wn mnwi p iawu.HM H Wi > < imn'm t>i ii iaWvT8wiWiBspi wwW t W M ^> i w i fti . ww^ ?WfT €?tatt Collesc of atgrfculturc St Cornell iHntbecsfitp atbaca. iS. j^. Uifirarp RC 512.M4'™" ""'"'■"•'"■'""■•'' ,,P,?sponsibility in mental disease. 3 1924 003 507 385 Cornell University Library The original of tliis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924003507385 THE INTERNATIONAL SCIENTIFIC SERIES. THE INTERNATIONAL SCIENTIFIC SERIES. RESPONSIBILITY MEE^TAL DISEASE BT HENRY MAUDSLEY, M.D., FELLOW OF THE BOTAL COLLEGE OF PHTBIGIAKR, FBOFESSOB OF UEDICAL JITBIB- FBUDSHCE IN XTNITEBBITT GOLLEGE, LOKDOIf, ETC., ETC.; ATTTHOB OF "BODY AND MIND," "PHTSIOLOGY AND PATHOLOGY OF THE HEBYOUS SYBTEH." NEW YORK: D. APPLETON AND COMPANY, 649 AND 551 BEOADWAT. 1874. CONTENTS. CHAPTER I. INTBODUCTOKT. PAOB Tneane persons in asylums : iow much they resemble and how much they differ from sane persons — Erroneous popular and legal notions — ^Feeling of repulsion towards insanity — Cruel treat- ment of tbe insane : from what causes it originated — Effects of the theological and the metaphysical spirit — Mind a function of brain, and disordered mind a, result of disordered brain — Influence of bodily organs on mental function — Physiological method of inquiry indispensable ; inadequacy of psychological method — Development of nervous system by education, and its necessary limits — The tyranny of organization — Hereditary influence— Moral responsibility — The criminal nature — Heredi- tary crime— The production of criminals : their defective physical and mental organization, and proneness to disease — Border-land between insanity and crime — Causes, course, and varieties of intellectual and moral degeneracy to be studied by the inductive method. ..... 1-37 CHAPTER II. THE BORDEKLAIfU. Xo distinct line of demarcation between sanity and insanity — Con- tinuity in nature — The borderland—The insane temperament — Transformation of nervous diseases — Kinship betw^een insanity and epilepsy, neuralgia, chorea, dipsomania — Functional and organic diseases of the brain— Hereditary predisposition : its pathological evolution through generations — Originalities of Vi CONTENTS. PAGE idea, feeling and impulse in connection with it — Insanity and the prophetic mania— The prophets of the Old Testament— The epileptic nature of Mahomet's visions and revelations— The madman and the reformer— Eccentricity and insanity — Deficiency or absence of moral sense a congenital fault of mental organization— Crime and insanity — Moral sense : its acquisition in the course of evolution; and its.dependence upon organization— Physical conditions of moral degeneracy — Con- clusions. ....... 38-65 CHAPTER III. DIFFEEENT FOEMS OF MENTAl DEEANGEMENT. Idiocy and imbecility^Kleptomania, pyromania, ftc, often mark iml;ecility — Intellectual and Affective insanity — General and partial mania — Monomania and melancholia — Dementia — General paralysis of the insane — Objections to the received system of classification according to certain prominent mental symptoms only — ^The lines on which it is proposed to lay down a better system — The diagnosis of insanity a strictly medical question — Morel's proposed classification — Skae's proposed classification — The path of future medical inquiry — The phy- sician's duty to declare the truth, however unpopular it may be. J . 66-87 CHAPTER IV. I.A"W AND INSAMITT. Early legal notions of insanity — Lord Hale's dictum — Mr. Justice Tracey's wild beast theory of madness — The trial of Hadfield : Erskine's declaration that delusion was the true cha- racter of insanity — The trial of Bellingham : Chief Justice Mansfidd's dictum that a knowledge of right and wrong gene- rally was the proper criterion of responsibility — The trial of McNaughten : answers of the English judges to questions put CONTENTS. VU PAGE by the House of Lords — A knowledge of right and wrong £u reference to the particular act at the time of committing it laid down as the true criterion of responsibility— One exception to this rule formulating the question to be left by the judge to the jury — ^Assumption by the judge of the function of the jury — Criticism of the answers of the English judges by American judges — ITncertainty of result in English trials where insanity is alleged — The dicta of American judges : cases of Boardman V. Woodman,' StatiY. Jones, and State v. Piie— Articles of the French penal, code and of the latest German penal code — Comment upon the right-and- wrong theory of responsibility. 2. Formal legal views of testamentary capacity: cases of Cart- Wright v. Cartvnight, Dew v. Clarice, and Waring v. Waring — Kecent American decisions — Judgment of the Court of Queen's Bench in the case of BamJca v. Ooodfellow — Comparison of the law relating to testamentary capacity with the law relating to criminal responsibility ..... 88-120 CHAPTER V. PARTIAL INSANITY. I. — Affective Iiisanity. Insanity comprises several forms of mental derangement — Varia- tions in the character of the symptoms of each form at different periods of its course — Early symptoms sometimes little marked, but of great significance : examples — Medical observation alone of the early stages of any value : misinterpretation of them by lawyers and others — Uselessness of the capital punishment of insane persons as an example to others. Affective insanity : 1. Impulsive insanity. Insane suicidal impulse or suicidal monomania : examples— Pathological nature of the insane impulse : an inability to control it may be accompanied by a consciousness of its morbid nature — Suicidal insanity strongly hereditary: example — Homicidal monomania: examples — Discussion of its nature — Perverted desires and deranged VIH CONTENTS. PAGE impulses common features iu all forms of mental derangement — Symptoms of derangement before an outbreak of homicidal insanity —Latent tendencies may discover themselves for the first time on the occasion of a powerful exciting cause — Condi- tions precedent of an outbreak : o. the insane neurosis ; 6. the epUeptio neurosis— a. Insane neurosis : with some degree of imbecility — case of Burton : without imbecility, but with manifestation of insane tendencies— case of Alton murderer — The homicidal impulse ; was it irresistible or un- resisted ? — S. Epileptic neurosis : the homicidal mania may precedie, take the place of, or follow an epileptic fit — 2. Moral insanity: its characteristic features and its causation— Moral alienation often precedes intellectual derangement, and remains after this has passed away ; attacks of it may alternate with attacks of regular mania and melancholia— Folie circulaire — Moral alienation in connection with epilepsy- Congenital moral imbecility- Conclusion. .. . . . 121-184 CHAPTER VI. PARTIAL INSANITY. II. — Pa/rtial InteUectual (or Ideational) Insanity. Simple melancholic depression preceding intellectual derangement : homicidal or suicidal outbreak : case of Charles Lamb's sister — Melancholia with hypochondriacal hallucinations and delusions ; homicide — Delusions of suspicion or persecution, and homicidal mania: case of Dr. Pownall — Concealment of their delusions by insane persons — Bodily symptoms preceding an outbreak of homicidal mania : the characters of the attack — Dangerous character of the insanity that is accompanied by delusions of persecution — An insane person does murder out of revenge : is he a responsible agent ?— Futility of argument against a delusion : a limited delusion indicates deeper mental derauge- ment : examples — Premeditation in planning and ingenuity in perpetrating homicide entirely consistent with insanity : ex- CONTEXTS. IX PAGE ample— Danger of recurrence of homicidal mania : examples — Conduct of insane persons after a homicidal act — Homi- cidal insanity in -which, first, the act is the direct offspring of the delusion ; and, secondly, in which it cannot be traced to its influence . — Hoffbauer's metaphysical criterion of responsibihty — The medical doctrine that partial insanity excludes the idea of criminality, whether or not the acts are the results of delusion : the reasons on which it is based — Discussion of the legal and medical views with regard to the working of an insane delusion in the mind : examples showing the impossibility of tracingits workings— Pathological meaning of the existence of an insane delusion, however limited — The right problem in homicidal insanity is to trace a connection, not between the delusion and the act, but between the disease and the act.. ...... 185-226 CHAPTER VII. EPILEPTIC INSANITY. Mania following epilepsy : its furious character — Masked epilepsy — Mental disorder preceding the epileptic attack— Epileptiform neurosis manifesting itself in periodical attacks of mental derangement : examples — Description of the symptoms of epileptic insanity : of those that go before and foretell an attack ; of those that are exhibited in the milder and the more severe forms of the disease ; and of those that are met with after long-continued epilepsy — Peculiar states of epileptic oon- scioxisness — Epileptic visions— Transitory mania, of epUeptic origin : examples— Jj'eatures of epileptic homicide — Transitory mania, without history of epilepsy — Somnambulism — The per- sistence of dream-hallucinations after -waking from sleep. 227-253 CHAPTER VIII. SENILE DEMENTIA. Symptoms of senile dementia in the order of their occurrence : loss of memory, impairment of perception, incoherent talk, in- X CONTENTS. PAGB capacity of comprehensioD, complete mental decay— Com- parison of its symptoms with those marking the natural decay of mind in old age— The mental character of old age — Failure of mind in febrile and other diseases — Loss of consciousness of personal identity. . . . . • 254-267 CHAPTER IX. THE PEEVENTIOS OF HTSAOTTY Man's power over himself to prevent insanity — Outcomes of an insane temperament — The exercise of self-control in insanity — The gradual evolution of character — The development of will : its power over the thoughts and feelings — The propagation of insanity through generations — Unwise marriages — The tyranny of the passion of love— The degeneration and regeneration of families — The intensification of the neurotic type — Hereditary predisposition, intemperance, and mental anxieties as causes of insanity— Exposition of the evil effects of intemperance — The prevention of insanity by education — The aim of a liberal education — Self-culture as an aim of life— Inconsistencies of thought, feeling, and actions : the injury to character which they imply — The kind of mental activity involved in the conduct of business : how it fails to satisfy the rec^uireraents of true mental culture— Mistaken views of religious duties — The control of the emotions — Mental hard work not a cause of insanity — The full development of the mental faculties a pro- tection against insanity — Undeveloped mentality — The study of the natural sciences aa a means of intellectual and moral training — The reign of law in human evolution— The moral duties consequent on the intellectual recognition of it 26S-303 KESPONSIBILITY IN MENTAL DISEASE. CHAPTER I. IXTEODUCTORY. Insane persons in asylnms : how much they resemble and how much they differ from sane persons — Erroneous popular and legal notions — ^Feeling of repulsion towards insanity^Cruel treatment of tbe insane : from what causes it originated — Effects of the theological and the metaphysical spirit — Mind a function of brain, and dis- ordered mind a result of disordered brain — Influence of bodily organs on mental function — Physiological method of inquiry indis- pensable ; inadequacy of psychological method — Development of nervous system by education, and its necessary limits — The tyranny of organization — Hereditary influence — Moral responsibility — ^The criminal nature — Hereditary crime— The production of criminals : their defective physical and mental organization, and proneness to disease — Border-land between insanity and crime — Causes, course, and varieties of intellectual and moral degeneracy to be studied by the inductive method. Notwithstanding the great change which has taken place in opinion and practice with regard to mental disease within the last century, there are still persons who, if invited to visit a lunatic asj'lum, would look on the pro- posal in much the same light an a proposal to visit the Zoological Gardens and inspect the wild beasts. They would certainly expect to see something entirely unlike 1 % EESPONSIBILITY IN MENTAL DISEASE. what they were used to see in their daily experience, and would probably come away not a little disappointed with the result of the visit : like Mr. Burke, they might ask, at th^ end of it, where the insane persons were. It is related of that great philosopher, orator, and statesman that, after going through the wards of a large lunatic asylum, he turned to the gentleman who had accompanied him, and said that he had not seen one person whom he considered insane. Thereupon his conductor called one of the patients who had particularly interested Mr. Burke by his ingenious political theories, and touched the sub- ject of his delusions, when he began immediately to talk of the porcupine quills which he imagined to grow from his skin after each meal, and became so incoherent that Mr. Burke was convinced that madmen were not all like the pictures which Hogarth painted of them. For the most part, they are very unlike. Of the in- mates of an asylum, some few might present noticeable peculiarities of appearance, demeanour, and conversation ; more would strike the observer by their dull look and listless attitude, as if they had no interest in anything in the heavens above or in the earth beneath ; while others would not show, either by their looks or by what they said or did, that they were not as other men are. So much would the casual observer see. The skilled observer would see more, but even he would not find a new world and a new race of beings ; he would find man changed, indeed, but not transformed. He would meet, as Esquirol has remarked, with " the same ideas, the same «irrors, the same passions, the same misfortunes : it is the ERRONEOUS POPULAR AND LEGAL NOTIONS. 3 same world; but in such a house the traits are stronger, the colours more vivid, the shades more marked, the effects more startling, because man is then seen in all his nakedness, because he does not dissimulate his thoughts, because he does not conceal his defects, because he lends not to his passions the charm which seduces, nor to his vices the appearances which deceive." Were the observer, whether casual or skilled, to reside for some length of time in an asylum, and thus to make himself practically acquainted with the Avays, thoughts, and feelings of its inmates, he would certainly discover how great a mistake it is to suppose, as is often done, that they are always so alienated from themselves and from their kind as not to be influenced by the same motives as sane persons in what they do or forbear to do. When an insane person is on his trial for some criminal offence, it is commonly taken for granted by the lawyers that if an ordinary motive for the act, such as anger, revenge, jealousy, or any other passion, can be discovered, Jhere is no ground... to allege in- sanity, or, atjiiy rate, no ground to allege exemption from responsibility by reason of insanity. The ideal madman whom the law creates is supposed to act without motives, or from such motives as it enters not into the mind of a sane person to conceive ; and if some one, who is plainly mad to all the world, acts from an ordinary motive in the perpetration of an offence, he is presumed to have acted sanely and with full capacity of responsi- bility. No greater rgislake could well be made. Much of the success of the modern humane treatment of insanity 4 RESPONSIBILITY IN MENTAL DISEASE. rests upon the recognition of two principles : first, that the insane have like passions with those who are not insane, and are restrained from doing wrong, and con- strained to do right, hy the same motives which have the same effects in sane persons ; secondly, that these motives are only effective within limits, and that beyond these limits they become powerless, the hope of reward being of no avail, and the expectation or infliction of punish- ment actually provoking more unreason and violence. By the skilful combination of these principles in practice it has come to pass that asylums are now, for the most part, quiet and orderly institutions, instead of being, as in olden times, dens of disorder and violence, and that the curious sight-seer, who visits an asylum as he would visit a menagerie, sees nothing extraordinary, and comes away disappointed. And yet, although in much so like, how different is the madman essentially ! Be the change in him what it may, it is plain that he has fallen from man's high estate, t^at he is no longer one with his kind, that he has lost the highest human attributes — those by which man is what he is among animals. Learned men may dispute con- cerning the nature and extent of the change ; but the way- faring man, though a fool, cannot fail to perceive it. Nor does the change fail to. influence him : deep in his heart there is generated an instinctive feeling of distrust, if not of actual repugnance ; he recoils in spite of himself from the distortion of humanity. Notwithstanding much bene- volence of sentiment towards those who are afflicted with insanity, and much righteous indignation against those CRUEL TEEATMENT OP THE INSANE. 5 who ill-use them, it is still true . that the public look upon the disease as a calamity of quite special kind, conceal it as a disgrace,' and sometimes treat it as a crime. By thfe feeling evinced, so unlike that which any other disease elicits, one is reminded of the way in which the lower animals and some savages act when one of their number falls sick : they slacken not their speed to allow the sufferer to continue with them, but leave it by the way- side to perish alone ; so far from helpful sympathy, they evince actual antipathy and drive it from among them : it is the saddest sight, indeed, to see the way in which animals thus persecute sometimes the sick and helpless member of the herd. Happily it results from the moral development of civilized man that he does not so act towards one who has fallen sick of an ordinary bodily disease; on the contrary, the affliction elicits his warm sympathy and active help. But it is not in the same measure so when the sickness is a sickness of mind. There is a dim but deep instinct that this is not a disease which is quite like other diseases, that a man by it " from himself is ta'en away," alienated from himself and from his kind, and that he is something of a reproach to the nature of humanity; the result being a vague feeling of antipathy like that which the lower animals display to- wards one of their kind that has fallen ill. At bottom this might seem to be curious evidence of the operation of the law of natural selection, whereby a diseased member that is unfitted for the natural functions of its kind is instinctively extruded from companionship. Just 6 EESPONSIBIIilTY IN MENTAL DISEASE. as the lower animals, and the savages who have to wander long distances, abandon or drive away the member that is incapacitated by bodily illness from holding its ground^ and whose presence would be an encumbrance ; so, in like manner, civilized nations, until recently, thrust out of sight into vile receptacles, _ where no mention of them more was heard, those members of the community who, through loss of reason, were unable to hold their own in the struggle for existence, and whose presence was felt as an encumbrance, a reproach, and a danger.* One of the saddest chapters in human history is that which describes the cruel manner in which the insane were treated in times past. Notwithstanding that it is happily a thing of the past, it will be instructive to inquire from what causes the barbarous usage sprang : for it was not common to all nations and all times; on the contrary, it had its birth in the ignorance and superstition of the dark ages of Christian Europe. Whatever may have been thought of madness among the peoples who preceded the ancient Greeks — and there is evidence that the Egyptians adopted a singularly enlightened and humane treatment — ^it is certain that the Greeks had comparatively sound theories of its nature as a disease to be cured by medical and moral means, and adopted principles of treatment in conformity with those theories. Their dra;matic poets, it is true, present terrible pictures of madmen pursued by the anger of the gods ; but these * In the four or five pages -which follow, I have repeated ia nearly the same words what has been already published in an address on "Conscience and Organization," in the second edition of my work on " Body and Mind." ANOIENT VIEWS OF INSANITY. 7 were poetical representations, which must not be taken as a measure of the best knowledge of the time. Then, as now, and indeed as ever in the history of man- kind, the true thinkers were emancipated from the fables and superstitions of the vulgar: the just measure of Greek intellect must be sought in the psychology of Plato, in the science of Aristotle, and in the medical doctrines of Hippocrates. This eminent physician and philosopher expressly re- pudiates the notion that one disease is of more divine origin than another. After saying that the Scythians ascribe the cause of certain disorders to God, he goes on to give his own opinion that these and all other disorders are neither more nor less of divine origin, and no one of them more divine or more human than another; that each has its own physical nature, and that none is produced without or apart from its nature. In what he says of the psychical symptoms of various diseases of the body he evinces such enlarged views of the scope of medical observation and practice as are not often evinced at the present day ; and the few observations in his works respecting the symptoms of delirium " evidence that clear and correct view of disease which has made this first observer a model to all succeed- ing times." He directs attention to such facts of obser- vation as the physical insensibility of the insane, the appearance of mental diseases in the spring, the occur- rence of disorder of the intellect after a continuance of fear and grief, the union of melancholy and epilepsy, the critical importance of hsemprrhoidal discharges in mania. 8 EESPONSIBILITY IN MENTAL DISEASE. the difficulty of curing madne,ss which commences after the age of forty, and the like. And as there was no superstition in these doctrines, so there was no harharism in his treatment, which was medical, and consisted principally in evacuation by the use of hellebore. But moral treatment was not unknown among the Greeks; for Asclepiades, who seems to have been the real founder of a psychical mode of cure, made use of love, wine, music, employment, and special means to attract the attention and exercise the memory. He recommended that bodily restraint should be avoided as much as possible, and that none but the most dangerous should be confined by bonds. Without going further into par- ticulars, enough has been said to show that the Greeks had acquired accurate notions of madness as a disease, which was to be cured by appropriate medical and moral treatment. How came it to pass that these enlightened views ever fell into oblivion ? The question is really only a part of the larger question, how it came to pass that the high aesthetic culture and brilliant intellectual development of the Grecian era, which might have seemed possessions of mankind for ever, were lost in the darkness and barbarism of the middle ages. To trace the causes of this so sad decline would be far beyond my present purpose ; suffice the fact that philosophy, which had mounted so high, was for a time sunk so low beneath the waves of superstition and ignorance, that it might well have never been in existence. And when at last a revival of learning took place, things were little better; empty scholastic subtleties EFFECTS OP THE THEOLOGICAL SPIRIT. V and metaphysical mysticism engaged the whole attention of men, who rivalled one another in verbal disputations, without agreement in the meaning of the terms they used, and in blind worship of the authority of Aristotle, without real regard to the true method of his philosophy or to the facts with which it dealt. As if knowledge were nothing more than a process of ingenious excogitation, they made no attempt to observe the phenomena of Nature, and to search out the laws governing them, but laboriously " invoked their own spirits to utter oracles to them ; " wherefore philosophy was little more than a web of un- meaning terms and of empty metaphysical subtleties. With this sort of intellectual activity was joined, as the result of the detestable spirit which inspired monastic teaching and monastic practice, a harsh religious asceti- cism, through which the body was looked down upon with contempt, as vile and despicable, the temple of Satan, the home of the fleshly lusts which war against the soul, and as needing to be vigilantly kept in subjection, to be crucified daily with its affections and lusts. It was the earthly prison-house of the spirit whose pure im mortal longings were to get free from it. Such was the monstrous doctrine of the relation of mind and body. What place could a rational theory of insanity have in such an atmosphere of thought and feeling ? The con- ception of it as a disease was impossible : it was ascribed t5 a supernatural operation, divine or diabolical, as the case might be — was a real possession of the individual by some extrinsic superior power.* If the ravings of the * The most learned physicians only put the devil a step further back, 10 EESPONSIBILITy IN MENTAL DISEASE person took a religious turn, and his life was a fanatical practice of some extraordinary penance— if, like St. Macarius, he slept for months together in a marsh, exposing his naked hody to the stings of venomous flies, — or, like St. Simeon Stylites, he spent the greater part of his life on a pillar sixty feet high, — or, like St. Anthony, the patriarch of monachism, he had never, in extreme old age, been guilty of washing his feet, — ^he was thought to have reached the ideal of human excellence, and was canonized as a saint ; more often his state was deemed to be a possession by the devil or other evil spirit, or the degrading effect of a soul enslaved by sin; from some cause or other he was a just victim of divine displeasure, and had been cast down in consequence from his high human estate. It was the natural result of such views of madness that men should treat him whom they believed to have a devil in him as they would have treated the devil could they have had the good fortune to lay hold of him. When he was not put to death as a heretic or a criminal, he was confined in a dungeon, where he lay chained on straw ; his food was thrown in, and the straw raked out through the bars ; sight-seers went to see him, as they went to see the wild beasts, for amusement; he was cowed by the whip, or other instrument of punishment, and was more neglected and worse treated than if he had been a wild beast. Many insane persons, too, were ackDowledging "such a preparation and disposition of the body through distemper of humours, -which giveth great advantage to the devU to work upon ; which distemper being cured by physical drugs and potions, tjie devil is driven away, and hath no more power over the same bodies." EFFECTS OF THE METAPHYSICAL SPIEIT. 11 without doubt executed as witches, or as persons who had, through witphcraft, entered into compact with Satan. It is a striking illustration, if we think of it, of the con- dition of thought at that time, and of the great change \yhich has taken place since, that such expressiops as the black art, witchcraft, diabolical possession, and the like, have fallen entirely out of use, and would be thought to convey no meaning if they were used now. They were fictitious causes invented to account for facts many of which undoubtedly lay within the domain of madness. Now it is a fact, abundantly exemplified in human history, that a practice often lasts for a long time after the theory which inspired it has lost its hold on the belief of mankind. No wonder, then, that the cruel treatment of the insane survived the belief in diabolical possession, though it is justly a wonder that it should have lasted into this century. The explanation of the seeming anomaly is to be sought, I believe, in the purely metaphysical views of mind which prevailed long after inductive science had invaded and made conquests of other departments of nature. Theology and metaphysics, having common interests, were naturally drawn into close alliance, in order to keep entire possession of the domain of mind, and to withstand the progress of inductive inquiry. .With the notions they cherished of the nature of mind, and of its relations to body, it was thought impossible, and would have been denounced as sacri- legious, to enter upon the study of it by the way of physical research. To have supposed that the innermost sanctuary of nature could be so entered through the 12 EESPONSIBILITY IN MENTAL DISEASE. humble portals of bodily functions, would have been re- garded as an unwarrantable and unholy exaltation of the body, which was full of all uncleanness, corruptible, of the earth earthy, and a gross degradation of the mind, which was incorruptible, of the heaven heavenly, and joint partaker of divine immortality. Whosoever had dared to propound such a doctrine would assuredly have been put to death as a blasphemer and a heretic. And yet he ought to have been hailed as a benefactor. It is impossible to say of any false belief which mankind have had that it has been the most pernicious in its effects ; but we may truly say of the theological notion of the relations of mind and body that it has been surpassed by few false doctrines in the evil which it has worked. The spirit of metaphysical speculation was scarcely less hostile to physical researches into mental function. For when inquirers had struggled successfully out of mere verbal disputation, and had applied themselves to the observation of mental phenomena, the method used was entirely one-sided; it was a system of mental introspection exclusively, each one looking into his own mind and propounding as philosophy what he thought he observed there ; the external observation of mind in all its various manifestations, and of the bodily conditions of all mental action, was ignored. When all knowledge of mental action was gained in this way by observation of self-consciousness, men naturally formed opinions from their own experience which they applied to the mental states of insane persons ; feeling that they themselves had a consciousness of right and wrong, and a power of EITECTS OF THE METAPHYSICAL SPIRIT. 13 will to do the right and forbear the wrong, they never doubted that madmen had a like clearness of conscious- ness and a like power of will— that they could, if they would, control their disorderly thoughts and acts. The dungeon, the chain, the whip, and other instruments of punishment were accordingly in constant use as means of coercion ; the result being that exhibitions of madness were witnessed which are no longer to be seen, " because they were not the simple product of malady, but of malady aggravated by mismanagement." What with the theological . notion of madness as a work of Satan in the individual, and what with the erroneous views of it subsequently begotten of the metaphysical spirit, it came to pass that the barbarous system was abolished only within the memory of men yet living. In sad truth may it be said that> so far as a knowledge of the nature of mental disease and of the proper mode of its treat- ment is concerned, mankind owe no thanks, but, on the contrary, much error and infinite human suffering, to theology and metaphysics. It was when men recognized insanity as a disease, which, like other diseases, might be alleviated or cured by medical and moral means — when they regained the standpoint which the ancient Grecians, had held-r-that they began the stniggle to free themselves in this matter from the bondage of false theology and mischievous metaphysics. But the emancipation is not yet com- plete. In many quarters there is the strongest desire evinced, and the most strenuous efforts are made, to exempt from physical researches the highest functions 2 14 BESPONSIBILITY IN MENTAL DISEASE. of mind, and particularly the so-called moral sense and the will ; while the old metaphysical spirit still inspires the criterion of responsihility which is sanctioned and acted upon by courts of justice in cases of insanity. If a madman be supposed to know he is doing wrong, or doing that which is contrary to law, when he does some act of violence, he is held to be not less responsible than a sane person. The conclusions reached by the observa- tions of self-consciousness in a sane mind are strictly applied to the phenomena of diseased mind ; not other- wise than as if it were solemnly enacted that the disorder and violence of convulsions should be measured by the order and method of voluntary movements, and that whosoever, being seized with convulsions, and knowing that he was convulsed, transgressed that measure, should be punished as a criminal. The unfortunate sufferer, or others on his behalf, might, it is true, innocently argue that the very natxire of convulsions excluded the idea of full voluntary control; but the metaphysical in- tuitionist would rejoin that it was certain from experience that man has a power of control over his movements ; that the convulsive movements were a clear proof to all the world that he had not exercised that power ; and that his convulsions, therefore, were justly punishable as crime. This pathological comparison is scientifically just, and its justness has oftentimes received terribly striking illustration in the effects of the legal criterion of responsibility ; for it is certain that in conformity with it many persons unquestionably insane, who have done homicide, not because they w&uld not, but because they MIND A FUNCTION OP THE BEAIN. 15 could not, exercise efficient control, have been, and still from time to time are, executed as simple criminals. Harsh and exaggerated as this statement might seem, there is not, I believe, in this or any other civilized country a physician, practically acquainted with the insane, who would not unhesitatingly endorse it. No one now-a-days who is engaged in the treatment of mental disease doubts that he has to do with the dis- ordered function of a bodily organ— of the brain. What- ever opinion may be held concerning the essential nature of mind, and its independence of matter, it is admitted on all sides that its manifestations take place through the nervous system, and are affected by the condition of the nervous parts which minister to them. If these are healthy, they are sound; if these are diseased, they are unsound. Insanity_is, in fact, disorder of brain pro- du&i»g" disc^der of miridf'^or^ to define its nature in greater— detail, it Is a disorder of the supreme nerve- centres of the brain— the special organs of mind— pro- ducing_.d^ran^ement_„.Qf_tiiought, feeling, and^ .action, togethgE..,or separately, -of- such ctegree or kind^_ as to incapacitaie-the.iijdividual for the relations of^Hie.* TEe opinion that insanity is a disease of the so-called immaterial part of our nature we may look upon as ex- ploded even in its last retreat. The arguments that have been adduced in favour of it — ^first, that madness is pro- . duced. sometimes by moral causes, and, secondly, that it is • Mind may be defined physiologically as a general term denoting the sum total of those functions of the brain which are known as thought, feeling,, an d will . By disorder of mind is meant disorder of^hose functions. " 16 -EKSPONSIBILITY IN MENTAL DISEASE, cured sometimes by moral means — are entirely consistent with the theory of material disease, while the arguments in favour of the maiefiansGcTheory are quite incon- sistent with the spiritualistic Hypothesis, which has the further disadvantage of not being within the range of rational human conception. To the argument that madness is produced sometimes by moral caiises, which must be admitted, it is sufficient to reply, first, that long-continued or excessive stimu- lation of any organ does notably induce physical disease of it, and that in this respect, therefore, the brain only obeys a general law of the organism ; and, secondly, that it is possible to produce experimentally, by entirely physical causes, mental derangement exactly similar to /that which is produced by moral causes. There are many facts which would justify us in laying it down as a generalization of inductive mental science, that a state of consciousness may be changed experimentally by agents which produce changes in the molecular constitution of those parts of the nervous system which minister t6 the manifestations of consciousness. Take, for example, the way in which, by the administration of opium or haschisch, we modify in a remarkable manner a person's conceptions of space and time and of other relations. To the second argument in favour of the immaterial nature of unsound mind, which is founded on the distinctly curative influence of moral treatment, the easy reply is, that moral means are beneficial in insanity by yielding repose to parts much needing repose, and by stimulating to activity parts much needing to be active ; by yielding repose to PHYSIOLOGICAL INQUIET INDISPENSABLE. 17 morbid thought and feeling, and by rousing into action healthy thought, feeling, and will. The aim of the physician in the treatment of insanity is to bring the means at his command to bear, directly or indirectly, on the disordered.^nei:»e''element. But, in striving to do this, he soon learns with how many bodily organs and functions he has really to do. To call mind a function of the brain may lead to much misapprehension, if it be thereby supposed that the brain is the only organ which is concerned in the function of mind. Th^re-is / not an organ in th e_bodywhich is not in intimate rela- /tion with the brain by means of its paths ^ nervous communication, which has not, so to speak, a special ^Correspondence with it through internuncial fibres, and which does not, therefore, aifect more or less plainly and specially its function as an organ of mind. It is not merely that a palpitating heart may cause anxiety and apprehension, or a disordered liver gloomy feelings, but there are good reasons to believe that each organ has its specific influence on the constitution and function of mind ; an influence not yet to be set forth scientifically, because it is exerted on that unconscious mental life which is the basis of all that we consciously feel and think. Were the heart of one man to be placed in the body of another it would probably make no dif- ference in the circulation of the blood, but it might make a real diflJerence in the temper of his mind. So close is the physiological sympathy of parts in the commonwealth of the body, that it is necessary in the physiological study of mind to regard it as a function 18 RESPONSIBILITY IN MENTAL DISEASE. of the whole organism, as comprehending the whole bodily life. It has been one of the results of the study of morbid mental action to make clear the importance of recognizing the influence of particular organs upon the constitution and function of mind. Pathological instances of pertur- bation of function have yielded intimations which we should have failed to obtain by observation only of the smooth and regular action of the. organism in health; and we can now say with the utmost confidence that although the mind may be studied by the psychological method of observing self-consciousness, it cannot be investigated fully by that method alone. As it was in time past, so in time to come error, confusion, and contradiction must flow from so exclusive and insufficient a method. In consequence of the theological and meta- physical views of mind, and of the way in which it was kept isolated from all other subjects of human inquiry, the phenomena of disordered mental action were, until quite recently, as much neglected by mental philosophers as the insane patients who exhibited them were neglected by those who had the care of them. It seems never to have occurred to metaphysicians that these phenomena could have any bearing on a philosophy of mind; certainty, had it done so, their exclusive method of inquiry would have proved singularly unfit for the observation of them ; and it is only recently, since the nature of insanity has been recognized, and the insane have been treated as sufl'erers from disease, that attempts have been syste- matically made to use the valuable material which they DEVELOPMENT OP NERVOUS SYSTEM BY EDUCATION- 19 furnish for the building up of an inductive mental science. Now, however, it may be laid down as an incontestable axiom, that the physiological method of study is essential to a scientific knowledge of mind, to a real acquaintance with its disorders, and to a successful treatment of them. Thus much it seemed necessary to say in order to clear the ground, and to define the position which I shall take in the following pages. But there is something more to be said before I go on to the consideration of the special matters which it is the aim of this book to treat of. Man is not, like some of the lower animals, born with the capacity of at once putting into full play his mental functions ; on the contrary, a long and patient education is necessary to develop the faculties with which he is endowed; such education being on the physical side, be it noted, a gradual development of the nerve centres -which minister to mind and its manifesta- tions. It costs him much practice before he learns to walk and to talk, while to think accurately is so hard a matter that many persons go to their graves without ever having acquired the power of doing so. When injury or disease has destroyed that part of the brain which ministers to the expression of ideas in speech, as in the condition of disease known as aphasia, the person must slowly learn again to talk his own language ; he is like a child learning to speak, or like one who is learning to talk a foreign language ; he must educate another por- tion of brain to do the work which the damaged portion can no longer do. 20 EESPONSIBILITT IN MENTAL DISEASE. So much in human development being due to educa- tion, it is evident that the training which a person undergoes must have a great influence on the growth of his intellect and the formation of his character. What he shall be and what he shall do will be determined in great measure by what has been done to bring into full activity the capabilities of his nature. But great as is the power of education, it is yet a sternly limited power; it is limited by the capacity of the individual nature, and can only work within this larger or smaller circle of necessity. No training in the world will avail to elicit grapes from thorns or figs from thistles ; in like manner, no mortal can transcend his nature ; and it will ever be impossible to raise a stable superstructure of intellect and character on bad natural foundations. Education can plainly act only, first, within the conditions imposed by the species, and, secondly, within the con- ditions imposed by the individual organization : can only, in the former case, determine what is predetermined in the organization of the nervous system and of the bodily machinery in connection with it — cannot, for ex- ample, ever teach a man to fly like a bird, or see like an eagle, or run like an antelope ; can only again, in the latter case, make actual the potentialities of the indi- vidual nature — cannot make a Socrates or a Shakspeare of every being born into the world. There was a foundation of fact, though not the fact of which he dreamed, in the speculations of the astrologer who believed that by observation of the star in the ascendant at the time of a mortal's birth he might predict THE TYBANNT OF ORGANIZATION. 21 his destiny. He was conscious of a fate in human life, but he failed to see that it was the fate made for a man by his inheritance. No power of microscope or chemistry, no power which science can make use of, will enable us to distinguish the human ovum from the ovum of a quadruped ; yet it is most certain that the former has inherited in its nature something whereby it developes under suitable conditions into the form of man, and that the latter has in like manner inherited something whereby it developes under suitable conditions into the form of a quadruped. Not only has the human ovum this destiny of the species in its nature, but each particular ovum has an individual inheritance which makes for it an indi- vidual destiny. Men are in much alike, but each indi- vidual differs in some respects from any other individual who now exists, or, it may be confidently assumed, ever has existed or ever will exist. And this is not a difference which is due to education or circumstances, but a fundamental difference of nature which neither education nor circumstances can eradicate. Let two persons be placed from birth in the same circumstances and subjected to the same training, they would not in the end have exactly the same pattern and capacity of mind any more than they would have the same pattern of face : eacli is under the dominion of the natural law of evolution of the antecedents of which he is the conse- quent, and could no more become the other than an oak could become an elm if their germs were planted in the same soil, warmed by the same sun, and watered by the 22 EESPONSIBtLITY IN MENTAIi DISEASE. same showers : each would display variations which by the operation of natural selection would issue finally in distinct varieties of character. There is a destiny made for a man by his ancestors, and no one can elude, were he able to attempt it, the, tyranny of his organization. The power of hersmaxy4ia&vL&nc& in determining an individual's nature, which when plainly stated must needs appear a truism, has been more or less distinctly recog- nized in all ages. Solomon proclaimed it to be the special merit of a good man that he leaves an inheritance to his children's children ; on the other hand, it has been declared that the sins of the . father shall be visited upon the children unto the third and fourth generations. Not that the failing of the father shall necessarily show in the children either in the same form or in any recognizable form ; it may undergo transformation in the second gene- ration, or may be entirely latent in it, not coming to the surface in any form until the third or fourth generation. But it will run on in the stream of family descent, some- times appearing on the surface, sometimes hidden beneath it, until, on the one hand,.it is either neutralized by the beneficial influences of wise intermarriages, or, on the other hand, reaches a pathological evolution which entails the decay and extinction of the family. It was a proverb in Israel that when the fathers have eaten sour grapes the children's teeth are set on edge ; and it was deemed no marvel that those whose fathers had stoned the prophets should reject Him who was gent unto them — " Ye are the children of those who stoned the prophets." The institution of caste HEREDITARY INFLUENCE. 23 among the Hindoos appears to have owed its origin to a recognition of the large play of hereditary in- fluence in human development; and that dread, inexor- able destiny, which has so great and grand a part in Grecian tragedy, and which Grecian heroes manfully con- tended against, although fore-knowing that they were inevitably doomed to defeat, was in some degree an em- bodiment of the deep feeling of the inevitable dependence of a man's present being on his antecedents in the past. " Bless not thyself only," says the author of the Eeligio Medici, " that thou wert born in Athens ; but, among thy multiplied acknowledgments, lift up one hand to heaven, that thou wert born of honest parents, that modesty, humility, and veracity, lay in the same egg, and came into the \rorld with thee. From such foundations thou may'st be happy . in a virtuous precocity, and make an early and long walk in goodnesg ; so may'st thou more naturally feel the contrariety, of vice unto nature, and resist some by the antidote of thy temper." When we observe what care and thought men give to the selective breed- ing of horses,, cows, and dogs, it is astonishing how little thought they take about the breeding of their own species : perceiving clearly that good or bad qualities in animals pass by hereditary transmission, they act habitually as if the same laws were not applicable to themselves ; as if men could be bred well by accident ; as if the destiny of each criminal and lunatic were determined, not by the operation of natural laws, but by a special dispensation too high for the re^ch of . human inquiries. When will man learn that he is at the head of nature only by virtue of the 24 EESPONSIBtLITI IN MENTAL DISEASE. operation of natural laws ? When will he learn that by the study of these laws and by deliberate conformity to them he may become the conscious framer of his own destiny ? Notwithstanding that the influence of hereditary ante- cedents upon the character of the individual has been admitted by all sorts and conditions of men, its important bearing upon moral responsibility has not received the serious consideration which it deserves. Laws are made and enforced on the supposition that all persons who have reached a certain age, arbitrarily fixed as the age of discretion, and are not deprived of theii" reason, have the capacity to know and obey them ; so that when the laws are broken, the punishment inflicted is in proportion to the nature of the offence and not to the actual moral responsibility of the individual. The legislator can know nothing of individuals ; he must necessarily assume a uniform standard of mental capacity so far as a know- ledge of right and wrong, and of moral power so far as resistance to unlawful impulses, are concerneii ; exceptions being made of children of tender age and of persons of unsound mind. There can be no question, however, that this as- I sumption is not in strict accordance with facts, and ' that there are in reality many persons who, without being actually imbecile or insane, are of lower moral responsibility than the average of mankind; they have been taught the same lessons as the rest of mankind, and have a full theoretical knowledge of them, but they have not really assimilated them ; the principles inculcated MOEAL EESPONSIBILITT. 25 never gain that hold of their minds which they gain in a sound and well-constituted nature. After all that can be said, an individual's nature will only assimilate, that is, will only make of the same kind with itself j what is fitted to further its special development, and this it will by a natural affinity find in the conditions of its life. To the end of the chapter of life the man will feel, think, and act according to his kind. The wicked are not wicked by deliberate choice of the advantages of wickedness, which are a delusion, or of the pleasures of wickedness, which are a snare, but by an inclination of their natures which makes the evil good to them and the good evil : that they choose the gratification of a present indulgence, in spite of the chance or certainty of future punishment and suffering, is often a proof not only of a natural affinity for the evil, but of a deficient understanding and a feeble will. The most sober and experienced prison officials are driven sooner or later to a conviction of the hopeless- ness of reforming habitual criminals. " The sad realities which I have contemplated," says Mr. Chesterton, " com- pel me to aver that at least nine-tenths of habitual depre- dators have no desire or intention to forsake their guilty course. They love the vices in which they have revelled. . . . 'Lord, how I do love thieving ; if I had thousands I would still be a thief,' I heard a youth exclaim on one occasion." * • It was the opinion of Plato that the wicked owe their wickedness to their organization and education, so that not they but their parents and instructors should be • B«velatioiis of Prison Life. By G. L. Chesterton. 26 RESPONSIBILITY IN MENTAL DISEASE. blamed; and other eminent philosophers, among whom Hippocrates is included, have maintained that there was no vice hut was the fruit of madness. "No man doth sin, but he is possest in some degree ; it is good divinity," says the learned Casaubon.* To uphold such a doctrine now-a-days would be thought a perilous thing to society, as removing from the wicked man the salutary fear of the penal consequences of his actions, which operates to turn him from his wickedness and to make him do that which is lawful and right. And yet, if the matter be considered deeply, it may appear that it would, perhaps, in the end make little difference whether the offender were sentenced in anger and sent to the seclusion of prison, or were sentenced more in sorrow than in anger, and consigned to the same sort of seclusion under the name of an asylum. The change would probably not lead either to an increase or to a decrease in the number of crimes committed in a year. It will be said, however, that if crime were con- sidered to be the fruit of madness, it would be wrong to punish an offender at all; he ought rather to be pitied and kindly cared for. But do we not in reality punish insanity, however little we may wish to do so ? The measures which are necessarily adopted for the proper care of the insane and for the protection of others are a punishment. It is a punishment, or at any rate it is the infliction of what they for the most * A Treatise concerning Enthusiasme, as it is an Effect of Nature ; but is mistaken by many for either Divine Inspiration or Diabolical Possession. By Metic Casaubon, D.D. THE CEIMINAL NATURE. 27 part regard as grievous suffering, to deprive them of liberty by confining them in asylums and to subject them to the disciphne of such establishments. More- over, it is unquestionably the best treatment to induce an insane person to work if he is fit to work, and there can be little doubt that there would be more recoveries from insanity than there are in our asylums if more work could be systematically enforced in them. Indeed, it is not improbable that the old, harsh and inhumane system of treating the insane was effectual in bringing back to their senses some few who, under the modem indulgent system, have no motives excited in their minds sufficiently powerful to induce them to make those efforts at self-control which are often the beginning of recovery. In like manner, though the criminal might be compassionated, it would still be necessary to deprive him of the power of doing further mischief; society has clearly the right to insist on that being done ; and though he might be kindly cared for, the truest kindness to him and others would still be the enforcement of that kind of discipline which was best fitted to bring him, if possible, to a healthy state of mind, even if it were hard labour within the measure of his strength. If we are satisfied that our prison-system is the best that can be devised for the prevention of crime and the reformation of the criminal, we may rest satisfied that it is the best treat- ment for the sort of insanity from which criminals suffer. No fear therefore of the practical ill consequences to society need deter us from looking on criminals as the unfortunate victims of a vicious organization and a bad ^P RESPONSIBILITY IN MENTAL DISEASE. education. But what in this age it would seem right that we should do, is to get rid of the angry feeling of retaliation which may be at the bottom of any judicial punishment, and of all penal measures that may be inspired by such feeling. Society having manufactured its criminals has scarcely the right, even if it were wise for its own sake, to treat them in an angry spirit of vengeance. Not until comparatively lately has much attention been given to the way in which criminals are produced. It was with them much as it was at one time with lunatics : to say of the former that they were wicked, and of the latter that they were mad, was thought to render any further explanation unnecessary and any further inquiry superfluous. It is certain, however, that lunatics and criminals are as much manufactured articles as are steam- engines and calico*printing . machines, only the processes of the organic manufactory are so complex that we are not able to follow them. They are neither accidents nor anomalies in the universe, but come by law and testify to causality ; and it is the business of science to find out what the causes are and by what laws they work. There is nothing accidental, nothing supernatural, in the impulse to do right or in the impulse to do wrong ; both come by inheritance or by education ; and science can no more rest content with the explanation which attributes one to the grace of Heaven and the other to the malice of the devil, than it could rest content with the explanation of insanity as a possession by the devil. The few and imperfect investigations of the personal THE PEODUCTION OP CRIMINALS. 29 and family histories of criminals which have yet been made are sufficient to excite some serious reflections. One fact which is brought stroiigly out by these inquiries is that crime is often hereditary^ that just as a man may inherit the stamp of the Bodily features and characters of his parents, so he may also inherit the impress of their evil passions and propensities : of the true thief as of the true poet it may be indeed said that he is born, not made. This is what observation of the phenomena of hereditary action would lead us to expect ; and although certain theologians, who are prone to square the order of nature to their notions of what it should be, may repel such a doctrine as the heritage of an immoral in place of a moral sense, they will in the end find it im- possible in this matter, as they have done in other matters, to contend against facts. To add to their misfortunes, many criminals are not only begotten, and conceived, and bred in crime, but they are instructed in it from their youth upw^irds, so that their original criminal instincts acquire a power which no subsequent efiforts to produce reformation will ever counteract. All persons who have made criminals their study, recognize a distinct criminal class of beings, who herd together in our large cities in a thieves' quarter, giving themselves up to intemperance, rioting in debauchery, without regard to marriage ties or the bars of consan- guinity, and propagating a criminal population of de- generate beings. For it is furthermore a matter of observation that this criminal class constitutes a de- generate or morbid variety of mankind, marked by 30 EESPONSIBILITr IN MENTAL DISEASE. peculiar low physical and mental characteristics. They are, it has been said, as distinctly marked off from the honest and well-bred operatives as " black-faced sheep are from other breeds," so that an experienced detective officer or prison official could pick them out from any promiscuous assembly at church or market.* Their family likeness betrays them as fellows " by the hand of nature marked, quoted and signed to do a deed of shame." They are scrofulous, not seldom deformed, with badly-formed angular heads ; are stupid, sullen^ sluggish, deficient in vital energy, and sometimes afflicted with epilepsy. As a class, they are of mean and defective in- tellect, though excessively cunning, and not a few of them are weak-minded and imbecile.t The women are ugly in features, and without grace of expression or movement. The children, who become juvenile criminals, do not evince the educational aptitude of the higher industrial classes : they are deficient in the power of attention and applica- tion, have bad memories, and make slow progress in learning ; many of them are weak in mind and body, and some of them actually imbecile. Mr. Bruce Thomson, * The Hereditary Nature of Crime. By J. B. Thomson. Journal of Mental Science, vol. xv., p. 487. t The mendicant thiefs are well known to prison officials as a class of person's of weak intellect, who tramp through the country, prowling about the different houses, and begging or stealing as the opportunity offers ; and it is by them that arson, rape, and other crimes are often perpetrated. In the county of Cumberland, a few years ago, the practice of committing them to prison as soon as they crossed the border was enforced. The direct result was a considerable increase in 'the number of admissions into the county asylum, to which they were transferred from gaol as being persons of imbecile or unsound inind. THE PRODUCTION OP CEIMINALS. 31 who in his official capacity as surgeon to the General Prison of Scotland had observed thousands of prisoners, declared that he had. not knowii one to exhibit any aesthetic talent; he had never seen a pen -sketch, a clever poem, or an ingenious contrivance produced by one of them.* Habitual criminals are, he says, without moral sense — are true moral imbeciles ; their moral insensibility is such that in the presence of temptation they have no self-control against crime; and among all the murderers he had known, amounting to nearly five hundred, only three could be ascertained to have expressed any remorse. He quotes among other testimonies to a like effect the opinion of a medical friend, a shrewd observer of men, much conversant with lunacy, and having had a long ex- perience among prisoners, who declared himself mainly impressed with their extreme deficiency or perversion of moral feeling, the strength of the evil propensities of their natures and their utter impracticability. " In all my ex- perience I have never seen such an accumulation of morbid appearances as I witness in the post mortem examinations of the prisoners who die here. Scarcely one of them can be said to die of one disease, for almost every organ of the body is more or less diseased ; and the wonder to me is that life could have been supported in such a diseased frame. Their moral nature seems equally diseased with their physical frame; and whilst their mode of life in prison reanimates their physical health, I doubt whether their minds are equally benefited, it * In this, however, his experience must have been singular; for other prison officers have not observed these deficiencies. 82 EESPONSIEILITY IN MENTAL DISEASE. improved at all. On a close acquaintance with criminals, of eighteen years' stan,ding, I consider that nine in ten are of inferior intellect, hut that all are excessively cunning." * We may accept then the authority of those who have studied criminals, that there is a class of them marked by defective physical and mental organization, one result of their natural defect, which really determines their destiny in life, being an extreme deficiency or complete absence of moral sense. In addition to the perversion or entire absence of moral sense, which experience of habitual criminals brings prominently out, other important facts disclosed by the investigation of their family histories are, that a considerable proportion of them are weak-minded or epileptic or become insane, or that they spring from families in which insanity, epilepsy, or some other neu- rosis exists, and that the diseases from which they suffer and of which they die are chiefly tubercular diseases and diseases of the nervous system. Grime is a sort of outlet in which their unsound tendencies are discharged ; they would go mad if they were not criminals, and they do not go mad because they are criminals. Crime is not then in all cases a simple affair of yielding to an evil impulse or a vicious passion, which might be checked were ordinary control exercised; it * " As in all families or races wliero physical degeneration is found, so among the criminal class we have very often abnormal states — such as spinal deformities, stammering, imperfect organs of speech, club-foot, cleft-palate, hare-lip, deafness, congenital blindness, paralysis, epilepsy, and scrofula. These usually accompany congenital weakness of mind." — Mr. Bruce Thomson, he. cit. DEFECTIVE MENTAL OEGANIZATION. 33 is clearly sometimes the result of an actual neurosis which has close relations of nature and descent to other neuroses, especially the epileptic and the insane neuroses ; and this neurosis is the physical result of physiological laws of production and evolution. No wonder that the criminal psychosis, which is the mental side of the neurosis, is for the most part an intract- able malady, punishment being of no avail to produce a permanent reformation. The dog returns to its vomit and the sow to its wallowing in the mire. A true reformation would be the re-forming of the individual nature ; and how can that which has been forming through generations be re-formed within the term of a single life ? Can the Ethiopian change his skin or the leopard his spots ? Thus then when we take the most decided forms of human wrong-doing, and examine the causes and nature of the moral degeneracy which they evince, we find that they are not merely subjects for the moral phi- losopher and the preacher, but that they rightly come within the scope of positive scientific research. The metaphysical notion of man as an abstract being endowed with a certain fixed moral potentiality to do the right and eschew the wrong, is as little applicable to each human being bom into the world as the notion of a certain fixed intellectual power would be applicable to each being, whether of good mental capacity, imbecile or idiot. There are, as natural phenomena, manifold gradations of un- derstanding from the highest intellect to the lowest idiocy, and there are also, as natural phenomena, various 34 RESPONSIBILITY IN MENTAL DISEASE. degrees of moral power between the highest energy of a well-fashionenl will and the complete absence of moral sense. Nor are intellect and moral power so depen- dent mutually as necessarily to vary together, the one increasing and decreasing as the other increases and decreases : experience proves conclusively that there may be much intellect with little morality and much morality with little intellect. There is a borderland between crime and insanity, near one boundary of which we meet with something of madness but more of sin, and near the other boundary of which something of sin but more of madness. A just estimate of the moral responsibility of the unhappy people inhabiting this borderland will assuredly not be made until we get rid of the metaphysical measure of responsibility as well as of the theological notion that vices and crimes are due to the instigation oi the devil, and proceed by way of observation and induction to sound generalizations concerning the origin of the moral sentiments, the laws of their development, and the causes, course and varieties of moral degeneracy. Here as in other departments of nature our aim should be the dis- covery of natural laws by patient interrogation of nature, not the invention of theories by invoking our own minds to utter oracles to us. It must be received as a scientific axiom that there is no study to which the inductive method of research is not applicable ; every attempt to prohibit such research by authority of any kind must be withstood and repelled with the utmost energy as a deadly attack upon the fundamental principle of scientific INDUCTIVE METHOD OF STUDY. 35 inquiry. With a better knowledge of crime, we may not come to the practice of treating' criminals as we now treat insane persons, but it is probable that we shall come to other and more tolerant sentiments, and that a less hostile feeling towards them, derived from a better know- ledge of defective organization, will beget an indulgence at any rate towards all doubtful cases inhabiting the borderland between insanity and crime ; in like manner as within living memory the feelings of mankind with regard to the insane have been entirely revolutionized by an inductive method of study. There are advantages in recognizing a just principle even when events are not ripe enough for its application, when it looks Utopian and excites the derision of practical men ; for it slowly modifies feelings and ideas, acts as a solvent of prejudices, and, notwithstanding seemingly insuperable difficulties, tends by hardly perceptible degrees to its realization in action. Tht sincere recognition of it is, as it were, a prophecy which finally brings about its own fulfilment: the Utopian idea of one age becoming often the common-place idea of a succeeding age. NOTE. The following account ia quoted by Casaubon in his Treatise concerning Enthusiasm from Joseplius Acosta. I append it as a striking illustra- tion of the way in which madness was sometimes innocently dealt with in the days of Acosta : — "There was (saith Acosta) in this very Xingdome of Peru (where himself was once Prsepositus Generalis), a man of great esteem in those dayes, a learned Divine and Professor (or Doctor) of Divinity. The same also accounted religious and orthodox : yea in a manner, the oracle, for his time, of this other world (America). This man being grown familiar with a certain muliercula (or, plain woman), which as another FhUumena or MaximUla that Montanus carried about, 36 EESPONSIBrLITT IN MENTAL DISEASE. boasted of lier self, that she was taught by an Angel certain great mysteries; and would also fall (or feign it at least) into trances and raptures, which carried her quite beside herself: he was at last so bewitched and captivated by her, that he did not stick to referre unto her concerning highest points of Divinity : entertain her aaswers, as oracles ; blaze her abroad, as a woman full of revelations, and very dear unto God ; though in very deed a woman, as of mean fortune, so of as mean a capacitie otherwise, except it were to forge lies. This woman then, whether really possest of the Devil, which is most likely, because of those ecstasies ; or whether she acted it with art and cunning, as some learned men suspected ; because she told him strange things con- cerning himself, that should come to passe, which his phansie, made yet greater : he did certainly the more willingly apply himself unto her, to be her disciple, whose ghostly Father he had been before. To be short ; he came at last to that, that he would take upon himself to do miracles, and did verily think that he did, when in very deed there was no ground at all for any such thought. For which, and for certain pro- positions contrary to the Faith, he had received from his Prophetesse, he was at last, by order of the Judges of the holy Inquisition, to the great astonishment of this whole kingdome, apprehended, and put in prison : where for the space of five years he was heard, tolerated, examined, until at last his incomparable pride and madnesse was made known unto all men. For whereas he pretended with all possible con- fidence and pertinacity, that he had a private angel, of whom he learned whatsoever he desired ; yea that he had been intimate with God Him- self, and conferred with him personally ; he would utter such fopperies as none would believe could proceed from any that were not stark mad : yet in very truth, the man was in perfect sense, as to soundnesse of brain ; as perfect as I myself can think myself, at this time now writing of him. Very sadly and soberly therefore he would affirm, that he should be a King : yea, and Pope too ; the Apostolical See being trans- lated to those parts : as also that holinesse was granted unto him above all angels, and heavenly hosts, and above aU apostles : yea that God had made profer unto him of hypostatical union, but that he refused to accept of it. • Moreover, that he was appointed to be Eedeemer of the ' world, as to matter of efficacy : which Christ, he said, had been no further then to sufficiency only. That all ecclesiastical estate was to be abrogated ; and that he would make new laws, plain and easie, by which the Coelibatus (or restraint of marriage) of Clergie-men shoiUd be taken away, multitude of wives allowed, and all necessity of confession {.voided. These things, and other things of that nature he would affirme with such earnest confidence, as we were all amazed, that any NOTE. 37 man could be in his right wits that held such opinions. In fine, after the examination of his actions, and heretical propositions, to the numi)er of a hundred and ten and upwards, either heretical all, or at least not agreeable to the sound doctrine of the Church ; as the manner of that High Court is, we were appointed to dispute with him, if possibly we might reduce him to sobriety. We were three in all, besides the Bishop of Quinto, that met before the Judges about it. The man being brought in, did plead his cause with that liberty and eloquence of speech, that I stand amazed to this day, that mere pride should bring a, man unto this. He acknowledged that his Doctrine, because above all humane reason, could not be proved but by Scripture and Miracles. As for Scripture ; that he had proved the truth of it by testimonies taken from thence, more clear and more pregnant than ever Paul had proved Jesus Christ to be the true Mcssias by. As for miracles ; that he had done so many and so great, that the Resurrection of Christ itself was not a greater Miracle. For that he had been dead verily and truly, and was risen again ; and that the truth of it had been made apparent \into all. All this while, though he had never a book in the prison, so that even his Breviary was taken away from him, he did quote places of Scripture out of the Prophets, the Apocalyps, the Psalms, and other books, so many and so long, that his very memory caused great admiration. But these places he did so apply to his phansies, and did so allegorize them, that any that heard him must needs either weep or laugh. But lastly, if we did yet require miracles, that he was ready' to be tried by them. And this he spake as either certainly mad himself, or accounting us all mad. For that by revelation it was come to his knowledge, he said, that the Serenissimus John of Austria was vanquished, by the Turks upon the seas : that Philip the most puissant king of Spain, had lost most part of his kingdom : that a Council was held at Kome, about the deposition of Pope Gregory, and anpther to be chosen in his place. That he told us these things, whereof we had had. certain intelligence, because we might 1)6 sure that they could not be known unto himself, but by immediate divine revelation. All which things, though they were so false that nothing could be more, yet still were they affirmed by him, as certainly known xmto us. But at last, having disputed with him two dayes to no effect at all; being led out with some others (as the fashion is in Spain) to be made a publick Spectacle ; he ceased not to look up to Heaven, expecting (as it seems the Devil had promised him,) that fire would come to consume both Inquisitors and spectators all. But in very deed, no such fire came from above ; but a flame came from below, which seized upon this pretended King, and Pope, and Redeemer, and new Law-giver, and quickly did reduce him into ashes." 3 CHAPTER II. THE BORDERLAND. No distinct line of demarcation between sanity and insanity — Continuity in nature— The borderland— The insane temperament— Transforma- tion of nervous diseases — Kinship between insanity and epilepsy, neuralgia, chorea, dipsomania — Functional and organic diseases of the brain— Hereditary predisposition : its pathological evolution through generations — Originalities of idea, feeling and impulse in connection with it — Insanity and the prophetic mania — The prophets of the Old Testament — The epileptic nature of Mahomet's visions and revelations — The madman and the reformer— Eccen- tricity and insanity — Deficiency or absence of moral sense a congenitid fault of mental organisation- Crime and insanity — Moral sense : its acquisition in the course of evolution ; and its dependence upon organization— Physical conditions of morsil degeneracy — Conclusions. It would certainly be vastly convenient, and would save a world of trouble, if it were possible to draw a hard and fast line, and to declare that all persons who were on one side of it must be sane and all persons who were on the other side of it must be insane. But a very little consideration will show how vain it is to attempt to make such a division. That nature makes no leaps, but passes from one complexion to its opposite by gradations so gentle that one shades imperceptibly into another, and no one can fix positively the point of transition, is a sufficiently trite observation. Nowhere is this more true than in respect of sanity and in- sanity ; it is unavoidable therefore that doubts, disputes CONTINUITY IN NATUEE. 39 and perplexities should arise in dealing with particular cases. The matter is made worse by the strong tendency which there is in the human mind to believe that there are actual divisions in nature corresponding with the more or less arbitrary divisions which are necessarily made in the acquisition and classification of knowledge; whence comes either an aversion, conscious or uncon- scious, to admit frankly the existence of intermediate instances which cannot be duly marshalled in distinct classes, or a disposition so to exaggerate resemblances and to overlook differences as to force the rebellious instances into one class or another. It is vain, how- ever, to shut our eyes to facts, however inconvenient they may be to oiir systems of classification; and, in very truth, these cases that will not be classified, these intermediate steps, are often of excellent use, if rightly appreciated, in breaking, down the barriers of artifi- cial distinctions and bridging the gaps between them. Opinions that might seem almost as opposite as heaven and hell, and for which men fight unto death, have really a bridge of connection, though it may be abridge of many arches, which their furious defenders fail to see. It would be no exaggeration to declare that there is so much in common between a most virtuous and a most vicious man as would render it impossible- to attain to a scientific understanding of the nature of the one without a scientific understanding of the nature of the other. In the formation and verification of our generalizations it is almost as incumbent upon us to look carefully to the intermediate 40 EESPONSIBILITY IN MENTAL DISEASE. instances between two classes as it is not to overlook opposing instances. It is of great importance then to recognise a border- land between sanity and insanity, and of greater import- ance still, not resting content with a mere theoretical recognition of it, to study carefully the doubtful cases with which it is peopled. The bearing of such study on our opinions, though at- first it may seem to be to confound well-established distinctions, and to make uncertain what before seemed certain, cannot fail in the end to be most beneficial. Assuredly it is a fact of experience that there are many persons who, without being insane, exhibit peculiarities of thought, feeling and character which render them unlike ordinary beings and make them objects of remark among their fellows. They may or may not ever become actually insane,' but they spring from families in which insanity or other nervous disease exists, and they bear in their temperament the marks of their peculiar heritage : they have in fact a distinct neurotic temperament — a certain neurosis, and some of them a more specially insane tempierament — an insane neurosis. We are, it is true, yet without any exact knowledge of the ways of hereditary action, but there can be no doubt of the general fact that individuals do sometimes inherit a positive tendency to a particular nervous disease from which one or other of their parents or ancestors has suffered. The son of an insane person carries in his organization a distinctly greater liability to an out- break of insanity under the ordinary conditions of life KINSHIP BETWEEN INSANITY AND EPILEPSY. 41 than the son of perfectly sane parents; in saying that he has a hereditary predisposition to insanity we ex- press this fact which is attested hy general experience. Another fact of observation is that the offspring of persons who have suffered from some nervous disease frequently inherit a liability to the attack of some other nervous disease than that Which has given them their neurotic heritage : there is a kinship between nervous diseases by virtue of which it comes to pass that they undergo trans- formation through generations. The two diseases most closely related in this way are insanity and epilepsy; the descendant of an epileptic parent being almost if not quite as likely to become insane as to become epileptic, and one or other of the descendants of an insane parent not unfrequently suffering from epilepsy. In like manner neuralgia in the parent may manifest itself in the offspring in the form of a tendency to insanity, and every experienced physician knows that if he meets in practice with a case of violent neuralgia, which occurs from time to time in an obscure way, without any discoverable morbid cause, he may pre- dicate the existence of insanity in the family with almost as great confidence as if the patient were actually insane. How it is we know not, but so it is that a certain form of neuralgia owes its origin mainly to a neurotic inheritance. Chorea, again, which has been described fancifully as " an insanity of the muscles," is a nervous disease which exhibits sometimes a close relation of descent to insanity or epilepsy; and in children descended from 42 RESPONSIBILITY IN MENTAL DISEASE. families in which there has been much insanity we meet occasionally with diseased phenomena that seem to be hybrids between chorea and epilepsy, or between chorea and insanity, and which pass finally into one of these more definite ruts of convulsive action. It may be remarked here by the way that in calling epilepsy and chorea convulsive diseases, what we mean is, that they are diseases in which the nerve centres that pre- side over movements, being deranged, have lost that co-ordination and subordination which are manifest in their healthy functions, and display irregular, perverted and violent action. In like manner insanity might truly be described as a chorea or convulsive disease of the mind, the derangement being in nerve centres whose functions are not motor but mental, and whose derangements therefore display themselves in convulsions not of the muscles but of mind. Hence it is that instances oc- casionally present themselves in which the disorder is transferred suddenly from one set of nerve centres to another, the old symptoms ceasing and quite a new order of symptoms supervening. Thus, a severe neu- ralgia disappears and the patient is attacked with some form of madness, the morbid conditions of perverted function having been transferred from the sensory centres to the mind centres ; when the madness has passed away the neuralgia may return. Again, convulsions cease and insanity occurs, the transference being from the motor centres to the mind centres ; or, conversely, the appearance of convulsions may be the determination EELATION BETWEEN INSANITY AND DIPSOMANIA. 43 of an attack of insanity. Instances like these indicate that the kind of morbid change which is the physical condition of deranged function in the sensory and motor nerve centres is similar to that which is the condition of morbid function in the mind centres; however that may be, they certainly warrant the conclusion that disease of mind is a derangement which is nowise metaphysical, but one strictly comparable with such other nervous disorders as neuralgia and convulsions. If we once for all clearly realize this just pathological conception of the nature of mental derangement, it will deliver us from a multitude of vain speculations, and we shall find it of essential use in our endeavours to arrive at correct opinions with regard to the responsibility of insane persons. There is another degenerate condition, if it be not actual disease, which has close relation to insanity, either as cause or effect — namely, dipsomania. A host of facts might be '. brought forward to prove that drunkenness in parents, especially that form of drunkenness known as dipsomania, which breaks out from time to time in un- controllable paroxysms, is a cause of idiocy, suicide or insanity in their offspring. It would seem to be truly a nervous disease, a kind of insanity ; in its outbreaks it displays the periodicity which is a common character of nervous diseases; and it exhibits its close kinship to insanity not only by the fact that when occurring in one generation it may become the occasion of mental derange- ment or suicide in the next generation, but conversely by the fact that insanity in the parent may occasion dipso* mania in the offspring. 44 EESPONSIBILITr IN MENTAL DISEASE. In pointing out the relations between mental and other nervous diseases, I have noticed instances of so-called functional diseases only, that is, diseases in which after death we fail to find, by the means of investigation which we have at our command, any actual morbid changes. Not that physical changes do not presumably exist in the intimate elements of structure to which our senses have not yet gained access : we believe confidently that as by means of the spectroscope we have discovered facts which, before its invention, were quite beyond our ken ; or as by means of the telescope we have discovered stars which, without its help, would have remained unknown to us ; so the time will come when by the invention of improved instruments of research the insensible movements of molecules will be as open to observation as are the molar movements of the heavens, and when those that come after us will not fail to discover the physical causes of derangements which we are now constrained to call functional. It is with so-called functional diseases, such as epilepsy, chorea, neuralgia, that insanity displays the most marked relationship, not with organic diseases such as apoplexy and softening of the brain, in which we are able to detect visible deterioration of the structure of the nerve centres. The reason of this probably is that while the functional diseases are strictly and essentially nervous, the organic diseases are rather due primarily to disease of other tissues. Apoplexy, for example, is caused by degeneration of the walls of the blood-vessels, and con- sequent rupture of them, is, as it were, an inundation FUNCTIONAL AND ORGANIC DISEASES OF THE BEAIN. 45 of the adjacent territory through the giving way of the banks of the stream, the destruction of nerve-structure being secondary to the effusion of blood. Softening of the brain again is probably owing to defective nutrition as much as to any inherent weakness of nerve element. Certain it is that those morbid changes, whatever they are, in the intimate elements of the nervous system, which are the conditions of mental derangement, are much more closely allied to the similarly obscure morbid conditions of epilepsy, neuralgia, and chorea, than they are to the visible and palpable injury of structure which we meet with in the so-called organic diseases. It is hardly necessary to point out that those who inherit a tendency or predisposition to insanity are, other things being equal, less favourably placed in the struggle o^ life than those who are free from such tendency ; their nervous centres are less stable, and more likely therefore to fall into derangement of function; and when the equili- brium of them has been disturbed, they do not, like perfectly soundly constituted centres, return easily after a short time to their old equilibrium, but are apt to find a more stable equilibrium in degenerate function; just as in the breaking up of highly complex organic compounds the components fall readily into more simple and stable combinations, until the human body, as it goes through the successive stages of putrefaction, is reduced at last to carbonic acid, water and ammonia. Not all the maxims of all the philosophies nor all the lessons of all the religions which the world has seen, will annihilate 46 EESPONSIBILIiy IN MENTAI, DISEASE. this physical impulse, though they may succeed in some instances in counteracting it. There are of course many degrees of hereditary pre- disposition : in some persons it is so slight that no one would suspect its existence, while others carry the sure marks of it in their countenance, manner and con- versation, presenting peculiarities sufficiently charac- teristic to justify the description of them under the name of the insane temperament or the insane neurosis. Not that every member of a family in which there is nervous or mental disease presents the insane tempera- ment; on the contrary, some persons who have had an insane father or mother do not exhibit any marked mental or bodily peculiarities. But although the heredi- tary neurosis does not display itself in them, it may still be there latent or dormant, not dead but sleeping, and may appear in a decided form in the next generatirti. The more closely we study mental derangements and their causation, the more clearly we perceive the influence of hereditary peculiarities, even though these may seem to be of a trivial kind, in the production of more marked neuropathic states in the offspring. "What can possibly have been the cause ? " is the question again and again asked of the physician by an anxious father or mother, who all the while carries in his physiognomy, gestures, or habits of thought and feeling the unmistake- able evidence of the cause. Were the physician to answer briefly and sincerely, the honest reply would be — " A pathological evolution of your nature." When the insane temperament has been developed in HEREDITARY PREDISPOSITION. 47 its most marked form, we must acknowledge that the hereditary predisposition has assumed the character of deterioration of race, and. that the individual represents the beginning of a degeneracy which, if not checked by favourable circumstances, will -go on increasing from generation to generation and end finally in the extreme degeneracy of idiocy. With the occurrence of idiocy there is happily the extinction of the degenerate variety, for with it come impotence and sterility. Beneath and beyond the little span of nature which lies within the reach of our faculties, with which our senses. bring us into relation, there is a power which inspires evolution on earth, taking good care that its work is done, no matter at what cost in time, in prodigality of life, in individual suffering, animal or human. Let it be observed now that in its less marked forms the insane neurosis is by no means the unmixed evil which it might on a superficial consideration appear to be. When we look into the matter it is truly remarkable how much mankind has been indebted for its originating impulses and for. special displays of talent, if not of genius, to individuals who themselves or whose parents have sprung from families in which there has been some predisposition to insanity. Such persons are apt to seize on and pursue the bypaths of thought which have been overlooked by more stable intellects, and so, by throwing a side light upon things, to discover unthought of rela- tions. One observes this tendency of mind even in those of them who have no particular genius or talent ; for they have a novel way of looking at things, do not run in the 48 BESPONSIBILITY IN MENTAL DISEASE. common groove of action or follow the ordinary routine of thought and feeling, but discover in their remarks a cer- tain originality and perhaps singularity, sometimes at a very early period of life. This is illustrated now and then by a remarkable aptitude for punning and by strange quirks and cranks of fancy, siich as a person not so pecu- liarly gifted might die before he could invent. Notable again is the emancipated way in which some of them dis- cuss, as if they were problems of mechanics, objects or events round which the associations of ideas and feelings have thrown a glamour of conventiopal sentiment. In iregard to most beliefs they are usually more or less heterodox or heretical, though often not constant, being apt to swing round suddenly from one point to a quite opposite point of the compass of belief. It is a fact too that they frequently display remarkable aesthetic feeling and special artistic talents and aptitudes. An intensity of feeling and energy characterizes them : inspired with strong faith in the opinions which they adopt, they ex- hibit much zeal aiid energy in the propagation of them, and so become useful as reformers ; they are possessed with a degree of fanaticism which bears them on to their end, reckless of the most formidable obstacles. A person of large, ealm and deep intellect, looking to the history of human development through the ages, and from what point it started ; estimating the value of beliefs ; contrasting the faiths of to-day with the faiths of the far distant past ; reflecting how different probably wull be the faiths of the most distant future to which imagination can reach ; and considering with the preacher the uncertain INSANITY AND THE PEOPHETIC MANIA. 49 end of all the labour wherewith man labours under the sun; — is not likely to be strongly moved to destroy vigorously what seems error, or strongly urged to propa- gate zealously what seems truth, is likely rather, like Pilate, not jestingly, but in a cold spirit of philosophy, to ask " What is truth ? " and amidst the turmoil of hot- headed partizans to sit, like Gallio, caring for none of these things. A narrowness and intensity of conviction, something of the same sort as the faith of a monomaniac in his particular revelation, and a fanatical zeal of action are necessary to constitute the reformer. And in very truth it will be found that many of the great reforms of thought and action have been initiated by persons either sprung from insane families, or some of whom might themselves have been thought insane. They present what in our ignorance we are constrained to call accidental variations of mental structure and function, which may, according to circumstances, either perish or initiate new lines of evolution. They have had the necessary zeal, and they have had also the impulse of originality, which is a sort of inspiration, for it cannot be acquired by re- flection; whence probably has arisen the superstitious notion, which has prevailed in certain countries, that the insane were divinely inspired. They were cracked, but, as it has been remarked, the crack let in light. It was because in olden times madness was identified with the prophetical mania, and believed to be of super- natural origin, that the belief in the inspiration of the insane was entertained. This was the case among eastern nations, and even among the ancient Greeks madness, 50 RESPONSIBILITY IN MENTAL DISEASE. like epilepsy, was accounted a sacred disease. Hence the word mania was used to mean both madness and the pro- phetic spirit: "the greatest blessings we have spring from madness, when granted by the Divine bounty," Plato represents Socrates as saying. "For the prophetess at Delphi and the priestesses at Dodona have, when mad, done many and noble services for Greece, both privately and publicly ; but in their sober senses little or nothing." It was as considering it noble when it happens by Divine decree, that they gave it this name ; but the men of the present day, by ignorantly inserting the letter r, have called it the prophetic art.* Thus madness is identified with Divine inspiration, and the madman in this sense " is found fault with by the multitude as out of his senses ; but it escapes the notice of the multitude that he is inspired." He is in fact in a higher and more exalted state of mind than that of a person in his sober senses, the result being not an increased power of calm and sus- tained thought, but brilliant flashes of wonderful insight. At the same time Plato distinguishes from this higher sort of mania the madness which proceeded from evil states of the body and the mind — the madness of folly, ignorance and insanity. There was the mania or madness belong- ing to the prophetic spirit, and there was the mania or * Navltt, madneBS — liamcii, the mad art— /xoyriK^, the prophetic art. On this subject I may refer to the Rev. Augustus Clissold's work on "The Prophetic Spirit in its relation to Wisdom and Madness," from which I have taken these quotations. Mr. Clissold points out what he considers to be the inconsistency of those who accept the divine origin of the visions of the ptophets of the Old Testament, and at the same time reject Swedenborg's visions and repudiate his prophetic claims. THE PEOPHETS OF THE OLD TESTAMENT. 51 madness of disease, running at times so close to one another as not to be distinguishable. The prophets of the Old Testament, speaking as they probably did, in an impassioned manner, and with vehement gesticulation, as though possessed by a spirit which they could not resist, were looked upon as raving madmen. " Wherefore came this mad fellow unto thee ?" is asked of Jehu. And Shemaiah writes a letter declaring that the prophet Jeremiah is mad, and ought to be put in prison^ — (Jeremiah xxix., 26 ; Isaiah lix., 15). Then, as sometimes now, it was true : " Yea truth faileth ; and he that departeth from evil is accounted mad." Of Christ himself it was afterwards said — " He is beside himself.' " He hath a devil and is mad,— why hear ye him ? " To Paul Festus exclaimed — " Paul, thou art beside thyself ; much learning doth make thee mad." It is plain then that there has always been something in common recog- nised between the mental state of the inspired genius or prophet, and the mental state of the madman, whence it has come to pass that the terms mania and alienation of mind have been used to designate both states. There was an alienation of mind which was the result of divine inspiration, in which the mind was in an exalted state, and there was an alienation of mind which was the result of disease — a mania which was divine inspiration, and a mania which was properly madness or possession by an evil spirit. Possessed by a good spirit, the individual was a prophet ; possessed by an evil spirit, he was a madman. Nor was it always easy to distinguish one state from the other, some of the prophets of the Old Testament, for 52 EESPONSIBILITY IN MENTAL DISEASE. example, presenting symptoms which can hardly be in- terpreted as other than the effects of madness ; certainly, if they were not mad, they imitated very closely some of its moat striking features.* Some may, perhaps, think it outrageous and absurd to suppose that any good or great event could proceed from a source contaminated by delusion or insanity ; but not to take other illustrations, let any one who is inclined to be of that opinion consider the rise and progress of Mahome- tanism. There can be little, if any, doubt in the minds of those who do not subscribe to that faith, that an epileptic seizure was the occasion of Mahomet's first vision and * Jeremiah, under the influence of the prophetic spirit, procures a linen girdle and puts it round his loins. He then takes a long journey to the Euphrates to hide tt there in the hole of a rock, returns, and again, after many days, takes another long journey to the same place to take the girdle again out of the hole, -when he finds it had begun to get rotten, and to be good for notl»ng. Ezekiel takes a tile, and portrays upon it the city of Jerusalem ; then he lays siege to this city on the tQe, builds a fort against it, and casts a mount against it, and sets a camp against it, and battering rams against it round about it; then he takes an iron pan, and sets it for a wall of iron between himself and the city, and lays siege to the pan, as he had done to the tile ; and for a long time lies upon his left side before the tile, and then upon his right ; he eats from time to time barley cakes which he had baked with cow's dung. The first command had been, "Thou shalt bake it with dung that Cometh out of man ; " but, in consequence of his protest, it was said, " Lo, I have given thee cow's dung for man's dung, and thou shalt prepare thy bread therewith." On another occasion he removes his household goods in the twilight by digging a hole through the wall of his house with his own hand, and carrying away some of his furniture on his own shoulders in the sight of some of the Jews, who came to sec the strange things he was doing. Isaiah loosed the sackcloth from his loins, put off his shoes from off his feet, stripped himself naked, and for a time walked naked and barefoot, under tlie influence of the prophetic spirit. Rosea declared that he was commanded to take a wife of whoredom ; and accordingly did so. THE MADltAN AND THE EEFORMER. 63 revelation, and that, deceived or deceiving, he made advantage of his distemper to beget himself the reputation of a divine authority. The character of his visions was exactly of that kind which medical experience shows to be natural to epilepsy ; similar visions which are believed in as realities and truths by those who have them occurring not unfrequently to epileptic patients confined in asylums. For my part I would as soon believe there was deception in the trance which converted Saul the persecutor into Paul the Apostle as believe that Mahomet at first doubted the reality of the events which he saw in his vision. But when we consider seriously what has come of these epileptic visions and ecstasies, we may well pause before venturing to declare what may or may not come of mad- ness or allied conditions, and be cautious how we give credit to revelations which transcend the reach of our rational faculties. It will not be necessary for the Mahometan to reject the good which there may be in the teachings of Mahomet because he is constrained to reject the supernatural authority on which they were based. The observed resemblance between prophetic inspira- tion and mania, which has been the occasion of the same name being applied to both, is a fact of no little interest in relation to what has been said of the insane tempera- ment and of the family antecedents of some of those who have given birth to new ideas or have initiated great reforms in the world. The insane person is in a minority of one in his opinions, and so at first is the reformer, the difi'er- ence being that the reformer's belief is an advance upon the received system of thought and so in time gets 54 EESPONSIBILITT IN MENTAL DISEASE. acceptance, wbile the belief of the former being opposed to the common sense of mankind gains not acceptance, but dies out with its possessor or with the few foolish persons whom it has perchance infected. But it has happened again and again in the world that opinions which seemed absurd to the common sense of mankind, and which were therefore accounted madness, have turned out to be true. The novel mode of looking at things, which is characteristic of the insane temperament, may be an intuitive insight, a sort of inspiration, which laboured reflection could never attain unto ; it is the very opposite in action to that bond of habit which enthrals the-mental life of the majority of mankind. The power of stepping out of the beaten track of thought, of bursting by a happy inspiration through the bonds of habit and ori- ginating a new line of reflection, is most rare, and should be welcomed in spite of its sometimes becoming extravagant or even degenerating into the vagaries of insanity. The individuals who manifest these impulses of development may not see their true relations, and may carry them to a ridiculous extreme, but they are still, perhaps, the uncon- scious organs of a new germ of thought, which shall plant itself and become largely fruitful in the minds of others of a larger philosophic capacity, but not perhaps capable of the originating inspiration ; for those who per- ceive and co-ordinate the tendencies of thought are com- monly not those who originate them. There are antagonistic forces at work in the deter- mination of the orbit of human thought as there are in the determination of the orbits of the planets — a ECCENTEICITY AND INSANITY. 55 centrifugal or revolutionary force giving the expansive impulse of new ideas and a centripetal or conservative force working in the restraining influence of ha,bit ; the resultant of their opposing actions being the determina- tion of the path of the evolution of mind. Add to the eccentric impulse the ardent enthusiasm and pas- sionate energy with which a belief is maintained and propagated, the self-sufficing faith which overcomes incre- dulity, gradually gaining disciples, and we have an explana- tion of the resemblance which has been noticed between the prophetic inspiration of genius and the mania of in- sanity. For the insane temperament may, according to the direction of its development, conduct its possessor to madness, or make him the originator of some new thought or new thing in the world ; the faith and labour with which he labours in the achievement of his aim actually saving him from the madness from which he might otherwise have suffered. Here as elsewhere we must have regard to the external circumstances as well as to the internal fact in the determination of the result : we shall sometimes find one member of a family who has had an active career in a suitable track, go on through life without ever breaking down into mental derangement, while another whose cir- cumstances have not been favourable becomes hoplessly insane. Those who devote themselves specially to the study and treatment of insanity are sometimes charged, not always unjustly, with the disposition to confound eccentricity with insanity, and to detect disease where persons not so biassed fail to perceive anything abnormal. Eccentricity 56 RESPONSIBILITY IN MENTAL DISEASE. is certainly not always insanity, but there can be no ques- tion that it is often the outcome of insane temperament, and may approach very near to or actually pass into insanity. Without making too much of peculiarities of thought, feeling, and conduct, that may be consistent with perfect sanity, there are facts to be borne in mind if the true interpretation of them is sought. In the first place, it will be observed that in families some members of which have displayed decided insanity, other members have been eccentric ; secondly, eccentricity, after lasting for a time as such, has culminated in insanity ; thirdly, monomaniacs who are known to be insane on certain sub- jects are often eccentric in their whole conduct; and, lastly, persons, who have been decidedly insane, having laboured under one of the recognised forms of mental derangement, often remain eccentric during life after their reputed recovery. While we acknowledge that the insane temperament is not always an unmixed evil, but may sometimes issue in a favourable development, we must concede at the same time that it is always more or less a danger to the indi- vidual. When subjected to any great stress, arising from outward circumstances or from bodily disorder, he is more likely to break down in health of mind than a soundly constituted and stable organisation. Such phy- siological changes as the advent of puberty with the bodily and mental commotion which accompanies it, the occurrence of pregnancy, the climacteric change, are some- times fraught with danger to the mental stability, while the disappointments and calamities of life will obviously CRIME AND INSANITY, 57 act with greater effect upon an unstable mental organisa- tion ; all these causes of disturbance meeting with a powerful co-operating cause in the constitutional predis- position. Moreover, the difficulties of education are greater in such a case. The natural impulses of the temperament manifest themselves early in life, requiring an attention and discipline which few persons are qualified to give, and which are not suitably applied in the routine of an ordinary education; the consequence being that during the important period of growth, when much may be done by proper training to determine the formation of character, the natural bias gains strength through indif- ference and inattention, or by a meddlesome interference is too violently checked. In the foregoing remarks I have spoken generally of the insane temperament, but there are really varieties of it, a description of which would properly find its place in a treatise on insanity. All our present concern is to recognise distinctly that there is such a temperament, which, though by no means abolishing an individual's responsibility, must be taken into account when deeds of violence are done which seem to mark the outbreak of actual mental derangement. Unwarrantable as it may appear, to assume a crime to be evidence of insanity, when there have not been any previous symptoms to indicate disease, it is still possible that the crime may mark the period when an insane tendency has passed into actual insanity — when the weak organ has given way under the strain put upon it. There is one occasional consequence of descent from 58 EESPONSIBILITY IN MENTAL DISEASE. an insane stock, however, which is of special interest in our present inquiry-^namely, an entire absence of the moral sense. To those who take the metaphysical view of mind, it will no doubt seem improbable that absence of moral sense should ever be a congenital fault of mental organisation, but if we are to put any trust in observation, we must acknowledge such a defect to occur sometimes in consequence of parental insanity. It may be witnessed, even in young children, who, long before they have known what vice meant, have evinced an entire absence of moral feeling with the active display of all sorts of immoral tendencies — a genuine moral imbecility or insanity. As there . are persons who cannot distinguish certain colours, having what is called colour-blindness, and others who, having no ear for music, cannot distinguish one tune from another, so there are some few who are congenitally deprived of moral sense. Associated with this defect there is frequently more or less intellectual deficiency, but not always ; it sometimes happens there is a remarkably acute intellect with no trace of moral feeling. Here, then, we are brought back to the connection between crime and insanity. A person who has no moral sense is naturally well fitted to become a criminal, and if his intellect is not strong enough to convince him that crime will not in the end succeed, and that it is, there- fore, on the lowest grounds a folly, he is very likely to become one. As I have pointed out in the first chapter, criminals often do come of fainilies in which insanity or some other neurosis exists, and instances are met with in CEIME AND INSANITY. 59 which one member of a family becomes insane, and another reckless, dissipated, depraved, or perhaps even criminal. Several striking instances of the kind are related by Morel,* who has ti-aced and set forth in an instructive manner the course of human degeneracy in the ; production oi morbid j;arieties . of the human kind. Dr. Prichard mentions the case of a family, several members of which were aflicted with insanity, and were confined in asylums ; they resembled each other ; and the disease showed itself when they attained nearly the same period of life. A younger brother had a dif- ferent organisation of body from the rest, and seemed likely to escape. There was only one other, instance of immunity from the disease in the family — one, as he remarks, of still greater calamity. It was that of a brother who had never been, nor was thought to be, actually insane, but who was through life a reckless and depraved reprobate, and occasioned the greatest distress and vexa- tion to his friends. If the' secrets of their natures were laid open, how many perverse and wrong-headed persons, whose lives have been a calamity to themselves and others, how many of the depraved characters in history, whose careers have been a cruel chastisanent to mankind, would be found to have owed their fates to some morbid predisposition ! Let it be noted, then, that the independent inquiries of observers in different departments of nature bring us to the same conclusion with regard to the essential depen- dence of moral sense upon organisation. In the first * Traits des Maladies Mentales. 60 EESPONSIBILITY IN MENTAL DISEASE. chapter it was pointed oiit that the investigations of those who have made criminals their study have resulted in a. conviction of a frequent defect or absence of moral sense, in consequence of defective organisation ; and it has now been shown that the observations of those who have made insanity their study, have resulted in a conviction that the absence of moral sense is an occasional result of descent from an insaiie family. Pursuing two distinct paths of inquiry we have reached the same conclusion. Moral feeling cannot, therefore, be considered satis- factorily from a mental stand-point alone, as if it had no connection with physical structure ; it is a function of organisation, and is as essentially dependent upon the integrity of that part of the nervous system which minis- ters to its manifestations as is any other display of mental function. Its sanction is given to such actions as are conducive to the well-being and the progress of the race, and its prohibitions fall upon such actions as would, if freely indulged in, lead to the degeneration, if not extinc- tion, of mankind ; in other words, when it is in healthy functional action, its function, like that of any other part of the body, is conducive to the well-being of the organism ; when it is not exercised it decays, and so leads to individual degeneration, and, through individuals, to degeneracy of race. The medical psychologist must hold that the best of the argument concerning the origin of the moral sense is with those who uphold its acquired nature. That the sentiments of common interest in the pri- mitive family and tribe, and the habitual reprobation DEVELOPMENT OF MOEAL SENSE. 61 of certain acts by individuals as injurious to the family or tribe, should finally generate a sentiment of right and wrong in regard to such acts, and that such sentiment should in the course of generations be transmitted by hereditary action as a more or less marked instinctive feelingj is in entire accordance with what we know of the results of education and of hereditary action. Time was, we know, when men wandered about the country in families or tribes. In order that they might rise from this nomadic state to a national existence, the acquisition and develop- ment of a moral sense must clearly have been essential conditions — ^not, however, as preformed agents, but as concomitant effects, of evolution.* This development is still going slowly on ; but the proof how little moral sense itself instigates progress is seen in the absence of it_ between nations. Men have risen to a national existence, but they have not yet' risen to an international existence. With moral principles that have not changed within historical times, nations still laud patriotism, which is actually a mark of moral incompleteness, as the highest virtue ; and statesmen sometimes think it a fine thing to sneer at cosmopolitanism. But it catinot be doubted that the time will come, though it may be yet afar off, when * " And if we could imagine the human race to live back again to its earliest infancy— to go backwards through all the scenes and experiences through which it has gone forward to its present height^— and to give back from its mind and character at each time and circumstance, as it passed it, exactly that which it gaiued when it was there before — should we not find the fragments and exuvise of the moral sense lying here and there along the retrograde path, and a condition at the beginning, which, whether simian or human, was bare of all true moral feeling." — Body and Mind, p. 58. 4 62 RESPONSIBILITY IN MENTAL DISEASE. nations will know and feel their interests to be one, when moral feeling shall be developed between them, and when they shall not learn war any more ; it will come as a step in evolution and as a condition of universal brotherhood, not otherwise than as, coming between tribes, it bound them into nations, and made patriotism the high vu-tue which it is believed to be.* If other arguments were needed in support of the opinion that conscience is a function of organization — - the highest and most delicate function of the highest and most complete development thereof — they might be drawn from observation of conditions of moral degeneracy. Let it be noted how it is perverted or destroyed some- times by disease or injury of brain. The last acquired faculty in ths progress of human evolution, it is the first to suffer when disease invades the mental organization. One of the first symptoms of insanity — one which declares itself before there is any intellectual derangement, before the person's friends suspect even that he is becoming insane — is a deadening or complete perversion of the moral sense. In extreme cases it is observed that the modest man becomes presumptuous and exacting, the chaste man lewd and obscene, the honest man a thief, and the truthful man an unblushing liar. Short of this, however, there is an observable impairment of the finer moral feelings — a something different, which the nearest * The patriotic feeling which makes the individual sacrifice himself for the good of his country is, of course, a high moral feeling; but the word "patriotism " is often used, or misused, to denote that national feeling which places the interests of a country before those of humanity, and which inspires auch an expression aa " Our country against the world." PHYSICAL CONDITIONS OF MOKAL DEGENERACY. 63 friends do not fail to feel, although they cannot always describe it. Now, these signs of moral perversion are really the first symptoms of a mental derangement which may, in its further course, go through all degrees of intellectual disorder, and end in destruction of mind, with visible de- struction of the nerve-cells which minister to mind. Is the end, then, dependent on organization, or rather disorgani- zation, and is the beginning not ? This course of degeneracy is but a summary in the individual of what may be traced through generations ; and in both caseswe are constrained to believe that the moral changes are as closely dependent upon physical causes as are the intellectual chimges which accompany or follow them. If it be not so, we may bid farewell to all investigation of mental function by a scientific method. Note, again, the effect which a severe attack of insanity sometimes produces upon the moral nature of the indi- vidual. The person entirely recovers his reason ; his intellectual faculties are as acute as ever, but his moral character is changed; he is no longer the moral man that he was ; tlie shock has destroyed the finest part of his mental organization. Henceforth his life may be as dif- ferent from his former life as, in an opposite direction, was the life of Saul of Tarsus from the life of Paul the Apostle to the Gentiles. An attack of epilepsy has pro- duced the same effect, effacing the moral sense as it effaces the memory sometimes ; and one of the most striking phenomena observed in asylums is the extreme change in moral character in the epileptic which precedes and heralds the approach of his fits. A fever or an injury 64 EESPONSmiLITY IN MENTAL DISEASE. to the head has in like manner transformed the moral character. Many instances from different quarters might be brought forward in illustration of such physical effect upon moral being, but one mentioned by Dr. Prichard, which lies to hand, may suffice. In a large and well- regulated family all the members save one boy were of quiet and sober habits, of excellent disposition, and regular and industrious. This boy met with a severe accident, which injured his head. As he grew up he was quite different from the other children; he was utterly unmanageable, dissipated, wild, addicted to all kinds of excesses, — ^was on the verge of madness, though not intellectually deranged. Pr. Wigan puts the matter in a way that may seem more £xtravagant than it really is when he says : — " I firmly believe that I have more than once changed the moral character of a boy by leeches to the inside of the nose." . In bringing this chapter to an end, I shall note down three definite propositions, and make one general reflec- tion, which may fitly be drawn from a consideration, of its contents. The propositions are these : — That there is an insane temperament which, without being itself disease, may easily and abruptly break down into actual disease under a strain from without or from within ; that moral feeling, like every other feeling, is a function of organiza- tion; that an absence of moral sense is an occasional result of descent from an insane family. The reflection which occurs is that, before entering upon the considera- tion of the degree and manner in which responsibility is modified by disease, it is necessary to realize the full CONCLUSIONS. 65 physiological meaning of these propositions — -to take home to our convictions the modified relations in which a physiological study of mind places questions that have been hitherto questions of pure psychology or theology. CHAPTER III. DIFTEEENT FORMS OF MENTAIi DEKAKGE5IENT. Idiocy and imbecility — Kleptomania, pyromania, &e., often mark imbecility — Intellectual and affective insanity — General and partial mania — Monomania and melancholia — Dementia — Genered paralysis of the insane — Objection to the received system of classification according to certain prominent mental symptoms only — The lines on which it is proposed to lay down a better system — The diagnosis of insanity a strictly medical question — Morel's proposed classifica- tion— Skae's proposed classificatiou— The path of future medical inquiry — The physician's duty to declare the truth, however un- popular it may be. The observer who proceeds to examine the different kinds of mental incapacity under which men labour, per- ceives at the outset that he must distinguish cases pf absence or weakness of mind from cases in which there is derangement of mind : the former being instances of Idiocy or Imbecility, the latter of Insanity proper. Idiocy is a defect of mind which is either congenital, or due to causes operating during the first few years of life, before there has been a development of the mental faculties, and may exist in different degrees ; the person afflicted with it may have the power of articulate speech, and manifest a limited degree of intelligence, or he may be utterly destitute of any semblance of intelligence and of the power of speech, being little more than a mere vegetating organism. Imbecility is simply weakness of mind owing to defective mental development, and may be of every IDIOCY AND IMBECILITY, 67 degree of deficiency, moral and intellectual ; on the one hand, passing by imperceptible gradations into idiocy, and, on the other hand, passing insensibly into ordinary intel- ligence. There are some imbeciles in whom a general deficiency of intelligence is accompanied by a singular development of it in a special direction ; they manifest, for instance, a surprising memory for details, such as dates, names, numbers, the exact particulars of distant events, which they recall and recount with the greatest ease and accuracy, or display certain remarkable me- chanical aptitudes, or exhibit a degree of cunning which might seem inconsistent with their general mental feeble- ness. To establish the existence of imbecility in any case it must be shown that there is a defect of under- standing, not merely from a want of development of the mental faculties in consequence of a deficient education, but a defect of understanding by reason of some natural incapacity which no education will overcome — a mental privation. It is clear, however, that ignorance which is the result of utter neglect, though neither doctors nor lawyers would regard it as imbecility, might justly, on grounds of humanity, be held to lessen responsibility. Obviously it must sometimes be a very difficult matter to decide whether there is actual imbecility or not, while the question of the degree of the individual's responsibility will be a more difficult one still — may, in fact, be practi- cally insoluble. There can be no dispute with regard to the irresponsibility of idiots ; deprived of understanding by a fate against which they cannot contend, it would be absurd to talk of responsibilities and obligations in con- 68 EESPONSIBILIIT IN MENTAL DISEASE. nection with them. But it is not so with imheciles : some of them fail as clearly as idiots to reach the standard of re- sponsibility, but others undoubtedly have a knowledge of right and wrong, and some power to do the right and for- bear the wrong. In face of their natural defect, however, it would not be just to assign to them a full measure of responsibility ; so that we are driven to recognise theore- tically an entire absence of responsibility and a modified responsibility. In like manner, some are capable of managing their affairs, others are not, while of others it is hard to say whether they are or are not. No special rules can be formulated for determining the question either of responsibility or capacity in conditions of imbecility; each case must be considered on its merits, the entire conduct of the individual through life being taken into account, in order to judge how far it betokens mental deficiency. It is a matter of observation that impulses to theft, incendiarism, and violence, are not uncommon in these cases where the intelligence is feeble and the pas- sions are strong ; and many crimes, such as arson, rape, theft, and homicide itself sometimes, are perpetrated by actual imbeciles : they are beings who have reached a lower stage of race-degeneracy than those criminals who, as pointed out in a former chapter, approach the imbecile type- On proceeding to examine the manifold varieties of insanity, it is found that they may be arranged in two great divisions according to the presence or absence of palpable intellectual derangement. The first division will be formed of all those cases in which there is insanity of INTELLECTUAL AND AFFECTIVE INSANITY. 69 thought or insanity with delusion, and may be described as Intellectual or Ideational Insanity : the second division will consist of all those cases in which, without delusion or incoherence, there is insanity of feeling and action, and may properly be described as Affective Insanity. Here, at the outset, medical experience comes into col- lision with legal tradition and populflr prejudice. The common opinion is that a person who is insane must discover his disease by delusions, or raving, or great extravagance of conduct, and that, failing some marked exhibition of the kind, he cannot be mad ; in fact, that madness, if it exist, is so palpable a thing that no one can fail to recognise it. Lawyers, whose knowledge of insalnity is for the most part not greater than that of the vulgar, share this opinion ; accordingly, when the physician testifies to the existence of less marked forms of disease, in which the indications are of a more subtile and obscure character, they are apt to think that he is propounding ingenious and fanciful theories, in order to exhibit his own cleverness, or that he has been so biassed by the nature of his studies that he will detect insanity wherever he sets earnestly to work to look for it. But facts remain and assert themselves when ridicule has spent itself in scorn of medical theories. There can be no doubt that there do exist cases of in- sanity in which the intellectual derangement is scarcely, if at all, apparent; and, furthermore, that some of the most dangerous forms of the disease are of this kind — most dangerous, indeed, because the insanity displays itself not in thought but in acts. It is necessary, therefore, to 70 EESPONSrBILITY IN MENTAL DISEASE. make a class of these cases, even though it may not please those who have not had the opportunity, or have not been at the pains, to acquaint themselves with the facts. On examining the cases of intellectual insanity or mania (the term mania being often used in its general sense as synonymous with insanity), it is seen that there are some in which the derangement of thought is general, the per- son exhibiting various delusions or more or less inco- herence, and that there are others in which the derange- ment of thought appears to be limited to one subject, or to a certain order of ideas, the understanding being clear in other matters. The former are included under the class of what is called General Mania, which may be acute or chronic, the latter under the class of Partial Mania, which is always of a chronic nature. It is seldom that any question of responsibility arises with regard to general mania, the mental derangement being unequivocal, al- though it may be remarked by the way that if the legal criterion of responsibility, which is a possession of know- ledge of right and wrong in reference to the particular act, were strictly enforced in every case, it would sometimes entail the condemnation and punishment of persons labouring under general mania, who, in the wantonness of their fury, do acts of violence which they know well they ought not to do, but which at the same time they cannot help doing. The existence of a so-called partial mania is readily admitted : there is neither popular nor legal unwilling- ness to concede that a man may be insane upon one point and sane in all other respects, although, rightly MONOMANIA AND MELANCHOLIA. 71 considered, such a doctrine is more remarkable than that a man should evince insanity of feeling and conduct without delusion ; indeed, there is a tendency rather to overrate the frequency of occurrence of such a state, and to give it a more rigid definition than is conformable with nature. The collision between medical experience and legal dogma takes place here in reference to the responsi- bility of a person so suffering, in the event of his com- mitting a crime which is not manifestly the offspring of his delusion; the lawyers asserting, and the doctors deny- ing, that he ought to be punished exactly as if he were of entirely sound mind. It is usual to make a subdivision of partial insanity into monomania and melancholia, according to the cha- racter of the feeling which accompanies the delusion of thought : when the person is elated, confident, self-com- placent, and has deranged ideas in conformity with these feelings, he is said to labour under monomania ; when he is depressed, wretched, distrustful, and has corresponding unsound ideas, he is said to labour under melancholia. Some authors, however, raise melancholia into a special class, using monomania and partial mania as synonymous terms, notwithstanding that some cases of melancholia really afford the most striking examples of partial insanity; this they do because cases occur in which there are many fearful apprehensions and delusions with corresponding distress — ^because, in fact, there is general intellectual derangement with melancholic depression. AH cases of melancholia cannot properly, therefore,, be described as cases of partial insanity, some being really cases of acute 72 EESPONSIBILITy IN MENTAL DISEASE. general derangement, which again run so near to, or so run into, acute mania that they cannot always be distinguished from it. The term monomania, if used of melancholia at all, should be applied to the chronic form of the disease only — ^to that which Esquirol proposed to distinguish as lypemania. The uncertainty of these divisions, which is thus made apparent, attests the arti- ficial and unsatisfactory nature of the received classifica- tion, which holds its ground only because a better one has not yet been propounded, or, if propounded, has not gained acceptance. When any of the above-mentioned forma of iiisanity has lasted for some time, without amendment taking place, the mind is often weakened, and the person, passing through degrees of craziness, falls finally into a condition of what is called dementia. It is the destruc- tion of mind by disease, and may of course be more or less general and complete ; in the worst cases demented patients have as little intelligence as the complete idiot, from whom, however, they differ in having lost what he never possessed. There is one striking form of insanity in which mental symptoms of a tolerably uniform character are accom- panied by symptoms of gradually increasing paralysis of the muscular system, and which runs a definite course to a fatal termination ; it is usual, therefore, to make of it a special class under the name of General Paralysii of the Insane. Here, it will be observed, there is a departure from the principle of classifying insanity accord- ing to its prominent mental features; the bodily symp- GENERAL PAEAitSIS OF THE INSANE, 73 toms which accompany the mental derangement being taken into account, and made the basis of the name. With this exception, however, the received classification is founded on the recognition of a few of the most pro- minent mental symptoms only— is purely psychological. It amounts simply to this: when a person is excited, and raves more or less incoherently, he has acute Tnania ; when, after subsiding into a more quiet state, he con- tinues to have delusions and to be incoherent, he has chronic mania; when he exhibits insane delusions on one subject or in regard to certain trains of thought, and talks sensibly in other respects, he is said to have monomania; when he is gloomy, wretched, and fancies himself ruined or damned, he has melancholia ; and when his memory is impaired, his feelings quenched, his intelligence enfeebled or extinct, he is said to be suffer- ing from dementia. Much dissatisfaction has' been felt with this classifica- tion, and many fruitless attempts have been made to supersede it by a better one. It is extremely vague, and obviously teaches us very little concerning the disease ; it is in fact a rough classification of certain marked symptoms, not an exact classification of the different varieties of disease Which are included under the general term insanity; we learn nothing from it concerning the cause of the particular form of disease, its course and duration, its probable termination, its most suitable treatment. Moreover, it has done not a little mischief by confining attention to a few general mental features, and diverting observation from the 74 RKSPONSIBILITT IN MENTAL DISEASE. various physical causes and Bymptoms of the disease ; it has strengthened the notion that insanity is a disease of mind, without at the same time bringing into pro- minence the fact that it is a disease of body also. No wonder it has been said that any one of good common sense is as competent as a medical man to determine whether a person is insane or not. This assertion would not be dispnted if we could only guarantee the application of true common sense, which proceeds from experience and knowledge, and in any department of scientific inquiry is the common sense of those who have these qualifications; the so-called common sense of any one not so enlightened is very apt to be common prejudice springing from ignorance ; and assuredly it would argue in such a one a very uncommon sense, if he was, without special experience, as competent as those who had laboured hard to inform themselves by a patient study of the disease in all its stages. Is it not truly strange that common sense should ever have been declared to be the measure of that the essence of which is that it is not sense — that it is utterly opposed to all the experience of sanity ? An example will serve best to show how necessary to the formation of a right conclusion is observation informed by experience. A man who has been hitherto temperate in all his habits, prudent and industrious in business, and exemplary in the relations of life, undergoes a great change of character, gives way to dissipation of all sorts, launches into reckless speculations in business, and becomes indif- ferent to his wife, his family, the obligations of his posi- tion ; his surprised friends see only the effects of vice, and OBJECTION TO THE SYSTEM OF CLASSIFICATION. 75- grieve over his sad fall from virtue; after a time they hear that he is in the police court accused of assaTilt or of stealing money or jewelry, and are not greatly astonished that his vices have brought him to such a pass. Examined by a competent physician, he is discovered to have a slight peculiarity of articulation and perhaps an in- equality of size of the pupils, symptoms which, in con- junction with the previous history, enable the physician to say with positive certainty that he is struck with a disease which, sapping by degrees his intellect and strength, will within no long time destroy his mental and bodily powers, and finally his life. Our knowledge is so exact that we can do what is the best test of a science — predict with certainty what will happen. The dissipiation, the speculation, and the theft itself were, as they often are, the first symptoms of general paralysis of the insane. Plainly, common sense without special experience could have small chance of coming to a right conclusion in such a case. The example will furthermore serve to show of what little service a classi- fication by mental symptoms only is, and what little in- formation we get when wo are obliged to be content with such a classification ; for in the early stages of the disease it would be necessary to describe them as those of affective or moral insanity, at a later stage as those of intellectual insanity, and finally as those of dementia. Thus one patient might, in the course of a short time, run through all the classes of symptoms while suffering from one and the same disease. So plain is this, and so characteristic are the mental and bodily features of 76 RESPONSIBILITY IN MENTAL DISEASE. general paralysis, that all writers on insanity are agreed in making it an exception to the general rule of classifi- cation; they constitute it a class by itself, thus giving the strongest practical condemnation ta a purely psycho- logical classification. The example which has been used to exhibit the defect may be used also to indicate the remedy. We have only to do with other forms of insanity as we have done with general paralysis — ^to study^ carefully their natural histories, and so to endeavour to arrive at a natural classification of them. By exact observation of the cause, the bodily and mental symptoms, and the course of the disease in each case, and by an accumulation of such observations, it is believed that we shall in time be able to form natural groups or families, each having certain characteristic features, -a knowledge of which will at once teach us something definite concerning the causation, course, and probable termination of a particular case belonging to the group. Gur aim should be to apply the strict rules of inductive observation and generalization to the study of insanity from its earliest beginnings to its latest stages — to inquire closely into the antecedent con- ditions of the disease in each case, to observe accurately all the facts,^phydcal and mental, that are presented in its course, to make experiments, as it were, on the patient, by using means to elicit his individual peculiarities of mind, as we use means to detect his bodily ailments^ and so to obtain a complete and accurate, history of the disease.. Hamtg accumulated a number of such observa- tionSr the arrangement of them in groups, or the gene- DIAGNOSIS OF INSANITY A MEDICAL QUESTION. 77 ralization of them into natural types, will follow, so that when a particular case presents itself in practice it will be possible, by referring it to its natural order, to bring definite information to bear upon it, instead of, as under the present system of denoting by a vague name a variety of diseases, some of which have nothing more in common than the particular symptom from which the name has been derived, gaining little or no definite know- ledge of it. It is evident that the farther medicine advances on this path of inductive inquiry, the less it will be exposed to the criticism of lawyers and others who have no practical knowledge of the disease. It will be impossible to declare, as an English Lord Chancellor ignorantly de- clared not long ago, that insanity is properly a subject of moral inquiry, and to condemn, as he ventured foolishly to do, "the evil habit which had grownup of assuming that it was a physical disease;" it will become more and more evident that the decision of its nature must be guided by the knowledge of those who have made it their study; and every one will see the absurdity of the pretension of lawyers to make a medical diagnosis of insanity without medical aid, as every one would now see the absurdity of their pretension to make a diagnosis of fever or of small- pox. Not that the cases are exactly similar : for while medical men are making a diagnosis of insanity in a doubtful case where it is alleged in explanation of crime, it nmst be remembered that the law is also concerned to make a diagnosis — the diagnosis of crime; and the symptoms from which both lawyers and medical men 78 EESPONSrBnJTT IN MENTAL DISEASK. must come to a conclusion are many of them the same. Unfortunately while the lawyer can see and appreciate the symptoms which indicate crime, he cannot appreciate the symptoms which mark disease ; these he overlooks or ignores, for they have no meaning to him ; and he is apt to think that the physician who does perceive them and recognise their serious meaning, is simply making crime evidence of insanity. The theft in the early stages of general paralysis is a sufficiently palpable fact ; who but a physician familiar with the disease can recognise the inequality of pupils and the peculiarity of articulation which mark the beginning of incurable brain-disease, and give the true interpretation of the theft ? Insanity being a disease which cannot exist apart from disorder. of bodily organs and functions, the diagnosis of it must belong to the physician; for he alone is competent to investigate and appreciate these disorders. Those who would take from him the diagnosis might as well claim to take the treatment of the disease. The late M. Morel, who was the distinguished phy- sician of the asylum of St. Yon, near Eouen, some years ago propounded a new sj'stem of classifying insanity, which, although not available for practical purposes and easily shown to be defective as a theoretical system, had the merit of expressing the tendencies of modern inquiries in a systematic form. His aim was the classification of mental disorders in relation to their causes, and he arranged all forms of them in six principal groups, each group having its different subdivisions into classes or varieties. The mention of these groups will serve fitly morel's proposed classification. 79 to show how essentially a bodily disease insanity is, and how little real knowledge of its causation and nature in any case can be obtained except by way of medical obser- vation and inference. The first group he designated Hereditary Insanity. All cases belonging to it have, he affirmed, special characters by which they may be recognised ; the outbreak of the disease may be determined by ordinary causes, but, once it has been developed, there are special features in its form, its course, and its termination which to a skilled observer clearly denote its origin. The second group comprises all cases of insanity in which the disease has been caused by the habitual use of intoxicating and narcotic substances, such as alcohol, opium, ha'schisch; or by poisonous substances, such as phosphorus, lead, and mercury; or by exposure to the baneful influence of marsh miasmata. The peculiar disorders of the physical and mental functions observed in all the varieties of this group, though presenting special dif- ferences necessitating subdivisions, have so much in common, are in fact said to be so far characteristic, as to warrant the formation of the group to. which he gave the name of Toxic Insanity. The third great group consists of insanity occasioned by the trans- formation of other neuroses, and includes hysterical, epileptic, and hypochondriacal insanitj'. The hysteria, the epilepsy, and the hypochondria exercise a special influence upon the nature of- the ideas and acts of those who suffer from them ; the kind of derangement in each case reflecling the fundamental character of tlie 80 RESPONSIBILITY IN MENTAL DISEASE. neurosis of wljich it is a transformation, although each kind has at the same time characters that are common to it and the other divisions of the group. His fourth group comprised all cases in which the insanity is owing to idiopathic disease of the brain. Chief among these is general paralysis of the insane, constituting the principal variety; another variety being formed of those cases in which there is gradual enfeeblement or abolition of the mental faculties in consec[uence of chronic disease of the brain or its menfbranes. The fifth group he designated Sympathetic Insanity, and it included all the cases in which the primary seat of disease is not in the brain, but in some other organ of the body, the brain being secondarily and sympathetically affected. The sixth and last group was not founded on any relation of the disease to its cause, the principle of the classification being departed from, but was made for the sake of convenience ; in it were included all cases of dementia — the terminal stage of mental degeneration. I shall not enter into an exposition of the faults of this scheme of classification which has been propounded by Morel ; let it suffice here to point out that it has the merit of bringing into just prominence the physical causation of insanity. Without doubt the disease may be caused in every one of the ways described by Morel ; and without doubt, when it is so caused, there are usually bodily symptoms which are as essential a part of the disease as are the mental symptoms which chiefly attract the attention. Instead then of seizing upon a prominent mental symptom, such as an impulse to suicide, homicide, theft, incendiarism. DR. SKAE's proposed CLASSIFICATION. 81 vhich may be met with in a particular case, and there- upon making such pathological entities as suicidal mania, homicidal mania, kleptomania, and pyromania, which have no existence as distinct diseases, the aim of the inquirer should be to observe carefully all the bodily and mental features, and to trace patiently in them the evolution of the cause. Given a case of insanity in which homicidal impulse is displayed he will observe with what other symptoms the impulse is associated, will thereupon refer the case to the natural group to which it belongs, and set forth its relations to its cause ; so he will present an accurate picture of a real disease, instead of concealing inadequate observation under a pretentious name, and offering the semblance of knowledge by the creation of what can be described only as a morbid metaphysical entity. To the late Dr. Skae of Morningside we are indebted for another praiseworthy attempt to distribute the varieties of mental derangement in natural groups having characteristic features. He proposed to classify insanity, not by its mental' symptoms, but by the bodily states of which the mental disorders are the accompaniments ; in this way he propounded as many as thirty-five groups, each having a particular bodily condition and a special psyt she teaches them to do some dirty or disgusting act. I feel that though there is no imbecility or insanity iu Alice, she does things which show a distressing want of moral susceptibility. She is now nine and a half years old. I have nothing further to add except that she shows a pleasurable destructiveness both of toys and clothing, and a total want of affection. She can be worked upon only through her conceit or appetite. Her maternal uncle is iu an asylum on account of similar deficiencies." CONCLUSION. 181 criminals ; in fact, when a person of the lower orders of society suffers in this way, he generally does something which causes him to be sent to prison, without question asked of the propriety of his fate. If the question be raised whether persons suffering from moral insanity should in every case be exempted from all responsibility for what they do wrong, I should shrink from answering it in the affirmative without quali- fication. They certainly have not the capacity of moral responsibility in its true sense ; all the responsibility which they are ' capable of feeling is that which springs from a fear of punishment. But experience shows that this apprehension does influence some of them bene- ficially, and that the actual infliction of punishment may do them good ; that in some few instances at any rate it is the best treatment which can be used. A diseased mind, like a diseased heart, may not incapacitate an individual for all actions, though it may positively incapacitate him for some ; as he may do a day's quiet work with disease of the heart, although he cannot run a race, so he may be equal to some of the lesser responsi- bilities of life when he is not quite sane, and not capable of bearing the strain of great obligations. In other instances there can be no question that the persons are not proper objects of punishment in any form ; and perhaps in any case the truest justice would be the admission of a modified responsibility, the degree thereof, where it existed, being determined by the parti- cular circumstances of each case. Assuredly moral insanity is disorder of mind pro- 9 J 82 RESPONSIBILITY IN MENTAL DISEASK. duced by disorder of brain. In examining the conditions of its occurrence we have seen how plainly it fol- lows the recognized causes of insanity ; how it may precede for a time the outbreaks of various forms of unequivocal general alienation; how it accompanies intellectual insanity in most of its varieties ; how it may follow other forms of general insanity; how it niay precede or follow epilepsy, or occur as a masked epilepsy ; how it may supervene at puberty on congenital moral imbecility; and how it may finally pass into dementia. These are facts of observation. Taking them fairly into consideration, and giving them the weight which they deserve, can we doubt that moral insanity is a form of detangement as genuine as any other form of mental derangement ? If the law cannot adjust the measure of punishment to the actual degree of responsi- bility, and in its regard to the welfare of society cares not greatly to trouble itself about the individual, that is no reason why we should shut our eyes to facts ; it is still our duty to place them on record, in the confident assur- ance that the time will come when men will be able to deal more wisely with them. Note. The following extracts from the letters of a young lady who was in a deeply melancholic state furnish a vivid picture of the way in which a suicidal idea may fasten upon the mijid, of the mental anguish which it may occasion, and of the strange inconsistency, not uncommon in mental derangement, of a strong inclination to suicide accompanying the belief that death will he immediately followed by the everlasting tormeuts of heU : — "I want you to know how^ much more the state of my soul has to do with the thought of suicide and with the agony in which I live than you would have any idea of from our short interview of yesterday. NOTE. 183 I left school at eighteen, and I am now thirty-one years of age. I can- not remember ever having the thought of destroying myself or any one else before leaving school, bnt I do remember now that many years ago I was every now and then distressed with the idea. I heard a long while ago that two of my great uncles had destroyed themselves, and that made me fear that I had inherited insanity. But now with regard to the exercises of my soiil. You, I suppose, regard my brain as the cause of all I suffer ; I cannot for one moment believe that. It is something that cannot be reached by any remedies, I am sure. Every day and all the day I have before me my past life with all its privileges, mercies and sins— my whole character clearly before me in every point — ^the maddest remorse at knowing .that up to this moment I have lived without God in the world, although outwardly so exemplary in many respects. I have such thoughts of time and eternity, heaven and heU, the soul and the body, and the relative importance of things material and spiritual as I believe no one has who is not on the verge of eternity. I have the inex- pressible agony of hnoming that my life is over so far as any possibility of salvation is concerned. Can you— no, you cannot— picture to yourself the anguish of one who has loving parents, brothers and sisters, all Christians going to heaven, a beautiful home, everything external to give nothing but happiness, yet so intensely realizing that there is nothing but Hell before her, that she does not know how to endure existence from day to day. You talk of my case as bad but not hope- less. I hiow that it is hopeless. I know that the worm that dieth not, that the fire that is not quenched, is raging within me. Burning memories' consume me every day, and 1 ask you what rest there can be for the brain when the soul is in such a hopeless state." In another letter, written about six weeks afterwards in the same strain, she says : — "I cannot and do not believe (Oh ! how I wish I could) that there is now sufficient cause in my body for my anguished state of heart and soul: it seems utterly impossible to me. Then another thing strikes me very forcibly. I was not getting gradually more susceptible when I heard of a murder or suicide. I had had no sudden shock ; indeed I had felt worse several years before. And yet without the slightest warning the thought came, was intermittent for three or four weeks, and then on my return home in July the thought was completely fastened upon me, so that I could not forget it one m™«te when awake— wherever I was, or whatever I was doing, positively I could not, although I longed to do so — for I had no desire, no motive, to commit suicide. How could I possibly have ! But very soon I became religiously depressed, and about the middle of «August I felt sure that I was lost for ever without the possibility of pardon. . . . Now I want you to see this very plainly 184 EESPONSIBILITY IN MENTAL DISEASE. that whereas at first I had every minute the thought of suicide without any motive to commit it, now and for a long time past the very hell in which my lost soul lives makes me so desperate that I feel as though I could not continue in the body— »o motiw, at first, though certainty of hell for ever now driving me to it. . . . What life has been, and what it should have been in every respect, I see now with the agony of one who knows that the probation is over, and that there is nothing but death and hell before him. Only with me I have not the privilege of being diseased in body, and thus stricken to death. I have got to put an end to myself through very agony of heart and soul — an unforgiven, lost soul. Now, can you truly say that weak nerves produce all this ? Oh ! it is not so. I am quite sure that I shall never again return to my home and family. Such bliss will never be for me. God will not thus rescue me from the very jaws of hell, for there it is, 1 assure you, that I am. And one day you and my friends will know that I was a terribly true prophetess." There are indications of mental improvement in some of the expressions in that letter, which were confirmed by the next, received a fortnight afterwards : — "I wished to be the first to have the pleasure of telling you of mj' decided improvement, but Mrs. has forestalled me. I was afraid of acknowledging it at first, lest the fancied change should prove a delusion. Mercifully it was not so. Oh ! how different I am from what I was even a week ago. . . . Still my thoughts run so much in one groove. The idea of suicide constantly there, without however the wish to conmiit it. Do you think the time will ever come when for a whole day I shall never even think of it ? I can- not yet imagine such freedom. I feel like one turned back from the brink of the grave to life and home and friends again— verily, I have been in a chamber of horrors 1 How glad I shall be to think less of myself 1 " After a little time more, she recovered entirely. CHAPTER VI. PARTIAL INSANITY. II. — Partial Intellectual for IdeationalJ Insanity, Simple melancholic depression preceding intellectual derangement : homicidal or suicidal outbreak : case of Charles Lamb's sister — Melancholia with hypochondriacal hallncinations and delusions ; homicide— Delusions of suspicion or persecution, and homicidal mania: case of Dr. Fownall — Concealment of their delusions by- insane persons — Bodily symptoms preceding an outbreak of homi- cidal mania : the characters of the attack — Dangerous character of the insanity that is accompanied by delusions of persecution — An insane person does murder out of revenge : is he a responsible agent ? — Futility of argument against a delusion : a limited delusion indicates deeper mental derangement : examples — Premeditation in planning and ingenuity in perpetrating homicide entirely con- sistent with insanity : example — Danger of recurrence of homicidal mania : examples — Conduct of insane persons after a homicidal act — Homicid2d insanity in which, first, the act is the direct ofiEspring of the delusion ; and, secondly, in which it cannot be traced to its influence— Hoifbauer'a metaphysical criterion of responsibility — The medical doctrine that partial insanity excludes the idea of criminality, whether or not the acts are the results of delusion : the reasons on which it is baaed— Discussion of the legal and medical views with regard to the working of an insane delusion in the mind : examples showing the impossibility of tracing its workings — Pathological meaning of the existence of an insane delusion, how- ever limited — The right problem in homicidal insanity is to trace a connection, not between the delusion and the act, but between the disease and the act. While admitting the existence of simple impulsive insanity, it must be acknowledged that most often symp- toms of derangement in addition to the morbid impulse, either antecedent to or concomitant with it, will be dis- 186 EESPONSmiLITY IN MENTAL DISEASE. covered, if a careful enough examination be made — such symptoms as previous marked melancholic depression, morbid suspicion, or actual delusions. It will be found that many of the suicides and homicides done by insane persons are done by persons labouring under commencing melancholia, before the disease has developed into the stage of intellectual derangement ; though overwhelmed with a vague fear or distress, dejected, sleepless, and feeling themselves overladen with the heavy burden of their miserable lives, they manifest no actual delusion, and are not thought by their friends or medical atten- dants ill enough to be placed under control. Of this kind apparently was the homicidal insanity of Charles Lamb's sister, Mary Lamb. "Worn down to a state of great nervous depression by attention to needle- work during the day and to her mother by night, she " had been moody and ill for a few days previously," says her brother's biographer, and the illness came to a crisis on the 23rd September. On that day, just before dinner, she seized a caaeknife which was lying on the table, pursued a little girl (her apprentice) round the room, hurled about the dinner forks, and finally, in a fit of uncontrollable frenzy, stabbed her mother to the heart. Her brother was at hand only in time to snatch the knife from her before further hurt could be done. He found his mother dead, and his father, who was in his dotage, bleeding from a wound on the forehead which he had received from one of the forks. She was sent to an asylum, where she recovered her reason in a short time, returning thence to live with her brother. Recurrent HOMICIDAL OE SUICIDAL OUTBREAK. 187 attacks of insanity afflicted her for the rest of her life, but when the indications of an attack presented them- selves, she placed herself or was placed under care in an asylum. Homicidal or suicidal insanity supervening on melan- cholic depression, with or without delusion, may he accepted as the usual order of its occurrence. A mother, worn down by anxiety and ill-health, becomes very low- spirited and desponding, imagines perhaps that her soul is lost, or that her family are coming to poverty, and one day, in a paroxysm of despair, kills her children in order to save them from misery on earth, or because she is so miserable that she knows not what she does. Under the influence of a like depression and like delu- sions a husband kills his wife. The symptoms exhibited by him before the act may be limited to great mental dejection of a hypochondriacal character, moodiness and loss of interest in all things, and perhaps a morbid feeling of despair concerning the state of his health or the state of his affairs ; his friends observe nothing more in him than that he is " very low," and, if they belong to the lower class, will probably describe him as " studying too much," by which they mean brooding too much. Suddenly on some occasion his mental suffering rises to such a jjitch of anguish or agony that he falls into a paroxysm of frenzy, during which he loses all self-control, and does violence to himself or some one else, not knowing at the time what he is doing, and being horror-stricken afterwards when he realizes what he has done. By the homicidal deed, which has been truly described as a raptus melancholicv,s,he 188 EESPONSIBILITY IN MENTAL DISEASE. is freed from his terrible and overwhelming emotion.returns perhaps to himself, and may display no present symptom of insanity. In such a case the delusion has no evident bearing upon the act, although both delusion and act are the manifest offspring of the insanity ; the passing frenzy is a pure convulsion of mind springing from that diseased state of the nerve-centres of mind, of which the depression and delusion are also expressions. In other cases, how- ever, it will be found, on inquiry, that there has been a suddenly arising hallucination or delusion -which has accompanied the act; a loud roaring sound in the ears, or a redness as of fire or of blood before the eyes, or a sulphurous smell in the nostrils, testifying to the disorder which has seized upon the sensory nerve-centres. One example will serve as an illustration of a class of cases. At the Derby Assizes, on December 16th, 1871, Samuel Wallis, a shoemaker, was indicted for the wilful murder of his wife, with whom he had always lived on the most affectionate terms. He had stabbed her in the neck in the night with a shoemaker's knife which he kept in the room for the purposes of his work, and had then walked away. "When apprehended, he was excited and said — "I was up in the fields, and .then I went down into the colliery. I came out again about dark. There was such a fearful thundering noise in the pit, I was so glad to get out. Brampton looked so black and dark, and trains were running up and down as fast as they could." The pit had not been worked for a long time, so that there could have been no noise, nor were there any trains running at Brampton. At the trial, a surgeon, who had CASE OF SAMUEL WALLIS. 189 attended tlie prisoner for some time, gave evidence that he had suffered from derangement of the stomach and liver and dejection of spirits, and that he was under the delu- sion that he would never recover. He had been sent away for change of air, but had only stayed one day, and he was to have gone away again on the very day of the murder. The witness gave it as his opinion that it was a case of homicidal mania, basing this opinion on the complete absence of motive, the nature of the act, the previous symptoms of mental disorder, and the subsequent con- duct. The surgeon of the gaol gave a similar opinion, and said that the prisoner had stated to him that the act was so impulsive he did not know what he was doing, and was horror-stricken when he discovered what he had done. The judge, in summing up, pointed out that there was no evidence of insanity at any other time, that he had no delusions, nor had. his conduct been eccentric. Still there was a complete absence of motive for the crime, and if they felt satisfied that he was in a state of frenzy at the time, and unconscious of the nature of the act he was doing, they must find him "Not guilty." " It might become a dangerous thing to permit this kind of defence to prevail; nevertheless, if they were perfectly satisfied it was so, they must say so." The .jury found liim guilty, but recommended him to mercy on account of previous weakness of mind ! He was sentenced to death, but the sentence was not carried into effect. Had he been tiied by some judges, it is certain that he would have been exectitedji as other similarly insane persons guilty of homicide have from time to time been. Had there been 190 EESPONSIBILITY IN MENTAL DISEASE. any ground for alleging ill-feeling against his wife, it is almost certain that, notwithstanding the 'testimony as to his insanity, he would have been executed. Had judge and jury really known anything of the nature of insanity, he certainly would not have been found guilty, but would have been acquitted at the trial on the ground of insanity; On examination of the recorded instances of homicidal insanity, it will be found that in many of them there have been delusions of suspicion or persecution accompanying the melancholic depression. The individual has believed himself to be continually insulted, reviled, followed, robbed, poisoned, or ruined in health and property, and has done homicide under the influence of such insane delusion. The following case is an instructive example : — Dr. Pownall, a medical practitioner, was admitted into the private asylum of Northwoods, under the care of Dr. Davey, on April 2nd, 1859. He was described in the medical certificates, which were dated on the same day, as •' having made a murderous attack on his mother-in-law, whom he usually respected and loved ; " " for the last three months he had become an altered man," had been " low and desponding," and " he had made an attempt to destroy himself." This was the third attack of alienation, the first having occurred when he was twenty- two years of age, the second after an interval of fourteen years, and the third after another interval of four years and a half. Between the attacks he had conducted successfully a large medical practice, and had been so much respected by his fellow- townsmen as to have been chosen mayor of the town. He CASE OF DE. POWNALL. 191 was described as being naturally an amiable and estimaljle man, but when insane, as violent and dangerous to him- self and others. The first indications of mental derange- ment were a mistrust of his nearest relatives and a suspicion of design on their part against his interests ; these symptoms being followed, after a time, by delusions that poison was mixed with his food and that he was otherwise injured, and by suicidal and homicidal violence. During his second attack of derangement, in 1854, he had shot a gentleman with whom he was out shooting j and although the coroner's inquest resulted in a verdict that the fatal injury was accidental, there were some who thought differently. On his arrival at Northwoods, Dr. Davey, who had an interview with him, found him a little agitated, but nothing more. He conversed in a calm and gentlemanly manner, and as the conversation was continued, wept and ex- pressed the deepest sorrow for his violence to his mother- in-law ; when asked to give up anything about him with which he might injure himself or others, he at once gave Dr. Davey two penknives. Thenceforward his behaviour and conversation were quiet and rational ; he joined Dr. Davey's family and children in their walks, and rode out with him and his son. He remained in the asylum for four months, and during the whole of that time betrayed no symptoms of mental disease, so that he was considered to be quite well, and was discharged as recovered on the 10th August. Eegard being had to his antecedents, hov^- ever, he was sent to the house of a medical man and was accompanied by an attendant. Twenty days after leaving 192 RESPONSIBILITY IN MENTAL DISEASE. Northwoods, on the 30th August, he killed a female servant by cutthig her throat with a razor, having shown no indication of insanity up to within a few hours of the act. Acquitted at his trial on the ground of insanity, he was sent to Bethlehem Hospital as a criminal lunatic, where he was under the care of the late Dr. Hood, who, speaking of his case after an observation of several months, said that " from that time up to the present, although he had watched him with no ordinary care, he did not know that he could attach any particular symptom of insanity to him," and that " supposing he was a private patient in my asylum, and the Commissioners in Lunacy asked me why I detained him, I do not know that I could give any definite reason for it." By the unhappy event in this case it was rendered plain that Dr. Pownall ' belonged to one of two classes of patients : either he was subject to periodical attacks of recurrent mania, or, as is more probable, he was able successfully to conceal his delusions when he had a strong motive to do so, and was living under conditions favour- able to the maintenance of tranquillity of mind. Which- ever be the true explanation, one thing is certain — that a man may present all the appearances of sanity, so as, if insane, to deceive the most skilled observers, unto the time of a fatal outbreak of homicidal mania. Of the fact that insane persons are capable of concealing for a long time in a complete manner their delusions of suspicion and persecution there can be no doubt; and this success- ful concealment of them, where they are known to exist, renders it not improbable that they have been present. ANTECEDENT BODILY SYMPTOMS. 193 undetected, in some cases of what has been supposed to be impulsive homicidal insajiity. But if a person may thus skilfully simulate sanity, when he feels it to be his interest to do so, it might naturally be argued that he exhibits sufiQcient clearness of consciousness and sufficient strength of will to make him justly responsible for an act which he knows to be a crime, and which he proves by his conduct he is not without will to resist. Granting that Dr. Pownall acted, as no doubt he did, under a delu- sion that the servant whom he killed had injured him in some way, and that the murder was the effect of the delu- sion, it might still be contended that he was responsible for what he did ; for supposing the imagined injury to have been real — supposing, in fact, his belief not to have been ii delusion, a man so sane in other regards must have known that to take her life was a crime punishable by death. Knowing this, had he the power to resist the impulse to kill her ? This was really the vital question in the case, as it is in other cases of homicidal insanity. We shall not be in a position to form a right judgment concerning any case of this kind unless we distinctly realize the possibility of an impulse to violence in an un- sound mind becoming at times perfectly uncontrollable. That must be admitted as a general proposition, the question whether the impulse was uncontrollable in a given case being determined in accordance with the particular facts. There are sometimes striking coin- cidences between the exacerbations of the mania and disturbances of the bodily health. Before an outbreak of homicidal. impulse it may be found that there has 194 RESPONSIBILITY IN MENTAL DISEASE. been a change in the patient's symptoms, physical and mental J his tongue is white, he is feverish, feels faint and ill, loses his spirits, is suspicious, anxious and disquieted; these are symptoms which in such a case are sometimes forerunners of the attack. When this breaks out, the mind is overwhelmed with such a vast and painful emotion, such an unspeakable feeling of anxiety and distress, that the deed of violence is, as it were, an explosion of it, an uncontrollable convulsion of energy giving utterance to an indescribable morbid feeling; knowing not what he is doing, he kills some one, friend or fancied enemy, or perhaps an entire stranger, not really from passion or revenge or enmity of any kind; but as a discharge which he must have of the terrible emotion with which he is possessed. The emotion corresponds in the higher centres of thought with the hallucination in the sensory centres, and the act which discharges it is as involuntary as the cry of agony or the spasmodic muscular tension produced by intense physical pain. Hence there are four things noticeable in homicidal mania : first, the paroxysmal nature of the actual violence, which takes place only when the emotiflii becomes unendurable, the idea or impulse, though pre- sent, being almost passive in the intervals ; secondly, the mighty relief which the patient feels directly he has done the deed, so that he is delivered from the extraordinary disquietude which he had • previously felt and may give a rational account of himself; thirdly, the frequency with which the attack is made upon a near relative- or upon any one, friend or stranger, who happens to be at hand CONCEALMENT OF DELUSIONS. 195 when the paroxysm occurs ; and, fourthly, the indifference which he displays afterwards to the dreadful nature of what he has done, which, having been done when he was alienated irom himself , was not more truly Ais act than convulsion is an act of will. It is hard to dive into the depths of a diseased mind, and quite impossible for a sane mind to realize what passes there, but so far as a description can he given, from a psychological point of view, of the state of mind of the homicidal madman, the records of experience indicate that it is what I have endeavoured to picture. Assuredly it is unjust to him to assert that he can always control an act which he knows theoretically to be wrong. The fear of death has no in- fluence whatever to strengthen the power of control during the paroxysm of painful emotion which overwhelms reflection ; a greater fear, the fear of hell and all its horrors, is of no avail in a mind deeply imbued with religious feeling to prevent suicide under similar circum- stances. The sufferer is the victim of disease and a proper subject for medical treatment, not a crimina and a proper subject for legal punishment. It sometimes happens in the case of a person labouring under delusions of persecution that an act of violence against others, which is attributed perhaps to the excite- ment of intoxication, is the first circumstance to betray the unsound mental state. The delusion may be con- cealed for a long time, notwithstanding persistent efforts to elicit it, when he suspects any danger to himself from the avowal of it. One of my patients, who had for some time had delusions that people in the 196 EESrONSIBILITy IN MENTAL DISEASE. streets, in hotels, and elsewhere were speaking ill of him, accusing him of vices of which he was innocent and otherwise persecuting him, was sent to an asylum on account of an outbreak of excitement in the middle of the night, during which he smashed the windows of the house and made a savage attack upon his mother. Before this scene he had been extremely cautious about giving utterance to his delusions, but when he found into what trouble they had brought him, it was impossible to elicit an avowal of them. Accordingly, after being some time in the asylum, he was discharged. Two years afterwards he consulted me about the persecution and torture to which he believed he was subjected night and day by being played on by electricity and mesmeric tricks, his whole muscular system being kept in a constant succession of jerks thereby; and on that occasion he confessed to me with some glee that he concealed and denied his delusions in the asylum, though he had them all the while, because he found he would not be released by the authorities if he confessed them. In these cases it is often most difficult to advise; for, on the one hand, a person, though labouring under delusions of the kind, may go on for years in the world, without compromising himself by any act of violence, wherefore it seems a harsh and unnecessary measure to place him under restraint; on the other hand, he may break out into dangerous violence at any moment. More or less dangerous therefore at all times, patients of this class are most dangerous when the delusions of per- secution are accompanied by a hypochondriacal gloom DOUBTFUL EESPONSIBILITY. 197 and depression, with abnormal sensations in the stomach, liver or other organ, and especially when, as sometimes happens, they imagine they hear a singular voice in the chest or stomach ; believing that their bodily sufferings are caused by the persecutions to which they are sub- jected, or obeying the imaginary voices which they hear, they are apt to revenge themselves on those whom they believe to he the causes of what they undergo. Often- times they first appeal in vain to the police or to persons higher in authority, whereupon they conclude that these are implicated in the conspiracy against them, or at any rate bribed to do nothing in the matter, and finding that they can nowhere get redress, they are driven to despera- tion, and fall back upon the inherent and inalienable right of man to protect his life at any cost. Or they do an insane act of violence in order to compel attention to their extraordinary case and to have the opportunity of declaring publicly in a court of justice what they have suffered, when the truth shall be made known and their persecutors confounded. When an insane person kills some one whom he believes to have injured him in health, property, or repu- tation, and when the act is done therefore out of revenge, what are we to say of his responsibility ? The English law, as we have seen, declares him to be liable to the punishment which would be inflicted if he were not insane ; the disease is considered to make no difference in his culpability ; the act is deemed to be his act not- withstanding his alienation. Moreover, the popular notion that a really insane person acts without motive, or at any 198 EESPONSIBILITY IN MENTAL DISEASE. rate not from the same motives which influence a sane person, strengthens the erroneous belief that when he acts out of revenge he is not truly insane or is not acting insanely. But a person does not, when he becomes insane, take leave of his human passions nor cease to be affected by ordinary motives, and when he acts from one of these motives he does not, by doing so, take leave of his insanity; if he kills some one out of revenge for an imagined injury he is still a madman taking his revenge. Nothing is more certain than that the inmates of lunatic asylums perpetrate violence of all kinds and degrees under the influence of the ordinary bad passions of human nature. The question then is, whether it is just to hold a madman who acts from revenge equally respon- sible with a sane person who does a similar act in a similar spirit. To answer in the affirmative unhesitatingly seems verily a bold if not a reckless thing when it is remem- bered that insanity is the effect and evidence of loss of power of will produced by disease, and that the final result of its increase is a complete abolition of will. The truth is, that what in the sane mind is controllable passion becomes in the insane mind uncontrollable in- sanity. The madman has an insane delusion that his neighbour is continually persecuting him in some absurdly impossible way; he knows at the same time that it is against the law of God and man to do murder, and he withstands for a long time the impulse of passion which instigates such vengeance ; perhaps he denounces his per- secutors to the authorities and appeals for redress; but A PAETIAL EESPONSIBILITT. 199 at last, either from further deterioration of health causing a greater activity of the delusion and less power of will, or from the great provocation of the occasion, he is driven to desperation, passion drowns reflection, sweeps away the trifling resistance of an enfeebled will, and hurries him into the deed of angry vengeance. To say of such an one that he has no power of control, or to say of him that he has the same power- of control as a sane person, -would be equally untrue. To be strictly just, we must admit some measure of responsibility in some cases, though not the full measure of a sane respon- sibility in any case ; at the most, we must admit an insane responsibility, such as is recognized in the management of asylums, where the insane are worked upon by ordinary motives, but are not punished as fully responsible agents when these motives fail to hold them in check and they break out into violence. It is of course impossible to measure with anything like exactness the intensity of a morbid impulse and the degree of resistance which the will may be capable of opposing to it ; some may have yielded to temptation, though convinced that they ought to have resisted it, and are therefore so far culpable ; but the disease with which they are aiflicted is already so great a calamity that the infliction of the extreme punishment of death would certainly seem " an inhumanity towards the defects of human nature." No power of will can hold in check the progress of disease, and it is truly a piece of strange irony to exact such a controlling power in a disease the special character 6{ which is to weaken the power of will and to increase the 200 EESPONSIBILITT IN MENTAL DISEASE. force of passion — to lessen the power of controlling what is more difficult of conti'ol. It will be enough to secure the community against the repetition of the offence by enforcing confinement for life. Let it be considered furthermore that an insane person's revenge for a fancied injury is truly a passion which springs from his disease; that it is the direct, and the act which it instigates the indirect, offspring pf the delusion ; and that what is demanded of him is that he should control a passion which is generated by morbid beliefs over which he has no control. It is impossible so to divide the personality into two distinct parts, one of which is in subjection to a morbid idea and irresponsible, while ,the other remains master of itself and responsible. The theory of such a division is most extraordinary when applied to the will and moral liberty ^to that which constitutes in the highest degree the unity of the human personality. Let any one who thinks otherwise converse freely with an insane person who has delusions of persecution — that he is watched, insulted in the streets, maliciously pursued and denounced wherever he goes, and who, apart from these delusions, appears to be as rational as other men are ; let him reason exhaus- tively with him and try to convince him of the error of his foolish belief; let him demand what evidence he has to warrant it, listen to it seriously, and then demonstrate how inconclusive and inconsistent it is ; let him set forth to him how absurd it is to suppose that any person should for no known reason pursue him as he imagines h^ is pursued, and how little they can have to gain by it; LIMITED DELUSIONS. 201 let bim point out further that no one else can discover the least evidence of what he believes, but that every one else considers it utterly impossible ; let him exhaust, as he may in vain, all the resources of argument in his endeavour to shake the delusion; — ^be will part from him a wiser and a sadder man in his knowledge of the extent of mental derangement which is betrayed by a limited delusion. Not long ago I tried all this with a most intelligent and highly cultivated gentleman who believed that there was a conspiracy against him, and that wherever be went in his travels through all parts of Europe he was followed and watched by the secret agents of his enemies. He acknowledged the justice of my arguments, admitted that all that he had observed and misinterpreted in the de- meanour of those whom he suspected was consistent with two theories — the theory of their innocence as well as that of their guilt, and confessed that while the former was reasonable and probable, the latter was most unreason- able and in the highest degree improbable; owned that he himself felt at times that he must be mad, and should probably consider any one else who believed as he did to be so; — and, I need hardly say, went his way without bating one jot of confidence in his delusions. Baillarger tells a story which teaches the same lesson in a striking way. When M. Trelat was intrusted provisionally with the management of the Bicetre, he bad under his charge a patient who believed that he had solved the problena of perpetual motion. After having in vain employed all the arguments which he could make use of to shake the 202 EESPONSIBILITY IN MENTAL DISEASE. delusion, the idea occurred to him that perhaps the great authority of Arago would have the most beneficial effect in convincing his patient. Arago, after having received the assurance that insanity was not a contagious malady, agreed to combat the delusion. The patient was taken to his study, where A. von Humboldt happened to be. When the. poor madman heard from M. Arago the firm and convincing disproof of his error, he was as it were stupefied, shed abundant tears, and deplored the loss of his illusion. The end which they had in view seemed to be attained, but M. Trelat and his patient had hardly gone twenty paces from the house when the latter turned to him and said — " It is all one ; M. Arago deceives himself; I am in the right/' The delusion of eternal , damnation is not uncommon in the melancholic form of insanity, and the friends of an insane person labouring under this terrible delusion will sometimes vainly try what the authority and arguments of a clergy- man will do to dissipate it— in one case of a patient under my care a distinguished bishop's aid was invoked in vain — no reasoning will touch its foundations — ' ■ You may as well : Forbid the sea for to obey the moon, As or by oath remove or counsel shake The fabric of his folly. The very fact that an insane delusion does persist in the mind is proof enough that the man cannot reason soundly; he will reason insanely, feel insanely, and sooner or later act insanely. Its foundations are not laid in reason, but in disease ; and it holds its ground in METHOD IN MADNESS. 203 the mind just as a cancer or other morbid growth holds its ground in the body, — ^by drawing to its own use and converting to its own nature the nutriment which should support healthy activity, and so . render its existence impossible. A cancer is physiologically illogical ; never- theless it persists, and finally kills the patient, being pathologically logical. In like manner an insane delusion, though psychologically unaccountable, has its foundation in the inexorable logic of pathology, and persists by perverting to its own use and maintenance the reasoning which should render its existence impossible. In the case of the delusion, as in the case of the cancer, we are concerned to observe the pathological phenomena, and to find out their laws; physiology will not help us much in the one case, nor psychology in the other; our in- vestigations must follow the paths of inductive inquiry. To hold an insane person responsible for what he feels and does in consequence of his insanity, yould be no less unjust than to hold him responsible for entertain- ing his delusions, in spite of the plainest evidence to contradict them. Before taking leave of these cases of homicidal in- sanity in which there have been delusions of suspicion and persecution, let it be noted that there may sometimes be the clearest evidence of premeditation iu the plan and of ingenuity in the execution of the deed. It is entirely consistent with insanity that the individual, knowing in the abstract the difference between right and wrong — nay more, knowing that he is doing wrong iu the particular instance — should contrive the means of murder, do it 204 RESPONSIBILITY IN MENTAL DISEASE. deliberately, and endeavour to escape the consequences afterwards. This is a statement which is not easy of acceptation by those who, measuring the workings of an unsound by the standard of a sound mind, conclude that he who shows so much reason and self-control in his manner of doing an ill deed, might use that reason and self-control to forbear doing it ; nevertheless, it is a generalization from experience, which no one who has a practical knowledge of insane persons will contest, and which no one who has studied scientifically the pathology of mind will find unphilosophical. A striking instance of the cool and daring cunning of insanity, and of the sense of responsibility that may accompany it, is related by the American writers Wharton and Still^ — writers who are far from exhibiting an undue indulgence in estimating the responsibility of the insane : — "A man named John Billman, who had been sent to the Eastern Penitentiary of Pennsylvania for horse-steal- ing, murdered his keeper under circumstances of great brutality, and yet with so much ingenuity as to elude suspicious of his intentions and almost conceal his flight. He hung a noose on the outside of the small window which is placed in the door of the cells to enable persons outside to look in ; he then induced the keeper, in order- to look at something on the floor directly at the foot of his door, to put his head entirely through ; the noose was then drawn, and but for an accident the man would have been strangled. Notwithstanding this attempt, the same keeper was inveigled into the cell alone a few days after- wardsj on the pretence of Billman being sick, and was there BECUBEENCE OF HOMICIDAI, MANIA. 205 killed by a blow on the head with a piece of washboard. Billman undressed him, changed clothes with him, placed him on the bed in such a position as to induce the general appearance of his being there himself, traversed in his assumed garb the corridor with an unconcerned air, addressed an apparently careless question to the gate- keeper, and sauntered listlessly down the street on which the gate opened. He was, however, soon caught ; but his insanity was so indisputable that the prosecuting autho- rities, after having instituted a careful and skilful medical examination, became convinced of his irresponsibility, and united upon the trial in asking a verdict of acquittal on the ground of insanity. He was then remanded for con- finement under the Pennsylvania practice ; and some time afterwards, when in a communicative mood, disclosed the fact of his having several years back murdered his father under circumstances which he detailed with great minute- ness and zest. Inquiries were instituted, and it was found that he had told the truth. The father had been found strangled in his bed, the son had been arrested for the crime, but so artfully had he contrived the homicide, that he had been acquitted by means of an alibi got up by means of a rapid ride at midnight and a feigned sleep in a chamber, into which he had clambered by a window. Here was not only a sense of guilt, but a keen apprecia- tion of the consequences of exposure, and an abundance of evidence of long-harboured intention and intelligent desigfi.-' Another lesson which may be drawn from this case is one which sad experience of homicidal mania has often 10 206 RESPONSIBILITY IN MENTAL DISEASE. taught — namely, the exceeding danger of a recurrence of the attack. One can hardly ever say of a person who has once laboured under it that he has recovered entirely, so sudden, unexpected, convulsive may be the outbreak of a paroxysm. Pinel mentions the case of an inmate of the Bicetre, who, sixteen years after he had strangled his children, assassinated two of his fellow-patients. And Esquirol relates the case of an advocate, of a gloomy and taciturn character, who was placed Under his care on account of an attack of insanity in which he had attempted to throw himself out of the window. During his illness he accused his wife of infidelity, believed himself damned> made attempts at suicide, and for a time refused food from fear of poison in it. After three months he seemed to be convalescent, and was removed by his wife. On their way home, though very affectionata to her and conversing reasonably, he had an angry altercation with a passenger who sat opposite to his wife, and of whom he was jealous. On the day. after his arrival home he topk by the h^'ir, as if to play with him, a boy of twelve years of age, his wife's brother, led him towards his desk, and then Iqt him go, saying, " It is not worth while.'' On the third day he went into the cellar, accompanied by his wife, under the pretext of seeing whether all was right there. A few minutes afterwards his sister-inrla^, aged twenty years, followed. As no one returaed,^ a servant went down to see what was the matter ; she found the two women dead, bathed in blood, while he was crouched in a corner behind some barrels, a razor lying some distance from him. He was .sent to Chareptp^v^ EXAMPLES. 207 At one tiriie he said tllat the cellar was lightened in a brilliant manner, and that the two ladies were devils who had come to seize upon him ; at another time he declared that he did not know what he was doing. It was very doubtful, however, whether hallucination had any thing to do with the murder, for he had evidently thought df killing the boy two days befoire, and he must have taken the razor into the cellar with a homicidal design. After being some time in the asylum he seemed to have recovered, although he showed a remarkable insensibility to the remembrance of what he had done. He wrote numerous letters to the authorities, declaring that he had been mad, that he was cured, and that he ought to be put in charge of his property and children. After having made these demands for several years, he was examined by Marc, who could not discover any intel- lectual disorder :-—" I remained," he said, "at least an boiir and a half alone with him, and during the long conversation which we had together, I was not able to detect the slightest- trace of mental disorder; but I was struck with' his indifference when I spoke with him of the double homicide which he had committed." Not- withstanding that Marc declared that it would be impru- dent to grant him his liberty, his importunities ultimately obtained it. He established himself with a woman in Parisi where he opened an office. Two years after his discharge, and ten years after the invasion of his disease^ he was seized with a new attack of fury, and but for the vigorous resistance of the woman with whom he lived, he would have thrown her out of tiie wihdbw. He was 208 KESPONSEBIHTy IN MENTAL DISEASE. sent to an aB}'Iam, where he died after some days of fearful delirium, in which he wished to kill himself and every one else. There is nothing uniform, immediately afterwards, in the conduct of patients of this class who have done or attempted to do homicide. In some the memory is obscure and confused, they scarcely understand what has happened, and they make no attempt to escape; others realize vividly what they have done as soon as the overwhelming emotion has been discharged in the act, and, obeying the reviving instinct of self-preservation, do at first attempt to escape, though they probably surrender themselves to justice in a little while. Some manifest a complete moral insen- sibility, seem perfectly indifferent to what they have done, and utterly unable to realize its criminal nature ; while others, when they come to themselves after the deed, display the keenest anguish and remorse. Attempts at suicide both before and after the homicide are not at all uncommon. I proceed now to consider another class of cases of homicidal < insanity — ^those in which there is a definite delusion in the mind, and the crime is the direct or indirect result of the delusion. When a father believes that he has received a command from Heaven to slay his son, and obeys it, there can be no manner of doubt of his insanity, and no one would impute the deed to him as a crime : it was the direct unqualified offspring of the delu* sion. Even lawyers admit readily that this kind of ihsanity excliides all responsibility for actions which can be shown to be in close relation to the particul^: delusion HOrFBAOER'S CEITEEION OF BESPONSIBIUTY. 209 under which the so-called monomaniac labours ; the vital question for them being how far the delusion has affected the mind of the agent at the time. No human punish- ment, it is supposed, would restrain him from doing what, though legally criminal, he believes it right to do ; his knowledge of right and wrong in this regard is destroj'ed by disease. But if the delusion cannot be shown to have influenced the act — ^if a man has the maddest de- sion which madness can imagine, and does a murder which cannot be traced to its influence — ^then it is declared that he ought not to be absolved from culpability ; that he ought justly to be held responsible in all other instances. Hoffbauer proposed that, in order to answer the question of responsibility in regard to the acts of insane persons, " the dominant impression in which their delusion consists should be regarded not as an error, but us truth ; in other words, their actions ought to be con- sidered as if they had been committed under the circum- stances under which the individual believed himself to act." If the imaginary circumstances make no change as to the imputability of the crime, then they ought to have no effect on the case under consideration ; if they lessen or destroy culpability, they ought to have that effect in the supposed instance. The man is to be assumed to have a dual. being — ^a sane and an insane personality.; and according as he acts in the former or in the latter capacity is to be condemned as a criminal or to be acquitted as a madman. Such is the criterion of responsibility which is founded on the metaphysics of insanity, and which com- mends itself to the approval of those who, like the 210 EESPONSIBILITY IN MENTAL DISEASE. emiuent philosopher Kant, hold that the determinatibii of the question in any case should be left to philosophers who have made the human mind their study, and not to physicians who have acquired a knowledge of the disease. It is fortunaite in this matter, as in other matters, that physicians have devoted themsielves to the patient obser- vation' of facts, instead of invoking their own minds to utter oracles to them, or accepting with reverence -the confused oracles which other minds might utter to them. They would have known little bf the nature of any disease or of the remedial action of Any drugs at this day had they depended only upon what those who had studied the physiology of the body could tell them ; and they would have knoWn little of the nature of mental diseases and of their proper mode of treatment if th6y had depended only upon what those who had studied .psychology could tell tliem. I have already pointed out that lawyers, in the importance which they assign to delusion as a mark of insanity; vastly overrate its value. Not half the insane acts of a person labouring nnd6r general mania are resilly the offspring of his delusions; they represent the overflow of morbid energy, are often aimless and motiveless, so far as we can judge — the mere con- vulsive expressions of disordered nerve-centres. Even the acts which are the ofiBpring of delusion are not such as are the logical outcome of it, or such as are adapted to the attainment of the delusive aim ; they are the results of insane reasonings from insane premises, or of impulses which Spring- up in insane hoffbauer's criteeion op responsibility. 211 minds without being connected with the existing delusions. - Let me suppose a case in order the better to appre- hend the doctrine which is legally propounded and the criticism to which it is open. An individual believes himself to be Jesus Christ, but talks rationally on all matters unconnected with his delusions, and conducts his affairs with intelligence ; nevertheless he one day sud- denly shoots somebody, and in due course is put on his trial for murder. It cannot be shown that he did the deed under the influence of his delusion ; moreover, if the imaginary circumstances were real, they would hardly absolve him from responsibility, seeing that it is not in accordance with the character of Jesus Christ to do murder, and seeing that a madman must theoretically be consistent with his character; he must therefore righteously be put to death as a criminal. Clearly the theoretical principle ill bears the test of practical appli- cation, for it is certain that, notwithstanding its founda- tions in metaphysical philosophy, in no civilized country in the world would such a person be executed as a murderer ; aiid, as a matter of fact, the principle is fre- quently violated in practice while it continues to be upheld in theory. Assuredly this is a mischievous thing, which cannot better be condemned than in the words used by Hoffbaiier in reference to another matter: — "All legislation ought to be founded on a knowledge of the object to which it is applied. If this knowledge's defec- tive, it would be much better that the law should not define at all than that it should make a bad definition, and 212 RESPONSIBILITY IN MENTAL DISEASE. introduce errors which, although contrary to its purpose, are perpetuated by its authority." The ordinary medical doctrine, which has been formu- lated as an induction from the practical observation of insanity, is that this so-called monomania, or, as it is called by English jurists, partial insanity or partial delusion, excludes the idea of criminality, and takes from the affected person all responsibility for his actions, whether or not these are the results of the delusion under which he labours. Let us weigh the value of the opposing dogmata. In the first place, the legal dogma is open to criticism from its own basis. It is not true that a person who has a delusion, and acts under its influence, has necessarily lost his knowledge of right and wrong in the particular case, or the power to control his actions in relation to his delusion; he may know quite well that what he does is contrary to law and will entail punish- ment, and the knowledge that other persons will consider it wrong and treat it as a crime may so far influence him as to prevent him from yielding to his own impulses. Nothing is more certain than that a monomaniac will sometimes conceal or deny his delusions, dissemble his feelings, and regulate his conduct accordingly, when he has a strong motive to do so, whether this be a lively fear of suffering or a strong hope of gain : he is neither with- out knowledge nor without power of control. In truth, it might often be justly said of such an one acting under a delusion that, although his knowledge is more at fault, he has greater power of control than the person who acts under a desperate insane impulse, and tb.at.he.is, there- MEDICAL DOCTBINK OF PAETIAL INSANITY. 213 fore, so far as culpability can be attached to madness, the more culpable of the two. The legal doctrine thus breaks down in its application to the cases which, it is supposed to specially cover : it is " hoist with its own petard." If English jurists would be logical, they must iiisist on the propriety of hanging an insane person who does murder under the influence of delusion, unless it can be clearly shown that he did not know the act was wrong; the burden of proving the incapacitating degree of his insanity being laid upon the lunatic in this as in other cases. The medical doctrine, by which monomania is held to exclude criminality, is founded mainly on the three following considerations : first, that a delusion may be concealed, wherefore it might be overlooked, although it had actually affected the conduct; secondly, that it is impossible to follow the workings of an unsound mind and to discriminate between a healthy and a morbid action thereof, it being beyond dispute that an act which a looker-on cannot discover to have any manner of con- nection with the delusion may still be the insanely logical outcome of it; and, thirdly, that it is impossible to isolate an insane delusion and thus to prevent the infection of its morbid nature from spreading, it being certain that the whole disorder in monomania is not restricted to one delusive idea, that the rest of the mind is in a more or less marked state of moral or affective alienation — ^in a state, therefore, in which insane impulses to acts of violence are likely to occur. The sum of the matter is that, in the condition called monomania, there is usually a 214 EESPONSIBZLITY IN MENTAL DISEASE. much deeper and' more geberiil mental disrangement than is supposed, and that it is impossible, in estiimating; the cause of pafticulax conduct, so to isolate the operation* of the partial insanity as to be able to say that the crime is unconnected with it. I shall say a few words on each of the above-mentioned considerations separately. (a) It would be easy to fill pages with stories exhiUting the extreme reticence which the insane sometimes display with regard to their delusions; but two or three instances will be enough. A commissioner who was sent to Bicetre in order to set at liberty those whom he should judge to have recovered, examined an old vine-dresser who, in his replies to questions, gave no indication of madness and uttered no incoherent expressions. The order was pre- pared, according to form, for his release, to which he had to put his signature; he took the pen and wrote the name of "Christ." Esqiiirol attended a gentleman who had made several attempts to destroy himself; he would ask for a pistol to shoot himself, saying, " I am tired of life*" He betrayed no illusion, and was generally cheerful. It was not until after two years that he confessed that he laboured under hallucinations of sight and hearing : he believed himself to be pursued by officers of the police ; saw and heard them, as bethought, through the apertures of his apartment, the walls of which he asserted were made of panels so arranged that all he said and did might be perceived from without. Dr. Hood had under his care a patient who was .placed in Bethlehem Hospital for having annoyed the Queen on one occasion in Eotten Eow by .presenting a petition to her praying for some CONCEALMENT OF DELUSIONS. 2i5 place under Government, and who was detained there for twenty years. For the last fifteen years he was there he had shown no symptom of his particular form of insanity, and for the last eight years no symptom of insanity at all. After a very strong effort Dr. Hood obtained his dis- charge ; but he had not been gone five months before he was sent back to the hospital, having addressed three or four letters to the Queen asking' for the hand of Princess Alice. Again, it is well known that some melancholic patients are so silent that it is only after their recovery we discover what their delusions really were, although these may have been of an extreme character, and may have dictated the most extraordinary conduct, and occa- sioned the most grievous suffering to themselves. How, then, is it possible in such cases to determine what actions are or are not in relation with the delusions? Many times is the asylum-physician perplexed to divine what are the unexpressed delusions tha;t are holding possession of his patient's mind and governing his conduct. If he could always do so, his duties would be far less anxious than they are now; but he might take the most acute (iounsel of any court; place him before patients whose lives were under the sway of delusions, and defy him with all his skill in examination and cross-examination to elicit what those delusions were. If he himself can giieSs, it is only because his conjectures are informed by past experience. Many a gibing sneer and ill-timed jest at medical testimony in courts of justice would be spared if those who utter them so glibly were to spend a few months in an asylum, and thus to bring home to their 216 EESPONSIBILITY IN MENTAL DISEASE. minds the extraordinary inconsistencies and the startling inexplicabilities displayed in the thoughts, feelings, and acts of those who dwell therein. (b) Few who have heard the accounts which insane persons sometimes give of the motives which have in- fluenced their acts, would venture to say positively that a particular act was unconnected with their known de- lusions, however independent of them it might seem to be. It is not true, in fact, that a madman reasons and acts logically from the false premiss of his delusion ; and it is monstrous in theory to assume that a belief which itself exists only in violation of all reason should conform in its action to laws which govern the action of, and are therefore appreciable by, a sound intelligence. If this were so, it would not be difficult to predict exactly from the character of his delusion what an insane person might do, and so to preclude mischief on all occasions. But the difficulty of their care, that which constitutes the chief anxiety in the management of them, is that, although we may know what they think, we cannot foretell what they will do; we may know full well their delusions, but we cannot follow the workings of them in their minds and foresee their outcome in action : there is an inco- herence between their ideas, and there is an incoherence between their ideas and actions. Locke's well-known saying, that madmen reason correctly from false pre- mises, is indeed far from true of all cases; they often reason insanely from insane premises ; they do not do those things which, were their delusions true beliefs, they ought to do, and they do those thmgs whi<;h, were their EXAMPLES. 217 delusions true beliefs, they ought not to do, and there is no health of. mind in them. Who, then, but a meta- physician adoring his theories and ignoring facts, would venture to declare how far an act had been influenced by a delusion ? There is a wellrknown case, which has been quoted by writers on medical jurisprudence, of a young man affected with some degree of imbecility, who was of childish manners, and evinced a strong propensity for wind- mills : he would go any distance to see a windmill, and would sit watching one for days together. His friends, hoping to do him good by a change of place, removed him to a part of the country where there were no windmills. On one occasion he set fire to the house in which he was placed, and on another occa- sion he enticed a child into a wood, and, in attempt- ing to murder it, cut and mangled its limbs with a knife in a horrible manner. Before these outbreaks he had never shown any dangerous propensities. Had all the professors of logic and moral philosophy in the country been set to work to discover the motive of his dangerous acts, it is probable that they would have failed to do so. And yet it was very simple : he had done them in order that he might be removed to some place where there were windmills. From time to time I see a gentleman who has been confined for some years in an asylum, having been placed there as a criminal lunatic. For some time before he was put under restraint he had alarmed his friends by his conduct, had flouiished a loaded. re-> 21& RESPONSIBILITY IN MENTAL DISEASE. volver in the street, and hftd at last sttucik on the head with an axe a cab-horse as he drove past it. He was acquitted at his trial on the ground of insanity. He had at the time the delusion that be was Jesus Christ, but soon after he was placed in confinement he was calm' and courteous in behaviour, rational in conversaticto, and so sane apparently that his wife made strong and repeated representations to the authorities in order to obtain his discharge. On two oocasionshe was examinedather request by two eminent physicians, who could find no insanity in him, and strongly recommended his discharge. And yet this gentleman, as it appeared afterwards, believed all the while that he was Jesus Christ, and had made the attack on the cab-horse in consequence of that delusion : he \dshed by the publicity which he would thus gain to attract attention to his missiori. Insane eUougli to conceive and act upon such a motive he was still in-* telligeiit enough to appear so sane as to deceive two physicians, who Were informed what had been his delusion and what he tad done. Given the act alone, could any one, however acute in the analysis of motives, have guessed the motive of it? Given the delusion; alone, could any one, however much experience of insanity he might have had, have predicted the course of action pursued ? Given the delusion and the act, what sane mind could, without help from the patient — which for years he would not give — ^have made known the connection which actually existed between them ? On one occasion I spent an hour with this gentleman, en- deavouring to elicit from him evidence of the delusion EXAMPLES. 21& which I was sure he ha!d, and an explanation of the inotive of the act, which I was sure was an insane one. He was quiet and gentlemanly throughout the interview ; but although I was convinced of his derangement from his inability or unwillingness to give any rational explanation of what he had done, and from certain marks of what seemed weakness of mind, I was not able to elicit any fact which would have sufficed to found a certificate of insanity upon. I may say, however, in excuse of my failure, that he had for some years been living a quiet and regular life in an asylum, free from cares and excite- ment, and that there was reason to believe he had been schooled to conceal his delusion by those who were striving to obtain his discharge. It was the more re- markable that a person who was capable of so much self- cdntrol should ever have acted in so insane a manner, and from what, even were the delusion Regarded as truth, must still be deemed so insane a motive. The example illustrates the absurdity of imposing on a sane mind the task of diving into the troubled depths of a liinatic's mind, and tracking the incoherfencies of his disordered thoughts and feelings ; of tracing the conneiction between mental phenomena, the essential character of which is that they are not coherent, that they follow one another in no logical relationj not in an order but' in a disorder of association opposed to all the experience of sanity. If a sane person could succeed in doing this it could be only on one condition — namely, that he should become as insane as the person whose mind he was studying : in that way only couldj he follow 220 KESPONSIBILITY IN MENTAL DISEASE. and appreciate its insane reasonings. The delusion is not itself tlie disease, it is only a striking symptom of the disease ; and it is certain that the criminal act may be a manifestation of the disease of which the delusion is a symptom, and that no connection between them may be detectable by a looker-on, notwithstanding the ex- istence of a real pathological connection. (c) When an insane delusion exists : in the mind, how- ever cii'cumscribed the range of its action may seem to be, the rest of the mind is certainly not sound; on the contrary, it is in a condition in which not only do impulses that are in relation with the delusion acquire an irresistible force, but in which unaccountable, impulses spring up without relation to it. Outside the recognised circle of morbid ideas there will be found, if a sufficiently careful examination be made by a competent person who knows the individual or knows the disease, evidence of mental disorder — evidence of such loss or perversion of natural feelings, such change of character and j habits, such excitability of disposition, with loss of self-control, and such weakening of mind, as constitute a general alienation , apart from the particular delusions. He is centred in himself, and it is a morbid self; social feelings wane or are extinguished; his intelligence is so far weakened that what he perceives at once to be the grossest folly in another, he cannot perceive to be any folly in himself; if he be sent to an asylum, it is extra.- ordipary how little able he seems to be to realise why he is there, and, in some .instances, what a strangely im- perfect appreciation he shows of the derangement of oilier PATHOLOGICAL MEANIN& OF DELUSION. 221 inmates. His delusions, which are the outgrowth of an exaggerated egoism, drain into themselves the energy or vitality of all his mental processes ; his mind is not unsound upon one point, hut an unsound mind expresses itself in a particular morbid action. An insane delusion will not spring up and grow in an unsuitable soil, and the soil which is suited to it is insanity: let that soil be changed to one of sanity — ^in other words, let the mind apart from the delusion be sound, and this will dwindle and die. If a so-called monomaniac has the delusion that his wife, whom he has hitherto loved and trusted entirely, is dishonouring or conspiring against him, the existence of a delusion so foreign to the whole habit of his healthy thought and feeling marks a deeper and more general derangement of mind, and it is impossible to foresee the extent of its possible influence upon his con- duct. At a meeting of the Societe Medico-Psychologique of Paris in 1873, Dr. Foville gave some interesting information as to the effects of the war upon certain pati6;nt3 who were labouring under a partial delirium, having delusions of persecution, and who would com- monly be called monomaniacs. On% patient who read the newspapers regularly, and appeared to follow all the events in a very intelligent manner, affirmed that he was not fool enough to accept as real either the accounts which he read or the incessant discharge of artillery which he heard ; that all the noise which he heard was produced by some fools who pre- tended to fire the cannon to amuse themselves, but whose 222 EESPONSmiLITY IK MENTAL DISEASE. teal end was to cause Mm to lose all patience, and to Have a pretext for causing him to perish of hunger by reducing more and more the allowance of food. Another patient repeated daily that the pretended war was only a comedy, all the scenes of Which had been previously arranged between the Prussians and French; that the guns and cannons were only loaded with powder; and that all reports as to the number of Mlled and wounded were pure invention. Doubtless many people were cati^t with the farce, but he was not one of them. A more remarkable case still was that of a captain of the Imperial Guard, who was admitted into Charenton some weeks only before the declaration of war, and who laboured under delusions of persecution. It might have been expected from his profession, from his having numerous relatives in the army, from his comparative lucidness — which on many subjects was perfect — that he would have been most interested in the military events, and would have fallowed the disasters of the war with the greatest attention. But it was exaictly the opposite. All the defeats and sieges of the war, the fall of the Empire, the investment of Paris, ihe conflicts before it, various episodes of which he saw with his own eyes, the bombardment of the forts, which be heard incessantly, the capitulation of Paris and its deplorable consequences — all were to him as if they had never happened^ Each event was related to him by several people, but he would not believe a word of what he was told ; all means were employed to convince him, but without success; he resisted all arguments, replying to them by taking PATHOl-OGICAL MEANIKG OE' DELUSION. 223 exception to them or by systematic denial. He never ceased to maintain that France was at peace, the Emperor at the Tuileries; that all means of communication were open, and that the authorities of the asylum made common cause with his persecutors by refusing to forward his letters to his relatives, and by witholding their answers to him; that all the noise made about the house by the eaftnonading was the work of some officers of his regi- ment — ^his open enemies; who were bent upon annoying him, and'whom he mentioned by name. One day he was shown five or six different newspapers, all of them of the same date, relating to the same facts ; he read theni with the same incredulity, maintaining that they were aU sham newspapers, printed for him alone by his persecutors, so determined were they not to desist, cost them what it might. Certainly, as Foville observes, these facts are of a nature to shake very strongly the theory according to which, through the mutual independence of the feculties, there is supposed to be biit ia partial lesion of them in iflbnOmania, without a general alteration in their har- itiony. No one could believe, unless he "was convinced by experience, how great and general may be the loss of power of appreciation, the impairmfent of intelligence, and the lesion of judgment manifested by iiisane persons who appekr rational on aiU save one or two subjects ; in no case can we predict how much madness the application of a sufficient test ma^ discover ; we can predict only that it will elicit a gl'eat deal more than appears on the surface. Nor -wiir the evidence of it be waiting in his ,224 BESPOKSIBILITY IN MENTAL DISEASE. conduct: inside an asylum, where his life is regular and monotonous, the sorcalled monomaniac may go on calmly from day to day, doing the simple duties set before him ; but if he be left to his own devices in the world, and especially if he be placed under conditions which ipapose a strain upon his mental resources, im- pulses of which neither he nor any one else can give a rational explanation are apt to arise in his mind and to realise themselves in his conduct. In order to form a conception of the nature of these frantic impulses, we must compare them with convulsive movements, which are the expressions of a morbid condition in the motor-centres similar to that frpm . which they originate in the mind- centres. Both in physiological and pathological actions we have instances of movements which take place in what is called sympathy with others, without having a manifest connection with them; as, for example, the useless contortions of the facial muscles which are so marked in some persons when making a muscular exertion, and certain convulsive movements which, ac- companying other directly caused convulsions, we describe as sympathetically excited. They occur together, although we dp not see why they should do so, just as in like manner sensations excited in one part of the body will somjetimes occasion sensations in another part, without our being able to assign a reason for the concomitance ; for to call them sympathetic is not an explanation ; it is merely to use a general name to bind together and denote a class of phenomena which, occurring together. THE RIGHT PEOBLEM IN HOMICIDAL INSANITY. 225 we cannot at present explain the connection of. The lesson which they teach us may, however, be profitably applied to the study of the function of the higher nerve- centres — those which minister to mind : an active morbid idea in the mind may excite into activity another idea which has no discoverable relation to it in consciousness, and this last may realise itself in some deed, which, so far as the primary idea is concerned, seems inexplicable ; there may, in fact, be a synergy of idea, as there is notably a synergy of movement, or a sympathy of sensation. A poor woman, the mother of two children, became depressed, and fancied that she was persecuted ; she was also suicidal, but went about her daily duties with regularity. One day, however, without seeming any- wise different from usual, she seized one of her children, and beat its head against the floor until it was dead ; and she would have done the same with the other child liad she not been prevented. She was sent to an asylum, where she recovered after a time ; but she never could tell how it was that she had killed her child, when she was so fond of it. The case is one of a class of cases in which frightful impulses spring up in the diseased mind, and drive the individual to a deed of violence ; they may be as little within control as are the convulsions of epilepsy, and the origin of them perhaps as little within the individual's knowledge as the origin of the impulse which entered the unfortunate herd of swine, and drove them over a steep place into the sea, so that they were drowned, was within their knowledge, 226 EESPONSlEILIir IN MENTAL DISEASE. The right problem for a court of justice to place before a scientific witness is to trace a connection not between the delusion and the act, which maybe undetectable — or, if detectable, such as would not excuse the act if the delusion were truf— ^but between the disease and the act. Certainly, it is an extraordinary demand to make, that when two symptoms of disease exist, the delusion and the criminal act, the one should be proved to. be the cause of the other; that the effects of a common cause should be proved . to be cause and effect. Out of the depths of deranged feeling ini^hich. the delusion is rppted there may spring up at any moment insane impulses; which are quite independent of it, but which, like it, are born of th0. disease. Thus much, then, with regard to the cases of homicidal insanity in which there is a distinct delusiop and tbe homicide has or has not an evident connection with it. In the next chapter I shall say something specially of homicide in connection with epilepsy. CHAPTER VII. EPILEPTIC INSANITY. Mania following epilepsy; its- furious cbai^cter — Masked epilepsy — Mental disorder precedinjg tto'^ileptio attack — Epileptiform neurosis manifesting itself in periodical attacks: of mental derange- ment : examples^T-D^scripi^ou of tt^Q symptoms oL epileptic insanity : of those that go liefore and foretell an attack ; of those that are exhibited in iHe milder and the more severe forms of the disease ; and. of those that are met with after long-continued epilepsy — > Peculiar states of epileptic consciousness — Epileptic visions — •Transitory maniai 61 epileptic origin: examples — Features or « epileptic homicidcT-Transitory mania, without history of epilepsy — Somnambulism — The persiste^tce of dreaiK-li^Uucinations . after waking from sleep. When a murder has been committed witHout apparent motive, and the reason of it seems inexplicable, it may chance that the perpeti-atpr is found on inquiry tp be afflicted with epilepsy. It is an important question, then, how far the existence of this disease affects his re- sponsibility. At the outset we may declare nnlesitatingly that an epileptic person may be quite as sane as one wlio is not so afflicted, and, in the event of his doing murder, quite as responsible ; though his passions are more violent, in the intervals between the fits there 9ia,y be nothing to warrant the slightest suspicion of any mental disorder. But it is an undoubted effect of epilepsy in some instances, as the experience of every asylum testifies, to produce mfental derangement of a furious kind ; and tbe nearer we get to the fit, the more 228 BESPONSIBILTTY IN MENTAL DISEASE. reason is there to suspect that the mind may have been aflFected; wherefore an old author, Zacchias, declared that every epileptic ought to be regarded as irresponsible for acts committed by him within three days before or after an epileptic attack. Without subscribing to this arbitrary limit, we certainly ought to scrutinise closely the forms of mental disorder which, occurring immediately before or after an attack, have led to the enunciation of such an opinion. What happens frequently in asylum epileptics is this : that after a fit, or a succession of fits, there follows a brief t^ttack of furious mania, which is known as epileptic mania. On account of its violent and destructive cha- racter, it is a most dangerous form of insanity ; for the patient, in a frenzy of excitement, unconscious of what he is doing, his senses perhaps possessed with frightful hallucinations, is driven to most destructive acts of violence against both animate and inanimate objects. After the excitement has lasted for a few days, or it may be only a few hours or a few minutes, it subsides, and the person comes to himself; if he has injured or killed some one in his fury, he realises for the first time what he has done. During the intervals between these epileptic and maniacal paroxysms, which may be intervals of weeks or months, he is calm and sensible ; there may be no mental impairment whatever at first, although after the disease has lasted for some time there will be loss of memory and weakness of mind, deepening into actual dementia in the worst cases. It is one of the saddest experiences of asylum life to witness the THE CHAEACTKK OF EPILEPTIC HOMICIDE*. 229 pitiful fate of those patients who have not sunk below the consciousness of their condition. Gentle, amiable, and industrious through their long intervals of lucidity, they hope against hope that each recurring paroxysm will be the last; they eagerly try all remedies, in the hope of curing the disease ; they see others leave the asylum restored to health, and confidently anticipate that their turn will also come ; but confidence wanes as the attacks r€cur, the mind is slowly weakened by the storms of fury through which it passes, and they sink finally into the apathy of dementia — a state of mere oblivion, in which they cease to hope or care more. This is one form of epileptic insanity in which homi- cide is sometimes done. When the disease has been so well established that it has been found necessary to send the patient to an asylum, there will be. no difficulty in recognising its nature, but when the mania follows the epileptic attack for the first time, and especially when it passes o£f after lasting for a few hours only, it is obvious that it might easily be overlooked. If the unfortunate sufferer has killed some one under these circumstances, and has not chanced to come under the observation of a skilled observer, it may go hard with him when he is put on his trial for murder. The character of the deed itself in such case may have the greatest significance ; if it has been doae with great violence, without indications of pre- meditation, without apparent motive, and without secrecy, and if the accused person is discovered to be the victim of epilepsy, it is probable that it has been done in a paroxysm following an epileptic fit. II 230 BESPONSIBILITY IN MENTAL DISEASE. A second form of epileptic insanity in which homicide IS sometimes done is really a masked epilepsy ; a transi- tory mania occurring in lieu of the usual convulsions. Instead of the morbid action aifecting the motor centres and issuing in a paroxysm of convulsions, it fixes upon the mind-centres and issues in a paroxysm of mania,, which IS, so to speak, an epilepsy of mind. Many cases of so-called transitory mania {mania transitoria) are really cases of this kind — cases of mental epilepsy. Both forms of mania may occur in the same patient at different times: his fits may be followed by mania, as is most often the case, or he may now and then have a maniacal taking the place of an epileptic paroxysm. Thus, in one case of epilepsy complicated with mania there were three kinds of symptoms at different times : (1) — Epilepsy pure and simple; (2) Epilepsy followed by violent delirium, chiefly of action, in which the' patient tumbled about on the ground in an extraordinary manner with great rapidity without speaking a word, this condition, during which intelligence and sensibility were abolished, lasting for ten minutes ; (3) An attack of mania without epilepsy, the patient falling, after the excitement, into an almost ecstatic state, from which he returned slowly to reason. Between these attacks he was quite sensible. The practical lesson which cases of this kind teach is, that in the event of homicide we must not insist on its being proved in every case that actual convulsions had occurred ; for the instance may be one of masked epilepsy. A third form of mental disorder occurring in connec- tion with epilepsy, and marked sometimes by a homicidal HOMICIDE BEFOEE EPILEPSY. 231 outbreak, is that which is observed now and then before the fits come on. Before their access a notable change often takes place in the character of the asylum-epileptic: instead of being, as he usually is, amiable and gentle, he becomes suspicious, sullen, and surly, and whereas he is generally ready to talk cheerfully, he will not answer at all, if addressed, or will answer shortly and surlily, or may answer with a blow ; he displays uncontrollable anger with or without some slight cause, and reckless violence ; the most indifferent question or remark, or the slightest accidental touch, may cause an oiitbreak of the extremest fury; wherefore he is, if much interfered with, most dangerous to others. With this condition of profound moral perversion, delusions of suspicion and hallucination of a vivid nature may or may not be associated : if he sets fire to a house, or kills some one, or does some other act of violence, it is either that he is overwhelmed with such a vague, vast, and painful feeling of mingled fear and apprehension, that he must find relief in convulsive action, or that he acts under the influence of some hallucination or delusion, or there may be a combination of these mental states. In due course the fits occur, the cloud of disordered feeling passes from the mind, suspicions and delusions disappear, and, after a short period of mental confusion and stupor, he returns to his amiable and gentle state, remaining so until an exactly similar moral change foretells the approach of the fits on another occasion. As an illustration of the danger of this kind of mental disorder take the following case :^A patient, aged thirty years, confined in the French asylum at Avignon, was 232 EESBONSIBILITY IN MENTAL DISEASE. subject to severe epileptic fits from time to time. On on6 occasion after an attack he threw himself out of the window ; on another occasion he seemed exhausted and desired to embrace his father, whom, but for help given, he would have strangled; on other occasions he was maniacal, and would kill everybody who came near him. In the intervals between the attacks he was sensible, pleasant, and amiable, though a little vain, as is common with such patients, and considering himself superior to the other inmates. He was attached to the Superintendent, who granted him indulgences, and for whom he worked willingly. • Towards the end of March he had a succes- sion of epileptic fits for two or three days, which were followed by incoherence, hallucinations, and great excite- ment. At the beginning of April he had a single fit. On the 21st of the month he held.out his hand to the Super- intendent whom he met, and uttered the word " Union," but otherwise exhibited no difference frbm his ordinary state. Next day he was still calm, but sombre. On the 23rd he was standing in a passage as the Supeiintendent passed ; he pretended to have a pain in the leg, and as the latter stooped down to examine it, he stabbed him violently to the heart with a pair of scissors, so that death took place in an hour and a half afterwards. In the following night he had an epileptic attack. When ques- tioned about: what he had done, he said that for some nights he had heard the voices of the members of a secret society, . telling him that if he did not kill the Superin- tendent he would be miserable all his life. He had uttered.the. word "Union" to ascertain whether the PPILEPTIFOEM NEUEOSIS : .EXAMPLES. 233 Su^erinteBdent had any connection with these voices and beloaged to the secret society. After the fatal act the epileptic attacks were more frequent for some time, the mental disorder was greater, and the lucid intervals were nirer and shorter, but during them he was sorry for what he had dons. Lastly, let me note that epileptic insanity, manifesting itself chiefly by irritability, suspicion, moroseness, and perversion of character, with periodical exacerbations of excitement, in which vicious or criminal acts are perpe- trated, showing itself, in fact, in a profound moral or affective derangementj may occur periodically from time to time for months or even years before distinct epileptic fits declare themselves, these at last making their appear- ance, and supplying the interpretation of the previously obscure attacks of recurrent derangement. Morel has pointed out that some cases of homicidal and suicidal mania are really cases of this kind in which an epilepti- form neurosis has existed for a long time in an unde- veloped or masked form. But as such attacks may occur periodically for some time before the access of genuine epilepsy, so may they also occur periodically for some time after it has ceased. Falret mentions one case in which, after epilepsy had ceased for twenty-one years, a strong impulse to homicide, which necessitated restraint, displayed' itself. I shall not, however, multiply examples, but content myself with the following instances : — A man, aged sixty-two, had in bis youth been subject to epilepsy, and had been discharged from the military service in con- sequence. After this the attacks gradually became more 234 EESPONSIBILITY IN MENTAL DISEASE. rare, and they finally ceased ; none having been observed for forty years. There was nothing particular noticeable in him except an inclination for good living and a condition of exaltation in the spring. One day he suddenly stabbed his aged mother in the throat several times, and vyhen she fell down he sat upon the body and stabbed her repeatedly. When he was seized, he exclaimed, " She is a villain who has done me all the injury possible; I ought to have killed her long ago." There was no discoverable motive for the crime; but it appeared that for several years during his periods of exaltation in the spring he had reviled his mother, and threatened to kill her ; and the date of the murder corresponded with the period of exaltation. A more striking case still is one related by Esquirol. A Swabian peasant, aged twenty-seven years, whose parents did not enjoy the best health, had been subject to epileptic fits from his eighth to his twenty-fifth year. But the character of his disease then underwent a change; in place of epileptic convulsions, the man fonnd himself seized with an irresistible impulse to commit murder. He felt the approach of the homicidal paroxysm for several hours, and sometimes for a day, before it came on, and then earnestly begged to be bound, lest he should commit a crime. " When it seizes me," he said, "I must kill some one, were it only an infant." His mother and father, whom he loved dearlyj'were the first victims of these fits : " Mother," he cried in a loud voice, " save yourself, or I must strangle you." Before the attack he was greatly exhausted, had slight convulsive movements in the limbs, and was overpowered THE SYMPTOMS OF EPILEPTIC INSANITY. 235 with a feeling of sleep, without heing able to go to sleep. During the paroxysm, which lasted one or two days, he retained consciousness, and knew perfectly that if he com- mitted murder he would be guilty of a crime ; and when he was put under restraint,. he made contortions and frightful grimaces, sometimes singing, and sometimes speaking in rhymes. When it was over, he cried, " Unloose me. Alas ! I have suffered greatly ; but I am well out of it, since I have killed no one.* Having thus briefly set forth the varying order of events in epilepsy complicated with mental disturbance, I shall now go on to say something more in detail of the character of the mental symptoms. They may be de- scribed under four divisions, — the first including those which sometimes go before an attack of epilepsy, and are known as its prodromata or forerunners; the second division including those which, corresponding in the mental sphere with those slighter forms of epilepsy that are known as epileptic vertigo, or the petit mat, Fah-et describes as a sort of petit mal ; the third including the more violent symptoms which wouldi correspond to the regular epileptic convulsions, or the so-called grand mal ; and the fourth including those symptoms of mental decay which follow long-continued epilepsy, and mark what is called epileptic dementia. First, then, with regard to the mental prodromata of epilepsy. As I have already said, some persons become * Other similar cases in which the cessation of epileptic fits was fol- lowed by attacks of mental epilepsy are related by Dr. Echevenia in a recent article on "Epileptic Insanity," in the American Journal of Insanity for July, 1873. 236 RESPONSIBILITY IN MENTAL DISEASE. morose, surly, irritable, and quarrelsome ; others exhibit great dulness of conception, enfeebled memory, corifusion of ideas — in fact, a physical and mental dulness or torpor ; others, on the other hand, display an unwonted gaiety, loquacity, and self-confidence, which contrast strangely with their usual dull and apathetic state. It has been pointed out by Falret that in some cases the same ideas, the same recollections, or the same hallucina- tions recur before the attack ; that on each occasion the person has the same vivid mental impression, or sees the same spectral illusions, or smells the same odour, or hears the same voice uttering the same words; and it is curious enough that the recurring idea or image is sometimes a reproduction of that which went before, and perhaps pro- voked, the first attacks. We may liken it to the strange sensation which, occurring in some part of the body im- mediately before the loss of consciousness and the con- vulsions, is known as the aura epileptica. It is certain, then, that there are in many cases of epilepsy mental dis- turbances which, though we may call them prodromata, are really a part qf the attack; and it is not a little strange, having regard to these and similar facts, that any one should ever have placed the morbid seat of epilepsy in the central or in the lower ganglia of the brain. The ordinary epileptic loses consciousness before he falls down in convulsions ; it would^ therefore seem that his supreme cerebral centres are in trouble before the storm affects the lower centres. 3. It is well known that there are some attacks of ejji- lepsy which may be described as abortive or incomplete. PECULIAR STATES OF EPILEPTIC CONSCIOUSNESS. 237 There are no convulsi&ns, nor does there appear to be a complete loss of consciousness ; the person utters a few unintelligible words, or makes some incomprehensible sounds, or he may exhibit indications of a profound but momentary terror, with or without grimaces or other slight muscular spasms, and then is Mmself again, quite unconscious of what has happened to him. A remarkable circumstance which has occasionally been observed in connection with these incomplete attacks is that, after tlie individual appears completely restored to himself, and speaks and acts as if he were so, the attack recurs, and when it has passed off and he is really himself, he re- members nothing of what, he said and did in the interval of seeming lucidity ; and yet this normal or apparently normal state of reason, in which he answers questions^ makes remarks, and does various acts, may last for hours or even days. He may be likened to a person in a dream who, being awakened out of it, talks sensibly with some one for a short time, soon goes to sleep again, continues his interrupted dream, and, on awakening finally, has no memory of the interval during which he talked. I have spoken of the intervening state of lucidity as a normal or apparently normal state, and such it certainly seems to be in some cases, so like his natural self does the individual appear ; but in other cases it is plain that, although he converses and acts as if he were quite conscious and master of himself, he is nevertheless not really in his normal state of mind; he exhibits a loss of perception, more or less confusion of ideas or incoherence of language, or even actual delusions, and does strange 238 RESPONSIBILITy IN MENTAL DISEASE. or foolish things which indicate some degree of mental aberration. Like the somnambulist, he only perceives the objects which affect his senses in so far as they are connected with the ideas and feelings which hold possession of his mind, or perceives them in the form and colour which his ideas and feelings impart to them. These peculiar states of epileptic consciousness are not only of great psychological interest, but also of practical consequence in relation to the question of responsibility ; for it is obvious that deeds might be done by an individual when in the anomalous state of consciousness, of which he might have no remembrance when in his really normal state, and for which, therefore, he could not justly be deemed fully accountable.* It is difficult for a healthy mind to realise such a pathological state of consciousness : in order to do so, or rather — as it must be impossible to truly realise it except on the condition of the sound mind becoming unsound — ^in order to form an approximate conception of it, it is necessary to draw conclusions, not from the experi- ences of self-consciousness, but from observation of those abnormal conditions of consciousness which are mani- fested in insanity, in somnambulism, in the hypnotic or so-called mesmeric state, and in certain dreams, where the individual evinces some perception of things around, and acts as an apparently voluntary agent, while he is clearly living in an internal world, and is cut off by his * Dr. Echeveiria discusses these conditions in an article on "Violence and Unconscious State of Epileptics in their relation to Medical Juris- prudence,'' in the American Journal qf Jnaanity for April, 1873. PECULIAE STATES OF EPILEPTIC CONSCIOUSNESS. 239 mental state from anything like an adequate appreciation of his relations to his surroundings. Some writers are in the hahit of describing these anomalous states of con- sciousness as states of unconsciousness, moved thereto probably by the metaphysical notion of consciousness as a definite invariable entity which must either be or not be ; but this is obviously a misuse of words ; and what it behoves us to learn from them is that consciousness is not a constant quantity, but a condition of mind subject to manifold variations both of degree and kind. The form of mental disorder which corresponds to the petit mal or epileptic vertigo may be described as a great confusion of ideas accompanied often by instantaneous im- pulses to violence. Those afflicted by it become sad and morose without any cause in external circumstances ; are profoundly distressed, and exhibit much irritation against those who are about them ; suffer from loss of memory and dulness of intelligence, so that they cannot collect and fix their thoughts ; feel sadly that they are no longer themselves, that they are impelled to strange or violent acts by a power which they cannot resist; oppressed by a vague anxiety or dread, they leave their homes and wander about the streets or the country ; all the painful ideas which they have conceived at different periods of their lives come back and fasten upon their minds ; they are overwhelmed with a vague anxiety and terror. In this state of confusion and distress they accuse their friends of hostility, and imagine persecutions which have no existence out of their morbid fancies; and they do unlawful deeds, such as theft, incendiarism, 240 EESPONSmiLITY IN MENTAL DISEASE. suicide, or homicide ; some relieving themselves by destroying inanimate objects, others killing theniselves in order to get rid of their anxieties and fears, and others attacking, in a blind and desperate manner, persons whom they chance to meet when their terror and distress have rendered tlieir impulses uncontrollable. The deed of violence done, either there is immediate relief, the inde- finable anxiety and confusion of ideas disappearing, and they recognize what they have done ; or they continue in a state of, excitement, unconscious, or very imperfectly conscious, of the gravity of their acts. "When they come to themselves, their memory is uncertain and confused, like that of a person awaking from a terrible nightmare ; they may remember the facts in a fragmentary way when they are recalled to their minds, or may deny them alto- gether. Let him who would realize, so far as it can be done by a sane mind, the mental state of these afflicted beings, try to recollect the most painful dream which he ever had; let him reflect on its grotesque inconsisten- cies, the blest relief which he experienced when he awoke and found it was a dream, the fragmentary remembrance which he retained of it, and the little desire which he had to live it over again in memory; let him then suppose it to be no dream, but conceive himself to be over- whelmed by the horrible nightmare day after day, and to be, as he surely would be, incapable of even the hope of relief ; what cry would then suffice to express his agony and despair save the cry of supreme agony, " My God, my God, why hast thou forsaken me ? " — what act save an act of suicide? EPILEPTIC MANIA. 241 3. Another form of epileptic mania is of a furious cha- racter throughout its course, and may be compared in the mental sphere with the so-called grand mal or genuine epileptic convulsions. It differs from other forms of mania in its sudden invasion ; either there are no premonitory symptoms, or they occur only a ievr hours before the attack. They are headache, redness and brilliancy of the eyes, alteration of voice, slight convul- sive movements of face or limbs, or sadness, irritability, and slight excitement. A second character, which is common to other forms of recurrent mania, is the close resemblance of one attack to another in its" prodromata, syinptoms, course, and termination; the same ideas, the same words, the same acts, are observed on each occasion; the attacks are almost as much alike as one epileptic fit is like another. Another character is the extreme vio- lence of the mania, which makes those who suffer from it the terror and danger of an asylum. There are frequent hallucinations of the senses: threatening voices in the ears, overpowering odours in the nostrils, flames of fire er the redness of blood before the eyes. Terrify- ing ideas have possession of their minds ; they see in those around them assassins who threaten their lives ; and their fury is : uncontrollable. Nevertheless, it is remarkable, considering their extreme fury, that their words are much less incoherent usually than those of other insane persons who are equally excited ; they comprehend and reply to questions more directly, and are more conscious of their surroundings ; and yet, in singular contrast with this feature, they exhibit an almost 242 EESPONSIBILITY IN MENTAL DISEASE. complete loss of memory of the attack after it has passed off. The mania is usually, of short duration, lasting only for a few days, and sometimes only for a few hours, and ceases as suddenly as it came on ; there is perhaps a short period of torpor, and the person is himself again, without remembering clearly, if he remember at all, what has happened. Between this form of general mania and the previously described form of partial mania it should be understood that there is every degree of variation exhibited in different cases. 4. Lastly, the result of long-continued epilepsy is to impair and Weaken the mind, producing, first, failure of memory, and ultimately a condition of dementia. In some instances this impairment affects principally, at any rate at the commencement, the moral faculties, giving rise to a state of moral imbecility or insanity; but, in the end, both moral and intellectual faculties are involved in a common ruin. Outbreaks of great maniacal excitement continue to occur from time to time in these cases. The classes of symptoms which I have thus briefly described include those which most commonly occur in connection with epilepsy, but it must not be supposed that other forms of mental disorder are not sometimes met with in connection with it; there is hardly a form of mental derangement that has not been found associated with it in occasional instances. A feature which is often very notable in epileptics is an exaggerated development of the religious sentiment, whereby it comes to pass that they see visions, and perhaps announce themselves as TRANSITORY MANIA OF EPILEPTIC ORIGIN. 243 the organs of special revelations from on high.* Like Swedenborg, they are sometimes carried up into heaven while yet in the flesh, and have conferences with angels, prophets, and even with the Supreme; or, like Mahomet, they are visited by angels, and are invested with a prophetic mission. Their visions, in fact, resemble very closely those which are said to have been seen by certain religious enthusiasts, and which have been the origin of certain religious creeds.t It will be the interesting work of a future inductive psychology to examine and point out how many supposed revelations of the supernatural, and how many theological beliefs founded on such revela- tions, have been the results of deranged nervous function — a deranged mentalism, if I may be permitted to coin such a word — of an epileptic or allied nature. It is important to bear in mind that the existence of epilepsy may be overlooked for some time in a person even by medical men, and this is perhaps more likely to be the case when there is a mental alienation which absorbs the attention. Attacks of epileptic vertigo are sometimes so slight that they are thought to be merely transient attacks of giddiness or faintness; and it is * There is an interesting paper on "Tlie Religious Sentiment in Epileptics," by James C. Howden, M.D., in the Journal of Mental Science for January, 1873. ■f An interesting chapter might be written upon the mental charac- teristics of the epileptic neurosis. There is the immense energy, such as was exemplified in Mahomet, Napoleon, &c. Then there is a sin- gularly vivid imagination, which is apt sometimes to occupy itself with painful or repulsive subjects. Probably the invention of the modern sensational novel, with its murders, bigamies, and other crimes, was an achievement of the epileptic imagination. 244 EESPONSIBILITY IN MENTAL DISEASE. notorious that patients labouring under them will often seek advice on account of some ailment which they attribute to the stomach or the liver, the real nature of their malady only being elicited by accident, or by questions aimed to discover what is suspected. Another reason why epilepsy is overlooked is because the attacks often occur in the night only, and the person may then be unaware that he has had them. These things con- sidered, it is extremely probable that many cases of so- called transitory mania might, if a careful enough examination were made, be found to be connected with epilepsy in some form or other. Delasiauve, who has insisted much on the frequency with which epilepsy exists undetected, relates the following instance : — H., who had been committed to the Bic^tre, was re-admitted after murdering his mother. At the trial he had been acquitted on the ground of insanity. Epilepsy had not been suspected in his case ; and at the asylum he dis- played complete lucidity, with the exception of short occasional excitements, up to his death, which occurred not long after his return to the asylum. Certain cir- cumstances, however, led M. Delasiauve t6 suspect epilepsy, and on inquiry he was able to trace his tem- porary aberrations, and therefore his overt acts, to previous nocturnal fits. He mentions another case of a young man, well bred, educated, and belonging to a respectable family, who was sent to prison for stealing. From prison he was transferred to the Bicetre on account of repeated epileptic fits, It was then ascertained that he had FEATUKES OF EPILEPTIC HOMICIDE. 245 been subject to epilepsy for years, and it became evident that the theft had been the result of mental disorder connected with the disease. He manifested two quite different natures. The one was limited to about a week before and after the ■ fits, when . he was irritable, gloomy, intemperate, prone to violence, and capable of every imaginable mischief. It was mainly at this time that, while preserving sufficient lucidity to execute intentionally an act, he failed in the necessary discernment to judge of its morality, as also in the necessary self-control to abstain from doing it. During the other condition, which was the normal one, his cha- racter was quite a contrast ; it was that of a man in the full possession of his senses, and free from any extrava- gance. Sometimes in place of this moral insanity there was an attack of incoherent and furious mania. What shall be said of the philosophy which would acknowledge the intellectual mania to be the result of disease, and yet declare the moral mania to be nothing more than depravity? It cannot be said that there are special features so distinctly marking an epileptic homicide as to enable us to identify it on every occasion ; but those which will commonly be observed are an absence of intelligible motive, an absence of premeditation, great determination and ferocity in the execution, much more violence than necessary being used, an absence of secresy in the exe- cution or of concealment afterwards, a great indifference and absence of remorse, and an incomplete and frag- mentary remembrance of all the circumstances, if not a 246 RESPONSIBILITT IN MENTAL DISEASE. complete forgetfulness of them.* Certainly, when a murderer lies down quietly to sleep by the side of the person whom he has just killed, we may safely predicate something abnormal in his condition ; and seeing that a heavy sleep usually follows the epileptic paroxysm, the probability is that the act was the outcome of the epileptic neurosis. It must not be supposed that the absence of motive and of premeditation which I have mentioned as features of epileptic homicide will be observed in all cases; though common, they are not constant. An insane epileptic may go about his work of murder deliberately and under the influence of a feeling of revenge or je^ousy. He is not emancipated by his twofold disease from the ordinary evil passions of envy, hatred, malice, and jealousy ; but, in estimating his accountability, it is not right to permit the evil passions to engage all our attention, and to forget that it is an insane person who is under their influence, and that they may be delusive morbid feelings, if they are not actually the cause or the offspring of the delusive ideas. We are in much need of a term to denote insane feelings, which shall carry as distinct a meaning in the moral sphere, convey as definite a notion of mental derangement, as does the word delusion when applied to an insane idea. Delusion is a term which is understood by lawyers to * "Whenever we meet witli isolated acta of violence, outrages to persons, homicide, suicide, arson, which nothing seems to have insti- gated, and when, upon attentive examination and thorough inquiry, we find a loss of memory after the perpetration of the act, with a periodicity in the recurrence of the same act, and a brief duration, we may diagnose larval epilepsy."— J. Faelet, Annal Med. Psyc, p. 162, Jan., 1873. TRANSITORY MANIA. 247 mark insanity : who will help their understandings by the invention of a term which, applied to the more funda- mental conditions of insane feeling and insane will, shall enable them to realise and talk of such states ? The right word is always a power; it gives definiteness to conception, and makes action more clear; and it would make a mighty difference if the fit word to denote insane feeling could be found and take its place in the vo- cabulary. Although epilepsy, masked or overt, will, I think, be found to be at the bottom of most cases of mania transi- toria, it must be admitted that there are some cases in which there is no evidence of epilepsy in any of its forms to be found ; but it may well be doubted whether a distinct insane neurosis is not always present in these cases. With such a constitutional predisposition, a genuine attack of acute insanity, lasting for a few hours only, or for a few days, may break out on the occasion of a suitable exciting cause, and during the paroxysm homi- cidal or other violence may be perpetrated. After child- birth it sometimes happens that a woman is seized with a j)aroxysm of acute mania of short duration, during which perhaps she kills her child without knowing what she is doing. The effect of alcoholic intemperance upon a person strongly predisposed to insanity, or upon one whom a former attack has left predisposed to a second, is some- times a short but acute mania of violent character with vivid hallucinations and destructive tendencies ; and a like effect may be produced by powerful moral causes, sexual excitement, and other recognised causes of insanity. On 248 EESPONsreiLiTY in mental disease. one occasion I was summoned late at night in haste to see a young woman who was in a state of acute, violent; and incoherent mania, the whole household being in the utmost dismay. She had gone to bed complaining of nothing more than a loss of appetite and a feeling of bodily illness, and the outbreak of mental disorder was quite sudden. Suitable treatment was adopted, and in the miDrning the excitement had passed off, some con- fusion of mind only remaining: she slept heavily during the day, and was soon herself again. Even in young children such paroxysms have been observed. Morel records two cases in which children, one of them being ten years and a half old, the other only five years old, fell into convulsions and lost the use of speech in consequence of a great fright ;- after- wards a maniacal fury with destructive tendencies and continual turbulence occurred ; in one case epilepsy followed, but in the other it did not. He also gives an account of a girl, aged eleven years, who had furious maniacal attacks, during which she attempted to kill her mother and injure her sisters, and who finally recovered. Other instances of a similar kind might be mentioned, but these will suffice to illustrate the fact that a transitory mania, accompanied by homicidal and other destruc- tive impulses, may be produced by a sufficient exciting cause in a person who has a distinct insane neurosis, just as epileptic convulsions or mania may be produced where the epileptic neurosis exists. They are really cases of acute general mania, only they are of much shorter duration than acute general mania commonly is. SOMNAMBULISM. 249 There can be no difference of opinion as to the irrespon- sibility of a person who commits a crime when labouring under such an attack, if there be satisfactory evidence of its occurrence. A difficulty might occur when the paroxysm was very short, and when there were no witnesses to testify to its nature : coming on suddenlj' and passing off suddenly, it is possible that it might be overlooked. This is more likely to happen when the Crime falls short of murder, as there is not then an equally merciful inclination to find an excuse, nor is an equally minute inquiry made into the person's antecedents. While conceding unhesitatingly the occurrence of an acute attack of transitory mania on the occasion of a sufficient exciting cause, where there was an epileptic • neurosis or an insane neurosis, or where there had been an injury to the head which had affected the mind at the time or afterwards, or where a previous attack of insanity had left behind it a tendency to the recurrence of the disease, I certainly hold that we ought to regard with extreme suspicion the allegation of transitory mania in excuse of crime where none of these conditions were present. Possibly there may have been a sudden out- break of insanity which ceased as suddenly as it came on; but, unless there was strong evidence of it other than the crime, it would be proper to refuse to admit it. Before concluding this chapter it will be convenient to say something with regard to a condition of consciousness that has some resemblance to those peculiar states of consciousness which are sometimes evinced in epilepsy ; I mean the state of somnambulism. There can be no 250 KESPONSIBILITy IN MENTAL DISEASE. doubt that some persons may rise from their beds while asleep, go through a series of complicated actions, and retire to bed again without awaking; in the morning feeling weary, tired, and out of sorts, but remem- bering nothing of what they have done, or remem- bering it only as a dream.. If a crime were done by a person in this condition, there could be no question of responsibility. But it must be borne in mind that somnambulism might easily be pretended, and assuredly the assertion of its occurrence for the first time when a crime had -been done would be extremely suspicious. It is really, if not itself a kind of nervous disorder, very closely allied to such nervous disorders as epilepsy, cata- lepsy, and hysteria ; it certainly indicates a decided neurosis; wherefore if any one really was subject to it, there could hardly fail to be evidence of its previous occurrence or of distinct nervous troubles.* Most physi- cians have in the course of their experience met with genuine instances of somnambulism ; but few, I imagine, can call to mind an instance in which an act of homicide or incendiarism has been perpetrated during sleep. The recorded cases have been quoted over and over again by successive authors, but they do not thereby gain any more weight than attaches to the original authority, and it is no easy matter to get at this and to test its value. Having regard, however, to the complicated acts which * I was not aware, when this was written, that the old medical writers had pointed out the affinity between epilepsy and somnambulism. But I learn from a recently published work on Megrim and Sich Head-ache, by Dr. Liveing, that I)r. Darwin, the distinguished author of Zoonomia, noticed it, and that Dr. Prichard also called attention to it. HALLUCINATIONS. 251 somnambulists unquestionably do perform in their sleep, there is certainly no reason in the nature of things why they should not set fire to the house, or commit suicide or homicide.* There is a condition intermediate between sleeping and waking in which, before consciousness is fully restored, the ideas and hallucinations of a dream persist for a time ; so that a man, even though awake, shall think he sees the images or hears the voices of his dream. " On awaking one morning out of a distressing dream," says Spinoza in one of his letters, "just as day was breaking, the images I had had present to me in my dream floated before my eyes as distinctly as if they had been actual objects. One form in particular, that of a leprous negro, whom I had never seen in my life, pre- sented itself to me with singular distinctness, but faded and in a great measure disappeared when, to turn my thoughts to something else, I fixed my eyes on a book ; as soon, however, as I allowed my eyes to wander from the page, the vision of the blackamoor presented itself with the same vividness as before. By-and-by it began to fade, and anon it disappeared entirely." To the same effect hear Casaubon : — " Aristotle, in his treatise on Dreams, gives an instance of it in children and young boys ; who after some terrible dream, though they be out of their dream, and their eyes full open (and light * The American newspapers have recently contained the account of a boy who in his sleep killed another boy, having left his bed in a state of somnambulism, and mounted into his victim's room by means of a ladder. When in prison, he got up in the night in a state of somnambu- lism, laid hold of a razor, and attempted the life of another prisoner. 252 RESPONSIBILITY IN MENTAL DISEASE. brought in sometimes, which I add because I know it to be true), think nevertheless for a while after that they see with their eyes what they saw in their dream. And Vitus Amerbachius, a learned man, in his book De Animd, lib. 4, confirms it to be true by his own experience, even when he was a man, if I mistake him not. But, whatever be the cause, the effect is certain." Most persons who have attended to their mental states will be able to furnish similar instances from their own experience. What it is'important for us to bear in mind in regard to these persistent dream-images is that, in the mental confusion of the moment, they may lead to respondent actions. There are on record well-authenticated cases in which persons who have been aroused from a frightful dream, in which they imagined that their lives were threatened, have violently attacked those who have awakened them," having seen in them the enemies from whom they dreamed they were in danger. Marc reports the following remarkable case of Bernard Schedmaizig, who awoke suddenly at night, and saw, as he believed, a frightful phantom. He twice called out, "Who is that?" and, receiving no answer, and imagining that the phantom was advancing upon him, he seized a hatchet which was beside him, attacked the spectre, and killed his wife. A somewhat similar case has been recorded : — A constable heard in the middle of the night a distressing cry of " Save my children ! " pro- ceed from a house. Hastening int.o it he met a woman in her night-dress, who was in the greatest con- fusion and excitement. Everything in the room was THE PEESISTENCE OF DEEAM HALLUCINATIONS. 253 in disorder, and two children cowered in one corner. Their mother cried repeatedly, "Where is my child? Have you caught him ? I must have thrown it out of the window." She had thrown it through one of the panes of the window, without opening it. She had dreamed that her children cried out to her that the house was on fire, and in the confusion of waking had thrown her youngest child out of the window in order to save it.* I doubt not that in this condition of brief transitory delirium the mental state is very much like that which sometimes occurs in epileptics immediately after a fit, when on reviving to consciousness they break out into delirium ; only it is of much shorter duration. It may be a question in some of these cases whether an over- looked epileptic attack, either in the form of vertigo or of convulsions, has not actually preceded the mental confusion and excitemeni^ of the half-waking delirium. However it may be caused, it ought certainly to exempt from responsibility any one who is so unfortunate as to commit violence when thus deprived of the consciousness of the nature of what he is doing. * Bucknill and Tiike'a Manual of Psycliological Medicine. 12 CHAPTER VIII. SENILE DEMENTIA. Symptoms of senile dementia in the order of their occurrence : loss of memory, impairment of perception, incoherent talk, incapacity of comprehension, complete mental decay — Companson of its symptoms with those marking the natural decay of mind in old age — The mental character of old age — Failure of mind in febrile and other diseases— Loss of consciousness of personal identity — Aphasia. In this chapter I propose to describe briefly the phenomena which mark senile dementia, forasmuch as important questions of testamentary capacity not un- frequently arise vrhen an old person whose faculties have undergone decay makes a will which is disappointing to those who have been looking forward to be his heirs. These phenomena have the further interest of exhibit- ing in a striking way the progressive decay of mind which accompanies decay of brain; a decay which in some instances almost reaches mental extinction before bodily dissolution. At the outset the natural decline of the mental faculties which in greater or less degree commonly accompanies the bodily decline of old age, should be distinguished from that greater loss of mental power which is known as senile dementia; notwith- standing that between the least -degree of the former and the worst stages of the latter there are all degrees of transition. It will be easily seen, then, that difficult medico-legal inquiries must sometimes occur in such LOSS OF MEMORY. 255 cases, and that the decision, whatever it be, may challenge criticism. The first marked symptom of the mental decay of senile dementia is an impairment of memory, especially of recent events. The past may be recalled with exact- ness; but recent impressions make no mark, soon pass away, and are , forgotten. It is not that they are not rightly apprehended at the time, for at this early stage perception takes place properly, but they are not retained. So it happens that the visit of a friend, or some similar event, which caused interest at the time, is clean forgotten after a few days, while a similar event of former years is remembered accurately. Because of the way in which impressions occasioned by present circumstances slip from the mind, while the ideas of the past abide, there is a want of connection between the circumstances of daily life and the habitual thoughts, and the person may talk and act in a way that is inconsistent with actual facts. Suppose him to have received notice of some property having been left to him, or of the death of some one whom he intended to remember in his will, it is quite possible that he might forget it, while retaining unimpaired, or not greatly impaired, the power of reasoning within the sphere of his recollection, and while remaining, therefore, capable of making a just and rational disposition of such property as he knew he possessed, and of doing right to those who were present to his mind. Or it may happen that, having made his will, he straightway forgets that he has done so, and begins after a short time to talk again of making his will. Hence there is often in such a case the appearance 256 BESPONSIBILITY IN MENTAL DISEASE. of a far greater mental aberration than the facts, when closely examined, really betoken. Let the attention be actively aroused by some stimulus, and the facts brought clearly to his mind, he will apprehend them correctly and pass a sound judgment upon them, although a few hours or a few days afterwards he may not, if questioned, be able to give an account of what he has said or done : he may, in fact, be capable of making a will, though incap- able, by reason of loss of memory, of taking proper care of himself and of managing his affairs. Following the failure of memory, or coincident with it in some cases, there is au impairment of the poWer of perception, so that the person fails ordinarily to appre- hend all the qualities of an object, and so makes mistakes as to the identities of persons or places. The activity of his mind being mainly in the' past, his memory of the lapse of time lost, and his perception of present circum- stances blunted, trains of ideas are mistaken for realities, and he talks as if he were now in a place where he was formerly, or supposes a person whom he sees for the first time to be some one whom he knew years ago. Neverthe- less, when his attention is called to the mistake, he recognises it and wonders perhaps how he could have , made it, though he may make it again next day. He may sell his property and speak of it as his afterwards ; ask the same question over and over again, forgetting that it has been asked and answered ; not recognise one whom he had previously known well; inquire after the health of some one who has been dead for some time, or ask after the health of the person with whom he is talking as if he LOSS OF MEMORY. 257 were asking after it from some one else. And yet it may be proved by documents that he is all the while filling up and signing cheques correctly, keeping his accounts accurately, and making no mistake in the management of his affairs. It is an important fact to be borne in mind that there may be great variations in his mental condition at different times according to his state of bodily health or to other causes of which we cannot always give an account. It will happen that he one day remembers an event of which he evinces no remembrance on another day, or that on one occasion he makes a mistake as to the identity of a person whom he recognises perfectly on another occasion. These variations in the degree of his memory and in the measure of his apprehension are indeed marked features of his condition. On one occa- sion I visited and examined an old lady, finding nothing more the matter with her mental state than loss of memory with regard to time ; but when I visited her again a short time afterwards in company with her nephew, I found, after he had left the room, that she con- founded him with his grandfather, regarding whom she retained the memory of some offence, and abused him accordingly, although she had seemingly recognised him when he was present and spoken kindly to him. Matters becoming worse, as the effacing action of decay proceeds, the impairment of memory and the loss of power of perception increase. The individual fails to recognise those who are about him while constantly receiving their attentions, and forgets everything that 258 EESrONSIBlLITY IN MENTAL DISEASE. occurs directly it has occurred. Even the past is not remembered coherently; incidents and persons are jumbled together in a confused way, and the conversation is a fragmentary and incoherent rambling. He does not recognise where he is, has no notion of the day of the week, or of the time of day, and will get up in the night insisting that it is daylight, or go to bed in the day- time ; will believe that he is engaged daily in occupations which he has not touched for years, or wonder why he is not so engaged, and blame those whom he imagines to be preventing him. Conversation he cannot follow, and only understands the simplest question when it is slowly and distinctly addressed to him ; or, apprehending its meaning and attempting to answer, he is incapable of carrying on the series of thoughts to the end of a sentence, his mind becomes confused and bewildered before he has uttered the half of his reply, and his expressions are consequently absurd and irrelevant. Feeling is involved with intelligence in the common " ruin of oblivion ; " by the ravages of decay he is brought to the philosopher's ideal of freedom from passion, although it sometimes happens that the remembered fragment of a former grudge gives a temporary animation to the language of his dotage. Finally, he cannot comprehend a simple question, does not understand at all; and his reply, if he makes one, is utterly irrelevant and incoherent. His habits are often uncleanly; he has lost even the animal instincts and propensities ; and so he lingers superfluous on the stage until exhaustion or apoplexy carries him off. Before this last stage of decay is reached, MENTAL DECAY OF OLD AGE. 259 however, there are sometimes delusions with periods of excitement : he has fears that some injury is to be done to him — that he is to be robbed, ruined, or kUled, does not sleep, complains and cries out, and is at times maniacal. Paroxysms of noisy excitement, with delusions and apprehensions of the character described, are, indeed, not uncommon features of senile dementia at one stage or other of its course. Such is the course of senile dementia — a gradually increasing decay of mind until there is nothing left that we properly called mind. Let me consider briefly the manner of its beginning, and compare its symptoms with the earliest indications of that natural decay of mental power which accompanies old age. For there is a charac- ter of mind which belongs to old age. The old man is sagacious, prudent, circumspect, sober in conjecture, ripe in judgment, measured in his language as in his move- ments ; he performs his ideas and his movements slowly and cautiously, for he has lost much of the energy and suppleness of his mind and frame ; his imagination is less brilliant and fruitful, and there is a languor of his intel- lectual faculties, although, under the influence of an active stimulus, they may momentarily reach their former height of energy. He ceases to take interest in and to duly appreciate the present ; cannot assimilate new things, but withdraws himself from participation in new movements, with which he feels no sympathy, to which he feels rather antipathy ; is without initiative, shrinks from enter- prise, accepts only the lessons of the past, is the laudator temporis acti, and brands often as revolution what he £60 RESPONSIBILITY IN MENTAL DISEASE. ought to welcome as eToIution. The diminution of the power of assimilation by the brain, which is the £rst result of its commencing decay, renders him incapable of tnily receiving or apprehending the lessons of the present, and so deprives him of what is essential to a just compre- hension and judgment of it ; so that, although an old man may be helpful in council out of the stores of his experience, he is by no means to be trusted as a leader in action. Let me note, then, that his loss of power of reception or apprehension of the quality and bearing of events is the beginning of that decay which ends by natural descent in the loss of perception which is so marked a character of senile dementia. Again there is in the old man not only an unwillingness or inability to receive, but an incapacity to hold or retain new impressions ; the brain bias lost both susceptibility to impressions and its power of regis- tering them, wherefore they pass away without perr manent effect upon the mind ; a condition of things marking the beginning of that decay which passes by a natural descent into the striking loss of memory of recent events in senile dementia. J'urthermore, the mind of the old man fails in the power of reproduction or recollection, so that ideas cannot be recalled through the established tracks of association. Lastly, from these three causes combined — ^failure of apprehension, of memory, and of recollection, there is necessarily a failure of the power to combine old and new into a new product of mental activity — ^a failure, that is, of productive imagination. This is the commencement of that decay which finally COMPARISON OF SYMPTOMS. 261 declares itself ia the loss of power of comparison of ideas and in the incoherence of senile dementia. To these stages of failure of intellect we may add the decline of the moral faculties which commonly accompanies old age, a declinie which, in dementia, may reach the stage of com- plete extinction of them. It appears then from what has heen said that the charac- ters of senile dementia mark a further stage of the same kind of degeneration which is exhibited in the earliest symptoms of the mental decay of old age. It must not be supposed, however, that the transition from the latter to the former state takes place in every case, or that when it does take place, it is always a quiet and gradual decline. In some cases the occurrence of actual dementia is ushered in by a condition of excitement which gives a factitious energy to the individual, deceiving per- haps himself and his friends ; he may suddenly exhibit an extraordinary activity in business or in speculation, making sales or investments of a startling kind, or he may break out into, sexual, alcoholic, or other excesses ; impatient of advice or opposition, he resents all interference or control, and sometimes occasions, by his conduct, no little distress and perplexity to his family. The excitement is really a sort of outburst of expiring energy, and is followed by dementia, the transition from the one to the other being sometimes quite sudden. It is, intertsting to note that very similar mental symptoms to those which are produced by the braiur decay of old age may be produced by other causes which inflict dam-age> temporary or permanent, upon the brain. 262 EESPONSIBILITY IN MENTAL DISEASE. We observe the same gradations of failing memory in febrile diseases, after injuries to the head, after apoplexy sometimes, and in persons broken down by intemperance. Very notable in the earlier stages of febrile diseases, and in debility after acute diseases, is the first stage of failing memoiy in which attention cannot be directed to a long train of thought, or to anything requiring a continued effort of mind. At a later stage of fever, it is evident that impressions do not leave any remembrance, though at the time there appears to be a perfect perception ; there is apprehension followed by complete forgetfulness. At a still later period external impressions are not perceived at all, or are perceived in a manner which cannot convey any distinct notion of their relations, while trains of ideas are believed to be realities. With this incapacity of present apprehension there may be observed, as in senile de- mentia, a wonderful activity of past ideas and the revival of memories which had been lost, so that a person in delirium will sometimes rave in a language of which he can scarcely remember a word when in health. Lastly, a state of stupor supervenes in which the mind is entirely cut off from the external world, and in which there is no internal activity, or not more than the occasional flicker of an expiring idea. In the act of dying, when death is not sudden, the same stages of failing memory and failing mind are often passed through ; and whosoever would realise what his probable mental state will be in that last scene of all, when he has the stage all to himself, and easily excites interest, however poorly he plays his part, may help himself to do so by a study of these successive stages of LOSS OF FEELING OF PEESONAL IDliNTITY. 263 mental decay. It is no wonder that the thoughts of child- hood then come back to the'mind, and that the dying man sometimes babbles in words which he had never used in his riper years; and those who would make much of these expressions when they are of a religious character, would do well to reflect that they are attending upon a patholo- gical scene, and to take heed lest they found conclusions agreeable to themselves upon the phenomena of mental decay. In these conditions of mental decay a man may lose the consciousness of personal identity, and it were much to be wished that metaphysicians who lay such gi-eat stress on the unity of the ego, and make so much use of it in their systems of philosophy, would explain, from their point of view, the phenomena of disordered identity. Surely a mind, even though manifesting itself through broken glimpses in a damaged brain, should not lose its consciousness of personal identity — should not be ignorant whose mind it is. To the physiologist, who sees in the unity of the ego simply the full and harmonious action of the different parts of the mental organisation, it can cause no surprise that, when the defacing action of decay . has destroyed centres of thought and paths of association, there should be a break of the harmony of function and a disruption of the unity of consciousness. The wonder would be if it were otherwise. It would seem quite natural that as mental function flickers irregularly and finally ceases before organic actions cease, there should be a loss of consciousness of identity before, through the death of the 264 EESPONSIBILITY IN MENTAL DISEASE. body, individuality is altogether extinguished, and that which was an individual blends with external nature. I have described specially the phenomena of senile dementia, but there are other conditions of mental im- pairment produced by disease which it would be too long a task to describe here : apoplexy, for example, may occasion all sorts and degrees of loss of memory, with weakness of mind, the study of which is well fitted to throw light upon the obscure relations of body and mind. There is, however, one peculiar state produced sometimes by an apopleptic attack of which I may say a few words — namely, an entire loss of the faculty of speech. In this condition, which is known as Aphasia, there is no loss of power over the muscles of speech, no paralysis of them ; but there is a complete forgetfulness of the words which are the expressions of the thoughts ; the person appears to understand in some cases all that is said to him, but he eannot answer a word; like Zapharias when he had seen the vision in the temple, he is speechless ; when he attempts to speak, he either makes a vain movement of his mouth,, or utters an unmeaning sound. In. other cases the person does not forget words altogether, but substitutes. Wrong words for those which he wishes to use ; wanting bread, for example, he asks for his boots, and is annoyed and angry when his boots are brought to him. When the right word is suggested to him, he may correct himself, or may show by the expression of his face that he perfectly understands it. This condition is usually associated with paralysis of the right side of the body, and has been tiupposed to be produced by disease THE INTELLIGENCE IN APHASIA. 265 or injury of a convolution of the left side of the brain — the third left frontal convolution, which has accordingly been declared by some to be the seat of the faculty of articulate language. It is obvious that difficult questions must sometimes arise with regard to the amount of understanding which a person who is in this aphasic state actually possesses : haVing lost the usual means by which intelligence is manifested, there will necessarily be a difficulty in gauging the measure of it. Hence it has happened that wills made by persons suffering from aphasia have been disputed. Some observers, chief among whom was the distinguished French physician Trousseau, have main- tained .that the understanding is always more or less defective in aphasia, and that those persons whoj having suffered from it and having recovered, have declared that all the time of their affliction they were in perfect posses- sion of their understanding, were really mistaken about themselves. TJiey were something like persons in dreams who fancy themselves to be reasoning profoundly and discoursing most eloquently, although all the While their ideas are incoherent, and what they say is un- intelligible. It is an obvious remark that, if a man's understanding be perfect, he ought to be able to show it even, though he has lost the power of articulate speech, speech being but one variety of the language of expres- sion. . He cannot write because his right hand is paralysed ; but if that were all he might soon learn the not very difficult task of writing with his left hand, or might put together separate letters so as to frame the 26G RESPONSIBILITY IN MENTAL DISEASE. words which he wanted. In some instances he can do BO. In the St. George's Hospital Eeports for 1867, Dr. William Ogle relates the case of a person who could write with his left hand words which he could not pronounce when asked, however hard he tried. His mind seemed quite clear, for he took an interest in what was going on around him, understood all that was said, listened, laughed, and expressed himself by suitable pantomine. In many other instances it unfortunately happens that there is a loss of the power of expression by writing as well as the power of verbal expression — a condition of what is called agraphia as well as a condition of aphasia : the person may understand words written as well as words spoken, but he cannot express himself either in the one way or in the other. This is not the place to discuss the general question of the nature of aphasia, which is as interesting in a psycho- logical point of view as it is diflBcult ; all that we are con- cerned with is the practical question whether an aphasic person is competent to make a will. It is quite possible that he might not be capable of sustained thought, might have suffered some impairment of thought, feeling, and will, and yet might know the nature and amount of his property, and be competent to express his wishes with regard to the disposal of it. Certainly we should not be warranted by the facts in affirming that an aphasic person is necessarily deprived of testamentary capacity. In one case which was tried in the English Probate Court — Peacock v. Lowe — but which was compromised at the con- clusion of the evidence in favour of the will, very strong TESTAMENTAEY CAPACITT IN APHASIA. 267 teBtimony as to the testator's general intelligence was given by those who were acquainted with him. He could not express himself by speech ; but he kept by him a dictionary to which he used to refer, and in which he indicated the required word, and on the whole succeeded thus in conveying his meaning in an intelligible manner. On the other hand, there are undoubtedly cases of aphasia in which the intelligence is very greatly impaired, and the sufferer quite incompetent to make a will. Each case must be decided on its own merits according to the evidence of the mental condition of the person as exhibited in his general conduct and in his particular manner of making known his wishes. CHAPTEE IX. THE PREVENTION OF INSANITY. Man'g power over himself to prevent insanity — Outcomes of an insane temperament — The exercise of self-control in insanity — The gradual evolution of character— The development of will : its power over the thoughts and feelings — The propagation of insanity through genera- tions — Unwise marriages — The tyranny of the passion of love — The degeneration and regeneration of families — The intensification of the neurotic type— Hereditary predisposition, intemperance, and mental anxieties as causes of insanity — Exposition of the evil effects of in- temperance — The prevention of insanity by education — The aim of a liberal education — Self-culture as an aim in life — Inconsistencies of thought, feeling, and actions : the injury to character which they imply-rThe kind of mental activity involved in the conduct of busi- ness : how it fails to satisfy the requirements of true mental culture — Mistaken views of religious duties — The control of the emotions — Mental hard work not a cause of insanity — The full development of the mental faculties a protectiou against insanity — Undeveloped mentality — The study of the natural sciences as » means of intel- lectual and moral training — The reign of law in human evolution — The moral duties consequent on the intellectual recognition of it. Most persons who have suffered from the malady of thought must at one period or other of their lives have had a feeling that it -would not be a hard matter to become insane, that in fact something of an effort was required to preserve their sanity. To those in whose blood a tendency to insanity runs this effort must without doubt be a sustained and severe one, being no less in some instances than a continual struggle to oppose the strong bent of their being. How far then is a man responsible for going mad '/ This is a question which man's rOWER OVER HIMSELF. 269 has not been much considered ; yet it is one well worthy of deep consideration ; for it is certain that a man has, or might have, some power over himself to prevent insanity.* However it be brought about, it is the dethronement of will, the loss of the power of co-ordi- nating the ideas and feelings ; and in the wise develop- ment of the control of will over the thoughts and feelings there is a power in ourselves which makes strongly for sanity. From time to time we may see two persons who have had the same faulty heritage, and who, so far as we can judge, have not diflEered much in the degree of their predisposition to insanity, go very different ways in life — one perhaps to reputation and success, the other to suicide or madness. A great purpose earnestly pursued through life, a purpose to the achievement of which the energies of the individual have been definitely bent, and which has, therefore, involved much renunciation and discipline of self, has perhaps been a saving labour to the one, while the absence of such a life-aim, whether great in itself or great to the individual in the self-discipline which its pursuit entailed, may have left the other with- out a sufficiently powerful motive to self-government, and so have opened the door to the perturbed streams of thought and feeling which make for madness. * More than twenty years ago, a small volume, entitled ' Man's Power over Himself to prevent or control Insanity," was published. It con- tained the substance of two lectures given at the Koyal Institution, by the late Beverend John Barlow, and was one of a series of Small Books on Great Subjects. Though excellent of its kind, the author regards the subject entirely from a moral point of view, and certainly in some re- spects overrates the power of control. 270 RESPONSIBILITY IN MENTAL DISEASE. Curious and interesting in this relation is it to observe in what strange and saving outcomes of action a vein of madness in the constitution sometimes displays itself; perhaps in an extreme miserliness, perhaps in the fana- tical adoption of extreme religious opinions and prac- tices, not seldom now-a-days in the follies of an imagined intercourse with the spiritual world, sometimes in a morbid vein of poetical delirium, and sometimes in the eager advocacy of extreme social or political theories. These will serve as general illustrations of what I mean, but it will be understood that there are numbers of parti- cular eccentricities having the same meaning which it is impossible to enumerate here. Sad, foolish, or danger ■* ous as such extravagances may seem in some instances, they may be regarded with indulgence as the directions of development which iiisane tendencies happily take ; happily, I may justly say, because, but for them, the result might unhappily be actual insanity. They are a vicarious relief, a sort of masked madness. When we come to consider the advice which it would be right to give for the guidance of one who was anxious to do that which might protect him from an attack of insanity, the greatness and the difficulty of the subject appears almost overwhelming. There can be no doubt that in the capability of self-formation which each one has in greater or less degree there lies a power over him- self to prevent insanity. Not many persons need go mad perhaps — at any rate from moral causes — ^if they only knew the resources of their nature, and knew how to develope them systematically. A practical experience of THE EXERCISE OF SELF-CONTEOL IN INSANITY. 271 the insane teaches us what a power of self-control even they sometimes evince when they have a sufficient motive to exert it. The fear of suffering by yielding to their insane propensities suffices in many instances to hold them in check; the occasional concealment or actual denial of their delusions, if they have something to fear from the discovery of them, or something to gain by the concealment of them, testifies to a power over themselves which sane persons might sometimes envy. The descrip- tions of cases of suicidal and homicidal mania which I have given in foregoing chapters show how even desperate insane impulses have been successfully resisted for a time in some instances, and resisted altogether in other instances. It is, indeed, in consequence of the power of self-control which insane persons have, and of the way in which those who have the care of them elicit it, that asylums have become for the most part quiet and orderly institutions, instead of being places of disorder, fury, and violence. The beginning of recovery from mental derangement is always a revival of the power of will ; such revival being possible forasmuch as the disease in many of its forms is unattended with organic morbid changes — ^is functional not organic. If the power then exists in the insane mind in such degree as to prevent the manifestations of madness, and, when aroused to action, to inaugurate recovery from it, is it not reasonable to suppose that it might, had it been properly trained and exercised originally, have, sufficed to prevent its occurrence ? The pity of it is that the power is often least developed where it is most wanted. 272 EESPONSIBILITY IN MENTAL DISEASE. It would be quite useless to inculcate rules for self- formation upon one whose character had taken a certain mould of development ; for character is a slow and gradual growth through action in relation to the circum- stances of life; it cannot be fashioned suddenly and through reflection only. A man can no more will than he can speak without having learned to do so, nor can he be taught volition any more than he can be taught speech except by practice. It was a pregnant saying, that the history of a man is his character ; to which one might add that whosoever would transform a character must undo a life history. The fixed and unchanging laws by which events come to pass hold sway in the domain of mind as in every other domain of nature. A striking illustration of the difficulty of realising the reign of law in the development of character and in the events of human life is afforded by the criticisms of those who have blamed Goethe because he made Werter commit suicide, instead of making him attain to clearer insight, calmer feeling, and a tranquil life after his sorrows ; had they reflected well they must have perceived that suicide was the natural and inevitable termination of the morbid sorrows of such a nature. It was the final explosion of a train of antecedent preparations, an event which was as certain to come as the death of the flower with a canker at its heart. Suicide or madness is the natural end of a morbidly sensitive nature, with a feeble will, unable to contend with the hard experiences of life. You might as well, in truth, preach moderation to the hurricane as talk philosophy to one whose THE DEVELOPMENT OF WILL. 273 antecedent life has conducted him to the edge of mad- ness. I cannot but think that moral philosophers have some- times exaggerated greatly the direct power of the will, as an abstract entity, over the thoughts and feelings, without at the same time having taken sufficient account of the slow and gradual way in which the concrete will itself must be formed. The culminating effort of mental deve- lopment, the final blossom of human evolution, it betokens a physiological development as real, though not as appa- rent, as that which distinguishes the nervous system of man from that of one of the lower animals. Time and systematic exercise are necessary to the gradual organisa- tion of the structure which shall manifest it in full func- tion. No one can resolve successfully by a mei-e effort of will to think in a certain way, or to feel in a certain way, or even, which is easier, to act always in accordance with certain rules; but he can, by acting upon the circum- stances which will in turn act upon him, imperceptibly modify his character: he can thus, by calling external circumstances to his aid, learn to withdraw his mind from one train of thought and feeling, the activity of which will thereupon subside, and can direct it to another train of thought and feelingj which will thereupon become active, and so by constant watchfulness over himself and by habitual exercise of will in the required du-ection, bring about insensibly the formation of such a habit of thought, feeling and action as he may wish to attain unto. He can mJake his character grow by degrees to the ideal which he sets before himself. 274 BESPONSIBILITI IN MENTAL DISEASE. The development of the power of co-ordinating in complex action various distinct muscles for the accom- plishment of a special end is truly the development of the volitional power of such purposive movements; in like manner the development of the power of co- ordinating ideas and feelings for the achievement of a special life-aim is the development of the volitional power to achieve it. There is a multitude of concrete volitions, but there is no abstract will apart from the particular volitions. Just in fact as an individual gains by practice a particular power over the muscles of his body, associating them in action for the perform- ance of complicated acts, which, without previous train- ing, he could no more perform than he could fly, and rendering his muscles iu this regard habitually obedient to the dictates of his will ; so can he gain by practice a particular power over the thoughts and feelings of his mind, associating them in action for the accomplishment of a definite purpose in life, and rendering them in this regard habitually obedient to the dictates of the will in the pursuit of its ideal. Striking examples of the gradual development of the power of will over both movements and ideas under most unfavourable conditions are witnessed in our idiot asylums ; the records of these establishments showing that there is hardly an idiot so low that he can- not be so far improved by patient and laborious culture as to acquire some power of self-government both in regard to his body and his miiid. Great then as the power of will unquestionably is, when rightly developed, we ought not to lose sight of the fact that its developiaent PROPAGATION OF INSANITY THROUGH GENERATIONS. 275 is effected only by the gradual education of a continued exercise in relation to the circumstances of life. It will be understood then how it is that when we con- sider deeply what advice should be given to a person who fears that he may become insane, we too often dis- cover that we have none to give which will be of much real use to him. His character, developed as it has been, will not assimilate advice that is counter to its affi- nities. We cannot efface the work of years of growth, cannot undo his mental organisation, and it is borne in upon us that advice, if it was to do any good, should have guided the direction of education. The physician soon learns how little effect the best counsels have upon those who, having a tendency to insanity, come to him to ask what they shall do to be saved from the threatened danger : they listen attentively, assent perhaps gratefully, go their ways, and do — exactly as they did before. But if we were seriously minded to check the increase or lessen the production of insanity, it would be neces- sary to begin even farther back, and to lay down rules to prevent the propagation of a disease which is one of the most hereditary of diseases. Although it cannot, like small-pox or fever, be communicated from individual to individual, and so be spread through a community, the lunatic being happily in a minoHty of one in the world, and not commonly infecting other persons with his mor- bid belief, yet unhappily it is a disease which, having existed in the parent, may entail upon the child a predis- position more or less strong to a like disease. If there is one conviction which a widening experience brings 276 BESPONSIBILITY IN MENTAl DISEASE. home to the practical physiciab, it is a conviction of the large part which hereditary predisposition in some form or other plays in the causation of insanity: it would scarcely he an exaggeration to say that few persons go mad, save from palpable physical causes, who do not show more or less plainly by their gait, manner, gestures, habits of thought, feeling and action, that they have a sort of predestination to madness. The inherited liability may be strong or weak ; it may be so weak as hardly to peril sanity amidst the most adverse circum- stances of life, or so strong as to issue in an outbreak of madness amidst the most favourable external circum- stances. Now it is certain that if we were interested in the breeding of a variety of animals, we should not think of breeding from a stock which was wanting in those qualities that were the highest characteristics of the species : we should not willingly select for breeding purposes a hound that was deficient in scent, or a grey- hound that was deficient in speed, or a racehorse that could neither stay well nor gallop fast. Is it right then to sanction propagation of his kind by an individual who is wanting in that which is the highest attribute of man — a sound and stable mental constitution ? I note this as a question to be seriously faced and sincerely answered, although not expecting that mankind, in the present state of their development, will either seriously face it or sincerely answer it. When one considers the reckless way in which persons, whatever the defects of their mental and bodily constitu- tion, often get married, without sense of responsibility UXWISE MAEEIAGES. 277 for the miseries which they entail upon those who will be the heirs of their infirmities, without regard, in fact, to anything but their own present gratification, one is driven to think either that man is not the pre-eminently reasoning and moral animal which he claims to be, or that there is in him an instinct which is deeper than knowledge. He has persuaded himself, rightly or wrongly, that in his case there is in the feeling of love between the sexes something of so sacred and mysterious a character as to justify disregard to consequences in marriage. We have only to look at the large part which love fills in novels, poetry and painting, and to consider what a justification of unreason in life it is held to be, to realise what a hold it has on him in his present state of development, and what a repugnance there would be to quench its glow by cold words of reason. At bottom, however, there is nothing particularly holy about it ; on the contrary, it is a passion which man shares with other animals; and when its essential nature and function are regarded, we shall nowhere find stronger evidence of a community of nature between man and animals. It is in this community of nature that we may per- ceive the explanation of the excitement, rejoicings, personal decoration, and feastings which continue to be the usual accompaniments of marriage, notwith- standing that reason might dictate a more quiet and sober carriage. For it would not be a very absurd thing if an ingenious person, considering curiously what a solemn undertaking marriage is, and what serious 13 278 EESPONSIEILITY IN MENTAL DISEASE. responsibilities it entails, were to maintain that men and women should enter into it soherly and rather sadly, under a grave sense of responsibility, as upon an uncertain voyage, and should reserve their rejoicings for the journey's end, when, having acted well their parts, they might fairly claim a nunc plaudite. But this would be contrary to the way of nature, in which a similar exaltation is displayed when the time of marriage arrives. There is then a transport throughout the vegetable and animal kingdoms, which put forth all the beauty of their colours and all the harmony of their sounds; for the flowers are the dress of love, and the spring melodies of birds are love songs. The temperature of the plant is then increased, and it is arrayed in a floral gloiy such that " Solomon in all his glory was not arrayed like one of these ; " the birds put on a gayer plumage, and their exaltation bursts forth in raptures of varied melody; everywhere the functions reach a. transport or ecstasy of love. Man displays his harmony with nature by a similar exaltation. In face of this instinct it would be a hard and unwel- come thing to lay down rules for the prevention and regulation of marriages in accordance with what might seem to be the sober dictates of reason, even if, which is not the case, science had arrived at such a degree of development as to be able to do so with exactness and authority. Moreover, we are not sure how great may be the compensating advantages of seemingly unwise marriages. It will be easier and more agreeable to admit that for the present men must go on marrying and DEGENEEATION AND EEGENEEATION OF FAMILIES. 279 giving in marriage without much reflection, and to "trust the universal plan will all protect." Nevertheless there is a certain amount of definite knowledge which we are bound to recognise, however we may deal with it. It is a fact that a pathological evolution — or, more correctly, a pathological degenera- tion — of mind does take place through generations. The course of events may be represented as some- thing in this wise : in the first generation we per- haps observe only a predominance of the nervous temperament, irritahilityj a tendency to cerebral con- gestion, with passionate and violent outbreaks; in the second generation there is an aggravation of the morbid tendencies, displaying itself in cerebral haemor- rhages, idiopathic affections of the brain, and in the appearance of such neuroses as epilepsy, hysteria and hypochondria; in the third generation, if no check has been opposed to the downward course, we meet with instinctive tendencies of a bad nature, exhibiting them- selves in eccentric, disorderly and dangerous acts, and with attacks of some forms of mental derangement ; and finally, in the fourth generation, matters going from bad to worse, we meet with deaf-mutism, imbecility and idiocy, and sterility, the terminus of the pathological decline being reached. Such is the course of degenera- tion when it proceeds unchecked. But an opposite course of regeneration of the family by happy marriages, wise education, and a prudent conduct "of life is possible ; the downward tendency may be thus checked, and even perhaps effaced in time. As 280 RESPONSIBILITY IN MENTAL DISEASE. things are at present, such regeneration is always acci- dental, is never designed and deliberately aimed at. How it may be done designedly and systematically, is certainly a most complex and difficult enquiry, but it is one which lies within the range of human faculty. The first condition of the enquiry is that men should realise that such apparently capricious events as the imbecility of one child and the genius of another child are effects of natural laws, that they are not less so than are the complex chemical combinations and decompositions which at one time were as obscure, and seemed as irregular, uncertain and meaningless, but which are now known to take place with unfailing uniformity under the same conditions. Let the same amount of patient observation and laborious investigation which has been applied by a succession of distinguished men to unravel the mysteries of chemical combinations, be applied to the observation and investigation of the more complex mysteries of the degeneration and regeneration of families, and there can be no doubt that light will be thrown upon the phenomena. Meanwhile men ought not to repudiate caution be- cause observation is defective, and wilfully to incur needless risks : they will go on falling in love, and, having fallen in love, they will go on marrying, and having married they will go on producing children, but there is no reason why a person having a heredi- tary predisposition to insanity should fall in love with and marry a person who has a similar predisposition. Falling in loye being much a matter of propinquity, they INTENSIFICATION OF THE NEUROTIC TYPE. 281 can keep out of the way of dangerous attraction, or if they have fallen in love they may surely pause before, in order to avoid the temporary sufiering of an act of sharp self-renunciation, they resolve to run the almost certain risk of bringing untold miseries upon one or more of the offspring of an ill-advised union.* It is an unfortunate circumstance that the tendency often is to an intensification of the neurotic type. In the first place, those who have it are prone, by a sort of elective affinity, to seek in marriage persons who have similar mental qualities, and with whom, therefore, they have a sympathy of tastes, feelings, and thoughts. Emotional susceptibilities, wild flights of imagination, and empty idealistic aspirations, such as they themselves indulge, excite their admiration and sympathy; while common sense, subordination of feeling, sober reflection, and a calm and regulated activity are repugnant to their nature. In the second place, by a similar natural affinity, they select those external circumstances of life the influence of which is adapted to foster rather than to check the special tendencies of their natures. They have not that strength of character and breadth of thought which would enable them to endure and learn to control whatever circumstances they might be placed in, and so to get the benefit of them, however repugnant • "Insanity is so prevalent in some families that we have known two, three or four children of the same parents suffering under the disorder. In the family of a brother and two sisters there were ten cases of in- sanity — five in one family, two in another, and three in a third — out of twenty members. " — Partial Derangement of the Mind, by John Cheyne, M.D. 282 EESPONSIBILITT IN MENTAL DISEASE. they might be, in self-culture ; but eagerly seek such as are grateful to them, and so intensify their peculiar tendencies, until these perhaps undergo a pathological development. In the third place, they apply to their children the same mismanagement which they apply to themselves. These are twice cursed : they are cursed in the inheritance of a bad descent, and in the training which they get, or rather the want of training from which they suffer, in consequence of parental peculiarities and defects. Here, then, are three important causes of an aggravation of a neurotic type which it does not lie beyond the wisdom and power of mankind greatly to obviate.* * It is impossible to place any reliance upon the information afforded by statistics concerning the influence of hereditary predisposition in the causation of insanity ; the difficulty of getting at the truth on this matter being such as to render them quite untrustworthy. To base a conclusion on available statistics would be to vastly underrate its influence as a cause ; whereas it is hardly possible, I believe, to overrate its actual im- portance. I am unwilling, for obvious reasons, to bring forward illus- trations from my own experience ; but in order to convey an idea of the character and extent of its probable operation, I may quote from a recently published paper the three following cases, which illustrate also the natural termination of degeneration going on through generations : — A man, A. B., of congenital weak mind, had six children, three of whom died during childhood ; the other three, one male and two females, were imbecile, and were sent to an asylum at the respective ages of forty, forty -two, and forty-four. The male had previously married, but had no children. The females having had no issue, the family happily becomes extinct with the present generation. A man, C.' D., labouring under dementia, whose first wife died insane, had by her a large family, four of Whom, two sons and two daughters, inherited mental unsoundness. The two daughters have not had children. One of the sons is unmarried ; the other is married and has had four children, all of whom died in childhood. But C. D. has had by a second wife, who is also insane, six children. Of these five died young, and the survivor is mentally defective. HEEEDITAEY PEEDISPOSITION, INTEMPEEANCE, &C. 283 If we refer to the enumerated causes of insanity in any book which treats of the subject, or in the first asylum report which comes to hand, we shall find that heredi- tary predisposition, intemperance, and mental anxieties and troubles of some kind or other cover nearly the whole field of causation. These are causes which it should be the work of mankind to remove, or, if not to remove entirely, at any rate to abate considerably : hereditary predisposition, by abstention from marriage or by prudent intermarriage ; intemperance, by temperance in living; mental anxieties, by the wise cultivation of the mind and by the formation of habits of self-government. Avoiding intemperance and other excesses, we shall cut off not only the insanity which is directly produced by it, but we shall prevent its indirect effects by cutting off a fruitful cause of hereditary predisposition to physical and mental degeneracy in the next generation ; and by cutting off such native infirmities of brain and mind, we shall prevent the emotional agitations and explosions which are the consequences of such infirmities and which act as the so-called moral causes of the disease. While we must admit hereditary influence to be the most powerful factor in the causation of insanity, there can be no doubt that intemperance stands next to it in A man, E. F., while insane, committed suicide. His mother was insane, and her sister died in an asylum. His grandmother was insane, and his grandfather was a drunkard. His father is described as " eccentric ; " his uncle was extremely morbid, and had a drunken son, who committed suicide. The other members of this family are, so far as can be ascertained, unmarried and without offspring.— "The means of checking the growth of Insanity in the Population." By G. J. Hearden, M.D. British Medical Journal, July 19, 1S73. 284 EESPONSIBILITT IN MENTAL DISEASE. . the list of efficient causes : it acts not only as a frequent exciting cause where there is hereditary predisposition, but as an originating cause of cerebral and mental degeneracy, as a producer of the disease de novo. If all hereditary causes of insanity were cut off, and if the disease were thus stamped out for a time, it would assu- redly soon be created anew by intemperance and other excesses. A striking example of the effects of intemper- ance in producing insanity has recently been furnished by the experience of the Glamorgan County Asylum. During the second half of the year 1871, the admissions of male patients were only 34, whereas they were 47 and 73 in the preceding and succeeding half years. During the first quarter of the year 1873, they were 10, whereas they were 21 and 18 in the preceding and succeeding quarters. There was no corresponding difference as regards female admissions. There was, however, a similar experience at the County prison, the production of crime as well as of insanity having diminished in a striking manner. Now the interest and instruction of these facts lie in this — that the exceptional periods corre- sponded exactly with the last two " strikes" in the coal andiron industries, in which Glamorganshire is extensively engaged. The decrease was undoubtedly due mainly to the fact that the labourers had no money to spend in drinking and in debauchery, that they were sober and temperate by compulsion, the direct result of which was that there was a marked decrease in the production of insanity and of crime.* * "iDBanity and Intemperance." By B. Yellowlees, M.B., British Medical Jpurnq,l, October 4th, 1873. THE EVIL EFFECTS OF INTEMPEEANCE. 285 If men took careful thought of the best use which they could make of their bodies, they would probably never take alcohol except as they would take a dose of medicine, in order to serve some special purpose. It is idle to say that there is any real necessity for persons who are in good health to indulge in any kind of alcoholic liquor. At the best it is an indulgence which is unnecessary ; at the worst, it is a vice which occasions infinite misei'y, sin, crime, madness, and disease. Short of the patent and undeniable ills which it is admitted on all hands to produce, it is at the bottom of manifold mischiefs that are never brought , directly home to it. How much ill work would not be done, how much good work would be better done, but for its baneful inspiration ! Each act of crime, each suicide, each outbreak of madness, each disease, occasioned by it, means an infinite amount of suffering endured and inflicted before matters have reached that climax. It may of course be said that a moderate consump- tion of alcoholic liquors can do no harm, must on the contrary do good, when exhausted nature feels the need of some stimulant. I am not prepared to say that it does any demonstrable harm, but at the same time it is not wise to have recourse to an alcoholic stimulant when recourse ought to be had to food or rest; and it is a serious harm to the mind to gain, as is some- times done, by the factitious aid of a stimulant, the energy which should come from the calm resolution of a developed will. What one sees happen often enough in life is this: there are persons of anxious and sus- 286 EESPONSIBILITT IN MENTAL DISEASE. ceptible temperament who, having to meet some strain in their work, or some trial in their lives, are prone to take a stimulant in order to give themselves the necessary nerve ; they fly to an artificial aid, which fails not in time to exact the penalty for the temporary help which it yields, instead of deliberately exerting their will and gaining thereby the advantage which such an exertion would give them on another occasion. Like the pawnbroker or the usurer, it is a present help at the cost of a frightful interest; and if the habit of recurring to it be formed, the end must be a bankruptcy of health. It is not possible to escape the penalties of weakening the will; sooner or later they are exacted in one way or another to the uttermost farthing : it is not possible, on the other hand, to overrate the advantages of strengthening the will by a wise exercise ; the fruits of such culture are an unfailing help in time of need. There are at least five distinct varieties of mental derangement which own alcoholic intemperance as their direct and efficient cause. Nor do other kinds of in- temperance fail to play their part in the causation of mental disorders. Were men with one consent to give up alcohol and other excesses — were they to live tempe- rately, soberly, and chastely, or what is fundamentally the same thing, ^olily, that is healthily — ^there can be no doubt that there would soon be a vast diminution in the amount of insanity in the world. It would be lessened in this generation, but still more so in the next gene- ration ; a part of which, as matters stand, will be begotten and bred under the pernicious auspices of parental THE PEEVENTION OF INSANITY BY EDUCATION. 287 excesses, and the infirmities and diseases engendered by them. But it is quite certain that men will not abandon their excesses in this day or generation ; that they will not adopt self-denying ordinances ; that they will not be at the pains to cherish their bodies, so as to develop their powers to the best advantage, and to make them the ready servants of an enlightened and well developed will. They will go on as before, producing insanity from lack of self-denial ; and when admonished of the steep and arduous path which they should follow, will go away, like one of old, sorrowful, because they have many passions. It is to the perfecting of mankind by the thorough application of a true system of education that we must look for the development of the knowledge and the power of self-restraint which shall enable them, not only to protect themselves from much insanity in one generation, but to cheek the propagation of it from generation to generation. It is not probable that much progress can be made in one generation ; for centuries are but seconds in the great process of human evolution ; none the less is it a duty to do all we can to carry it forward, in the con- fident hope that the day will dawn although it is yet only the twelfth hour of the night. Unhappily we are not yet agreed as to what should be the true aim and character of education. Regarding the subject from a scientific point of view, the best education would seem to be that which was directed to teach man to understand himself, and to understand the nature which surrounds him, and of which he is a part and a product ; so to enable him, as 288 KESPONSIBtLITT IN MENTAL DISEASE. its conscious minister and interpreter, to bring himself into harmony with nature in his thoughts and actions ; and so to promote the progressing evolution of nature through him, its conscious self. The highest evolution of which man's being is capable, physically, morally and intellectually, through knowledge of, and obedience to, those natural laws which govern not only the physical world, but, not less surely, every thought and feeling which it enters into his mind to conceive — must be the aim of an education founded on a truly scientific psy- chology. But if this be the true aim of education, how vast a revolution remains to be accomplished! How many things are men yet taught which they ought not to be taught, and how many things are they not taught which they ought to be taught ! To lay down the principles of mental hygiene on a scientific basis would, alas, be to offend many cherished beliefs, and to go counter to the convictions of all but a small minority of mankind. Nevertheless, I believe that the aims of a true education would, if sincerely recognised and earnestly pursued,' do more than all the maxims of philosophy have done, and all the arts of medicine can do, to lessen the amount of insanity on earth. It will be admitted that as regards a knowledge of the laws of his own nature and of their relations to the laws of external nature, man is yet in a position of ignorance very like that in which the savages of old were, or the savages of to-day are, in regard to a knowledge of the laws of physical nature. Like them, he feels their effects without understanding their nature ; like them, he THE BEIGN OP LAW IN MAn's NATUEE. 289 cherishes superstitious belief instead of systematically setting to work to enlighten his understanding ; like them, he puts up prayers where he should exert an intelligent will ; like them, he suffers from the stern and inexorable dominion of laws which he has not been taught to under- stand, and which he does not even recognise when he suffers by them. No one can of course fail to testify, consciously or unconsciously, to the workings of natural laws in his being; he witnesses to them, though he cannot trace them, in his thoughts, feelings and actions, and thus inevitably acquires crude empirical rules to guide him ; but the misfortune is that he is apt thereupon to assign an immediate supernatural aigency, and to prostrate himself in helpless fear when he ought to proceed reve- rently to enquire and then intelligently to obey. Is there any fundamental difference between the savage coming to destruction through ignorance of the law of gravitation and the civilised European coming to madness through ignorance of the laws of his own nature, and of the laws of the nature of things and men around him ? Insanity is simply a discord in the universe — ^the result and evidence of a want of harmony between an individual human nature and the nature surrounding it, and of which it is a part. The marvel is perhaps that there are not more insane persons than there are, considering how blindly men are yet compelled to live in very complex relations, how much they depend upon the crude instincts of empiricism, how little they have yet systematically done to know nature in themselves and themselves in nature. 290 RESPONSIBILITY IN MENTAL DISEASE. Let US not deceive ourselves with vain imaginations^ The life of an individual in this age of civilisation is assuredly not a life in which the best use is made of his physical, moral, and intellectual capacities. . When we search into the causes of disease, how many diseases are directly or indirectly traceable to breaches of those laws which govern the development and the health of the body! I have already laid stress upon the disastrous effects of intemperance, and what I have said must suffice now as an illustration of disease caused by igno- rance or disdain of the laws of health. But when we pass from the consideration of the management of the body to the consideration of that of mind, we shall dis- cover as little evidence of a sincere desire and resolution to bring the feelings and thoughts into harmony with nature, and- to develop the powers of the mind to the utmost. There is hardly any one who sets self-develop- ment before himself as an aim in life. The aims which chiefly predominate — ^riches, positioUi power, applause of men, are such as inevitably breed and foster many bad passions in the eager competition to attain them. Hence, in fact, come disappointed ambition, jealousy, grief from loss of fortune, all the torments of wounded self-love, and a thousand other mental sufferings — the commonly enu- merated moral causes of insanity. They are griefs of a kind to which a rightly-developed nature should not fall a prey. There need be no disappointed ambition, if a man were to set before himself a true aim in life, anc^to work definitely for it; no envy nor jealousy, if he considered that it mattered not whether he did a great thing or some INCONSISTENCIES OF THOUGHT, FEELING, &C. 291 one else did it, nature's only concern being that it should be done ; no grief from loss of fortune, if he estimated at its true value that which fortune can bring Mm and that. which fortune can never bring him; no wounded self-love, if he had learned well the eternal lesson of life — self-renunciation. But men exhibit a marvellous facility of deceiving themselves; while professing to esteem those worldly aims as of little account, as infinitely trivial in com- parison with the momentous concerns of the life to come, they at the same time concentrate all the real hopes, aspirations, and edergies of their lives upon the pursuit of them. Thus their nature is an incon- sistency; it is a house divided against itself, and how can it stand when trouble comes? How can a nature be strong which is at war with itself, whose faith and works are in discord ? A decrease in the amount of insanity in the world would probably take place in a generation or two, if men were to cease to deceive them- selves, and were to make their natures strong by making a real harmony of themr— if they would learn to be sincere to themselves in examining rigorously the founda- tions of their beliefs, and in estimating the quality of the aims which they actually pursue, and of the means by which they pursue them. There is a practice, highly esteemed in England, of carefully preserving certain animals called foxes, in order that they may be hunted to death for the amusement of men and women who follow the chase on horseback witb extraordinary ardour and enthusiasm. It is deemed an 292 EESPONSIBILITY IN MENTAL DISEASE. honour to be present at the death, when the exhausted beast is torn to pieces by the dogs, he or she who i s the first to attain that enviable position receiving as a trophy a share with the dogs in the fragments of its body — the tail. Artists are so full of admiration of the different scenes of the chase, that they employ their talents in painting them, and the pictures are purchased by lovers of the sport, in order to adorn the walls of their houses. Thus art lends its elevating influence to glorify the so-called manly s^ort, which, savage as it might seem, excites no horror in the most gentle breast. And yet, while this is so, there is in England an active society for the prevention of cruelty to ani- mals, which takes no step to prevent this systematic preservation of animals for the systematic infliction of suffering and death upon them as a sport, and which is even sincerely supported by foxhunters. Moreover, those who enthusiastically follow the cruel chase are followers also of the meek and lowly Nazarene. And they are unconscious of an inconsistency in themselves ! If man's facility of self-deception were not incalculable, one knows not how he could dare face the judgment on his life, which he professes to expect after death, when the deliberate and systematic infliction of suffering has been his pleasure; not as an end, certainly, still as a means to an unworthy end. Boasting himself over the beasts that perish, he is probably the only animal which inflicts suffering and death as a mere amusement for itself. I have not brought forward this illustration in order to INCONSISTENCIES OF THOUGHT, FEELING, &C. 293 speculate upon the possible influence of the pursuit of a cruel sport, upon the character, but as one among other inconsistencies which might be adduced in order to point out the impossibility of real sincerity of thought while there is such flagrant self-deception. This is indeed the evil of it. Unconscious self-deception it may be, but it is not less hurtful, nay, it is perhaps an indication of more hurt to character, on that account. No one can live in inconsistent habits of thought, feeling, and actipn, without injury to the sincerity and wholeness of his nature, and to the clearness and strength of his understanding. While he fails to see in its true light such a cruel practice as the infliction of torture and of death for the purposes of his amusement, it is impossible that he can see other things in their true light. The best guarantee of clear apprehension, right feeling, vigorous understanding, and intelligent will, in any relation of life, lies in the formation of a habit of sound apprehension, right feeling, vigorous understanding, and intelligent will in former relations — in other words, in the sincere and thorough development of the intellectual and moral nature. The stronger and more complete this development is, the better will the individual be fortified against the inroads of any kind of mental degeneracy. There are many similar inconsistencies of thought and character which might, were this the place for it, be brought forward to show how far men yet are from doing justice to their mental faculties by developing them consistently to the utmost of their capacities. In order 204 EESPONSIEILITY IN MENTAL DISEASE. to do that successfully it will be necessary to set before themselves a worthy aim in life, and to work definitely for it. The question to be entertained and decided at the outset will be, whether this aim shall be internal or external — whether the individual shall seek first the completest developnaent of which his nature is capable, other gains, such as riches, reputation, power, being allowed to fall to him by the way ; or whether he shall seek worldly success, the formation of character being allowed to be a secondary and incidental matter ? It is a vital question, the practical answer to which must influence most materially the training and cultivation of the mind. As a matter of fact it admits of no doubt that self- development is not made a life-aim ; that such formation of character as takes place does, in the great majority of men, take place, as it were, by chance, without premeditation, as an incidental effect of the discipline and training which they undergo in the pursuit of other life-aims. Is it any marvel, then, that the theoretical recognition of a higher aim in life which they make once a week as a conventional duty has no real informing influence in the formation of character; that it is a doctrine which, by an easy self-deception, is held on the condition of its being a sort of sleeping partner, and taking no active pari in the management of afiiairs ? No argument is needed to prove that it must be hurtful to the intellectual and moral nature to hold a belief on such terms. "Without doubt the practical aims of life, and the labour and self-denial necessary to the achievement of THE KIND OF MENTAL ACTIVITY. 295 fliem, do entail a large amount of self-discipline of a more or less useful kind. But it is not less certain that the full development of the resources of the mental nature can he achieved only hy a deliberate culture and sus- tained activity of the mind as an aim in itself. A man may conduct successfully an important business or pro- fession, once he has acquired the knowledge of it, without much real mental activity— almost automatically, indeed. By accustoming himself to attend habitually to a certain class of ideas, he is able to attend to them quite easily, to compare them almost unconsciously, and to carry out instinctively, as it were, the conduct which they dictate; his knowledge and action become a sort of acquired instinct — the automatic work of nerve-centres that have been trained thereto, as nerve- centres are trained to perform easily the laboriously acquired function of walking. He observes, judges, and acts with as little conscious effort of attention as he uses for talking or walking, or as a skilful accountant uses in casting up a column of figures. It is true that the original labour of acquisition has cost him an expen- diture of considerable mental activity; but once the faculty has been acquired, it demands little attention, and, if exercised within reasonable limits, occasions little fatigue. Plainly, then, an important business may be carried on without calling into action the higher faculties of the mind, by which the knowledge of it was in the first instance acquired ; and it is no exaggeration to say that a great many persons never exercise any real mental 296 EESrONSlEILITY IN MENTAL DISEASE. activity, never undergo any real development, after they have hecome skilled in the special work of their lives. Their thoughts run in a groove so well worn .that the difficulty is to get out of it. The higher faculties heing unused undergo decay, if not degeneration ; real mental application becomes first difficult and then impossible ; and when a calamity occurs they are without internal resources to enable them to bear up against its strain. When they are taken from the routine of their labours they have no interests, they can turn to no intellectual work, are a torment to themselves and to others, as they go through the tedious process of a decay of mind. The matter is worse when a person has made success in business the one aim of his life, when he has by long concentration of desire and energy upon such an aim so completely grown to it as to have made it the main part of his inner life — that to which all his thoughts, feelings, and actions are directed ; then if some error of his own, or some misfortune beyond his control, shatters his hopes, destroys the pride of his previous accomplishments, lays low the fabric which he has been building with all the eagerness and energy of an intense egoism, he is left naked and defenceless against his afflictions, sinks into melancholy, and from melancholy into madness. To neglect the continued culture and exercise of the intellectual and moral faculties is to leave the mind at the mercy of external circumstances : with it as with the body, to cease to strive is to begin to die. If the foregoing remarks be true, it is obvious that MISTAKEN VIEWS OF EELIGIOUS DUTIES. 297 when any one becomes insane who has been actively engaged in the conduct of a large business, the fact cannot justly be accounted evidence of the powerlessness of mental activity to prevent insanity. His pursuit has failed completely to satisfy the requirements of a proper mental culture. It is the same with another great interest of life, which, were it as real as it is reputed to be, should exert a most powerful influence upon the development of the mental nature — ^namely, religion. The majority of men discharge its duties automatically, and accept its doctrines formally, paying to these a lip- homage, without ever having a distinct grasp of them, or ever pursuing them in thought to their logical conse- quences ; they believe vaguely, without ever caring to realise distinctly what it is that they think they believe ; are content with a kind of belief which they would certainly at once repudiate in their worldly affairs. It needs no argument to prove that such a slovenly habit of thought is not only not conducive to, but is greatly hurtful to, mental culture, and that any mind which is content to hold beliefs on those terms is ill fortified by the develop- ment of its powers to exercise sound reflection on other subjects, or to react vigorously to the end under the burdens laid upon it. Furthermore, while the lessons of religion inculcate the duty of subduing those passions which have their roots in a strong self-feeling, they do not, in the way they are too often taught, enforce that completer self- renunciation which consists in the conviction of per- sonal insignificance, and in the suppression of egoism, 298 EESPONSIBILITT IN MENTAL DISEASE, even if it be the egoism of excessive sensibility and of a too tender conscience. There can be no doubt that harm is sometimes done to persons of a sus- ceptible mind by encouraging or stimulating them to reflect upon their feelings, instead cf inciting them to put the energy of their feelings into a well-ordered mental activity. There is but one true cure for suffering, and that is action ; and a healthy mind, like a healthy bodj', should lose the consciousness of self in the energy of action. By self-introspection and self-analysis, especially -when these are inculcated as a religious duty upon persons who, from bodily or other causes, are inclined to excessive susceptibilities, a morbid egoism is fostered, which is sometimes mistaken for an awakened conscience. But a tender conscience of that kind, overrating its own importance, may easily pass into insanity, unless counterbalanced by the sobering influence of active outward occupations and interests. It cannot but go ill with any one when he becomes the centre round which his thoughts, feelings, and actions move habitu- ally ; and it is certainly a mistake in the culture of mind to develop the emotional part at the expense of the intellect and will. In the religious life, as in the worldly life, the feelings must be kept in due subordi- nation, otherwise it will be in vain to pray to be granted "in health, wealth, and wisdom long to live." For prayer will not compensate for lack of knowledge and lack of will in the government of the mind and in the conduct of life ; and to inculcate or foster a habit of THE CONTROL OP THE EMOTIONS. 299 supplication which is merely a formal or sentimental . invocation of help from on high, instead of enforcing the duty of enlightening the understanding and strengthen- ing the will, is to go methodically to work to undermine the intellect and the will. " I call man's inability to moderate and control the affective or emotional element in his nature Slaveky," says Spinoza. " For man under the dominion of his affections is not master of himself, but is controlled by fate; as it were, so that in seeing and even approving the better course, he nevertheless feels himself constrained to follow the worse." Without doubt, if man could thus attain to freedom by moderating and controlling the affective or emotional element in his nature, he would vastly lessen the sum of insanity upon earth ; for he would get rid at one stroke of the so-called moral causes of the disease. Men seldom, if ever, go mad from great intellectual activity, if it be unaccompanied by emotional agitation ; it is when the feelings are deeply engaged that the stability of the mind is most endangered ; and when persons are said to have gone insane, or to have com- mitted suicide, from mental overwork, the truth in nine cases out of ten, if not in all cases, is that anxieties and apprehensions, disappointed ambition, envies and jealou- sies, the wounds of an exaggerated self-love, or similar heartaches, have been the real causes of their break- down : and these are causes which all have their footing in an undue self-feeling. Depressing passions, with the congenial thoughts which they call up and keep active in the mind, involve a large expenditure of 300 EESPONSrBILITY IN MENTAL DISEASE. . nerve-force, and if the mind has not gained, by cultiva- tion, an internal power of withdrawing the attention from them and of fixing it on other and more healthy trains of thought, or if favourable external circum- stances do not counteract them, aiding the individual to do what he cannot do for himself, there can be in the end but one result — insolvency. Slight excesses of expenditure over income, in vital as in financial matters, must be charged to the capital account, and though each excess may be by itself slight, they are cumulative, and inevitably tell their tale at last. The formation of a character in which the thoughts, feelings, and actions are under the habitual guidance of a well fashioned will, is perhaps the hardest task in the world, being, when accomplished, the highest effort of self-development. It represents the attainment by con- scious method of a harmony of the individual nature in itself, and of the completest harmony between man and nature; a condition in which the individual has suc- ceeded in making the best of himself, of the human nature with which he has to do, and of the world in which he moves and has his being. And assuredly the pursuit of this self-culture through life may be pre- sented to mankind as an aim the attainment of whtbh, rendering them superior to circumstances, will protect them from the injurious operation of those painful emotions which often make shipwreck of the mental health. There is a way, then, hard and long and weary though it be, of counteracting the third of those .powerful causes which I have previously declared to THE STUDY OF THE NATURAL SCIENCES. 301 be by much the most influential in the production of insanit}'. I am unwilling to conclude these desultory reflections, and to bring this chapter of hints rather than of expo- sition to an end, without pointing out that the ordinary education of the day systematically leaves undeveloped a vast amount of mentality in the race. It would seem in- dispensable to a right training of the mind of every child that it should be instructed in the knowledge of the nature of the world in which it has been placed, and of which it is a part. The relations of the earth in the planetary system, the changes which have taken place on its surface through the ages, the elements of which it is formed, and the laws of their combinations and decompo- sitions, the nature and function of the vegetable and animal life on its surface, the constitution of the human body and mind, and the relations of body and mind to their environment, are subjects on which a vast amount of knowledge has been formulated in the various natural sciences. It is strange, when we think of it, that any education, which leaves a man ignorant of these things should be deemed an education at all ; marvellous that intelligent men should be content to go through their lives knowing little more of them than the savages. Apart, however, from the positive duty of man to get the clearest understanding possible of his relations with his surroundings, in order to make the best of them for the promotion of his own development, the study and pursuit of the natural sciences furnish a most valuable training of the intellectual faculties, through 14 302 EESPONSIBILITY IN MENTAL DISEASE. the steps of observation, generalisation, abstraction, inductive and deductive reasoning. No other studies are so well fitted to teach him to observe accurately and to reason correctly; for in the sciences truth is earnestly pursued for its own sake, without regard to whether it may seem useful or not, and without regard to preconceived opinion, or to the claims of authority of any kind ; and in them a conclusion is not accepted as true until it has been subjected to every possible verification. What is truth if it be not the adequate expression in human thought of sincere relations between man and nature, undergoing modification and increasing in complexity as these relations daily become more true, special, and complex in the successive developments of the different sciences ? In these developments, and in the arts founded upon them, nature is undergoing its latest evolution through man, its last and highest product. How then can any one be properly trained to make the best of his powers and to discharge fitly his functions in the world, how can he be educated in the true sense of the word, if he be left without knowledge of natural science ? It will not be denied that there are a great many persons who are quite incapable of sustained attention, accurate observation, and sound reasoning. They are unable to apprehend a question distinctly, and to fix their attention to it; use words without attaching a definite meaning to them ; cherish beliefs without realising the true nature of what they affirm ; wander in an incoherent way from subjects which they attempt to discuss ; believe THE REIGN OF LAW IN HUMAN EVOLUTION. 303 as their fears, affections, or interests prompt; and mis- take prejudices or vague feelings for well-founded con- victions. Now these are intellectual faults which a man cannot be guilty of in gaining a proper knowledge of the physical sciences. In such labour he must concentrate his attention, must apprehend clearly the definite mean- ings of words, must submit his understanding to the facts with humility and perseverance, must patiently follow the successive steps by which the results have been acquired : he can only know in so far as he himself is the humble minister and honest interpreter of nature, or fol- lows in the footsteps of those who, having been successful ministers and interpreters of nature, have unfolded the various sciences. In proportion as he deviates, in the study of any science, from this right method, will his knowledge be defective or erroneous. This being so, it would seem obvious that nothing can be better adapted than such a study to strengthen and develop his intel- lectual faculties ; for it is not merely the knowledge of a particular science which he gains, but he gains a useful habit of mind — a habit of close observation and accurate reasoning, which will serve him well in every other in- quiry. He gains not only the power of an increased knowledge, but an increased power of gaining knowledge : his intellectual development is along the path of nature's evolution. The more truthfully his thoughts reflect nature in one of her domains, the more easily will other domains of nature be reflected in his mind; for one science thoroughly learnt contains implicitly, quoad the intellectual processes concerned in its attainment, all 304 EESPONSIBIUTY IN MENTAL DISEASE. sciences. His trained understanding makes him the potential master of them all. Nor is the moral nature uninfluenced beneficially bj the pursuit of science. It is a labour in which there is but one way of succeeding, and that is through obedi- ence. To penetrate the secrets of nature and to become master of her laws, patience, humility, and veracity are essential qualities. And by veracity in this relation is meant not only the sincere expression of opinion, once formed, but sincerity also in the ap- prehension of truth — a perfect freedom from bias and an entire sincerity of nature in forming and weighing opinions, as well as in uttering them. It may be said, no doubt, that the formation of a character implies more than an increase of knowledge by the inductive method, or an increase of the intellectual power which increased knowledge imparts. That is not a matter for discussion now : it is enough for the present purpose to point out that education by the scientific method does demand and therefore strengthen certain qualities of the moral nature. And one may take leave to think that, whatever may be the power which best promotes moral development, it can be nothing but an advantage to an individual to have such a knowledge of the reign of moral law in the domain of human evolution as an inductive method of study will impart to his understanding. It would simplify discussions on education if the truth were distinctly apprehended that morality is not dependent for its existence upon religion, and that men are not dependent only upon revelation for their knowledge of it. THE SCIENTIFIC BASIS OP MOEAIITT. dU& Let them realise that nature works through moral laws, as clearly as they realise her operation through physical laws, and they will have as strong a sense or feeling of the folly of disobeying the former as they now have of the folly of disobeying the latter. The result must be that morality will obtain as strong a sanction from an in- ductive method of study as it now has, and has happily long had, from authority, and that an increased know- ledge will confer an increased feeling of duty and an increased power to perform it. It is difficult to realise the reigri of law in our relations with human nature ; for we are unable to look at the matter calmly and objectively as we can in our investiga- tions of physical nature ; our sympathies and antipathies as beings of the same kind are necessarily stirred ; and we unavoidably mingle our feelings with our apprehen- sions and conceptions. There will always be therefore a feeling of approbation of right and of disapprobation of wrong action superadded to the intellectual recognition of moral law, such as does not accompany a like obedi- ence to or infraction of physical laws. Thus the ethical element, the imperative mandate, is added to the utilita- rian basis. But utilitarianism is an unfortunate word, which, not- withstanding elaborate explanations of what is really meant by it, will continue to give undeservedly an ill odour to the theory of morals based upon it. We may justly say undeservedly, because it is certain that morality is a condition of the progress of evolution in the domain of human nature, and that it is therefore in 306 RESPONSIBILITY IN MENTAL DISEASE. the highest sense utilitarian, as promoting in the long-run the welfare of mankind and of the individuals who colisti- tute mankind. The opponents of utilitarianism will never be persuaded, however, that it does not mean selfishness — that the theory of it is not to place happi- ness to the individual as an immediate end. But the happiness of the race, the exaltation of humanity, is its real end, in ministering to which a right-minded person is to find inward satisfaction, even though the way be through self-denial and suffering ; if this be selfishness it is so only in so far as it is selfish for mankind to desire and strive to progress in evolution. The good effects of observance of, and the evil consequences of infraction of, moral law are often remote. That all sin is avenged upon earth is true, but it is not true that a man cannot escape the consequences of his ill-doing; it would be more true to say that mankind cannot escape the conse- quences of a man's ill-doing. In like manner, so far as immediate results are con- cerned, obedience to moral law, or well-doing, is often a sacrifice to duty — a self-sacrifice, such as a parent makes for his child and finds his happiness in making ; its ministration to the eventual happiness of mankind, much less of the individual, may not be apparent. But the generalisation from experience having been more or less consciously made, and having by accumulation and transmission of effects through generations been fixed in the nature as a moral sense or instinct — acquisition having become endowment here as in other depart- ments of organic development — ^it is obeyed as a duty THE ORGANIZATION OF MOEAL SENSE. 307 by a well-born person, without an intellectual appre- hension of its whole operation, and even in scorn of the immediate painful consequences of such obedi- ence.* It is formed as instincts are formed in animals, and then obeyed, as they are obeyed, almost blindly ; obedience bringing inward satisfaction", not- withstanding that it may bring external privation and suffering. The development of the mental organisation being part of the order of nature, and talking place in accordance with the laws of the nature which surrounds it and of which it is part and product, the moral law in man is the conscious reflection of the moral law in the universe — a result among other results of nature having become selfconscious in man. And the building up of * Des impressions particnli^rea, mais conatantes et toujours les mimes, sont done capable de modifier les dispositions organiques et de rendre leurs modiiications fixes dans les races. . . . Et si les causes d€termin- antes de 1' habitude premiere ne discontinuent point d'agir pendant la durge de plusieura ggnSrations auccessivea, il se forme une nouveUe nature acquiae, laquelle ne peut, ^ son tour, £tre changge, qu'autaut que ces mSmea causes cessent d'agir pendant longtemps, et aurtout que des causes di£fgrentes viennent d'imprimer & rgconomie animale une autre suite de determinations. — ' Bapports du, Physigue et du Moral de VSornme.' — P. J. Gr. Cabania. The fact that where foxes are much persecuted the young ones show themselves much more cunning and distrustful from the first than old f oxea in places where they are not persecuted, was thought by one learned author an absolute demonstration that animals had language ; but F. Cuvier explained it by the hereditary transmission of acquired instincts. For other examples of the transmission of acquired faculties see the elaborate Traitg Philosophique et Physiologique de l'Hgrgdit§ Naturelle, by Dr. Prosper Lucas, 1847. But these scattered observations have now found their place, and have been supplemented by many others, in Mr. Darwin's exposition of hia great law of evolution. 308 EESPONSIBILITY IN MENTAL DISEASE. a moral science by the application of the inductive method to the study of moral phenomena, so far from weakening the authority of conscience, cannot fail to strengthen the feeling of duty to do the right and eschew the wrong, by showing plainly how, through the unfailing operation of natural law, the former surely brings good and the latter evil upon mankind. That it should be necessary to enter into arguments to prove the moral nature of men to be a proper subject of scientific study, and to set forth the bene- ficial effect which such a study must have upon the understanding and the moral nature, will probably be thought as extraordinary a thing in the years to come as it seems extraordinary to us now that persons should have had to set forth elaborate reasons in times past to disprove the existence of witchcraft. Meanwhile, it is plain that in neglecting a most promising means of mental training, and in thus failing to develop to the utmost all the resources of their mental nature, men do not do all that they might do to protect themselves from the inroads of mental derangement. It is, indeed, to the development of the vast amount of undeveloped mentality which there assuredly is among mankind that we may look with confident hope for the diminution in time to come of the sum of insanity upon earth. INDEX. AcosTA, Josephus, on possession by the devil, 35 Age, the mental decay of old, 259- 261 Alcohol, the abuse of, 2S5 Anthony, St.; 10 Aphasia, 264; condition of under- standing in, 265 ; Trousseau on, 265; Dr. W. Ogle, on a case of, 266 Arnold, trial of, 90 Asclepiades, on the treatment of in- sanity, 8 Astrology, the speculations of, 20 Asylum, lunatic, popular notion of, 1 ; Mr. Burke's visit to, 2 Aura epileptica, 165, 236 Banks v. OoodfcUovj, case of, 115 Barlow, Reverend John, on the pre- vention of insanity, 269 Bartlett, Judge, on testamentary capacity, 115 BeU, Chief Justice, on the criterion of responsibility, 103 Bellingfaam, trial of, 92 Billman, case of, 201 Bisgrove, case of, 167 Boardman v. Woodman, case of, 104, 108, 111, 115 Body, the theological contempt of, 12 ; sympathy of organs of, 17 Brain, function of, 15; disorder of, 15; organic sympathies of, 17; education of, 19; pathological study of, 154 Browne, Sir Thomas, on hereditary influence, 23 Burke, Mr., his visit to A lunatic asylum, 2 Burton, case of, 157 Cabasis, p. J. G., on the transmis- sion of acquired faculties, 307. Casaubon, Meric, on sin, 26; on madness, 35 ; on the persistence of dream-haliucinations, 251 Capacity, testamentary, 111-120 Cartwright V. Cartwright, case of, 112 Character, formation of, 272, 294, . 300 Cheyne, Dr. John, on the prevalence of insanity, 281 Chorea, kinship of, to insanity, 42, 151 Classification of insanity, 66-85 Clissold, Kev. Augustus, on the pro- phetic spirit, 50 Cockburn, Chief Justice, on testa- mentary capacity, 115 Code, French penal, 108; German penal, 109 C(^e, Sir ,£ , on the execution of meulmen, 123 Conolly, Dr., on the duty of the medical witness, 86 ; on suicidal insanity, 139; on homicidal im- pulse, 147 Consciousness, physical modifica- tions of, 16 Crime, viewed as insanity, 26 ; here- ditary nature of, 29 ; in imbecility, 68 Criminals, 25-33 ; the treatment of. 310 INDEX. 27 ; the production of, 28 ; defec- tive organisation of, 30 Cuvier, F., on acquired instincts, 307 Dklasiauvb, on undetected epilepsy, 244 Delusions, as the test of insanity, 91, 113, 114; concealment of, 192, 214; of persecution, 190, 196; futility of argument agaipst, 200; as causes of homicide, 208, 252 ; influence upon conduct, 216 Dementia, 72 ; epileptic, 242; senile, 254-264 ; moral, 242, 261 Demoniacal possession, 10 Dew V. Clarht, case of, 113 Dipsomania, 43, 83 Doe, Judge, on testa of responsi- bility, 107, 111 Dreaming, insanity and, 160 ; per- sistence of hallucinations of, 251. EOOENTBICITT, 55, 270 Echeverria, Dr., on epileptic in- sanity, 235 ; |an epileptic uncon- BciousnesB, 238 Education, power and limits of, 20; criminal, 29 ; the true aim of, 287 Emotions, as cause of insanity, 290, 299 ; undue development of, 298 EpilepEiy, in criminals, 32 ; kinship to insanity, 41; the neurosis of, 156, 165; masked, 166, 230; mental prodromaba of, 235 ; pecu- liar state of consciousness in, 237 ; symptoms of mania of,. 239-242 ; undetected, 243 Epileptics, religious sentiment in, 243; visions of, 243 ; imagination of, 243 Erskine, Mr., on delusion as the test of insanity, 91, 114 Esquirol, on insanity without de- lusion, 142, 147; on moral in- sanity, 175 ; on the recurrence of homicidal mania, 206 ; on the con- cealment of delusions, 214 ; on homicidal mania after epilepsy, 235 Ettmuller, on insanity without de- lusion, 140 Falret, Jules, on homicidal im- pulse after epilepsy, 233 ; on the symptoms of epilepsy, 235 Family, degeneration and regenera- tion of, 279 Feelings, reUtiou of, to belief, 152; insane, 194, 246; the control of, 299 Folic circulaire, 176-178 Foville, Dr., on the condition of mind in monomania, 221 Foxhunting, 291 Oriesingeb, on the sudden outbreak of insanity, 155 Hadfield, trial of, 91 Hale, Lord, on partial and total in- sanity, 89 ; on witches, 106 Hearden, Dr. J. Q., on hereditiry predisposition to insanity,- 282 Hereditary influence, 21—23; Solo- , man on, 22 ; Jewish recognition of, 22 ; Sir Thomas Browne on, 23 ; in the causation of insanity, 282; Dr. Prosper Lucas on, 307 Hippocrates, on insanity, 7 ; on vice, 26 HoEfbauer, his criterion of responsi- bility, 209; criticism of, 210 Homicide, in simple melancholia, ] 23, 131, 187 ; premeditation in, 293; epileptic, 229, 245; during sleep, 251 ; after dreams, 252 ; conduct after, 208 Homicidal impulse, irresistible or unresisted, 164, 193 ; before, in place of, and after epilepsy, 169, 228-235; the result of insane emotion, 194 ; the result of delu- sion, 208 Homicidal insanity, 125, 126, 140- INDEX. 311 170 ", Buddeu outbreak of, 155, with mental imbebility, 167; re- currence of, 206 Howden, Dr.' J. C, on the religions sentiment in epileptics, 213 Idea, morbid, 148, 149 ; synergy of, 225 Identity, loss of consciousness of, 263 Idiocy, 66, 89 ; absence of responsi- bility in, 67 Imbecility, 67 : responsibility in, 68; crime in, 68; moral, 179, 242 Impulses, insane, 531 Insane, the manners and appearance of, 2, 3 ; the motives of, 3, 4 ; dis- trust of, 4; barbarous treatment of, 10 ; 'executed as witches, 11 ; the punishment of, 15, 27, 128, 129 ; belief in inspiration of, 49 Insanity, concealment of , 5 ; Orecian views of, 6, 7, 8 ; Hippocrates on, 7i 8 ; Asclepiades on treatment of, 8 ; theological view- of, 9, 10 ; metaphysical view of, 13; defini- tion of, 15 ; , moral causes and moral treatment of, 16; no de- marcation between sanity and, 38 , kinship between epilepsy and, 41 ; neuralgia and, 41 ; chorea and, 42; 151; dipsomania and, 43; the prophetic mania and, 49 ; eccen- tricity and, 55; intellectual, 69 ; affective, 69, 120-184, 132 ; classi- fication of, 66-85 ; hereditary, 79 ; toxic, 79 ; idiopathic, 80, 83 ; sym- pathetiif, 80 ; epileptic, 82, 227- 253; of pubescence, 82; of preg- nancy, 82; puerperal, 82; of Jac- tation, 82 ; climacteric, 82 ; phthi- sical, 83 ; senile, 83, 264-264 ; sthenic and asthenic, 83 ; various forms and phases of, 122 ; early symptoms of, 123, 130 ; course of, 125; homicidal, 126, 140—170; without delusion, 131; sudden outbreak of, 155 ; partial intel- lectual, 185-226; the prevention of, 268-308 ; hereditary transmis- sion of, 275, 282; intemperance as a cause of, 283 Intellect, the development of, 303 Intemperance, a cause of insanity, 283 Judges, answers of, to the House of Lords, 96-98 Kleptomania, 82, 126 Ladd, Judge, on the dicta of English judges, ■ 99 ; on tests of responsi- bility, 106 Lamb, Mary, insanity of, 186 Love, the passion of, 277 Life-aims, 294 Lypemania, insanity of, 186 Lucas, Dr. Prosper, on hereditary influence, 307 MAOAliins, St., 10 Mahomet, visions of, 52, 243; the epilepsy of, 53, 243 Mania, the prophetic, 49 ; general, 70; partial, 70; without delusion, 131; epileptic, 228; transitory, 230, 244, 247 Mansfield, Lord, on responsibility in insanity, 92 Marc, on homicidal insanity, 145 ; on masked epilepsy, 167; on concealed insanity, 207 - Marriages, wise'and unwise, 279-281 McNaughteq, trial of, 95 Medical evidence, 86 Memory,' loss of, in senile dementia, • 255-258; in old age, 260; in apoplexy and fever, 262; in dying, 262 Melancholia, 71, 73; simple, 123, 131 ; homicide in, 187 Metaphysics, the spirit of, 12, 13 312 INDEX. Meyer, Luclwig, on a masked epi- lepsy, 167 Mind, relation to body, 9, 12, 15, 17 ; metaphysical views of, 11 ; scientific definition of, 15 ; method of study of, 18 ; degeneration of, 279 ; necessity of exercise of, 295 Monasticism, the spirit of, 9 Monomania, 71, 78; condition of mind in, 220 Morality, the inductive study of, 305 Moral insanity, 132, 1.70-182; Dr. Prichardon, 59, 64, 174; Esquirol on, 175 ; in connection with epi- lepsy, 178, 242; with imbecility, 179 Moral nature, the development of, 304 Moral responsibility, defective, 25; degrees of, 34; inductive study of, 34 Moral sense, scientific study of, 34 ; deficiency or absence of, 68 ; ' a function of organisation, 60 ; the origin of, 61 ; degeneracy of, 62- 64 Morel on morbid varieties, 69 ; on the classification of insanity, 78- 81;. on homicidal impulse, 170; on mania as a masked epilepsy, 233 ; on mania transitoria, 248 Morbid idea, relation of, to will, 144, 148, 149 Movements, synergy of, 224 Natural laws, ignorance of, 289; breach of, 290. Natural science, the study of, 301 Nature, individual differences of, 21 ; inconsistencies of, 291 Neuralgia, kinship to insanity, 41 Neurosis, the criminal, 33 ; the insane, 40, 46, 156, 161 ; trans- formation of, 79; the epileptic, 156, 165 Nervous diseases, transformation of, 41 ; functional and organic, 44 Nicholl, Sir John, on testamentary capacity, 113 PABALTSia, general, 72 ; crime in, 75 Ferley, Chief Justice, on tests of responsibility, 104 Peacock v. Lowe, case of, 266 Penzance, Lord, on testamentary capacity, 115 Pinel, on insanity without delusion, 141 ; on recurrent homicidal mania, 206 Plato, on wickedness, 25; on mad- ness and the prophetic mania, 50 Pownall, Dr., case of, 190 Predisposition, hereditatr, 46, 275, 282 Prichard, Dr., on moral insanity, 59, 64, 174 Psychosis, the criminal, 33 Pyron^ania, 81, 161, 163 Rae, Dr, on Lord Mansfield's dic- tum, 93 BaptuB melancholicus, 187 Reformer, the, temperament of, 53 Religion, the misuse of, 297 Responsibility, criterion of, in in- sanity, 14, 90-111 ; in imbecility, 68; in partial insanity, 89; Mr. Justice Tracey on, 90 ; Judge Ladd on, 99 ; Chief Justice Bell on, 1 03 ; Chief Justice Perley on, 104 ; Judge Doe on, 107, 111 ; Hoff- bauer on, 209; medical doctrine of, 212; discussion of medical and legal doctrines of, 212-226 SaLF-coKTROii in insanity,-271 Self-formation, 294 Self-deception, 293 Shakspeare on responsibility iu insanity, 127 Skae, Dr., on the classification of insanity, 81-83; on homicidal impulse, 165 State V. Jones, case of, 99 State V. Pike, case of, 104, 107 INDEX. 813 Slate V. Vt'eir, case of, 102 Stevens v. StcUe of Indiana, case of, 1 03 Smith V. Tihbitt, case of, 115 Somnambulism, 250 Spinoza, on the persistence of dream- hallucinations, 251 ; on the control of the feelings, 299 Stylites, Simeon, 10 Suicide, in simple melancholia, 123 Suicidal insanity, 133-140; heredi- tary transmission of, 131 Swedenborg, epileptic visions of, 213 Sympathy, organic, 17 Temfexamhnt, the insane, 46, 56, 161 Theology, the spirit of, 9 Thomson, Bruce, on criminals. 30-32 Traoey, Justice, on responsibility in insanity, 90 Transformation of nervous diseases, 41 Trousseau, on irresistible impulses in epilepsy, 90; on the under- standing in Aphasia, 265 Utiutarianism, 305 Wallis, Samuel, case of, 18S Waring v. Waring, case of, 115 Werter, the suicide of, 272 Wharton and Stills on a case of homicidal insanity, 204 Wightman, Justice, on the desire to be hanged, 158 Will, freedom of, 109, 111; power of making a, 111-120; loss of power of. Ill, 125; fluctuations of, 149 1 control of, 269 ; develop- ment of, 273 Wynne, Sir William, on testamentary capacity, 112 Yellowlees, Dr. D., on intemperance as a cause of insanity, 284 THE END. 'Opinions of the Press on the "International Scientific Series." Tyndall's Forms of Water. t vol., lamo. Cloth. Illustrated Price, $1.50, *' In the volume now published, Professor Tyndall has presented a noble illustration of the acuteness and subtlety of his intellectual powers, the scope and insight of his scientific vision, his singular command of the appropriate language of exposition, and the peculiar vivacity and grace with which he unfolds the results of intricate scientific research." — N, Y. Tridune. '* The * Forms of Water,* by Professor Tyndall, is an interesting and instructive Hctle volume, admirably printed and illustrated. Prepared expressly for this series, it is in some measure a guarantee of the excellence of the volumes that will follow, and an indication that the publishers will spare no pains to include in the series the freshest in- vestigadons of the best scientific mxaAs." -^Boston journal. " This series is admirably commenced by this little volume firom the pen of Prof. Tyndall. A perfect master of his subject, he presents in a style easy and attracdve his methods of investigation, and the results obtained, and gives to the reader a clear con- ception of all the wondrous transformations to which water is subjected."— C^MrM/»an. II, Bagehot s Physics and Politics. I vol., r2mo. Price, $1.50. " If the * International Scientific Series ' proceeds as it has begun, it will more than fulfil the promise given to the reading public in its prospectus; The first volume, by Professor Tyndall, wa^ a model of lucid and attractive scientific exposition ; and now we have a second, by Mr. Walter Bagehot, which is not only very lucid and charming, but also original and suggestive in the highest degree. Nowhere since the publication of Sir Henry Maine's 'Ancient Law,* have we seen so many fruitful thoughts sug- gested in the course of a couple of hundred pages. . . . To do justice to Mr, Bage- hot's fertile book, would require a long article. With the best of intentions, we are conscious of having given but a sorry account of it in these brief paragraphs. But we hope we have said enough to commend it to the attention of the thoughtful reader."— Prof. John Fiske, in the Atlantic Monthly. " Mr, Bagehot's style is clear and vigorous. We refrain from giving a fuller ac- count of these suggestive essays, only because we are sure that our readers will find it worth their while to peruse the book for themselves ; and we sincerely hope that the forthcoming parts of the 'International Scientific Series' will be as interesting." — A tkenmum. " Mr. Bagehot discusses an immense variety of topics connected with Ae progress of societies and nations, and the development of their distinctive peculiarities; and his book shows an abundance of ingenious and original thought." — ^Alfred Russell Wallace, in Nature. D, APPLETON & CO., Publishers, 549 & 551 Broadway, N. Y. opinions of the Press on the ^^International Scientific Series.^* III. Foods. By X)r. EDWARD SMITH. I vol., i2mo. Cloth. Illustrated. Price, $1.75. In making up The International Scientific Series, Dr. Edward Smith was se- lected as the ablest man in England to treat the important subject of Foods. His services were secured for the undertaking, and the little treatise he has produced shows that the choice of a writer on this subject was most fortunate, as the book is unquestionably the clearest and best-digested compend of the Science of Foods that has appeared in our language. "The book contains a series of diagrams, displaying the effects of sleep and meals on pulsation and respiration, and of various kinds of food on respiration, which, as ^e results ofDr. Smith's own experiments, possess a very high value. We have not far to go in this work for occasions of favorable criticism; they occur throughout, but are perhaps most apparent in those parts of the subject with which Dr. Smith's name is es- pecially linked." — London Examiner. ."The union of scientific and popular treatment in the composition oftlus work will afford an attraction to many readers who would have been indifferent to purely theoreti- cal details. . . . Sdll his work abounds in information, much of which is of great value, and a part of which could not easily be obtained from other sources. Its interest is de- cidedly enhanced for students who demand both clearness and exactness of statement, by the profusion of well-executed woodcuts, diagrams, and tables, which accompany th^ volume The suggestions of the author on the use of tea and coffee, and of the va^ nous forms of alcohol, ^though perhaps not strictly of a novel character, are highly in- strucUve, and form an interesting portion of the volume." — N„ K Tribune, IV. Body and Mind. THE THEORIES OF THEIR RELATION. By ALEXANDER BAIN, LL. D. I vol., l2mo. Cloth. , Price, $1.50. Professor Bain is the author of two well-known standard works upon the Science of Mind— "The Senses and the Intellect," and "The Emotions and the Will." He is one of the highest living authorities in the school which holds that there can be no sound or valid psychology unless the mind and the body are studied, as they existj together. " It contains a forcible statement of the connection between mind and body, study- ing their subtle interworkings ' by the light of the most recent physiological investiga- tions. The summary in Chapter V., of the investigations of Dr. Lionel Beale of the embodiment of die intellectual functions in the cerebral system, will be found the freshest and most interesting part of his book. Prof. Bain's own theory of the Connec- tion between |:he jnenUd; and me bodily part in man is stated by himself to be as follows : There is * one substance, witJi two sets of properties, two sides, the physical and the mental-^ dpubl^-faced unity* While, in the strongest manner, asserting the union of mind withbrai^fhe yet denies 'the association of union /w^&ctf,' but asserts the union of close succession in tlj^ie,* holding that ' the SEune being 19, ^ alternate fits, un- der extended and under unextended consciousness." ' — Christian Register, D. APPLETON & CO., Publishers, S49& 551 Broadway, N. Y. opinions of the Press on the '''' International Scientific Series J*^ The Study of Sociology. By HERBERT SPENCER. i2mo. Cloth Price, $1.50. " The Study of Sociology " was written for the purpose of conveying to the reading public more definite ideas concerning the nature, claims, scope, limits, and difficulties, of the Science of Sociology. It is intended to prepare the way for the author's great work on the '* Principles of Sociology," which is to follow the " Principles of Psychol- ogy." But, while serving thus as an introduction to the larger work, the present vol- ume is complete in itself. Its style is exceedingly clear and vigorous, and the book abounds with a wealth of illustration. " The philosopher whose distinguished name gives weight and influence to this vol- ume, has given in its pages some of the finest specimens of reasoning in all its forms and departments. There is a fascination in his array of facts, incidents, and opinions, which draws on the reader to ascertain his conclusions. The coolness and calmness of his treatment of acknowledged difficulties and grave objections to his theories win for him a close attention and_ sustained effort, on the part of the reader, to comprehend, fol- low, grasp, and appropriate his principles. This book, independently of its bearing upon sociology, is valuable as lucidly showing what those essential characteristics are which entitle any arrangement and connection of facts and deductions to be called a science. ' * '•^Episcopalian. "To those who are already acquainted with Mr. Spencer's writing, there is no need of recommending the work ; to those who are not, we would say, that by reading ' The Study of Sociology ' they will gain the acquaintance of an author who, for knowledge, depth of thought, skill in elucidation, and originality of ideas, stands prominently for- ward in the front rank of the glorious army of modem thinkers. ' The Study of Soci- ology' is the fifth of * The International Scientific Series,* and for beauty of tjrpe and elegant appearance is worthy of the great publishing-house of Messrs. Appleton& Co." —Boston Gazetie, "This volume belongs to 'The International Scientific Series,* which was projected with so high a standard and which is being so successfully carried out.i The value and character of the whole may fairly be judged by this and the preceding volumes. The principle of the enterprise is that each subject shall be treated by the writer of greatest eminence in that department of inquiry, and it is well illustrated in the present work. Herbert Spencer is unquestionably the foremost living thinker in the psjrchological and sociological fidds, and this volume is an important contribution to the science of which it treats. ..... It will prove more popular than any of its author's other creations, for it is more plainly addressed to the people and has a more practical and less speculative cast. It will require thought, but it is well worth thinking about."~~'Aiianjf Evening journal. "Whether the reader agrees with the author or not, he will be delighted with the work, not only for the beauty and purity of its style, and breadth and cyclopedic char- acter of Mr. Spencer's mind, but also for its freedom from prejudice and kindred imper- fections." — Norwich Bulletin. "This work compels admira'tion by the evidence which, it cives of immense re- search, study, and observation; and is withal written in a popular and very pleasing style. It is a fascinating work, as well as one of deep practical thought." — Boston Post. D. APPLETON & CO., Publishers, 549. & 551 Broadway, N. Y. Opinians of the Press on the " International Scientific Series," VI. The New Chemistry. By JOSIAH P. COOKE, Jr., Erving Professor of Chemistry and Mineralogy in Harvard University. I vol., i2mo. Cloth Price, $2.00. ** The book of Frof. Cooke is a model of the modem popular science work. It has just the due proportion of fact, philosophy, ^d tru^ rQinance, to make it a jascinating companion, either for the voyage or the &t\xAy."— Daily Graphic, *' This admirable monograph, by the distinguished Erving Professor of Chemistry in Harvard University, is the first American contribution to *The International Scien- tific Series,' and a more attractive piece of work in the way of popular exposition upon a difficult subject has not appeared in a long time. It not only well sustams the char- acter of the volumes with which it is associated, but its reproduction in European coun- tries will be an honor to American science. It is^ moreover, in an eminent degree, timely, for, between the abandonment of its old views and tiie bewilderment caused by the new, chemical science was getting into a demoralized condition. A work was greatly needed that should relieve the discomfort of transition, and bridge over the gulf between the old order of ideas and those which are to succeed them. Professor Cooke's compendious contribution to the present exigencies of chemical literature will give the students of the science exactly the help they need, and pass them over by an easy and pleasant route into the new realm of chemical philosophy." — New York Tribune. ** All the chemists in the country will enjoy its perusal, and many will seize upon it as a thing longed for. For,* to those advanced students who have kept well abreast of the chemical tide, it offers a c»lm philosophy. To those others, youngest of the class, who have emerged from the schools since new methods have prevailed, it presents a generalization, drawing to its use all the data, the relations of which the newl^-fledged lact-seeker may but £mly perceive without its aid. . . . To the old chemists, Prof. Cooke's treatise is like a message from beyond the mountain. They have heard c^ changes in the science ; the clash of the battle of old andnew theories has stirred them from afar. The tidings, too, had come that the old had given .way ; and little more than this they knew. . . . Prof. Cooke's * New Chemistry ' must do wide service in bringing to close sight the little known and the longed for. ... As a philosophy it is elemen- tary, but, as a book of science, ordinary readers will find It sufficiently advanced." — U^a Morning Herald, "A book of much higher rank than most publications of its class. It treats only of modem chemical theories— relating to molecules, combining proportions, reactions, atomic weights, isomerisiA, and the synthesis of organic compounds — taking one into the very arcana of chemical mysteries. Though there are no more recondite branches of the sdehce than those here explained and illustrated, such is Professor Cooke's clearness that he may be said to msdce every thing plain to the average reader, who will but take p^ns with his lessons. Professor Cooke reminds us, in his simplicity and lucidity of statement, of Professor Tyndall, dian which there can be no higher praise." — New York journal 0/ Commerce. "The aim of the work Is to furnish a hand-book of a symmetrical science, resting fundamentally upon the law of Avogadro that 'equal volumes of all substances, when in the state of gas and under like conditions, contain the same number of molecules.' It is to a rigid adherence to this law and the deductions which flow from it that chem- istry, as how taught, owes the marked difference which separates it from the chemistry taught a few years ago. The original lectures of Professor Cooke, enlarged and somewhat modified, present in their present form a clear and full exposition of the sci- ence, and will form a useful textrfaook as well as a volume of unusual interest to the lovers of physical science."— iVtfw York World. D, APPLETON & CO., Publishers, 549 & 551 Broadway, N. Y. opinions of the Press on the ^^ hiternaiional Scientific SeriesJ^ VII. The Conservation of Energy. By BALFOUR STEWART, LL. D. With an Appendix^ treating of the Vital and Mental Applications of the Doctrine* X vol., 121X10. Cloth Price, $1.50. Note i0 the American Edition, "The ^eat prominence which the modern doctrine of the Conservation of Energy or Correlation of Forces has lately assumed in the world of thought, has made a simple and popular explanation of the subject very desirable. The present work of Dr. Bal- four Stewart, contributed to the 'International Scientific Series/ fully meets this re- quirement, as it is probably the clearest and most elementary statement of the question that has yet been attempted. Simplein language, copious and familiar in illustration, and remarkably lucid in the presentation of mcts and principles, his little treatise forms just the introduction to the great problem of the interaction of natural forces that is re- quired by general readers. But Prof. Stewart having confined himself mainly to the physical aspects of the subject, it was desirable that his views should be supplemented Xi-!f a statement of the operation of the principle in the spheres of life and mind. An Appendix has, accordmgly, been added to the Amencan edition of Br. Stewart's work, in which these applications of the law are considered. " Prof. Joseph Le Conte published a very able essay fourteen years ago on the * Correlation of the Physical and Vital Forces, which was extensively reprinted abroad, and placed the name of the author among the leading interpreters of the subject. His mode of presenting it was regarded as peculiarly happy, and was widely adopted by other writers. After further investigations and more mature reflection, he has recently re- stated his views, and has kindly furnished the revised essay for insertion in this volume. '* Prof. A. Bain, the celebrated Psycholo^t of Aberdeen, who has done so much to advance the study of mind in its physiological relations, prepared an interesting lec- ture not long ago on the 'Correlation of the Mervous and Mental Forces,' -ivhich wns read with much interest at the time of its publication, and is now reprinted as a suitable exposition of that branch of the subject. These two essays, by carrying out the prin- ciple in the field of vital and mental phen omena, will serve to give completeness and much greater value to the present volume." "The great physical generalization called * The Conservation of Energy* is in an intermediate state. It is so new that all kinds of false ideas are prevalent about it; it is so exact that these cannot be tolerated ; and thus its circumstances are such as to make so thorough and simple a treatise as this, by Prof. Balfour Stewart, a boon to science and the world at large. " The scheme of the book is simple, as is naturally the case when the subject-mat- ter comprehends but one single law of Nature and its manifestations. _ The first two chapters are devoted^ to the consideration of mechanical energy and its change into heat, Prof. Stewart rightly devoting special attention to these two forms of enerpy, compared with which all others are insignificant in practical, if not in theoretical, im- portance. ' The remaining form^ of energy are then explained, and the law of its-con- servation is stated, and its operation traced through all varieties of transmutations. An historical sketch of the progress of the science and an examination of Prof. Thomson's correlative theory of the 'Dissipation of Energy ' follow ; and the work concludes with a chapter on the 'Position of Life,' which is closely connected with a well-known essay written some years ago by Prof. Stewart and Mr. Lockyer. The style is all that it should be ; it is difficult to understand how so much information can. be contained in so few words. Prof. Stewart could not have been nearly so sticcessful in this respect had he been in any degree a pedant. No such writer would permit himself to use the quaint language and still quainter similes and and illustrations that make the hook so readable, and yet there is scarcely one that is out of place, or illegitimately ustd, or likely to mislead."— ^Sa/wnfoy Review. D. APPLETON & CO., Publishers, 549 & 551 Broadway, N. Y. A thoughtful and valuable contribution to the best religious literature of the day, RELIGION AND SCIENCE. A Series of Sunday Lectures on the Relation of Natural and Revealed Religion, or the Truths revealed in Nature and Scripture. By JOSEPH LE CONTE, FI10F£330It Ot GEOLOST ASD HATTBAI. BISTOBT IH THE UKrTEBSITY 07 CAI.IFOEHU, limo, cloth. Price, $1.50. OPINIONS OF THE FltESS. " This work is chiefly remarkable as a conscientious effort to reconcile the revelations of Science with those of Scripture, and will be very use- ful to teachers of the different Sunday-schools." — Detroit Union. "It will be seen, by this risumi of the topics, that Prof. Le Conte grapples with some of the gravest questions which agitate the thinking world. He treats of them all with dignity and fairness, and in a man- ner so clear, persuasive, and eloquent, as to engage the undivided at- tention of the reader. We commend the book cordially to the regard of all who are interested in whatever pertains to the discussion of these grave questions, and especially to those who desire to examine closely the strong foundations on which the Christian faith is reared." — Boston Journal. "A reverent student of Nature and religion is the best-qualified man to instruct others in their harmony. ' The author at first intended his wo(k for a Bible-class, but, as it grew under his hands, it seemed well to give it form in a neat volume. The lectures are from a decidedly re- ligious stand-point, and as such present a new method of treatment." — Philadelphia. Age. "This volume is made up of lectures delivered to his pupils, and is written with much clearness of thought and unusual clearness of ex- fression, although the author's English is not always above leproach. t is partly a treatise on natural theology and partly a defense of the Bible against the assaults of modern science. In the latter aspect the author's method is an eminently wise one. He accepts whatever sci- ence has proved, and he also accepts the divine origin of the Bible. Where the two seem to conflict he prefers to await the reconciliation, which is inevitable if botli are true, rather tlian to waste time and words in inventing ingenious and doubtful theories to force them into'seeming accord. Both as a theologian and a man of science, Prof. Le Conte's opinions are entitled to respectful attention, and there are few who will not recognize his book as a thoughtful and valuable contribution to the best religious literature of the day." — New York World, D, APPLETON & CO., Publishers, 549 & SS' Broadway, N. Y. DESCRIPTIVE SOCIOLOGY. Mb. Herbert Spenoeb has been for several years engaged, with the aid of three educated gentlemen in his employ, in collecting and organizing the facts concerning all orders of human societies, which must constitute the data of a true Social Science. He tabulates these facts so as conveniently to admit of ex- tensive comparison, and gives the authorities separately. He divides the races of mankind into three great groups : the savage races, the existing civilizations, and the extinct civilizations, and to each he devotes a series of works. The first installment, THE SOCIOLOGICAL HISTORY OF ENGLAND, in seven continuous tables, folio, with seventy pages of verifying text, is now ready. This work will be a perfect Cydopsdia of the facts of Social Science, independent of all theories, and will be invaluable to all interested in social problems. Price, five dollars. This great work is spoken of as follows : Trom the British Quarterly Eeview. "No words are needed to indicate tbe immense labor here bestowed, or the great eodological benefit which snch a mass of tahnlated matter done nnder ench competent direction will confer. The work will constitnte an epoch in the science of comparative sociology." From the Saturday Seview. " The plan of the ' Deecriptive Sociology ' ia new, and the task is one eminently fitted to be dealt with by Mr. Herbert Spencer's faculty of scientific organizing. His object is to examine the vatnral laws which govern ttc development of societies, as he has ex- amined in formei parts of his system those which govern the development of individnal life. Now, it is obvious that the development of societies can be stndied only in their history, and that general conclusions which shall hold good beyond the limits O^artica- iar societies cannot be safely drawn except from a very wide range of facts. Mr. Spen- cer has therefore conceived the plan of mating a preliminary collection, or perhaps we should lather say abstract, of materials which when complete will be a classified epi- tome of nnive. sal history." " From the London Examiner. " Of the treatment, in the main, we cannot speak too higJily;- and we must accept It as a wonderfally snccessftal first attempt to fDmish the student of social science with data standing toward his conclusions in a relation like that in which accounts of the structures and functions of diifereut types of animals stand to the conclusions of the biologist." DESCHANEL'S NATURAL PHILOSOPHY. Natural Philosophy: AN ELEMENTARY TREATISE. By PROFESSOR DESCHANEL, of Paris. Translated, with Eztensire Additions, By J. D. Eterett, D. C. L., F. K. S., PBOFEMSOB OF HATITBAL FHILOSOFnY IN THE QITEXN'S COLLEGE, BELFAST. 1 vol., mediam 8to. Uluetrated by 760 Wood EngniTings and 8 Colored Plates. Cloth, $6J)0, Published, also, separately, in Four Parts. Limp cloth, each $1.75. Part I. MECHANICS, HTDE09TATIC8, and PNEUMATICS. Part II. HEAT. Part III. EIJlCTEICiTT and MAGNETISM. Part IT. SOUND and LIGHT. Saturday Review. ^ Systematically arranged, clearly written, and admirably illustrated, showing no less than than 760 engravings on wood and three colored plates, it forms a model work for a class of experimental physics. Far from losing in its English dress any of the qualities of matter or style which distinguished it in its original form, it may be said to have gained in the able hands of Professor Everett, both by way of arrangement and of incorporation of fresh matter, without parting in the translation with any of the freshness or force of the author's text." Athenmum. ** A good working class-book for students in experimental physics." Westminsfer JReview. '^An excellent handbook of physics, especially suitable for self-instruction. . . . The work is published in a magnificent style ; the woodcuts especially are admirable.^' Quarterly Journal of Science. " We have no work in our own scientific literature to be compared with it, and we are glad that the translation has fallen into such good hands as those of Professor Everett. ... It will form an admirable text-book." nature. "The engravings with which the work is illustrated are especially good, a point in which most of our English scientific works are lamentably deficient. The clearness of Deschaners explanations is admirably preserved in the translation, while the value of the treatise is considerably enhanced by somo important additions. . . . We believe the book vrill be found to supply a real need." D. APPLETON & CO., New York. New Scientific Works. ' The Beginnings of Life: Being some Account of the Nature, Modes of Origin and Transformation of the Liower Organisms. By H. Charlton Bastian, M. D., F. R. S. 2 vols., 8vo. With upward oif lOO Illustrations. Price, $5.00. " His preliminary chapteis on the correlation of the vital and physical_ forces,, on the nature and theories of life, on organized and organizahle matter, on the relations of the ani- mal, vegetable, and mineral kingdoms, and on cell-phenomena and cell-doctrines, form the clearest and most readable exposition of these subjects that we have yet seen, and they have a value quite independent of the special inquiry to which they are an introduction." — Pop- ular Science Monthly, "It is a book which will malte its mark, and must produce a powerful sensation."— Ifaiure. The Ancient Stone Invplements, Weapons, and Ornaments of Great Britain. By John Evans, F. R. S., F. S. A., Honorary Secretary of the Geological and Numismatic Societies of London, etc. I vol., 8vo. With 2 Plates and 476 Woodcuts, Price, $5.00. . " We congratulate all those who are^ interested in these researches — and they are now many — on the ample and valuable additions which the author has made to this new and in- teresting chapter U) the history of our rdiix."— Nature, Town Geology. By the Rev. Chas. Kingsley, F. L, S., F. G. S., Canon of Chester. I vol. Cloth. , Price, $1.50. An interacting and valuable book. The high standing of the author is a sufficient guaiw anty for the excellence of the work, and will secure for it an extensive cireulation. A Hand-Book of Chemical Technology. By Rudolf Wagner, Ph. D., Professor of Chemical Technology at the University of Wurtzburg. Translated and edited, from the eighth German edition, with extensive AiSditions. By Wm. Crookes, F. R. S. With 336 Illustrations, i vol., 8vo. 761 pages. Cloth, $5.00. The several editions of Professor Rudolf Wagner's " Handbnch der Cheraischen Tech. nologie " have succeeded each other so rapidly, that no apology is needed in offerine a etanslation to the public. D. APPLETOH & CO., Publishers, 549 fr" SS' Broadway, New Yari. A New Magazine for Students and Cultivated Readers. THK POPULAR SCIENCE MONTHLY, CONDUCTED BY Profeseop E. L. YOUMANS. The growing importance of scientific knowledge to all classes of the community calls for more efficient means of diffusing it. The Popular Science Monthly has been started to promote this object, and supplies a want met b^ no other periodical in the United States. It contains instructive and attractive articles, and abstracts of articles, original, selected, and illustrated, from the leading scientific men of differ- ent countries, giving the latest interpretations of natural phenomena, ex- |)laining the applications of science to the practical aits, and to the opera- tions of domestic life. It is designed to give especial promiiience to those branches of science which help to a better understanding of the nature of man ; to present the claims of scientific education ; and the bearings of science upon questions of society and government. How the various subjects of current opinion are affected by the advance of scientific inquiry will also be considered. In Its literary character, this periodical aims to be popular, without be- ing superficial, and appeals to the intelligent reading-classes of the commu- nity. It seeks to procure authentic statements from men who know their subjects, and who will address the non-scientific public for purposes of ex- position and explanation. It will have contributions from Herbert Spencer, Professor Huxley, Professor Tyndall, Mr. Darwin, and other writers identified with specu- lative thought and scientific investigation. THE POPULAR SCIENCE MONTHLY is published in a large octavo, handsomely printed on clear type. Terms, Five Dollars per annum, or Fifty Cents per copy. OPINIONS OF THE PRESS. " Just the publication needed at the present day." — Montreal Gazette. " It is, beyond comparison, the best attempt at journalism of the kind ever made in thil country." — Home youmaL " Th^initial number is admirably constituted." — Evening Mail. *' In our opinion, the right idea has been happily hit in the plan of tHs new monthly." '^Buffalo Cotirier. " A journal which promises to be of eminent value to the cause of popular education in this country," — N. V, Tribune. IMPORTANT TO CLUBS. The Popular Science Monthly will be supplied at reduced rates with any periodi- cal published in this country. . . Any person remitting Twenty Dollars for four yearly subscnptions will receive an ex- In copy gratis, or five yearly subscriptions for 9ao. T he Po pular Science Monthly and Appletons' Journal (weekly), per annum, $8.00 ^^ Payment^ in all cases, must be in advance. Remittances should be made by postal money-order sr check to the Publishers, 9. AFFLEIOIT it 00., 519 k 551 Broadway, "Ss^ York. vmniKitimm i m>nmwmnm»t» mmmmmmmii'i»itii»fm'iitfiKm>m mmmmmmmmmmmm ft ■<^^:^'^k Scientific series