mania for the ensuing week, when a note in 
the case book states—“ He still. remains excited, raving incoherently, 
and wandering restlessly about his room. His speech is at times foul 
and profane, and his habits generally revolting. His attention can be 
arrested only with great difficulty, and then so momentarily as to 
elicit no rational reply.” The more significant features of his case 
were as follows :—‘ Extreme emotional disturbance, manifested by 
frequent weeping or fits of the wildest terror, in which he shrieked 
wildly, trembled in his limbs, and indicated by his gestures the 
presence of hallucinations of special senses. His whole demeanour 
was indicative of intense suspicion, occasionally manifested by violent 
aggressive conduct. On physical examination it was noted that his 
pupils were equal, sluggish in action, and not contracted. His tongue 
was moist, protruded straight and steadily. There was a profuse flow 
of saliva from the mouth. Respiratory and circulatory systems were 
normal. The pulse 92 and soft. Ten days after admission he was 
still incoherent; sleep could be obtained only upon the administration 
of chloral. He required feeding by the funnel. There was retention 
of urine necessitating catheterism. He was at this period taking 


1878. ] | Clinical Notes and Cases. 565 


drachm doses of bromide of potassium twice daily. This state of 
matters continued unchanged until a month after his admission, when 
his excitement suddenly disappeared and he became torpid, apathetic, 
and extremely feeble. His gait was tottering, nor could he walk un- 
supported. | His skin was cool, being usually about 99°. His 
breathing natural, but pulse slightly quickened. He took food regu- 
larly. His face was flushed. For a couple of days he remained in 
an utterly prostrate condition, lying motionless in bed, making no 
response to questions, but not comatose. There was diminished 
sensibility over right side of body, most marked, however, in the arm. 
He remained thus for a week, gradually developed symptoms of 
hypostatic pneumonia, and sank five weeks after admission. 

The following is an abstract from the post-mortem 
records :— 

‘The skull somewhat thick, of normal density, sinuses contain dark 
clotted blood. There is considerable wasting over all the lobes, es- 
pecially the occipital. The membranes strip with difficulty, but 
nowhere is the cortex torn on their removal. . There is slight opacity 
over the frontal and parietal regions. The pia mater is tough, thick, 
and congested, of a deep bluish appearance. The whole brain weighs 
1461 grammes. The grey matter is rather thin. There is a distinct 
mottled congestion of the white matter, but with this exception 
nothing abnormal was presented in the naked eye examination of the 
cortical or medullary regions. There was no special focus of softening 
throughout the hemispheres, and the ganglia at the base were healthy. 
Three ounces of fluid escaped on removal of the brain. Microscopic 
examination revealed a condition of disseminated sclerosis of the 
white matter. ‘The patches of sclerosis were very numerous and in 
constant connection with the vessels. There was abundant prolifera- 
tion of the nuclei along the course of the vessels, and deposits of 
hematoidin crystals in the sheaths. The grey matter was unaffected, 
the nerve cells appeared normal, but the sclerosed patches extended 
up through the medullary strands as far as the spindle-cell or deepest 
layer of the cortex.” 


A Peculiar Case of Melancholia, with Cancerous Tumour of 
the Middle Lobe of Bram, Disease of Kidneys, Liver, 
Pylorus, &c. By T. 8. Crousron, M.D. 


Specimen shown at Edinburgh Quarterly Meeting. 


History.—A. B., et. 58, a lady of good education, cheerful and 
frank disposition, domestic and industrious habits, who had enjoyed 
good health, and had a family of several children. Temperament 
not neurotic. No hereditary predisposition to insanity. Pre- 
disposing cause of attack seemed to be domestic anxiety and a 
sudden alarm of fire. Had been falling off in flesh, appetite, and 


566 Clinical Notes and Cases. . [Jan., 


strength before mental attack. But became depressed for some weeks 
before admission, and soon became possessed with the delusion that 
she was very wicked, had syphilis, and would infect those round her. 
She refused food, was sleepless, and imagined she had no passage in 
her bowels. 

Admitted into Royal Edinburgh Asylum 22nd September, 1876. 

State on Admission.— Extreme depression, says she is very wicked, 
is lost, has syphilis, and is not fit to be here. Has an anxious, worn, 
pinched expression of face. Cannot be interested in anything 
outside herself. Memory seems fairly good. Is coherent, and can 
answer questions: very thin, colour very bad. Has enlargement 
of the thyroid body, with prominent eyeballs. No paralysis or 
anesthesia. Tongue slightly coated. Bowels very costive. Pulse 
88, weak. Temp. 98°3°, 


Abstract of Progress of Case. 


September 23rd.—Patient was ordered a tonic—quinine and hydro- 
chloric acid, and to have two glasses of sherry daily. 

For a time patient showed a slight improvement, but this proved 
very temporary, and the melancholic condition became aggra- 
vated. She slept badly, occasionally having a good night, but 
generally being restless, with broken, disturbed sleep. The appetite 
was much impaired, patient taking very little food, and ultimately 
refusing food altogether, so that on one occasion, in November, she 
had to be fed with the stomach pump. ‘The tongue was clean, but 
dry; the bowels were costive, and had to be regulated by occasional 
doses of compound liquorice powder and other aperients. Patient 
had a pinched, anxious expression of face, and lost flesh. Mentally, 
she was in a condition of great depression, with numerous delusions. 
At admission, and for some time afterwards, the delusions were of the 
simple melancholic character; she fancied that she was lost to all 
eternity, that she had misconducted herself in youth, and that she was 
now suffering from a disease which she had contracted at that time; 
that she had ruined her husband and family, and that there was no 
place for her at home at all, Along with this there was considerable 
enfeeblement of mind ; she was childish, querulous, and unreasoning 
in her conduct ; and her memory was much impaired, especially as to 
recent events. After having been in the asylum for weeks she 
would maintain that it was only one long day since she came; she 
complained that the days never came to an end, and that she was 
compelled to take an extraordinary number of meals in each day, 
When asked to go to dinner, she would querulously reply that it was 
not half-an-hour since she had taken breakfast. She showed little 
interest in what passed around her; could be got to take little 
or no part in work or amusements, but was always harping 
upon her own miserable condition, and in conversation giving 
1eady expression to her delusions. She was very disinclined to 


1878. ] Clinical Notes and Cases. 567 


take the usual open-air exercise, and would meet the doctor on his 
morning visit with the constant request that she should be allowed to 
remain in the parlour, as she was too weak to walk ; when compelled 
to go out, she thought that she was being treated unkindly, and this 
idea at times almost amounted to a delusion that she was persecuted 
by the attendants and when visited by her friends she would fre- 
quently make ungrounded complaints against them. 

With occasional slight variations from time to time, patient’s 
mental condition during the winter continued much the same as that 
noted above—depression and enfeeblement, with delusions of a 
melancholic type. But during this time her physical health was 
becoming greatly impaired, she took her food badly, and only with 
much coaxing (though the stomach pump did not again require to 
be used); she was restless at nights; the bowels were still costive 
more or less. There was great emaciation; a slight jaundiced or 
yellow tint of the conjunctiva; and a markedly cachectic appearance, 
such as to make one at once suspect that the patient might be 
labouring under organic, and possibly malignant, disease. From 
time to time repeated physical examination of the thorax and 
abdomen was made with the object of detecting any organic disease 
that might exist; but no evidence of such disease could be found. 
No enlargement of the liver could be made out. The urine was 
examined particularly for bile, but only the faintest trace was found ; 
beyond frequently containing a very large quantity of urates, the 
urine indeed showed nothing abnormal. It was difficult to make a 
satisfactory examination of the organs, as the patient complained 
bitterly whenever she was touched; and her statements as to the 
parts in which she felt pain or tenderness on pressure were inco- 
herent, and could not be relied on. 

April 12th.—Ordered compound cod liver oil emulsion, with pep- 
sine and hypophosphite of lime. The marasmic condition still con- 
tinued, and at one time, in the beginning of May, it seemed as if the 
patient were actually dying. But after this, again, her physical 
health seemed to improve slightly, and mentally she was for a time 
less acutely melancholic. She still laboured under delusions of the 
same melancholic character as before, but did not so constantly give 
expression to them. 

On the 10th of July, patient met with an accident, fallen over some 
stairs at the entrance to the corridor. She complained of great pain, 
and on examination there were found some of the appearances of 
intra-capsular fracture of the neck of the right femur. For this the 
long splint was applied, at Professor Annandale’s suggestion, and the 
patient was confined to bed for six weeks. During this detention in 
bed, patient seemed to be somewhat better—she was altogether 
quieter, slept better at night, and took her food better and without the 
constant querulous complaining which she used to exhibit previously ; 
- and the delusions, though still of the same melancholic character, 


568 Clinical Notes and Cases. [Jan., 


were much less prominent than before. But at this time the bowels 
were very much confined, requiring the frequent use of purgative 
medicine; and the stools were pale-coloured and very offensive, 
though firm in consistence. After the removal of the splint on the 
20th of August, there was found to be still some eversion of the knee 
and foot, but no shortening of the limb. Patient, however, seemed 
unable to use the limb. Altogether the patient seemed to have made 
a fair recovery from her accident; but very soon the marasmic condi- 
tion became aggravated, and in spite of the use of a most nourishing 
diet (eggs, milk, beef tea, custards, and whatever else she would take), 
and of stimulants (sherry, and afterwards brandy), patient grew 
rapidly weaker. Soon she was unable to leave her bed; a bed-sore 
formed over the sacrum, and in spite of treatment, continued to 
enlarge, with great offensive discharge. She took her food readily, 
but only in small quantity; mentally she was still depressed and en- 
feebled, but her former delusions seemed now greatly in abeyance, and 
the burden of her conversation now was that the attendants would 
treat her with patience, as she would not trouble them long. Great 
cedematous swelling appeared in the feet, and gradually extended up 
the legs. The pulse became small and very thready, and latterly 
could sometimes scarcely be felt at the wrist. The bowels at this 
time were much more regular than previously, and the stools more 
natural in appearance. Patient grew weaker and weaker, and ulti- 
mately sank October 15th, 1877. 

Autopsy 24 hours after death. 

Body much emaciated. Extensive bed-sore over sacrum. 

Brain.—Vessels at base atheromatous. Vertex healthy-looking. 
There was a tumour, the size of a hen’s egg, growing from upper 
part of petrous portion of left temporal bone, weighing half-an-ounce, 
and attached to the inner table of the bone, which was somewhat 
softened. The tumour was encysted in the brain matter, but not at- 
tached to it, lying quite free in a cup-shaped cavity. The contiguous 
brain substance was flattend out and somewhat softened. 

The cancerous mass on microscopic examination was found to 
consist of small cells, lying in the meshes of a delicate stroma, alto- 
gether much resembling brain matter, but distinguishable from it by 
the absence of .the characteristic larger brain cells of the grey matter. 
The brain was not cut up, but kept as a specimen. 

Heart.—Valves competent. Atheroma of coronary arteries— 
ulcerating atheroma of aorta—atheroma of mitral valve. Substance 
healthy. 

Lungs.— Normal. 

Abdomen.—There were several small secondary masses of cancer at 
the pyloric end of stomach, the orifice of which was constricted. No 
secondary cancer in liver, kidneys, glands, or other organs. The 
splenic artery was enormously tortuous and dilated. 

Liver was fatty, with thickening of the coats of its arteries and bile 


1878.] Clinical Notes and Cases. 569 


ducts, and considerable increase of fibrous tissue round them. The 
fibrous tissue round the bile ducts was deeply stained with bile 
even to the smallest duct. 

Spleen.—Normal. 

Kidneys —Right Kidney: Full of very large cysts; substance 
otherwise normal. Left Kidney: Marked cystic degeneration. The 
renal substance almost gone, its place being taken by numbers of 
cysts, many of them containing dark foetid fluid matter. 

No fracture of femur had occurred. 


Commentary.—The questions which occur to onein regard to 
such a case, are these-— 


1. What was the probable duration of each of the bodily 
diseases ?- | 

2. What was the real cause of death ? 

3. Can any direct connection be traced between the mental 
conditions and the bodily diseases ? 


In regard to the duration of each of the distinct diseases 
she had, the only guides one has in forming an opinion are — 
the pathological appearances after death. Not one of them 
produced unequivocal symptoms during life by which they 
could have been certainly diagnosed, or their course deter- 
mined. The cystic condition of kidney seemed undoubtedly 
to have been the first departure from health. But then, on 
admission, it did not cause albuminuria, cedema, or any other 
symptoms referable to renal disease. It was only, in fact, 
within two months of death that this was so. 

The contraction at the pyloric orifice of the stomach must 
have existed some time, but there are no data for saying how 
long. There is fair reason, however, for connecting this with 
the loss in flesh, falling off in appetite, and discomfort in the 
region of the stomach and bowels, as that came on in the 
latter months of 1876, and preceded the insanity. The liver 
had clearly been disordered in its functions, and obstruction of 
its ducts had been suspected by us during her disease and the 
urine examined for bile, a trace being found in it. In fact, I 
had a strong suspicion of obstruction of its ducts from the 
mental symptoms being similar to those which had been 
present in such a case that I once had under my charge. 

The cancerous tumour of the brain had been utterly unsuspec- 
ted, and had produced no symptoms whatever, either sensory or 
motor. Such a tumour as that I cannot imagine would have 
grown to that size within the skull, where there is so little 
room for ready expansion, in less than twelve months, and 

XXIII. 38 


570 Clinical Notes and Cases. (Jan. 


probably it took a longer time than that. My experience of 
such tumours would lead me to say that its duration was 
over a year. 

The chief characteristic of the melancholia was an idea 
that every one was finding fault with her, and she always 
spoke in a deprecatory tone—“ You must not blame me.” 
“You mustn’t worry me to take more.” ‘TI really have done 
as well as I can.” “ Don’t cause me pain.” ‘ You won’t ask 
me to go out to-day,” these things beig said when no one 
was near her. 

The cause of death in this case was really the exhaustion 
and failure of bodily nutrition, caused by the presence of all 
the diseases and morbid states of mind and body. Their com- 
bined evil effects had reached that point which was incompa- 
tible with life. 

The mental symptoms were from the beginning of that 
type of melancholia that has been associated with disorders or 
disease of the alimentary canal. The cry of the organism for 
suitable nutriment, which is revealed to consciousness as appe- 
tite, was quite abolished, and there was instead, at one time, a 
strong repugnance to food. Digestion was impaired. There 
was clearly strong feelings of organic discomfort after eating. 
The bowels were very costive, and her delusions exaggerated 
their costiveness into months between each passage of her 
bowels. Her abdomen and abdominal muscles felt hard and 
stretched. The hyperzsthesia she had was referred for the 
most part to her bowels. With all this there was extreme 
emaciation, though plenty of nourishment was taken into the 
stomach. 

There are undoubtedly certain markedly abdominal cases of 
melancholia in which the innervation of digestion and alimenta- 
tion is impaired. Just as the normal feeling of well-being, which 
is the mental sign of general organic health, is abolished in 
melancholia, so, as a part of this and a very special and dis- 
tinctive part of it, in such cases the desire for food and drink, 
feeling of pleasure in taking food, the satisfaction after it, the 
organic comfort which the normal peristaltic action and 
movement of the bowels give, are all abolished, and painful 
states take the place of the pleasurable ones. This case was a 
very exaggerated example and type of such cases. I think it 
is beyond a doubt that we shall find that the cause of all this 
is a disordered working of that portion of the brain which 
presides over the function of alimentation, and secondarily in a 
disordered working of the organic nerve ganglia that so 


1878. ] Clinical Notes and Cases. yal 


abound in the abdomen—the sympathetic system of nerves, 
the semilunar and visceral ganglia, and the small nerve 
ganglia in the coats of the bowels. Ferrier thinks that the pos- 
terior lobes of the brain are the seat of the organic brain func- 
tions but there is no proof of this, and the lower portions of 
the middle lobes are yet quite unappropriated as to localised 
functions. It may be that their functions are those of presiding 
over and regulating alimentation and digestion. The real cause 
of abolition of the normal food appetites in so many diseases 
and states of disordered health and their perversion in other 
instances is unknown, but beyond a doubt we must refer them 
to some central cause in the brain. ‘This case might be sup- 
posed to point that way. 





Case of Right Hemiplegia resulting from Closure of the Left 
Carotid Artery due to Thickening of Fibrous Tissue around 
at, caused apparently by Irritation of a Hypertrophied 
Clinoid Process. By J. J. Brown, M.B., Royal Edinburgh 
Asylum. (Specumen shown at last Quarterly Meeting of 
the Association in Hdinburgh.) 


K. W., female, wt. 60. Admitted on the evening of Oct. 
11th, 1877. : 


No history could be obtained beyond the facts stated in the medical 
certificates, which were that the patient had been excited, and was 
found wandering about the streets in a half-naked condition. 

On admission she was slightly excited and somewhat enfeebled. 
She talked in a rambling and childish manner, was restless, wandered 
about the ward without any apparent purpose, but was in no way 
violent. When walking patient inclined to the right side, and the right 
leg seemed a little weaker than the other, but no other distinct motor 
paralysis could be detected, and the sensation of the right side was 
unimpaired. There was complete amaurosis of the left eye and in- 
complete of the right, but patient could give no account of how it 
came on, &c. 

Lungs.—No dulness on percussion; sibilant rales were heard all 
over both, and patient complained of cough, accompanied with ex- 
pectoration. 

Pulse 84. Temperature 984° F, 

Other organs normal. ; 

Oct. 12th.—Patient slept well during the night, this morning talks 
quite rationally, seems free from excitement, but is somewhat en- 
feebled. She states that the sight of the left eye has been lost for 
some months, that it gradually became affected, and that now the 
sight of the right eye is affected in the same manner. 


572 Clinical Notes and Cases. [Jan., - 


Oct. 18th.— During the night patient has had:a distinct attack of 
right hemiplegia. She is unconscious this morning, cannot move her 
right arm or leg, and the sensation of both these limbs is entirely 
lost. Deglutition is much impaired, she is unable to protrude her 
tongue, but there is no apparent paralysis of the facial muscles. 
Pulse 108. Temperature 99° F. 

Symptoms remained much as noted, except that the bronchitis 
became gradually more severe, and patient died on Oct, 27th. 

Post-mortem examination 48 hours after death. 

Cranium.—Dura mater was slightly adherent at vertex to the 
underlying structures, otherwise healthy. Pia mater was opaque and 
milky all over the vertex, but was non-adherent to the grey matter of 
the convolutions, Convolutions were somewhat atrophied, sulci wider 
than normal, and filled with a clear serous fluid. There was con- 
siderable difficulty in removing the brain owing to the fibrous struc- 
ture about the region of the Sella Turcica. On examining the skull 
the left posterior clinoid process was seen to be hytrophied, being fully 
a quarter of an inch in length and an eighth of an inch in width. 
In front of this the left carotid artery was hypertrophied in all its 
coats, and the lumen of the vessel almost occluded, Around the 
vessel and in the Sella Turcica the structures were firm, fibrous, and 
matted together. The right carotid artery appeared perfectly normal. 
The base of the brain after its removal presented a fibrous struc- 
ture involving the left optic tract, the left half of the optic commis- 
sure and the left optic nerve completely matting the parts together, 
and through which the left carotid artery passed. The right optic 
nerve was hypertrophied, while the left was much atrophied, being 
quite tough and fibrous. No embolus was found, though earefully 
looked for. Well marked granulations were seen on the floor of the 
fourth ventricle, otherwise nothing abnormal could be detected. 
Lungs were edematous and the larger bronchi inflamed. Other 
organs normal. 


OCCASIONAL NOTES OF THE QUARTER. 





Payment for Work done im Asylums. 


The following is an extract from the report of Dr. Orange, 
of the Broadmoor Criminal Asylum, for 1876 :— 


Although there can be no question that the inmates of a lunatic 
asylum are themselves benefited by being employed in suitable work, 
and although it might, therefore, be theoretically held that the officer 
placed in charge of an asylum would be perfectly justified, on this 
ground alone, in compelling the whole of the able-bodied inmates to 


1878. ] Occasional Notes of the Quarter. 573 


labour, still it would, as a matter of course, be found in practice to be 
impossible, in dealing with lunatics, to carry out any such system of 
compulsion. 

Inasmuch, then, as coercion and punishment, with the object of 
promoting industry, are inapplicable to insane persons, and as they 
would indeed, if tried, be found in practice to be not only cruel but 
unsuccessful, recourse must necessarily be had to some system or 
other of rewards. Previously to the year 1875 the chief kind of 
reward offered for useful work consisted, in this asylum, of a luncheon 
of bread and cheese, with beer, in the forenoon, with a further smaller 
ration of beer in the middle of the afternoon’s work. In 1875 the 
issuing of beer in the forenoon and afternoon, as a reward for work, 
was discontinued, and a scheme was introduced instead by which a 
small proportion of the money value of the work actually done is 
credited to the workers, to be expended for them, according to their 
individual tastes, in procuring trifling luxuries of a harmless nature. 
As a result of the operation of this scheme it was found that the 
money value of the work done by the patients in the shoemakers’ 
shop in the year 1876 exceeded the money value of the work done in 
1873 (the year preceding the introduction of the scheme) by 160 per 
cent., whilst in the tailors’ shop the extent of increase was 120 per 
cent., and similar results have been obtained in other departments of 
labour ; and thus, notwithstanding the allotment of sums of money 
to the working patients, the annual cost of maintenance has under- 
gone reduction to a very appreciable extent. The discontinuance of 
the issue of beer in the forenoon and afternoon caused a saving upon 
that item alone, during the year, of £1605. 

From the time at which the control of the repairs of the buildings 
was transferred from the Council to the Office of Works no use what- 
ever was made of the labour of the patients in that department until 
the month of June in last year, at which time the Office of Works 
gave their sanction to the employment of a party of patients in the 
work of painting. 

Between that time and the end of the year the money value of this 
description of work, executed by the patients and their attendants, 
amounted, according to a return, furnished by the Office of Works, to 
the sum of £228 19s. 6d. 


Dr. Major on Statistical Tables of the Causes of 
Insanity. 


In proceeding now to offer, for the opinion and judgment of others, 
a method of tabulation which I venture to think would meet many of 
the requirements of the case, and be free from the sources of fallacy 
inseparable from the system which usually obtains, I have merely to 


574 Occasional Notes of the Quarter. [Jan., 


express a hope that it may be considered worthy of being-weighed in 
the balance and dealt with strictly on its merits. 

The feeling of utter failure experienced in endeavouring to draw 
up with accuracy a table of causes in the usual manner, led me to 
consider whether it would not be possible to devise a system which, 
while being simple and easy of application, might at the same time 
embody more facts than the usual method, and so be more truthful 
and accurate. And, finally, a scheme suggested itself, to describe 
and illustrate which will now be my object. 

The course proposed is extremely simple. It is (1) that in record- 
ing each case, with respect to its causation, the circumstances, however 
few, or however numerous, which seem, on the information available, 
to have exercised a causative influence, shonld be fairly stated; and 
(2) that in placing the supposed causes in a tabular form, they should 
be simply added together, like with like, and irrespective of the 
number of cases under consideration. To give an illustration of the 
plan suggested, I take six cases at random from the case book. 


Name. Causes. 

M.S Hereditary tendency (to insanity), alcoholism, 
previous attacks. 

M.A.S. Over-lactation, grief. 

he? Old age, grief. 

8.J.C. Hereditary tendency, climacteric period. 

Sb: Old age. 

KH. A. H. Grief, privation, climacteric period. 


Adding and tabulating like causes in the above six cases, the 
results may be expressed as follows :— 


. Cases. 
Hereditary tendency contributed to the production of — 2 
Alcoholism 
Over-lactation 
Grief 
Old age ” ” 
Climacteric period 5 
Privation 


a 99 
9 Pe) 
oP) 19 


oP) 
9 99 


mb ho Oo ee 


Of course, if desired, the sub-division into moral and physical 
causes can, under this system, be made in the usual way, and probably 
the table would derive additional value by the percentage value of 
each causative agency being given. These are matters of detail ; the 
essential point being that of no single cause it is stated that it has 
produced a given number of cases, but that it has been concerned in 
their production. 

The chief advantage claimed for the system, as now submitted, has 
been already pretty clearly indicated in the course of my remarks. 
Instead of pausing in perplexity over cases to the causation of which 


1878.] Occasional Notes of the Quarter. 575 


several influeuces appear to have contributed, and endeavouring to 
weigh their relative importance, so as to be as little incorrect as 
possible in stating the cause, there is nothing to do but to record 
carefully and conscientiously all the influences which appear to have 
played a part. Take a case (no uncommon occurrence) in which there 
is shown to have been hereditary tendency to insanity, mental anxiety, 
and alcoholic excess as facts in the history. Who shall decide on 
which to throw the responsibility and which to exclude? Is it not 
more probable that all have played a part, and that to attempt to 
dissociate them is impossible, and must fail? The system proposed 
provides for any such contingency, and gives to all the adverse 
influences a place. 

But it may be urged that the value of positive data as to the num- 
ber of cases of insanity traceable to a given cause, and that cause 
only, is too great to be given up. It would certainly be so if it could 
be shown that in a majority of cases it were possible to ascertain the 
fact; but if, as [ have contended, this is impossible, then, as it 
appears to me, it is better to remain satisfied with data, which if not 
so definite and precise as could be wished, nevertheless express im- 
portant facts and furnish reliable information. 

It may be objected, in the second place, that by the proposed method 
all causes would appear to be of equal potency: that is to say, no 
special indication is given of those which singly have or appear to 
have occasioned the insanity. I must admit the force of the objection, 
which, however, applies equally well in reality, if not on paper, to 
the system commonly in use, Practically, the most important cause 
will be that the occurrence of which is most frequently noted, and 
this is at once indicated in the method of tabulation proposed, 

Finally, it may be urged that it is safer in stating causes to give 
too little than too much, that it is better to omit the record of some 
condition which may have been causative, rather than to introduce 
such as those which may have had no influence. Possibly this is so. 
Practically, however, with care, serious error in over-statement will, 
I think, be usually avoided.—Journal of Psychological Medicine, 
vol. wit. 


Fraternal Congratulations. 


The Association of Medical Superintendents of American 
Asylums concluded the scientific proceedings of their Annual 
Meeting with the following resolution, which was adopted :— 


Resolved—That we congratulate our much-esteemed colleague, Dr. 
Andrew MacFarland, an early, useful and beloved member~ of this 
Association, upon his new social relations assumed with Miss Abbie 


576 Occasional Notes of the Quarter. [Jan., 


King, in our presence. We sincerely hope his days may be long, his 
life happy, and that he may walk, and not faint, may run and not grow 
weary. 


We reciprocate the wishes of his American brethren, that 
Dr. MacFarland may not faint when he walks, and may not 
grow weary when he runs, if he is imprudent enough to run ; 
but we are perplexed to guess what social relations Miss Abbie 
King and he have instituted. 





Chloroform Delusions. 


A surgeon’s assistant, named George Howard, was tried at 
the Midland Circuit on Noy. 9th, for rape on a Mrs. Child, 
to whom he had administered chloroform for the purpose of 
taking out a tooth. Mrs. Child seems only to have been put 
partially under the influence of the anesthetic, and was stupid 
and speechless afterwards for atime. She affirmed that it was 
while in this state, being quite conscious, but having no power 
of motion, that the crime was committed. This was proved to 
have been merely a delusion on her part, no doubt due to per- 
verted sensations and sexual excitation during partial aneesthesia, 
the delusion persisting afterwards. Dr. Richardson said that 
he had known persons in the second stage of chloroform inha- 
lations subject to delusions as to what had taken place under 
the influence of chloroform. He mentioned one case, in which 
a lady had had an exactly similar delusion to that of Mrs. Child, 
although her father and several other persons were present 
when Dr. Richardson had administered the chloroform, and 
persisted in her belief long after the influence of the anesthetic 
had passed off. Mr. Mills said that patients of the fair sex 
frequently had delusions of an erotic nature under such circum- 
stances. 


1878.] B77 


PART IIl.—-REVIEWS. 





The Lunacy Blue Books. 


1,.—Thirty-first Report of the Commissioners in Lunacy, for 
1876. 


2.—Nineteenth Annual Report of the General Board of Com- 
missioners in Lunacy for Scotland, for 1876. 


3.—Twenty-sixth Report on the District Criminal and 
Private Lunatic Asylums in Ireland, for 1876. 


The interest of the Annual Blue Books on Lunacy has been 
somewhat lessened this year by the enquiry into Lunacy 
Law by a Committee of the House of Commons, an abstract of 
which is published elsewhere (‘ Original Articles,” p. 457.) 
But those most useful and elaborate reviews of the condition of 
the insane for the year 1876 are in no respect less worthy of 
attention than usual to the real student of the subject. 

The total number of lunatics and idiots in England on the 
12th Jan., 1877, was 66,636, an increase of 1,720 for the year. 
The number in Scotland was 8,862 being an increase of 353. 
This increase in England is at about the usual rate (1,755, for 
ten years), it is decidedly above that rate in Scotland. 

There were 7,348 private patients in England, not including 
the criminals, and 59,039 paupers, while in Scotland the numbers 
were 1,566, and 7,239. ‘This is a most singular and remarkable 
disproportion between the two classes of patients m the two 
countries, the cause of which it is difficult to account for. 
England only pays for 12:4 per cent. of its lunatics from private 
sources, while Scotland, the poorer country, supports 21°6 per 
cent. of them without public aid. Is this owing to the differ- 
ence in the poor laws of the two countries ? or to the character 
of the people? or to a difference in public feeling about pauper 
asylums ? or to the fact that there exists in Scotland abundant 
and good accommodation for middle-class and even poor patients 
in the numerous great chartered asylums? In England the 
increase of private patients for the year, too, was only 119, 
while it was 64 in Scotland. At the Scotch rate, the English 
would have been 700. 


It appears that in England, out of the 47,037 pauper 
patients in asylums, public and private, 2,589 paid the whole 


578 Reviews. [Jan., 


cost of their maintenance, and 3,801 paid part of that cost. 
There is no means of finding out those numbers in the Scotch 
Report. We hope it will appear in that for next year. Those 
facts illustrating the social relations of lunacy are very im- 
portant. 

It thus appears that in the case ‘of 5°5 per cent. of the pauper 
lunatics under treatment, the guardians are recouped entirely or 
nearly for the cost of maintenance. In discussions arising upon 
demands for further asylum accommodation, complaints have some- 
times been made of the injustice (to ratepayers) of the reception or 
retention of such patients in Pauper Asylums. Yet it is difficult to 
see what other provision could, in existing circumstances, be made for 
these persons, for the vast majority of whom even the lowest scale of 
payment in a Registered Hospital or Licensed House would be out of 
the question. 


The English Commissioners have beeen gradually carrying 
out a suggestion which we made in reviewing their report in 1869 
(see Vol. xvi., p. 434), to adopt “‘a scientific system of statistics” 
by which we ventured to say “that infinite strides might be 
made in our knowledge of insanity, the laws which govern its 
accession, the classes of society in which it is most common, 
the ages and occupations in which it most frequently occurs, 
the forms it assumes, the chances of its cure, the influences on 
it of treatment, and the forms of mortality it produces ;” these 
statistics being drawn up by “every asylum superimtendent, 
and arranged and collated by such a central authority as the 
Lunacy Commission.” We said that such a scheme “ would 
be in the direction of individualising those 62,023 persons, of 
whom the Lunacy Commission in Great Britain have cogni- 
zance,” and that “‘the present state of medical science de- 
mands that something of this kind should be done.” ‘The 
Commissioners have made a most admirable attempt this 
year to go into the causes of insanity by a statistical enquiry. 
This has cost much labour, part of which has been most 
cheerfully given by the superintendents of asylums, and the 

-tables from XIII. to XX. will for ever stand a most important 
and valuable addition to our knowledge on the subject. No 
man in future writing a text book on insanity can afford to 
pass over those tables. We only regret that the space at our 
disposal in this number does not allow us to go fully into them, 
but we propose to devote a special article to their results. A 
medical contemporary has indeed ventured to say they are of no 
use, but the profound ignorance of such a statement is only 
equalled by its thoughtless presumption. We have no hesita- 


1878.] Reviews. 579 


tion in saying that such statistical inquiries, or such as 
that published in our January number of last year by Dr. 
Mitchell, are of infinite importance to the science of medicine 
and to the State. Though they are not complete, they are facts, 
and not mere speculations. ‘Those tables are the great and 
interesting feature of the English Report this year. The follow- 
ing is the general account of the new tables :— 


On reference to the Tables (XIII.-X X.) it will at once be seen that 
the total of “causes assigned” exceeds the total of “ patients ad- 
mitted.” The excess is owing to there being in many instances two 
combined ‘causes ” assigned. In no instance, however, has the 
same cause being counted both as predisposing and exciting in the 
same individual. It would, of course, not be safe to draw positive 
deductions from the returns of a single year, but the broad results set 
forth in the summaries are, we think, interesting and valuable, as 
showing in upwards of 10,000 cases admitted from all classes of the 
community the ascertained influences that have most frequently pre- 
vailed in producing insanity, as well as the occupation or social posi- 
tion of the individuals attacked. For special reasons, into which it 
is needless to enter, a small number (60) of the actual admissions of 
the year have been necessarily excluded from tabulation. 

Table XIII, the first of the new series, shows the occupations and 
professions, arranged in “classes”? and “orders” according to the 
census tables, of the patients admitted durmg 1876, together with 
the relative proportion of these patients to the aggregate of persons of 
the same occupations and professions at the date of the census of 1871. 

Table XIV. consists of a summary of the “ causes of insanity,”’ as 
far as they could be ascertained, in reference to the patients, private 
and pauper, admitted in the year 1876, into all the institutions. 
Columns are appended showing the proportion borne to the whole 
number admitted, by the number of instances where a particular 
‘‘cause’’ was assigned. arene 

In 8,008 instances, or 21 per cent. of the whole 14,152 admissions, 
the “causes” were “unknown.’’ Considering the inherent difficulty 
of the subject, this proportion of unascertained “ causes” cannot be 
deemed unexpectedly large, 

In Table XV. the percentages of the various “causes ” have been 
separately calculated, so as to distinguish between the experience of 
county and borough asylums on the one hand, where pauper patients 
are almost exclusively admitted, and of hospitals and licensed houses 
on the other hand, where chiefly private patients are received. 

Table XVI. shows the “causes” of insanity, arranged according to 
the occupations and professions of the patients; and the percentages 
of these patients will be found in Table X VII. 

Table X VIII. sets forth with regard to the various occupations and 
professions of those admitted, the extent and proportion in which 


580 Reviews. [Jan., 


epilepsy and general paralysis have been found to co-exist with in- 
sanity. 

This is a good account of the results attained to in the 
County and Borough Asylums for the year :-— 


It will be seen on an examination of the foregoing Tables, V., VI. 
and WITI., that the recoveries have been fully 2 per cent. higher than 
those of the previous year, and that the mortality has been 
favourable, having been nearly 1 per cent. lower than that of the year 
1875, and slightly below the average of the last 18 years. 


The following are the facts in regard to weekly cost for the 
year in those institutions :— 

The weekly cost per head of maintenance, medicine, clothing and 
care of patients in county asylums, averaged 9s. 103d., and in borough 
asylums, lls. 103d., and in both taken together, 10s. 18d. These 
results show an increase, in the aggregate, upon those of the preced- 
ing year, of little more than 1d. per head; but it is to be noted that 
in the borough asylums the advance is as much as 4d. per head. ‘The 
increase appears chiefly in the item of ‘ provisions.” 


The details of the averages of weekly cost are as follows :— 





County | Borough 
Asylums.|/Asylums. 





ee 
Provisions (including malt liquor in ordinary diet) A ‘ § 5 2 
Clothing © OF-). TOF 
Salaries and Wages ... 2. 12%~2 6s 
Necessaries, e.g. fuel, light, washing, &c. 1 Of |; 1 5 
Surgery and Dispensary ... 0 03; 0 1 
Wines, spirits, porter O al} 1. 01s 
Charge to Furniture and Bedding O 5%} O 8 
Maintenance Garden and Farm 0 7%| 0 6 
Account. Miscellaneous 0 4 0 7% 
Less moneys received for Articles, Goods, and Produce 
Sold (exclusive of those consumed in the Asylum) ...) 0 33] O 33 





Total Average Weekly cost per head eam ee 9 10% | 11 108 





1878. | Reviews. 581 


We commend very earnestly to the attention of the Com- 
missioners the suggestions we made in the review from which 
we have quoted (Vol. xvi., p. 427), as to the duty which hes 
on them to explain the causes of the present enormous yearly 
increase in the number of the registered insane. We think 
that this is a duty they owe to the State, which is their pay- 
master, and to the medical and legal professions to which they 
belong. 

The entries in regard to individual asylums are, no doubt, 
interesting to those immediately concerned, but we should 
greatly like to see some more systematic mode of taking up 
the things reported on, and some general principle adopted, by 
which we could fairly compare one institution with another. 
Kven at the risk of being thought egotistical, we must again 
draw the attention of the Visiting Commissioners to a scheme 
of reporting which we suggested in noticing their report for 
1871 (Vol. xviii., p. 552), and the adoption of which, for one 
year, would certainly be an agreeable variety to themselves, 
and of much interest and use to the superintendents of 
asylums. 

In regard to the Scotch Report, we can only make a few 
extracts. 


To what extent Incurable and Harmless Patients can be provided for 
in Workhouses.—It further appears from these tables that rather more 
than seven-tenths of all the pauper lunatics are accommodated in 
asylums, and rather less than three-tenths in lunatic wards of poor- 
houses and private dwellings. The proportion in lunatic wards of 
poorhouses is about an eleventh of the whole number, but in several 
counties the proportion becomes higher, rising, for instance, in Dum- 
bartonshire to nearly four-tenths of all the pauper lunatics chargeable 
to the county, and in Linlithgowshire to nearly three-tenths. These 
facts may be held as affording some indication of the extent to 
which lunatic wards of poorhouses are capable of relieving the de- 
mand for asylum accommodation, by providing for the incurable and 
harmless. 

Causes of the Increase of Insanity.—In our last Report we pointed 
out that “it does not follow from these facts that there is any greater 
production of insanity in the country. It is possible that they only 
express what might be looked for as the result (1) of the increased 
facilities of obtaining gratuitous treatment and maintenance in asy- 
lums; (2) of the diminished dislike to resort to the treatment of 
insane persons in asylums; (8) of the increased readiness to adopt 
the more costly forms of treatment, in consequence (a) of the greater 
wealth of the country, which affects the admissions both of private 


582 Reviews. _ pany 


and pauper patients, and (6) of the relief to local taxation from Im- 
perial sources, which affects only the admission of paupers; and (4) 
of the altered medical and public opinion as to what constitutes lunacy 
which can be certified as rendering the subject of it a fit and proper 
person to be placed under care and treatment in an asylum.” 

Effect of the Government Grant.—It is possible that the large 
increase of the number of pauper patients admitted in 1875 and 1876 
may be, in some measure, due to the grant from Government towards 
the maintenance of pauper lunatics. It is almost certain, indeed, that 
the relieving of local taxation, in such a matter as the cost of lunacy, 
will have a tendency to lead parochial authorities to include among 
lunatics persons who would not be so included if the whole burden of 
their maintenance fell directly and exclusively on the.ratepayers of the 
parish, It would not be safe, however, as yet, to attribute the un- 
usual increase of the number of pauper lunatics, which has taken 
place during the last two years, to the operation of the grant, though, 
during that period, we have had occasion, in aconsiderable number of 
cases, to inquire into the necessity for placing persons on the roll of 
lunatics, whose unsoundness of mind appeared to be slight, and who 
had previously been treated as ordinary paupers. If further experi- 
ence should show that this relief of local taxation is leading to an 
unnecessary and undesirable increase of the number of pauper luna- 
tics, Government may eventually require either to adopt some measure 
for determining those who ought, in their own interests, or in the 
interests of the community, to be treated as insane, or to devise some 
scheme by which the local burdens could be relieved without encou- 
raging an increase of the number of pauper lunatics. 

Voluntary Patients—The number of voluntary patients admitted 
into asylums in 1876 was 45. The corresponding numbers in 1874 
and 1875 were respectively 48 and 50. Their whole number at present 
in the asylums of Scotland is 37. 

Voluntary patients are not registered as lunatics—their names and 
other particulars regarding them being entered in a special register. 


The total number of voluntary patients admitted ito asy- 
lums in Scotland since 1862 has been 418, and we notice 
that the number is rising year by year. 


Character of the Disease in Voluntary Patients.—The great majority 
of voluntary patients are persons who place themselves under treatment 
in consequence of a habit of indulging to excess in the use of alcoholic 
stimulants ; but there are not a few who do so in consequence of labour- 
ing under mental depression. Occasionally it happens that a person whose 
application for admission into an asylum as a voluntary patient has 
been sanctioned, is subsequently found, in consequence of mental in- ~ 
firmity or disorder, to be scarcely capable of understanding the nature 
of his action in the matter. Such a person is either discharged, or, 


1878.] Reviews. 583 


after being duly certified to be a lunatic, and to be a fit and proper 
subject for care and treatment in an asylum, remains there under an 
order of the Sheriff. Sometimes this step is taken at our instance, 
but it is generally taken at the instance of the medical superintendent 
of the asylum, without interference on the part of the Board. It 
appears that at least 85 of the whole number of voluntary patients 
since 1862 were thus certified, and retained as ordinary lunatics, under 
the order of the Sheriff. 

All voluntary patients are produced to us at our visits to asylums, 
and care is then taken that they rightly understand their position. 
Beyond this, however, our inquiries regarding them do not necessarily 
go, though it frequently happens that the history and condition of 
voluntary patients become fully known to us. 


“ PROGRESSIVE History” oF 1,319 PATIENTS ADMITTED IN 1868, 


TABLE X. 























Progressive History of Patients first Admitted into 
Asylums in 1868. 
RM . 
23 co} S g 4 
© | Re-admitted during the Year. : S 
Years. : q e€-adcmitte uring e Be FE f : ao & 3 
(aD) eo oO > 2) ey 
as eS gelas| = AAS 
S| 8 & Total number of/S 2132) q S 
pies tees ee sent eo mS A 4 
oO E a Re-admissions. 6S 5 2 ya 
| et || oat = 
1S08> b L310 1688 1 cn. || ea 38 3805 | 97 | 107 848 
1869 irre ant is lk 83 209 | 70 | 94 558 
1870 ax AO 40 51 | 23 | 60 464 
1871 se 386 | 3 42 88 | 25 | 48 395 
1872 ees 35 2 39 26 | 13 28 367 
1873 ise BA MAN (cece 26 23 | 15 25 330 
1874 xe PS a4 23 15 | 11 13 314 
1875 pene ON OES) ead 21 IG ') -94- 1s 297 
1876 ae We ta 19 13 4 9 290 





SR a IT OR PO SPS LES LE ETE EE AEF SEES 





This Table shows (1) that a large proportion of recoveries takes 
place among patients within the first two years after their admission ; 
(2) that a great and sudden diminution in the number of recoveries 
takes place in the third year; and (2) that the death-rate among the 
inmates of asylums diminishes with the length of residence. 


584 Reviews. [Jan., 


Disuse of Walled Airing Courts.—The Reports frequently allude 
to the disuse of walled airing courts. Ina considerable number of 
Scotch asylums the disuse of these courts is complete. In several 
of them the walls have been pulled down, while in others, which have 
been recently built, no walls have ever been erected. This disuse of 
walled airing courts may be described as the position of the Hadding- 
ton, Argyll, Inverness, Perth, and Midlothian District Asylums, of 
the Edinburgh Royal Asylum, and of the Woodille, Ricartsbar, and 
Abbey Parochial Asylums. These institutions are without walled 
airing courts. It is understood that in the opinion of superin- 
tendents no increased difficulty of management has resulted from 
this change, which is generally regarded as having added to the con- 
tentment and wellbeing of the patients. Perhaps, however, the 
anxieties of management are somewhat increased by it. In some 
asylums, such as those of Fife and Montrose, the airing courts, 
though the walls still stand, are incomplete disuse and are constantly 
open. Itis probable that nowhere in Scotland would walled airing 
courts now forma part of the plan of a new asylum, so decidedly 
is experience held to have shown that their disuse is an advantage. 
So far aS we are aware, the feature of asylum construction and 
management to which we here refer prevails in no other country. 

Unlocked Doors.—The Reports of the Commissioners show that in 
a large number of our asylums the doors are being furnished with 
locks having ordinary handles. The constant and offensive use of a 
key in opening the doors is thus avoided, and pro tanto the sense of 
imprisonment is done away with. In several asylums, notably the 
District Asylums of Fife and Kinross, and of Midlothian and 
Peebles, the doors—like those of an ordinary dwelling—are always 
unlocked, so that a large proportion of the patients may enter and 
leave the asylum at will, or may pass freely from one part of the 
asylum to another. 

Training of Idiots in Private Houses.—Dr. Sibbald concludes his 
report with some interesting and important observations on the 
efficient training of idiots in private dwellings, under the care either 
of relatives or strangers, a subject which on former occasions has 
been adverted to in the reports of the Deputy Commissioners. He 
ends this part of his report with the following remarks:—It should 
always be borne in mind that the amount of mental culture or develop- 
ment that can be attained by any treatment in the lower class of im- 
beciles is exceedingly small. No amount of education will ever make 
them self-supporting ; no work they can be taught to do will ever be 
equal in commercial value to the supervision they will require in the 
doing of it. Indeed, we obtain almost all that we can hope for, if they 
acquire cleanly and orderly habits so as to be innoxious to themselves 
and others, if they become attached to those with whom they are 
associated, and if they acquire an interest in the ordinary events of 
their daily life. The difference between the condition of those in 


1878. ] Reviews. 585 


whose cases these objects have been fairly attained, and those in 
whose cases no efforts for their attainment have been made, is in 
many cases all the difference between happiness and extreme misery, 
But I incline to believe that efforts in the direction of higher culture 
are generally fruitless, and sometimes even hurtful. I therefore 
strongly recommend that such patients should, where suitable guardians 
can be got, be placed under private care, as affording the best oppor- 
tunity for the development of such faculties as they possess, and the 
attainment of such happiness as they can feel. In all cases it is most 
important that an effort should be made as early in life as possible to 
train them like infants to cleanly habits. If this is successfully 
accomplished, the chief difficulty and discomfort which threatened 
their future years will have been overcome. I submit these observa- 
tions because it is not sufficiently recognised by some of those in- 
terested in the improvement of idiots, how much may in favourable 
circumstances be done for them without removing them from their 
natural surroundings.” 

The 26th Report of the Inspectors of Irish Asylums, which 
appeared in May last, is shorter than usual, many of the statistical 
tables having been left out, and the subject matter curtailed. It 
contains at the same time a large amount of information with 
reference to the care and treatment of the insane in Ireland, and the 
condition of district asylums. 

Fromit we find that on the 31st of December, 1876, there were— 


In Public Asylums . ; ‘ . 8,073 
In Central Asylum for Criminals . oA 
In Lucan Government Asylum . : ‘ 24 
In Private Asylums : : 5 . 644 
In Poorhouses ] : ; : ‘ . , 9,216 

12,128 


Showing, when compared with last year, an increase of 346 in public 
institutions, of 87 in poorhouses, and a decrease of 9 in private 
licensed houses, and of the reputed insane at large a diminution of 
241. ‘So that virtually, making allowances for the fluctuations 
of the population of the country generally, little or no alteration 
has obtained in regard to its lunatic element — 18,625 persons 
being reported to us as mentally affected in 1875, and 18,730 in 
1876. The statistics with which we deal, collected at different 
times, and in some instances by different parties, warrant, from their 
similarity, a very presumable fidelity in their accuracy; so that 
we may set down 8°50 per thousand in proportion to the 5,314,000 
inhabitants of Ireland as more or less mentally impaired.” 

From the above and from the concluding paragraph of their report, 
it would appear that the Inspectors are fully convinced that “ lunacy 
at present is certainly not on the increase in Ireland.” 

The number of idiots is said to have decreased, due to the exten- 

XI, 39 


586 Reviews. | [Jan., 


sion of union and asylum accommodation in the existing generation, 
preventing thereby the propagation “of so sad an infliction through 
wandering imbeciles and lunatics.” If no other good result could be 
shown from the expenditure involved in supporting establishments for 
the care and treatment of those suffering under the different forms of 
disease to which the human brain is heir, the decrease of idiocy is of 
itself an object the attainment of which should repay any outlay, and 
be a subject of congratulation to all in apy way interested in the 
human race. : | 

The Inspectors refer to the different modes in which patients were 
admitted to district asylums during the year—232 by order of Boards 
of Governors or Inspectors, 798 as urgent by the Physicians, while 
1,239 were committed by Magistrates as dangerous lunatics. Surely 
it can be neither necessary nor beneficial to have so many different ways 
of admission to Irish lunatic asylums; it cannot be deemed bene- 
_ ficial, on the one hand, to delay the admission of a patient, if a 
fitting case for asylum treatment, until the meeting of the Board; or, 
on the other hand, to convert a human being suffering from disease of 
his brain, who, it may be, never committed a criminal act before he was 
seized with this disease, into a criminal. 

Ere this, we had hoped that the 10th section of Lord Mayo’s Act, 
30th and 31st Vict., cap. 118, with reference to dangerous lunatics, 
would have been amended. Nothing can be more subversive of all 
modern ideas of the treatment of the insane than thus to transform 
them into criminals, to make their disease a crime for which they are 
liable to be seized by the police, handcuffed, brought before two 
magistrates in open court, and carried to an asylum under an armed 
escort. In no other country is such a thing known, and we can see 
no reason for the continuance of an Act which is so universally dis- 
approved of. In England the form of admission is found applicable 
to all cases, and it certainly contains much fuller information of the 
history of the patient than either of the forms used in Ireland. 

The discharges amount to— 


Recovered. : - oD 
Improved . : sD 
Unimproved : . 45 
Deaths : P ~ tao 
From these results we can congratulate the Irish Inspectors on the 
very high percentage of recoveries, which speaks well for the efficiency 
of Irish lunatic asylums. The death-rate, taking the average ratio 
to the total in asylums during the past year, was 7°60 per cent.— 
certainly not an “unfavourable proportion,’ remembering, as the 
Inspectors point out, “that the insane are subject to the combined 
and depressing influences of physical and mental disease, and the re- 
action of one on the other—a condition which can be diminished only 
by proper asylum treatment, and the benefits derivable from constant 
care, good dietary, exercise in the open air, and suitable occupation.” 


1878. ] Reviews. 587 


With reference to the general management of Irish District 
Asylums, the Inspectors report in favourable terms. Enlargements 
and interior improvements of a structural character to a large extent 
are being carried out ; increased means of comfort and better furni- 
ture have been obtained, so as to provide accommodation for about 
500 patients, and to render these institutions ‘more creditable to the 
country, and in character with the best regulated elsewhere.” May 
we hope that the Inspectors will continue to urge the Governors of 
Trish Asylums still to advance in well-doing, and not rest satisfied 
with the progress which has been made. 

In two counties, Derry and Armagh, the recommendations of the 
Inspectors to provide suitable accommodation for the insane poor have 
been as yet unattended to. The Inspectors point out, however, that 
‘As under the Ist and 2nd George IV., cap. 33, as well as sub- 
Sequent amendments, the decision rests with the Executive, alike in 
both cases, they anticipate the pressing wants of the lunatic popula- 
tion of both districts will be speedily supplied.” As under the Ist 
and 2nd George IV., cap. 83, the Lord-Lieutenant has power to build 
as many asylums as he sees fit, and as under the 8th and 9th Vic., 
cap. 107, he has also power to enlarge them whenever it is deemed 
necessary, the onus of not making the required provision for these 
two counties must, therefore, fall upon the Government ; in fact, we 
can only wonder that so long a time has been allowed to elapse with- 
out some action being taken to put an end to a state of things which 
is neither creditable to the counties to which the asylums belong, nor 
to those responsible, in any way, for their management. 

‘There are other asylums in which improvements and alterations 
have been suggested by the Inspectors, and, although not adopted by 
their Boards to the extent we could desire, it is unnecessary to refer 
to them in the present report, the unwillingness we have to deal with 
not arising from any opposition to our views, but from a dislike to 
incur expenses, however small, without an unavoidable obligation to 
do so; and it may be said that the Governors of these institutions, 
while desirous to act in a spirit of fair consideration to justifiable 
applications, are by no means inclined to be over liberal in pecuniary 
outlays, and the less so, we are disposed to think, since the concession 
of the rate in aid.” 

We must, therefore, suppose that the improvements of Irish 
asylums, which placed them “in character with the best regulated 
elsewhere,” must have been of a very partial nature, and leave a large 
field for future operation. The primary intention of the Legislature in 
giving the rate in aid was presumably not to put money into the pockets 
of the ratepayers, but to supply the means of proper treatment and cure 
to the insane poor, so offering the chance of cure where hope remains, 
and alleviating the sufferings of those whose disease has rendered 
their case hopeless. As the Government have so generously con- 
tributed to so noble a cause, we can only hope that they will not 


588 Reviews. [Jan., 


allow the money to be converted from its proper use to the mere parsi- 
moniousness lessening of the local rates. 

With reference to superannuation, the Inspectors go on to say :— 

“The table of officers, which will not appear again for five years, 
has been thoroughly revised up to the period of presentation—such 
revision being advisable as the dates of original appointments will 
constitute a basis hereafter for the superannuation of Resident Medical 
Superintendents.” 

By this we would understand that the Government has determined 
to deal in a generous spirit with the Medical Superintendents of 
Irish asylums by allowing them to count their years of service toward 
superannuation from the first day of their appointment, no matter 
how often changed from one asylum to another ; thus a very old and 
palpable grievance of Irish Asylum Medical Officers has been done 
away with, and for this they have to thank the Inspectors. May 
we hope that the Chief Secretary will extend this rule to the 
computation of the period of service required for good service 
pay. By a late Order in Council it is lawful for the Lord- Lieutenant 
to increase the salary of any Resident Medical Superintendent who 
may have served eight years in any asylum. If it is necessary that 
the whole of this time should be spent in the same asylum, a man 
will scarcely care to be promoted, lest he lose the fruits of his labours. 

We are glad to find from the same table an increase in the number 
of Assistant Medical Officers, from four in 1874 (vide 24th Report) 
to eight. This is certainly a step in the right direction, and shows 
that the Inspectors are alive to the necessity of keeping pace with 
the advance of public opinion of all other civilised countries—of 
making the asylums under their care, not merely houses of detention, 
but institutions for the treatment of insanity and for the advance of 
psychological study. In all other countries, except Ireland, the office 
of Visiting Physician, a merely honorary one, has given place to that 
of one or more Assistant Medical Officers, who are able to give their 
whole time and attention to the work of the asylum, and to the study 
of psychology—but in Ireland we find the Richmond Asylum, con- 
taining 1,066 patients, with only one Assistant, and three Visiting 
Physicians—Omagh and Limerick, containing 499 and 428 respec- 
tively, with no Assistant Medical Officer. It must, therefore, be 
concluded that these two latter asylums, containing so large a number 
of patients, must at times be left without the care of a medical man— 
in fact, without any proper head—that when the Medical Superin- 
tendent is at home he must be very much overworked, if he does his 
duty properly, and have little or no time for scientific study. 

The Inspectors next refer to the expenditure, as given in Table 19, 
page 60, in which a change has been made. Instead of giving the 
return for the year 1876, ‘the table in question represents the - 
reliable and unalterable fiscal condition of affairs during 
the year 1875, as audited.” So that although we are obliged 


1878. | Reviews. 589 


to look back a year for the cost of Irish asylums, no doubt can be en- 
tertained of their accuracy, nor can any future additions or deductions 
be madein them. As the inspectors point out, “When it is borne 
in mind that this expenditure is based on periodical estimates during 
the year, framed by the governors at their monthly meetings with ex- 
actitude, subsequently transmitted to our office for examination, and 
afterwards liable to be further checked in the office of the Privy 
Council, we think no reasonable apprehension need be entertained in 
any quarter as to the adequacy of the organisation in connexion with 
this department of asylum management.” When referring to 
the expenditure, the Inspectors draw attention to the salaries of clerks 
which they do not consider sufficient, and propose an increase. “ We 
hope during the year to be in a position to devise a scale upon the 
basis of existing rates which, taking contingent circumstances into 
account, shall at least approach uniformity.” To us the wages of the 
attendants and nurses, who are in immediate attendance on the insane, 
and on whom their treatment greatly depends, call much more urgently 
for supervision—clerks are well able to fight their own battle, and 
Boards of Governors are always sure to see that they are well paid; 
but by referring to Table No. 21, it would appear that their estimate 
of the remuneration necessary to attract a respectable class of persons 
to take charge of the insane seems to be a very low one, the remune- 
ration being less in many asylums than what an ordinary day labourer 
or dairymaid would receive. If Boards of Governors have so little idea 
of the importance of offering sufficient wages to obtain a superior class 
of attendants and nurses, it behoves the Government to step in and 
protect the interests of the insane, who are unable to protect them- 
selves. 

No better argument could be brought forward of the necessity of 
placing asylums in Ireland under State contro] than the  con- 
sideration of this very table, No. 21. When we find Boards of Gover- 
nors offering £10 per annum for male attendants and £7 for nurses, 
we can only conclude that the chief idea of such Boards of Governors 
is to keep down the cost of the asylum, and that they must be utterly 
ignorant of the responsibility devolving on them of providing proper 
protection and care for the insane. And it is impossible to hope that 
a radical and thorough reform will be made in the general condition 
of Irish lunatic asylums, so as to raise them to the modern standard 
of institutions for the care and treatment of the insane, until they are 
handed over to the Executive and freed from the narrow views, the 
ignorance and parsimony of local Boards. 

The Act of last Session placing gaols under State controlis a plea 
for a further step on the part of the Government to take the manage- 
ment of Irish lunatic asylums into their own hands. The treatment 
of insanity is undoubtedly as worthy an object of solicitude to those 
whose motto was Sanitas Sanitatum, omnia Sanitas, as’ the suppres- 
sion of crime, particularly as the Treasury now contribute so largely 


590 Reviews. [Jan., 


to the support of these institutions. Amongst the many benefits to 
be derived from the change would be the organisation of a regular 
staff of trained attendants and nurses, who would be promoted from one 
asylum to another according to merit, and knowing that their future 
advancement depended on their own exertions, would be stimulated to 
acquire a knowledge of this work. 

The Inspectors next give a short account of the condition of the in- 
sane in Irish workhouses. The total number of those mentally 
afflicted in these institutions is 3,216, showing no material difference 
from the numbers given in past years, so that it would appear that the 
9th sect., of the 38th and 39th Vict., cap. 67, which enacts “ That the 
Guardians of any Poor Law Union in Ireland may receive into the 
workhouse of such union any chronic lunatic, not being dangerous, 
selected by the Resident Medical Superintendent of the District 
Asylum,” the terms to be agreed on between the Guardians and 
Board of Governors, and the expenses to be considered part of the 
expenses of the District Asylum, and to be paid by the Governors— 
has not been found to work practically. Such has heretofore been 
the result of all attempts to transfer insane patients to workhouses 
in Ireland—attempts that have now been so often made, that it 
might be supposed that the repeated failures would have satisfied 
everyone of the inadequacy of the present rules for removing the in- 
sane from the care of an asylum to the wards of workhouses where no 
suitable arrangements exist for their care. 

The Report of the Medical Superintendent of the Central Asylum 
at Dundrum is embodied by the Inspectors in their Report. From it 
we learn that the daily average number was 166, an increase of one 
on last year, costing £37 15s. 2d. per head, the cost of coal, new 
work, repairs, and furniture not included. 

Dr. Ashe complains much of the unsatisfactory arrangement for the 
supply of fresh water to the asylum, which is at present “ supplied 
from the pumps on the premises, which are altogether worked by 
the hand labour of the inmates. I need hardly point out,’ he con- 
tinues, ‘that the labour of raising the water supply of an institution 
like this through a height of 100 feet, by the manual work of insane 
patients, is far from desirable.” | 

Private asylums have occupied much of the attention of the 
Inspectors during the year, as they consider these institutions as 
altogether under their control, ‘‘ who thus become responsible in the 
eyes of society for their proper management, and the liberty of the 
subject.” “On this account they have visited them four times oftener 
than the act requires, by which means they are enabled to satisfy 
themselves that no want of ordinary or professional care shall occur 
in the treatment of private patients.” 

On the 31st December, 1875, there were 653 patients in the 
private asylums of Ireland. On the 1st January of this year, the 
number remaining was 644, 


1878. ] | Reviews. 591 


The Inspectors bear testimony to the good results from the 
treatment carried out in these institutions, and defend them against 
the many adverse criticisms of which we have latterly heard so much. 

“ Analysing the operations of private asylums in the past year, the 
results are certainly not unfavourable, and as tested by recoveries, 
improvements and deaths, superior to what obtained in district 
asylums during the same period; 133 sent out either absolutely 
cured or benefited out of 851 under treatment, is satisfactory, whilst 
the mortality, calculated on the same basis, scarcely over four per 
cent., is three per cent. less than in similar public institutions. 
We are not sorry in a spirit of justice to make the preceding 
contrast, as a prejudice exists, and rather extensively, that private 
licensed houses should not be sustained as it were out of the mis- 
fortunes of others. Now, although in some instances a cupidity, by 
no means laudable on the part of some of the proprietors, may be 
found yet, we cannot but think that in the hands of persons of 
education and integrity, they are calculated to render essential 
benefits to the community at large.” 

The Inspectors call attention to what they consider a peculiar 
characteristic of the insanity of Ireland, as distinguished from that 
affliction in the sister countries, viz. :—that the proportion of lunatics 
in’ Ireland is very much » greater amongst the single, whereas in 
England and Scotland the very reverse is the case. It is possible 
that the ratio of married to single in the two countries might throw 
some light on the subject. 

The report finishes by areference to the question of the increase of 
insanity. 

‘“‘ In conclusion, and respecting a long mooted question, we would 
observe that, judging from the number of inmates of the better 
classes in private asylums, and as regards the number of those in 
public institutions; if their longevity—owing to recent improve- 
ments in the treatment of the insane—be taken into account, we 
should say that lunacy at present is certainly not on the increase in 
this country.” 

The remainder of the Blue Book consists of statistics, giving as 
usual much useful information on the wages of the staffs of the 
different public asylums; but we are sorry that no attempt has been 
made to introduce the tables recommended by the Medico-Psycho- 
logical Association. For many years past three Official Blue 
Books on lunacy in the United Kingdom have been published, 
each containing different statistical returns. It must be evident that 
if we are to have satisfactory information on insanity, we must have 
similar tables for the different parts of the kingdom. 


592 Reviews, [Jan., 


Insanity and its Treatment. By G. Freupinc BuanpForp, 
M.D. Oxon., F.R.C.P., Lecturer on Psychological 
Medicine at the School of St. George’s Hospital, London. 
Oliver and Boyd, Edinburgh, 1877. (Second Hdition.) 


We can give a hearty welcome to this second edition of 
Dr. Blandford’s practical treatise. Since the first edition 
went out of print there has been no book to which the 
general practitioner could so satisfactorily refer for guidance 
in his dealing with mental disease. The views which it con- 
tained were not only founded on a wide experience and ex- 
tensive knowledge, but the conclusions arrived at were 
evidently the result of a judgment peculiarly calm and 
judicial. The new edition, though to a considerable extent 
re-written, remains substantially the same book, and deserves 
the same success as its predecessor. Weare glad to add that 
the author has scarcely increased the size of the work, thus 
evincing a power of resisting temptation which is unfor- 
tunately as rare as it is commendable. 

The great bulk of the volume is devoted to the discussion 
of the practical details of diagnosis and treatment, and to 
giving useful information and advice to the practitioner as to 
his powers and duties in dealing with insanity in its legal 
relations. It is, perhaps, unavoidable in any such work to 
devote some space also to a consideration of the systems of 
classification that have been proposed by other writers on 
insanity, to the geographical distribution, and to other points 
resting on statistical enquiry. But we are glad to see that 
Dr. Blandford has not thought proper to occupy many of his 
pages with such subjects. The first two lectures which dis- 
cuss the physiological conditions necessary to the healthy 
performance of mental action have been to a considerable 
extent re-written for this edition so as to give due place to 
the results of the investigations of Ferrier and others who 
have been working in the same direction. The views ex- 
pressed are sound and clearly explained, without running 
into detail on points of no practical significance. They also 
give the key-note to the pathological and therapeutical views 
chiefly insisted on throughout the rest of the lectures. He 
enquires—“ What are the conditions necessary to mental 
health over which the individual or the community can 
exercise control ?” The absence of these constitute the pre- 
ventible causes of insanity, the restoration of them when lost 
constitute the most rational indications of treatment. The 


1878.] Reviews. 593 


chief of such physiological requirements are thus summed 
up by the author :— 


Given a healthy apparatus, free from defect, we require for its 
working a due amount of material in the shape of food, to be con- 
verted through the agency of the digestive and circulatory system into 
healthy blood, supplying the waste in the brain cells. This blood 
must be in all respects fit for its purpose, rich in oxygen and all 
necessary ingredients, and free from all impurities, as urea, bile, 
carbonic acid, or other poisons. Secondly, we require for the due 
discharge of mental action a certain amount of heat. Thirdly, we 
must at stated intervals have a period of rest and cessation, which in 
man is given by sleep. Failing any of these, mental action becomes 
disordered, and finally ceases. 


It is a somewhat remarkable feature of a book on insanity 
that it should adopt no definite system of classification, yet 
such is the case with the work before us. Those systems 
which have been proposed or adopted by some of the more 
eminent writers are placed before the reader; but none being 
in the author’s opinion satisfactory, none are made systematic 
use of in the book. The guiding idea which seems to have been 
followed is to take up in the most convenient order every 
form of mental disorder which has been described, and every 
aspect from which mental disorder has been viewed without 
reference to what nosological or pathological theory they may 
seem to involve, if only they seem fitted to aid us in obtain- 
ing clearer views of treatment or prognosis; but it is also 
pointed out that many such forms and aspects have no claim 
to be considered permanently established in their positions. 
The scope of Dr. Blandford’s view may be gathered from the 
following passages :— 


‘‘ Physicians engaged in the cure and treatment of insanity,” he 
says, ‘‘ will never be able practically to lay aside the classification of 
mania and melancholia—will be for ever compelled to treat melancholy 
as one thing and mania as another.” But he adds that “ as patho- 
logists they will comprehend under these general names a multitude 
of conditions which must be assumed, but cannot at present be de- 
monstrated, but which year by year will be more and more 
differentiated and specialized, not by fixing our attention upon one 
condition, and one only in each case, but by looking on every case as 
the result of an infinite number. . . . . . If we can examine 
the individual at the outset of the disorder, and thoroughly ascertain 
his history, we may be able to lay down with considerable accuracy 
his pathological condition. He is not yet in a state which warrants 
the name of mania or of melancholia, still less of dementia; but his 


594 Reviews. [Jan., 


state is clearly aberration of mind and disturbance of brain function 
depending on some conditions or causes such as I have been describ- 
ing to you. But as the disorder becomes more marked and _ syste- 
matized, it will be found to assume one or other of certain forms, and 
to be accompanied by certain symptoms which have gained for it the 
name of mania, or melancholia, or acute dementia; and as the treat- 
ment and prognosis must vary according to the symptoms, I shall 
pass in review some specimens of these different patients, that I may 
be enabled to give you some practical advice as to what you are to do 
when called upon to treat them. To classify insanity perfectly we 
ought to be able to connect the symptoms of exaltation or depression 
with the pathological history of the individual; but this at present 
we cannot do.” 


We believe that Dr. Blandford has done wisely in discard- 
ing any attempt ata systematic classification of insanity, not 
only because he can thus make his treatise more practically 
useful, but also because it is indeed impossible to construct a 
scientific classification of the fragmentary elements of that 
incomplete group of conditions which are included in the 
general idea of insanity. To fail to see that such a classifi- 
cation is impossible seems to us to imply an ignoring of the 
relation of disordered mental function to disease in general. 
The attempts of Skae, Morel, Tuke, and others, have been 
useful as affording systematised modes of looking at the sub- 
ject. The symptomatological, or, as it has been called, the | 
psychological classification of HEsquirol, indeed remains still 
the most efficient of all the systems for practical use. But 
it must be remembered that this system is purely sympto- 
matological, and can no more be looked on as a classification 
of mental diseases than a catalogue of such symptoms as 
cough, dyspnoea, expectoration, etc., could be regarded as a 
classification of respiratory diseases. Itis only by keeping 
carefully in view the relation of mental disorders to diseased 
conditions of every kind that any true idea of its pathology 
can be obtained. 

Wherever disease manifests itself in disorder of the mental 
function of the brain, whether by exaltation or depression, by 
excitement or enfeeblement, whether the disorder be of short 
or of long duration, we must have to the eye of the scientific 
pathologists a state of mental disease or insanity. But it is 
of the highest importance to bear in mind that disordered 
function in any organ is not in itself a disease, but only a 
symptom, though it may in many instances be the chief 
symptom, of a disease. And it would be a mistake to regard 


1878. ] Reviews. 595 


every disorder affecting any one organ or system of organs 
as being of necessity included within one special class of 
diseases. In many diseases, all the functions of the body are 
disordered, and in no disease is the morbid disturbance 
limited to one system of organs. But even if this were not uni- 
versally admitted, disturbances of the function of respiration 
or of the action of the circulatory system have as much claim 
as mental disorders to be regarded as special classes of diseases. 
And we might with equal propriety enquire whether excite- 
ment or depression of the circulation ought to be regarded 
as distinct forms of disease as to enquire whether maniacal 
or melancholic conditions ought to be so regarded. If our 
clinical knowledge were sufficient to make it practicable, 
mental disorders would find their proper places in the 
symptomatology of the several diseases in which they occur. 
The transitory mental disorders occurring in acute diseases 
would be described as part of the phenomena constituting 
their clinical history ; the mental disturbance occurring with 
chronic diseases would be similarly associated with their 
respective histories; and the various forms of mental perver- 
sion or enfeeblement left behind by different diseases would 
be described among their other sequele. Such a mode of 
representing mental disorders is indeed impossible in the 
present imperfect state of our knowledge; but we are con- 
vinced that it is the only mode by which they can be 
relegated to their proper position in a truly scientific patho- 
logical system. 

The great obstacle which has stood in the way, and which 
still stands in the way, of a comprehensive scientific view of 
the subject is the fact that social and legal considerations have 
forced upon us an artificial and unscientific limitation of our 
conception of the nature of mental diseases. We are obliged 
to exclude from our social view of the nature of insanity all 
mental disorders which do not render the patients incapable 
of performing their ordinary duties. And from what remains 
after these have been eliminated, we have still to exclude all 
conditions of mental disorder that can be recognised as 
transitory. Thus shorn of a large portion of the acute 
. forms of disorder and of almost all the milder forms, 
it is easy to understand that difficulty has been experienced 
in adapting to the truncated remnant a system of classifica- 
tion which to be satisfactory at all must be suitable to all 
the members of the complete group. 

To prevent misconception of the view of insanity that is 


“a 


596 Reviews. [Jan., 


here insisted on, a few words may be necessary in regard to 
that large number of the insane who do not labour under 
any active disease of which the mental symptoms can be 
symptomatic. These all belong to the class in which the 
mental perversion or weakness is more or less chronic, and 
they divide themselves naturally into two great sub-divisions— 
those in whom the abnormality of mental action represents 
the permanent injury that has remained after the subsidence 
of active morbid processes, and those in whom it represents 
some failure in development affecting the organ of the mind 
or some premature occurrence of decay. The first of these 
sub-divisions corresponds in the purely somatic sphere to such 
conditions as the permanent modifications in the shape of the 
bones which may be left by rheumatism, and which perma- 
nently modify the gait or other movements of the individual. 
And it can be no justification of a refusal to classify them 
in analogous positions in our scientific system, that an 
altered gait is regarded practically as consistent with 
health, and that a twist in our reasoning processes may 
necessitate seclusion in an asylum. It is merely because 
in the one case the lesion does not seriously affect the 
conduct and social relations of the individual, and that in 
the other case it does seriously affect them, that it is 
necessary to treat them so very differently in practice. The 
same considerations also apply to the scientific analogies 
and wide practical differences between the physical and 
mental conditions which result from failure of development 
or premature decay. 

We must not leave the consideration of Dr. Blandford’s 
book without drawing attention to the thorough manner in 
which he lays before the reader the various modes of treat- 
ment which should be adopted, not only in the different 
forms of insanity, but also in the different circumstances in 
which it may be necessary for the practitioner to treat them. 
The book is full of important instruction as to details of 
treatment. The administration of drugs, modes of giving 
nourishment—forcible and otherwise ; the circumstances in 
which asylum treatment ought or ought not to be resorted to, 
and the precautions which must be taken by medical men 

in such circumstances, both in the interest of themselves 
and of their patients, are all given in the most satisfactory 
manner. As an illustration of the author’s practical 
manner, we may give, before closing this notice, his instruc- 
tions as to the mode of obtaining and conducting an interview 


1878. ] Reviews. 597 


with a patient whose condition it is necessary to ascer- 
tain :— 


Concerning the cases of acute disease, in which the mind is 
temporarily disordered, little is to be said. You will not think of 
signing certificates here. And in acute insanity, where medical 
assistance is urgently needed, there will be little difficulty in 
appreciating the state of mind, and signing a certificate. In these 
cases, the real difficulty experienced is more frequently in gaining 
access to the patient, and engaging him in conversation. This done, 
his malady is revealed, and our end is accomplished. In gaining 
admittance to a patient, our difficulties may come from the patient 
himself, or from ill-judging or ill-meaning friends, who, because they 
think that all doctors are leagued together to shut every one up 
in a madhouse, or because they have an interest in keeping the 
patient where he is, frustrate the endeavours which perhaps his 
nearest of kin are making for his safety or cure. Such persons 
resist the inspection of the patient, on the plea that he is not insane, 
but only a little excited, and requires rest and quiet. They will 
insist that he is not dangerous, and to the best of their ability they 
will keep him from doing anything very outrageous. I suppose that 
scarcely one lunatic has ever been placed in an asylum without some 
of his friends or acquaintances denouncing the sinfulness of the 
proceeding. There is, however, little danger, though there may be 
some difficulty, in visiting such a patient. There is more to be 
apprehended from one who himself dreads and avoids you, and who 
from a fear that you are coming to dohimsome harm may resist to 
the uttermost, using murderous weapons. In such a case, it is not 
possible to lay down rules which are universally applicable. You have 
to converse with the patient, to assure yourself of his insanity, to signa 
certificate. Here, ifat all, it may be justifiable and necessary for you 
to resort to stratagem, to invent an excuse for an interview, to feign 
to be other than a doctor. Such measures are to be avoided when it 
is possible, and they often can be avoided by tact or by open and 
straightforward plain speaking. They often lead to great difficulties, 
cause the patient to distrust all about him, and give him occasion to 
make great complaint. But I am not prepared to say they can 
always be dispensed with. If a madman has armed himself with a 
revolver, and vows that he will not be shut up, and if he has by pre- 
vious experience found out that doctors are a necessary item in the 
process, he will be a bold man who will go in a strictly professional 
capacity to sign a certificate. One thing is certain, that stratagems 
are better left alone in many cases where friends urge their adoption, 
especially the devices invented by friends, which frequently are so 
clumsy, that you may by them be absolutely debarred from having the 
requisite conversation with the alleged lunatic. I have, on arriving 
at a house, been shown suddenly into a patient’s room, and introduced 


598 Reviews. | [Jan., 


to him as some person of whvuse name, occupation, or relationship, I 
was utterly ignorant. If you are introduced, not as a doctor, but 
as a lawyer, man of business, or the like, you cannot discuss the 
patient’s health, mental or bodily, and questions which you may wish 
to put, will sound impertinent or absurd, or will make him suspect 
you to be a doctor in disguise, and he may then refuse to hold any 
conversation with you. In most cases go as a doctor, and as nothing 
else. You have then areason, whether he admits it or not, for cross- 
examining him closely as to his bodily and mental health. If 
stratagem is absolutely necessary, consider it well before-hand, its 
probable direction and consequences, and be sure that those in league 
with you play their parts faithfully. I am assuming now that the 
insanity of the patient is not doubted, but that conversation with him 
is difficult. The peculiar features of the insanity will furnish 
suggestions for your plan of proceeding. One man has invented a 
marvellous scheme for enriching himself and all belonging to him, 
You are come to treat with him for the purchase of his patent, or a 
partnership in his business. Another is going to buy houses and 
lands. You have houses and lands to sell. There is little difficulty 
in dealing with such, or in gaining access to them. SBut if a man is 
suspicious, fears a conspiracy, and shuts himself up against policemen, 
bailiffs, or the like, he may resist strenuously all efforts to observe 
him. Such a patient is, however, by the nature of his case fearful ; 
and if, accompanied by sufficient assistants, you boldly confront him, 
he will probably not be able to escape entering into conversation with 
you. If access is denied to you, not by the patient, but by others, 
you must consider how the law stands. A man’s own house in this 
country is his castle, and sane or insane he cannot be removed 
thence except for some good reason, and after lawful proceedings, 
The law allows a man’s relatives or friends to remove him from home 
for treatment or cure, upon a legal order and certificate, but if a 
husband chooses to keep his insane wife in his own house, or a wife 
her insane husband, no one can order his or her removal, unless it 
can be shown that he or she is improperly treated or neglected. 
Cases of this kind often arise, and the lunacy authorities are appealed 
to and requested to give an order for the patient’s removal ; but they 
have not the power, and the only method of effecting it is to lay 
information before a justice or justices, as I have mentioned in my 
last lecture.” 


We observe that a German translation of the book has 
been undertaken by Dr. H. Kornfeld, district medical officer 
(Kreisphysician) in Woklau, and is now being g published by 
Enslin, of Berlin. Much of the legal information given by 
Dr. Blandford, will, we fear, prove useless to a German 
practitioner. If, however, the translator ventures to adapt 
the paragraphs dealing with the relations of insanity to 


1878. ] Reviews. 599 


English law, so as to make them applicable to the German 
law, or if he merely supplements them by a statement of 
how the German law differs from the English, we shall be 
furnished with a valuable comparative statement to which we 
shall look forward with interest. In the meantime we 
congratulate Dr. Blandford on the increase to the numbers 
of his audience which will result from the appearance of the 
lectures in the German tongue. 





Report on the Lunatic Asylums in New Zealand. By Dr. F. W. 
A. Sxau, Inspector of Lunatic Asylwms for that Colony. 1st 
July, 1877. 


This is the first report by the recently-appointed Inspector of 
Asylums for New Zealand, and we may say at once that we think 
it a very good and a very thorough-going report. ‘There is no 
doubt that an Inspector of Asylums was not appointed a day 
too soon in that colony, and his appointment now will be the 
means of doing an enormous amount of good to the insane, and 
of saving a vast amount of money to the colony in the long run. 
Its lunacy policy will be shaped in a definite direction in accord- 
ance with the most recent and the most humane ideas that pre- 
vail in Hurope, and the institutions will be remodelled and re- 
organised on a proper plan according to the most improved 
ideas. There will be no doing and undoing, while a public 
confidence in asylums will arise in the colony that will prevent 
anything like panic lunacy legislation or wasteful expenditure. 

It appears there are in New Zealand 785 lunatics distributed 
in 8 asylums, the largest, that at Dunedin, having 235, and the 
smallest (New Plymouth) 4 inmates. Dr. Skae describes the 
condition of each asylum, and in reading his descriptions of 
some of them we seem to be taken back to the Parliamentary 
Committee’s Report of 1815. In speaking of the Auckland asy- 
lum he says—“ The condition of the patients generally speaking 
is deplorable. The great majority of them are simply prisoners, 
who are not, and in the present circumstances of the asylum 
cannot be, subjected to any system of treatment curative or 
palliative. They have neither occupation or amusement.”’ Re- 
garding the management of the Wellington asylum he says that a 
portion of it is of a “quite disgusting description,” that the 
matron gets £225 a year, and that the “deputy keeper” on being 
asked for a certain return got a week’s leave of absence and took 


600 Reviews, [Jan., 


his passage at once to London! The fortunate attendants in 
that institution got £146 a year, “in addition to their keep,” 
before Dr. Skae inspected it. They should have been good at 
that figure. The Inspector estimates that there is “ satisfactory 
accommodation ”’ for 270 patients in institutions in the colony, 
leaving 513 who at present occupy overcrowded or otherwise 
unsatisfactory accommodation. One thing is very remarkable 
about the asylums, that, while land must have been cheap 
when they were built, all of them are utterly deficient in this 
sine gud non of agood asylum. No doubt Dr. Skae, with his 
Scotch ideas as to large asylum farms, will at once remedy this. 

He strongly advocates the appointment of medical superin- 
tendents for the larger asylums instead of visiting physicians. 
“ A merely visiting physician, unless he be a man of unusual 
force of character, is apt so far as the general management is 
concerned to lapse into the condition of adummy.” Almost 
all that is creditable in the New Zealand asylums is the work 
of their superintendents” (non-medical), but “so sure as know- 
ledge is power, so sure is 1 that competent medical superinten- 
dents will accomplish better results than non-medical ones, no 
matter how zealous, kind-hearted and devoted they may be.” 
Throughout, the report is written in a very interesting style, 
strongly fitted to enlighten and educate the public opinion of 
the colony on the subject of insanity and asylums. He is 
against the idea of a “central asylum” for the colony, and. 
quotes all the authorities in favour of small manageable institu- 
tions. 

Here are facts for our pessimists. ‘It would appear that in- 
sanity is very common in New Zealand,” there being one insane 
person in asylums to every 509 of the population. “The ratio 
of recoveries to admissions in the colonial asylums is 13° per 
cent higher than in the Scotch and Irish asylums, and 28 per cent 
higher than in English county and borough asylums.” Their 
death rate was 6°70 per cent. on the average numbers resident, and 
4°49 on the total number under treatment, being about 44 per 
cent. lower than in England. No doubt a medical sceptic of the 
future will point triumphantly to those results of the non- 
medical pre-inspectorial era, and contrast them with those of 
the well organised lunatic hospital of his own time. Well-off 
people in New Zealand send their friends to the public asylums, 
and have them paid for out of the rates; but this point is to 
be looked into. Of the 48 deaths in all the asylums only 
one was from phthisis, while nine were from general paralysis. 

The space at our disposal does not allow of our going into 


1878. ] Reviews. 601 


the reports on the individual asylums, but all of them are pains- 
taking and instructive, and many of them racy and entertaining. 
Regarding the Wellington asylum, some parts of which he thinks 
were expressly constructed conformably to the “ wild beast 
theory of insanity,” he speaks of a patient being placed “in a cell 
remote from supervision, badly lighted by a small, barred 
window near the roof, having a sloping floor with a drain to 
carry off urine, and furnished with a fixed privy and a straw 
bag, and having a slit in the wall through which food can be 
pushed.” This is merely a fair specimen from dozens of such 
entries. There are plans of many of the colonial asylums at 
the end of the Report. We wish Dr. Skae much success in the 
great and humane work that lies before him, 





Disease of the Mind. Notes on the Harly Management, 
European and American Progress, Modern Methods, &c., 
on the Treatment of Insanity, with especial reference to the 
Needs of Massachusetts and the United States. By Cuarius 
I’. Fotsom, M.D., Secretary to the Massachusetts Board of 
Health, 1877. : 


This is a reprint of a part of the Highth Annual Report of the 
State Board of Health of Massachusetts. The fact that any Board 
of Health should issue such a report, gives us a high opinion of 
its breadth of view and largeness of conception of its functions. 
It is difficult to say which part of the book is best, the his- 
torical or the descriptive portions. Dr. Folsom, who is clearly 
a man of advanced views, gives a short history of the early and 
recent treatment of the insane in this and other countries— 
enters into the question of restraint or non-restraint, treats of 
the responsibility for crime among the insane, of the question 
of supervision by the State, and of medical education in regard 
to mental diseases and the letters and opinions of many men 
of eminence in regard to those matters are quoted. The book is 
illustrated with plans and plates. We greatly regret that we 
cannot devote more space to some of the questions so ably 
treated of by the author. 


OG 06 4O 


602 [Jan., 


PART IIl—PSYCHOLOGICAL RETROSPECT. 


German Retrospect. 
By Wiu1am W. Irexanp, Larbert, Stirlingshire. 
(Continued from Oct. No., 1877. Vol, wait. p. 406.) 


Since writing the portion of the German Retrospect in the last 
number of the Journal, the following periodicals have been received :— 

“ Archiv fir Psychiatrie,” vii. Band, 1 Heft, 2 Heft, 3tes Heft. 
Berlin: 1877. 

“‘ Allgemeine Zeitschrift fiir Psychiatrie,” xxxiiier Band, 4tes Heft. 
1876; und xxxiver Band, 1, 2, 3, 4, 5and 6tes Heft. Berlin: 1877. 

‘“Trrenfreund,” No. 11 and 12, 1876, and 1, 2, and 3 “ Heilbronn,” 
1877. 


Albuminuria after Epileptic and Paralytic Attacks.—The article 
of Dr. 8. Rabow on the urine in the insane has been already 
translated by Dr. McDowall, and appears in the July number 
of the “ Journal of Mental Science.” Dr. Rabow confirms Huppert’s 
observation that albumen is found, though apparently in small quan- 
tities, in the urine of epileptics. 

Dr. Max Huppert gives in the “ Archiv,” vi.-vii. Band, 1 Heft, a 
continuation of his studies on this discovery, which he announced 
several years ago in Virchow’s “ Archiv.” 

He finds that paralytic attacks as well as those in the course of 
general paralysis, whether epileptic or epileptiform, are followed by 
albuminuria, that the quantity of albumen is greater, and its pro- 
duction lasts longer, and that hyaline tube casts and red corpuscles 
are found in greater numbers after paralytic attacks than after epileptic 
fits. He concludes from this, that the albumen in these two cases 
comes from a different source. Dr. Huppert, however, admits that 
albuminuria may be found in other nervous diseases, and, indeed, there 
are few diseases at all in which albumen may not be found at one time 
or another in the urine. In the same number of the “ Archiv,” Dr. 
Rabenau pursues the subject of albuminuria in paralytic insanity. He 
finds it commoner in this affection than in any other cerebral disease, 
and thinks it independent of alteration of the kidneys. 

Dr. C. Furstner (‘ Archiv,” vi. Band, 8 Heft) finds albumen in the 
urine of those labouring under delirium tremens, and that the quantity 
of the albumen was proportional to the intensity of the delirium: albu- 
men is sometimes found in the urine of habitual drinkers. Dr. Furst- 
ner gives, as the result of his numerous examinations, that albumi- 


1878.] Psychological Retrospect. 603 


nuria is far from being a constant symptom of epileptic fits. A tran- 
sitory reaction of albumen is often found, but not always. In three 
eases of the status epilepticus which ended fatally, no trace of albumen 
could be found in the urine. This albuminuria may be of cerebral 
instead of renal origin, as Claude Bernard has found in the brain a 
centre (in the crus cerebri) on the irritation of which albumen appears 
in the urine. 

Dr. Richter (‘* Archiv,” vi. Band, 2 Heft) has arrived at a different 
conclusion. He has carefully examined the urine in a large number of 
insane people, in the Asylum of Gottingen, and states itas the result 
that if albumen appear in the urine of insane paralytics, it is simply 
owing to disease of the kidneys or urinary passages. Perhaps this is 
going too far, for every physician knows that albuminuria may occur 
in the course of a great variety of diseases where there is no 
morbid alteration of the kidneys. From the directions given how to 
detect albumen in the urine of epileptics, it is clear the quantity found 
is often very minute. 

Kopfdruck, or Irritability of the Brain.—Dr. F. Runge, of Nassau, 
has in the ‘‘ Archiv,” v. Band, 3 Heft, a valuable article upon Kopf- 
druck, or, as we might call it, constriction or tightness in the head. 
When resulting from wounds or injuries to the head, this affection has 
been described by surgeons under the term irritability of the brain. 
It is a very distinct disease, and I always thought it very rare. Dr. 
Runge, however, has collected as many as two hundred instances of it. 
The principal symptoms are a feeling of tightness, and in severe cases, 
of weight in the head. A tight neckcloth, or even tight clothes, feel 
disagreeable. It is often combined with swimming in the head, 
or a feeling that consciousness will soon pass away. Headache was 
observed in twenty per cent. of the cases studied. The mental symp- 
toms are very distressing, but do not generally amount to insanity. 
The intellect per se in most cases is unaffected; the understanding, 
memory, imagination and other mental faculties seem unimpaired, but 
the power of hard work is much injured. To use Dr. Runge’s des- 
cription, as soon as the patient has carried on his office-work for a 
short time, the feeling of tightness in the head commences, or the 
pain, where this is a symptom, begins to arise. There is an increasing 
difficulty to keep the attention upon one object. The patient glances 
over a page without retaining a word, and a feeling of distress steadily 
increases til! it compels him to stop his work. In bad cases every 
forced mental exertion brings on an exacerbation of the malady. 
Where the disease is less severe, continued work is difficult, though 
a good deal may be done by passing from one kind of work to another. 
Where insanity appears it takes the form of melancholia. Hypochon- 
dria is said to be common. In some cases there is sleeplessness, but 
sometimes there is a greater tendency to sleep. The muscular power 
is also injured, ‘The patient is easily fatigued, and needs to rest a 
little every now and then. In six per cent. of Dr. Kunge’s cases 


604 Psychological Retrospect. [Jan., 


agoraphobia was noticed—that is a feeling of anguish which comes 
over people when crossing large squares or open spaces. One of the 
commonest causes of this condition is chronic inflammation of the 
internal ear, or of the nasal and temporal sinuses. Sometimes it is 
caused by wounds in the head. In some cases it seems dependent 
upon affections of the bowels and uterine disease. It often lasts a 
long time, some times many years; nevertheless the author thinks 
the prognosis not unfavourable. Most cases recover if properly 
treated. Dr. Runge has seen complete recovery after the disease had 
lasted above five years with bad relapses, and has seen enduring im- 
provement where the disease had lasted above twenty years with 
temporary exacerbations and remissions. After it has lasted eight 
years a complete recovery is rare, though improvement is likely enough 
to take place. 

There have been no opportunities of finding out the changes induced 
by this disease after death, since it is rarely if ever mortal. Dr. 
Runge thinks that the fact that the patient can pass from ease to 
extreme distress in a few minutes, indicates some rapid change in the 
vessels, probably slowness of circulation in the capillaries, owing to 
deficient vaso-motor innervation. He thinks that pressure may exist 
upon the vessels at the foramina of the skull, which, acting upon the 
accompanying nerves, may cause the feeling of constriction. 

The treatment he recommends is rest of the affected organ, rest 
from mental exertion, and freedom from disquietude. The patient 
should lead a quiet and idle life for two or three months. Change of 
air and scene are useful, though sometimes the annoyances and dis- 
comforts of travelling do harm; but Dr. Runge has found residence 
in high situations, as in some health resorts of Switzerland, to be 
contraindicated. The diet should be non-stimulating; wine, beer, 
and condiments should be abstained from; and the author has known 
cases where two or three cups of strong coffee brought back the dis- 
tress for a week at a time. Dr. Runge says that many of the vege- 
tarians whom he had met had suffered from Kopfdruck, and preferred 
an unstimulating diet, because it relieved their malady. 

The uterine disorder is sometimes successfully treated without the 
irritability of the brain passing away. | 

The author recommends cold baths to the legs and lower part of the 
body, which he thinks have a more permanent action in calling blood to 
the surface than hot baths. He observes that parts exposed to the cold 
are habitually red. He does not recommend cold baths applied to the 
head, but sometimes uses bromide of potassium where there is a 
tendency to melancholia, He has tried electricity, but in only one 
case did he find it successful. | This was an officer who was wounded 
in the parietal bone, and suffered very much from dull headaches, 
giddiness, and distress in pursuing his usual employment. The con- 
stant stream was applied to the cicatrix of the wound; the head- 
ache almost immediately passed away, and after eight days of 


1878. ] Psychological Retrospect. | 605 


the application, he was able to go back to his regiment completely 
cured, 

Cures of General Paralysis —Dr. Moriz Gauster, in ‘‘Centra- 
blatt,” No. 8 and 9, 1876, gives an account of a man forty-three years 
of age, who had the usual symptoms of general paralysis. The speech 
was much affected, the power of the legs injured, the temperature 
rose at night. He boasted about his palaces, his jewels, his golden 
cup,and so on. The affection commenced in the autumn of 1874, 
and became well pronounced about the end of February; but a year 
after he was quite recovered, and returned to his former occupation 
with a scarcely perceptible diminution of mental power. Dr. Gauster 
remarks that drugs had nothing to do with the fortunate result, nor 
was there anything very peculiar in the treatment. It appears that 
this is the second recovery from general paralysis recorded by Dr. 
Gauster. Dr. Schile (‘‘Zeitschrift,” xxxii. Band, 6 Heft), gives another 
case of cure of this disease. The patient was a clerk forty-four years 
of age. He took ill in 1867, and was brought to the asylum at 
Illenau, from which he was discharged in 1868. He seemed quite 
recovered in 1870, and has remained in good health ever since. Dr. 
Flemming, of Schwerin, swells the glory of German medicine by add- 
ing another case recorded in the “ Irrenfreund” (No. 1 and 2, 1877). 
A curious feature which he brings out in the history of these re- 
coveries is the existence in the course of the disease of intermissions 
in the symptoms of the malady. In one instance, the motor disorder 
in the legs disappeared for two days, and then for four days, afterwards 
returning. In another case (Schile’s), the mental integrity returned 
for some days, and the patient recognised his previous delusions, 
though the motor disorder remained. In Dr. Flemming’s case, there 
were remissions in the symptoms taking the tertian form, It is likely 
enough that in view of the occasional uncertainty in the diagnosis of 
general paralysis these recoveries will be regarded with some dis- 
trust, but as far as the symptoms are detailed they would have been 
classed at once as unambiguous cases of this dreadful disorder. 

General Paralysis in an Imbecile—In an article upon idiots, and 
institutions for idiots (“ Zeitschrift,” xxxiii. Band, 2 Heft), Dr. Kohler 
tells us that general paralysis was once observed in a boy suffering 
from hereditary imbecility. There was progressive weakness of the 
legs, starting of the muscles in all the limbs, and convulsive move- 
ments in the muscles of the face, lips and tongue, combined with a 
feeling of optimism. After death there was found to be chronic 
meningitis with degeneration of the brain substance, and general 
humidity (Durchfeuchtung’) of the brain. 

This conjunction of general paralysis and imbecility is extremely 
rare. 

Hereditary Ataxia Muscularis—Dr. J. Thomsen (“ Archiv,” vi. 
Band, 3 Heft), a physician in Schleswig, gives an account of a here- 
ditary neurosis which has followed his family for four generations. 


606 Psychological Retrospect. [Jan., 


One of its forms has been described by Sir Charles Bell as an affec- 
tion of the voluntary nerves, consisting in imperfect or capricious 
performance by the muscles of the behests of the will. The patient 
in ordinary circumstances has a complete control over the voluntary 
muscles, but under the influence of some sudden emotion he becomes 
incapable of doing what he wishes. ‘This defective action extends to 
all the voluntary muscles, including the orbicularis palpebrarum and 
oris, as well as the muscles of the tongue; but the sphincters are not 
affected. It is analogous to stammering which only affects the 
muscles of the larynx. The patient, who can walk perhaps twenty 
miles, falls down when he tries to lead a lady to the table, or a 
sudden noise or alarm in the road causes him to sink on the ground, 
though in other moods he is quite capable of performing the very 
same actions. The attack is accompanied with tonic spasms or stiff- 
ness of the muscles; but there is no loss of consciousness as in 
epilepsy. 

Dr. Thomsen names the disorder ataxia muscularis. His maternal 
great grandmother was the wife of a Danish officer belonging to a 
family still flourishing in Denmark. Apparently the officer and his 
wife were of the same stock, but the degree of relationship is not 
given. This lady had two sisters, who both died insane, and she her- 
self died of puerperal mania, leaving an only son, who lived to the 
age of sixty-four, and, like his mother’s sisters, died insane. He left 
four children; the eldest was a son in whom the ataxia appeared, 
though slightly. After his thirtieth year, he (7.e., Dr. Thomsen’s 
uncle) incurred a penalty in a court of justice, but was let free on his 
insanity being recognised. The mental derangement which followed 
the family is described as a species of imbecility, and haziness and 
obscurity in the ideas, with a disposition to silliness, and brooding 
over trifles resembling that form of mental weakness which some- 
times follows old age. This man, the uncle, had three sons and one 
daughter. The two eldest sons were much subject to the ataxia; the 
third son had no trace of it, but was from an early period of his life 
inclined to depression of spirits, and shot himself in the twenty-ninth 
year of his life. The daughter, apparently the fourth child, was also 
afflicted with ataxia. She left a son, who was healthy and became a 
medical practitioner. This concludes the history of the first son. 
The second son, also the author’s uncle, was a man of feeble mental 
powers. He had seven children, several of whom inherited the 
muscular incapacity, and all of whom were of feeble intellect. The 
younger daughter, the author’s aunt, also inherited ataxia and imbe- 
cility. She had four daughters, of whom two had curvature of the 
spine. The eldest daughter, the only healthy member of the family, 
was & woman of uncommon intellectual gifts. The second daughter 
was imbecile. 

_ The mother of Dr. Thomsen, whom we have passed over for the 
_ time, was the second eldest of the children of the only son of the 


1878. ] Psychological Retrospect. 607 


Danish lady. She was healthy both in mind and body through a 
life which had many difficulties and trials. She was married at the 
age of seventeen, and had thirteen children to two husbands, of whom 
the author was the eldest. Of the first marriage there were two 
sons and two daughters, twins. One of these daughters was affected by 
the ataxia, the other twin was quite free. Of the second marriage 
there were one boy and eight girls ; but of these thirteen children seven 
had this distressing malady, while the rest were quite free from it. 
One sister was for a time insane, otherwise there was no mental 
derangement among the rest, save a slight tendency to melancholy. 

Dr. Thomsen remarks that he and a younger sister, who had the 
most resemblance to their grandfather’s family, were most severely 
visited by the ataxia. He recalls the remark of Cullen, that those 
children who most resemble their parents are most likely to be visited 
by the hereditary disease. In the fourth generation—the author’s 
children and those of his brothers and sisters—there are thirty-six 
persons, but only six have the ataxia. He himself has five sons, one 
of whom died young, but not before he had showed the hereditary 
ataxia. Only one of the three living is troubled with the motor 
disease. He is well made, of uncommon muscular strength, and as 
the ataxia was not apparent he was taken for the conscription, but had 
in course of time to be released as incapable of performing military 
service. A portion of the biceps was removed at the desire of this 
young man for scientific examination, but the muscular fibres 
appeared under the microscope to be quite normal. The different 
families with whom they intermarried were healthy and seem to have 
contributed in no way to the hereditary neurosis. There was thus in 
five generations out of sixty members twenty-three affected with 
ataxia muscularis, several of whom were imbecile or simple- minded, 
and seven especially stated to have been insane. 

As the fifth generation was the least affected, the ancestral malady 
appears to be dying out. 

Contrary Sexual Feelings.—In the “ Archiv” (vi. Band, 2 Heft), 
Dr. C. Westphal and Dr. Servaes, and in the “ Zeitschrift”’ (xxxiil. 
Band, 2 Heft), Dr. Stark have papers upon Contrary Sexual Feel- 
ings. Instances are given both in men and women. The male is in- 
different to women, or even dislikes them, but his desires are 
attracted by good-looking young men. The same perversion of feel- 
ing was acknowledged by some women. ‘The dislike or indifference 
to the other sex distinguishes this aberration from feelings about 
which the poets of Greece and Rome sometimes made little mystery. 

In a case given by Dr. Servaes, the man who had got into an 
asylum confessed that his desires had been perverted by depravity in 
boyhood. 

A young man, mentioned by Westphal, had never yielded to his 
feelings, which he regarded with alarm, and from which he was 
anxious to escape. They had begun when he was eight years old, but 


608 Psychological Retrospect. [Jan., 


after having grown up he had an attack of melancholia, which soon 
passed away. 

In other instances this perversion of instinct seems to be unaccom- 
panied by any other mental or nervous derangement, and the patient 
has only avowed his condition to the physician in the hope of getting 
rid of it. 

In the “Archiv” (vii. Band, 2 Heft) Dr. Krafft Ebing has a 
learned article upon this and other perversious of the sexual appetite. 

Gribelsucht: The Metaphysical Mania.—Dr, Oscar berger has a 
long study, in the ‘‘ Archiv’’ (vi. Band, 1 Heft), upon Grubelsucht. 
The mental symptoms of this disorder consist in an irresistible current 
of ideas taking the form of useless inquiries as to the how and why of 
everything pushed beyond the limits of what all people of any sense 
have treated as the usual range of the knowable. 

A well-educated young man, a student of Jaw, describes his own 
thoughts and feelings when subjected to this distressing condition. 
To take one of his own examples, the idea comes to him why has a 
chair four legs? Why not one only? ‘The answer occurs, because 
according to the laws of nature a stool with one leg would not stand, 
but then his wandering thoughts hurry him away with a succession ot 
endless questions. Why is it a law of nature? Why is there not an 
attractive force which would keep a chair up on one leg? At the 
same time, while his thoughts were hurried on with feverish activity 
in such useless speculations, his attention was still occupied in the 
observation of the accustomed objects of daily life, though after a 
weak and drowsy fashion. ‘There were, therefore, two simultaneous 
currents of thought in his mind. He also described himself while 
subject to these paroxysms as being in such a hazy condition that he 
did not distinguish what he had dreamed from what he had read, or 
seen in a picture from what he had lived through. His memory and 
powers of concentration were weakened, and often all things round 
about him appeared small, so that he seemed to himself unusually 
large in relation to them, or the reverse. He also noticed that his 
taste for particular notes in music was variable. Sometimes he pre- 
ferred the octave in the middle of the piano and the higher tones ap- 
peared unpleasant. At another time the higher tones displeased him, 
and he again was fond of tunes in which the middle octaves pre- 
vailed. These paroxysms lasted from one to twelve hours. They 
were accompanied by a feeling of distress, a burning sensation in the 
head, and redness, with sometimes nervous twitchings, in the face. 
Occasionally, too, there was a sudden bending of the head upon the 
chest. The paroxysms left him in a state of mental exhaustion and 
bodily lassitude. Apart from this his general health was said to be 
tolerable, and he completely recovered under the influence of a 
summer’s residence in the country, the use of bromide of potassium 
and some mild hydropathic treatment. Dr. Berger compares this case 
with a few recorded by other writers. The subjects of this form of 


18738.) Psychological Retrospect. 609 


mental disorder seem generally to be young people, and they seldom 
require to enter asylums. 

Delusions of Memory.—Dr. Arnold Pick (“ Archiv,” vi. Band, 2 
Heft) gives some account of a man who had curious delusions of 
memory. He was a furrier, and had travelled, practising his trade, to 
Copenhagen and St. Petersburg. He was very excitable, suffered 
from headaches, and fancied that people put poison in his food, and 
listened to his conversation. He thought that he heard voices weep- 
ing above his room. On account of such delusions he was sent to the 
asylum at Wehnen. He is described as rather a weakly man for his 
age, which is above thirty. He possesses a good memory, and is 
skilful at mathematics. From his early years he had a vague con- 
sciousness as if the events he was passing through had been already 
experienced. At first these notions, which now and then occur to 
most people, were of a dim and uncertain character, but in the course 
of time they got clearer, so that he thought he possessed a double 
nature. It seemed that the combinations of social life, the changes 
of the weather, the events of the political world, repeated themselves 
to him for the second time. He thought it strange that no one ever 
mentioned those repetitions of events. He spoke about them to his 
friends, but only got evasive replies. 

The first time that these illnsions were clearly pourtrayed in his 
mind was in the autumn of 1868, in St. Petersburg. Visits to pleasure 
resorts, the sight of public amusements, and casual interviews with 
persons so affected his memory that he was convinced that he had 
already visited the same places and seen the same men, under exactly 
the same circumstances. Sometimes this conviction occurred in the 
same day ; but it often became clearer days after, when he had leisure 
to think over the events. Sometimes the renewed recollection came 
during the night ; this Dr. Pick considers to be a form of dreaming. 

Is the Marriage of Women a Preservative against Relapses in 
Insanity ?—Dr. Dick discusses this question in the “ Irrenfreund ”’ 
(No. 6, 1877). Taking the women under thirty years of age who 
left Klingenminster during a period of sixteen years, twenty three 
have beeu married, and nine have required to return to the asylum. 
He also ascertained from the Burgermeister, as far as 1s known, the fate 
of all the young women discharged, and found out that the greater 
number of relapses took place in single women. As the result of his 
inquiries whether marriage is a preservative for women against relapses 
into insanity in youth Nasse supports the same opinion. One can 
marry with a good heart ; it is \wenty-two against one that there will be 
no relapse, but if the girl does not marry, there is a danger of relapse 
of twenty-two in fifty-one. This statement seems so strong that one 
is disposed to agree with Dr, Dick’s objections to the way Dr. Nasse’s 
statistics were put together. One need not be astonished that three- 
fifths of the young women who leave Dr. Nasse’s asyluin succeed in 
getting husbands; the natural ardour women show in this pursuit 


610 Psychological Retrospect. [Jan., 


would, in their case, be much increased by the desire of escaping from 
a relapse of insanity. It may, however, be objected that those women 
in whom the recovery was most thorough would likely be those who 
gained the desired preservative. Dr. Dick was only once consulted by one 
of his old patients as to whether it was prudent to marry. There was no 
hereditary tendency in her family. The insanity came on when she 
was twenty years, and was preceded by chlorosis, when an attack of 
mania was brought on apparently by severe fright. It completely 
disappeared after eight months. The general health was also re- 
established, and three years had elapsed since she left the asylum. 
The doctor thought the marriage might take place, and she has now been 
married seven years, and is a happy wife and mother. The question 
whether it was likely such women should have children deranged in 
mind, is alluded to as one of great importance, but no facts are given 
to help us towards its solution. 

Insanity of Murad V.—In the “ Zeitschrift”? (xxxiv. Band, 1 
Heft), there is a long enquiry into the nature of the illness of the 
Sultan Murad V. It will be remembered that, during August of 
1876, Dr. Leidesdorf, of Vienna, was sent for, to be consulted as to 
the mental condition of the Sultan, and as everything must come to 
the public now-a-days, it is supposed that the different newspaper 
articles quoted contain the result of the observations of that learned 
physician. Apparently insanity is hereditary in the house of Osman, 
as indeed it is in that of most European reigning families. Sultan 
Ibrahim was a maniac, Sultan Mahmud a drunkard; Abd-ul Medjid, 
the father of Murad, died from the results of his excesses in vino et 
venere, and his uncle, Sultan Abd-ul Aziz, brought Turkey into 
its unfortunate condition by his indolence and his senseless ex- 
travagancies. Murad himself, a man of 86 years of age, of origi- 
nally good constitution, was imprisoned by his uncle, and thought his 
life in great danger. In order to escape from the painful conscious- - 
ness of his position, he was in the habit of indulging in spirituous 
liquors. Suddenly called by the deposition of Abd-ul Aziz to preside 
over the destinies of Turkey, at a most unhappy period of her history, 
he was deeply affected by the violent death of his predecessor, and the 
frightful murder of his two ministers, Hussein Avni and Raschid 
Pasha, by the Circassian Hassan. These distressing events, acting 
on an exhausted constitution, caused continued sleeplessness, and 
finally plunged him into a deep melancholy. He told Dr. Leidesdorf 
that he had a feeling of constriction about the chest. ‘1 live,’ he 
said, ‘two lives, one known to me, and clear to my comprehension, 
the other contained within it, obscure and incomprehensible. On my 
ascension to the throne, I saw everything full of fowers ; now the floor 
of my chamber, when I look at it, seems to be sown with bayonets.” 

Dr. Leidesdorf thought that Murad might recover, if properly 
treated, in three months, a prognosis which was not well received 
by those who wished to dethrone him. He was said to be a man 


1878. ] Psychological Retrospect. 611 


of a kindly heart, and more likely to be a good ruler than his 
successor, who only cared for himself. It is reported in the news- 
paper that he has now recovered, but as he is still in a species of con-| 
finement, this cannot be exactly known. 

Paralysis Treated by Electricity—Dr. C. Hisenlohr (“ Archiv,” vi. 
Band, 2 Heft) has used the induced current very successfully in the 
treatment of partial paralysis, especially in the leg, following upon 
typhus fever. From the limited nature of the paralysis, and the un- 
equal excitability to electricity in the affected limbs, he considers that 
the loss of power is in these cases owing to an exudation in the neuri- 
lemma of the branches of the sciatic nerve, accompanying a serous 
effusion into the cavities of the joints. 

Beer Used Against Sleeplessness.—Dr. Wittich (“ Archiv,” vi. Band, 
2 Heft), gives the results of his experiments in treating restless 
lunatics of the male sex. The remedies that he especially recommends 
are bromide of potassium and beer. He has been in the habit of 
giving the latter beverage in doses of one to two litres, and the results 
were highly satisfactory. Though Dr. Wittich did not venture to give 
beer in cases of acute mania, he found it very successful in fifteen 
cases of sleeplessness. As the Germans have shown a decided taste 
for that liquor when sane, it is not likely that there will be any diffi- 
culty in administering it to their lunatics, and it is even possible that 
some stickler for the equality of the sexes may yet enquire why such 
a pleasing method of cure is not extended to female patients. 





PART IV.-NOTES AND NEWS. 


DEPUTATION TO THE LORD ADVOCATE IN REGARD TO THE 
LUNACY LAW. 


On Friday, 2nd November, a deputation of asylum superintendents, mem- 
bers of district boards, and managers of Royal Asylums, waited on the Lord 
Advocate at his chambers, Hdinburgh, with the view of bringing under the 
notice of his Lordship an omission in the Scotch lunacy law, there being no 
provisions at present for granting pensions to old and deserving officers in the 
Scotch district and parochial asylums, as in England and Ireland. The depu- 
tation consisted of Professor Balfour, Professor Maclagan, Dr. Fraser, ex- 
Bailie Miller, Mr. D. Scott Moncrieff, W.S., Mr. Cowan, of Beeslack, Dr. 
Cameron, Lochgilphead; Dr. Jamieson, Aberdeen ; Dr. Anderson, Rosewell; Dr. 
Grierson, Melrose; Dr. Wallace, Greenock; Dr. Makintosh, Murthly; Dr. 
Rutherford, Lenzie; Dr. Ireland, Larbert; Dr. Clouston, Morningside; Dr. 
Rorie, Dundee; Dr. Howden, Montrose, &c. The deputation were introduced 
by Professor Maclagan, who strongly supported the views of the deputation. 
Dr. Mackintosh, addressing his Lordship, said—The reasons which have caused 
the medical and other officers of the public asylums of Scotland to come before 
you are, I think, fairly set forth in the petition which was placed in your Lord- 
ship’s hands some months ago. I need not, therefore, refer to them in detail, 
but would only draw your attention to the anomalous (and at the same time, 
disadvantageous) conditions in which such officials are placed when contrasted 


612 Notes and News. [Jan., 


with their brethren in England and Ireland. Most of us had hoped that the 
matter would, ere this, have been taken up by the General Board of Lunacy 
for Scotland, but the Board (who received a deputation last February in the 
most courteous manner) has no intention of moving in this or any other legisla- 
tion at pressnt. Moreover, the Commissioners thought that the best course 
was that now adopted—viz., to bring the subject. before you ourselves. The 
service which we have the honour to represent is as much a public service as 
the army and navy, or as the civil and parochial services, and perhaps it is not 
exceeded by any of them in the increasing attention which is necessary, or by 
the harassing nature of the duties. It therefore seems the more reasonable 
(besides being a simple act of justice) to place the service on a footing in 
regard to superannuation allowances similar to that occupied by the public 
asylums of England and Ireland. In urging upon your Lordship the great need 
foras speedy a solution of the question as possible, we do so in the knowledge 
that several special amendments of a similar nature have been made. More- 
over, we are satisfied that the insertion of such a clause as that indicated in 
the petition as an amendment into the Act, will be an important day in the 
history of such institutions, both as regards the efficiency and stability of the 
staff, and the comfort of the inmates. Mr. Cowan, of Beeslack, asa member of a 
district lunacy board, also urged the injustice and impolicy of the present 
law. The Lord Advocate said that he would give the subject his most favour- 
able consideration. It seemed avery proper matter to have been brought be- 
fore him, the only question being when he could get an opportunity of intro- 
ducing a clause to remedy the present defect. 


INDIAN HEMP THE CAUSE OF 30 PER CENT. OF THE INSANITY 
OF BENGAL. 


The following is an abstract of news from the ‘Calcutta Gazette: ”—“ The 
Lieutenant-Governor is anxious to make it understood that, though very desirous 
to increase the revenue, he does not wish io increase consumption. From 
figures given, it appears that the revenue has increased in 1876-77 to 255,766 
rupees. Some of these sources of revenue are decoctions of hemp, one of the 
most deleterious of which is gunga. An unconscious and painful comment on 
the iniquity of seeking revenue out of the sale of these pernicious poisons is 
contained in the fact as stated in the annual report on lunatic asylums in 
Bengal, resolutions on which were published in the same “ Gazette.” From this 
it appears that among the causes of insanity excess in the use of gunga has 
accounted for 30°66 per cent. of the total number of lunatics. 


DR. MACKENZIE BACON. 


Ata congregation of the University of Cambridge, on November 1st, the 

_ Honorary Degree of Master of Arts was conferred on Dr. George Mackenzie 
Bacon, the resident medical superintendent of the Cambridgeshire and Isle of 
Ely Lunatic Asylum. In the course of an eloquent Latin speech, the Public 
Orator, after referring to the fact that in the ancient world Athens alone set 
up in her market place an altar to the Goddess of Pity, and that even Athens 
knew of no hospitals, noticed the vast improvement that even recent times had 
witnessed in the treatment of pauper lunatics. Referring to Dr. Bacon, he 
drew attention to the valuable services he had gratuitously rendered for the 
last nine years to the medical students of the University, by affording them 
facilities for clinical instruction in diseases of the brain, concluding as follows: 


1878.] Notes and News, 613 


““Tpse Hippocrates medicines pater discipulos suos jurejurando obstrinxisse 
dicitur, sese magistri sui filiis artem medicam nulla acceptéa mercede esse 
tradituros, quanto autem preestantius est hunc Hippocratis discipulum nullo 
jurejarando devinctum sed sua sponte motum, non jam in suorum preceptorum 
progeniem sed in alienzs Academiz adolescentes tantum beneficium gratis con- 
tulisse. Tu vero qui alumnis nostris magno cum fructu medice artis magister 
sponte exhibisti honoris caus& artium magister nobis esto.” Dr. Bacon was 
then admitted to the degree of M.A. in the usual manner.—Biit. Med. Journal, 
Nov. 10. 


THE PROFITS OF LITERATURE. 


Longfellow is independent in circumstances—probably worth 100,000 dols. to 
200,000 dols.; but the greatest part of it has come through his wife, long since 
deceased, who was rich in her own right. 

Emerson has not madefrom his remarkable little volumes over 20,000 dols. 
He has gained nearly as much more by lecturing; and yet, by excellent man- 
agement, which one might not expect from the high idealist, and by a serene 
philosophy of a practical sort, he continues to live on his small property. 

Bryant is often cited as an instance of a rich author. Heis rich, but not by 
authorship. All the money he has directly earned by his pen, outside of his 
journal, would not exceed, in all probability, 25,000 dols., notwithstanding his 
estate is estimated at 500,000 dols. 

Hawthorn was poor to his dying-day,and might have suffered but for his 
appointment to the consulship at Liverpool by his friend, President Pierce. 

Lowell was independent in circumstances—no thanks to his fine poetry and 
essays, however. 

Whittier, like most thrifty New Englanders, owns his own house, and beneath 
its humble roof, it is said, he has subsisted—he is a batchelor, you know—on 
500 dols. a year. 

Holmes is well off by the practice of the medical profession, by marriage, 
and inheritauce, albeit not by poems, lectures, novels, nor “ Autocrats of the 
Breakfast Table.” All that he has written bas not brought him 25,000 dols. 

J. G. Holland is frequently named as an author who has amassed wealth. 
His books have sold as largely as those of any American writer, and, whatever 
may be thought of his ability, he still has a vast constituency. He is not at 
all rich in the New York sense; he may be worth 200,000 dols., but most of this 
he has got by his partnership in the “ Springfield Republican.” 

George William Curtis is dependent on his salary from the Harpers; so is 
Mr. William D. Howells dependent upon his editorship of the “ Atlantic’; Brete 
Harte, T. B. Aldrich, James Parton, J. T. Trowbridge, R. H. Stoddard, and T. 
W. Higginson, mainly upon fugitive writing.—Printer’s Circular. 


Appointments. 


Brook, C., M.R.C.S.E., L.S.A.L., has been appointed an Honorary Surgeon 
to the Lincoln Lunatic Hospital, vice Broadbent, deceased. 


CuHEVALLIER, B., M.D., M.R.C.P.L., has been appointed Medical Superinten- 
dent of the Borough of Ipswich Lunatic asylum, vice Long, resigned. 

Jonzs, D.J., M.B., C.M., has been appointed Assistant Medical Officer to the 
Somersetshire Lunatic Asylum, Wells, vice Adam, resigned. 


614 Notes and News. 


Lawson, R., M.B., C.M., has been appointed Resident Medical Superinten- 
dent and Secretary to the Wonford House Hospital for the Insane, near Exeter, 
vice Lyle, resigned. 


Mann, H. W., M.B., has been appointed Resident-Assistant Physician to ing 
Stirling ‘District Lunatic Asylum, Larbert. 


SEwarp, W. J., M.B., M.R.C.S.E., L.S.A.L., has been souetea Assistant 
Medical Officer of the Female Department of the Middlesex Lunatic Asylum, 
Colney Hatch, vice Skelton, resigned. 


Watson, Dr. T. H., has been appointed Assistant Medical Officer to the Fife 
and Kinross Lunatic Asylum, Cupar, vice Foot, appointed a Medical Officer to 
the Walsingham Union. 


WILKINSON, T. M., L.R.C.P.Ed., L.R.C.8.Ed., L.S.A.L., has been appointed a 
Surgeon to the County Hospital, Lincoln, vice Broadbent, deceased. 


EHRRATUM.—In the Report of the Annual Meeting of the Medico-Psycholoy.- 
cal Association in the last No. of the Journal, at page 441, Dr. Bucknill is re- 
ported to have said, “Ifthe public wish to find patients unjustly detained in 
asylums, they would not look in private asylums, but in public ones.” This 
should have been, “If the public wish to find patients detained for lengthened 
periods in asylums, they would not look in private asylums, but in public ones.” 


On account of the pressure on our space, we have been compelled to let an 
Original Article, our French Retrospect, the Report of the Edinburgh 
Quarterly Meeting of the Medico-Psychological Association and a large amount 
of other important matter stand over until the next number. 








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