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GAYLORD
THE

PHYSIOLOGY AND PATHOLOGY OF MIND.
 
THE
PHYSIOLOGY AND PATHOLOGY

OF MIND.

BY

HENRY MAUDSLEY, M.D. Lonp.

PHYSICIAN TO THE WEST LONDON HOSPITAL 5
LECTURER ON INSANITY AT ST. MARY’S HOSPITAL MEDICAL SCHOOL;
FELLOW OF UNIVERSITY COLLEGE, LONDON;
HONORARY MEMBER OF THE MEDIOO-PSYCHOLOGICAL SOCIETY OF PARIS, AND
OF THE IMPERJAL SOCIETY OF PHYSICIANS OF VIENNA;
FORMERLY RESIDENT PHYSICIAN OF THE MANCHESTER ROYAL LUNATIC HOSPITAL, ETC.

  

SECOND EDITION, REVISED.

London :
MACMILLAN AND CO.
1868.

Ath

[The Right of Translation and Reproduction is reserved. ]
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LONDON:
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PREFACE TO THE SECOND EDITION.

(PRERE are only two observations which it seems necessary to
make by way of preface to this edition. The first is, that it
has not been my conscious desire or aim throughout the work to
discard entirely the psychological method of inquiry into mental
phenomena, although the earnest advocacy of the physiological
method has, naturally perhaps, led some readers to assume
such a design. Hitherto, it must be remembered, the latter
has hardly had any place, the former having been exclusively
employed, in the study of mind. Now it is obviously impossible
to set forth the fruitfulness and the rich promise of the physio-
logical method, and to elevate it to its rightful position, without
exposing the shortcomings and the barrenness of the psycho-
logical method, and degrading it to a lower rank than that
which it has unjustly usurped. The second observation is, that
this work may, by virtue of its plan and mode of execution,
rightly claim to be judged, not in parts, but as a whole.
Statements which in one place may appear too absolute, or
entirely unwarranted, will have their justification, or the show
of it, at any rate, in other parts of the book. It may not be
amiss, then; to allege that an adequate criticism of the First
Part cannot be made without some consideration of the Second
Part; and that in like manner the study of the Second or
Pathological Part cannot be undertaken to the best advantage
without a previous study of the First or Physiological Part.
This edition has been carefully revised, with the view of
removing some inaccuracies, and contains additional matter, for
the purpose of elucidating certain obscurities, which occurred
in the first edition. An index has also been added for con-
venience of reference.

Hanwe tt, W.
March 16:h, 1868.
PREFACE TO THE FIRST EDITION.

HE aim which I have had in view throughout this work
has been twofold: first, to treat of mental phenomena
from a physiological rather than from a metaphysical point
of view ; and, secondly, to bring the manifold instructive in-
stances presented by the unsound mind to bear upon the
interpretation of the obscure problems of mental science.
Indeed it has been my desire to do what I could in
order to put a happy end to the “inauspicious divorce”
between the Physiology and Pathology of Mind, and to effect
a reconciliation between these two branches of the same
science. When I first applied myself, upwards of ten years
since, to the practical study of insanity, having laid up before-
hand some store of metaphysical philosophy, it was no small
surprise and discouragement to find, on the one hand, that
the theoretical knowledge acquired had no bearing whatever
on, no discoverable relation to, the facts that daily came
under observation, and, on the other hand, that writers on
mental diseases, while giving the fullest information concern-
ing them, treated their subject as if it belonged to a science
entirely distinct from that which was concerned with the
sound mind. This state of things could not fail to produce
an immediate mental disquietude, and ultimately to give
rise to the endeavour on my part to arrive at sume definite
conviction with regard to the physical conditions of mental
function, and the relation of the phenomena of the sound
and unsound mind. Of that endeavour the present work is
the result. It can claim no more authority than what is due
to a-sincere purpose faithfully pursued, and to such truth as
may be contained in it. The First Part, resting as it does
mainly on the physiological method of inquiry into mental
phenomena, will certainly not command the assent of those
PREFACE TO THE FIRST EDITION. vii

who put entire faith in the psychological method of interro-
gating self-consciousness; it must appeal rather to those who
have made themselves acquainted with the latest advances
in physiology, and with the present state of physiological
psychology in Germany, and who are familiar with the writ-
ings of such as Professor Bain, Mr. Herbert Spencer, Dr.
Laycock, and Dr. Carpenter, in this country. The Second Part
of the book may stand on its own account as a treatise on
the causes, varieties, pathology, and treatment of mental
diseases, apart from all question of the proper method to
be pursued in the investigation of mental phenomena, Even
those who advocate the psychological method of interrogating
self-consciousness do not insist on the application of it to
the scientific study of the madman’s mind.

In laying down the plan of this work, and in thus entering
upon a task not before systematically attempted, I could not
fail to experience the serious disadvantage, not only of having
no guide to follow, but of being compelled by the scope of the
work to deviate from the paths already made in metaphysics,
physiology, and pathology respectively. In order to bring
the results of the cultivation of these different branches of
science into any sort of harmony, it was plainly necessary
not to travel too far on paths which diverged more and more
with every step forward. For this reason I have passed by
many interesting questions which have long occupied a large
space in metaphysics, and have deliberately omitted many
discussions which were at one time intended to form a part

‘of the book. In like manner, it seemed desirable, when treat-
ing of the physiology of mental action, to omit anatomical
description of the nervous system, leaving the knowledge of
it to be obtained in a more complete and satisfactory form
from books specially dealing with the subject. Lastly, the
pathology of diseases of the nervous system generally, although
throwing much light on the pathology of mental diseases,
could not find fitting place, and was after some hesitation
sacrificed, in order to preserve the harmony of design, and
to prevent the book growing to an immoderate bulk. Indeed,
as may be easily conceived, it has been throughout far more
difficult to determine what to leave out than what to put in,
viii PREFACE TO THE FIRST EDITION.

the proportion of material collected for the, purposes of the
project, but not directly used, exceeding that which has been
actually used in its execution. I am fully sensible of the
disadvantages resulting from these omissions: an amount of
knowledge on the reader’s part is taken for granted which he
may not have, and without which many things may appear
obscure to him, and many assertions unwarrantable. It may
well be, too, that either the metaphysician, or the physiologist,
or the pathologist, looking at the work from his particular
standpoint, will see reason to pronounce it defective. Whoso-
ever will, however, be at the pains to compare the discordant
results of metaphysical, physiological, and pathological studies
of mind, remembering that they are actually concerned with
the same subject-matter, cannot fail to recognise and con-
fess the uselessness of an exclusive method, and the pressing
need of combined action and of a more philosophical mode
of proceeding. If the work now offered to the public be
successful in its aim, it will make evident how indispensable
is the method advocated, and how full it is of promise of the
most fruitful results.

In conclusion, I am glad to add a sincere expression of thanks
to my friend Dr. Blandford, for his advice and assistance
during the passage of the book through the press.

Ture Lawn, Hanwe.t, W.
Feb. 5th, 1867.
CONTENTS.

PART I.
THE PHYSIOLOGY OF MIND.

CHAPTER I.
ON THE METHOD OF THE STUDY OF MIND.

spects of nature terrible to man in the infancy of thought ; whence supersti-
tious feelings and fancies regarding nature. As these disappear metaphysical
entities are assigned as natural causes, and man deems himself the “ measure
of the universe.” Finally, the interrogation and interpretation of nature,
after the inductive method, begin ; fruitful results of this method. Is the-
inductive method, objectively applied, available for the study of Mind?
Difficulties in the way of such application. Development of biography, and.
absence of any progress in metaphysics, are evidences of its value. Psychological
method of interrogating self-consciousness palpably inadequate ; contradictory
results of its use, and impossibility of applying it inductively. Self-conscious-
ness unreliable in the information which it does give, and incompetent to give
any account of a large part of mental activity: gives no account of the mental
phenomena of the infant, of the uncultivated adult, and of the insane ; no
account of the bodily conditions which underlie every mental manifestation ;
no account of the large field of unconscious mental action exhibited, not only
in the unconscious assimilation of impressions, but in the registration of ideas
and their associations, in their latent existence and influence when not active,
and in their recall into activity ; and no account of the influence organically
exerted upon the brain by other organs of the body. Incompetency of self-
consciousness further displayed by examination of its real nature. Physiology
cannot any longer be ignored ; henceforth necessary to associate the Physiolo-
gical with the Psychological method ; the former being really the more im-
portant and fruitful method. The study of the plan of development of Mind,
the study of its forms of degeneration, the study of its progress and regress,
as exhibited in history, and the study of biography, should not be neglected.
The union of empirical and rational faculties, really advocated by Bacon as -
his method, is strictly applicable to the investigation of mental as of other
natural phenomena. The question of relative value of inductive or deductive
reasoning often a question of the capacity of him who uses it; difference
between genius and mediocrity—Conclusion . . . . . . . Page 1—40

CHAPTER II.
MIND AND THE NERVOUS SYSTEM.

he term “ Mind” used in different senses : in its scientific sense as a natural
force ; and in its popular sense as an abstraction made into a metaphysical
entity. The brain certainly the organ of the Mind, and the nervous cells the
immediate agents of mental function. Mental power an organized result: in
the proper centres—a mental organization. No nerve in lowest animal forms;
perception of stimulus being the direct physical effect in a homogeneous sub-
stance. The differentiation of tissues in higher animals demands special
means of intercommunication: the nervous system, at first very simple, sub-
x CONTENTS.

serving this function. With increasing complexity of organization, a corre-
sponding complexity of the nervous system. Organs of special senses appear
in very rudimentary form at first; corresponding central nervous ganglia
constitute entire brain in Invertebrata. Rudiments of cerebral hemispheres
and rudimentary ideation in fishes. Convolution of the grey matter of the
hemispheres in the higher mammals, and corresponding increase of intelli-
gence in them. Differences in the size of the brain, and in the complexity of
its convolutions, in different races of men, and in different individuals of the
same race ; corresponding differences in intellectual development. Human
embryonic development conforms with general plan of development of Verte-
brata. Discrimination of nervous centres: (a) primary, or Ideational ; (0)
secondary, or Sensorial ; (c) tertiary, or Reflex; (d) quaternary, or Organic.
The evidence of the different functions of these centres is anatomical, physio-
logical, experimental, and pathological. Lockhart Clarke on the structure
of the convolutions in man. Discriminating observation of mental phe-
nomena necessary, and metaphysical conception of Mind no longer tenable.
Mind the most dependent of all the natural forces ; relations of mental force
in nature. Concluding remarks . . .... . . =. . Page 41—70

CHAPTER III.
THE SPINAL CORD AND REFLEX ACTION.

Spinal cord contains the nervous centres of many reflex or automatic movements.
Earliest movements of infant are reflex ; automatic acts of anencephalic infant
and of decapitated frog. Analysis of Pfitiger’s experiments on the frog. So-
called design of an act not necessarily evidence of consciousness. Spinal cord
the centre of many acquired or secondary automatic movements; illustrations.
The motor faculties mostly acquired in man by education and exercise, but
innate in many animals. Bearing of instances of acquired adaptation of means
to end on the doctrine of final causes. Motor faculties are exhausted by exer-
cise, and require periodical rest for restoration of power by nutrition. Quan-
titative and qualitative relation of reaction to the impression. Hereditary
transmission of acquired faculties implants the germ of innate endowment.
Pitiiger’s laws of reflex movements. Causes of disorder of function of spinal
cord : (a) original differences of constitution ; (b) excessive action ; (c) quantity
and quality of the blood ; (d) eccentric irritation ; (¢) interruption of its con-
nexion with the brain. Close sympathy between different parts of the nervous
system. Clear conceptions of the functions of spinal centres indispensable to
the study of the functions of the higher nervous centres . . . Page 71—98

CHAPTER IV.
THE SENSORY CENTRES AND SENSATION.

Collections of grey matter constituting the sensory ganglia intervene between the
spinal centres and the supreme hemispherical ganglia. Anatomical relations
of different grey nuclei yet uncertain, but nerve-fibres certainly connected with
their cells. Sensory ganglia with connected motor nuclei the centres of inde-
pendent reaction—of sensori-motor movements: examples. Sensations not
innate in man, but acquired by gradual formation; difference between him
and the animals in this regard. The idea of organization necessary to the
just interpretation of sensation; assimilation and differentiation. Association
of sensations. Sensori-motor acts both irregular and co-ordinate; of co-
ordinate acts, some are primary automatic, others secondary automatic.
Persistence of sensori-motor acts in animals after the removal of their cerebral
hemispheres. Acquired sensori-motor acts constitute a great part of the daily
action of life; illustrations. Psychological view of sensation at variance with
physiological facts. Subordination of the sensory centres to the cerebral
ganglia. Causes of disorder of the sensory ganglia: (a) original defects ;
(6) excessive stimulation ; (c) quantity and quality of blood ; (d) reflex irrita>
tion ; (e) influence of cerebral hemispheres (?). Concluding remarks on the
analogy between the functions of the sensory centres and of the spinal

centres . . . . «+ 2 . . Page 99—-122
CONTENTS. xi

CHAPTER V.
THE SUPREME CEREBRAL CENTRES AND IDEATION.

Cortical cells of the hemispheres the centres of Ideation. No certain knowledge
of the functions of different convolutions. Cortical cells the centres of inde-
pendent reaction ; of ideomotor movements, which may take place without
will and without consciousness: illustrations. Notion of innate idea unten-
able. Idea a gradual organization. Different signification of an idea according
to. different states of culture. The so-called fundamental or universal in-
tuitions. Different modes of action of idea: (a) on movements, voluntary
and involuntary, conscious and unconscious; (2) on the sensory ganglia,—
physiologically, as a regular part of mental function ; pathologieally, in the
production of hallucinations ; (c) on the functions of nutrition and secretion :
illustrations; (@) on other ideas: reflection or deliberation. Relation of
consciousness to Ideational activity. Comparison of ideas with movements in
regard to their association, their relation to consciousness, and the limited
power which the mind has over them. The character of the particular asso-
ciation of Ideas determined by (w) the individual nature, (6) special life-
experience. Need of an individual psychology. General laws of association
of ideas. Concluding remarks on the illustration of Von Baer’s law of progress,
from the general to the special in development, afforded by the development
oLidéas «+ = F & e BB oe oe we we ORS . . Page 123—147

CHAPTER VI.
ON EMOTION.

Relation of emotion to idea. Influence of the state of nerve-element on emotion.
Idea favourable to self-expansion is agreeable ; an idea opposed to self-expan-
sion disagreeable. Appetite or desire for agreeable stimulus, and repulsion or
avoidance of a painful one, as motives of action. Equilibrium between indi-
vidual and his surroundings not accompanied with desire. Intellectual life
does not furnish the impulses to action, but the desires do, Character of
emotion determined by the nature of external stimulus, and by the condition
of nerve-element, original, or as modified by culture. Ccenesthesis. Nervous
centres of ideas and emotions the same: emotions as many and various as
ideas. Psychical tone ; how determined? The conception of the ego and the
moral sense. Intimate connexion of emotion with the organic life ; illustra-
tion of their reciprocal influence. Action of disordered emotion. Primitive
passions, according to Spinoza. Difficulties of the psychological method of
studying emotion. Hereditary action in the improvement of human feeling.
Law of progress from the general to the special, exhibited in the development
of the emotions . . 2 eS Re ee Page 147—167

CHAPTER VII.
ON VOLITION.

The will not a single, undecomposable faculty of uniform power, but varies as its
cause varies: differs in quantity and quality, according to the preceding reflec-
tion. According to the common view of it, an abstraction is made into a
metaphysical entity. Self-consciousness reveals the particular state of mind
of the moment, but not the long series of causes on which it depends; hence
the opinion of free-will, Examples from madman, drunkard, &c. The
design in the particular volition is a result of a gradually effected mental
organization : a physical necessity, not transcending or anticipating, but con-
forming with, experience. Erroneous notions as to the autocratic power of
will. Its actual power considered (1) over movements, and (2) over the
mental operations. 1. Over movements: (@) no power over the involuntary
movements essential to life; (6) no power to effect voluntary movements’
until they have been acquired by practice ; (c) cannot control the means, can
only will the event. 2. Over mental operations: (a) the formation of ideas,
and of their associations independent of it ; (b) its impotency in the early stages
of mental development—in the young child and in the savage ; (c) cannot call
up a particular train of thought, or dismiss a train of thought, except through
xii CONTENTS.

associations of ideas that are beyond its control, and sometimes not at all. As
many centres of volitional reaction in the brain as there are centres of ideas.
Volition built up from residua of previous volitions of a like kind. To the
freest action of the will there are necessary an unimpeded association of ideas
and a strong personality. Character not determined by the will, but deter-
inining it in the particular act. Relation of emotion to volition. Differences
in the quality and energy of the will. Will the highest force in nature ; its
highest function creative—initiating a new development of nature.

Page 168—190

CHAPTER VIII.
ON ACTUATION.

Movements leave behind them residua in the motor centres, whence a repository
of latent or abstract movements. Motor residua or intuitions intervene be-
tween motive and act, and are related to conception on the reactive side as
sensation is on the receptive side. Actuation proposed for the psychological
designation of this department. Motor intuitions mostly innate in animals,
acquired in man. Tlustrations from vision, speech, the phenomena of hypno-
tism, paralysis, insanity, &c. Aphasia in its bearings on motor intuitions.
Muscular hallucinations. Co-ordinate convulsions. The muscular sense ; its
‘relation to the motor intuitions, and the necessary part which it plays in
mental function. The will acts upon muscles indirectly through the motor
nervous centres. Orderly subordination of nervous centres in the expression
of the will in action. Natural differences between different persons, in the
power of expression, by speech or otherwise . . . . . Page 191—208

CHAPTER IX.
ON MEMORY AND IMAGINATION.

Memory exists in every organic element of the body—an organic registration of
impressions. No memory of what we have not had experience, and no expe-
rience ever entirely forgotten. Physiological ideas of assimilation and
differentiation necessary to the interpretation of its phenomena. Power of
imagination built up by the assimilation not only of the like in ideas, but
also of the relations of ideas. Its productive or creative power is, in its
highest display, involuntary aud unconscious : it is the supreme manifestation
of organic evolution. Relation of memory to imagination. The action of
imagination. Differences in the character of memory in different persons.
Manifold disorders to which memory is liable. The memory of early youth
and of old age. No exact memory of pain: why? . . . Page 209-222

PART II.

THE PATHOLOGY OF MIND.

CHAPTER I.
ON THE CAUSES OF INSANITY,

Concurrence of causes in the production of Insanity. Moral and physical causes
cannot be exactly discriminated. Predisposing causes: the influence of civili-
zation ; over-population and the struggle for existence ; over-crowding and
insanitary conditions; eager pursuit of wealth, and deterioration of the
moral nature ; sex; education ; religion ; condition of life ; age and period of
life ; hereditary predisposition. Proximate causes of disorder of the ideational
centres :—(1) Original differences in constitution—(«) imperfectly developed
brains of the microcephalic type, (b) cretinism, (c) arrest of development by
disease, (2) the insane temperament, or neurosis spasmodica ; (2) Quantity and
quality of the blood—anzmia and congestion ; alcohol, opium, and other medi-
cinal substances, organic poison introduced from without or bred in the body,
and defective development of the blood itself; (8) Reflex irritation or patholo-
gical sympathy—illustrations ; (4) Excessive functional activity—overwork,
CONTENTS. xiii

emotional agitation, depressing passions, physical exhaustion, &c. ; (5) Injury
and disease of the brain—abscess, tumour, tubercle, syphilis. Concluding
remarks on the special causation of the different forms of insanity. Mental
derangement a matter of degree. Appendix of cases, illustrating the causation
ofinsanity . . 1... Gt Gr eis ar ae as Page 2283—297:

» CHAPTER II.
ON THE INSANITY OF EARLY LITE.

Insanity of young children must be of a simple kind, the mental organization
being imperfect. Convulsions prove fatal at the earliest age: more or less
sensorial insanity associated with them in some cases. Comparison of infantile
insanity with the insanity of animals, and with epileptic fury. The organiza-
tion of sensory residua, and hallucinations of the senses: hallucinations not
uncommon in infancy; examples. Choreie insanity and the phenomena of
somnambulism. Organization of idea. Incoherent conversation and fallacious
memory of children. Delusions. Resemblance between mania of children
and the delirium of adults. Hallucinations produced by morbid ideas. The
difference between fancy and imagination corresponds with the difference
between deliriwm and mania. Forms of insanity met with in children
grouped :—(1) Monomania, when there is a powerful impulse to some act of
violence ; (2) Choreic mania—examples ; (3) Cataleptoid insanity—illustra-
tions ; (4) Epileptic insanity, preceding, taking the place of, or following, the
usual convulsions—examples ; (5) Mania; (6) Melancholia ; (7) Affective
insanity—(a) Instinctive or impulsive ; perversions of the instinct of self-
conservation and the instinct for propagation, (b) Moral insanity—examples.
The insane child is a degenerate variety or morbid kind—never reverts to the
type of any animal : theroid degenerations of mankind are pathological speci-
mens. Concluding remarks upon the seeming precocity of vice in some insane
children! 2 2 = 6 « oo  & woe we & & x Page 298—334

CHAPTER III.
THE VARIETIES OF INSANITY.

1. The insane temperament—its characteristics. Eccentricity and insanity. The
relation of certain kinds of talent to insanity displayed ; also the wide differ-
ence between the highest genius and any kind of madness. The bodily and
mental characters of a.strong hereditary predisposition. The different varieties
‘of mental disease fall into two great divisions—Affective and Jdeational.
2. Affective Insanity: (a) Jmpulsive—the nature of it described and illus-
trated by examples ; enumeration of its causes and exposition of its frequent
connexion with epilepsy ; (6) Moral Insanity—precedes the outbreak of other
forms of insanity sometimes, and persists for a time after disappearance of
intellectual disorder ; displayed chiefly in the degeneration of the social senti-
ments: examples. Vicious actt not proof of moral insanity ; its connexion
with other forms of mental derangement and with epilepsy. 3. Ideational
Insanity: (a) Partial, including monpmania and chronic melancholia ;
(6) General, including mania and melancholia, chronic and acute. Modified
classification of mental diseases. The nature, varieties, symptoms, and course
of partial ideational insanity discussed and illustrated by examples. The
nature, varieties, symptoms, and course of general ideational insanity.
4, Dementia, acute and chronic. Causes of acute dementia, and examples.
Chronic dementia ; three groups of cases according to the degree of mental
degeneration, 5. General Paralysis—its causes, symptoms, and course.
Note on the classification of insanity. Note on the temperature in insanity.

Page 335—427
CHAPTER IV.
THE PATHOLOGY OF INSANITY.

Absence of morbid appearances after death no proof of the absence of morbid
changes: illustrations of abolition of nervous function without recognisable
changes of structure. 1. Summary of latest physiological researches into
nervous function: time-rate of conduction ; electro-motor properties of nerve,
xiv

CONTENTS.

and the changes produced by the electrotonic state ; Katelectrotonus and Ane-
lectrotonus ; chemical changes produced by functional activity. 2. Indivi-
duality of nerve element considered : functional relation between the individual
element and its supply of blood; state of the cerebral circulation during
sleep ; results of the extreme exhaustion of nerve element, and of the effects
of poisons upon it; its modification by the habit of exercise through the
residua of previous activity. 3. Reflex pathological action or pathological
sympathy—illustrations. Morbid anatomy of insanity : (1) Morbid products,
such as Tumour, Abscess, Cysticercus, &c.; intermittence of mental symptoms,
and extreme incoherence of them when they occur in such cases. (2) Morbid
appearances in the Brain and Membranes -in_ acute insanity 3 in chronic in-
sanity; in general paralysis; in syphilitic dementia. Weight and specific
gravity of the brain in insanity. Microscopical researches, and interpretation
of the results of them. Summary of the kinds of degeneration met with in
the brain after insanity : (a) Inflammatory degeneration ; (b) Connective tissue
degeneration ; (c) Fatty degeneration ; (d) Amyloid and colloid degeneration ;
(e) Pigmentary degeneration ; (f) Calcareous degeneration. (3) Morbid con-
ditions of other organs of the body—of the lungs, the heart, the abdominal
organs, and the sexual organs. Concluding observations . . Page 428—471

CHAPTER V.
THE DIAGNOSIS OF INSANITY.

The difficulty of the diagnosis in some cases. Acute mania: diagnosis from

meningitis ; the difference between acute mania caused by intemperance, and
delirium tremens. Chronic mania and feigned insanity. Hysteria and mania.
The mode of detecting partial ideational insanity, monomaniacal or melan-
cholic. Hypochondria and melancholia. Eccentricity and insanity—the
important differences between them. The diagnosis of moral insanity and
of irresistible homicidal impulse. The detection of general paralysis in its
earliest stages. On the mode of conducting the examination of an insane
patient . ae ee ee ae . Page 472—484

CHAPTER VI.
THE PROGNOSIS OF INSANITY.

Insanity reduces the mean duration of life. The indications of a fatal termination.

The probability of recovery depends on the form, the duration, and the cause
of the disease. Melancholia the most curable, acute mania coming next. The
indications of recovery. The prognosis very bad in chronic mania, mono-
mania, and moral insanity, but good in acute dementia. The prognosis in
puerperal, climacteric, metastatic, epileptic, hysterical, syphilitic and senile
insanity. - The causes of the disease influencing the prognosis. The age most
favourable to recovery. The proportion of recoveries, relapses, and deaths.
Evil effects of injudicious interference . . . . . . . Page 485—491

CHAPTER VII.
THE TREATMENT OF INSANITY.

The difficulties in the way of treatment; the working of the Lunacy Acts; the

INDEX .

public horror of insanity, and the social prejudices regarding it. The practice
of indiscriminate sequestration unjustifiable. The true principle to have in
view: argument in favour of it. The treatment of the insane in private
dwellings. Condition of the Chancery patients. The evils of monstrous
asylums. Necessity of early treatment. Moral treatment of insanity ; change
of residence, occupation, amusements, &c. Medical treatment: warm and
cold baths; blood-letting ; counter-irritants; diet; stimulants: the use of
opium ; digitalis ; hyoscyamus, hydrocyanie acid and bromide of potassium ;
tonics, Concluding remarks upon the treatment of chronic insanity.

Page 492—516
iow ee O1F
PART L.

THE PHYSIOLOGY OF MIND.

CHAPTER I, ON THE METHOD oF THE StuDY oF MIND.

IJ. Minp anp THE Nervous System.

”

» IIIf. Tae Sprnau Corp, or Tertiary Nervous CenTRESs; on NERVOUS
CENTRES OF REFLEX ACTION.

IV. SEconDARY NERVOUS CENTRES, OR SENSORY GANGLIA; SENSORIUM
ComMMUNE.

V. HEMISPHERICAL GANGLIA; CoRTICAL CELLS OF THE CEREBRAL
HEMISPHERES ; IDEATIONAL NERVous CENTRES; PRIMARY
NeERvovus CENTRES; INTELLECTORIUM COMMUNE.

» VI. Emorton.
VII. Vonirion.

VIII. Moron Nervous Centres on Motortum CoMMUNE, AND ACTU-
ATION OR EFFECTION.

”

IX. Mrmory AND IMAGINATION,

”
THE

PHYSIOLOGY AND PATHOLOGY OF MIND.

CHAPTER I.

ON THE METHOD OF THE STUDY OF MIND.

“Ich sag’ es dir: ein Kerl, der speculirt,
Ist wie ein Thier, auf diirrer Heide
Von einem bisen Geist im Kreis herum gefiihrt,
Und rings umher liegt schone griine Weide.”
Faust.

ee right estimate of his relations to external nature has

ever been to man a matter of extreme difficulty and uncer-
tainty, In the savage state of his infancy he feels himself so little
in the presence of nature’s vastness, so helpless in conflict with
its resistless forces, that he falls down in abject prostration before
its various powers. The earth of a sudden heaves beneath his
trembling feet, and his shattered dwellings bury him in their
ruins ; the swelling waters overpass their accustomed boundaries
and indifferently sweep away his property or his life; the furious
hurricane ruthlessly destroys the labour of years; and famine or
pestilence, regardless of his streaming eyes and piteous prayers,
stalks in desolating march through a horror-stricken people. In
the deep consciousness of his individual powerlessness he falls
down in an agony of terror and worships the causes of his
sufferings: he deifies the powers of nature, builds altars to pro-
pitiate the angry Neptune, and, by offering sacrifices of that
which is most dear to him, even his own flesh and blood, hopes
to mitigate the fury of Phoebus Apollo and to stay the dreadful
.clang of his silver how. Everything appears supernatural because
he knows nothing of the natural; palsied with fear, he cannot

* B
2 ON THR METHOD OF [cHaP.

observe and investigate; himself he feels to be insignificant and
helpless, while to nature he looks up with reverential awe as
mighty and all-powerful. Reflect on the fearful feelings which
any apparent exception to the regular course of nature even now
produces, on the superstitious dread which of a certainty follows
such unfamiliar event, and it will not be difficult to realize the
extreme mental prostration of primitive mankind.

‘Through familiarity, however, consternation after a while sub-
sides, and the spirit of inquiry follows upon that of reverence ;
the prostrate being rises from his knees to examine into the
causes of events, Experience, sooner or later, reveals the uni-
formity with which they come to pass; he discovers more or less
of the laws of their occurrence, and perceives that he can by
applying his knowledge avoid much of the damage which he
has hitherto suffered—that he can, by attending to their laws,
even turn to his profit those once dreaded physical forces. Now
it is that man begins to feel that he has a much higher position
in nature than in his infancy he had imagined ; for a time he
looks upon himself as belonging to the same order as the things
around him; and he emancipates himself in great part from the
dominion of the priests in whom he had hitherto believed as the
sacred propitiators of the gods whom his fears had fashioned.
When his creeds are seen to spring from an imperfection of the
intellect, the prayers founded on them are abandoned as marking
an imperfection of the will.

Thales of Miletus is said to have been the first who, in this
advance amongst the Greeks, laid aside the priestly character
and stood forth as a pure philosopher; and those who imme-
diately followed him, and constituted the Ionian school of philo-
sophy, having an instinctive feeling of the unity between man
and nature, did seek objectively for a first principle of things—
the dpxn—common to him and the rest of nature. This slow and
tedious method was soon, however, abandoned for the easier and
quicker method of deduction from consciousness: abstractions
were made from the concrete by the active mind; and the
abstractions, being then projected out of the mind and converted
into objective realities, were looked upon and applied as actual
entities in nature. Anaximander, diving into his own mind and
finding something inconceivable there, gave to it the name of
| THE STUDY OF MIND. 3

1e Infinite, and, transferring it outwards, was thenceforth quite
mtent to pronounce it to be the true origin of all things; whilst
ythagoras, going perhaps still further into the unmeaning, pro-
aimed numbers, which are mere arbitrary symbols, to be actual
sistences and the essences of things. Thus it was that man,
mgetful of his early humility, rose by degrees to the creation
f the laws of an external world after the pattern of his own
1oughts: such motives as he felt to influence his own actions
rere held also to be the principles governing the relations of
xternal objects: and natural phenomena were explained by
ympathies, loves, discords, hates. As the child attributes life
» the dead objects around it, speaking to them and thinking
) receive answers from them, so mankind, in the childhood of
iought, assigns its subjective feelings to objective nature, en-
rely subordinating the physical to the metaphysical: it is but
nother form of that anthropomorphism by which the Dryad
ras placed in the tree, the Naiad in the fountain, Atropos
rith her scissors near the running life-thread, and a Sun-god
nthroned in the place of a law of gravitation. As was natural,
1an, who thus imposed his laws upon nature, soon lost all his
omer humility, and from one erroneous extreme passed to the
pposite: as he once fell abjectly down in an agony of fear, so
ow he rose proudly up in an ecstasy of conceit.

The assertion that man is the measure of the universe was the
efinite expression of this metaphysical stage of human develop-
rent. But it was a state that must plainly be fruitless of real
nowledge; there could be no general agreement among men
then each one looked into his own mind, and, arbitrarily making
that he thought he found there the laws and principles of ex-
srnal nature, constructed the laws of the world out of the depths
f his own consciousness. Disputes must continually arise about
rords when words have not definite meanings; and the unavoid-
ble issue must be Sophistry and Pyrrhonism. This has been so;
ae history of the human mind shows that systems of scepticism
ave regularly alternated with systems of philosophy. Fruitful
f empty ideas and wild fancies, philosophy has not been unlike
iose barren women who would fain have the rumbling of wind
» be the motion of offspring. Convinced of the vanity of its
mbitious attempts, Socrates endeavoured to bring philosophy
4 ON THE METHOD OF [cHat.

down from the clouds, introduced it into the cities, and applied
it to the conduct. of human life; while Plato and Aristotle,
opposite as were their professed methods, were both alive to the
vagueness of the common disputations, and both laboured hard
to fix definitely the meanings of words. But words cannot attain
to definiteness save as living outgrowths of realities, as the exact
expressions of the phenomena of life in the increasing speciality
of human adaptation to external nature. As it is with life
objectively, and as it is with cognition or subjective life, so is it
with the language in which the phenomena are embodied: in
the organic growth of a language there is a continuous differen-
tiation, first of nouns into substantives and adjectives, then of
the latter into adjectives proper and nouns abstract ; synonymes
again disappear, each getting its special appropriation, and super-
fluous words are taken up by new developments and combi-
nations of thought. How, then, was it possible that a one-sided
method, which entirely ignored the examination of nature, should
do more than repeat the same things over and over again in
words which, though they might be different, were yet not less
indefinite? The results have answered to the absurdity of the
method ; for, after being in fashion for more than two thousand
years, nothing has been established by it; “not only what was
asserted once is asserted still, but what was a question once is a
question still, and instead of being resolved by discussion is
only fixed and fed.” (+)

Perhaps if men had always lived in the sunny climes of the
south, where the luxuriance of nature allowed of human indo-
lence, they might have continued vainly to speculate; but when
they were brought face to face with Nature in the rugged north,
and were driven to force by persevering labour the means of
subsistence from her sterile bosom, then there arose the necessity
to observe her processes and investigate her secret ways. There
was an unavoidable intending of the mind to the realities of
nature; and this practice, which the exigencies of living first
enforced, became in the fulness of time with those who had
leisure and opportunity the disposition consciously to interrogate
and interpret Nature. In Roger Bacon, we see the human mind
striving unconsciously, as it were, after the true method of

(1) See Notes at the end of the Chapters.
J THE STUDY OF MIND. 5

levelopment ; while in the Chancellor Bacon, who ‘systematized
he principles and laid down the rules of the inductive philo-
ophy, we observe it doing with design and method that which
t had hitherto been blindly aiming at. But as it is with the
nfant, so was it with humanity ; action preceded consciousness,
nd Bacon himself was the efflux of a spirit which prevailed and
.ot the creator of it. By thus humbling himself to obey, man
‘as conquered nature; and those plenteous “fruits and invented
vorks” which Bacon confidently anticipated as “sponsors and
ureties” for the truth of his method, have been reaped in the
ichest abundance.

It seems strange enough now to us that men should not have
ooner hit upon the excellent and profitable method of induction.
Tow came it to pass that when they surveyed organic nature, as
iristotle notably did, they failed to perceive the progress in
evelopment. from the general and simple to the special and
omplex, which is evident throughout it? Had they but formu-
arized this law of increasing speciality and complexity in organic
daptation to external nature, then they had scarcely failed to
pply it to conscious human development; and that would have
een to establish deductively the necessity of the inductive
1ethod. Unfortunately, Aristotle stood alone; and it remains
is particular merit to have foreseen in some sort the value of
ae inductive method. Had he also consistently followed it in
ractice, which he did not, there was an impassable hindrance
) its general adoption, in the moral errors engendered by the
ietaphysical or subjective method, of which Plato was so
owerful a representative and so influential an exponent. Man,
3 the measure of the universe, esteemed himself far too highly
) descend to be the servant and interpreter of nature; and this
‘roneous conceit not only affected his conception of his rela-
on to the rest of nature, but permeated his social nature, and
itiated his whole habit of thought: the superstitious reverence
*the Greek who would put to death a victorious general because
2 had left his dead unburied on the field of battle, must have
revented Aristotle from anatomical examination of the structure
‘the human body. The same errors are continually reappearing
| human history: what happened in the Middle Ages may illus-
ate for us the habit of Greek thought; for at that time mistaken
6 ON THE METHOD OF (car.

religious prejudice allied itself most closely with the metaphy-
sical method which exalted man so much over the rest of nature,
opposing most virulently the birth of positive science, which
seemed to threaten to degrade him; and for a time it was almost
doubtful which would win. Can we wonder, then, that the
erroneous method was triumphant in Greece in the fourth cen-
tury before Christ, when it is only recently in England, in the
nineteenth century after Christ, that the ‘barbarian’s reverence
for a dead body has permitted anatomical dissection, and when
the finger-bone of a saint, or a rag of his clothing, is still trea-
sured up, in some parts of the world, as a most precious relic
endued with miraculous virtues! The evil of the metaphysical
method was not intellectual deficiency only, but a corresponding
baneful moral error.
The adoption of the inductive method, which makes man the
servant and interpreter of Nature, is in reality the systematic
pursuance of the law of progress in organic development; it is
the conscious intending of the mind to external realities, the
submitting of the understanding to things—in other words, the
increasing speciality of internal adjustment to external impres-
sions; and the result is a victory by obedience, an individual
increase through adaptation to outward relations, in accordance
with the so-called principle of natural selection. The mental
capacity of one who is deprived of any one of his senses, which
are the inlets to impressions from without, or the gateways of
knowledge, is less than that of one who is in the full posses-
sion of all his senses; and the great advances in science have
uniformly corresponded with the invention of some instrument
by which the power of the senses has been increased, or their
range of action extended. Astronomy is that which the eye has
been enabled to see by the aid of the telescope; the revelations of
the inmost processes of nature have been due to the increased
power of vision which the. microscope has conferred; the ex-
tremely delicate balance has supplied to science a numerical
exactness; the spectrum has furnished a means of analysing
the constitution of the heavenly bodies; and the galvanometer
already gives the most hopeful presage of important discoveries
in nervous function. Through the senses has knowledge entered.
and the intellect has in turn devised means for extending the
4 THE STUDY OF MIND. 1

ction and increasing the discriminating exactness of the senses:
here have been action and reaction and progressive specialization
nd complication thereof. The two aspects of this relation we
esignate, in their highest manifestations, as cognition and.
ction, or science and art.

Thus much concerning the historical evolution of the induc-,
ive method. But now comes the important question, whether
t is available for the study of the whole of nature. Can we
ipply the true inductive and objective method to the investiga-
ion of psychical as well as of physical nature? In the latter.
ase, it has long received universal sanction ; but in the study of
t man’s mind it is still a question what mabthiod should rightly.
xe employed. Plainly, it is not possible by simple observation
of others to form true inductions as to their mental phenomena ;
the defect of an observation which reaches only to the visible
results of invisible operations, exposes us without protection to
ihe hypocrisy, conscious or unconscious, of the individual; and
ihe positive tendency, which no one can avoid, to interpret the
iction of another mind according to the measure of one’s own, to
see not what is in the object, but what is in the subject, fre-
yuently vitiates an assumed penetration into motives. If we call
‘o our aid the principles of the received system of psychology,
matters are not mended; for its ill-defined terms and vague
waditions, injuriously affecting our perceptions, and overruling
she understanding, do not fail to confuse and falsify inferences,
[t must unfortunately be added that, in the present state of
dhysiological science, it is quite impossible to ascertain, by
»bservation and experiment, the nature of those organic pro-
xesses which are the bodily conditions of mental phenomena.
[here would appear, then, to be no help for it but to have entire
-ecourse to the psychological method—that method of interro-
sating self-consciousness which has found so much favour at all
imes. Before making any such admission, let this reflection be
weighed: that the instinctive nisus of mankind commonly pre-
xedes the recognition of systematic method ; that men, without
snowing why, do follow a course which there exist very good
‘easons for. Nay more: the practical instincts of mankind often
work beneficially in an actual contradiction to their professed
loctrines. When in the Middle Ages faith was put in the
8 ON THE METHOD OF [cHap.

philosophy of the schools, the interrogation of nature by experi-
ment was going on in many places; and the superstitious people
that believe in the direct interference of spirits or of gods, still
adopt such means of self-protection as a simple experience of
nature teaches. Man does not consciously determine his method
and then enter upon it; he enters blindly upon it, and at a
certain stage awakes to consciousness. In the onward flowing
stream of nature’s organic evolution, life first becomes self-
conscious in man: in the slumbering mental development of
mankind, it is the genius who at due time awakens to active con-
sciousness the sleeping century. It would indeed go hard with
mankind if they must act wittingly before they acted at all.

Two facts come out very distinctly from a candid observation
of the state of thought at the present day. One of these is the
little favour in which metaphysics is held, and the very general
conviction that there is no profit in it: the consequence of which
firmly fixed belief is, that it is cultivated as a science only by
those whose particular business it is to do so, who are engaged
not in action, wherein the true balance of life is maintained, but
in dreaming in professorial chairs; or if by any others, by the
ambitious youth who goes through an attack of metaphysics as
a child goes through an attack of measles, getting haply an
immunity from a similar affection for the rest of his life; or
lastly, by the untrained and immature intellects of those meta-
physical dabblers who continue youths for life. A second fact,
which has scarcely yet been sufficiently weighed, is the extreme
favour in which biography is held at the present time, and the
large development which it is receiving.

Let us look first at the import of biography. As the business
of a man in the world is action of some kind, and as his action
undoubtedly results from the relations between him and his
surroundings, it is plain that biography, which estimates both
the individual and his circumstances, and displays their re-
actions, can alone give an adequate account of the man. What
was the mortal’s force of character, whut was the force of circum-
stances, how he struggled with them, and how he was affected by
them,—what was the life-product under the particular conditions
of its evolution :—these are the questions which a good biography
aspires to answer. It regards men as concrete beings, acknow-
THE STUDY OF MIND. 9.

iges the differences between them in characters and capabilities,
cognises the helpful or baneful influence of surroundings, and
tiently unfolds the texture of life as the inevitable result of
e elements out of which, and the conditions under which, it
is been worked. It is, in fact, the application of positive
ience to human life, and the necessary consequence of the
‘ogress of the inductive philosophy. No marvel, then, that
ography forms so large a part of the literature of the day, and
at novels, its more or less faithful mirrors, are in so great
quest. The instincts of mankind are here, as heretofore, in
lvance of systematic knowledge or method.

On the other hand, the metaphysician deals with man as an
ystract or ideal being, postulates him as a certain constant
uantity, and thereupon confidently enunciates empty propo-
tions. The consequence is, that metaphysics has never made
ry advance, but has only appeared in new garb; nor can it in
uth advance, unless some great addition is made to the inborn
ower of the human mind. It surely argues no little conceit in
ay one to believe that what Plato and Descartes have not done,
2, following the same method, will do.* Plato interrogated his
wn mind, and set forth its answers with a clearness, subtlety,
ad elegance of style that is unsurpassed and unsurpassable ;
ntil then the very unlikely event of a better mind than his
aking its appearance, his system may well remain as the
Jequate representative of what the metaphysical method can
scomplish. Superseded by a mure fruitful method, it is prac-
cally obsolete; and its rare advocate, when such an one is
yund, may be said, like the Aturian parrot of which Humboldt
alls, to speak in the language of an extinct tribe to a people
‘hich understand him not.t

But the method of interrogating self-consciousness may be
mployed, and is largely employed, without carrying it to a
ietaphysical extreme. Empirical psychology, founded on direct

x “Jt would be an unsound fancy and self-contradictory, to expect that things
hich have never yet been done can be done, except by means which have never
et been tried.” —Nov. Org. Aphorism vi.

+ © There still lives, and it is a singular fact, an old parrot in Maypures which
annot be understood, because, as the natives assert, it speaks the language of the
‘tures—an extinct tribe of Indians, whose last refuge was the rocks of the
vaming cataract of the Orinoco.”—Humsoipr, Views of Nature, i, p. 172.
10 ON THE METHOD OF [cHapP,

consciousness as distinguished from the transcendental conscious.
ness on which metaphysics is based, claims to give a faithful
record of our different states of mind and their mutual relations,
and has been extravagantly lauded, by the Scotch school, as an
inductive science. Its value as a science must plainly rest upon
the sufficiency and reliability of consciousness as a witness of
that which takes place in the mind. Is the foundation then
sufficiently secure? It may well be doubted; and for the
following reasons :—

(a.) There are but few individuals who are capable of attending
to the succession of phenomena in their own minds; such intro-
spection demanding a particular cultivation, and being practised
with any degree of, or pretence to, success by those only who
have learned the terms, and been imbued with the theories, of
the system of psychology supposed to be thereby established.
And with what success ?

(b.) There is no agreement between those who have acquired
the power of introspection: and men of apparently equal culti-
vation and capacity will, with the utmost sincerity and confi-
dence, lay down directly contradictory propositions. It is not
possible to convince either opponent of error, as it might be in a
matter of objective science, because he appeals to a witness
whose evidence can be taken by no one but himself, and whose
veracity, therefore, cannot be tested. He brings forward the
factitious deliverances of his individual consciousness, but no fact
which is capable of being demonstrated to another mind.

(c.) To direct consciousness inwardly to the observation of a
particular state of mind is to isolate that activity for the time, to
cut it off from its relations, and, therefore, to render it unnatural
In order to observe its own action, it is necessary that the mind
‘pause from activity; and yet it is the train of activity that is to
be observed. As long as you cannot effect the pause necessary
-for self-contemplation, there can be no observation of the current
of activity: if the pause is effected, then there can be nothing
to observe. This cannot be accounted a vain and theoretical
objection, for the results of introspection too surely confirm its
validity: what was a question once is a question still, and
instead of being resolved by introspective analysis is only fixed
and fed. (7)
THE STUDY OF MIND. li

(d.) The madman’s delusion is of itself sufficient to excite
ofound distrust, not only in the objective truth, but in the
bjective worth, of the testimony of an individual’s self-con-
iousness. Descartes laid down the test of a true belief to be
at which the mind could clearly and distinctly conceive: if
ere is one thing more clearly and distinctly conceived than
iother, it is commonly the madman’s delusion. No marvel,
ien, that psychologists, since the time of Descartes, have held
iat the veracity of consciousness is to be relied upon only under
rtain rules, from the violation of which, Sir W. Hamilton.
rlieved, the contradictions of philosophy have arisen. On what
ridence, then, do the rules rest? Either on the evidence of
msciousness, whence it happens that each philosopher and each
inatic has his own rules, and no advance is made; or upon the
gservation and judgment of mankind, to confess which is very
iach like throwing self-consciousness overboard—not otherwise
lan aS was advantageously done by positive science when the
gures on the thermometer, and not the subjective feelings of
eat or cold, were recognised to be the true test of the indi-
idual’s temperature.

It is not merely a charge against self-consciousness that it is
ot reliable in that of which it does give information ; but it is
provable charge against it that it does not give any account
f a large and important part of our mental activity: its light
zaches only to states of consciousness, net to states of mind.
ts evidence, then, is not only untrustworthy save under con-
itions which it nowise helps us to fix, but it is of little value,
ecause it has reference only to a small part of that for which its
astimony is invoked. May we not then justly say that self-
onsciousness is utterly incompetent to supply the facts for the
uilding up of a truly inductive psychology? Let the following
easons further warrant the assertion :—

1, It is the fundamental maxim of the inductive philosophy
hat observation should begin with simple instances, ascent
eing made gradually from them through appropriate generaliza-
ions, and that no particulars should be neglected. How does
be interrogation of self-consciousness fulfil this most just de-
aand? It is a method which is applicable only to mind at a
igh degree of development, so that it perforce begins with those
12 ON THE METHOD OF [cHaP.

most complex instances which give the least certain information;
while it passes completely by mind in its lower stages of develop-
ment, so that it ignores those simpler instances which give the
best or securest information. In this it resembles the philosopher
who, while he gazed upon the stars, fell into the water ; “ for if,”
as Bacon says, “he had looked down, he might have seen the stars
in the water, but, looking aloft, he could not see the water in the
stars.” (?) Where has the animal any place in the accepted system
of psychology ? or the child, the direction of whose early mental
development is commonly decisive of its future destiny? To
speak of induction where so many important instances are neg-
lected, and others are selected according to caprice or the ease
of convenience, is to rob the word of all definite meaning, and
most mischievously to misuse it. A psychology which is truly
inductive must follow the order of nature, and begin where mind
begins in the animal and infant, gradually rising thence to those
higher and more complex mental phenomena which the intro-
spective philosopher discerns or thinks he discerns. Certainly
it may be said, and it has been said, that inferences as to the
mental phenomena of the child can be correctly formed from the
phenomena of the adult mind. But it is exactly because such
erroneous inferences have been made, that the mental phenomena
of the child have been misunderstood and misinterpreted, and
that psychology has not received the benefit of the correction
which a faithful observation of them would have furnished. It
was the physiologist who by a careful observation of the lower
animals, “ having entered firmly on the true road, and submitting
his indorstending to things,” arrived at generalizations which
were found to explain many of the mental phenomena of the
child, and which have furthermore thrown so much light upon
the mental life of the adult. The careful study of the genesis of
mind is as necessary to a true knowledge of mental phenomena
as the study of its plan of development confessedly is to an
adequate conception of the bodily lite.

Again, it might be thought a monstrous mistake of nature to
have brought forth so many idiots and lunatics, seeing that
the introspective psychologists, though making a profession of
induction with their lips, take no notice whatever of the large
collection of instances afforded by such unwelcome anomalies,
THE STUDY OF MIND, 13

wtainly it may be said, and no doubt it has been said, that the
ental phenomena of the idiot or lunatic are morbid, and do not,
erefore, concern psychology. It is true that they do not con-
rm a psychology which violently separates itself from nature.
it it is exactly because psychology has thus unwarrantably
vered itself from nature—of which the so-called morbid phe-
mena are no less natural a part than are the phenomena of
‘alth—that it has not sure foundations; that it is not inductive;
at it has not received the benefit of the corrective instances
hich a faithful observation of the unsound mind would have
forded. In reality the phenomena of insanity, presenting a
wiation of conditions which cannot be produced artificially—
ie wnstantia contradictoria—furnish what in such matter ought
‘have been seized with the utmost eagerness ; namely, actual
‘periments well suited to correct false generalization and to
tablish the principles of a truly inductive science. The laws
"mental action are not miraculously changed nor reversed in
adness, though the conditions of their operation are different ;
id nature does not recognise the artificial and ill-starred
visions which men, for the sake of convenience, and not
afrequently in the interests of ignorance, make.

2. Consciousness gives no account of the essential material
mditions which underlie every mental manifestation, and de-
ymine the character of it; let the function of an individual’s
rtic ganglia be abolished by disease or otherwise, and he would
yt be conscious that he was blind until experience had con-
need him of it. On grounds which will not easily be shaken
is now indeed admitted, that with every display of mental
‘tivity there is a correlative change or waste of nervous
ement; and on the condition of the material substratum must
spend the degree and character of the manifested energy or the
ental phenomenon. Now the received system of psychology
ves no attention to these manifold variations of feeling in the
me individual, which are due to temporary modifications of the
rdily state, and by which the ideas of the relations of objects
self and to one another are so greatly influenced. The quality
‘the ideas which arise in the mind under certain circumstances,
ie whole character indeed of our insight at the time, is notably
termined in great part by the feeling which may then have
14 ON THE METHOD OF [cHaP-

sway ; and that feeling is not always objectively caused, but may
be entirely due to a particular bodily condition, as the daily
experience of every one may convince him, and as the earlier
phenomena of insanity often illustrate in a striking manner.
Again, Bacon long ago set down individual psychology as want~
ing; and insisted on a scientific and accurate dissection of minds
and characters, and the secret dispositions of particular men, so
“that from the knowledge thereof better rules may be framed for
the treatment of the mind.” (*) As far as the present psychology
is concerned, the individual might have no existence in nature ;
he is an inconvenience to a system which, in neglecting the
individual constitution or temperament, ignores another large
collection of valuable instances. As far as truth is concerned,
however, the individual is of some moment, seeing that he often
positively contradicts the principles arbitrarily laid down by a
theoretical system.

When the theologist, who occupies himself with the supersen-
suous, has said all that he has to say from his point of view;
when the jurist, who represents those principles which the
wisdom of society has established, has in turn exhaustively
argued from his point of view,—then the ultimate appeal in a
concrete case must be to the physician, who deals with the bodily
life; through his ground only can the theologist and jurist pass
to their departments ; and they must accept their knowledge of
it from him: on the foundation of facts which the faithful inves-
tigation of the bodily nature lays, must rest, if they are to rest
safely, their systems. Certainly it is not probable that this most
desirable and inevitable result will come to pass in this day or
generation ; for it is not unknown how slowly the light of know-
ledge penetrates the thick fogs of ignorance, nor how furiously
irritated prejudice opposes the gentle advent of new truth. Hap-
pily, it is certain that in the mortality of man lies the salvation —
of truth.

3. There is an appropriation of external impressions by the
mind or brain, which regularly takes place without any, or only
with a very obscure, affection of consciousness, As the various
organs of the body select from the blood the material suitable to
their nourishment, and assimilate it, so the organ of the mind
unconsciously appropriates, through the inlets of the senses, the
t] THE STUDY OF MIND. 15

influences of its surroundings. The impressions which it thus
receives and retains do not produce definite ideas and feelings,
but they nevertheless permanently affect the mind’s nature; so
that as an individual consciously provides his food, and then
leaves the due assimilation of it to the unconscious action of the
organism, in like manner may he consciously arrange the cir-
cumstances in which he will live, but cannot then prevent the
unconscious assimilation of their influence, and the correspond-
ing modification of his character. Not only slight habits of
movement are thus acquired, but habits of thought and feeling
are imperceptibly organized; so that an acquired nature may
ultimately govern one who is not at all conscious that he has
changed. Let any one take careful note of his dreams, and he
will find that many of the seemingly unfamiliar things with
which his mind is then occupied, and which appear to be new
and strange productions, are traceable to the unconscious appro-
priations of the day. There are other stories on record like that
well-known one which Coleridge quotes of the servant-girl who,
in the ravings of fever, repeated long passages in the Hebrew
language, which she did not understand, and could not repeat
when well, but which, when living with a clergyman, she had
heard him read aloud.* The remarkable memories of certain
idiots, who, utterly destitute of intelligence, will repeat the
longest stories with the greatest accuracy, testify also to this un-
conscious cerebral action; and the way in which the excitement
of a great sorrow, or some other cause, as the last flicker of de-
parting life, will sometimes call forth in idiots manifestations of
mind of which they always seemed incapable, renders it certain
that much is unconsciously taken up by them which cannot be
uttered, but which leaves its relics in the mind.

Tt is a truth which cannot be too distinctly borne in mind,
that consciousness is not co-extensive with mind. From the
first moment of its independent existence the brain begins to
assimilate impressions from without, and to react thereto in
corresponding organic adaptations ; this it does at first without

* « A Lutheran clergyman of Philadelphia informed Dr. Rush that Germans
and Swedes, of whom he had a considerable number in his congregation, when
_near death, always prayed in their native language, though some of them, he was

confident, had not spoken the language for fifty or sixty years. ” ABERCROMBIE,
On the Intellectual Powers, p. 148.
16 ON THE METHOD OF [cuar.

consciousness, and this it continues to do unconsciously more
or less throughout life. Thus it is that mental power is being
organized before the supervention of consciousness, and that the.
mind is subsequently regularly modified as a natural process
without the intervention of consciousness. The preconscious
action of the mind, as certain metaphysical psychologists in
Germany have called it, and the unconscious action of the mind,
which is now established beyond all rational doubt, are assuredly
facts of which the most ardent introspective psychologist must
admit that self-consciousness can give us no account,

4, Everything which has existed with any completeness in con-
sciousness is preserved, after its disappearance therefrom, in the
mind or brain, and may reappear in consciousness at some future
time. That which persists or is retained has been differently
described as a residuum, or relic, or trace, or vestige, or again as
potential, or latent, or dormant idea ; and it is on the existence
of such residua that memory depends. Not only definite ideas, .
however, but all affections of the nervous system, feelings of
pleasure and pain, desires, and even its outward reactions, thus
leave behind them their residua, and lay the foundations of modes
of thought, feeling, and action. Particular talents are sometimes
formed quite, or almost quite, involuntarily ; and complex actions,
which were first consciously performed by dint of great applica-
tion, become by repetition automatic ; ideas, which were at first
consciously associated, ultimately call one another up without
any consciousness, as we see in the quick perception or intuition
of the man of large worldly experience ;-and feelings, once active,
leave behind them their unconscious residua, thus affecting the
general tone of the character, so that, apart from the original
or inborn nature of the individual, contentment, melancholy,
cowardice, bravery, and even moral feeling, are generated as the
results of particular life experiences. Consciousness is not able
to give any account of the manner in which these various residua :
are perpetuated, and how they exist latent in the mind; but a
fever, a poison in the blood, or a dream, may at any moment recall ©
ideas, feelings, and activities which seem for ever vanished. The _
lunatic sometimes reverts, in his ravings, to scenes and events of
which, when in his sound senses, he has no memory ; the fever-
stricken patient may pour out passages in a language which he ©
1.] THE STUDY OF MIND. 17

understands not, but which he has accidentally heard ; a dream
of being at school again brings back with painful vividness the
school feelings; and before him who is drowning every event
of his life seems to flash in one moment of strange and vivid
consciousness. Some who suffer from recurrent insanity re-
member only, in their lucid intervals, the facts of former lucid
intervals, and in their paroxysms the ideas, feelings, and events
of former paroxysms. Dreams not remembered in the waking
state may yet affect future dreams, appearing in them as vague
and confused recollections.

It has been before said that mind and consciousness are not
synonymous ; it may now be added, that the existence of mind
does not necessarily involve the activity of mind. Descartes
certainly maintained that the mind always thinks; and others,
resting on that assumption, have held that we must always
dream in sleep, because the mind, being spiritual, cannot cease
to act; for non-activity would be non-existence. Sueh opinions
only illustrate how completely metaphysical conceptions may
overrule the best understanding: so far from the mind being
always active, it is the fact that at each moment the greater part
of the mind is not only unconscious, but inactive. Mental power
exists in statical equilibrium as well as in manifested energy ;
and the utmost tension of a particular mental activity may not
avail to call forth from their secret repository the dormant ener-
gies of latent residua, even when most urgently needed: no man
can call to mind at any moment the thousandth part of his
knowledge. How utterly helpless is consciousness to give any
account of the statical condition of mind! Butas statical mind
is in reality the statical condition of the organic element which
ministers to its manifestations, tt is plain that, if we ever are
to know anything of inactive mind, it is to the progress of
physiology that we must look for information.

5. Consciousness reveals nothing of the process by which one
idea calls another into activity, and has no control whatever over
the manner of the reproduction ; it is only when the idea is made
active by virtue of some association, when the effect solicits or
extorts attention, that we are conscious of it; and there is no
power in the mind to call up ideas indifferently. If we would
recollect something which at the moment escapes us, confessedly

c
18 ON THE METHOD OF [cHAP.

the best way of succeeding is to permit the mind to work
unconsciously ; and while the consciousness is otherwise occu-
pied, the forgotten name or circumstance will oftentimes flash
into the memory. In composition, the writer’s consciousness 1s
engaged chiefly with his pen and with the sentences which he is
forming, while the results of the mind’s unconscious working,
matured by an insensible gestation, rise from unknown depths
into consciousness, and are by its help embodied in appropriate
words.

Not only is the actual process of the association of our ideas
independent of consciousness, but that assimilation or blending
of similar ideas, or of the like in different ideas, by which general
ideas are formed, is in no way under the control or cognizance of
consciousness. When the like in two perceptions is appropriated,
while that in which they differ is neglected, it would seem to be
by an assimilative action of the nerve-cell or cells of the brain
which, particularly modified by the first impression, have an
attraction or affinity for a like subsequent impression: the cell
so modified and so ministering takes to itself that which is suit-
able and which it can assimilate, or make of the same kind with
itself, while it rejects, for appropriation by other cells, that which
is unlike and which will not blend. Now this organic process
takes place, like the organic action of other elements of the body,
quite out of the reach of consciousness; we are not aware how
our general and abstract ideas are formed; the due material is
consciously supplied, and there is an unconscious elaboration of
the result. Mental development thus represents a sort of nutri-
tion and organization ; or, as Milton aptly says of the opinions
of good men that they are truth in the making, so we may truly
say of the formation of our general and complex ideas, that it is
mind in the making, When the individual brain is a well-con-
stituted one, and has been duly cultivated, the results of its latent
activity, starting into consciousness suddenly, sometimes appear
like intuitions ; they are strange and startling, as the products
of a dream ofttimes are, to the mind which has actually produced
them. Hence it was no extravagant fancy in Plato that he looked |
upon them as reminiscences of a previous higher existence. Plato’s
mind was a mind of the highest order, and the results of its
unconscious activity, as they flashed into consciousness, might
1] THE STUDY OF MIND. 19

well seem intuitions of a better life quite beyond the reach of
present will.

But the process of unconscious mental elaboration is suffi-
ciently illustrated in daily experience. In dreams some can
compose vigorously and fluently, or speak most eloquently, who
can do nothing of the sort when awake; schoolboys know how
much a night’s rest improves their knowledge of a lesson which
they have been learning before going to bed; great writers or
great artists, as is well known, have been truly astonished at
their own creations, and cannot conceive how they contrived to
produce them; and to the unconscious action of the mind is
owing, most probably, that occasional sudden consciousness, which
almost every one at some time has, of having been before in
exactly the same circumstances as those which are then present,
though the thing was impossible; but the action of the mind
in the assimilation of events here anticipates consciousness,
which, when aroused, finds a familiarity in them. Inventions
seem, even to the discoverers, to be matters of accident and good
fortune; the most voracious plagiarist is commonly the most
unconscious ; the best thoughts of an author are always the
unwilled thoughts which surprise himself; and the poet under
the inspiration of creative activity is, so far as consciousness is
concerned, being dictated to. If we reflect, we shall see that it
must be so; the products of creative activity, in so far as they
transcend the hitherto experienced, are unknown to the creator
himself before they come forth, and cannot therefore be the
result of a definite act of his will; for to an act of will a con-
_ ception of the result is necessary. “The character,” says Jean

Paul, speaking of the poet’s work, “must appear living before
you, and you must hear it, not merely see it; it must, as takes
place in dreams, dictate to you, not you to it; and so much so
that in the quiet hour before you might perhaps be able to fore-
tell the what but not the how. A poet who must reflect whether
in a given case he shall make a character say yes or no—to the
devil with him: he is only a stupid corpse.”*

If an inherited excellence of brain has conferred upon the indi-
vidual great inborn capacity, it is well; but if he has not such
heritage, then no amount of conscious effort will completely make

* Aesthetik.
c2
20 ON THE METHOD OF [omar.

up for the defect, As in the germ of the higher animal there is
the potentiality of many kinds of tissue, while in the germ of the
lower animal there is only the potentiality of a few kinds of
tissue; so in the good brain of a happily endowed man, there is
the potentiality of great assimilation and of great and varied de-
velopment, while in the man of low mental endowment there is
only the potentiality of a scanty assimilation and of small develop-
ment. But it is ridiculous to suppose that the man of genius
is ever a fountain of self-generating energy ; whosoever expends
much in productive activity must take much in by appropriation ;
whence comes what of truth there is in the observation that
genius is a genius for industry. To believe that any one, how
great soever his natural genius, can pour forth with spontaneous
ease the results of great productive activity, without correspond-
ing labour in appropriation, is no less absurd than it would be to
believe that the acorn can grow into the mighty monarch of the
forest, without air and light, and without the kindly influence of
the soil.

It has been previously said that mental action does not neces-
sarily imply consciousness, and again, that mental existence does
not necessarily involve mental activity: it may now be affirmed
that the most important part of mental action, the essential pro-
cess on which thinking depends, is unconscious mental activity.
We repeat, then, the question: how can self-consciousness suffice
to furnish the facts of a true mental science ?

6. The brain not only receives impressions unconsciously,
registers impressions without the co-operation of conscicusness,
elaborates material unconsciously, calls latent residua again into
activity without consciousness, but it responds also as an organ
of organic life to the internal stimuli which it receives uncon-
sciously from other organs of the body. As the central organ to
which the various organic stimuli of a complex whole pass, and
where they are duly co-ordinated, it must needs have most im-
portant and intimate sympathies with the other parts of the
harmonious system; and a regular quiet activity, of which we
only become occasionally conscious in its abnormal results, does
prevail, as the consequence and expression of these organic sym-
pathies. On the whole, this activity is even of more consequence
in determining the character of our feeling, or the tone of our
1] THE STUDY OF MIND. 21

disposition, than that which follows impressions received from
the external world ; when disturbed in a painful way, it becomes
the occasion of that feeling of gloom or discomfort which does not
itself give rise to anything more than an indefinite anticipation
of coming affliction, but which clouds ideas that arise, rendering
them obscure, unfaithfully representative, and painful. The
rapidity and success of conception, and the reaction of one con-
ception upon another, are much affected by the state of this active
but unconscious cerebral life: the poet is compelled to wait for
the moment of inspiration; and the thinker, after great but fruit-
less pains, must often tarry until a more favourable disposition of
mind. In insanity, the influence of this activity is most marked ;
for it then happens that the morbid state of some internal organ
becomes the basis of a painful but formless feeling of profound
depression, which ultimately condenses into some definite delu-
sion. In dreams its influence is no less manifest; for he who
has gone to sleep with a disturbance of some internal organ may
find the character of his dreams determined by the feeling of
the oppression of self of which the organic trouble is the cause:
he is thwarted, he is afflicted, he is at school again, or under
sentence of death; in some way or other his personality is
oppressed. Most plainly of all, however, does the influence of
the sexual organs upon the mind witness to this operation ; and
it was no wild flight of “that noted liar fancy” in Schlegel, but a
truly grounded creation of the imagination, that he represented
a pregnant woman as being visited every night by a beautiful
child, which gently raised her eyelids and looked silently at her,
but which disappeared for ever after delivery.* Whatever then
may be thought of the theory of Bichat, who located the passions
in the organs of organic life, it must be admitted that he therein
evinced a just recognition of the importance of that unconscious
cerebral activity which is the expression of the organic sym-
pathies of the brain.

In dealing with unconscious mental activity, and with mind
in a statical condition, it has been a necessity to speak of brain

* “In Schlegels—viel zu wenig erkanntem—Florentin sieht eine Schwangere
immer ein schénes Wunderkind, das mit ihr Nachts die Augen aufschlagt, ihr
stumm entgegen liuft u. s. w. und welches unter der Entbindung auf immer
verschwindet.”’—JuAN Pau, Aesthetth.
22 ON THE METHOD OF [cHap.

and cerebral action, where I would willingly, to avoid offence
that might be taken thereat, have spoken, had it been possible,
of mind and mental action; but it was impossible, if one was to
be truthful and intelligible, to do otherwise. When the impor-
tant influence on mental life of the brain, as an organ of organic
life, comes to be considered, there are no words available for
expressing the phenomena in the language of the received
psychology, which, though it admits the brain to be the organ of
the mind, takes no notice whatever of it as an organ. Let us
briefly add, then, what the relations of the brain as a bodily
organ are.

1. The brain has, as previously set forth, a life of relation ;
which may be properly distinguished into—(a) a relation with
external nature through the inlets of the senses; and (0) a rela-
tion with the other organs of the body, through the nervous
system distributed throughout the body. These have already
been sufficiently dwelt upon here ; they will receive fuller atten-
tion afterwards.

2. But the brain has also a life of nutrition, or, if we might so
call it, a vegetative life. In this, its true organic life, there is a
nutritive assimilation of suitable material from the blood by the
nerve-cell ; a restoration of the statical equilibrium being thereby
effected after each display of energy. The extent of the nutri-
tive repair, and the mould which it takes, must plainly be deter-
mined by the extent and form of the waste which has been the
condition of the display of function: the material change or
waste in the nerve-cell, which the activity of an idea implies, is
replaced from the blood according to the mould or pattern of the
particular idea ; statical idea thus following through the agency
of nutritive attraction upon the waste through functional repul-
sion of active idea. The elements of the nerve-cell grow to the
form in which it energizes. This organic process of repair is
not usually attended with consciousness, and yet it may obtrude
itself into consciousness: as the function of any organ, which
proceeds, when all is well, without exciting any sensation, does,
under conditions of disorder, give rise to unusual sensation or to
actual pain ; so the organic life of the brain, which usually passes
peaceably without exciting consciousness, may under certain
conditions thrust itself forward into consciousness and produce
1] THE STUDY OF MIND. 23

anomalous effects, When this happens, the abnormal effect is
not manifest in sensation, for the hemispheres of the brain, as
physiologists well know, are not sensitive in that sense; but it
is displayed in the involuntary appearance of emotional ideas
in consciousness, and in consequent confusion of thought; the
statical idea becomes energy, not through the usual train of asso-
ciation, but by reason of the abnormal stimulus from the inner
life. Thus it is that the presence of alcohol, or some other
such foreign agent, in the blood will excite into activity ideas
which lie out of the usual path of association, which the utmost
tension of consciousness would fail to arouse, and which the
will cannot repress nor control. Whosoever will be at the pains
of attending to his own daily experience will find that ideas
frequently arise into consciousness without any apparent relation
‘to those previously active ; without, in fact, any possibility of ex-
plaining, guoad consciousness, why and whence they come. (°)

To what has been before said of unconscious mental action
this more may now be added—that the deep basis of all mental
action lies in the organic life of the brain, the characteristic of
which in health is, that it proceeds without consciousness. He
whose brain makes him conscious that he has a brain is not well,
but ill; and thought that is conscious of itself is not natural and
healthy thought. How little competent, then, is consciousness
to supply the facts of an inductive science of mind! Pneuma-
tology was at one time subdivided into theology, demonology, and
psychology ; all three resting on the evidence of the inner wit-
ness. Demonology has taken its place in the history of human
error and superstition; theology is confessedly now best sup-
ported by those who strive to ascend inductively from nature’s
law up to nature's God; and psychology, generally forsaken,
stays its fall by appropriating the discoveries of physiology,
preserving only in its nomenclature the shadow of its ancient
authority and state. On what foundation can a science of mind
surely rest save on the faithful observation of all available
instances, whether psychical or physiological ?

Why, however, it will naturally be’ asked, repudiate and dis-
parage introspective psychology, now that it evinces some dispo-
sition to abandon its exclusive mode of procedure and to profit
by the discoveries of physiology ? Because the union, as desired
24 ON THE METHOD OF [cHaP.

by it, is an unnatural and unhallowed union, which can only
issue in abortions or give birth to monsters ; not otherwise than
as Ixion, designing impiously to embrace Juno, had intercourse
with the clouds and begat centaurs. It is not a mere skimming
of physiological text-books, and a superficial acquaintance with
the nature and functions of the nervous system, which will put
meaning into the vague and abstract language of psychology ;
that would simply be to subject physiology to the tortures of
Mezentins—to stifle the living in the embraces of the dead ; but
it is a sound general knowledge of the whole domain of organi-
zation, at the head of which stands the nervous system, and the
final achievement of which is mind, that is indispensably pre-
requisite to the formation of fundamentally true conceptions of
mental phenomena on a physiological basis. These conceptions,
thus vitally impregnated, and the language in which they are
expressed, cannot be reconciled with the language of psychology,
which, borrowed at first from observation of the senses, has now
become so abstract and been so depraved by its divorce from
nature, as to be empty of real meaning. Words! words! words!
but what an aching vacuum of matter! The question between
modern physiology and the old psychology, is not a question of
eclectic appropriation by the latter of the discoveries of the
former, but a fundamental question of method of study.

Such are the charges against seJf-consciousness whereon is
founded the conclusion as to its incompetency : they show that
he who thinks to illuminate the whole range of mental action by
the light of his own consciousness is not unlike one who should
go about to illuminate the universe with a rushlight. A reflec-
tion on the true nature of consciousness will surely tend to con-
firm that opinion. Whoever faithfully and firmly endeavours to
obtain a definite idea of what is meant by consciousness, will
find it nowise so easy a matter as the frequent and ready use of
the word might imply. Metaphysicians, faithful to the vague-
ness of their ideas, and definite only in individual assumption,
are by no means agreed in the meaning which they attach to it;
and it sometimes happens that the same mwetaphysician uses the
word in two or three different senses in different parts of his
book : Sir W. Hamilton uses it at one time as synonymous with
mind, at another time as synonymous with knowledge, and at
4] THE STUDY OF MIND. 25

other time to express a condition of mental activity. That
chere should be such little certainty about that upon which their
philosophy fundamentally rests must be allowed to be no small
misfortune to the metaphysicians.

What consciousness is will appear better if its relations be
closely examined without prejudice. It will then appear that it
is not separable from knowledge ; that it exists only as a part of
the concrete mental act; that it has no more power of withdraw-
ing from the particular phenomenon and of taking full and fair
observation of it, than a boy has of jumping over his own shadow.
Consciousness is not a faculty or substance, but a quality or
attribute of the concrete mental act; and it may exist in differ-
ent degrees of intensity or it may be absent altogether. In so
far as there is consciousness, there is certainly mental activity ;
but it is not true that in so far as there is mental activity there
is consciousness ; it is only with a certain intensity of representa-
tion or conception that consciousness appears. What else, then,
is the so-called interrogation of consciousness but a self-revela-
tion of the particular mental act, whose character it must needs
share? Consciousness can never be a valid and unprejudiced
witness ; for although it testifies to the existence of a particular
mental modification, yet when that modification has anything
of a morbid character, consciousness is affected by the taint and
is morbid also. Accordingly, the lunatic appeals to the evidence
of his own consciousness for the truth of his hallucination or
delusion, and insists that he has as sure evidence of its reality as
he has of the argument of any one who may try- to convince him
of his error: and is he not right from a subjective standpoint?
To one who has vertigo the world turns round. A man may easily
be conscious of freewill when, isolating the particular mental
act, he cuts himself off from the consideration of the causes
which have preceded it, and on which it depends. “There is no
force,” says Leibnitz, “in the reason alleged by Descartes to
prove the independence of our free actions by a pretended lively
internal sentiment. It is as if the needle should take pleasure
in turning to the north; for it would suppose that it turned
independently of any other cause, not perceiving the insensible
motions of the magnetic matter.”* Is it not supremely ridicu-

* Essais de Théodicée, Pt. I.
26 ON THE METHOD OF (cusp,

lous that, while we cannot trust consciousness in so simple. a
matter as whether we are hot or cold, we should be content to
rely entirely on its evidence in the complex phenomena of our
highest mental activity? The truth is, that what has very often
happened before has happened here: the quality or attribute has
been abstracted from the concrete, and the abstraction converted
into an entity ; the attribute, consciousness, has miraculously got
rid of its substance, and then with a wonderful assurance as-
sumed the office of observing and passing judgment upon its
nature from a higher region of being. Descartes was in this
case the clever architect; and his success has fully justified ©
his art: while the metaphysical stage of human development
lasts, his work will doubtless endure. ‘
That the subjective mnethod—the method of interrogating self-
consciousness—is not adequate to the construction of a true
mental science, has now seemingly been sufficiently established,
This is not to say that it is worthless; for when not strained
beyond its capabilities, its results may, in the hands of competent
men, be very useful. D’Alembert compares Locke to Newton, and
makes it a special praise to him that he was content to descend
within, and that, after having contemplated himself for a long
while, he presented in his “ Essay’’ the mirror in which he had
seen himself; “in a word, he reduced psychology to that which
it should be, the experimental physics of the mind.” But it was
not because of this method, but in spite of it, that Locke was
greatly successful ; it was because he possessed a powerful and
well-balanced mind, the direct utterances of which he sincerely
expressed, that the results which he obtained, in whatever
nomenclature they may be clothed, are and always will be valu-
able; they are the self-revelations of an excellently constituted
and well-trained mind. The insufficiency of the method used is
proved by the fact that others adopting it, but wanting his sound
sense, directly contradicted him at the time, and do so still.
Furthermore, Locke did not confine himself to the interrogation
of his own consciousness ; for he introduced the practice—for
which Cousin was so angry with him—of referring to savages
and children. And we may take leave to suggest that the most
valuable part of Locke’s psychology, that which has been a
lasting addition to knowledge, really was the result of the
1.] THE STUDY OF MIND. 27

employment of the inductive or rather objective method.* Nay
more: if any one will be at the pains to examine into the history
of the development of psychology up to its present stage, he may
be surprised to find how much the important acquisitions of new
truth and the corrections of old errors have been due, not to the
interrogation of self-consciousness, but to external observation,
though it was not recognised as a systematic method. The past
history of psychology—its instinctive progress, so to speak—no
less than the consideration of its present state, proves the
necessity of admitting the objective method.

That which a just reflection incontestably teaches, the present
state of physiology practically illustrates. Though very im-
perfect as a science, physiology is still sufficiently advanced to
prove that no psychology can endure except it be based upon its
investigations. Let it not, moreover, be forgotten, as it is so apt
to be, that the divisions in our knowledge are artificial; that
they should be accepted, and used rather, as Bacon says, “for
lines to mark or distinguish, than sections to divide and separate;
in order that solution of continuity in sciences may always be
avoided.”t Not the smallest atom that floats in the sunbeam,
nor the minutest molecule that vibrates within the microcosm of
an organic cell, but is bound as a part of the mysterious whole in
an inextricable harmony with the laws by which planets move in
their appointed orbits, or with the laws which govern the mar-
vellous creations of godlike genius. Above all things it is now
necessary that the absolute and unholy barrier set up between
psychical and physical nature be broken down, and that a just
conception of mind be formed, founded on a faithful recognition
of all those phenomena of nature which lead by imperceptible
gradations up to this its highest evolution. Happily the beneficial
change is being gradually effected, and ignorant prejudice or
offended self-love in vain opposes a progress in knowledge which
reflects the course of progress in nature: the stars in their
courses fight for such truth, and its angry adversary might as
well hope to blow out with his pernicious breath the all-inspiring
light of the sun as to extinguish its ever-waxing splendour.

No one pretends that physiology can, for many years to come,

* Psychology cannot, in fact, be truly inductive unless it is studied objec-
tively. + De Augmentis Scientiarum, B. iv.
28 ON THE METHOD OF [cuap.

furnish the complete data of a positive mental science: all that
it can at present do is to overthrow the data of a false psychology.
It is easy, no doubt, for any one to point to the completeness of
our ignorance, and to maintain that physiology never will securely
fix the foundations of a mental science, just as it was easy to say,
before the invention of the telescope, that the ways of the planets
could never be traced and calculated. The confident dogmatist
in this matter might well learn caution from an instructive
example of the rash error of a greater philosopher than he can
claim or hope to be:—“TIt is the absurdity of these opinions,”
said Bacon, “that has driven men to the diurnal motion of the
earth ; which, I am convinced, is most false.” * What should fairly
and honestly be weighed is, that mind is the last, the highest, the
cousummate evolution of nature’s development, and that, there-
fore, it must be the last, the most complex, and most difficult
object of human study. There are really no grounds for ex-
pecting a positive science of mind at present; for to its estab-
lishment the completion of the other sciences is necessary ; and,
as is well known, it is ‘only lately that the metaphysical spirit
has been got rid of in astronomy, physics, and chemistry, and
that these sciences, after more than two thousand years of idle
and shifting fancies, have attained to certain principles. Still
more recently has physiology emerged from the fog, and this
for obvious reasons: in the first place it is absolutely dependent
upon the physical and chemical sciences, and must, therefore,
wait for the progress of them ;"and, in the second place, its close
relations to psychology have tended to keep it the victim of the
metaphysical spirit. That, therefore, which should be in this
matter is that which is; and instead of being a cause of despair,
is a ground of hope.

But let it not be forgotten that the physiological method deals
only with one (I.) division of the matter to which the objective
method is to be applied; there are other divisions not. less
valuable :—

II. The study of the plan of development of mind, as exhibited
in the animal, the barbarian, and the infant, furnishes results of
the greatest value, and is as essential to a true mental science as
the study of its development confessedly is to a full knowledge

* De Augmentis Scientiarum, B. iii,
1] THE STUDY OF MIND. 29

of the bodily organism. By that means we get at the deep and
true telations of phenomena, and are enabled to correct the
erroneous inferences of a superficial observation; by examination
of the barbarian, for example, we eliminate the hypocrisy which
is the result of the social condition, and which is apt to mislead
us in the civilized individual.

IIT. The study of the degeneration of mind, as exhibited in the
different forms of idiccy and insanity, is indispensable as it is
invaluable. So we avail ourselves of the experiments provided
by nature, and bring our generalizations to a most searching test.
Hitherto the phenomena of insanity have been entirely ignored
by psychologists and most grievously misinterpreted by the vul-
gar, because interpreted by the false conclusions of a subjective
psychology. Had not the revelations of consciousness in dreams
and in delirium been constantly neglected by the professed in-
ductive psychologists, truer generalizations must perforce have
been formed ere this, and fewer irresponsible lunatics would have
been executed as responsible criminals. Why those who put so
much faith in the subjective method do reject such a large and
important collection of instances as dreams and madmen furnish,
they have never thought proper to explain.

IV. The study of biography and of autobiography, which has
already been described as the application of positive science to
human life, will plainly afford essential aid in the formation of a
positive science of mind. Thus we trace the development of
the mind in the individual as affected by hereditary influences,
education, and the circumstances of life. Concerning auto-
biographies, however, it will not be amiss to bear in mind an
observation made by Feuchtersleben, that “they are only of
value to the competent judge, because we must see in them not
so much what they relate as what, by their manner of relation,
is undesignedly betrayed.”

V. The study of the progress or regress of the human mind,
as exhibited in history, most difficult as the task is, cannot be
neglected by one who wishes to be thoroughly equipped for the
arduous work of constructing a positive mental science. The
unhappy tendencies which lead to individual error and degene-
ration are those which on a national scale conduct peoples to
destruction; and the nisus of an epoch is summed up in the
30 ON THE METHOD OF [cHap.,

biography of its great man.* Freed from the many disturbing
conditions which interfere so much with his observation of the
individual, the philosopher may perhaps discover in history the
laws of human progress in their generality and simplicity, as
Newton discovered, in the motions of the heavenly bodies, the
law which he would in vain have looked for had he watched the
fall of every apple in Europe. Moreover, in the language,
literature, art, and the political, social and religious institutions
of men, there are important materials for the construction of a
science of mind.

May we not then truly say that he only is the true psycho-
logist who, occupied with the observation of the whole of human
nature, avails himself not alone of every means which science
affords for the investigation of the bodily conditions which
assuredly underlie every display of function, conscious or uncon-
scious, but also of every help, subjective or objective, which
is furnished by the mental manifestations of animal and of
man, whether undeveloped, degenerate, or cultivated? Here,
as everywhere else in nature, the student must deliberately
apply himself to a close communion with the external, must
intend his mind to the realities which surround him, and thus,
by patient internal adjustment to outward relations, gradually
evolve into conscious development those inner truths which are
the unavoidable expressions of the harmony between himself
and nature. By diligent colligation of facts, patient observation
of their relations, and careful consilience of inductions, he will
attain to sound generalizations in this as in other departments
of nature; in no other way can he do so. Of old it was the
fashion to try to explain nature from a very incomplete know-
ledge of man; but it is the certain tendency of advancing
science to explain man on the basis of a perfecting knowledge
of nature.

Having fairly admitted a method, it behoves us to take heed
that we are not too exclusive in its application, To this there is
a strong inclination : even in the investigation of physical nature
men now frequently write of induction as Bacon himself never

* “When nature has work to be done,” says Emerson, ‘‘she creates a genius

todo it. Follow the great man, and you shall see what the world has at heart in
these ages, There is no omen like that.”
1] THE STUDY OF MIND. 31

wrote of it. It might seem, from the usual fashion of speech,
that the function of the mind was merely that of a polished and
passive mirror, in which natural phenomena should be allowed
simply to reflect themselves; whereas every state of conscious-
ness is a developmental result of the relation between mind and
the impression, of the subject and object. What Bacon strove
so earnestly to abolish was that method of systematically looking
into the mind and, by torture of self-consciousness, drawing
thence empty ideas, as the spider forms a web out of its own
substance,—that ill-starred divorce between mind and nature
which had been cultivated by the Schoolmen ag a method.
What he wished, on the other hand, to establish was a happy
marriage between mind and matter, between subject and object,
to prevent the “ mind being withdrawn from things farther than
was necessary to bring into a harmonious conjunction the ideas
and the impressions made upon the senses.” * For, as he says,

* “Nos vero intellectum longius 4 rebus non abstrahimus quam ut rerum
imagines et radii (utin sensu fit) coire possint.” (Proleg. Instaurat. Magn.) This
passage, as usually rendered, is not intelligible; the translation in the text, if not
literally exact, evidently, as the context proves, expresses Bacon’s true meaning.
He had objected to all before him that some had wrongly regarded the sense as
the measure of things, while others, equally wrongly, ‘‘after having only a little
while turned their eyes upon things, and instances, and experience, then straight-
way, as if invention were nothing more than a certain process of excogitation,
have fallen, as it were, to invoke their own spirits to utter oracles to them. But
we,” he goes on, “modestly and perseveringly keeping ourselves conversant among
things, never withdraw our understanding,” &c. Mr. Spedding, in his adinirable
edition of Bacon’s works, translates the passage thus :—‘‘I, on the contrary,
withdraw my intellect from them no further than may suffice to let the images
and rays of natural objects meet in a point, as they do in the sense of vision.”
According to this interpretation, —if there really is any meaning in it—the images
and rays of objects express the same thing. Mr. Wood’s translation, in Mr.
Montagu’s edition, is :—‘‘ We abstract our understanding no further from them
than is necessary to prevent the confusion of the images of things with their
radiation, a confusion similar to that we experience by our senses.” This is worse
still ; ut possint cotre means, certainly, ‘‘that they may come together,” not “that
they may not mingle or may be prevented from mingling.” After all, the 95th
Aphorism furnishes thejclearest and surest commentary on the passage—‘‘ Those
who have treated the sciences were either empirics or rationalists. The empirics,
like ants, only lay up stores and use them ; the rationalists, like spiders, spin
webs out of themselves; but the bee takes a middle course, gathering her
matter from the flowers of the field and garden, and digesting and preparing it
by her native powers. In like manner, that is the true office and work of philo-
sophy which, not trusting too much to the faculties of the mind, does not lay
up the matter, afforded by natural history and mechanical experience, entire or
unfashioned in the memory, but treasures it after being first elaborated and
32 ON THE METHOD OF | CHAP.

the testimony and information of the senses have reference
always to man, not to the universe; and it is a great error to
assert that the sense is the measure of things. But by his
method of effecting, as completely as possible, a reconciliation
between the subjective and objective, he hoped to have “estab-
lished for ever a true and lawful marriage between the empirical
and the rational faculty, the unkind and ill-starred divorce and
separation of which has thrown into confusion all the affairs of
the human family.” The mind that is in harmony with the laws
of nature, in an intimate sympathy with the course of events,
is strong with the strength of nature, and is developed by
its force.

A contemplation of the earliest stages of human development,
as exhibited by the savages, certainly constrains the admission
that the conscious or designed co-operation of the mind in the
adaptation of man to external nature was not great. The fact
is, however, in exact conformity with what has already been
asserted with regard to the nature and domain of consciousness ;
assuredly it is not consciousness, the natural result of a due
development, which gives the impulse to development; this
coming from a source that is past finding out—from the primeval
central Power which hurled the planets on their courses, and
holds the lasting orbs of heaven in their just poise and move-
ment. In virtue of the fundamental impulse of its being,
mankind struggles, at first blindly, towards a knowledge of and
adaptation to external nature, until that which has been insen-
sibly acquired through generations becomes an inborn addition
to the power of the mind, and that which was unconsciously :
done becomes conscious method. ,

It were well, then, that this idea took deep and firm root

digested in the understanding. And, therefore, we have a good ground of hope,
from the close and strict union of the experimental and rational faculty, which
have not hitherto been united.” In the very place where the obscure passage
occurs, he says, after speaking of the inauspicious divorce usually made between
mind and nature—“The explanation of which things, and of the true relation
between the nature of things and the nature of the mind, is as the strewing
and decoration of the bridal chamber of the Mind and Universe, the Divine
Goodness assisting ; out of which marriage let us hope (and this be the prayer
of the bridal song) there may spring helps to man, and a line and race of

inventions that may in some degree subdue and overcome the necessities and
miseries of humanity.”
1] THE STUDY OF MIND. 33

in our thoughts: that the development of mind, both in the
individual and through generations, is a gradual process of orga-
nization—a process in which Nature is undergoing her latest
and most consummate development. In reality we do not fail
virtually to recognise this in the case of language, whose organic
growth, as we scientifically trace it, is the result of the unseen
organization of thought that lies beneath, and alone gives it
meaning. His own consciousness, faithfully interpreted, might
suffice to reveal to each one the gradual maturing, or becoming,
through which a process of thought continually goes in his
mind. So has it been with mankind: at first there was an
instinctive or pure organic development, the human race strug-
gling on, as the child does, without being conscious of its ego ;
then, as it reached a certain stage of development, it became, as
the youth does, exceedingly self-conscious, and an extravagant
and unhealthy metaphysical subjectivity was the expression of
an undue self-feeling; and finally, as the happily developing
individual passes from an undue subjectivity to a calm objective
manner of viewing things, so Bacon may be said to mark the
epoch of a corresponding happy change in the development of
mankind. Let us entirely get rid, however, of the notion that
the objective study of nature means merely the sensory per-
ception of it; we see, not with the eye, but through it; and to
any one who is above the level of the animal the sun is not a
bright disc of fire about the size of ‘a cheese, but an immense orb
moving through space with its attendant planetary system at
the rate of some 400,000 miles a day.* Now, such is the
wondrous harmony, connexion, and continuity pervading that
mysterious whole which we call Nature, that it is impossible to
get a just and clear idea of one pure circle of her works without
that idea becoming most useful in flashing a light into obscure
and unknown regions, and in thus aiding the conscious estab-
lishment of a further harmony of adaptation between man and
nature.t The brilliant insight or intuition of the man of genius,

_ * “Weare deluded and led by the fallacies of the senses, for instance, to believe
that it is the eye that sees, and the ear that hears ; although the eye and the ear
are only the organs or instruments through which the soul perceives the modes
of the ultimate world.”—SwEDENBoRG, Animal Kingdom, ii. 336.
+ “Denn wo Natur im reinen Kreise waltet ergreifen alle Welten sich.”—
Gorrun, Faust.
D
34 ON THE METHOD OF [cHap,

who so often anticipates the slow result of systematic investi-
gation, witnesses with singular force to that truth. Far Wiser
than many of his commentators have been, Bacon accordingly
failed not to appreciate clearly the exceeding value of idea in
the interpretation of nature.

But if the due co-operation of the mind is necessary, if the
harmony of subjective and objective was Bacon’s real method, in
the prosecution of physical science, how much more useful must
the just union of the empirical and rational faculties be in the
study of mental science; the task then being to apply the ideas
of the mind to the interpretation of the mind’s processes of
activity. It must assuredly be allowed that the light of one’s
own train of thought is often most serviceable in interpreting the
mind of another ;so much so, indeed, that one may know what
is passing therein with not less certainty, sometimes even with
greater certainty, than when it is actually uttered. In order to
be successful in this sort of intuition, however, not only good
natural insight, but a large experience of life and men, is most
necessary, else the most grievous mistakes may be made; here,
as elsewhere, power is acquired by intending the mind to external
realities, by submitting the understanding to things. Plainly,
too, this objective application of our ideas to the interpretation
of another mind is a very different matter from the deliberate
direction of consciousness to its own states,—that introspective
analysis of the processes of thought whereby, as before said, the
natural train of ideas being interrupted and the tension of a
particular activity maintained, an artificial state of mind is pro-
duced, and a tortured self-consciousness, like an individual put
to the torture, makes confessions that are utterly unreliable. The
genuine utterances of his inner life, or the sincere and direct
revelations of the man of great natural ability and good training,
are the highest truths—what Plato has written is of eternal
interest ; but the contradictory anatomical revelations of internal
analysis by the professed psychologists are the vainest word
jugglings with which a tenacious perseverance has vexed a long-
suffering world. They should justly be opposed, as by Bacon ;
or shunned, as by Shakespeare ; or abhorred, as by Goethe :—
“Ich habe nie an Denken gedacht.” As in the child there is
no consciousness of the ego, so in the highest development of
1] THE STUDY OF MIND. 35

humanity, as represented by these our greatest, there seems to
have been reached a similar unconsciousness of the ego; and the
individual, in intimate and congenial sympathy with nature,
carries forward its organic evolution with a child-like uncon-
sciousness and a child-like success.

Before concluding this chapter it may be well distinctly to
affirm a truth which is an unwelcome one, because it flatters not
the self-love of mankind; and it is this, that there is all the
difference in the world between the gifted man of genius, who"
can often anticipate the slow results of systematic investigation,
and who strikes out new paths, and the common herd of mortals,
who must plod on with patient humility in the old tracks, “with
manifold motions making little speed:” it is the difference
between the butterfly which flies and feeds on honey and the
caterpillar which crawls and gorges on leaves. Men, ever eager

o “pare the mountain to the plain,” will not willingly confess
this; nevertheless it is most true. Rules and systems are
necessary for the ordinarily endowed mortals, whose business it
is to gather together and arrange the materials ; the genius, who
is the architect, has, like nature, an unconscious system of his
own. It is the fate of its nature, and no demerit, that the cater-
pillar must crawl: it is the fate of its nature, and no merit, that
the butterfly must fly. The question, so much disputed, of the
relative extent of applicability of the so-called inductive and
deductive methods, often resolves itself into a question as to
what manner of man it is who is to use them—whether one who
has senses only, who has eyes and sees not, or one who has senses
and a soul; whether one who can only collect so-called facts of
observation, or one who can bind together the thousand scattered
facts by the organizing idea, and thus guarantee them to be facts.
‘What an offence to the chartered imbecility of industrious medio-
crity that Plato, Shakespeare, Goethe, Humboldt, Bacon too, and,
in truth, every man who had anything of inspiration in him,
were not mere sense-machines for registering observations, but
rather instruments on which the melody of nature, like sphere
music, was made for the benefit and delectation of such as have
ears to hear! That some so virulently declaim against theory is
as though the eunuch should declaim against lechery: it is the

chastity of impotence.
D2
36 ON THE METHOD OF [cuap,

So rarely, however, does nature produce one of thése men
gifted with that high and subtile quality called genius—being
scarce, indeed, equal to the production of one in a century—and
so self-sufficing are they when they do appear, that we, gratefully
accepting them as visits of angels, or much as Plato accepted
his super-celestial ideas, need not vainly concern ourselves about
their manner of working. It is not by such anxious troubling
that one will come; it is not by introspective prying into and
torture of its own self-consciousness that mankind evolves the
genius; the mature result of its unconscious development flows
at due time into consciousness with a grateful surprise, and from
time to time the slumbering centuries are thus awakened. It is
by the patient and diligent work at systematic adaptation to the
external by the rank and file of mankind; it is by the conscien-
tious labour of each one, after the inductive method, in that little
sphere of nature, whether psychical or physical, which in the
necessary division of labour has fallen to his lot—that a con-
dition of evolution is reached at which the genius bursts forth,
Tiresome, then, as the minute man of observation may sometimes
seem as he exults over his scattered facts as if they were final,
and magnifies his molecules into mountains as if they were
eternal, it is well that he should thus enthusiastically esteem his
-work ; and no one but will give a patient attention as he reflects
how indispensable the humblest unit is in the social organism,
and how excellent a spur vanity is to industry. Not unamusing,
though somewhat saddening, is it, however, to witness the painful
surprise of the man of observation, his jealous indignation and
clamorous outcry, when the result at which he and his fellow-
labourers have been so patiently, though blindly, working— :
when the genius-product of the century which he has helped to
create, starts into life—when the metamorphosis is completed:
amusing, because the patient worker is supremely astonished at
a result which, though preparing, he nowise foresaw ; saddening,
because individually he is annihilated, and all the toil in which
he spent his strength is swallowed up in the product which,
gathering up the different lines of investigation and thought, and
giving to them a unity of development, now by epigenesis ensues.
We perceive, then, how it is that a great genius cannot come save
at long intervals, as the tree cannot blossom but at its due season.
1] THE STUDY OF MIND. 37

But why should any one, great or little, fret and fume because
he is likely soon to be forgotten? The genius himself, as indi-
vidual, is after all of but little account ; it is only as the birth of
the travailing centuries that he exists, only so far as he is a true
birth of them and adequately representative that he is of value:
the more individual he is the more transitory will be his fame.
When he is immortal, he has become a mere name marking an
epoch, and no longer an individual. "Whosoever, in a foolish
conceit of originality, strains after novelty and neglects the
scattered and perhaps obscure labours of others who have pre-
ceded him, or who are contemporaneous with him ; whosoever,
over-careful of his individual fame, cannot carry forward. his
own evolution with a serene indifference to neglect or censure,
but makes puerile demands on the approbation of the world—
may rest content that he is not a complete birth of the age, but
more or less an abortive monstrosity: the more extreme he is as
a monstrosity the more original must he needs be.*

Viewing mental development, whether in the individual or in
the race, as a process of organization, as the consummate display
of nature’s organic evolution, and recognising, as we must do,
the most favourable conditions of such evolution to be the most
intimate harmony between man and nature, we may rightly
conclude, so far as concerns the rule of a conscious method of.
inquiry, with the ancient and well-grounded maxim— Learn to
know thyself in nature, that so thou mayest know nature in
thyself.”()

NOTES.

1 (p. 4).—“Insomuch that many times not only what was asserted
once is asserted still, but what was a question once is a question still,
and instead of being resolved by discussion, is only fixed and fed.”—
Bacon, Proleg. Inst. Magn.

2 (p. 10).—The received psychology M. Comte calls an “illusory
psychology, which is the last phase of theology,” and says that it

* « What is all history but the work of ideas,” says Emerson, “‘a record of the
indisputable energy which his infinite aspirations infuse into man? Has any
grand and lasting thing been done? Who did it? Plainly not one man, but all
‘men: it was the prevalence of, and inundation of an idea.”
38 ON THE METHOD OF [cwap,

“ pretends to accomplish the discovery of the laws of the human mind
by contemplating it in itself ; that is, by separating it from causes and
effects.” (Miss Martineau’s Translation, p. 11.) Again, he says: “In
order to observe, your intellect must pause from activity; yet it is this
very activity that you want to observe. If you cannot effect the pause,
you cannot observe; if you do effect it, there is nothing to observe.
The results of such a method are in proportion to its absurdity.”
(Ibid. p. 11.)

3 (p, 12).— But the truth is, that they are not the highest in-
stances which give the best or securest information, as is expressed,
not inelegantly, in the common story of the philosopher, who, while
he gazed upon the stars, fell into the water; for if he had looked
down, he might have seen the stars in the water, but, looking aloft, he
could not see the water in the stars.” —De Augment. Scient. B. ii.

* (p. 14).—Individual Psychology Bacon set down as wanting ; he
euforces its study, “so that we may have a scientific and accurate dis-
section of mind and characters, and the secret dispositions of particular
men may be revealed, and that from the knowledge thereof better
rules may be framed for the treatment of the mind.”—De Augment.
Scient. B. vii.

5 (p. 23).—“ It is to be regretted that he (Dugald Stewart) had not
studied (he even treats it as inconceivable) the Leibnitzian doctrine of
what has not been well denominated obscure perceptions or tdeas—that
is, acts and affections of mind, which, manifesting their existence in
their effects, are themselves out of consciousness or apperception. The
fact of such latent modifications is now established beyond all rational
doubt; and on the supposition of their reality, we are able to solve
various psychological phenomena otherwise inexplicable. Among
these are many of those attributed to habit.” (Sir W. Hamilton, in
his edition of Reid, p. 551.)

“Ich sehe nicht,” says Leibnitz, “dass die Cartesianer jemals
beweisen haben oder beweisen kénnen, dass jede Vorstellung von
Rewusstsein begleitet ist.” And again :—“ Darin namlich haben die
Cartesianer sehr gefehlt, dass sie die Vorstellungen, deren man sich
nicht bewusst ist, fiir nichts rechneten. Das war auch der Grund,
warum sie glaubten, dass nur die Geiste Monaden waren, und dass
es keine Seelen der Thiere oder andere Entelechien gebe.”—Leibnitz
als Denker. Auswahl seiner kleinern Aufsdtze. By G. Schelling.
Pp. 108 and 115.

Fichte, in his Bestimmung des Menschen—“ In jedem Momente ihrer
Dauer ist die Natur ein zusammenhingendes Ganze; in jedem Momente
1.] THE STUDY OF MIND. 89

muss jeder einzelne Theil derselbe so sein wie er ist, weil alle tibrigen
sind wie sie sind ; und du kénntest kein Sandkdrnchen von seiner
Stelle verriicken, ohne dadurch vielleicht alle Theile des unermesslichen
Ganzen hindurch etwas zu veriindern. Aber jeder Moment dieser
Dauer ist bestimmt ‘durch alle abgelaufenen Momente, und wird
bestimmen alle kiinftigen Momente, und du kannst in dem gegen-
wartigen keines Sandkirne Lage anders denken als sie ist, ohne dass
du gendthigt wiirdest die ganze Vergangenheit ins Unbestimmte
hinauf, und die ganze Zukunft ins Unbestimmte herab dir anders zu
denken.”—Stimmtliche Werke, ii. 178.

It is only right to add, that the fullest exposition of unconscious
mental action is to be found in Beneke’s works. A summary of his
views is contained in his Lehrbuch der Psychologie als Naturwissenschaft.

6 (p. 37).—Since this chapter was written, and, indeed, separately
published, Mr. J. S. Mill has made a powerful defence of the so-called
Psychological Method. In his criticism of Comte in the Westminster
Review for April 1865, and in his “ Examination of Sir W. Hamilton’s
Philosophy,” he has said all that can be said in favour of the Psycho-
logical Method, and has done what could be done to disparage the
Physiological Method. This he had already done many years ago in
the second volume of his “System of Logic,” and he is now only
consistent in returning to the charge. Nevertheless, the admirers of
Mr. Mill may well experience regret to see him serving with so
much zeal on what is a so desperately forlorn hope. Physiology seems
never to have been a favourite study with Mr. Mill—in none of his
writings does he exhibit any indications of being really acquainted
with it; for itis hardly possible to conceive that any one having a
knowledge of the present state of this science, would disparage it as
he has done, and exalt so highly the psychological method of investi-
gating mental phenomena. The wonder is, however, that he who has
done so much to expound the system of Comte, and to strengthen
and complete it, should on this question take leave of it entirely, and
follow and laud a method of research which is so directly opposed to
the method of positive science. Of course, I speak now strictly of the
method, not of Comte’s application of it in his unfounded phreno-
logical speculations, which are scarcely less wild and absurd than his
religious delirium appears to be. However, though one may suspect
Mr. Mill to be unfortunate in his ignorance, or entirely mistaken in
his estimate, of the physiological method, one cannot fail to profit by
the study of his arguments on behalf of the psychological method,
and by his exposition of its merits. By parading the whole force
40 ON ?THE METHOD OF THE STUDY OF MIND.

of the reasons in favour of it, he has exhibited, not so much its
‘strength as its weakness, and has undesignedly given important
assistance to the physiological method. For the reasons why he has
not been convincing, and why this chapter has been left unmodified,
I may refer to the arguments set forth in a review of his “ Examina-
tion of Sir W. Hamilton’s Philosophy” in the Journal of Mental
Science for January 1866. “Mr. Mill,” it is there said, “has a high
opinion of the psychological method of inquiry into mental phenomena,
and thinks Comte to have committed a great error in discarding it,
Whether that be true or not is not the question now; we may admit
it to be true, and still ask whether it is a sufficient reason for ignoring
those important results of the physiological method of research which
bear vitally on psychology ; whether, in fact, because a certain method
has some worth, it can therefore afford to dispense entirely with the
aid furnished by other methods.”

And again :—“ The present complaint against Mr. Mill is that he
takes no notice of the effects of recent scientific conceptions on the
questions referred to philosophy ; that he goes on exactly as he might
have gone on if he had lived in the days of Aristotle ; that at a time
when a new method, highly fertile in fact and of more fruitful promise,
was available, he persists in trying to do, by the old method, what
Plato, Descartes, Locke, Berkeley, and a host of others have not done.
Now, we have not the slightest faith that ten thousand Mills will,
following the same method, do what these great men have not done;
but there can be no question that, had Mr. Mill chosen to avail
himself of the new material and the new method, which his great
predecessors had not in their day, he would have done what no other
living man could have done.”
CHAPTER II.

THE MIND AND THE NERVOUS SYSTEM.

“ That which perceives is a part of nature as truly as the objects of perception
which act on it, and, as a part of nature, is itself an object of investigation purely
physical. I+ is known to us only in the successive changes which constitute the
variety of our feelings : but the regular sequence of these changes admits of being
traced, like the regularity which we are capable of discovering in the successive
changes of our bodily frame. There isa Physiology of the Mind, then, as there
is a Physiology of the Body—a science which examines the phenomena of our
spiritual part simply as phenomena, and from the order of their succession, or
other circumstances of analogy, arranges them in classes, under certain general
names; as, in the physiology of our corporeal part, we consider the phenomena
of a different kind which the body exhibits, and reduce all the diversities of
these under the names of a few general functions.”—Sketch of a System of
Philosophy of the Human Mind, by T. Brown, M.D.

CREE crude proposition of Cabanis,* that the brain secretes
thought as the liver secretes bile, has been a subject of much
ridicule to those who have not received it with outcries of dis-
approbation and disgust. Assuredly it is not an exact expression
of the facts; one may rightly admit the brain to be the principal
organ of the mind, without accepting the fallacious comparison
of mental action with biliary secretion. Here as elsewhere, con-
fusion is bred by the common use of the word “ secretion” to
express, not only the functional process but the secreted product,
both the insensible vital changes and the tangible results of
them. It is of great importance to try to fix, with as much
precision as possible, what we mean by mind. ;

In the first place, mind, viewed in its scientific sense as a
natural force, cannot be observed and handled and dealt with
as a palpable object.; like electricity, or gravity, or any other

* “Nous concluons avec Ja méme certitude que le cerveau digére en quelque
sort les impressions; qu’il fait organiquement la sécrétion dela pensée.”—Rapport
du Physique et du Moral de? Homme, par P. J. G. Cabanis. ;
42 THE MIND [cHap.

of the natural forces, it is appreciable only in the changes of
matter which are the conditions of its manifestation. Few, if
any, will now be found to deny that with each display of mental
power there are correlative changes in the material substratum ;
that every phenomenon of mind is the result, as manifest energy,
of some change, molecular, chemical, or vital, in the nervous
elements of the brain. Chemical analysis of the so-called extrac-
tives of nerve testifies to definite change or “waste” through
functional activity ; for there are found, as products of a retro-
grade metamorphosis, lactic acid, kreatin, uric acid, probably also
hypoxanthin, and, representing the fatty acids, formic and acetic
acids, These products are very like those which are found in
muscle after its functional activity: in the performance of an
idea, as in the performance of a movement, there is a retrograde
metamorphosis of organic element; the display of energy is at
the cost of the highly-organized matter, which undergoes degene-
ration or passes from a higher to a lower grade of being; and
the retrograde products are, so far as is at present known, very
similar in muscle and nerve. While the contents of nerves,
again, are neutral during rest in the living state, they become
acid after death, and after great activity during life: the same is
the case also with regard to muscle. Furthermore, after pro-
longed mental exercise, the products of the metamorphosis of
nerve element, into the composition of which phosphorus enters
largely, are recognised in an increase of phosphates in the urine;
while it is only by supposing an idea to be accompanied by a
sorrelative change in the nerve-cells that we can explain the ex-
haustion following excessive mental work and the breaking down
of the brain in extreme cases. These things being so, what is it
which in a physiological sense we designate mind? Not the
material products of cerebral activity, but the marvellous energy
which cannot be grasped and handled. Here, then, is made
manifest a fallacy of the axiom propounded by Cabanis: it is
plain that the tangible results of the brain’s activity, the waste
matters which pass into the blood for assimilation by tissues of
a lower kind, and for ultimate excretion from the body, might
not less rightly be called the secretion of the brain, and be com-

pared to the bile, than the intangible energy revealed in the
mental phenomena,
11] AND THE NERVOUS SYSTEM. 43

Secondly, it is most needful, in order to avoid confusion, to
apprehend the exact signification of what is understood by mind,
according to the common and vague use of the word. It is
really a general term acquired by observation of and abstraction
from the manifold variety of mental phenomena: by such obser-
vation of the particular phenomena and appropriate abstraction
from them we get, as an ultimate generalization; the general
conception, or the, so to speak, essential idea, of mind. An
‘illustration will help to exhibit what we mean, The steam-
engine is a complicated mechanism, of the construction and
mode of action of which many people know very little, but it
has a very definite function of which those who know nothing
of its construction can still form a sufficiently distinct con-
ception ; the co-ordinate, integral action of the steam-engine, as
we conceive it, is different from the nicely-adjusted mechanism
or from the action of any part of it. But the function of the
engine is dependent on the mechanism and on the co-ordinate
action of its parts, cannot be dissociated from these, and has no
real existence apart from them, though it may exist separately
as a conception in our minds. By observation of the mechanism
and appropriate abstraction we get the essential idea of the
steam-engine,—a fundamental idea of it, which, as our ultimate
generalization, expresses its very nature as such, containing,
as Coleridge would have said, “the inmost principles of its
possibility as a steam-engine.” So likewise with regard to the
manifold phenomena of mind; by observation of them and
abstraction from the particular we get the general conception or
the essential idea of mind, an idea which has no more existence
out of the mind than any other abstract idea or general term.
In virtue, however, of that powerful tendency m the human
mind to make the reality conformable to the idea, a tendency
which has been at the bottom of so much confusion in philo-
sophy, this general conception has been converted into an objec-
tive entity, and allowed to tyrannize over the understanding.
A metaphysical abstraction has been made into a spiritual
entity, and a complete barrier thereby interposed in the way
of positive investigation. Whatever be the real nature of
mind—and of that there is no need to speak here—it is most
certainly dependent for its every manifestation on the brain
“4 THE MIND [cHap.

and nervous system ; and now that scientific research is daily
disclosing more clearly the relations between it and its organ, it
is plainly most desirable to guard against the common’ meta-
physical conception of mind, by recognising the true subjective
character of the conception and the mode of its origin and
‘growth.

A third important consideration is, that mental power is
truly an organized result, not, strictly speaking, built up, but
‘matured by insensible degrees in the course of life. The brain
is not, like the liver, the heart and other internal organs, capa-
ble from the time of birth of all the functions which it ever
discharges ; for while, in common with them, it has a certain
organic function to which it is born equal, its high special
character in man as the organ of conscious life, the supreme
instrument of his relations with the rest of nature, is developed
only by a long and patient education. Though the brain, then,
is formed during embryonic life, its highest development only
takes place after birth; and, as will hereafter appear, the same
gradual] progress from the general to the special, which is
exhibited in the development of the organ, is witnessed in the
development of our intelligence. How inexact and misleading
in this regard, therefore, is any comparison between it and
the liver!

Nevertheless, it must be distinctly laid down, that mental
action is as surely dependent on the nervous structure as the
function of the liver confessedly is on the hepatic structure:
that is the fundamental principle upon which the fabric of a
mental science must rest. The countless thousands of nerve-
cells which form so great a part of the delicate structure of the
brain, are undoubtedly the centres of its functional activity:
we know right well from experiment, that the ganglionic nerve-
cells scattered through the tissues of organs, as for example
through the walls of the intestines or the structure of the heart,
are centres of nerve force ministering to their organic action; and
we may confidently infer that the ganglionic cells of the brain,
which are not similarly amenable to observation and experi-
ment, have a like function. Certainly they are not inexhaustible
centres of self-generating force; they give out no more than
what they have in one way or another taken in; they receive
1.] AND THE NERVOUS SYSTEM. 45

material from the blood, which they assimilate, or make of the
same kind with themselves; a correlative metamorphosis of
force necessarily accompanying this upward transformation of
matter, and the nerve-cell thus becoming, so long as its equili-
brium is preserved, a centre of statical power of the highest
vital quality. The maintenance of the equilibrium of nerve
element is the condition of latent thought—it is mind statical ;
the manifestation of thought involves the change or destruction
of nerve element. The nerve-cell of the brain, it might in
fact be said, represents statical thought, while thought repre-
sents dynamical nerve-cell, or, more properly, the energy of
nerve-cell.

So far from discussing whether mind is the function of the
brain, the business which science now has. immediately be-
fore it is the more special investigation of the conditions of
activity of the ganglionic nerve-cell or groups of nerve-cells.
If we look to those humbler animals in which nervous tissue
wakes its first appearance, it is plain that the simple mode of
its existence in them allows of no other manner of proceeding ;
if we trace upwards the gradual increasing complication of the
nervous system through the animal kingdom, it is evident that
such manner of proceeding is the only one to furnish the
materials of a comprehensive and sound induction; and if we
duly weigh the results of physiological experiment and patho-
logical research, it is no less certain that we must discard
scientific investigation altogether in cerebral physiology, if we
reject the ganglionic nerve-cell of the brain as a centre of
mental force.

In the lowest forms of animal life nerve does not exist: the
Protozoa aud many of the Zoophytes are destitute of any trace
of nervous system. The most simple beings consist of a uniform,
homogeneous substance, by means of which all their functions
are executed. They are nourished without digestive organs ;
breathe without respiratory organs; feel and move without
organs of. sense, without muscles, without nervous system..
The stimulus which the little creature receives from without
produces some change in the molecular relations of its almost
homogeneous substance, and these insensible movements would
seem to amount collectively to the sensible movement which it
46 THE MIND [cuap,

makes; the molecular process in such case being not unlike
that which takes place and issues in the coagulation of
the blood, when the fibrine is brought in contact, as some
think, with a foreign substance.* The perception of the
stimulus by the creature is the molecular change which ensues,
the imperceptible motion passing, by reason of the homo-
geneity of its substance, with the greatest ease from element
to element of the same kind, as it were by an infection, or
as happens in the sensitive plant; and the sum of the mole-
cular motions, as necessarily determined in direction by the
form of the animal, or by some not yet recognised cause, results
in the visible movement. The recent researches of Graham into
the colloidal condition of matter have proved the necessity of
considerable modification in our usual conception of solid matter:
instead of the notion of impenetrable, inert matter, we must
substitute the idea of matter which, in its colloidal state, is
penetrable, exhibits energy, and is widely susceptible to external
agents, “its existence being a continued metastasis.” This sort
of energy is not a result of chemical action, for colloids are
singularly inert in all ordinary chemical relations, but a result
of its unknown intimate molecular constitution ; and the un-
doubted existence of colloidal energy in organic substances
which are usually considered inert and called dead, may well
warrant the belief of its larger and more essential operation in
organic matter, in the state of instability of composition in which
it is when under the condition of life. Such energy would
then suffice to account for the simple uniform movements of the
homogeneous substance of which the lowest animal consists;
and the absence of any differentiation of structure is a sufficient
reason of the absence of any localization of function and of the
general uniform reaction to different impressions. But it will
be observed that even the movements of these simplest crea-
tures, in which there is not the least indication of the ele-
ments of a nervous system, are not entirely vague, confused,
and indefinite; they present certain indications of adaptation
to functional ends, :

With the differentiation of tissue and increasing. complexity

* Croonian Lecture before the Royal Society, 1863. By Professor J. Lister,
F.R.S. + Philosophical Transactions, 1862.
11] AND THE NERVOUS SYSTEM. AZT

of organization, which are met with as we ascend in the animal
kingdom, the nervous tissue appears, but at first under a very
simple form. Its simplest type may be represented as two fibres
that are connected by a nerve-cell or a ganglionic group of nerve-
cells ; the fibres are apparently simple conductors, and might be
roughly compared to the conducting wires of a telegraph, while
the cell, being the centre in which nerve force is generated,
may be compared to the telegraphic apparatus ; in it the effect
which the stimulus of the afferent or centripetal nerve excites, is
transmitted along the efferent or centrifugal nerve, and therein
is displayed the simplest form of that reflex action which plays
so large a part in animal life.* This type of structure is re-
peated through the complex nervous system of all the higher
animals. Cut across the afferent nerve, or otherwise interrupt
its continuity, the impression cannot reach the centre ; cut across
the efferent nerve, the central excitation is powerless to influence
the muscles or parts to which it is distributed. Not all the passion
and eloquence of a Demosthenes couid force its way outwards into
words, if the motor nerves of the tongue were cut across. Owing
to the differences of kinds of tissue, and to the specialization of
organs in the more complex animal, there cannot plainly be that
intimate molecular sympathy between all parts which there is in
the homogeneous substance of the simplest monad ; the easy
motion, as by an infection, from particle to particle, is not possible
in the heterogeneous body, where the elements are of a different
kind: accordingly special provision is required for insuring
communication between different parts, and for co-ordinating
and harmonizing the activity of different organs. The animal

* The fibres act as simple conductors, and have like physiological properties,
Philippeau and Vulpian (Comptes Rendus, vi.) and Rosenthal (Centralblatt,
No. 29, 1864) have succeeded in uniting the central end of the cut lingual
nerve, the sensory nerve of the tongue, with the peripheral end of the cut hypo-
glossal, the motor nerve of the tongue. Stimulation of the central part of the
lingual produced contractions of the tongue, such as normally follow stimulation
of the hypoglossal. Thus it is proved that the end of a sensory nerve may be
united with the end of a motor nerve, and when the union is complete, excitation
of the sensory may be transmitted to the motor fibres. Inversely, stimulation
of the peripheral end of the hypoglossal produced evidence of pain. It would
seem that the neurility is the same in all nerves ; the difference of function being
due, not to difference of physiological properties, but to difference of connexion
of the fibres. Sce also Legons sur la Physiologie Générale, et comparée du Systéme
Nerveux, par A. Vulpian. 1866.
48 THE MIND [cHap.

must be rendered capable of associating a number of distinct
actions for definite ends. This function, necessitated by the
physiological division of labour, the nervous system subserves ;
and we might compare it to that which the gifted generalizer
fulfils in human development: he grasps the results of the
various special investigations which a necessary division of
labour enforces, brings them together, and elaborates a result
in which the different lines of thought are co-ordinated, and a
unity of action is marked out for future progress. The nervous
system effects the synthesis which the specialization of organic
instruments in the analysis of nature renders necessary ; it is
the highest expression of that principle of individuation which
is the characteristic feature of life in all its forms, but most
manifest in its highest. To this function it is well adapted,
first, by the extent of its distribution, and, secondly, by its
exceeding sensibility, whereby an impression made at one part
is almost instantly felt at any distance.

With the increasing complexity of organization, which marks
the increasing speciality of organic adaptation to external nature,
or, in other words, which marks an ascent in the scale of animal
life, there is a progressive complication of the nervous system:
special developments ministering to special purposes take place,
The fibres appear to preserve their characters as simple conduc-
tors, while a development of special structures at their peripheral,
and of special ganglionic cells at their central endings, reveals
the increasing speciality and complexity of function. Upon the
special structures at the peripheral ends, which are, as it were,
the instruments of analysis, depends the kind of the impression
made ; and by the nature of the nerve-cells with which the cen-
tral end of the nerve is connected, the kind of impression that
is perceived and the character of the reaction thereto are deter-
mined, Accordingly, we find that, with the appearances of the
organs of the special senses, as we mount in the scale of animal
life, there is a corresponding increase in the ganglionic centres,
which, being clustered together, form the primitive rudiments of
a brain, and represent, in the main, those sensory ganglia which
in man lie between the decussation of the pyramids and the
floors of the lateral ventricles. It is not known with certainty
when the different organs of the special senses severally make
1.] AND THE NERVOUS SYSTEM. 49

heir first appearance, for they are at first very rudimentary ; in
che starfish, which belongs to the humble Echinodermata, there
s at the extremity of each ray a small red spot which is said to
oresent the characteristics of a rudimentary eye; but whether
‘his be so or not, it is certain that special structures, adapted to
he reception of particular impressions, as of light, of sound,
f touch, render the higher animal capable of more numerous,
special, and complex relations with external nature. There is
\ diffusion through the entire substance of the simplest creatures
f physiological properties which are specialized and localized in
the higher animals,*

Not till we arrive as high as the fishes, and not then in the
‘ingular Amphioxus, do we discover anything more in the. brain
‘han sensory ganglia connected with the origins. of nerves ; so
ar there is no trace of cerebral hemispheres, or of brain proper.
-t is plain then that the cerebral hemispheres are not essential
0 sensation and the motor reaction to sensation; for they are
together wanting where both these functions are displayed in
\ lively and vigorous way. To the simpler relation between the
ndividual organism and external nature, which is denoted by
‘eflex action, there now succeeds that more complex relation
tf sensory perception and sensorimotor reaction, as Dr. Carpenter
ras called it; in place of reaction to a general stimulus, discri-
ninations of impressions, and corresponding special reactions
vy virtue of structures specially adapted, are witnessed. This
‘ondition of the development of the nervous system, which is

* When a special sense fails in man, the general sensibility may partially
eplace it. ‘‘I have known several instances,” says Abercrombie, ‘of persons
ffected with that extreme degree of deafness, which occurs in the deaf and dumb,
zho had a peculiar susceptibility to particular kinds of sounds, depending, appa-
ently, on an impression communicated to their organs of touch or simple sensa-
ion. They could tell, for instance, the approach of a carriage in the street
rithout seeing it, before it was taken notice of by persons who had the use of all
heir senses.”—On the Intellectual Powers, Kruse, who was completely deaf,
evertheless had a bodily feeling of: music ; and different instruments affected
im differently. Musical tones seemed to his perception to have much analogy
‘ith colours. The sound of a trumpet was yellow to him ; that of a drum, red;
hat of the organ, green ; &.—Early History of Mankind, by J. B. Tylor. In
is Reminiscences of the Opera, My. Lumley tells of a friend who used to compare
he voices of the different celebrated singers to different colours, distinguishing
hem so. It is an old saying of a blind man, that he thought scarlet was like the
ound of a trumpet. : a

= E
50 THE MIND © [cHaP.

natural and permanent in so many of the lower animals, cor-
responds to that artificial state of things which may be produced
experimentally in a higher animal by depriving it of its hemi-
spheres. The kind of function manifest is strictly comparable to
the early brief stage of the infant’s mental life before the cerebral
hemispheres have come into action, or to those phenomena of
mental life sometimes displayed by the adult, as for example
by the somnambulists, when the influence of the cerebral hemi-
spheres is suspended.

Here let us make a reflection: how important it is clearly to
distinguish and denote special features, which, being included.
under, or described by, a general term, are so commonly con-
founded. What different perceptions or reactions, for example,
are confounded by the loose way of using the word sensibility !
The infusorial animalcule, which has no nervous tissue, is said to be
sensible of a stimulus ; the higher animal, with its special senses,
to be sensible of light, or of sound, as the case may be; and, if
made to suffer, to be sensible of pain ; while itis common enough
to speak of man being sensible of pleasure, horror, or disgust,
according to the nature of the active ideas. If we use the generic
term sensibility to express the fundamental reaction, as we may
perhaps properly do, it is highly important that we proceed
further to distinguish by appropriate terms the special differences ;
the sensibility of pain is not the sensibility of sense, nor is the
sensibility of the infusorial animalcule equivalent to either of
these. So far we have taken pains to distinguish that form of
sensibility and reaction proper to the lowest animals, and which
might be called irritability; that form of reaction, or reflex
action, which is the lowest expression of nervous function ; and
that form of reaction to which the sensory ganglia minister, and
which is rightly called sensorial.

It is in fishes that the rudiments of cerebral hemispheres first
appear. In them they are represented by a thin layer or projec-
tion of nervous matter in front of the corpora quadrigemina,
covering the corpora striata and the optic thalami; in the
Amphibia, they have already increased somewhat in size ;* in
Birds, the corpora quadrigemina are pushed out to some extent

; * The Perenni-branchiate reptiles retain the fish character of brain all their
lives; the Batrachians have it only during their tadpole state.
1] AND THE NERVOUS SYSTEM. 51

oy their further increase ; in the Mammalia, they begin to cover
he corpora quadrigemina, and, as we ascend in the scale of life,
gradually increase backwards until, in some of the higher
nonkeys, and in man, they entirely cover the cerebellum.

In this ascent through the series of vertebrate animals, it is
ound that the relations of the sensory ganglia remain alike
shroughout, the chief differences being differences in the relative
size of them. Their functions, as primary constituents of the
grain, may then fairly be counted the same in all the vertebrata,
md indeed in all the animals in which they exist. As the
1emispheres appear as secondary constituents—secondary, be it
10ted, in the order of development, but primary in dignity—we
nay rightly conclude their function to be secondary to that which
ihe primary constituents or sensory ganglia fulfil, The impres-
sions received by the sensory centres, when they do not react
lirectly outwards, as they may do where hemispheres exist, and as
‘hey must do where hemispheres do not exist, are in fact passed
mwards in the brain to the cells which are spread over the
1emispheres, and there further fashioned into what are called
‘deas or conceptions. Here then we come to another kind of sen-
‘ibility, with its appropriate reaction, to which a special nervous
sentre ministers ; and it is known as perception, or, more strictly,
deational perception. As the hemispheres have this function,
ind are not necessary to sensory perception, it is quite in accord-
mce with what might be predicted, that, as experiments prove,
they are insensible to pain, and do not give rise to any display
f that kind of feeling when they are injured.* They have,
wwreeably to their special nature, a sensibility of their own to
he ideas that are fashioned in them ; so that these may be plea-
urable or painful, or have other particular emotional qualities.t

Observation of the mental phenomena of those animals in
vhich cerebral hemispheres exist, fully confirms the foregoing
‘ew of their function and import. In Fishes there is the first
listinct appearance of simple ideas, and of the lowest rudiments
f emotion ; carp will collect to be fed at the sound of a bell,

* An animal—a hen, for example—which makes violent movements while the
kin is being cut and the roof of its skull removed, remains quite quiet while its
emispheres are being sliced away bit by bit.

+ Emotion is strictly, perhaps, the sensibility of the supreme centres to ideas.

E2
32 THE MIND [cuap,

thus giving evidence of the association of two simple ideas ;
and a shark, suspicious of mischief, will avoid the baited hook.
In Birds, conformably to the increased development of the
hemispheres, the manifestations of intelligence are much greater ;
the tricks which some of them may be taught are truly marvel-
lous, and those who teach them know how much different birds
differ in intelligence and temper. Nor are simple emotional
exhibitions wanting amongst them ; very evident at times is the
feeling of rivalry or jealousy in canaries, and there are undoubted
instances on record in which an orphan bird has owed its life to
the kindly care of birds of a different species.* In Mammalia a
gradual advance in intelligence may be traced from very lowly
manifestations up to those highest forms of brute reason which
assuredly differ only in degree from the lowest forms of human
intelligence.t Consider how plainly, in the dog, a conception
often intervenes between the sensation and the usual respondent
movement, so that the animal refrains from doing what it has a
strong impulse to do; the impression has been passed on to the
hemispheres, and their controlling action brought into play. It
is needless to speak of the various emotions, nay, the veritable
moral feeling, displayed by the dog and other domesticated
animals, A single reflection will show, what anatomy might
lead us to predicate, how limited is the range of animal intelli-
gence: if the fox, cunning as it is, had but the sense to learn to
climb a tree, like the cat, men would soon give up hunting it,
But the fox, like so many men, cannot get out of the usual groove
of thought, cannot originate anything; and, like not a few
scheming plotters, it wastes a great deal of low cunning in
efforts which a little larger view of things would render quite
unnecessary.

As we ascend through the Mammalian series, we find that not
only do the hemispheres increase in size by gradually extending
backwards, but that the grey surface of them is further increased
by being thrown into folds or convolutions. While the lower
Mammals are entirely destitute of such convolutions, these are
present, as a rule, in simple forms in the Ruminantia and
, * Anatomie comparée du Systtme Nerveux, par Leuret et Gratiolet.

+ For examples of wonderful intelligence in different animals, I may refer to a
paper by me on the Genesis of Mind in the Journal of Mental-Science, 1862.
1] AND THE NERVOUS SYSTEM. 53

Pachydermata ; they are more fully developed in the Carnivora,
and most fully developed in the apes and in man. It is true
that we cannot at present unfold an exact relation between the
development of the convolutions and the degree of intelligence
in different animals; for the brains of the ass, the sheep, and
the ox are more convoluted than those of the beaver, the cat,
and the dog. But the relative size of the animals must be taken
into account in such comparison, The volume of a body such
as the brain, which increases in size, increases in greater propor-
tion than the supertficies, and the latter again in greater proportion
than the diameter. Now in each natural group or order of
Mammalia, the head, but especially the capacity of the skull,
has a certain relation to the body, a relation which remains
pretty constant in different species; the head of the tiger or
of the lion, for example, has about the same relation to the
body as that of the cat’s head to its body, although the sizes
of the animals are so different. It follows then that, the
volume of the brain of the tiger in relation to the size of the
body being the same as in the cat, the superficies of the brain
is proportionately greater in the smaller animal; and that,
consequently, in order to get a proportionate extent of grey
surface in the larger animal, this must be convoluted in it, when
it may remain nearly smooth in the smaller one. If in two
animals of equal size, and of like form of structure, the con-
volutions are differently fashioned, then it may be said with
certainty that one will be more intelligent than the other in
proportion as its convolutions are more numerous and com-
plicated, and the sulci deeper.

That proposition is true of man. The intellectual differences
which exist between the Bosjesman, or the Negro, and the
European are attended with differences in the extent and com-
plication of the nervous substance of the brain. Gratiolet has
carefully figured and described the brain of the Hottentot Venus,
who was no idiot; and what is at once striking in the figure is
the simplicity sont regular arrangement of the convolutions of the
frontal: lobe; they present an. almost perfect symmetry in the
two hamieshaiea: “such ag is never exhibited in the normal
brains of the Caucasian race,” and which involuntarily recalls
the regularity and symmetry of ‘the cerebral convolutions in the
54 THE MIND [cHap,

lower animals. The brain of this Bosjeswoman was, in truth,
inferior to that of a white woman arrived at the normal stage of
development: “it could be compared only with the brain of a
white who is idiotic from arrest of cerebral development.”
Moreover, the differences between it and the brain of the white
are unquestionably of the same kind as, though less in degree
than, those which exist between the ape’s brain and that of man,
as Professor Huxley has distinctly pointed out.* Mr. Marshall
has recently examined a Bushwoman’s brain, and has found like
evidence of structural inferiority; the primary convolutions,
though all present, were smaller than in the European, and much
less complicated ; the external connecting convolutions were still
more remarkably defective; the secondary sulci and convolu-
tions were everywhere decidedly less developed; there was a
deficiency of the system of transverse commissural fibres ; and in
size, and in every one of the signs of comparative inferiority, “ it
leaned, as it were, to the higher quadrumanous forms.” t The
brain of the Negro is superior to that of the Bushman, but still it
does not reach the levek of the white man’s brain; the weight of
the male Negro’s brain is less than that of the average European
female; and the greater symmetry of its convolutions, and the
narrowness of the hemispheres in front, are points in which it
resembles the brain of the ourang-outang, as even Tiedemann,
the Negro’s advocate, has admitted.

Among Europeans it is found that, other circumstances being
alike, the size of the brain bears a general relation to the mental
power of the individual, although apparent exceptions to the
rule sometimes occur. The average weight of the brain in the
educated class is certainly greater than in the uneducated; and
some carefully-compiled tables in a valuable paper by Dr.
Thurnam prove that, while the average brain weight of ordinary
Europeans is 49 oz. in distinguished men it is 54:6 oz{ On
the other hand, the brain is commonly very small in idiots;

* Man’s Place in Nature.

+ Philosophical Transactions, 1865.

+ On the Weight of the Human Brain, by John Thurnam, M.D. ; Journal of
Mental Science, April 1866. Professor Wagner has carefully figured and described
the brains of five very distinguished men. The extremely complex arrangement
of the convolutions was most remarkable.—The Convolutions of the Human
Cerebrum, by W. Turner, M.B, 1866.
u.] AND THE NERVOUS SYSTEM. 25

the parts being not only smaller, but less complex, and the con-
volutions in particular being simpler and less developed. Mr.
Marshall found the convolutions of the cerebra of the two idiots
which he examined to be fewer in number than in the apes, the
brains being in this respect more simple than the brain of the
gibbon, and approaching that of the baboon. In fact, there are
microcephalic idiots which present a complete series of stages of
descent. from man to the apes. As a general proposition, it is
certainly true that we find the evidence of a correspondence
between the development of the cerebral hemispheres and the
degree of intelligence, when we examine the different races or
kinds of men, as we do when we survey the scale of animal life.

As in the series of the manifold productions of her creative
art Nature has made no violent leap, but has passed by gentle
gradations from one species of animal to another, and from the
highest animal to the lowest man, it is not surprising that the
embryonic development of man should present indications of the
general plan.* It admits of no question that man does, in the
course of his development, pass through stages closely resembling
those through which other vertebrate animals pass; and that
these transitory conditions in. him are not unlike the forms that
are permanent in the lower animals. There is a very close mor-
phological resemblance between the human ovum and the lowest
animals with which we are acquainted, the microscopic Grega-
rinida;t in both, an outer membrane contains a soft semi-fluid

* «That there should be more species of intelligent beings above us,” says

Locke, ‘‘than there are of visible or material below us, is probable to me from
hence that in all the corporeal world we see no chasms or gaps.” But how
can it be safe to apply to the unseen a generalization from the seen ?
+ “The Gregarinida,” says Huxley, ‘are all microscopic, and any one of them,
leaving minor modifications aside, may be said to consist of a sac, comprised of a
more or less structureless, not very well defined membrane, containing a soft
semi-fluid substance, in the midst or at one end of which lies a delicate vesicle ;
in the centre of the latter is a more solid particle. No doubt many persons will
be struck with the close resemblance of the structure of this body to that which
is possessed by the ovum. You might take the more solid particle to be the
representative of the germinal spot, and the vesicle to be that of the germinal
vesicle ; while the semi-fluid sarcodic contents might be regarded as the yelk, and.
the outer membrane as the vitelline membrane. I do not wish to strain the
analogy too far, but it is at any rate interesting to observe the close morphological
resemblance between one of the lowest of animals, and that form in which all
the higher animals commence their existence.” —Lect. on Comp. Anat. 1864.
56 THE MIND [cuar.

substance, at one end of which is a delicate vesicle, having in it
a solid particle or spot. At the earliest stages of its develop-
ment no human power can distinguish the human ovum from
that of a quadruped; and, as it proceeds to its destined end,
it passes through similar stages to those through which other
vertebrate embryos pass. That which is true of the whole body
is true also of the development of the brain, The brain of the
human fcetus at the sixth week consists of a series of vesicles,
the foremost of which, a double one, representing the cerebrum,
is the smallest, and the hindmost, representing the cerebellum,
the largest. In front of the latter is the vesicle of the corpora
quadrigemina ; and in front again of this, the vesicle of the third
ventricle, which contains also the thalami optici, and which, as
development proceeds, becomes covered, as do the corpora quad-
rigemina, by the backward growth of the hemispheres in front of
it. At this stage the human brain resembles the fully-formed
brain of the fish, more closely the brain of the foetal fish, in the
small proportion which the cerebral hemispheres bear to the
other parts, in the absence of convolutions, in the deficiency of
commissures, and in the general simplicity of structure. About
the twelfth week of embryonic life there is a great resemblance
to the brain of the bird: the cerebral hemispheres are much
increased in size, and arch back towards the thalami optici and
the corpora quadrigemina, though there are still no convolutions,
and the commissures are very deficient. Up to this time the
cerebral hemispheres represent no more than the rudiments of
the anterior lobes; they do not yet completely cover the thalami
optici, nor indeed pass the grade of development which is per-
manent in the Marsupial Mammalia. During the fourth and
early part of the fifth month, the middle lobes develop back-
wards and cover the corpora quadrigemina; and, subsequently,
the posterior lobes sprout out, so to speak, and gradually extend
backwards so as to cover and overlap the cerebellum. It was
upon the erroneous assumption that the posterior lobes were
peculiar to man, that Professor Owen grounded his division of
the Archencephala ; but it has now been proved unquestionably
that the posterior lobes exist in the apes, and that in some of
them they extend as far back as they do in man. It is easy to
perceive, then, that an arrest of development of the human brain
11] AND THE NERVOUS SYSTEM. 57

may leave it very much in the condition of an animal brain;
and it is found in some cases, as a matter of fact, that congenital
idiots have brains very like those of the monkeys.

As man is thus a sort of compendium of animal nature,
paralleling nature, as Sir Thomas Browne has it, in the cosmo-
graphy of himself, all the different modes of nervous function
are exhibited in the workings of his organism. The so-called
irritability of tissue, whereby it reacts to a stimulus without the
help of nerve, may be of the same kind as that molecular energy
of matter manifest in the movements of the humblest animal :
whether the nerve ends outside the sarcolemma of muscle, or
within it, there can be no doubt that it is not distributed to
every part of the sarcous element; and, at any rate, when all
nervous influence is withdrawn, an energy still exists sufficient
to produce rigor mortis of the muscle.* The simplest mode of
nervous action in man, comparable to that of the lowest animals
that possess nerve, is exhibited by the scattered ganglionic cells
belonging to the sympathetic system, which are concerned in
certain organic processes. The heart’s action, for example, is
due to the ganglionic cells dispersed through its substance ;
Meissner has recently shown that nerve-cells disseminated
through the tissues of the intestines govern their motions; and
Lister thinks it probable that cells scattered’ in the tissues pre-
side over the contractions of the arteries, and even the remark-
able diffusion of the pigment granules which takes place in the
stellate cells of the frog’s skin. The separate elements of the
tissue are co-ordinated by the individual nerve-cells; and these
co-ordinating centres, again, are found to be under the control of
the cerebro-spinal centres. In the spinal cord the ganglionic
nerve-cells are collected together, and so united that groups of

* Tt has furthermore been recently maintained by Bilharz and Kiihne, that
the nerves pass by continuity into the muscular substance, as in the electric
organs of the fishes they pass continuously into the protoplasm of the electric
plates. The controversy respecting the manner in which nerves end in muscles
seems, then, likely to terminate in the conclusion that they do not end at all, but
pass by continuity of substance into the sarcous elements, The observations of
Kiihne and Rouget prove that the nerve fibre, reduced to its axis cylinder,
penetrates the sarcolemma, and is lost. The nervous filaments of insects cannot
sometimes be distinguished from the other elements by means of the microscope.
Pfliiger has discovered that the nerves to the glands penctrate the walls of the
cells, and, as he believes, end in the nuclei.
58 THE MIND [cuar.

them become independent centres of combined movements in
answer to stimuli; this arrangement representing the entire
nervous system of those animals in which no organs of special
sense have yet appeared. Still higher in the scale of the nervous
system, the sensory ganglia, formed of multitudes of specially
endowed cells, are clustered together, and form a very important
part of the brain of man, while in many animals, as already
seen, they constitute the whole of the brain. In the cerebral
hemispheres there is a still greater specialization of structure
with corresponding exaltation of function ; and, conformably to
its highest degree in man, there are in him the highest and the
most complex manifestations of mental function. In the human
organism, then, is summed up the animal kingdom, which
actually presents us with a sort of analysis of it; for in the
functions ‘of man we observe, as in a microcosm, an integration
and barmonious co-ordination of different vital actions which
are separately displayed by different members of the animal
kingdom.

In dealing with the function of the nervous system in man,
it is, then, most necessary to distinguish the different nervous
centres :—

1, There are the primary centres, or ideational centres, consti-
tuted by the grey matter of the convolutions of the hemispheres.

2. There are the secondary nervous centres, or sensory centres,
constituted by the collections of grey matter that lie between
the decussation of the pyramids and the floors of the lateral
ventricles.

3. There are the tertiary nervous centres, or centres of reflex
action, constituted mainly by the grey matter of the spinal cord.

4, There are the organic nervous centres, as we might call
them, belonging to the sympathetic system. They consist of
a set of ganglionic bodies distributed mainly over the viscera,
and connected with one another and with the spinal centres
by internuntiant cords.

Each distinct centre is subordinated to the centre immediately
above it, but is at the same time capable of determining and
maintaining certain movements of its own without the inter-
vention of its supreme centre. The organization is such that a
due independent local action is compatible with the proper
11.J AND THE NERVOUS SYSTEM. 59

control of a superior central authority. The ganglionic cell of
the sympathetic co-ordinates the energy of the separate ele-
ments of the tissue in which it is placed, and thus represents
the simplest form of a principle of individuation ;* through the
cells of the spinal centre the functions of the different organic
centres are so co-ordinated as to have their subordinate but
essential place in the movements of animal life—and herein
is witnessed a further and higher individuation; the spinal
centres are similarly controlled by the sensory centres, and
these, in their turn, are subordinate to the controlling action of
the cerebral hemispheres, and especially to the action of the
will, which, properly fashioned, represents the highest display
of the principle of individuation. The greater the subordina-
tion of parts in any animal, the higher and the more perfect it
is.| Were it not well if man in his social life could contrive to
imitate this excellent organization ?

Most important and varied functions having been assigned to
nerve-cells, it may be asked, On what evidence do the statements
rest? On the evidence of anatomical investigation, experiments
upon animals, and physiological and pathological researches.

(a) Anatomical Evidence.—It is certainly not possible to trace
every nerve fibre to its connexion with a cell, and till lately no
such connexion had been distinctly seen ; but it has now been
observed in many instances, and most investigators believe that
neither in the brain nor in the spinal cord does there exist an
isolated apolar nerve-cell; such, if supposed to be seen, being
in reality one which has had its processes torn away, or not
being a nerve-cell at all, but a connective tissue corpuscle.
This is an inference which has scarcely less certainty than an
observed fact; it is not necessary, as Goethe has said, to travel
round the world in order to feel sure that the heavens are
everywhere above it.

* Coleridge, in his “Hints towards the Formation of a comprehensive Theory
of Life,” takes from Schelling the definition—“ Life is the principle of Indi-
viduation.”

+ After speaking of an organisn as a collection of individual elements, Goethe
goes on to say :—“Je unvolkommener das Geschopf ist desto mehr sind diese
Theile einander gleich oder Shnlich, und desto mehr gleichen sie dem Ganzen.
Je volkommener das Geschépf wird, desto untbnlicher werden die Theile einander.

Je abnlicher die Theile einander sind, desto weniger sind sic einander subordinirt.
Die Subordination der Theile deutet auf ein volkommeneres Geschopf.”
60 THE MIND [cHar.

Granting the constant connexion of the fibre with the cell, are
the ganglionic cells so numerous and so arranged as to render it
conceivable that they can adequately minister to the manifold
and complex manifestations of our mental life? Most certainly
they are: Mr. Lockhart Clarke’s careful and valuable researches
into the structure of the cortical layers of the hemispheres
reveal a variety, delicacy, and complexity of constitution such
as answer to the varied and complex manifestations of mind.
The following concise summary of those important researches,
for which I am indebted to Mr. Lockhart Clarke’s kindness, will
indicate exactly how the complexity of physical structure agrees
with the complexity of mental function :—

“Tn the human brain most of the convolutions, when properly
examined, may be seen to consist of at least seven distinct and
concentric layers of nervous substance, which are alternately
paler and darker from the circumference to the centre. The
laminated structure is most strongly marked at the extremity of
the posterior lobe. In this situation all the nerve-cells are small,
but differ considerably in shape, and are much more abundant in
some layers than in others. In the superficial layer, which is
pale, they are round, oval, fusiform, and angular, but not nume-
rous. The second and darker layer is densely crowded with
cells of a similar kind,in company with others that are pyriform
and pyramidal, and lie with their tapering ends either toward
the surface or parallel with it, in connexion with fibres which
run in corresponding directions. The broader ends of the pyra-
midal cells give off two, three, four, or more processes, which run
partly towards the central white axis of the convolution and in
part horizontally along the plane of the layer, to be continuous,
like those at the opposite ends of the cells, with nerve fibres
running in different directions.

“The third layer is of a much paler colour. It is crossed,
however, at right angles by narrow and elongated groups of
small cells and nuclei of the same general appearance as those
of the preceding layer. These groups are separated from each
other by bundles of fibres radiating towards the surface from
the central white axis of the convolution, and together with
them form a beautiful fan-like structure.

“The fourth layer also contains elongated groups of small
11.] AND THE NERVOUS SYSTEM. 61

cells and nuclei, radiating at right angles to its plane; but the
groups are broader, more regular, and, together with the bundles
of fibres between them, present a more distinctly fan-like
arrangement.

“The fifth layer is again paler‘and somewhat white. It con-
tains, however, cells and nuclei which have a general resem-
blance to those of the preceding layers, but they exhibit only a
faintly radiating arrangement.

“The sixth and most internal layer is reddish-grey. It not
only abounds with cells like those already described, but con-
tains others that are rather larger. It is only here and there
that the cells are collected into elongated groups which give the
appearance of radiations. On its under side it gradually blends
with the central white axis of the convolution, into which its
cells are scattered for some distance.

“The seventh layer is this central white stem or axis of the
convolution. On every side it gives off bundles of fibres, which
diverge in all directions, and in a fan-like manner, towards the
surface through the several grey layers. As they pass between
the elongated and radiating groups of cells in the inmwer grey
layers, some of them become continuous with the processes of
the cells in the same section or plane, but others bend round and
run horizontally, both in a transverse and longitudinal direction
(in reference to the course of the entire convolution), and with
various degrees of obliquity. While the bundles themselves are
by this means reduced in size, their component jibres become
finer in proportion as they traverse the layers towards the sur-
face, in consequence, apparently, of branches which they give off
to be connected with cells in their course. Those which reach
the outer grey layer are reduced to the finest dimensions, and
form a close network with which the nuclei and cells are in
connexion.

“ Besides these fibres, which diverge from the central white
axis of the convolution, another set, springing from the same
source, converge, or rather curve inwards from opposite sides, to
form arches along some of the grey layers. These arciform fibres
run in different planes—transversely, obliquely, and longitu-
dinally—and appear to be partly continuous with those of the
divergent set which bend round, as already stated, to follow a
62 THE MIND [orap.

similar course. All these fibres establish an infinite number of
communications in every direction between different parts of
each convolution, between different convolutions, and between
these and the central white substance.

“The other convolutions of the cerebral hemispheres differ
from those at the extremities of the posterior lobes, not only by the
comparative faintness of their several layers, but also by the
appearance of some of their cells, We have already seen that,
at the extremity of the posterior lobe, the cells of ALL the layers
are small and of nearly uniform size, the inner layer only con-
taining some that are a little larger. But, on proceeding forward
from this point, the convolutions are found-to contain a number
of cells of a much larger kind. <A section, for instance, taken
from a convolution at the vertex, contains a number of large,
triangular, oval, and pyramidal cells, scattered at various inter-
vals through the two inner bands of arciform fibres and the grey
layer between them, in company with a multitude of smaller
cells which differ but little from those at the extremity of the
posterior lobe. The pyramidal cells are very peculiar. Their
bases are quadrangular, directed towards the central white sub-
stance, and each gives off four or more processes which run
partly towards the centre to be continuous with fibres radiating
from the central white axis, and partly parallel with the surface
of the convolution to be continuous with arciform fibres. The
processes frequently subdivide into minute branches, which form
part of the network between them. The opposite end of the
cell tapers gradually into a straight process, which runs directly
towards the surface of the convolution, and may be traced to a
surprising distance, giving off minute branches in its course, and
becoming lost, like the others, in the surrounding network.
Many of these cells, as well as others of a triangular, oval, and
pytiform shape, are as large as those in the anterior grey sub-
stance of the spinal cord.

“In other convolutions the vesicular structure is again some-
what modified. Thus, in the surface convolution of the great
longitudinal fissure, on a level with the anterior extremity of the
corpus callosum, and therefore corresponding to what is called
the superior frontal couvolution, all the three inner layers of
grey substance are thronged with pyramidal, triangular, and-oval
u.] AND THE NERVOUS SYSTEM. 63

cells of considerable size and in much greater number than in the
situation last mentioned. Between these, as usual, is a multitude
of nuclei and smaller cells. The inner orbital convolution, situated
on the outer side of the olfactory bulb, contains a vast multitude
of pyriform, pyramidal, and triangular cells, arranged in very
regular order, but none that are so large as many of those
found 4n the convolutions at the vertex. Again, in the insula,
or island of Reil, which overlies the extra-ventricular portion
of the corpus striatum, a great number of the cells are somewhat
larger, and the general aspect of the tissue is rather different.
A further variety is presented by the temporo-sphenoidal lobe,
which covers the insula and is continuous with it; for while in
the superficial and deep layers the cells are rather small, the
middle layer is crowded with pyramidal and oval cells of con-
siderable and rather uniform size. But not only in different
convolutions does the structure assume, to a greater or less
extent, a variety of modifications, but even different parts of
the same convolution may vary with regard either to the
arrangement or the relative size of their cells.

“ Between the cells of the convolutions in man and those
of the ape tribe I could not perceive any difference whatever ;
but they certainly differ in some respects from those of the
larger Mammalia—from those, for instance, of the ox, sheep,
or cat,” *

Schroeder van der Kolk has found a different structure of the
grey substance of the convolutions in the anterior and posterior
lobes of the dog and the rabbit: in the anterior lobes of the
rabbit there are bundles of fibres, with cells, mostly tripolar,
between them; in the posterior lobes there is a regular series of
pedunculated cells, which are placed close to one another, like
organ pipes; there are also single larger cells. As the result of
his investigations, continued through an industrious lifetime, he
states positively that, wherever there are differences of function,
there differences of structure and composition and connexion

* In the first edition of this work an error occurred in the brief abstract made
of Mr. Clarke’s investigations, as they appear in the Proceedings of the Royal
Society, vol. xii. 1863. I regret the mistake the less, as it has been the occa-
sion of my receiving, from Mr. Clarke’s own pen, the above clear and concise
description’of his latest researches,
64 TUE MIND (cuap,

do exist ; “ microscopical investigation has established this in
the completest manner.” *

Although there are observable differences in the size and con~
figuration of the cells of the cortical layer, as of the cells of
other centres, yet it is clear that we cannot at present penetrate
those intimate special differences in constitution or composition
which the variety of their functions implies. These eSsential
differences are not such, indeed, as the microscope is ever likely
to reveal; for they probably depend on the intimate chemical
composition, and are not likely, even if we could isolate cells as
required, to be disclosed until chemistry has arrived at a micro-
scopical application, or until some means has been discovered of
penetrating the molecular constitution of nerve element. Those
who may be disposed to think it impossible that such important
constitutional differences should exist in so small a compass,
might reflect with advantage on the various undetectable con-
ditions which may confessedly exist in the minutest organic
matter; as, for example, in the delicate microscopic spermato-
zoon, or in the intangible virus of a fever. And yet it is from
the conjunction of a minute spermatozoon with a minute germinal
vesicle that are produced the muscles, vessels, nerves, and brain
—the intellectual organs of a Socrates or a Cesar. Consider,
again, the infinite littleness of the odorous particles that affect
the smell, and, more wonderful still, the marvellous discri-
minating susceptibility of sense to these undetected agents.
The exquisite minuteness and consummate delicacy of the
operations going on in the most intimate recesses of nature
are even more striking and wonderful than the vastness and
grandeur with which the astronomer is concerned. “ What the
immensity is to the astronomer or geologist,’ says Sir H.
Holland, “such are these infinitely small dimensions of matter
in space to the physiologist.” Of what may happen in a world
into which human senses have not yet found means of entering
we are no better entitled to speak than the blind man is to talk of
the appearance of objects. In such matter it would be more wise
to adopt Tertullian’s maxim, “ Credo quia impossibile est,” than

* Die Pathologie und Therapie der Geisteskrankheiten auf Anatomisch-
Physiologischer Grundlage. Von J. L, C, Schroeder van der Kolk. 1863,
11] AND THE NERVOUS SYSTEM. 65

that which is so much favoured by the conceit of human igno-
rance—that a thing is impossible because it appears to be
inconceivable.

(0) Experiments on Animals have distinctly proved the differ-
ences between the functions of the ganglionic cells that constitute
the principal different nervous centres; but such results will
more properly find their place afterwards. Let it suffice here to
say that the sight of an animal may be destroyed by injury to
its corpora quadrigemina as surely as by burning out its eyes.
Nothing, however, has yet been done by experiments towards
distinguishing the functions of different convolutions.

(c) Physiological Evidence—The study of the plan of develop-
ment of the nervous system through the animal kingdom, with
the corresponding progress in complexity of function, undoubtedly
furnishes the best testimony in favour of differences in the
constitution and function of the nerve-cells, That evidence has
already been sufficiently set forth.

The hopeless vanity of all discussions concerning infinite or
absolute truth might well have been made manifest by this
physiological reflection: that our perception of external nature
is the effect which the object produces, through an adapted
medium, in certain of our central nerve-cells, an effect on which
we can exercise no influence. Excite that condition of the
central cell otherwise than by the stimulus from without, the
perception does not fail to ensue: a blow on the eye produces
flashes of light; on closing the eyes after looking at the sun a
spectrum of it remains, which, as it slowly fades away, may be
brightened and darkened alternately for a time by pressing the
eye and removing the pressure ; a disturbance of the circulation
in the auditory ganglia gives rise to noises in the ears: in fact,
all the senses may be excited subjectively. The reason is
evident: because the perception depends upon the special nature
of the central célls and the mechanism by which the stimulus
is conveyed to them. The idea in the mind is the result of an
action excited in the nerve centres; the external impression not
being conveyed to them, but exciting the physiological property
of the nerve, its newrility, which thereupon gives rise in them
to the special effect. Accordingly, the effect of any stimulus
capable of affecting one of the special senses is of the same kind

F
66 THE MIND (owar.

as that produced by its proper stimulus: thus the effect of the
electric stimulus on the optic ganglia is to cause a sensation of
light ; on the olfactory nerves, some kind of smell; on the gus-
tatory nerves, some kind of taste. This is as clear evidence
as any one can desire of specific differences between nerve-cells
which to the eye often appear exactly alike. That man is by
nature thus limited to the reception of certain special im-
pressions through a few avenues, proves how limited must be
his knowledge at the best: it may well be that there are many
things in nature of which he has not, and cannot have, any
kind of knowledge; and that a new sense conferred upon him
might alter the whole aspect of the universe.

What is true of the cells of the sensory ganglia is probably
no less true of the cells of the higher centres of intelligence.
There is reason to assume differences, not merely between the
ganglionic cells of one lobe of the brain and those of another, but
also between one cell or group of cells and another cell or group
‘of cells. The law of progress from the general to the special
in organic development does not, it may be presumed, cease its
action suddenly at the cerebral hemispheres. The philosopher
is not, it is true, in possession of more senses than the savage ;
but he unquestionably has more numerous and complex con-
volutions, and, therefore, many more ganglionic cells in the
primary centres of intelligence. By intending his mind to the
realities of external nature he acquires information through the
senses, but his intelligence reacts advantageously upon the
senses ; he constructs instruments which extend their power of
observation,—thus acquires, as it were, new artificial senses, so
that hitherto obscure relations of external nature are disclosed to
him, and he attains to more special and complex relations there-
with. Ifin the nervous centres cortical cells of a higher quality
than the savage has, do not answer to this increased speciality
and complexity of external relations, it is contrary to all the
analogy of organic development, as it is also an unintelligible
freak of nature to have crowded the hemispherical ganglia with
nerve-cells which are merely repetitions of one another.

(d) Pathological Evidence—This will be brought forward in
detail at a later period. Let it suffice here to say, that
Schroeder van der Kolk can venture to assert that he never
11] AND THE NERVOUS SYSTEM, 67.

failed to discover pathological changes in insanity, and that,
when intellectual disorder especially has existed, he has found,
the cortical layer under the frontal bones to be darker coloured;
more firmly connected with the pia mater, or softened ; in melan-
cholia, on the other hand, where the feelings mainly are excited
or depressed, the pathological changes were found principally
in the convolutions of the upper and hind lobes. In old age
when the memory fails, he thinks that the cells of the cortical
layers are visibly atrophied. The very many and various dis-
orders to which the memory is liable, failures of every possible
degree and character, which can only be described by being given
in detail, surely indicate in no uncertain way the different nature
of different cells in the. cortical layers of the hemispheres.

Thus much, then, by way of setting forth facts which will not
easily be discredited. What is the unavoidable conclusion ?
That no true scientific result can possibly proceed from the
vague and general employment, without further discrimination,
of mental action to embrace phenomena of such manifestly
different nature. If the psychologists had duly minded the old
but wholesome maxim, that whosoever distinguishes well teaches
well, they might have found in the revelations of self-con-
sciousness, when interpreted without bias, those distinctions
which an investigation of the physiology of the nervous system
in man and animals establishes beyond all question. But the
metaphysical conception of mind, the abstraction made into an
entity, has overridden all discerning observation, and, confound-
ing well-marked differences ina vague obscurity, has constructed
a loose system of undefined words in place of an exact and posi-
tive science of facts. Instead of mind being, as assumed, a
wondrous entity, the independent source of power and self-sufii-
cient cause of causes, an honest observation proves incontestably
that it is the most dependent of all the natural forces. It is the
highest development of force, and to its existence all the lower
natural forces are indispensably prerequisite.

It is most needful, if we would avoid hopeless confusion and
often-made error, once for all to form a just and definite concep-
tion of what we mean by mental force, and of its position in
nature, To deal with mind apart from the consideration of the
matter through the changes of which it is manifested is truly no

F 2
68 LHE MIND [cHaP.

less vain and absurd than it would confessedly be to attempt to
handle electricity and gravitation as forces apart from the changes
in matter by which alone we know them. As there are different
kinds of matter, so there are different modes of force, in the uni-
verse; and as we rise from the common physical matter in which
physical laws hold sway up to chemical matter and chemical
forces, and from chemical matter again up to living matter and
its modes of force, so do we rise in the scale of life from the
lowest kind of living matter, with its corresponding force or
energy, through different kinds of histological elements, with
their corresponding energies or functions, up to the highest kind
of living matter and corresponding mode of force with which we
are acquainted, viz. nerve element and nerve force. But, when
we have arrived at nerve element and nerve force, it behoves us
not to rest content with the general idea, but to bestow pains on
the patient and careful discrimination of the different kinds of
nerve-cells in the nervous system, and to study their different
manifestations of energy. So only shall we obtain the ground-
work of a true conception of the relations of mind and the
nervous system.

The chief feature to be noted in this upward transformation
of matter and correlative metamorphosis of force is, that the
exaltation or transpeciation on each occasion represents an
increased speciality of elements, and a greater complexity of
combinations, in a smaller space: all exaltation of matter and
force is, as it were, a concentration thereof. As one equivalent
of chemical force corresponds to several equivalents of inferior
force, and one equivalent of vita] force to several equivalents of
chemical force; so in the scale of tissues the higher kind repre-
sents a more complex elementary constitution, and a greater
number of simultaneously acting forces, than the kind of tissue
below it in dignity. If we suppose a higher tissue to undergo
decomposition, or retrograde metamorphosis of its matter, with
which must necessarily coincide a resolution of its energy into
lower modes, then we might say that a single monad of the
higher tissue, or one equivalent of its force, would equal in value
several monads of the lower kind of tissue, or several equivalents
of its force. The characteristic of living matter is the com-
plexity of combinations and the variety of elements in so small
11] AND THE NERVOUS SYSTEM. 69

a compass that we cannot yet trace them; and in nerve structure
this complication and concentration is carried to its highest
pitch. Nervous tissue with’ its energy is, therefore, dependent
for its existence on all the lower kinds of tissue that have pre-
ceded it in the order of development: all the’ force of nature
could not develop a nerve-cell directly out of inorganic matter.
The highest energy in nature is really the most dependent ; in
the fact that it is so dependent, that it implicitly contains the
essence or abstraction of all the lower kinds of energy, lies the
reason of the powerful influence which it is able to exercise over
all the lower forces that are subservient to its evolution. As the
man of genius implicitly contains humanity, so nerve element
implicitly contains nature.*

What is the progress or nisws that is manifest on survey-
ing nature as a whole? Is it not the struggle to arrive at
consciousness, to attain to self-communion? In the series of
her manifold productions man was, so to speak, says Goethe,
the first dialogue that Nature held with God. Every poet,
then, who is sensitive to a hitherto unrevealed subtlety of
human feeling, every philosopher who apprehends and reveals
a hitherto unobserved relation in nature, is, each in his
place, aiding the onward progress; in his art nature is
undergoing evolution; in him the world is, more or less,
regenerate.

“To whom the wing hierarch replied :—
O Adam, one Almighty is, from whom
All things proceed, and up to Him return,
If not depraved from good, created all
Such to perfection, one first matter all,
Indued with various forms, various degrees
Of substance, and in things that live, of life ;
But more refined, more spirituous, and pure,
As nearer to Him placed, or nearer tending,
Each int their several active spheres assigned,
Till body up to spirit work, in bounds
Proportioned to each kind. So from the root
Springs lighter the green stalk, from thence the leaves

* For the further development of this view of life, I may refer to an article
on the “Theory of Vitality,” in the British and Foreign Med.-Chir. Review,
October 1863.
70

THE MIND AND THE NERVOUS SYSTEM. [cwap. 11,

More aery, last the bright consummate flower

Spirits odérous breathes: flowers and their fruit,

Man’s nourishment, by gradual scale sublimed,
To vital spirits aspire, to animal,
To intellectual ; give both life and sense,
Fancy*and understanding ; whence the soul
Reason, receives, and reason is her being,
Discursive, or intuitive ; discourse
Is oftest yours, the latter most is ours,
Differing but in degree, of kind the same.”
Paradise Lost, B. v.
CHAPTER III.

THE SPINAL CORD, OR TERTIARY NERVOUS CENTRES ; OR
NERVOUS CENTRES OF REFLEX ACTION,

Cee for the present any mention of the organic
nervous centres of the sympathetic system—first, because
they minister chiefly to the organic life, and very little is
definitely known about them ; and, secondly, because something
will be said of them incidentally when treating of the Passions
—we go on to show forth the functions of the spinal cord. Jt
is not a conducting organ only, but contains many independent
nerve centres. A large part of human activity notably takes
place without any voluntary control, or even without any con-
sciousness on the part of the individual; and of these un-
‘conscious or involuntary actions a great part is as plainly due to
the independent power of reaction which the ganglionic cells of
the spinal cord have. If it be cut across at a spot below where
‘the respiratory nerves are given off, all sensation and motor
power are lost in the parts of the body below the section. But
if the sole of the foot be then tickled with a feather, the leg is
drawn up, though the man is unaware of it unless informed by
others of what has happened. Such automatic action of the
spinal cord, manifest enough in the actions of man, but still more
so in those of the lower animals, may be illustrated both from
the animal kingdom and from the phenomena of human life.
When the earliest actions of the new-born infant are observed,
it is plain that, like the movements of the foetus within the
mother’s womb, or the movements of many of the lower animals,
they are simply reflex to impressions, and take place without
will, or even without consciousness. The anencephalic infant, in
which absence of brain involves an absence of consciousness,
not only exhibits movements of its limbs, but is capable also of
72 THE SPINAL CORD, OR [cHar.

the associated reflex acts of sucking and crying. A decapitated
frog, to the thigh of which acetic acid has been applied, makes
certain movements for the purpose of wiping off the acid; and
if the head of a frog, which is clinging to the female at the season
of copulation, be cut off, the animal still holds her fast; nay, if
its paw be afterwards cut off, clings to her with its bloody stump.
The spinal cord is plainly, then, not only a centre of irregular
reflex movements, but it is also a centre of co-ordinate or so-called
designed actions, Pfliiger wetted with acetic acid the thigh of a
decapitated frog over its internal condyle; it wiped it off with
the dorsal surface of the foot of the same side: he thereupon cut
off the foot, and applied the acid to the same spot; the animal,
as though it were deceived, as the man who has lost a limb at
first is, by an eccentric sensation, would have wiped it off again
with the foot of that side, but of course could not. After some
fruitless efforts, therefore, it ceased to try in that way, seemed
unquiet, “as though it were searching for some new means,” and
at last it either made use of the foot of the leg which was left,
or it so bent the mutilated limb that it succeeded in wiping it
against the side of its body. So much was Pfliiger impressed by
this wonderful adaptation of means to an end in a headless
animal, that he actually inferred that the spinal cord, like the
brain, was possessed of sensorial functions. Others, who would
scarce admit the supposition to be true of man, have thought
that it might be sa of some of the lower animals. Instead of
rightly grounding their judgment of the complex phenomena in
man on their experience of the simpler instances exhibited by
the lower animals, they applied to the lower animals their sub-
jective misinterpretation of the complex phenomena in man.(!)
It is obviously quite possible to draw another inference from
Pfliiger’s experiment: that the so-called design of an act does
not necessarily witness to the co-existence of will, forethought,
or consciousness; that actions “having the semblance of pre-
designing consciousness” may, nevertheless, be unattended with
consciousness.* No doubt there is a definite purpose in the
* Very interesting, in relation to this matter, are Prochaska’s observations,
published in 1784:—‘‘ Cum itaque precipua functio sensorii communis consistat
in reflexione impressionum sensoriarum in motorias, notandum est quod ista

reflenio nel anima inscid vel vero animd conscid fiat.” He gives numerous
examples, often given since by other authors, and adds :— Omnes iste actiones
11.] TERTIARY NERVOUS CENTRES, ETC. 73

moyements which the maimed frog makes, as there is definite
purpose in the movements of the anencephalic infant’s lips, or in
the respiratory movements of man or animal; but in all these
instances the co-ordinate activity is the result of an innate nervous
constitution, an original endowment of the nervous centres.
Accordingly we see that the frog which has lost its legs acts as if
the limbs were still there, which, were there intelligent conscious-
ness, it plainly should not, and only employs other means when
the irritating action of the stimulus continues unaffected by its
efforts. As the movement which takes place in the sensitive
plant—the Mimosa pudica—when it is irritated, is not limited to
the spot where the irritation acts,-but extends, if this be sufficiently
intense, to the whole plant; or, as in certain morbid states of the
human organism, the continuance of an irritation, which at first
only causes slight reflex action, may produce a more general in-
voluntary reaction, or convulsions; so in the frog, the enduring
stimulus, which has not been affected by the customary reflex
movement, now gives rise to those further physiological move-
ments which would have been made use of had the creature
still possessed its brain. In the constitution of the spinal cord
are implanted the capabilities of such co-ordinate energies ; and
the degree of the irritation determines the extent of the activity.
There takes place an irradiation of the stimulus. But this happens
without consciousness ; and all the design which there is in the
movement is of the same kind as the design which there is in
the formation of a crystal, or in the plan of growth of a tree.
A crystal cannot overstep the laws of its form, nor can a tree
grow up into heaven; the particles of the crystal aggregate after
a certain definite plan, and thus strictly manifest design. Are
we, then, to assume that, because of the design, there is con-
sciousness in the forming crystal or the growing tree? Certainly
not; and yet it is to such extreme conclusion that the arguments
of those who look upon the so-called design of an act as testifying
to consciousness logically lead. The design of an act is nothing
else but the correlate in the mind of the observer of the law of

ex organismo et physicis legibus sensorio communi propriis fluunt, suntque prop-
terea spontanee et automatice.”—Commentatio de Functionibus Systematis
Nervosi, p. 88. 1784, It must be remembered that Prochaska included the
spinal cord under the sensoriwm commune.
74 THE SPINAL CORD, OR [cuap.

the matter in nature; and each observer will see in any event
exactly that amount of design which he brings with him the
faculty of seeing.

Much fruitless theory would have been avoided if the real
nature of design had been kept distinctly in mind. The notion
that the soul works unconsciously in the building up of the
organism, which has at different times been so much in fashion,
rests entirely upon the assumption that an intelligent principle
or agent must be immanent in organic matter which is going
through certain definite changes. But if in the formation of an
organ, why not also in the formation of a chemical compound
with its definite properties? The function is the necessary result
of a certain definite organic structure under certain conditions,
and in that sense must needs minister to the furtherance of its
well-being. But an organic action, with never so beautifully
manifest a design, may, under changed conditions, become as
disastrous as it is usually beneficial; the peristaltic movements
‘of the intestines, which serve so essential a purpose in the eco-
nomy, may, and actually do, in the case of some obstruction,
become the cause of intolerable suffering and a painful death.
Where, then, is the design of their disastrous continuance? The
repair of a ruptured urethra will, instead of restoring the integ-
rity of the canal and then ceasing, go on, with a final purpose sin-
gularly and obstinately mischievous, to produce an obliteration
of the canal, unless human art come to the rescue. M. Bert has
made many extremely interesting experiments on grafting parts
cut from the body of one animal on that of another. For example,
‘he cut off the paw of a young rat, and grafted it in the flank of
another rat; it took root there, and went through its normal
growth. Where was the design of its going through its regular
development there? Or what, in the adoption and nutrition of
this useless member, was the final purpose of the so-called intelli-
gent vital principle of the rat on which the graft was made?
Whatever design we recognise is really an idea that is gradually
formed in our minds from repeated experiences of the law of the
matter, a law which acts necessarily, fatally, blindly. Any other
kind of design can exist only in the creative mind; and into the
question of what exists there science cannot enter. Those who
would rashly venture to do so might call to mind and weigh the
II] TERTIARY NERVOUS CENTRES, ETC. 75

sagacious remark of Spinoza, that the idea of a perfect God is
incompatible with the conception of such working after an
aim, “because God would then desire something which He
was without.”

It will not be amiss to take note here of the very different
way in which we are in the habit of regarding dead matter and
living matter. In dead matter the form is looked upon as the
attribute of the matter, whereas, on the other hand, in living
bodies the matter is treated as the attribute of the form: in
inorganic nature the matter is the essential thing, in the organic’
creation the form is all in all. But to neglect the exact con-
sideration of the conditions and combinations of matter, as:
determining organic form, is not less mischievous than it is to
concentrate all attention upon the matter in inorganic nature.*
What are inseparably joined together in nature let us not vainly
attempt to put asunder. Mindful of this maxim we shall not
be so much tempted to fall back upon that vague and shifting
doctrine of final causes which has done so great harm in science,
or, as Bacon has it, has strangely defiled philosophy, and which,
though often rejected absolutely, and now banished from the
more advanced sciences, still works injuriously in biology, where.
so much is yet recondite and obscure. (2) The human under-
standing can indeed best impose its own rules on nature there
where the truth is most inaccessible and least known. Not only
does it in biology look for a final cause answering to its own
measure, but, having found this, or created it, proceeds straight-
way to superadd its own attribute of ‘vonsciousness, so that
wherever evidence of design is met with, be it only in the
function of the spinal cord of a decapitated frog, there con-
sciousness is assumed. Is it not a marvel that no teleologist has
yet been found to maintain that the final cause of the moon is
to act as a “tug” to the vessels on our tidal rivers ?

There can be no difficulty in admitting that the spinal cord is
an independent centre of so-called aim-working acts that are not
attended with consciousness. It is the centre, however, not only
of co-ordinate action the capability of which has been implanted
in- its original constitution, but also of co-ordinate action the

* Indeed, the chemists are now discovering how much the qualities of sub-
stances are determined by different molecular arrangements of the same atoms.
76 THE SPINAL CORD, OR [ouap.

power of which has been gradually acquired and matured
through individual experience. Like the brain, the spinal cord
has, so to speak, its memory, and must be educated ; the reaction
which it displays, in consequence of a particular impression
conveyed to it from without, does not vanish issueless, leaving
the ganglionic cells unmodified after its force has been expended.
With the display of energy there is a coincident change or waste
of nerve element; and, although a subsequent regeneration or
restoration of the statical equilibrium takes place by the quiet
process of nutrition, yet the nutritive repair, filling up the loss
which has been made, must plainly take the form made by the
energy and coincident material change. Thereby the definite
activity is to some extent realized or embodied in the structure
of the spinal cord, existing there for the future as a motor
residuum, or as, so to speak, a potential or abstract movement ;
accordingly there is thenceforth a tendency to the recurrence of
the particular activity—a tendency which becomes stronger with
every repetition of it. Every impression which is made leaves
behind it, therefore, its trace or residuum, which is again quickened
into activity on the occasion of an appropriate stimulus; the
faculties of the spinal cord are thus gradually formed and matured.
When a series or group of movements are, after many voluntary
efforts, associated, they notably become more and more easy, and
less and less separable, with every repetition, until at last they
are firmly fixed in the constitution of the cord, become a part of
the faculty of it, and may be accomplished without effort or even
without consciousness : they are the secondary or acquired auto-
matic acts, as described by Hartley. (°) In this way walking be-
comes so far a reflex or automatic act that a man in a profound
abstraction may continue to walk without being conscious where
he is going, and find himself, when he is aroused from his reverie,
in a different place from that which he intended to visit. In
that form of epilepsy known as the petit mal, an individual
sometimes continues automatically, whilst consciousness is quite
abolished, the act which he was engaged in when the attack
seized him: a shoemaker used frequently to wound his fingers
with the awl as he went on with his work during the attack,
and on one occasion walked into a pond of water during the
suspension of consciousness; and a woman whom Schroeder
u] TERTIARY NERVOUS CENTRES, ETC. 77

van der Kolk knew, continued eating or drinking, or the occupa-
tion she was about, being quite unconscious on recovery of what
had happened. Trousseau mentions a young amateur musician
subject to epileptic vertigo, who sometimes had a fit lasting for
ten or fifteen seconds whilst playing the violin. Though he
was perfectly unconscious of everything around him, and neither
heard nor saw those whom he was accompanying, he still went
on playing in time during the attack. The same author also
mentions an architect who had long been subject to epilepsy,
and did not fear to go up the highest scaffoldings, though per-
fectly aware that he had often had fits while walking across
narrow planks at a pretty considerable height. He had never met
with an accident, although, when in a fit, he ran rapidly over scaf-
foldings, shrieking out his own name in a loud and abrupt voice.
A quarter of a minute afterwards he resumed his occupation and
gave his orders to the workmen ; but unless he was told of it, he
had no idea of the singular act which he had been committing.*
Tn fact, if ally one attends to his ordinary actions during the day,
it will be surprising how small a proportion of them are con-
sciously willed, how large a proportion of them are the results
of the acquired automatic action of the organism. It is suffi-
ciently evident that the faculties of the spinal cord are, for the
most part, not inborn in man, but gradually built up by virtue
of experience and education ; in their formation they illustrate
the progress of human adaptation to external nature.

Certainly the capability of certain associated voluntary move-
ments, or the germ of such capability, does appear to exist as an
innate endowment of the spinal cord even in man, whilst in
the lower animals it is very evident. As the young animal,
directly it is born, can sometimes use its limbs with complete
effect, or as the infant, previous to any experience, is capable of
that association or catenation of movements necessary to crying,
breathing, or coughing, so likewise does there appear to be, as
Mr. Bain argues,f the germ of a locomotive harmony in the

* “The condition of such persons may be compared to somnambulism, or to what
happens in the case of certain persons who answer questions during sleep, but do
not recollect anything when they wake up.”—TrovssEav, Clinical Lectures,
vol. i, p. 59.

+ The Senses and the Intellect, Zl ed. It has long been distinctly recognised
as a general law that when a moderate stimulus excites several motor nerves,
78 THE SPINAL CORD, OR: [cHaAP,

original conformation of the nervous centres of man. Not only
does the analogy of the lower animals favour the belief in the
original existence of such an associating link, but the tendency
to an alternate action of the lower limbs, and of the two sides
of the body, observably precedes any acquisition of experience.
There is, furthermore, a proneness to the involuntary association
of the motions of corresponding parts of the two sides of the
body ; and, as Miiller has observed, the less perfect the action of
the nervous system in man, or the less developed volition is, the
more general are the associate movements. It would be a fruit-
less task, however, to attempt to fix the value of this pre-estab-
lished arrangement in man, where it is obviously at best rather
a potentiality than an actuality ; and, for all practical purposes,
we must view the faculties of his spinal cord as acquired by
education. The child certainly has the capability of learning to
walk, but the actual process of learning involves the expenditure
of much time and energy, and represents a progressing develop-
ment of the spinal cord: it is the faculty thereof in the making.
Of course it is not to be supposed that the spinal centres of
themselves ordinarily suffice for all the complicated movements
of walking, although they may do so: all that is claimed is, that
they are the automatic centres of certain associate movements,
-which have been acquired, and which constitute a large part of
our daily action.*

these are physiologically connected : first, inasmuch as all the fibres going to a
particular muscle are simultaneously excited, so that partial movement of the
muscle does not take place ; secondly, as the regular reflex activity implicates
such muscles as are functionally co-ordinated, the associated action of which
produces certain physiological effects—e.g. coughing, sneezing, swallowing. In
the electric fish, the malapterus, the nerve going to the electric apparatus is at
first a single fibre which divides and subdivides in its course, until it furnishes as
many branches as there are electric plates ; so that the creature cannot isolate a
part of the apparatus, but must put all the plates into action together. Mr.
Bain’s elaborate but vague discussion illustrates the difficulty, one might say the
vanity, of attempting to treat such questions satisfactorily from a psychological
point of view. The lovomotive harmony is the result of the connexions of certain
cells and groups of cells in the spinal cord. “Si Yhomme, le lapin, le moi-
neau, le pigeon, ne marchent pas dés leur naissance, c'est uniquement & cause
du développement incomplet des divers organes, et surtout, sans doute, des centres
nerveux. Si l’enfant naissait en présentant un degré de développement égal &

celui qu offre le cochon d'Inde, il marcherait das le premier jour.”—VuLpIAN (op.
cett.), p. 529.

* Schroeder van der Kolk, after saying that the production of harmonized
u1J TERTIARY NERVOUS CENTRES, ETC. 79

This power of co-ordinate action, which the spinal centres
acquire by assimilation of the influence of the individual’s
surroundings and respondent reaction thereto, is plainly a most
useful, as it is a most necessary, provision of nature. For if an
act became no easier after being done several times, if the care-
ful direction of consciousness were necessary on every occasion
to its accomplishment, it is evident that the whole activity of a
lifetime might be confined to one or two deeds—that no progress
could take place in development, A man might be occupied all
day in dressing and undressing himself; the washing of his
hands or the fastening of a button would be as difficult to him
on each occasion as to the child on its first trial; and he would
furthermore be completely exhausted by his exertions. For
while secondary automatic acts are accomplished with compara-
tively little weariness—in this regard approaching the organic
movements, or the original reflex movements—the conscious
efforts of the will soon produce exhaustion. A spinal cord with-
out memory would simply be an idiotic spinal cord incapable of
culture—a degenerate nervous centre in which the organization
of special faculties could not take place. It is the lesson of a
good education so consciously to exercise it in reference to its
surroundings-that it shall act automatically, in accordance with
the relations of the individual in his particular walk of life.

The phenomena of secondary automatic action are well fitted
to exhibit the mode of origin and nature of what we call design.
It is here observably an acquisition that is gradually organized
in respondence to particular experience and education; repre-
senting as it does the acquired nature of nerve element, its mani-
festation is the simple result of the constitution of the material
substratum, just as the properties of any chemical element are
the unavoidable result of its nature. That means are adapted to

movement is due to the ultimate connexion of certain groups of ganglionic
cells in the spinal cord, goes on to say—‘‘ It has always been incomprehensible
to me, how any one could ever have referred it (co-ordination) to the cere-
bellum. If the cause of this co-ordination lay in the cerebellum, no horizontal
reflex ‘movements could take place in a deeapitated frog.’—On the Minute
Structure of Spinal Cord and Medulla Oblongata, p. 72. The supposition that
the cerebellum is the sole centre of co-ordination is now, in fact, abandoned as
untenable. There never was any real scientific evidence to support it, while there
was positive evidence against it .(See Versuch einer physiologischen Patholoyie
der Nerven, von G. Valentin, 1864, vol. ii. p. 68.)
80 THE SPINAL CORD, OR [oHar.

the production of an end in the phenomena of life, is but another
way of saying that what we please to call life exists; for if
means were not adapted to an end, there could plainly be no
end; and if we choose to assume a certain result to be the end
of certain means, then we are but saying that, according to our
experience, certain combinations of matter have certain definite
properties. In the building up of the secondary automatic facul-
ties of the spinal centres, we are thus able to trace through the
course of its formation in individual life that design which we
meet with fully formed in the innate faculties of so many
animals ; but which even in that case has been as we shall here-
after see, gradually organized through generations. If it be said
that the gradual building up by education of this embodied
design into the constitution of the nervous centres is itself an
evidence of design, then we can only answer, that such propo-
sition is merely a statement in other words of the fact that
things exist as they do, and add the expression of a conviction
that science cannot enter into the councils of creation. The
growth of a cancer until it kills the body, or of a vice until it
ruins the mind, are neither more nor less evidence of design.
Should these considerations not be satisfactory to the teleolo-
gists, it will be sufficient to recall to them the already given
observation of Spinoza, and to congratulate them on their power
of diving into “the mysteries of things as if they were God’s
spies.” Were it not well, however, that they should condescend
to humble things, and unfold to us, for example, the final cause
of the mammary gland and nipple in the male animal ?

As the faculties of the spinal cord are built up by organiza-
tion, so must they be kept up by due nutrition. If not so
preserved in vigour, if exhausted by excesses of any kind, the
ill effects are manifest in degenerate action ; instead of definite
co-ordinate action ministering to the well-being of the individual,
there ensue irregular spasmodic or convulsive movements, which,
though inevitable consequences of the degenerate condition of
the nerve centres, serve no good end, but have strangely forgotten
their beneficial design.* Mr. Paget has rendered it extremely

* They have, no doubt, their design quite as much as the healthy movements,
in so far as they accomplish what they cannot help doing, their destiny—in
other words, fulfil the law which necessitates them.
uu] TERTIARY NERVOUS CENTRES, GTC. 81

probable that the rhythmical organic movements, such as those
of the heart, of respiration, of the cilia, are due to a rhythmical
nutrition ; that is, “a method of nutrition in which the acting parts
are, at certain periods, raised, with time-regulated progress, to a
state of instability of composition, from which they then decline,
and in their decline discharge nerve-force.” * It is intelligible,
therefore, why they are never tired when acting naturally ;
between each succeeding act of function a nutritive repair takes
place, and the time of each occurrence of the movement repre-
sents the time-rate of nutrition. But the spinal centres are
equally dependent on nutrition for the maintenance of their
functions; the structural or chemical change produced by the
ordinary activity of the day must be repaired during a period of
cessation of action. This restoration most likely takes place
during sleep; and there is some reason to believe that the
periodical action of the spinal centres is, like rhythmical organic
movement, dependent upon, or closely related to, the time-rate
of nutrition. The unconscious quiet manner in which the auto-
matic action of the spinal centres is performed, though in one
way or another the work is continuous during waking, might
seem at first sight to render no cessation of action necessary ;
put a little reflection shows that here, as elsewhere, the expendi-
ture of force must be balanced by a corresponding supply. If no
rest be allowed, the exhaustion is evinced, first, in an inability to
accomplish successfully the most delicate or complex associated
movements—in a loss, that is, of design; then in trembling
incapacity, which, if the degeneration increases, may pass on to
actual spasmodic movements and finally to paralysis. Therein
we have sure evidence that the constitution of the nerve ele-
ment has suffered from the drain of activity.

A reflection which oecurs, in considering the nervous mecha-
nism by which the action and reaction between the individual
and nature take place, is as to the disproportionate exhibition of
force by the organism to the force of the simple impression which
may happen to be made upon it. How, with due regard to the
principle of the conservation of force, do we account for this
seeming generation of energy? In the first place, the central

* Croonian Lecture before the Royal Society, 1857. +
G
82 THE SPINAL CORD, OR [omar.

ganglionic cell is not a simple impassive body, which merely
reflects or passes onwards a received current of activity, without
affecting it or being affected by it: on the contrary, it is the
complexly constituted, supremely endowed centre in which force
is released or evolved on the occasion of a suitable stimulus ; and
that which is perceived, as it were, in the spinal cord is not the
actual impression made upon the afferent nerve, but it is the
effect produced in the particular central nerve cell or cells,
Is it not plain enough how this force or energy is evolved, or, as
it were, unfolded in the cell? By the disturbance of the statical
equilibrium of an intensely vital structure ; by a change of the
material into lower kinds, or a degeneration of it, and a correla-
tive resolution of its force into lower modes and larger volu-
metrical display, There is not any actual generation of force;
there is a transformation of the high quality of latent force
which the nervous monad implies into actual force of a lower
quality and larger display. Consider what has been previously
said as to the nature of nerve element and its position in the
universe : it will then be sufficiently evident what manner of
process it is that takes place. Slowly and, as it were, laboriously,
by a steady appropriation and ascent through many gradations
of vitality, does organic element arrive at the complex and
supreme nature of nerve structure; quickly and easily does
nerve element give back force and matter to nature, in the
rapid resolution which the accomplishment of its function
implies. (4)

Thus much concerning the inherent force of the spinal cord as
a nervous centre. In the second place, bear in mind the nature
of its acquired faculties, and the great expenditure of force made
upon its education. In the registration of impressions made
upon it, in the assimilation of their residua, there is slowly
embodied a quantity of energy as an organic addition of power;
force is being stored up in the gradual organization of its
faculties. The exhaustion which we feel from our efforts to
acquire any particular skill of movements, as in learning to
dance,-the labour given to the frequent voluntary repetition of
the stimulus and adapted reaction thereto, until by practice the
definite relation has been established, and the desired skill
acquired ;—these testify to the expenditure of so much force
111.) TERTIARY NERVOUS CENTRES, ETC. 83

which has been laid up as statical power in the constitution of
the ganglionic cells of the cord, rendering possible for the future
a group of associated movements in answer to a moderate and, as
might often seem, disproportionate stimulus from without. Like
the brain, the spinal cord lays up good store of power in its
memory. Man’s life truly represents a progressive development
of the nervous system, none the less so because it takes place out
of the womb instead of in it, The regular transmutation of
motions which are at. first voluntary into secondary automatic
motions, as Hartley called them, is due to a gradually effected
organization in the proper centres ; and we may rest assured of
this, that co-ordinate activity always testifies to stored-up power,
either innate or acquired.

The way in which an acquired faculty of the parent animal is
sometimes distinctly transmitted to the progeny as a heritage,
instinct, or innate endowment, furnishes a striking confirmation
of the foregoing observations. Power which has been laboriously
acquired and stored up as statical in one generation manifestly
in such case becomes the inborn faculty of the next; and the
development takes place in accordance with that law of in-
creasing speciality and complexity of adaptation to external
nature which is traceable through the animal kingdom, or, in
other words, that law of progress from the general to the special
in development which the appearance of nerve force amongst
natural forces and the complexity of the nervous system of man
both illustrate. As the vital force gathers up into itself in-
ferior forces, and might be justly said to be a development of
them, or as in the appearance of nerve force simpler and more
general forces are gathered up and concentrated in a more special
and complex mode of energy ; so again, a further specialization
takes place in the development of the nervous system, whether
watched through generations or through individual life. Not
by limiting our observation to the life of the individual, how-
ever, who is but a link in the chain of organic beings con-
necting the past with the future, shall we come at the full
truth; the present individual is the inevitable consequence of
his antecedents in the past, and through the examination of these
alone de we arrive at the adequate explanation of him. It
behoves us, then, having found any faculty to be innate, not to

G2
84 THE SPINAL CORD, OR [cuar.

rest content there, but steadily to follow backwards the line of
causation, and thus to display, if possible, its manner of origin.
This is the more necessary with the lower animals, where so
much is innate.

And now, having done with the general functions of the spinal
cord as an aggregation of independent nerve centres ministering
to the animal life, let us add that they were distinctly recognised
by the physiologist long before the anatomist was in a condition
to give the physical explanation. It is only recently that the
nerve fibres which pass to or from the spinal cord have been
proved to be connected with the unipolar, bipolar, and multi-
polar cells of its grey substance; and this so plainly as to justify
the belief that an isolated apolar nervous cell does not exist in
the spinal cord or brain.* For the conveyance of an impression
to the grey centres, and for the passage of the reacting force
outwards, there is thus revealed a definite physical path, along
which the current of activity travels. From the cells with
which nerves are connected, again, other processes go to join
neighbouring cells, and thus, forming a connecting path between
them, enable them to act together: hundreds of ganglionic
cells are yoked together by such anastomoses, and, functionally
co-ordinated thereby, represent the centres of innervation of
corresponding systems of motor nerves. By similar anastomoses
the ganglionic cells of different nervous centres are connected,
and thus a means is afforded for the communication of the
activity of one centre to another. A consideration of the
nervous system of the Annelida will assist in the conception
of the physiological nature of the spinal cord. In those humble
creatures the central nervous system consists of a ganglionic
apparatus, each ganglion of which is united to that which pre-
cedes it, and that which follows it, by longer or shorter nervous
connexions. Now the spinal cord of the Vertebrata may be
considered as an analogous ganglionic apparatus, the connect-
ing cords of which are not seen by reason of the coalescence
of the ganglia. From a physiological point of view, therefore,
the grey substance may be considered as formed of distinct
segments, each segment consisting of a group or association of

* The connexions of fibres with cells have been observed most plainly in the
lamprey by Owsjannikow, and by Bidder and his pupils of the Dorpat School,
11] TERTIARY NERVOUS CENTRES, ETO. 85

cells, and having connected with it the roots of two anterior
motor and two posterior sensory nerves. Many, therefore, are
the channels by which the activity excited in the nerve-cell
by the stimulus of the efferent nerve may be disposed of: it
may at once be reflected on an efferent nerve, and pass into
muscular motion; or it may pass to other interconnected cells,
and, acting thus upon a system of nerves, produce associated
movements, either such as proceed from the cord nearly on the
same level as the afferent nerve enters, or from a different level ;
or, lastly, it may pass upwards, and excite the higher functionally
co-ordinated centres.

To Pfliiger belongs the merit of having first attempted to
systematize the laws of the reflex movements. They are :—
1. The law of simultaneous conduction for one-sided reflex move-
ments. When a reflex movement takes place only on one side
of the body in consequence of a stimulus, it is always on the
same side of the body as the irritation of the afferent nerve; the
reason being probably that the motor nerves proceed from gan-
glionic cells which are in direct connexion with the stimulated
afferent nerves.—2. The law of symmetry of reflea action. When
a stimulus has produced reflex movements on one side, and its
continuance or its further extension in the spinal cord produces
movements of the opposite side, then the corresponding muscles
only of this side are affected. This is owing, no doubt, to the
commissural system, which connects together the corresponding
ganglionic cells of the two halves of the cord.—3. The unequally
intense reflex action of the two sides in the event of both being
affected. When the reflex action is stronger on one side than
upon the other, the stronger movements take place upon the side
of the irritation—4. The law of irradiation of reflex action, by
which an extension of reflex action takes place from the nerves
in which it first appears to neighbouring ones, owing to the
communications between the different systems or groups of gan-
glionic cells. When the excitation of an afferent cerebral nerve
is transferred to motor nerves, we observe that the roots of both
sorts of nerves are placed nearly upon the same level in the
central organ, or that the motor nerve lies a little behind or
below, never in front of or above, the afferent nerve. If the
reflex action spreads further, the way of irradiation is downwards
86 THE SPINAL CORD, OR [cuap.

to the medulla oblongata; stimulation of the optic nerve, for
example, produces contraction of the iris. In the spinal cord
the primarily affected motor nerve lies nearly on the level of the
stimulated sensory nerve. But if the reflex action spreads, then
it passes upwards towards the medulla, When the irritation
has arrived at the medulla, then it may pass downwards again.
—b5. The reflex action produced by the irritation of a sensory
nerve can only appear in three places, whether one-sided or
occurring on both sides of the body. (a) It appears in the
motor nerves which lie nearly on the same level with the
excited sensory nerve. (0) If reflex action implicates the motor
nerves on a different level, these motor nerves are constantly
such as spring from the medulla oblongata: tetanus and hys-
terical convulsions, in consequence of local irritations, furnish
examples. (c) The reflex action affects the muscles of the body
generally; the principal focus of irradiation thereof being the
medulla oblongata.

I proceed next to indicate briefly the causes which affect the
functional activity of the spinal cord :—

1, As an original fact, the ganglionic cells may have a greater
or less stability of composition. It sometimes happens that a
child is born with so great a natural instability of nerve element,
that the most violent convulsions ensue on the occasion of very
slight irritation. Or the evil may be less serious, and the indi-
vidual may be equal to the ordinary emergencies of a quiet,
favourably spent life; but there is an absence of that reserve
power necessary to meet the extraordinary emergencies and
unusual strain of adverse events. When, therefore, an unac-
customed stress is laid upon the feeble nerve element, it is
unequal to the demand made upon it, and breaks down into a
rapid degeneration. This innate feebleness is evinced by an
excessive irritability; it is truly an irritable weakness; and its
most common cause is an unfortunate inheritance, the curse of
a bad descent. Any sort of disease of the nervous system in the
parent seems to predispose more or less to this ill condition of
the child, the acquired deterioration of the parent becoming the
inborn organic feebleness of the offspring.

The degeneration of nerve element in the ganglionic cells
reveals itself in a disturbance of the co-ordinate or aim-working
ut] TERTIARY NERVOUS CENTRES, ETC. 87

activity which, as we have already seen, marks the highest
development of its function. Convulsions are the sure signs
of a weakness or lowered vitality of nerve element,—a defect
which, though we cannot yet ascertain its exact nature, certainly
implies an unstable equilibrium of the organic constitution. Each
central nerve-cell exists in close relations, physical and physio-
logical, with other nerve-cells ; when, regardless of these rela-
tions, it reacts directly outwards on its own account, it is very
much like an individual in a social system who, by reason of
madness, is unable to maintain his due social relations.

Not only may an excess of irritability be a defect in the nature
of the ganglionic cell, but this may be defective also by reason
of a great insensibility of nature and a want of power of assimi-
lation. In congenital idiots the central cells of the cord do
plainly sometimes partake of the degeneracy of the brain, and
are idiotic also; they are incapable of receiving impressions
with any vividness, and of retaining the traces or residua of
such as they do receive,—incapable of education. Spasms of
the limbs, sometimes limited to the toe, to one arm or leg, at
other times more general; contractions of a foot, or of the knees
to such degree as to make the heels touch the buttocks; more
frequent still, paralytic conditions of varying degree and extent,
atrophied limbs, now and then indulging in convulsive move-
ment ;—all these morbid states are met with in idiots, and,
though in part attributable to the brain, are certainly in part
due to degeneration of a spinal cord utterly oblivious of its
design or final purpose in the universe. In some cases
where the morbid degeneration is not so extreme, it is not
impossible to teach such combinations of movements as are
necessary for the common work of life. It may be observed
incidentally that the ease and rapidity with which those idiots
who have by perseverance been taught difficult feats of action,
perform them—the machine-like exactness of their movements
—display well the important functions of the spinal cord as an
independent nerve centre; for they display its functions in a
case in which the influence of the cerebral hemispheres is almost
excluded.

2. The functional action of the spinal ganglionic cells may
suffer from the too powerful or prolonged action of an external
88 THE SPINAL CORD, OR [cHap.

stimulus, or from an activity continued without due interval
of rest. The molecular degeneration or waste, which is the
condition of functional activity, must be repaired by rest and
nutrition ; the nerve-cell is no inexhaustible fountain of force,
but must take in from one quarter what it gives out in another;
and if due time be not allowed for the development of its highly
vital structure by assimilation of matter of a lower quality, it is
certain that, notwithstanding the best innate constitution, de-
terioration must ensue as surely as a fuelless fire must go out.
In that degeneration of the spinal cord which sometimes occurs
in consequence of masturbation or great venereal excess, one of
the first symptoms is a loss of co-ordinating power over the
motions of the legs—a loss, in other words, of that which is the
last organized faculty of the spinal centres. The startings of the
limbs, and the partial contractions of certain muscles which
may follow, do not evince increased power, as some have heed-
lessly fancied, but are the indications of lowered vitality ; they
are the incoherent manifestations of a degenerate instability of
nerve element. When such a morbid condition of things is
brought about, there is necessarily a failure in the power of the
ganglionic cells to receive and assimilate impressions: hence it
is that in general paralytics, in whom the memory of each inde-
pendent nervous centre is decayed, there is not only an inability
to accomplish successfully the actions to which they have been
accustomed—as, for example, an inability of a tailor, whom from
his conversation one would deem quite capable of his work, to
sew ; but there is also the impossibility of teaching them new
combinations of movements. In other sorts of lunatics this is
often possible: though mentally much degenerate, and actually
lost for ever to the world, they may by persevering training be
made useful in certain simple relations to which they grow and
react as automatic machines, their own cerebral hemispheres not
interfering ; the general paralytics, in whom the disease has
advanced so far as to affect the cord, cannot thus be utilized.

3. The supply of blood and the condition of it are manifestly
of the greatest consequence to the welfare of the spinal cells.
The grey matter of the cord is very richly supplied with capil-
laries, to the end that there may be a quick renewal of blood
ministering to the active interchange that goes on between the
11.] TERTIARY NERVOUS CENTRES, ETC. 89

ganglionic cell and the nutrient fluid ; the enormous consump-
tion of force in nervous function demands such an abundance of
supply. When the supply of blood is suddenly cut off, as in
the well-known experiments of Stannius, Brown-Séquard, and.
Schiff, the nervous activity is presently paralysed, and rigor
-mortis of the muscles ensues. When the supply of blood is,
soon restored to a part in which rigor mortis has taken place,
as in Brown-Séquard’s experiment of injecting warm blood
into the stiffened arm of an executed criminal, the muscles
presently regain their contractility, and the nerves their irrita-
bility. As a complete cutting-off of the blood is paralysis of
nerve element, so a deficiency of blood, or of material in it fitted.
for the nutrition of nerve, is to the extent of its existence a cause
of degeneration or instability of nerve element. Such deteriora-
tion is exhibited by cachectic and anemic persons in a great
irritability, and in a disposition to spasms or convulsions—an
acquired condition not unlike that which is sometimes inherited.
The state of the blood may be vitiated by reason of the
presence of some foreign matter which, whether bred in it or
introduced from without, acts injuriously, or as a direct poison.
on the individual nerve-cells. Strychnia notably so affects them
that, on the occasion of the slightest stimulus, they react in
convulsive activity; while the woorara poison, on the other
hand, produces a sort of stupor, or coma, and paralyses all
activity. Moreover, if a sufficiently large quantity of strychnia
be introduced under the skin of a frog, the effects may closely
resemble those produced by the woorara poison; death taking
place without any, or with only very feeble, convulsions. Opium,
which usually produces coma in man, produces convulsions in
frogs. We might, were it needful, accept these different effects
of poisons, which are alike’ positively injurious to the integrity of
nerve element, as evidence that convulsions do not mean strength,
are not the result of an increase in the proper vital activity of
parts, but the result of degenerate vital action, and the fore-
runners of paralysis. These vegetable poisons indicate also, by
their different effects, the fine differences of composition in the
ganglionic cells of the central nervous system; they are the
most sensitive reagents in this regard which we yet possess.

There is reason to believe that the presence of too much blood
90 THE SPINAL CORD, OR [cHAP.

in the spinal cord may be as baneful as an insufficient supply.
All the symptoms of disorder of nerve element which accom-
pany anwmia may certainly be produced also by congestion,
or hyperemia. However, this matter will be more properly
and more fully considered when we come to the pathology
of nerve.

4. The existence of a persistent cause of eccentric irritation,
whether the result of injury or disease in some part of the body,
may give rise to a morbid state of the spinal nerve-cells by a
so-called sympathetic or reflex action. WVolkmann has observed
movements to be produced in the limbs of a decapitated frog by
stimulation of the intestinal canal; the results being much more
evident if the animal has previously been poisoned with strychnia.
The convulsions which sometimes take place during teething in
children, or owing to the presence of worms in the intestines, are
familiar examples of such secondary effect upon a susceptible
growing nervous system. It is necessary to distinguish two
kinds of effects of this reflex action—or, perhaps, different
degrees of the same kind of effect—namely, a reflex functional
modification and a reflex nutritive modification.

The irritation of a decayed tooth may, as is well known, give
rise to a contraction of the muscles of one side of the neck, or
to a violent facial neuralgia, or to blindness or deafness, all
which presently disappear upon the removal of the cause of
mischief. A functional derangement only has existed so far.
But the irritation of a bad tooth produces a greater and more
lasting effect, when, as does now and then happen, an abscess in
the glands of the neck takes place in consequence of it, and
remains an incurable fistula until the removal of the scarce sus-
pected cause. The nutritive derangement has been caused and
kept up by the reflex irritation. It must certainly be allowed
that the functional disorder, when it alone seems to exist, does
testify to some kind of change in the molecular relations of the
ganglionic cells; but as the abnormal modification vanishes the
moment the real cause of mischief, the bad tooth, is gone, it is
scarcely possible. to view the disturbed function as evidence of
any serious chemical or organic derangement in the nerve-cells.
With the continuance of the cause of irritation, the functional
disorder undoubtedly may, and is liable to, pass into disorder of
ut] TERTIARY NERVOUS CENTRES, ETC. 91

nutrition, The relations of these different degrees or kinds of
derangement to the morbid cause are such that we might not
unfairly represent the sole existing functional derangement as
due to a modification of the polar molecules of the nerve ele-
ment, while the abnormal nutrition may be supposed to mark
an actual chemical change in its constitution.

Again, as the spinal centres minister both to our animal life
and to our organic life, they necessarily have, in the former case,
a periodical function; in the latter case, a continuous function.*
When, therefore, a morbid condition of the ganglionic cells, as
subserving the animal life, exists, the functional derangement
will probably be not continuous but intermittent. Thus, in
epilepsy, it appears as if the reacting centres must be gradually
charged until they reach a certain tension or instability, when
the statical equilibrium is destroyed, and they discharge them-
selves violently. Something of the same kind takes place in the
poisonous action of strychnia: a dog so poisoned will fall down
in convulsions, but, according to Schroeder van der Kolk,
they cease after a time, and the animal seems to be perfectly
well; even for so long as an hour it may be touched or stroked
without harm; after which the susceptibility again becomes so
great, that by simply blowing upon the skin convulsions are
reproduced. When, on the other hand, the function of the
spinal centres, as ministering to the organic life, is deranged,
then the morbid effect will not unlikely be continuous, The
experiments of Lister, showing that the movements of the
granules in the pigment cells of the frog’s skin are under the
control of the spinal system, and the investigations of Bernard,
agree to prove that the cerebro-spinal axis not only regulates
the contractions of the small arteries, but directly influences
the organic elements engaged in nutrition and secretion. The
moment food is introduced into the mouth there is a flow of
saliva, and of gastric juice. Numerous examples have been of
old quoted of distant modifications of nutrition in consequenge
of some irritation of a centripetal nerve: a large secretion of
extremely acid gastric juice has been cured by the extirpation of

* They have, however, a continuous action upon the voluntary muscles in
maintaining their tonicity, as also upon the sphincters in keeping up their
contraction.
92 THE SPINAL CORD, OR [cHar.

painful piles; ptyalism is sometimes produced by neuralgia, as
lachrymation frequently is by neuralgia of the fifth nerve ; irrita-
tion of the uterus, or of the skin of the breasts, or of the mucous
membrane of the vagina, will sometimes give rise to the secretion
of milk; and menstruation may follow irritation of the ovaries,
or the application of warm poultices to the breasts. We witness _
phenomena due to this reflex nutritive action again in the sym-
pathy which one eye so often exhibits with disease of the other ;
in the congestion of the eye or the actual amaurosis which some-
times accompanies severe neuralgia; in the paraplegia due to
displacement or disease of the uterus; and in many other
instances too numerous to be mentioned.* Pfliiger quotes from
Dieffenbach a striking case, which admirably illustrates the
effects of an eccentric irritation upon the spinal cord. A young
girl fell upon a wine-glass, and cut one hand with a piece of
the broken glass; for years afterwards she suffered from violent
neuralgic pains and emaciation, with contraction and complete
uselessness of the hand. She was afflicted also with severe
attacks of epilepsy. On cutting through the cicatrix of the old
wound, a minute splinter of glass, which had wounded the nerve,
was detected; the nerve was also thickened and hardened. After
removal of the glass, the neuralgia and epilepsy disappeared, and
the girl recovered the entire use of her hand.

5. Lastly, the severance of the connexion between the brain
and the ganglionic cells of the spinal cord seems in some degree
to affect their function. When a nerve is cut across in the living
body, the peripheral end soon undergoes fatty degeneration, while
the central end remains unchanged after years; and this degene-
ration is not owing solely to the inactivity of the nerve, for it
still takes place when the nerve is regularly stimulated, and
takes place much less quickly in frogs and cold-blooded animals

* It is customary now to describe as reflex the modifications of sensation, as
well as those of nutrition, secretion, and motion, which occur in a distant part
by reason of the irritation of some afferent nerve ; but it is a question deserving
consideration whether the old word sympathy is not more appropriate to designate
the modifications of sensation, and whether the word ‘‘reflex” should not be applied
specially to the reflection of a stimulus from an afferent on to an efferent nerve.
The motion too which sometimes occurs in a part not from direct stimulation,
but sympathetically with motion excited in some other part of the body, might
not improperly be described as synergy.
m1.) TERTIARY NERVOUS CENTRES, ETC. 93

than in warm-blooded animals. The researches of Waller—which
have been confirmed by Longet, Schiff, and others—are most
important in regard to this subject. It is certainly a fair conclu-
sion from them that the nerve fibres have their nutrition sub-
jected in some measure to the nerve centres ; these would indeed
appear to play in relation to them the part of nutritive centres.
‘»After apoplexy in or about the corpus striatum, Turck professes
to have found granular cells in the course of the fibres as they
pass downwards, so that such cells were met with in the spinal
cord on the opposite side to the seat of disease. It is known,
too, that the removal of the brain in the lower animals increases
the ease with which reflex movements take place; and there are
many cases on record in which the reflex action has been increased
in man when disease or injury has interrupted the continuity of
the spinal centres with the brain. May we not, then, conclude
from such facts that a positive influence is exercised by the brain
upon the nutrition! of the ganglionic cells of the cord and the
nerve fibres which proceed from the cerebro-spinal axis, as well
as by the spinal centres on the nerve fibres which proceed directly
from them? In fact, may we not justly conclude that such an
influence is exerted by every nerve centre on the centre which is
subordinate to it, and on the nerves which proceed from it? The
inference would be agreeable to what we know of the direct
influence of the functional action of the brain upon that of the
cord; the reflex acts in health being for the most part notably
subordinate to the control of the will, As a guiding influence
passes from above downwards when the cerebro-spinal system is
ministering to the functions of animal life; so it is not impro-
bable that the brain, in the accomplishment of its function as an
organ of organic life, exerts some power which is favourable to
the nutrition of the parts which lie below it, and which are the
instruments through which it acts. This influence being with-
drawn, an exaggeration of the excitability of the cord occurs,
such as a wound causing tetanus may produce, or such as was
produced by Brown-Séquard in guinea-pigs, when, having injured
their spinal cord two or three weeks before, he was able to
excite epileptiform convulsions at will, by pitching the skin of
the face. It is true that some have thought to explain in another
way the increase in the reflex movements which follows the
94 THE SPINAL CORD, OR [cHap,

severance of communication between the brain and cord; they
have attributed it to the augmented energy of the spinal centres,
and to the concentration of the stimulus, now that a path for the
dispersion of its force is cut off. Such theory is not innocent of
the vulgar error of regarding as increased energy that which is
truly a diminution or deterioration of the higher vital energy of
the part. Has it ever yet happened to any one to discover that
the co-ordinate reflex acts were made more energetic or effective
by cutting off the influence of the brain? One most necessary
function of the brain is to exert an inhibitory power over the
nerve centres that lie below it, just as man exercises a beneficial
control over his fellow animals of a lower order of dignity; and
the increased irregular activity of the lower centres surely
betokens a degeneration: it is like the turbulent, aimless action
of a democracy without a head.

Such, then, are the disturbing causes which may affect the
activity of the spinal cord, both as a conducting path and as an
independent centre of the generation of nerve-power. When
we reflect upon the great proportion of the daily actions of life
that are effected by its unconscious agency, we cannot but per-
ceive how most important is the due preservation of its integrity.
No culture of the mind, however careful, no effort of the will,
however strong, will avail to prevent irregular and convulsive
action when a certain degree of instability of nerve element has,
from one cause or another, been produced in the spinal cells. It
would be as absurd to preach control to the spasms of chorea, or
restraint to the convulsions of epilepsy, as to preach moderation
to the east wind, or gentleness to the hurricane. That which in
such case has its foundation in a definite physical cause must
have its cure in the production of a definite physical change.

So certain and intimate is the sympathy between the indivi-
dual nerve-cells in that well-organized commonwealth which the
nervous system represents, that a local disturbance is soon felt
more or less distinctly throughout the whole state. When any
serious degeneration of the ganglionic cells of the cord exists,
there is not only an indisposition or inability to carry out as
subordinate agents the commands which come from above; but
there is a complaint sent upwards—a moan of discontent or pain
reaches the supreme authority. That is the meaning of the
111.] TERTIARY NERVOUS CENTRES, ETC. 95

feelings of weariness, heaviness, achings of the limbs, and utter
lassitude which accompany disorder of the spinal centres; and
the convulsive spasms, the local contractions or paralysis of
muscles, are the first signs of a coming rebellion. If the warn-
ings do not receive timely attention, a riot may easily become
a rebellion; for when organic processes, which normally go on
without consciousness, force themselves into consciousness, it is
the certain mark of a vital degeneration. If the appeal is made
in vain, then further degeneration ensues. Not only is there
irregular revolutionary action of a subordinate, but there is pro
tanto a weakening of the stipreme authority; it is less able to
control what is more difficult of control. When due subordina-
tion of parts exists, and the individual cell conforms to the laws
of the system, then the authority of the head is strengthened,
A foolish despot, forgetting in the pride of his power that the
strength and worth of a government flow from and rest upon
the well-being of the governed, may fancy that he can safely
disregard the cry of the suffering and the oppressed; but when he
closes his ears to complaints, he closes his eyes to consequences,
and finally wakes up to find his power slipped from him, and
himself entered upon the way of destruction. So is it with the
nervous system: the cells are the individuals, and, as in the
state, so here, there are individuals of higher dignity and of
lower dignity ; but the well-being and power of the higher indi-
viduals are entirely dependent upon the well-being and content-
ment of the humbler workers in the spinal cord, which do so
great a part of the daily work of life. The form of government
is that of a constitutional monarchy, in which every interest is
duly represented through adequate channels, and in which, con-
sequently, there is a proper subordination of parts.

I have lingered thus long upon the spinal cord, because most
of what has been said with regard to its functions may, with
the necessary change of terms, be applied to the other nervous
centres, A distinct conception of the nature and mode of
development of the functions of the spinal centres is the best, is
indeed the only adequate, preparation for an entrance upon the
study of cerebral action; it is an indispensable prerequisite
to the right understanding of the higher displays of nervous
function, and alone fixes the sure basis whereon to build a true
96 THE SPINAL CORD, OR [cuapP.

mental science.* In this way we apply the laws generalized
from the more simple cases to disentangle the phenomena of the
more complex cases. Any system not so founded follows not
the order of development in nature, and must be unstable and
insecure: Nature herself protests against it with energetic elo-
quence when she makes, as she unquestionably sometimes does,
morbid action of the cells of the cerebral hemispheres vicarious
of the morbid action of the spinal cells.

NOTES.

1 (p. 72).—Pfliiger compares the movements of a decapitated animal
with those of a sleeping man, deeming the movements in both to be
conscious. He tickled the right nostril of a sleeping boy, and the lad
rubbed it with his right hand : when Pfliiger tickled the left nostril the
lad rubbed it with his left hand. If he held the sleeper’s right hand
without waking him, and tickled his right nostril, the boy first made
attempts with his right hand to rub it, but when this did not succeed,
and the irritation continued, he then made use of the left hand.

For a fuller discussion of the assumed consciousness of the spinal
cord I must refer to my review of Mr. Bain on the “Senses and the
Intellect,” in the Journal of Mental Science for January 1865, pp.
558, 559. I will only now add a quotation from Spinoza, as translated
by M. Saisset. “Personne, en effet, n’a déterminé encore ce dont le
corps est capable; en d’autres termes personne n’a encore appris de
Vexpérience ce que le corps peut faire et ce qu’il ne peut pas faire, par
les seules lois de la nature corporelle et sans recevoir de l’4me aucune
détermination.” ‘This is not astonishing,” he adds, “as no one has
sufficiently studied the functions of the body,” and instances the
marvellous acts of animals and somnambulists—“ toutes choses qui
montrent assez que le corps humain, par les seules lois de la nature,
est capable d’une foule d’opérations qui sont pour l’Ame jointe & ce
corps un objet d’étonnement. .... J’ajoute enfin que le mécanisme
du corps humain est fait avec un art qui surpasse infiniment l’industrie
humaine.” The associating link of many movements—azs, for example,
of those of the heart, of the eye, of breathing—plainly exists in the

* Jn the ‘‘ Archiv. fiir Physiolog. Heilkunde,” 1843, there is an excellent paper
by Prof. Griesinger, ‘‘ Ueber psychische Reflexactionen, mit einem Blick auf das
Wesen der psychischen Krankheiten ;’’ and another in the same Journal for
1854, “Neue Beitrige zur Physiologie und Pathologie des Gehirns.”
11. | TERTIARY NERVOUS CENTRES, ETC. 97

conformation of the nervous centres; the wisdom or design is
exhibited in the primary arrangement, whereby the reactions of the
organism necessarily following do, as a rule, minister to the further-
ance of its well-being.

2 (p. 75).—‘ And therefore it was a good answer,” says Bacon, “that
was made by one who when they showed him hanging in a temple
a picture of those who had paid their vows as having escaped ship-
wreck, and would have him say whether he did not now acknowledge
the power of the gods, ‘Ay,’ asks he again, ‘ but where are they
painted that were drowned after their vows?’” Speaking of final
causes, upon which the human understanding falls back, he says that
they “ have clearly relation to the nature of man rather than to the
nature of the universe; and from this source have strangely defiled
philosophy.”—WVov. Org. Aphorism xlviii.

3 (p. 76).—* After the actions which are most perfectly voluntary
have been rendered so by one set of associations, they may, by another,
be made to depend upon the most diminutive sensations, ideas, and
motions, such as the mind scarce regards, or is conscious of ; and which,
therefore, it can scarce recollect the moment after the action is over.
Hence it follows that association not only converts automatic action
into voluntary, but voluntary ones into automatic. For these actions,
of which the mind is scarce conscious, and which follow mechanically,
as it were, some precedent diminutive sensation, idea, or motion, and
without any effort of the mind, are rather to be ascribed to the body
than the mind, @.e. are to be referred to the head of automatic action.
I shall call them automatic motions of the secondary kind to distin-
guish them from those which are originally automatic, and from the
voluntary ones; and shall now give a few instances of this double
transmutation of motions, viz. of automatic into voluntary, and of
voluntary into automatic.” He instances the manner in which children
learn, and especially the way we learn to speak, to play on the harpsi-
chord, ,&c. “The doctrine of vibrations explains all the original
automatic motions ; that of association, the voluntary and secondarily
automatic ones.’—HartiEy’s Theory of the Human Mind, edited by
Priestley, pp. 32, 39.

4 (p. 82).—“ Impressionum sensoriarum in motorias reflexio, que in
sensorio communi fit, non peragitur juxta solas leges physicas, ubi
angulus reflexionis equalis est angulo incidentie, et ubi, quanta fit
actio, tanta etiam sequitur reactio; sed leges peculiares, a natura in
pulpam medullarem sensorii quasi scriptas, sequitur ista reflexio quas
ex solis effectibus tantum noscere, neutiquam vero assequi nostro

H
98 THE SPINAL CORD, ETC. [cHap, m1.

ingenio valemus. Generalis tamen lex, qué commune sensérium im-
pressiones sensorias in motorias reflectit, est nostri conservatio : ita ub
impressiones externas corpore nostro noscituras sequantur certs im-
pressiones motoriz, motus producture eo collimantes, ut monumentum,
a corpore nostro arceatur, amoveaturque ; et vice versa impressiones
externas seu sensorias, nobis profuturas, sequantur impressiones interns
seu motoriz, motus producture eo tendentes, ut gratus ille status ultro
conservetur.”—PROCHASKA, op. cit. p. 88.
CHAPTER IV.

SECONDARY NERVOUS CENTRES, OR SENSORY GANGLIA;
SENSORIUM COMMUNE.

ae different collections of grey matter which exist in the

medulla oblongata, and at the base of the brain, the con-
tinuations of the grey matter of the spinal cord, consist chiefly
of the nervous centres of the higher senses, with corresponding
centres of motional reaction. Continuing the grey substance as
high as the floor of the lateral ventricles, they include the optic
thalami, the corpora striata, the corpora quadrigemina, and the
different sensory centres that are placed in the medulla oblon-
gata, the tuber annulare, and the cerebral peduncles. The
olfactory bulbs, which lie at the base of the anterior cerebral
lobes, must also be included in the sensorium commune. Any
one of the senses may be destroyed by injury to its sensory
ganglion as surely as by actual destruction of its organ; blind-
ness is produced by injury to the corpora quadrigemina, smell
is abolished by destruction of the olfactory bulbs. These gan-
glionic centres are thus intermediate between the higher hemi-
spherical ganglia above and the spinal centres below them; to
those they are subordinate, to these they are superordinate. In
many of the lower animals, as already pointed out, the brain
consists of nothing more than the sensory ganglia, with centres
of motional reaction.

It is not the place here to enter into a discussion of the
different opinions which have been entertained regarding the
exact centres of the different senses ; much of what is said on
these difficult questions is still conjectural. It was maintained
by Dr. Todd, who has been supported in his views by Dr. Car-
penter, that the seat of common sensation is located in the

H 2
100 SECONDARY NERVOUS CENTRES, OR [owar.

thalami optici, because it is in these bodies that the anterior
columns of the spinal cord seem to terminate; and that the
corpora striata, to which the posterior columns of the cord pass,
are the corresponding motor centres. Vulpian, however, has
brought forward strong arguments in favour of assigning the
seat of common sensation to the tuber annulare. After the
removal of the corpora striata, the tubercula quadrigemina, and
the cerebellum—the tuber annulare and the medulla oblongata
being the only parts of the encephalon left—he found that dogs
and rabbits evinced, by violent agitation and decided cries of suf-
fering, the pain felt when severely pinched or otherwise irritated.
Moreover, injuries of the thalami optici, pathological or experi-
mental, do not weaken sensibility, but do often produce motor
paralysis. He concludes that we are yet in entire ignorance of
the special functions both of the thalami optici and the corpora
striata. Notwithstanding this opinion, those who have examined
the arguments on this subject will probably conclude that
Vulpian’s theory concerning the tuber annulare has blinded him
to the import of the evidence in favour of the thalami optici and
the corpora striata as sensory and motor centres respectively.
It may well be that they are not the entire centres, and that
there are other centres of sensibility and motion in the tuber
annulare and cerebral peduncles; but that they do minister to
those functions it is hardly possible to doubt. Meanwhile all
that concerns us here, in dealing with the cerebral functions
from a psychological point of view, is to have some general
term to embrace and designate all the centres of sensation;
and for this purpose we shall employ the term sensoriwm com-
mune, using it to denote the common centres of sensation, and
not, as Vulpian and some others have misused it, to designate
the centres of common sensation. In a similar sense we shall
subsequently use the terms motoriwm commune and intellectorium
commune,

The ganglionic centres of the sensorium commune are formed
of numerous nerve-cells, which, like those of the spinal cord,
are in connexion with afferent and efferent nerves; the afferent
nerves in this case coming mostly from the organs of the special
senses. The impressions which the afferent nerves bring are,
therefore, special in kind, as also are the grey nuclei to which
Iv; SENSORY GANGLIA, ETO, 101

they are brought; a progressive differentiation of structure
.and function is manifest; and we might describe the sen-
sorium commune physiologically as a spinal cord, the afferent
nerves of which are the nerves of the special senses, or rather
of the various kinds of sensibility. For although we usually
distinguish only between the special senses and general sensi-
bility, yet there are really different kinds of the latter, each
probably having its special nucleus: the tactile sense, the sense
of temperature, the muscular sense, and the peculiar sensibility
of the glans penis, differ not in degree only, but in kind. An
exact knowledge of the anatomical relations of the different grey
nuclei is still wanting, notwithstanding the patient investigations
of Schroeder van der Kolk, All that we are certain of is, that
the fibres of the nerves are connected with the cells, as may be
most easily seen in the case of the auditory nerve and ganglion ;
that manifold connexions exist between different nuclei; and
that fibres may sometimes be traced from the nucleus of a
sensory nerve to a motor nerve upon which it is known to exert
a reflex action. The trigeminus, or fifth nerve, for example,
passes from above downwards through the medulla, and in its
downward course forms reflex connexions with all the motor
nerves of the medulla as it approaches the level of their nuclei ;
in this way the facial, the glossopharyngeal, the vagus, the
spinal accessory, and the hypoglossal receive communications
from it. The ganglionic cells of different nuclei also differ in
form and size; and Schroeder van der Kolk holds that, as a
general rule, at every spot where fibres are given off for the
performance of any special function, there fresh groups of gan-
glionic cells giving origin to them appear. We justly conclude,
then, that, as we should @ priori expect, specially constituted
ganglionic cells minister to special functions; that the central
cells are, as it were, the workshops in which, on the occasion
of a suitable stimulus, the peculiar current necessary for the
performance of the specific action is excited. A message is sent
up to them by the appointed channels, and they reply by sending
through the regular motor channels the particular energies which
it is their function to supply. Charged with their proper force
during the assimilating process of nutrition, it exists in them as
statical power, or latent energy; and the condition of unstable
102 SECONDARY NERVOUS CENTRES, OR [cHap.

vital equilibrium is upset, the force being then discharged, as
the Leyden jar is, when a certain stimulus meets with a suffi-
cient tension.

The natural course of a stimulus, all the force of which is not
reflected upon an efferent nerve in the spinal centres, is upwards
to the sensorium commune, where it becomes the occasion of a
new order of phenomena; the law of extension of reflex action
excited by a spinal nerve observably being, as Pfliiger has shown,
from below upwards to the medulla. Having arrived at the
ganglionic cells of the sensorium commune, the stimulus may be
at once reflected through the motor nuclei on a motor nerve, for
which there is provision in a direct physical path, and involun-
tary movements may thus take place in answer to a sensation,
just as involuntary movements take place from the spinal centres
without any sensation. The ganglionic cells of the sensory
centres are unquestionably centres of independent reaction, and
in association with their proper motor nuclei give rise to a class
of reflex movements of their. own. When a man lies with the
lower half of his body paralysed in consequence of injury or
disease of his spinal cord, the tickling of the soles of his feet will
sometimes produce reflex movements of which he is unconscious.
When a man lies with no paralysis of his limbs, but with a
perfectly sound spinal cord, the sudden application of a hot iron
to his foot or leg will give rise to a movement quite as involun-
tary as that which takes place in the paralysed limb, but, in this
case, in answer to a painful sensation; the reaction takes place
in the sensory ganglia, and the movement is sensori-motor. Had
the hot iron been applied to the paralysed limbs, no movement
would have followed,because the path of the stimulus was cut
off as completely as the current of the electric stimulus is inter-
rupted when the telegraphic wires are cut across. Take away
that part of the brain of an animal which lies above the sensory
ganglia, and it is still capable of sensori-motor movement, like as
the animal which possesses no cerebral hemispheres is: because
the ganglionic cell is a centre of independent reaction—a station
on the line which may either send on the message or send off an
answer.* (‘) Make a complete transverse section of the nervous

* Mr. James Mill clearly recognised this class of movements. ‘‘Innumerable
facts are capable of being adduced to prove that sensation is a cause of muscular
1v.] SENSORY GANGLIA, ETC. 103

centres in the rat immediately above the medulla oblongata, and
pinch its foot severely: it will utter a short sharp cry of pain,
which is reflex or sensori-motor. Now destroy the medulla
oblongata, and again pinch the foot: there will be reflex move-
ments, but no cry. The rat, by reason perhaps of having been
hunted through so many generations, is a very fearful animal,
very susceptible, scampering away at the least unusual sound.
If its cerebral hemispheres, its corpora striata, and optic thalami
be removed, it remains quiet; but if a sharp noise be made, such
as a cat makes sometimes, the animal makes a bound away, and
repeats the jump each time that the noise is made.*

Examples of sensori-motor movements are to be found in
the involuntary closure of the eyelids when the conjunctiva is
touched, or when a strong light falls upon the eye; in the dis-
tortion of the face on account of a sour taste; in the quick with-
drawal of the hand when it is touched by something hot; in the
ery which excessive pain calls forth ; in the motions of sucking
which take place when the nipple is put between the infant’s
lips ; in coughing and sneezing; and in yawning on seeing some
one else yawn. Illustrations of acquired movements of this class
are seen in the adaptation of the walk to the music of a military
band, in dancing, in the articulation of words on seeing their
appropriate signs, and in many other of the common actions of
life of which we are not conscious at the time, but of the neces-
sity of which, were there no power of automatically performing
them, we should soon become actively conscious. The instinctive
actions of animals fall under the category of consensual acts :
without the intervention of any conception, the sensation at once
excites the appropriate movement, and the animal is as skilful
on its first trial as it is after a life experience. It is true that
the instinctive life is extremely limited in man, but sensori-
motor action plays a large part in such manifestations of it as

action,” p. 258. After instancing, as examples, sneezing, coughing, the con-
traction of the pupils, and the movements of the eyelids, he says: ‘‘We seem
authorized, therefore, by the fullest evidence, to assume that sensation is the
mental cause, whatever the physical links, of 2 great proportion of the mus-
cular contractions of our frame ; and that among those so produced are found
some of the most constant, the most remarkable, and the most important of that
great class of corporeal phenomena.” —Analysis of the Human Mind, yp. 2665.
* Vulpian, op. cit. p. 548.
104 SECONDARY NERVOUS CENTRES, OR [cHar.

are witnessed ; in the taking of food the movements of mastica-
tion and deglutition, like the earlier ones of sucking, are in
answer to sensations, as also are some of the co-ordinated move-
ments necessary to the gratification of the instinct of procrea-
tion. The adjustment of the human eye to distances, which
takes place with such marvellous quickness and accuracy, is
effected, according to the best authorities, by a change in the
convexity of the lens or the cornea, and an alteration in the
direction of the axes of the eyes. It is not a voluntary, not
even a conscious act, but a consensual act in respondence to a
visual sensation, and it is well suited to convey a notion of
what an instinctive act in an animal is.*

It was said, when treating of the spinal cord, that its faculties
were, for the most part, not innate but acquired by education ;
and the same thing may be said of the sensory centres. Sensa-
tion is not, as the common use of the word might seem to imply,
a certain inborn faculty of constant quantity, but in reality a
general term embracing a multitude of particular phenomena
that exhibit every degree of variation both in quantity and
quality. The sensation of each sense is a gradually organized
result or faculty that is matured through experience; the visual
sensation of the adult is a very different matter from that of the
child whose eyes have recently opened upon the world; Mr.
Nunneley’s patient, whose sight was restored by operation, held
his hands before his face to prevent objects touching his eyes;
the wine-taster’s cultivated sense is nowise comparable with that
of a man who knows nothing of wine; the tactile sensation of
the blind man differs toto cwlo from that of the man who has
always had the full use of his eyes. The complete and definite
sensation is slowly built up in the proper nervous centres from
the residua or traces which previous sensations of a like kind
have left behind them; and the sensation of the cultivated
sense thus sums up, as it were, a thousand experiences, as one
word often contains the accumulated acquisitions of genera-

* For the best summary and discussion of the theories of vision, see Theorte
des Sehens und ratimlichen Vorstellens vom physikalischen, physiologischen und
psychologischen Standpunkte aus betrachtet. Halle, 1861. By C. 8. Cornelius. Also

by the same author, Zur Theorie des Sehens mit Riicksicht auf die neuesten
Arbeiten tn diesem Gebiete, 1864.
1v.] SENSORY GANGLIA, ETO. 105

tions.* Simple as a sensation appears, it is in reality infinitely
compound. (?) We do not see, hear, or otherwise perceive by
sense the exact impression made on the organ, but the effect
excited by the impression in the nerve centre; in other words,
we perceive the interpretation of the impression which our
previous experience has made familiar to us. Vision, Bishop
Berkeley aptly says, is a language speaking to the eye, which
we are not conscious to have learned because we have been
learning it ever since we were born, All that is innate in the
different ganglionic centres is a specific power of reaction to
certain impressions made upon organs specially adapted to re-
ceive them; but as the waste following activity is restored by
nutrition, and a trace or residuum is thus embodied in the con-
stitution of the nervous centre, becoming more complete and
distinct with each succeeding repetition of the impression, it
comes to pass that an acquired nature is ultimately grafted by
education on the original nature of the cell. In the common
metaphysical conception of sensation as a certain constant
faculty, what happens is this: the abstraction from the par-
ticular is converted into an objective entity which thenceforth
‘leads captive the understanding.

Whether, as some hold, our perception of the form and dis-
tance of external objects be due to our muscular experience, or
whether, as others maintain, our visual sensation by itself may
give the notion of extension and distance, it is certain that our
ordinary estimates of distance are very gradually acquired. But
it is not so in many animals: the young swallow can seize its
small prey with as accurate a skill as the old one can after a life-
experience ; and there is a fish that spurts a drop of water at the
little insect moving above the surface, and fails not to bring it
down. The intuition of distance is obviously in such cases
complete and distinct from the first. It is, however, conformable
to the law of development from the general to the special in the

* In regard to this question, an experiment by Volkmann, quoted by Fick, is
interesting and instructive. When the finger, or any limited portion of skin on
one side of the body, is frequently experimented upon with the compasses, in
order to test the degree of sensibility, and its tactile sensibility thereby increased,
as. it notably is, above the level of that of neighbouring parts, the symmetrical part
of the skin on the opposite side of the body will be found to be almost as acute,
—an experimental proof of the same kind as that which the stereoscope furnishes.
106 SECONDARY NERVOUS CENTRES, OR [cuap.

organic world, that what is innate in some of the lower animals
should be acquired by man: the absence of such limitation in
his original nature marks his higher freedom. Still it is most
interesting to observe how much even he is indebted to original
endowment in this very matter of estimating distance. For
what is the immediate cause that determines the muscular
adjustment of the eye to distance? The act is consensual, or,
using the vaguer term, instinctive, in respondence to a visual
sensation or picture—an act of which there is no direct con-
sciousness, and over which the will has no direct control.
Though the process is confused and uncertain at first, unlike
in that regard the process in the lower animals, yet it is not
long before the proper muscular adaptations are acquired and
definite muscular intuitions organized. Plainly, then, very
much is due to the pre-arranged constitution of the nervous
centres even in man. And while we assert that sensation is
not an inborn faculty of constant value in man, it behoves
us not to forget the fact that there are implanted in the con-
stitution of his nervous centres the capabilities of certain
definite associated movements answering to certain sensations,
The idea to be formed and fixed in the mind from a consi-
deration of the phenomena of the development of sensation, and
necessary to its proper interpretation, as indeed to the “interpre-
tation of every manifestation of life, is the idea of organization.
The mind is not like a sheet of white paper which receives just
what is written upon it, nor like a mirror which simply reflects
more or less faithfully every object, but by it is connoted a
plastic power ministering to a complex process of organization,
in which what is suitable to development is assimilated, what
is unsuitable is rejected. By the appropriation of the like in
impressions made upon the senses we acquire a sensation, of
which we might speak, as we do when speaking of idea, as
general or abstract ; it henceforth exists, latent or potential, as
a faculty of the sensory centres, and on the occasion of the
appropriate impression renders the sensation clear and definite—
in other words, gives the interpretation. It is exactly like what
happens in the spinal centres, and exactly like what happens, as
we shall hereafter see, in the ideational centres. Coincidently
with the assimilation of the like in impressions, there is neces-
rv. SENSORY GANGLIA, ETC. 107

sarily a rejection of the unlike, which, being then appropriated
by other cells, becomes the foundation, or lays the basis, of the
faculty of another sensation, just as nutrient material which is
not taken up by one kind of tissue element is assimilated by
another kind. In the education of the senses, then, there takes
place a differentiation of cells ;-in other words, a discernment, as
well as an improvement of the faculty of each kind of sensation
by the blending of similar residua. There is an analysis sepa-
rating the unlike, a synthesis blending the like; and by the
two processes of differentiation and integration are our sensa-
tions gradually formed and developed. The process illustrates
the increasing speciality of individual adaptation to external
nature; and the length of childhood in man is in relation to
the formation of his complex sensations.

The organization of our sensations is not, however, limited
simply to the formation of the particular sensation; by it is
effected also the association or catenation of sensations. In
animals there can be no doubt that one sensation frequently calls
another into activity, in accordance with the order established
among them, without the intervention of idea; they are much
more dependent on sensation than man is, and therefore the asso-
ciation of sensations in the causation of movements is more
marked. Hence it is that blinding of one eye produces verti-
ginous movements in pigeons, as Flourens and Longet have
shown, and that section of the semicircular canals of the ear
also produces various disturbances of movements. The trouble,
inconvenience, and occasional vertiginous feelings produced for
a time in man when he suddenly loses his hearing in one ear,
probably spring from the interruption to the complex. associa-
tion of sensations habitual to him in the daily movements of
life. He only learns how much he depends on such associations
when disorder or loss of them occurs. It is certainly difficult
in him to eliminate the influence of the higher cerebral centres,
yet in those functions in which consensual action has most
part—in the taking of food, for example, where succeeding sen-
sations bring into successive action different complex muscular
movements and again in the sexual act—there is abundant
evidence of an association of sensations.

-Thus much concerning sensation, viewed on its passive or
108 SECONDARY NERVOUS CENTRES, OR [cmap.

receptive side. Let us say something more of the active, re-
acting, or distributive side—of the movements which take place
in answer to sensations. These reactions may, like the reflex
movements of the spinal cord, be irregular, as when a wry face
is produced by a sour taste, or a general start of the body follows
a sudden loud noise ; or co-ordinate, as in coughing and sneezing.
Of the co-ordinate or designed movements, again, some are innate,
as those of the animals mostly are; others are acquired or
secondarily automatic, as is mostly the case in man.

The instinctive acts of animals are, for the most part, innate
sensori-motor actions. They have for aim the preservation of
the individual and the propagation of the species ; and are com-
parable to such movements in man as the closure of the eyelid
when the conjunctiva is touched or the eye threatened, the
withdrawal of the hand when suddenly burnt, the sneezing by
which an offending body is ejected from the air-passages, or some
of the movements in sexual intercourse. The faculty of executing
them exists in the pre-arranged constitution of the nervous
centres, and is entirely independent of will or experience; so
that, if we chose to assume a consciousness in the individual
cells ministering to them, we should say that they possessed a
notion of the end to be effected. Now the cells probably possess
such notion exactly in the same manner as the elements of a
chemical compound possess a notion of the end which they are
going to accomplish, or as the wind bloweth where it listeth ;*
accordingly they do not fail at times to make terrible mistakes,
and perhaps miserably to kill an individual by continuing vio-
lently a reflex action, in the cessation of which lay the only
hope of life. When the cerebral hemispheres are experimentally
removed in animals, as was done by Flourens and Schiff, the
sensori-motor acts abide: the animal appears as if in a sleep or
dream, and takes no notice ; yet if a pigeon so treated be thrown
into the air, it flies; if laid on its back, it gets up; the pupil

* “ Whoever will examine the language of mankind, may find that we apply
expressions to bodies which belong properly to our own manner of proceeding ;
and, how well soever we know the contrary, speak of them as voluntary agents,
exercising powers of their own; thus it is said that the wind bloweth where it
listeth, and we say of water that it will not mingle with oil, that it will force its
way, &c.. terms expressive of a choice, compliance, and resolution similar to
those exercised by man.”’—Tucxzr’s Light of Nature, vol. ii. p. 545.
1v.] SENSORY GANGLIA, ETC. 109

contracts to light, and in a very bright light the eyes are shut;
it will dress its feathers if they are ruffled, and will sometimes
follow by a movement of the head the movement of a candle
hither and thither: certain impressions are plainly received, but
they are not further fashioned into ideas, because the nervous
centres of ideas have been removed; and, as has been aptly
observed, the animal would die of hunger before a plateful of
food, although it would swallow the food if put far enough into
its mouth. The clenching of the teeth in man during severe
pain is sensori-motor, and only a less degree of the same kind of
reflex action which in lockjaw becomes actual spasm. Schroeder
van der Kolk mentions a lady who had her breast amputated
under chloroform, and who, though she felt no pain, was per-
fectly conscious on awakening that she had heard herself shriek ;
and he has witnessed violent shrieking in apoplexy, where there
was no trace of consciousness. Any one who has walked through
a parrot house, and heard the fearful noise which these scream-
ing creatures make, must surely have felt an involuntary incli-
nation to shriek also.

It must be borne in mind that the sensori-motor reaction may
be excited not only by the stimulus from,without, but also by, so
to speak, sensation from within the body—by the organic stimuli.
Flourens has observed birds deprived of their hemispheres stand
on one leg, and after a time, owing probably to a sensation of
fatigue, change to the other leg; shake their heads, and put
them under the wings for sleep; ruffle their feathers, and some-
times plume them with their beaks. Intelligence and will can
have no part in such movements; they are sensori-motor, and
some of them obviously take place in answer to sensations
arising within the body. It is not because we have no direct
consciousness of the operation of the stimuli that they do not
therefore influence the mental life. In animals, the actions
respondent to them constitute the principal manifestations of
their psychical life; and in man, when the influence of the
higher nervous centres is weakened by disease, or when an
organic stimulus has an abnormal activity, as happens often in
insanity, we sometimes see the instinct for food or the sexual
instinct manifested with an utter shamelessness. In such cases
there is great truth in an observation made by Jacobi, that the
110 SECONDARY NERVOUS CENTRES, OR [cmar.

actions of the insane have an instinct-like character, as their
physiognomies take on an animal-like look. The great revo-
lution effected in the mental nature of man at the time when
the organs of reproduction come into functional activity, affords
a striking illustration of a physiological effect which in less
degree is common to all the organic stimuli. And no account of
the sensori-motor actions can be complete which fails to give due
appreciation to the influence of a stimulus arising within the
organism as an exciting cause of certain associated or aim-
working-movements.

Of more importance than the innate sensori-motor acts in
human development are those which are acquired, and which
are often called the secondary automatic acts. When any one
moves about in a house or a room with the objects in which he
is quite familiar, he is scarce more conscious of the greater part
of his movements or of the objects around than he is of the
movements of his breathing or of his particular steps in walking;
notwithstanding which he does not run against the chairs nor
stumble at the stairs, but fairly adapts his movements to the
positions of objects. But if-some new piece of furniture be
placed in a part of the room where there was nothing before, the
chances are that he does stumble against it, until, by familiarity
or habit, the sensation of its presence has been associated with
a corresponding movement. It will sometimes happen that,
when the mind has been deeply occupied, a person has walked
from one place to another through busy streets and yet been
unable, on reflecting afterwards, to say positively which way
he took, though he has undoubtedly had sensory perceptions
of the objects which he has avoided in his walk. In dancing,
in playing some musical instrument, in writing, in that grace
and ease of movement acquired by social cultivation, we have
other excellent examples of acquired consensual acts. A more
striking instance, perhaps, than any of these is the association
which is established by education between particular sounds, or
particular visual sensations, and the adapted complex movements
for the articulation of the appropriate words. Children plainly
exhibit a great tendency to imitate a particular sound, when
there is certainly not yet any idea of what the sound means;
and, as every one knows, it is sufficiently easy to read aloud
Iv.] SENSORY GANGLIA, ETC. lll

without the slightest attention to the meaning of what is read,
the consciousness being otherwise engaged. A story is told of
a child which could speak both in English and German, but
which always replied to a question in the language in which it
was addressed, and could not reply to an English question in
German, or to a German question in English. Without doubt
the child connected definite ideas with the words used ; but the
fact that it could not put the same ideas into one language or
the other, as required, showed the dominion exercised by the
sound over the articulating movements—the mechanical con-
nexion established between sensation and movement. Language,
difficult as it is of acquisition, ultimately gets all the ease of a
reflex act, and so many waste floods of fruitless words are poured
forth without fatigue by some who, like Peter proposing to build
the three tabernacles, know not what they say. Consciousness is
not a necessary accompaniment ; talking may be conscious, semi-
conscious, or entirely unconscious. Secondary automatic acts of
a like kind are also observably acquired by animals, although in
them the consensual acts are mostly innate; particular habits
or tricks being observably taught to them or acquired by them.
How many of the common actions of man’s everyday life fall
under the category of consensual acts, few people sufficiently
consider.

It is of the utmost importance to a true conception of the
nature of mental action that the full meaning and real bearing
of the foregoing facts should be distinctly realized. From a
physiological point of view they are readily enough admitted ;
but the moment sensation is viewed as a mental faculty, an
entirely new order of ideas commonly supervenes, and it appears
to be thought monstrous to suppose that the full sensation is
not innate, but gradually matured through years of experience.
Then, again, it is almost impossible to make those who take the
metaphysical view of mental action, realize the organic connexion
which is established between the stimulus, or the sensation, and
certain movements, whereby these finally become mechanical or
automatic: when any end is accomplished, they fail not instantly
to assign intelligence, and to assume design. It is not necessary
to repeat here what was said of design, when treating of the
spinal cord: the act, with whatever of design it contains, is the
112 SECONDARY NERVOUS CENTRES, OR [cHap.

necessary result of a certain constitution, innate or acquired, of
the nervous centres. In the humbler animals the life-aims are
merely organic ; the sensory ganglia suffice, therefore, as nervous
apparatus; and the faculties of them, being primordial, are
comparatively few, fixed, and simple. In man, however, whose
relations are so much more numerous and special, whose life-aims
reach far beyond the mere organic, there is not only a further
complication of the nervous system as an original fact, but there
is an acquired adaptation throughout life of the sensory ganglia
to the complex external relations, so that their functional mani-
festations are more numerous, special, and complex. But in the
latter case, as in the former, the action is ultimately automatic,
and then as effectually accomplished without consciousness as
with it. Until the psychologists ground their conceptions on
these simple truths, they must continue to struggle fruitlessly in
the maze of undefined words.

Observation has been so much vitiated, and the understanding
so enslaved, by the influence of time-honoured metaphysical
conceptions of mental phenomena and by the use of meta-
physical language, that it is one of the hardest things in the
world to observe mental acts faithfully and accurately, and to
interpret them naturally. There would seem to be a positive
inability in certain minds to conceive mental action of any kind
taking place with different degrees of consciousness or with no
consciousness at all; and this constitutes the great difficulty in
the endeavour to dati forth in their natural order the phenomena
of sensation and sensori-motor action, and to appraise their real
nature. Now it admits of no question whatever that sensations
and their respondent movements, which excite consciousness
when first experienced, gradually become completely organized
in the appropriate nerve centres, and then take place without
consciousness. We cannot, therefore, strictly speaking, use the
word memory as applicable to such casés, because of the absence
of consciousness ; the memory which exists is an unconscious
memory. Furthermore, the term perception is very apt to cause
confusion in its application to the senses. Where there is
sensation, it is said, there is perception; and where there is
perception, there is idea or intelligence: how then can you
justly discriminate between the sensorial functions and the
1v.] SENSORY GANGLIA, ETC. 113

ideational functions? The fallacy here lies in the vague use
of the word “ perception”—in the confounding of all kinds of
perception under the one general notion. There are in reality
different kinds of perception—sensorial perception and ideational
or intellectual perception ; the former a kind of instinctive act,
the latter an intellectual act. Though, like all other species in
nature, these run into one another, they still present marked
differences, and must be distinguished in a true science of mind.
A conception of the kind of perception which animals without
cerebral hemispheres have, or of that which the somnambulist
has, the functions of whose cerebral hemispheres are in abeyance,
will materially assist us in the apprehension of the phenomena
of sensorial perception in man and in the right interpretation
of them. What degree of consciousness accompanies this per-
ception is not easily determined; the common notion of con-
sciousness, which is applied in all cases, is taken entirely from
reflective consciousness, or self-consciousness, the seat of which
undoubtedly is in the highest ganglionic centres—the nerve
centres of intelligence; but a reflection upon the degree of con-
sciousness which any one has of the different steps of his toilet,
or of the objects in a room among which he moves when his
mind is fully occupied, and of the entire unconsciousness with
which a sensation of light causes contraction of the iris, or the
distance of an object looked at causes an accommodation of the
eye, will convey an idea of the small part which consciousness
plays in the ordinary perception of the senses, and in the motor
reactions thereto.

If those who are disposed to take the metaphysical view of
mental action, insist on seeing an act of intelligence in every
kind of perception, then it will be necessary to give another
name to that sensory perception of impressions which takes place
where there are no cerebral hemispheres, or where these have
been removed, which takes place in fact without the animal
perceiving that it perceives, Even so philosophical a writer as
Miiller thought the sensory centres to be endowed with some
degree of voluntary power, because of the remarkable actions to
which they minister; thus unwarrantably introducing into his
observation, and applying to his interpretation, of the functions
of the secondary nerve centres, conceptions derived from his

I
114 SECONDARY NERVOUS CENTRES, OR [cHAP,

knowledge of the higher or primary nerve centres. This was to
reverse the natural order of investigation, and to apply the
complex and obscure to the interpretation, or rather the misin-
terpretation, of the more simple, instead of ascending inductively
through the simple to the complex. Those who maintain every
kind of perception to be an act of intelligence are guilty of the
same error as that which Miiller fell into ; and they will assuredly
continue to stumble into confusion and error until they modify
in some degree, or get entirely rid of, the metaphysical notions
of consciousness.

The reaction of the motor ganglia in the sensorium commune,
whether designed or undesigned, co-ordinate or irregular, may
be excited not only by impressions conveyed to them by afferent
nerves, and by the so-called organic stimuli, but also by a
stimulus descending from above. An idea or an impulse of the
will, coming from the higher nervous centres, may act upon the
ganglionic secondary centres, and call forth those movements
which are commonly reflex to impressions from without. In
such case it is tolerably certain that the idea or volitional im-
pulse does not act directly on the motor nerve-fibres, but that it
acts indirectly through the ganglionic cells of the motor nuclei,
in which the potentiality of the movement exists latent, statical,
or abstract; the stimulus from above disturbing the organic
equilibrium, and, as it were, releasing or setting free the move-
ment together with whatsoever of design there is in it; the same
operations are performed, and through the same means, as when
the impression conveyed by the afferent nerve from without
excites the movement. Thus the will is entirely dependent for
its outward realization upon that mechanism of automatic action
which is gradually organized in the subordinate centres; it
cannot, as we shall hereafter see, at once instigate successfully
a new movement, nor can it execute any movement without
a guiding sensation of some kind: the cultivation of the senses,
and the special adaptations of their reactions, which are gradually
organized, are necessary antecedents, essential prerequisites,
to the due formation and operation of will. The sensorium
commune represents, in fact, various independent nervous
centres, and never does act merely as a conductor transmitting
unmodified the stimulus, whether this ascend from without, or
1v.] SENSORY GANGLIA, ETC. 115

descend from the cerebral hemispheres. Bear this clearly in
mind, and the memory of it will help to get rid of some diffi-
culties, when we come to deal with the will.

It is not needful to say anything here of the seeming dispro-
portionate amount of force given out in the movement which is
respondent to a moderate stimulus to the sensory ganglia; inas-
much as what was said in this regard of the spinal centres is
strictly applicable to the secondary nervous centres. A special
investigation would only serve here, as elsewhere, to adduce
needless evidence in support of the principle of the conservation
of force.

And now let us briefly indicate the general causes of disorder
of the functions of the sensory ganglia: they are mainly such
as have been already pointed out as causes of disturbance of the
functions of the spinal cord :—

1. As a natural fact, there may be an innate vice, feebleness,
or instability of composition of the ganglionic cells. Such fault
of nature is commonly owing to the existence of some nervous
disease in the hereditary antecedéiits ; but it may of course be
due to any other of the many recondite causes of degeneration
of nerve element. Hallucinations of vision are by no means
unfrequent amongst some children at an early age, especially
among such as suffer from chorea. And in those rare cases in
which insanity occurs in children almost from the time of their
nativity, it is chiefly exhibited in violent and irregular sensori-
motor movements ; herein resembling essentially the insanity
that sometimes ensues in animals. The unnatural laughter,
the shrieking, the biting, and the tearing of the insane infant
assuredly testify to a degenerate state of the motor and sensory
cells in the sensorium commune: one might even venture to say
that there was a true sensorial madness, It is most interesting
to add that the disorder may alternate with, or be replaced by,
general convulsions, the madness ceasing when the convulsions
supervene, and supervening when the convulsions cease ; there
is a transference of the disturbance from one system of nervous
centres to another.

Again, there may be every degree of deficient sensibility down
to actual insensibility of the ganglionic cells of the sensory
ganglia, It is obvious that people differ naturally in the acute-

12
116 SECONDARY NERVOUS CENTRES, OR [cHAP.

ness of their senses ; and in idiots the senses notably partake of
the general stupidity. In them the hearing is frequently defec-
tive; smell is often imperfect, the olfactory bulbs being insuffi-
ciently developed ; taste absent or extremely vitiated, so that
they will eat unconcerned the filthiest or the most pungent
matters ; and the sensibility of the skin is sometimes extensively
absent, or it is generally dull, so that they suffer very little pain
from injuries. The idiots of the lowest class: have usually
no other affection but that of hunger, which they exhibit by
unrest, grunting, or the like; but even some of these miser-
able creatures have at times attacks of fury, without evident
reason, in which they scratch, strike and bite, as the insane
infant does.

Dulness of sensibility, when not nearly reaching the stage of
idiotic degeneration, is of course unfavourable to intellectual
acquisition ; but, on the other hand, a very acute and delicate
sensibility is attended with evils and dangers of its own. In
the former case, although there is a hindrance to assimilation,
yet that which is appropriated is commonly retained with great
persistency ; in the latter case, there is certainly quick reaction,
but no lasting appropriation, and, if the sensibility is intensified
beyond a certain point, there may even be a lapse into that
degenerate state in which, not the special sensation, but pain is
felt, and irregular and convulsive reaction takes place. It is of
no small importance that these natural differences in the consti-
tution of the ganglionic cells should be plainly recognised, for
they unquestionably are at the root of certain differences in
individual character and intellect.

2, An excessive use of the senses, without due intervals of rest,
produces exhaustion, or actual degeneration of them ; here, as
elsewhere, the force expended must be restored, if the energy of
the matter is to be maintained. A too powerful impression
made upon any sense may also diminish, or actually destroy, its
power of reaction; immediate paralysis of sight, of hearing, or
of smell has followed a sudden and powerful impression upon the
particular sense ; and if the paralysis is not complete, the sensi-
bility of the sense for weaker impressions may still be lowered for
some time. Moreover, the sensation itself may persist for a while
after the cause of it has disappeared, as when an image of the
v.] SENSORY GANGLIA, ETC. 117

sun remains after we have ceased to look at it, or-the roar of the
cannon abides in the ears after the firing has ceased. Such per-
sistence of action in the ganglionic cell will serve to convey a
notion of the condition of things when there is hallucination
otherwise caused.

3. The state of the blood has the most direct effect upon the
functions of the sensory ganglia. Too much blood, as is well
known, gives rise to subjective sensations, such as flashes of light
-before the eyes, and roaring in the-ears ; but it is not so generally
‘known that, when the abnormal action reaches a certain intensity,
movements responsive to, or sympathetic with, the hallucina-
tions may take place. Nevertheless, they may: as the sensory
ganglia have an independent action in health, so also may they
act independently in disease ; and as in health there is co-ordinate
or designed sensori-motor action, so in disease there may be
convulsive sensori-motor action evincing more or less co-ordina-
tion or design. Of violent, but more or less co-ordinate, action
we have, I think,'a good example in the raving and dangerous
fury which often follows a succession of severe epileptic fits, and
which I take leave to describe as in great part a true sensorial
insanity. The patient’s senses are possessed with hallucinations,
his ganglionic central cells in a state of convulsive action ;
before the eyes are blood-red flames of fire, amidst which whoso-
ever happens to present himself, appears as a devil, or otherwise
horribly transformed ; the ears are filled with a terrible roaring
noise, or resound with a voice imperatively commanding him to
save himself; the smell is perhaps one of sulphurous stifling ;
and the desperate and violent actions are, like the furious acts
of the mad elephant, the convulsive reactions to such fearful
hallucinations. The individual in such state is a machine set in
destructive motion, and he perpetrates the extremest violence
or the most desperate murder without consciousness at the
time, and without memory of it afterwards. When we come to
-the general pathology of insanity, we shall have more to say
upon this matter.

A deficiency of healthy blood is a cause of disorder of the
sensory centres. A great loss of blood powerfully affects the
senses; the anemia of chlorotic and hysterical women is the
probable cause of the many anomalous sensations and motor
118 SECONDARY NERVOUS CENTRES, OR [cHAP.

disturbances, which disappear as the condition of the blood im-
proves ; and a manifest poverty of blood often accompanies the
chorea of children with its hallucinations.

A perverted condition of the blood, whether from something
bred in the body or introduced from without, is known to be a
powerful cause of sensory disorder. Evidence of such injurious
influence we have in the hallucinations which sometimes follow
for a time certain acute diseases, as well as in the delirium which
occurs in the course of them; in the effects which alcohol pro-
duces upon the senses; in the actions of poisons, such as bella-
donna and aconite, which markedly affect the senses; and
especially in the operation of haschisch, a poison which, appears
to concentrate its action upon the sensorium commune.* In
hydrophobia the presence of a virus in the blood notably gives
rise to most violent nervous disturbance ; the sight or sound of
‘a fluid, a movement in the room, or a current of air, being suffi-
cient to excite terrible convulsions.

4, An irritation operating by reflex action is undoubtedly the
occasional cause of sensorial disturbance. Pressure upon or
wound of a sensitive nerve has sometimes produced extensive
paralysis of sensibility ; a bad tooth may notably give rise to
amaurosis ; vertigo, hallucinations, and illusions are now and
then plainly the result of an irritation proceeding from a centri-
petal nerve, not perhaps felt in any other way than as it is
testified by effects which disappear with the removal of the irri-
tation. An interesting example of severe disturbance of the
nervous centres from a slight eccentric irritation, is related by
Dr. Brown-Séquard, to whom it was communicated by Mr.
C. De Morgan. A lad, aged fourteen, as he was getting up in
the morning, was heard by his father to be making a great noise
in his bedroom. On the latter rushing into the room, he found
his son in his shirt, violently agitated, talking incoherently, and
breaking to pieces the furniture. His father caught hold of him
and put him back into bed, where at once the boy became com-
posed, but did not seem at all conscious of what he had done.
On getting out of bed he had felt something odd, he said, but

* Regarding the effects of haschisch, I may refer, in addition to Moreau’s well
known experiments, to De Luca in the Journal de Pharmacie, 1862, tome xlii,
p. 396.
1v.] SENSORY GANGLIA, ETC. 119

he was quite well. A surgeon, who was sent for, found him
reading quietly, with clear tongue and cheerful countenance, and
wishful to get up. He had never had epilepsy, but had enjoyed
good health hitherto. He was told to get up; but on putting
his feet on the floor, and standing up, his countenance instantly
changed, the jaw became violently convulsed, and he was about
to rush forward, when he was seized, and pushed back on to the
bed. At once he became calm again, said he had felt odd, but
was surprised when asked what was the matter with him. He
had been fishing on the previous day, and having got his line
entangled, had waded into the river to disengage it, but was not
aware that he had hurt his feet in any way,—that he had even
scratched them. “ But on holding up the right great toe with
my finger and thumb, to examine the sole of the foot, the leg
was drawn up, and the muscles of the jaw were suddenly con-
vulsed, and on letting go the toe these effects instantly ceased.”
There was no redness, no swelling, but on the bulb of the toe a
small elevation, as if a bit of gravel, less than the head of a pin,
had .been pressed beneath the cuticle. On compressing this
against the nail cautiously, a slight convulsion ensued ; there
was no pricking when pressed, but he said something made him
feel very odd. The slightly raised part was clipped away; no
gravel was found, but the strange sensation was gone, and never
returned.*

The general bodily feeling which results from the sum of the
different organic processes is not attended with any definite
consciousness, or idea, of the causes that give rise to it; the
organic stimuli are, in fact, organically felt, but do not in the
natural state of health excite, as a stimulus to one of the special
senses does, a particular state of consciousness; and when the

* Lectures on the Phystology and Pathology of the Central Nervous System, by
Dr. Brown-Séquard, 1860, A case singularly like the one above related is quoted
by Burrows (Commentaries on Insanity, p. 215) from Hufeland, A boy between
thirteen and fourteen years’ of age suddenly began to talk in « yery wild and
incoherent way, and at length became ungovernable. This state was assuaged by
soporifics. But the paroxysm was observed to recur whenever he was placed on
his feet. On examination, a reddish spot was noticed on one foot, which, when
pressed, always occasioned a fresh paroxysm. Upon an incision being made, a

minute piece of glass was discovered, and extracted. During the operation the
patient was furious, but every symptom of violence vanished when the offending

cause was removed.
120 SECONDARY NERVOUS CENTRES, OR [cHap.

organic stimuli do force themselves into consciousness, as
happens in disease, then it is in pain that their action is felt.
In respect of our organic feeling we are, in reality, not unlike
those humble animals that have a general sensibility without
any organs for special discrimination and comparison. Having
no idea of the particular cause of any modification in this
general feeling, we are plainly most favourably placed for the
generation of illusions with regard to the cause. Consequently
it is not surprising to find that the insane frequently have
extravagant hallucinations and illusions respecting the cause of
an abnormal sensation, which is actually due to a morbid state
of some internal organ ; they think to interpret it as its unusual
character seems to demand, and in accordance with their
experience of the definite perceptions of the special senses ;
and accordingly they attribute the anomalous feeling to frogs,
serpents, or other such creatures that have got into their
insides.

5, Whether any beneficial influence is exerted upon the
nutrition of the nervous centres of the sensorium commune by
the centres that lie above it, must remain uncertain, though it is
extremely probable. No trustworthy conclusions can be drawn
from experiments in which the cerebral hemispheres have been
removed, for the mischief done is far too great to warrant any
inference. It is certain that an area of morbid activity in the
cerebral hemispheres may act injuriously upon the sensory
centres, and give rise to secondary derangement of their
functions; but the result is then most likely due to reflex or
sympathetic action, the morbid centre acting as a morbid centre
of irritation in another internal organ notably does.

In concluding this account of the sensory nervous centres, we.
have only to add that a review of their relations and functions
does certainly establish a close analogy with the relations and
functions of the spinal centres. In both cases there are nervous.
centres which have the power of independent reaction, though
they are usually subordinated to the control of higher centres ;
in both cases the faculties are for the most part organized in
relation to outward circumstances through the plastic power of
the nervous centres ; and, in both cases, the independent power
of action of the centres may, by reason of disease, be exhibited.
iv.) SENSORY GANGLIA, ETC. 121

in explosive demonstration. The convulsive paroxysm which
seizes on the cells of the sensorium commune, and drives the
furious epileptic on to desperate violence, is as little within his
control as is the convulsion of his limbs that is owing to disease
of the spinal cord.

NOTES.

1 (p.102).—Tt ought not to be forgotten that Dr. Darwin distinguished
voluntary from sensori-motor movements. ‘ Many common actions of
life are produced in a similar manner (i.e. by sensation). If a fly
settle on my forehead, whilst I am intent on my present occupation, I
dislodge it with my finger without exciting my attention or breaking
the train of my ideas.”—Zoonomia, vol. i. p. 40. “Other muscular
motions, that are most frequently connected with our sensations, as
those of the sphincter of the bladder and anus, and the musculi
erectores penis, were originally excited into motion by irritation, for
young children make water, and have other evacuations, without
attention to these circumstanves—‘et primis etiam ab incunabulis
tenduntur seepius puerorum penes, amore nondum expergefacto,’ So
the nipples of young women are liable to become turgid by irritation,
long before they are in a situation to be excited by the pleasure of
giving milk to the lips of the child.”—Jtid., p. 38. “There is a
criterion by which we may distinguish our voluntary acts or thoughts
from those that are excited by our sensations. The former are always
employed about the means to acquire pleasurable objects, or to avoid
painful ones; while the latter are employed about the possession of
those that are already in our power.” And he goes on to say that the
ideas and actions of brutes, like those of children, are almost per-
petually produced by their present pleasure or their present pains ;
they seldom busy themselves about the means of procuring future
pliss or avoiding future misery.—J6ed., vol. i. p. 184.

2 (p. 105).—‘‘ ALciPHRON :—If vision be only a language speaking
to the eyes, it may be asked, when did men learn this language? To
acquire the knowledge of so many signs as go to the making up a

‘language, is a work of some difficulty.- But will any one say he hath
spent time, or been at pains, to learn this language ?

“‘ EupHRaNnor :—No wonder we cannot assign a time beyond our
remotest memory. If we have been all practising this language ever
since our first entrance into the world—if the author of nature con-
stantly speaks to the eyes of all mankind, even in their earliest infancy,
122 SECONDARY NERVOUS CENTRES, ETC. [cHAP. Iv.

whenever their eyes are open in the light, whether alone or in company,
it doth not seem to be at all strange that men should not be aware that
shey had ever learned a language begun so early, and practised so con-
stantly as this of vision. And if we also consider that it is the same
‘hroughout the whole world, and not like other languages, differing in
lifferent places, it will not seem unaccountable that man should mistake
ihe connexion between the proper objects of sight and the things sig-
aified by them to be founded in necessary relation, or likeness, or that
hey should even take them for the same things. Hence it seems
xasy to conceive why men, who do not think, should confound in this
anguage of vision the signs with the things signified, otherwise than
ihey are wont to do in the various particular languages formed by
ihe several nations of men.”—BisHop Berxeiey’s Minute Philosopher,
vol. i, p. 393.
CHAPTER V.

HEMISPHERICAL GANGLIA ; CORTICAL CELLS OF THE CEREBRAL
HEMISPHERES ; IDEATIONAL NERVOUS CENTRES;* PRIMARY
NERVOUS CENTRES ; INTELLECTORIUM COMMUNE.

HAT the nerve-cells which exist in countless numbers in the
grey cortical layers of the hemispheres are the nervous
centres of ideas, is fully admitted by all those who have most
studied the physiology of the brain, and are best entitled to
speak on the matter. The cerebral hemispheres represent, in
reality, two large ganglia that lie above the sensory centres, and
are superadded in man and the higher animals for the further
fashioning of impressions, or of sensory perceptions, into ideas
or conceptions. This important step in the evolution of the
human mind consists in the abstraction of the essential from the
particular and its re-embodiment in idea; it is strictly an ideali-
zation of the sensory impressions, and represents, so to speak, an
epigenetic development of nature: what the true artist does in
his art nature does continually in the development of the human
mind. Looking not at the individual man and his work as the
end, but looking at him as a small and subordinate part of the
vast and harmonious whole, as a means to a far-off end, it is suf-
ficiently evident that the history of mankind is the history of
the latest and highest organic development—that in the evolution
of the human mind nature is undergoing its consummate de-
velopment through man. And the law manifest in this highest
display of organic development, is still that law of progressive

* “We have not a name for that complex notion which embraces, as one whole,
all the different phenomena to which the term ‘Idea’ relates. As we say ‘Sen-
sation,’ we might also say ‘Ideation ;’ it would be a very useful word ; and there
is no objection to it, except the pedantic habit of decrying a new term.”—JAMES
Mit, Analysts of the Human Mind, p. 42.
124 HEMISPHERICAL GANGLIA, OR (crap.

specialization and increasing complexity which has been trace-
able through the long chain of organic beings. So exquisitely
delicate, however, are the organic processes of mental develop-
ment which take place in the minute cells of the cortical layers,
that they are certainly, so far as our present means of investiga-
tion reach, quite impenetrable to the senses; the mysteries of
their secret operations cannot be unravelled ; they are like nebulz
which no telescope can yet resolve.

The cerebral hemispheres are not alone the nerve centres of
ideas, but they are also the centres of emotion and volition.
In animals that are deprived of their hemispheres, all trace of
spontaneity or will in their movements disappears; this effect
being, as might be expected, much more evident in experiments
on the higher than on the lower Vertebrata. In Fishes, as for
example in the carp, scarcely any difference is observed in its
swimming after its hemispheres have been removed ; but if its
movements be watched more carefully, and compared with those
of a carp which has not been mutilated, a certain change will be
recognised. According to Vulpian, it moves forward in a straight
line, never turning to one side or the other except when it meets
with an obstacle, and not stopping until it is completely fatigued ;
it seems impelled to move by some necessity, a necessity oc-
casioned probably by the stimulus of the water on its body.
The more marked effects produced in the higher Vertebrata by
the removal of the hemispheres have already been described.

The anatomists believe that they have now demonstrated that
the nerve-fibres which ascend from the spinal cord through the
medulla oblongata do not pass directly to the surface of the
hemispheres, but end in the ganglionic cells of the corpora
striata and optic thalami; new fibres starting from these cells,
and radiating to the cortical cells, to establish the communication
between the primary and secondary nervous centres.* There is,
then, a sufficient anatomical reason for an inference previously
made on other grounds, which is, that an idea, or an impulse of

* Vulpian, however, believes that some fibres from the cerebral peduncles pass
directly to the cerebral hemispheres of the corresponding side, either through the
corpus striatum or beneath it; founding his opinion on some cases in which he
has seen lesion of the hemispheres, not affecting the corpus striatum, followed by
a descending atrophy of nerve fibres analogous to that which follows lesion of the

corpus striatum.
v.] IDEATIONAL NERVOUS CENTRES. 125

the will, cannot act directly upon the motor nerve-fibres of the
body, but can only act through the medium of the proper subor-
dinate centres. There is an explanation also of the fact that
irritation of the white substance of the brain does not occasion
either movements or signs of pain. It is extremely probable,
again, that different convolutions of the brain do discharge dif-
ferent functions in our mental life; but the precise mapping out
of the cerebral surface, and the classification of the mental
faculties, which the phrenologists have rashly made, will not
bear scientific examination. That the broad, high, and prominent
forehead indicates great intellectual power was believed in Greece,
and is commonly accepted as true now; the examination of the
brains of animals and idiots, and the comparison of the brain of
the lowest savage with the brain of the civilized European, cer-
tainly tend to strengthen the belief. Narrow and pointed hemi-
spheres assuredly do mark an approach to the character of the
monkey’s brain. There is some reason to believe also, that the
upper part of the brain and the posterior lobes have more to do
with feeling than with the understanding. Huschke has found
these parts to be proportionably more developed in women than
in men; and Schroeder van der Kolk thought that his patho-
logical researches had afforded him the most convincing proofs
that the anterior lobes of the brain were the seat of the higher
intellectual faculties, while the upper and posterior lobes
ministered rather to the emotional life. Recently some obser-
vations have been made with the view of establishing a theory,
that a portion of the anterior lobe, the third frontal convolution
of the left hemisphere, was the seat of language; but the obser-
vations reported are unsatisfactory, directly contradictory obser-
vations are overlooked or ignored, and it is contrary to the first
principles of psychology to suppose that language, complex and
organic as it is in its intellectual character as the sign or symbol
of the idea, can have so limited and defined a seat in the brain.
On the whole, it must be confessed that, so far, we have not any
certain and definite knowledge of the functions of the different
parts of the cerebral convolutions. The anatomists cannot even
agree on any convolution as peculiar to man; all that they can
surely say is, that his convolutions are more complex and less.
symmetrical than those of the monkey. “If man was made in
126 HEMISPHERICAL GANGLIA, OR [cHap.

the image of God, he was also made in the image of an
ape.” *

The cortical cells of the hemispheres, like the ganglionic cells
of the sensory centres and of the spinal cord, may certainly act
as nervous centres of independent reaction. Without any vo-
lition, or even in direct defiance of volitional effort, an idea
which has become active may pass outwards, and produce move-
ment, or some other effect upon the body. The suddenly excited
idea of the ludicrous, for example, causes involuntary laughter ;
the idea of an insult, a quick movement of retaliation; the idea
of a beautiful woman, a glow of amatorial passion ; the idea of a
great impending danger, or of a sudden terrible affliction, serious
or even fatal disturbance of the organic life; the idea of an
object, sometimes an actual hallucination. Most of the earlier
actions of children are prompted by ideas and feelings which are
excited by suggestions from without, and which immediately
react outwards. In the phenomena of electro-biology or hyp-
notism, the mind of the patient is possessed with the ideas
which the operator suggests, so that his body becomes an auto-
matic machine, set in motion by them. Every one’s experience
will recall to him occasions on which an idea excited in his
mind could not be dismissed therefrom by the will, and perhaps
would not let him rest until he had realized it in action, even
though such realization appeared to his judgment inadvisable.
Those who have attended carefully to the course of their own
thoughts, and reflected upon their actions, will readily acknow-
ledge that an idea sometimes arises and produces a movement
without there having been any active consciousness of it, the
effect being that which first arouses consciousness, if it be
aroused at all. How many of the daily actions of life, thus
accomplished, are we never conscious of unless we set ourselves
deliberately to reflect. It is most certain that there may be a
reaction outwards of an ideational nerve-cell, independently of
volition, and even without consciousness. ,

As it is with the faculties of the spinal and the sensory
centres, so is it with the faculties of the ideational centres:
they are not innate, but are developed by education. The
notion of innate idea, in the exact meaning of the word, as con-

* Hallam, Introduction to History of Europe,
v.J IDEATIONAL NERVOUS CENTRES. 127

natural or contemporary with birth, is not less untenable and
absurd than an innate pregnancy. (') But if by innate is only
meant that, by the necessity of his nature, a well-constituted
individual placed in certain circumstances will acquire certain
ideas, then all the phenomena of a man’s life, bodily or mental,
are just as innate or natural. It is necessary here to distinguish
between what is predetermined by the nature of things, and what
is preformed. The formation of an idea is an organic evolution
in the appropriate nervous centres, a development which is
gradually completed in consequence of successive experiences of
a like kind. The impressions of the different properties or
qualities of an object received through the different senses, are
combined inthe compound idea of it which is gradually matured
in the mind; there is a consilience of sensory perceptions in
the production of the idea ; and henceforth we can make asser-
tions concerning the object when it is not present to sense. The
cells of the cerebral ganglia do, in reality, idealize the sensory
perceptions : grasping that which is essential in them, and sup-
pressing or rejecting the unessential, they mould them by their
plastic faculty into the organic unity of an idea, in accordance
with fundamental laws. Every idea is thus an intuition, and
implicitly comprises far more than it explicitly displays. It is
not the idea of any particular object or event, but the idea of
every object and event of a particular kind. Herein the process
of ideation only follows the law of organic development as
manifest everywhere, and as previously illustrated in the de-
velopment of nerve element itself. Whosoever, biassed by the
metaphysical conception of mind, finds it difficult to realize
this process of the organic growth of idea, let him reflect upon
the manner of organic growth which confessedly takes place in
the language in which our ideas get embodiment. Language
was not innate in mankind; it has undergone a slow develop-
ment through the ages, in conformity with the development
of thought ; and by using the study of language as an instru-
ment of the analysis of ideas, we may make use of the science
of what is seen to indicate the nature of processes that at
present are unseen.

Those who are metaphysically minded have done with idea as
they have done with sensation: they have converted a complex
128 HEMISPHERICAL GANGLIA, OR [ctap,

notion or general term summing up a great number of varied
phenomena into an actual entity, and thenceforth allowed it to
tyrannize over the thoughts. It is a great and mischievous error
to suppose that an idea of the same object or event has always
a uniform quantitative and qualitative value; and the way in
which it is the custom to speak of. certain abstract ideas, as if
they were constant entities admitting of no variation, nor of the
shadow of a change, is a remarkable example of that self-decep-
tion by which man fondly fools himself “with many words
making nothing understood.” An idea may be definite, clear,
and adequate, or it may be indefinite, obscure, and inadequate ;
it by no means follows, therefore, that because the same name
is given to an idea in two persons, it has the same value in each.
Certain ideas will always have a different value in persons at
a different stage of cultivation; and when the well-meaning
traveller, or the ardent missionary thinks to find in the miser-
able savage the idea of a god, he should take heed that he is not
erroneously interpreting the savage mind by the text of his own.
The ideas of virtue and vice, for which the Australian savage
confessedly has no words in his language, cannot be implanted
or organized in his mind, until, by cultivation continued through
generations, he has been humanized and civilized. (?)

To acquire those so-called fundamental ideas, universal in-
tuitions, or categories of the understanding, of which some meta-
physicians make so much, as constant elements, though they
differ greatly in value in different people, there is no other need
but, using Hobbes’ words, “ to be born a man, and live with the
use of his five senses.” (?) Because all men have a common nature,
and because the nature by which all men are surrounded is the
same, therefore are developed certain ideas which have a universal
application, but they are nowise independent of experience ; on
the contrary, the universality of their character is owing to the
very fact that in every experience they are implicitly suggested
or involved, so that they finally become fixed as endowments
‘in the acquired nature or organization of the nervous centres ;
sonscious acquisition becoming here, as elsewhere, unconscious
faculty, by virtue of an organic process. But their absolute
ruth, as expressions of certain fundamental relations between
nan and nature, is only guaranteed by the assumption of an
v.] IDEATIONAL NERVCUS CENTRES, 129

unchanging persistence of these relations ; a new sense conferred
upon him would entirely change the aspect of things, and render
necessary a new order of fundamental ideas.* (+)

Having said thus much concerning the manner in which our
ideas are acquired, I proceed to indicate the different ways in
which the reaction of an idea, when active, may be displayed :
having considered idea as statical, it now remains to consider it
in actual energy.

(a) The reflex action or reaction of an ideational nerve-cell
may be downwards upon the motor centres, and may thus give
rise to what has been called ideomotor movement.t (®) The energy
may be exerted either upon the involuntary or upon the volun-
tary muscles ; and in the latter case, it takes place either with
consciousness or without consciousness. The idea that the bowels
will act may notably sometimes so affect their involuntary
peristaltic movements as to produce evacuation of them; the
idea that vomiting must take place, when a qualmish feeling
exists, will certainly hasten vomiting; the idea of a nervous
man that he cannot effect sexual intercourse assuredly may
render him incapable of it; and there is a very remarkable
instance told in the Philosophical Transactions of a man who
could for a time stop the motions of his heart.{ These are

» “We can conceive ourselves as endowed with smelling and not enjoying any
other faculty. In that case, we should have no idea of objects as seeable, as
hearable, as touchable, or tasteable. We should have a train of smells; the
smell at one time of the rose, at another of the violet, at another of carrion,
and so on. Our life would be a train of smells.”—J. Mii1, Analysis of the Human
Mind.

+ “To prove that Ideas, as well as Sensations, are the cause of muscular
actions, it is necessary to make choice of cases in which the idea is in no danger
of being confounded with that state of mind called the Will. And hardly any
case will answer this condition, except some of those which are held to be
involuntary, for the Idea itself never can be very clearly distinguished from the
Will.”—J. M111, op. cit. p. 265. He instances yawning on seeing some one yawn,
the infectious power of convulsions, laughter, sobbing, the swallowing of saliva,
if assured that you cannot. ‘‘It seems, therefore, to be established by a simple
induction, that muscular actions follow ideas, as invariable antecedent and con-
sequent, in other words, as cause and effect ; that, whenever we have obtained a
command over the ideas, we have also obtained a command over the motions ;
and that we cannot perform associate contractions of several muscles, till we have
established, by repetition, the ready association of the ideas.” —Jbid. p. 274.

+ “There is an instance told in the Philosophical Transactions of a man who
could for « time stop the motions of his heart when he pleased ; and Mr. D. has

K

\
130 HEMISPHERICAL GANGLIA, OR [cHAP,

examples of the influence of idea upon the involuntary muscles,
and they are conformable to what has been previously said of
the subordination of the organic nerve centres to the cerebro-
spinal system. Some people even are able, through a vivid idea
of shuddering, or of something creeping over their skin, to pro-
duce a cutis anserina, or goose’s skin: the immediate effect of
the idea in this case, however, is probably to excite the appro-
priate sensation which thereupon gives rise to the sequent
phenomena. Examples of the action of idea upon our voluntary
muscles are witnessed in every hour of our waking life. Very
few, in fact, of the familiar acts of a day call the will into
action: when not sensori-motor they are mostly prompted by
ideas. But the point on which I would lay stress here is, that
such ideomotor movements may take place, not only without
any intervention of the will, but also without consciousness ;
they are automatically accomplished, like the actions of the sleep-
walker, in obedience to an idea or a series of ideas, of which there
is no active consciousness. It may seem paradoxical to assert,
not merely that ideas may exist in the mind without any con-
sciousness of them—which every one admits in their dormant,
latent, or statical condition they may—but that an idea, or a
train of associated ideas, may be quickened into action, and
instigate movements, without themselves being attended to.
But it is unquestionably so: a great part of the chain of our
waking thoughts, and of the series of our daily actions, actually
never is attended to: at first consciously acquired, these have
now become automatic. Persons who have a habit of talking to
themselves are generally unaware that they are talking, and
yet they are performing both associated ideas and associated
movements.

It is surprising how uncomfortable any one may be made by
the obscure notion of something which he ought to have said
or done ou some occasion, but did not say or do, and which he
cannot for the life of him now remember. There is a dim feel-
ing of some impulse unsatisfied, an effort, as it were, of the lost
idea to get into consciousness ; this activity is not sufficient to

often told me he could so far increase the peristaltic motion of his bowels by
voluntary efforts as to produce an evacuation by a stool at any time in half-an-
hour.”’—Zoonomia, vol. i. p. 39.
v.] IDEATIONAL NERVOUS. CENTRES. 131

excite consciousness, but sufficient to react upon the unconscious
mental life, and to produce a feeling of discomfort or vague
unrest, which is relieved directly the idea bursts into conscious-
ness. Then, again, when an active idea has once taken firm
possession of consciousness, how hard a matter it is to dismiss
it! Some weak-minded persons cannot do so until they have
expended its force in suitable action: let a hysterical woman
get a vivid idea of some action that she must do: the idea
becomes a fate which she must sooner or later obey, not other-
wise than as in electro-biology or hypnotism the patient is
governed by the idea which the operator suggests. Let a quick-
tempered man conceive a great insult suddenly done to him: in
a moment, without any intervention of the will, the idea reacts
upon the muscles of his body, and produces more or less general
tension of them. Let a man engaged in a fight get the idea that
he will be beaten: his muscular energy is weakened, and he is
already half conquered.

(6) The reflex action of an ideational nerve-cell may operate
downwards not only upon the motor nuclei, but also upon
the sensory ganglia. As the idea is excited into activity by
the impression on the senses, so it may in turn react down-
wards upon the sensory centres, giving rise even under certain
circumstances to illusions and hallucinations. The idea of a
nauseous taste may excite the sensation to such a degree as to
produce vomiting ; the sight of a person about to run a sharp
instrument over glass will set the teeth on edge; the images of
dreams are sometimes, as Spinoza has remarked, really visible
for a while after the eyes are open. The celebrated Baron von
Swieten, says Dr. Darwin, who illustrates this kind of ideational
action by many instances, “was present when the putrid carcase
of a dead ‘dog exploded with prodigious stench ; and, some years
afterwards, accidentally riding along the same road, he was
thrown into the same sickness and vomiting by the idea of the
stench, as he had before experienced from the perception of it.”

The action of idea upon our sensory ganglia is a regular part
of our mental life; for the co-operation of sensory activity is
nothing less than necessary to clear conception and representa-
tion. In order to form a distinct and definite conception of what
is not present to sense, we are compelled to form some sort of

K 2
132 HEMISPHERICAL GANGLIA, OR [cuap.

image of it in the mind; the sense of sight, which anatomically
is in most extensive connexion with the cerebral ganglia, afford-
ing us the greatest assistance in this regard. Men differ much
in the power which they have of thus rendering an idea sensible.
Goethe could call up an image at will, and make it undergo
various transformations, as it were, before his eyes; Shelley
appears to have been, on one occasion at least, the victim of
positive hallucinations generated by his ideas. But the most
remarkable instance of a habit of seeing his own ideas as actual
images was afforded by the engraver, William Blake. “ You
have only to work up imagination to the state of vision, and the
thing is done,” was his own account of the genesis of his visions.*
To render definite the creations of the imagination, and to give
fit expressions to them, they must be accompanied by some
sensorial representation. The great writers whose vivid descrip-
tions of scenery or events hold our attention and stir our feelings,
have this power in high degree; they create for themselves a
world of sense by the influence of idea, and then strive to present
vividly to us what they have thus represented to their own minds.
Natural endowments being equal, those writers who have the
greatest number of residua stored up in consequence of much
and varied experience, are best qualified to call up vivid images,
and best qualified to call up such as are truly representative of
nature; whilst those who are wanting in experience, or who

» ‘Dr, Ferriar mentions of himself that, when at the age of fourteen, if he
had been viewing any interesting object in the course of the day, as a romantic
ruin, a fine seat, or a review of troops, as soon as evening came the whole scene
was brought before him with a brilliancy equal to what it possessed in daylight,
and remained visible for some minutes.” ABERCROMBIE, On the Intellectual
Powers. Sir I. Newton could recall an ocular spectrum of the sun when he went
into the dark and directed his mind intensely, ‘‘ as when a man looks earnestly
to see a thing which is difficult to be seen.” From these recollected images of
objects of sense, which the reason duly distinguishes from the realities around,
we meet with examples marking a gradual transition to those spectral images or
illusions which cannot be distinguished from realities, which, in fact, compel
belief and excite emotions and actions in accordance with their character. Aber-
crombie mentions a patient who had the power of creating the illusion by an
effort of will, but had no power of removing it. A step farther, and there is
neither the power of calling up an illusion at will—for it rises in spite of the will—
nor of distinguishing it from realities, nor of dismissing it at will. It is excited
by some morbid cause, confounds itself with realities, compels belief, and domi-
nates the conduct.
v.] IDEATIONAL NERVOUS CENTRES. 133

have not sufficiently cultivated observation, are apt to become
visionary, vague, and unreal. Even in matters of scientific
research, the scientific imagination by which hypotheses are
successively framed until a fit one is obtained, its verification
completed, and a discovery thus made, is based upon a previous
careful training of the senses in scientific observation, and works
by means of sensory representations. Natural endowments not
being equal, however, we then perceive the wide difference which
there is between one who has an adequate idea and one who has
not. The latter, in describing scenery or events, will give a tedious
picture characterised by minute industry and overwrought detail,
in which there is no due subordination of parts, no organic unity
of idea—in which truly soul is wanting—and from which, there-
fore, no one can carry away a true idea of the whole: unpregnant
of his subject, he has been going about to give a photographic
copy or a minute delineation of what cannot be photographed ;
he has laboured to realize the appearance until at last only
something unreal remains.* The former, on the other hand, pro-
duces, by virtue of the plastic power of idea, a picture in which
the unessential is suppressed, the essential thoroughly grasped
aod moulded into an organic unity, in which due subordination
and co-ordination of parts prevail, and from which, therefore, a
true idea of the whole may be educed ; truly comprehending or
‘grasping his subject, he has in fact idealized the sensory per-
ceptions, producing the illusion of a higher reality, and has
displayed a real development of nature. This sort of difference
between men is not less evident in scientific working. One man
records, with a praiseworthy but tedious industry, the uncon-
nected impressions made upon his senses, and never gets further
than that: fondly thinking that he sees with his eye, and not
through it, he would, were he set to describe the sun for the
first time, describe it as a bright disc about the size of a big

* “For facts,” Lord Shaftesbury observes in his Characteristics, ‘* unably
related, though with the greatest sincerity and good faith, may prove the worst
sort of deceit: and mere lies, judiciously composed, can teach us the truth of
-things beyond any manner. But to amuse ourselves with such authors as neither
know how to lye, nor #el2 truth, discovers a taste which methinks no one should
be apt to envy. The greatest critic says of the greatest of poets, when he extols
him the highest, that above all others he understood how to lye: AcbiSdoxe 5&
KéAwora"Opnpos Kal robs dAAous moeudy Acryely os de.”
134 HEMISPHERICAL GANGLIA, OR [onap.

cheese, and rest content for the future with this sensory repre-
sentation of it. The other and truer man of science succeeds
in combining, by means of the organizing power of idea, the
scattered impressions made upon the senses, is able by com-
parison to complement or correct the impression made on a
particular sense, and to form to himself a true image of the sun,
not as a mere disc of fire, but as an immense central body
moving through space, with its attendant planetary system.
Only those who are destitute of idea would dream of rejecting
entirely the aid of idea in scientific inquiries.

These observations will not be a useless digression if they
serve to teach how essential to the completeness of conception
is the functional action of the sensory ganglia, how much our
intellectual development depends, not only upon the cultivation
of careful habits of observation, but also upon the co-operation
of the sensory centres in the subsequent intellectual action. The
excitation and cultivation of the sensorial cells are necessary
antecedents, in the order of mental development, to the activity
of the ideational cell; and the ideational cell in turn effects its
complete function in the formation of a distinct conception by
reacting downwards upon the sensory centres. This secondary
intervention of the sensory ganglia is not peculiar to man, being,
perhaps, more evidently displayed in some of the lower animals.
When the dog scents the rabbit, and begins to scratch furiously
at the burrow, it is plain that the sense of smell has excited
either directly the visual image of the rabbit, or rather, as the
dreaming of the dog would seem to indicate, the idea of the
rabbit, which idea thereupon calls up the appropriate image.
It is worthy of remark in this relation, how singularly effective
in man the sense of smell is in recalling vividly the ideas and
images of forgotten scenes and places. The reaction of ideas upon
the senses is again very notable in dreams; and in insanity,
when the nerve centres are disordered and their relations dis-
turbed, actual hallucinations of a sense, such as cannot be
corrected by the evidence of unaffected senses, or by reflection,
are sometimes due to the influence of morbid ideas. This dis-
ordered action is, after all, only an exaggeration of a process
which is natural in our mental life. The idea cannot receive
its stimulus directly from the external world, nor can it react
v.] IDEATIONAL NERVOUS CENTRES. 135

directly upon the external world; both in its origin and in its
expression are the senses concerned.

(c) A third important, though little recognised, way in which
idea may operate, is upon the functions of nutrition and secre-
tion. Whether the idea act, as is probable, directly upon the
organic elements of the part through its nerves, or indirectly
by an effect upon the vaso-motor system, it is certain that
the influence of an idea may increase or lessen ‘a secretion,
and may modify nutrition, The idea of foud will cause a flow
of saliva; a sympathetic idea, a flow of tears; the idea of itching
in a particular spot will give rise to an itching there; and the
idea that a structural defect will certainly be removed by a par-
ticular act does sometimes so affect the organic action of the
part as to produce acure. The most successful physician is ever
one who inspires his patient with the greatest confidence in the
virtue of his remedies. Bacon rightly, therefore, would have us
inquire into the best means to “ fortify and exalt the imagina-
tion.” “ And here,” he says, “ comes in crookedly and danger-
ously a palliation and defence of a great part of ceremonial
magic. For it may be speciously pretended that ceremonies,
characters, charms, gesticulations, amulets, and the like, do not
derive their power from any tacit or sacramental contract with
evil spirits, but serve only to strengthen and exalt the imagi-
nation of him who uses them.”* |

(d) There is yet another path which the energy of an idea
may take. As, in reflex action of the spinal cord, the residual
force which was over and above what passed directly outwards
in the reaction travelled upwards to the sensorium commune and
excited sensation; and as in sensori-motor action the residual
force which was over and above what passed outwards in the
reaction travelled up to the cortical cells, and gave rise to idea ;
so ,in ideational action the force which does not pass, or the
residual force which may be over and above what does pass,
immediately outwards in the reaction, abides in action in the
cortical centres, and passes therein from cell to cell. There is
no superimposed collection of cells of a higher kind to which it
might now ascend, and wherein it might excite a higher kind
of mental activity; there is, instead, an infinite multitude of

* De Augmentis Scientiarum, B. iv.
136 HEMISPHERICAL GANGLIA, OR [emap.

nerve-cells in the cortical layers, having most numerous, varied,
and intricate connexions, whereby excitation may be communi-
cated from one to another. This communication is what does
take place, when one idea calls up another by some association,
itself partly or wholly disappearing in the act. It is probable
that one idea can only call another into activity through its own
partial or entire disappearance from consciousness, as one wave
disappears in the production of another; but it is, perhaps,
doubtful whether this, which is Miiller’s simile, expresses the
condition of things so well as that of Hobbes, who looked upon
one idea as obscured by the more active one, “in such manner
as the light of the sun obscureth the light of the stars ; which
stars do no less exercise their virtue, by which they are visible,
in the day than in the night:’*(®) There is, as would appear,
not only a transference, but a transformation of force from cell
to cell within the hemispherical ganglia; and the energy of the
particular cell, or the idea for the moment active, is attended
with consciousness. We are now come, then, to another sphere
of mental activity, namely, activity within consciousness, or
reflection.

It behoves us here to settle clearly in our minds. the relation
of consciousness to ideational function, or at any rate to be on
-our guard against considering consciousness as co-extensive with

* Dr. Brown (Physiology of the Mind, p. 223) held, however, that the slightest
attention to the successive states of mind would show, ‘‘ that a conception, after
giving rise to some new conception, does not always cease to be itself a part of our
continued consciousness.” He thought that it often remained so as to co-exist
with the conception which itself had induced, and might afterwards suggest other
conceptions, or other feelings, with which it might then co-exist in a still more
complex group. ‘‘ We compare, we choose, in our internal plans, because
different objects are together present to our conceptions.” Sir W. Hamilton
limited to six the number of objects which might exist in consciousness at the
same timeg and Mr. J. S. Mill, in his Examination of Sir W. Hamilton's
Philosophy, allows a ‘‘ great multitude of states, more or less conscious, which
often co-exist in the mind!” On this.question Sir H. Holland has some excellent
remarks in his “ Chapters on Mental Physiology ;” and for a fuller notice of it
than would be proper here, I may refer to a review, in the Journal of Mental
Science for January 1866, of Mr. J. S. Mill’s criticism of Sir W. Hamilton. It
would appear that ideas are in this regard like movements: several of them may
be in simultaneous action, though not equally present to consciousness. Experience
proves again that a more acute pain will frequently obscure or suspend a less
severe one before existing, though the causes of the latter are still active.
Similarly a new and stronger emotion will often banish weaker one.
v.] IDEATIONAL NERVOUS CENTRES. 137

such function. When the whole energy-of an idea that is excited
passes immediately outwards in ideomotor action, then there is
scarce any, or there may be no, consciousness of it; in order that
there may be consciousness of the idea, it is necessary not only
that its excitation reach a certain intensity, but that the whole
force of it do not pass immediately outwards in the reaction.
The persistence for a time of a certain degree of intensity of
energy in the ideational cell would certainly appear to be the
condition of consciousness. Accordingly when the process of
reflection is going on, quietly and rapidly, through the regular
association of ideas, there is no consciousness of the steps; in
the train of thought one idea calls another into activity without
being itself attended to, so that the result may appear as if
sudden and accidental, and it may be very difficult, or quite
impossible, to retrace the steps, or take up the successive links,
by which it was evolved. In the course of a day how many
thoughts or ideas do thus suddenly start into consciousness, or,
as we may say, suddenly strike us! The excitation of one
ideational cell would seem to be communicated immediately to
another, and the energy thus to run through a series by a con-
tinuous transformation, with no residual persistence at any of
the intermediate stages.

A conception of the way in whieh a group or series of move-
ments are observably associated, and the faculty of them is
firmly organised in the nervous centres, so that they are hence-
forth automatically performed, will be found most serviceable
in the interpretation of the phenomena of ideational activity.
Like muscular motions, ideas are associated in groups or series ;
like them, they become easier with repetition ; like them, they
are excited into action by an appropriate stimulus; like them,
when once associated, they are not easily separated ; like them,
they may be accomplished without consciousness; like them,
they demand an appreciable time for their accomplishment ;
and like them, they are fatigued by prolonged exercise. The
question of the time necessary for the performance, so to speak,
of an idea is really a most important one, which has not hitherto
received sufficient attention. It is sometimes not less than the
time required for the performance of a muscular motion ; for, as
Dr. Darwin observed, a musician can press the keys of a harpsi-
138 HEMISPHERICAL GANGLIA, OR [cHar.

chord with his fingers in the order of a tune which he has been
accustomed to play, in as little a time as he can run over those
notes in his mind. Nay, an idea may even require more time
than a movement: how many times in a day do we cover our
eyes with our eyelids without ever perceiving that we are in
the dark? In this case, as Dr. Darwin has also observed, the
muscular motion of the eyelid is performed quicker than the
idea of light can be changed for that of darkness: the twinkling
of an eye being quicker than thought.(") The interference of
consciousness is often an actual hindrance to the association of
ideas, as it notably is to the performance of movements that
have attained the complete ease of an automatic execution.
it happens that we try hard to recall something to mind, and
are unable by the utmost effort of volition, and the strongest
direction of consciousness, to do so: we thereupon give up the
attempt, and direct our attention to something else ; and, after
a while, the result for which we strove in vain, flashes into
consciousness : the automatic action of the brain has worked it
out. That is exactly what we might expect to happen: for if
consciousness implies a persistence of the tension of a nerve-
cell’s energy, then in proportion to the degree of persistent
tension must be the retardation of, or hindrance to, the process
of association of ideas, which is effected by a transference of
energy from one to another of the catenated cells. An active
consciousness is always detrimental to the best and most suc-
cessful thought: the thinker who is actively attentive to the
succession of his ideas is thinking to little purpose; what the
genuine thinker observes is that he is conscious of the words
which he is uttering or writing, while the thought, unconsciously
elaborated by the organic action of the brain, flows from unpene-
trated depths into consciousness. Reflection is then, in reality,
the reflex action of the cells in their relations in the cerebral
ganglia: it is the reaction of one cell to a stimulus from a
neighbouring cell, and the sequent transference of its energy to
another cell—the reflection of it. Adéention is the arrest of the
transformation of energy for a moment—the maintenance of a
particular ¢ension. Bear in mind what was said of the varying
value of an idea and of the manner of its gradual organization
in the nervous centres, and the applicability of the term delibera-
ve] "IDEATIONAL_ NERVOUS CENTRES. 139

tion to a process of thought, as a weighing or balancing ‘of one
reason against another, will be evident. Or if we prefer the
term ratiocination, we may say, with Hobbes, that by it is meant
computation. “ Now to compute is either to collect the sum of
many things that are added together, or to know what remains
when one thing is taken from another, fatiocination, therefore,
is the same with addition and subtraction.” Subtract the energy
of an opposing idea from a more powerful one, and the energy
left represents the resultant force of impulse after deliberation ;
add the energy of a like idea to another, and the sum represents
the force of the resolution. After severe reflection or delibera-
tion the decision or resolution may be held to signify that we
have resolved, to the best of our ability, the complex equation
set us.

Though reflection is a process of mental aetivity that takes
place within consciousness, yet consciousness itself, when fairly
examined, will show how limited is the power of the mind over
the train of its ideas. The formation of an idea is an organic
process that takes place by imperceptible degrees beyond the
range of consciousness ; the idea, when formed, exists in a latent,
quiescent or dormant state; and it may even be made active,
and its energy duly expended, without consciousness. In like
manner the catenation of a group or series of ideas is an organic
process of which consciousness has no knowledge, and over
which volition has no control; once the train is firmly linked
together by this organized coherence, the excitation of one must
needs bring on the excitation of the others, one after another, as
it traverses its appointed orbit, rising above the mental horizon
into consciousness, and in due order again sinking below it.
The power of the mind over the succession of its states is
plainly at best but a limited faculty; herein corresponding
with that limited control which an individual has over the
phenomena of his bodily life, where conscious and uncon-
scious, voluntary and involuntary, aets are so intimately inter-
mixed. To make states of consciousness synonymous with
states of mind, as some have heedlessly done, is scarcely less
unwarrantable than it would be to assert all bodily acts to be
conscious acts.

There yet remains something more to be said concerning the
140 HEMISPHERICAL GANGLIA, Ok [cHap.

association of ideas. The anatomical connexions of a nerve-cell
in the cerebral ganglia do, of a necessity, limit the direction and
extent of its action upon other cells; it cannot act on other
cells indifferently ; for it may be deemed tolerably certain that
as the conduction in nerve-fibres demonstrably does not pass
from one to another except by continuity of tissue, so the
activity of one cell cannot be communicated to another except
along an anastomosing process. Besides, or within, this neces-
sary limitation, which exists in the anatomical constitution
of the nervous centres, there is a further determination of
the manner of association by the individual life experience,
just as is the case with movements. “Not every thought to
every thought succeeds indifferently ;” but, as all ideas have
been acquired by means of experience, and we have “no imagi-
nation whereof we have not formerly had sense in whole or
in parts,’ so the connexions which ideas have with one
another in the brain must answer in some manner the order
of experience; and even an individual’s habit of association of
ideas will witness to the influence of his particular education
and surroundings, Social life would simply be rendered impos-
sible if we could not depend upon the uniformity of the laws
of nature in man as well as out of him; if one idea followed
another casually, it would be all one as if one event in nature
occurred without connexion with another. That one idea does
seemingly follow another casually, or at any rate without recog-
nisable coherence, justifies us, we are in the habit of thinking,
in shutting a man up in a lunatic asylum; and one of the first
signs of insanity confessedly is an unaccountable change in, or
disruption of, the particular uniformity of an individual charac-
ter. The foundation of our laws, and the maxims of life,
entirely rest upon the constancy of laws in the human mind;
“a prisoner who has neither money nor interest,” Hume very-
aptly says, “discovers the impossibility of his escape as well
when he considers the obstinacy of the gaoler as the walls and
bars with which he is surrounded; and, in all attempts for his
freedom, chooses rather to work upon the stone and iron of the
one than upon the inflexible nature of the other.” Although
ideas are thus as definitely ‘associated in the mind by phy-
sical necessity as are cause and effect in external nature; yet,
v.] IDEATIONAL NERVOUS CENTRES. 141

because sometimes one idea has succeeded another in our ex-
perience, and sometimes another, it is not certain always in so
obscure and complex a labyrinth what idea shall in a given
case ensue; only this is certain, that it shall be an idea that
has been associated with it at one time or another. Neces-
sity is, in truth, confessed in every deliberation and in every
act of our life,

Because each one has a certain specific nature as a human
being, and because the external nature in relation with which
each one exists is the same, therefore are inevitably formed cer-
tain general associations which cannot without great difficulty,
or anywise, be dissociated, just as different movements are so
linked together in all men that they cannot be dissociated.
Such are what have been described as the general laws of asso-
ciation of ideas—those of cause and effect, of contiguity in time
and space, of resemblance, of contrast; in all which ways, it is
true, one idea may follow another, though also in many other
ways. We are enabled, however, by virtue of the general laws of
association in which all men agree, to predict the general course
of human conduct, and to establish laws for the regulation of the
social state. Within these general principles, however, there are
numerous subordinate differences; the special character of an
individual’s association of ideas being determined partly by his
original nature, and partly by his special education and life-
experience,

That natural differences in the mental susceptibilities of dif-
ferent persons do influence the character of their association of
ideas, is shown, as Dr. Priestley long since pointed out,* by the
greater ease with which some men associate those co-existences
of sensory perceptions which combine to constitute the idea of
an object, while others associate more readily those successive
sensory impressions which go to form the idea of an event.
These different tendencies and dispositions are really at the
foundation of two different types of mind. In the former case,
there is a mind attentive to the discrimination of impressions,
skilful in discernment, and susceptible to the pleasurable and
painful properties of things—in fact, a mind good at description,
and fond of natural history; in the latter case, there is a mind

* In his Introduction to Hartley.
142 HEMISPHERICAL GANGLIA, OR [cHaAP.

observant of the order of occurrence of phenomena, prone to the
investigation of the genesis of things, or the connexion of cause
and effect—in fact, a philosophic intellect, affecting science and
abstract truth, to which an event that can be nowise explained
or displayed as an evolution of antecedent causes, is a painful
tribulation. Such mind is at the opposite end of the scale to
that of the “poor idiot born,” who, by reason of his imperfect
constitution, has but few ideas, and cannot duly associate those
few, just as he is capable of but few imperfectly associated
movements. Forget not, however, that between the idiot at
the bottom of the scale of human life, and the philosopher
at its summit, there are to be met with beings representing
every grade of the transition.

Special adaptations to particular circumstances of life also
concur to lay the foundation of individual habits of thought
and conduct. The successful tact or skill of one man in circum-
stances in which the awkwardness or failure of another is
striking, is the consequence of a rapid association of ideas
which has, from repeated special experience, become so familiar,
so much a habit, as to appear like an intuition. In such case
the group, or series of ideas, is so closely united, so firmly
organised, as to behave almost as one idea; while the excitation,
though sufficient for the desired end, does not take place to such
degree as to produce consciousness.* Even the instantaneous
and acute judgment of a much experienced and well-trained
mind, which is sometimes so rapid as to look like an instinct or
intuition, is founded upon a previous careful training in obser-
vation and reflection; it depends in reality on an excellent
association of ideas that has been organized in correspondence

* “Not only do simple ideas, by strong association, run together, and form
somplex ideas; but a complex idea, when the simple ideas which compose it have
become so consolidated that it always appears as one, is capable of entering into
zombinations with other ideas, both simple and complex. Thus two complex
ideas may be united together by a strong association, and coalesce into one, in
the same manner as two or more simple ideas coalesce into one. This union of
two complex ideas into one, Dr. Hartley has called a duplex idea. Two also of
these duplex ideas, or doubly compounded ideas, may unite into one; and these,
wain, into other compounds without end.” .... ‘‘ How many complex or
luplex ideas are all united in the idea of furniture? How many more in the idea
of merchandise? How many more in the idea called Every Thing?”—J. Mut,
ap. cit. p. 82.
v.} IDEATIONAL NERVOUS CENTRES. 143

with, or adaptation to, the series of co-existences and succes-
sions in external nature; and thus it comes to pass that even
the judgment uf an individual in his particular relations of life
becomes almost automatic. When it is said, again, that a man’s
character is completely formed, we express thereby the fact that
he has acquired certain definite combinations and associations
of ideas which, firmly organized, henceforth avail him in the
different circumstances of life. It is evident, then, that if we
had a complete knowledge of the inner nature of an mdividual,
if we could penetrate that most exquisitely organised fabric of
thought which by reason of his particular education and life-
experience has been grafted on the original capabilities, it
would be possible to foretell with certainty his mode of thought
and conduct under any given circumstances. Is not this a pre-
diction which, as it is, those who know a man best can often
make, with close approximation to truth? But inasmuch as
no two minds are exactly alike originally, and as no two persons
have precisely similar experiences, the speciality of human con-
ditions being infinite in variety, we cannot obtain the exact and
complete elements for a correct and definite judgment of the
operation of a given cause upon any individual. None the less
true is it that every cause does operate definitely by as stern
a necessity as any which exists in physical nature.

Once more, then, is it rendered evident how necessary to
a complete psychology of the individual is the consideration
of the circumstances in which he has lived, and in relation to
which he has developed, as well as the observation of his habits
of thought, feeling, and action. From what has been said of
ideas and their associations, it is obvious that in the same
language, when used hy different people, there must often be
considerable difference in regard to the fulness and exactness
of the ideas conveyed by it.(*) In translation from one language
to another it plainly appears that ideas, which have a general
resemblance, have yet certain special differences according to
the depth of thought, the religion, the manners and customs
of the different nations; it is as hard a matter to convey
adequately in the French language the meaning of German
philosophy as it is to express adequately, by the corresponding
German words, the exact meaning of the French names for
144 HEMISPHERICAL GANGLIA, OR [crap,

different shades of elegant vice or elegant cookery. And who-
soever enters upon the study of psychology with the assumption
that an idea deemed or called the same has always the same
constant value in different people of the same nation, will be led
into the vainest errors by so false a metaphysical conception.
Do not men owe most of their errors and disputes to the fact
that they cannot come to a right understanding of words?
How should they, indeed, when by the same word is frequently
signified an idea at very different stages of its evolution ?

It remains only to add here, that the successive formation of
ideas in mental development and the progressive complexity of
their association and of their interaction in the supreme centres
of the brain, illustrate, as do the development of the spinal
centres and the development of the sensory centres, an increas-
ing organic specialization in the relations of man to external
nature; that Von Baer’s law of progress from the general
and simple to the special and complex here, as elsewhere in
organic development, has sway.

Thus far, then, we have exhibited the path of distribution for
the energy of an.idea when it does not pass outwards in a direct
reaction to the stimulus from without: it travels from cell to
cell within the cortical layers of the hemispheres, and thus gives
rise to reflection. But at the end of all this wandering or of the
various transformations, as the final result of reflection, there
may still be a reaction downwards, and consequent outward
activity of the individual. When that takes place it is voli-
tiona’ action: the will, abstractly speaking, is the resultant of
the complex interaction of the supreme ganglionic cerebral
cells. We ascend gradually to this highest manifestation of
force by tracing upwards the fundamental reaction of nerve-cell
through reflex action, sensori-motor action, and ideo-motor
action: in our knowledge of the more simple phenomena we
have a guide with which to enter on the study of those which
are more complex and obscure. As, however, there is usually
present in the action of will some desire of a good to be
obtained, or of an evil to be shunned, it will be proper, before
considering the nature of volition, to deal with the emotions,
To them, therefore, shall the next chapter be devoted.
vi] IDEATIONAL NERVOUS CENTRES. 145

NOTES.

1 (p. 127).—“For what is meant by innate? If innate be equivalent
to natural, then all the perceptions and ideas of the mind must be
allowed to be innate or natural, in whatever sense we take the latter
words, whether in opposition to what is uncommon, artificial, or mira-
culous. If by innate he meant contemporary to our birth, the dispute
seems to be frivolous ; nor is it worth while to inquire at what time
thinking begins, whether before, at, or after our birth. Again, the
word idea seems to be commonly taken in a very loose sense by Locke
and others as standing for any of our perceptions, our sensations and
passions, as well as our thoughts. Now, in this sense, I should desire
to know what can be meant by asserting that self-love, or resentment
of injuries, or the passion between the sexes, is not innate ?”—Humg,
Essay concerning the Human Understanding.

2 (p. 128).—“T cannot but think that the two main articles of
belief which have been set down to the credit of the Indian—namely,
the Great Spirit or Creator, and the Happy Hunting-grounds in a future
world,—are the results of missionary teaching, the work of the Fathers
Hennepin, Marguette, and their noble army of martyred Jesuit fol-
lowers.” .... The Manitou, which we are obliged to translate
“Spirit,” exists everywhere ; they believe there is a manitou in water,
in fire, in stars, in grass, &c.; it is the essence of Fetishism. “It is
doubtful whether these savages ever grasped the idea of a human soul.”
.... “Ido not believe that an Indian of the plains ever became a
Christian. He must first be humanized, then civilized, and, lastly,
Christianized ; and, as has been said before, I doubt his surviving the
operation.” —The City of the Saints, by R. F. Burton, p. 133.

8 (p. 128).—“There is no other act of man’s mind that I can
remember, naturally planted in him, so as to need no other thing in
the exercise of it, but to be born a man and live with the use of
his five senses. Those other faculties of which I shall speak by and
by, and which seem proper to man only, are acquired and increased
by study and industry, and of most men learned by instruction and
discipline ; and proceed all from the invention of word and speech.”—
Hossss, Leviathan, ch. iii.

4 (p, 129).—“The first consideration I have upon the subject: of
the senses is that I make a doubt whether or no man be furnished
with all natural senses. I see several animals who live an entire and

L
146 HEMISPHERICAL GANGLIA, OR [cHaP.

perfect life, some without sight, others without hearing ; who knows
whether to us also, one, two, three, or many other senses may not be
wanting? For if any one be wanting, our examination cannot dis-
cover the defect.” “Tis the privilege of the senses to be the utmost
limit of our discovery ; there is nothing beyond them that can assist us
in exploration, not so much as one sense in the discovery of another.”...

“There is no sense that has not a mighty dominion, and that does
not by its power introduce an infinite number of knowledges. If we
were defective in the intelligence of sounds, of harmony and of the
voice, it would cause an unimaginable confusion in all the rest of our
science ; for, besides what belongs to the proper effect of every sense,
how many arguments, consequences, and conclusions, do we draw to
other things, by comparing one sense with another? Let an under-
standing man imagine human nature originally produced without the
sense of seeing, and consider what ignorance and trouble such a defect
would bring upon him, what a darkness and blindness in the soul ; he
will then see by that of how great importance to the knowledge of
truth, the privation of such another sense, or of two or three, should
we be so deprived, would be. We have formed a truth by the con-
currence of our five senses ; but, perhaps, we should have the consent
and contribution of eight or ten to make a certain discovery of it in its
essence.”—MontaIGne’s Essays.

5 (p. 129).—It would appear that one hemisphere of the brain can
only act, whether by means of idea or volitionally, on the limbs of the
opposite side, that it cannot act upon the limbs of the same side of the
body. Philipeaux and Vulpian injured or removed portions of the
left hemisphere in dogs. All of them are said to have exhibited a
slight degree of paralysis of the right side, and moved in a circle
when forced to move. The hemiplegia was slight, though evident, for
the animals supported themselves on the enfeebled limbs. But was
there a true hemiplegia? Was not the paralysis spurious, and due
really to the loss of intelligence and volition in the damaged hemi-
sphere, so that the animal only had sensori-motor power left on that
side? Accordingly, as the left side continued to act freely under the
instigation of the will proceeding from the right hemisphere, while the
left depended on sensori-motor action only, or on synergy with the
‘right, the animal was made to move in a circle.

8 (p, 136).—“ The decay of sense in men waking is not the decay
of the motion made in sense, but an obscuring of it, in such manner as
the light of the sun obscureth the light of the stars ; which stars do no
less exercise their virtues, by which they are visible, in the day than in
v.] IDEATIONAL NERVOUS CENTRES. 147

the night. But because among many strokes which our eyes, ears,
and other organs receive from external bodies, the predominant only is
sensible ; therefore, the light of the sun being predominant, we are
not affected with the action of the stars.”—Leviathan, ch. vi.

7 (p. 138).—“ The time taken up in performing an idea is likewise
much the same as that taken up in performing a muscular motion. A
musician can press the keys of an harpsichord with his fingers in the
order of a tune he has been accustomed to play in as little time as he
cau run over these notes in his mind. So we many times in an hour
cover our eyeballs, without perceiving that we are in the dark ; hence
the perception or idea of light is not changed for that of darkness in
‘so small a time as the twinkling of an eye, so that, in. this case, the
muscular motion of the eyelid is performed quicker than the perception
of light can be changed for that of darkness.” —Zoonomia, vol. i, p. 24.
8 (p. 143),—*It will easily appear from the observations here made
upon words, and the associations which adhere to them, that the lan-
guages of different ages and nations must bear a general resemblanee to
each other, and yet have considerable particular differences ; whence any
one may be translated into any other, so as to convey the same ideas
in general, and yet not with perfect precision and exactness. They
must resemble one another because the phenomena of nature, which
they are all intended to express, and the uses and exigencies of human
life, tofwhich they minister, have a general resemblance. But then,
as the bodily make and genius of each people, the air, soil, and
climate, commerce, arts, science, religion, &¢., make considerable
differences in different ages and nations, it is natural to expect that the
languages should have proportionable differences in respect of each
other.”—Harriey’s Theory of the Human Mind, by Dr. Priestley.

“‘ Wherefore, as men owe all their true ratiocination to the right
understanding of speech, so also they owe their errors to the misunder-
standing of the same; and as all the ornaments of philosophy proceed
only from man, so from man also is derived the ugly absurdity of false
opinions. For speech has something in it like to a spider's web (as it
was said of old of Solon’s laws), for by contexture of words tender
and delicate wits are ensnared and stopped; but strong wits break
easily through them.”—Hozsns, vol. i. p. 36.

L2
CHAPTER VI.

THE EMOTIONS.

M** is patient and agent; he suffers certain passions, and
does certain actions. Passion is actual suffering, and
‘depresses; action is the cure for suffering, and elevates. A
calm deliberation involves an equilibrium between suffering and
doing ; but in so far as an idea is attended with some feeling,
whether of pleasure or of pain, or of a more special character,
it is to that extent emotional; and if the feeling preponderate,
the idea is obscured, and the state of mind is then called an
emotion or a passion. The definite form of the idea in the
material substratum is obscured or partially lost in the agitation
or commotion of the nerve elements, Strictly speaking, all con-
scious psychical states are, at first, feelings ; but, after having been
experienced several times, they are adequately and definitely
organized, and become almost automatic or indifferent under
ordinary circumstances. So long as the ideas or mental states are
not adequately organized in correspondence with the individual’s
external relations, more or less feeling will attend their excita-
tion: they will, in fact, be more or less emotional. When the
equilibrium between the subjective and objective is duly estab-
lished, there is no passion, and there is but little emotion. (1)

It has been sufficiently evident, up to the present point, that
the condition of the nervous centres is of the greatest conse-
quence in respect of the formation of the so-called mental
faculties, and of the manifestation of their functions; it will
now be seen that this condition is of still more manifest im-
portance in regard to the phenomena of the emotions, Every
one’s experience teaches him that an idea which is at one time
indifferent, being accompanied by no feeling of pleasure o1
CHAP. VI.] THE EMOTIONS. 149

discomfort, may, at another time, be attended by some feeling of
discomfort, or become positively painful. And it requires no very
attentive observation of men to discover that different persons
are very differently affected by one and the same object, and
often pass very different judgments upon it in consequence. So
rouch is this the case that we are in the constant habit of dis-
tinguishing men by the difference of their emotional disposition,
or of the temper of their minds, and of speaking accordingly of
one man as timid ; of another as courageous; of one as irritable,
quick-tempered ; of another as even-tempered, placid. One of
the earliest symptoms of an oncoming insanity, and one that is
almost universally present as the expression of a commencing
deterioration, howsoever caused, of the nervous centres, is an
emotional disturbance, upon which follows more or less per-
version of judgment. It is feeling, or the affective life, that
reveals the deep essential nature of the man; for it expresses the
tone of his nerve element, which again is the result of its
actual constitution or composition, inherited and acquired.

The first occurring observation is, that an idea which is favour-
able to the impulses or strivings of the individual, to self-ex-
pansion, is accompanied by a feeling of more or less pleasure;
and that an idea which betokens individual restriction, which is
opposed to the expansion of self, is attended with a feeling of
more or less discomfort or pain. As the organic germ does,
under circumstances favourable to its inherent developmental
impulse, incorporate matter from without, exhibiting its gratifi-
cation by its growth, and, under unfavourable conditions, does
not assimilate, but manifests its suffering or passion by its
decay ; so likewise the ganglionic nerve-cell of the hemi-
spheres attests by a pleasant emotion the furtherance of its
development, and declares by a painful feeling of discomfort the
restriction or injury which it suffers from an unfavourable
stimulus. Even in the earliest sensation, therefore, the exist-
ence of pain or pleasure is a sort of obscure judgment on its
advantage or disadvantage to the personality or self—a judgment
in which, as Herbart has observed, the subject cannot yet be
separated from the predicate that expresses praise or blame.*

* “Bin Urtheil, in dem nur das Vorgestellte sich noch nicht von dem
Pradicate, das Beifall oder Tadel ausdriickt, sondern lasst.” —HERBaRT..
150 THE EMOTIONS. (cap.

Among so many dangers, then, “ to have a care of one’s self is,”
in the words of Hobbes, “so far from being a matter scornfully
to be looked at, that one has neither the power nor wish to have
done otherwise. For every man is desirous of what is good for
him, and shuns what is evil, but chiefly the chiefest of natural
evils, which is death; and this he doth by a certain impulsion
of nature, no less than that whereby a stone moves downwards.” (”)
Children and savages best exhibit in a naked simplicity the
different passions that result from the affection of self by what,
when painful, is deemed an ill; when pleasurable, a good.

It is necessary to bear in mind that a stimulus, which in
moderation gives rise to a pleasant idea, or rather emotion, will,
when too prolonged or too powerful, produce discomfort or pain,
and consequent efforts to escape from it. There is then a desire
to shun the stimulus, like as one altogether noxious is shunned ;
the desire becoming the motive or spring of action. The impulse
in such case is described as desire, because there is consciousness
of it; but it is without doubt the equivalent in a higher kind of
tissue of that effort which the lowest animal organism exhibits,
without consciousness, in getting away from an injurious stimu-
lus. In both instances there is, in truth, the display of the
so-called self-conservative impulse which is immanent in all
living matter—an impulse or instinct, which, whatever deeper
facts of intimate composition may be connoted by it, is the
essential condition of the continued existence of organic element:
Such reaction of organic element is as natural and necessary as
the reaction of any chemical compound, because as much the con-
sequence of the properties of matter thus organically combined.
When the stimulus to a hemispherical nerve-cell is not in
sufficient force to satisfy the demands of the latter—when, in
fact, it is inadequate,—then there is the manifestation of an
affinity or attraction by the nervous centre, an outward impulse,
appetency, or striving, which, again, as it occurs in consciousness,
is revealed to us as desire, craving, or appetite. There is no
difference, indeed, as Spinoza observes, between appetite and
desire, except in so far as the latter implies consciousness ;
desire is self-conscious appetite. (*) Because we have an appetite
or desire for something, therefore we judge it to be good: it
certainly is not because a thing is judged to be good that we
vi] THE “MOTIONS. 151

have an appetite or desire for it. Here, again, there is an
exact correspondence with that attraction, impulse, or striving
of organic element towards a favourable stimulus manifested
throughout nature, and the necessary correlate of which is a
repulsion of what is unfavourable. Because the affinity is
exhibited in vital structure, we are prone, when observing it,
to transfer our own states of consciousness to the organic element,
and, therefore, to represent it on all occasions as striving, by
means of a self-conservative impulse or instinct, for the stimulus
favourable to its growth. But the attraction is no less a physical
necessity than the attraction of an acid for an alkali, of the
needle to the pole, or of positive for negative electricity; if
there were no stimulus, there would be no reaction on the part:
of the organic element ; if the stimulus were in injurious excess,
or otherwise unfavourable, there must be disturbance of the
statical equilibrium, and a reaction of repulsion; and when the
stimulus is favourable but deficient, the reaction is evinced in
an attraction or affinity for an additional amount, like as a non-
neutralized acid will take up more alkali, or as unsatisfied
appetite craves more nutriment. Now, it is most important
that we do not allow the presence of consciousness to mislead us
as to what is the fundamental condition of things in the gan-
glionic cells of the brain. Here, as elsewhere, healthy organic
element manifests its fundamental properties, pursuing the good,
eschewing the ill; and consciousness is something superadded,
but which nowise abolishes them. The striving after a pleasing
impression, or the effort to avoid a painful one, is at bottom a
physical consequence of the nature of the ganglionic cell in its
relation to a certain stimulus ;.and the reaction or desire becomes
the motive of a general action on the part of the individual for
the purpose of satisfying a want, or of shunning an ill. The
care of himself no man in good health has the power of neglect-
ing. To cease to strive is to begin to die, physically, morally,
and intellectually.

It is obvious then, not only how desires become the motives
of action, but how they are gradually evolved into their complete
form out of the unconscious organic appetites. In the desire of
the adult there is necessarily some sort of conception of what is
desired, though it is at times a not very definite one; but in
152 THE EMOTIONS. [crap,

the child, as in the idiot, we frequently witness a vague restless-
ness evincing an undefined want of, or desire for, something of
which itself is unconscious, but which, when obtained, presently
produces quiet and satisfaction: the organic life speaks out with
an as yet inarticulate utterance. Most striking is that example.
of the evolution of organic life into consciousness which is
observed at the time of puberty, when new organs come into
action; then vague and ill-understood desires give rise to
obscure impulses that have no defined aim, and produce a rest-
lessness which, when misapplied, is often mischievous: the
amorous appetite thus first declares its existence. But to prove
how little it is indebted to the consciousness which is a natural
subsequent development, it is only necessary to reflect that even
in man the desire sometimes attains to a knowledge of its aim,
and to a sort of satisfaction, in dreams before it does so in real
life. This simple reflection might of itself suffice to teach psy-
chologists how far more fundamental than any conscious mental
state is the unconscious mental or cerebral life. Given an ill-
constituted or imperfectly developed brain at the time when the
sexual appetite makes its appearance, and what is the result ?
None other than that which happens with the lower animal,
where love is naked lust, and the sight of the female excites a
desire that immediately issues in uncontrollable efforts for its
gratification. Given, on the other hand, a well constituted and
naturally developed brain, the sexual desire undergoes a complex
development in consciousness: from its basis are evolved all
those delicate, exalted, and beautiful feelings of love that consti-
tute the store of the poet, and play so great a part in human
happiness and in human sorrow. What, however, is true of
these particular desires is true of all our desires: it may be
fitly said, with Bacon, “that the mind in its own nature would
be temperate and staid, if the affections, as winds, did not put it
in tumult and perturbation ;” or, with Nova is, that “life is a
feverish activity excited by passion.”

When the circumstances are exactly adapted to the capacity
of the organic element, then are they most favourable to the
development of the latter; and a steady growth of it fails not to
testify to the complete harmony of the relations. Or, adopting
the language proper in such case to the highest relations of man,
vi] THE EMOTIONS. 153

there is an equilibrium between the subjective and the objective,
and no passion: there is neither a painful feeling with consequent
desire to avoid a suffering, nor is there a feeling of insufficient
satisfaction with consequent desire to increase or continue an
enjoyment; but a steady assimilation, promoting the evolution of
idea, goes favourably on: intellectual development is then most
favoured. As there is no outward striving or craving in such
case, the energy of the response to the stimulus is expended in.
the growth of the idea and in the reaction of it upon other ideas,
—in other words, in intellectual development. Conception and
desire, therefore, stand in a sort of opposition to one another,
although in every mental act they co-exist in greater or less:
relative degree ; in every conception there is, or has once been,
as previously said, some feeling; and again, in every distinct
desire there is a conception of something desired. But the oppo-
sition between them is in reality a matter of the degree of for-
mation of the idea or conception ; for, whatever its nature, there
is always more or less feeling with it when first experienced,
which, however, disappears in proportion as it becomes definitely
organized ; and even though some little feeling or desire remains
connected with the idea, it may often remain in consciousness,
or only modify reflection, not being of sufficient degree to pass
into outward manifestation. May we not then justly affirm, as
we clearly perceive, that the intellectual life does not supply the
motive, or impulse, to action ; that the understanding, or reason,
is not the cause of our outward actions, but that the desires are ?
A strong desire or longing for a certain object in life often brings
its own accomplishment. The desire is the expression of the
individual’s character, the manifestation of the essential affinities
of his nature ; accordingly he strives with all his might to attain
unto the aim which he sets before him, and probably succeeds
either in a direct or acircuitous way. Thus it is that aspirations
are often prophecies, the harbingers of what a man shall be in a
condition to perform. Men of great reasoning powers, on the
other hand, are notoriously not unfrequently incapacitated thereby
from energetic action; they balance reasons so nicely that no one
of them outweighs another, and they can come to no decision:
with them, as with Hamlet, meditation paralyses action. In fact,
the power of the understanding is reflective and inhibitory, being
154 THE EMOTIONS. [cuap.

exhibited rather in the hindrance of passion-prompted action,
and_in the guidance of our impulses, than in the instigation
of conduct; its office in the individual as in the race is,
as Comte observed, not to impart the habitual impulsion, but
deliberative. (4)

As there are two factors which go to the production of an
emotion—namely, the organic element and the external stimulus
—it is plain that the character of the emotional result will not
be determined only by the nature of the stimulus, but will
depend greatly also upon the condition of the organic element.
The equilibrium between the individual and his surroundings
may, in fact, be disturbed by a subjective modification, or an
internal commotion, as well as by an unwonted impression from
without. When some bodily derangement has affected the con-
dition of the cells of the cerebral ganglia, either directly or by
a sympathetic action, then an idea arising is accompanied with
certain emotional qualities, though it is an idea which, in health,
is commonly indifferent ; just as when a morbid state of an organ
of sense, or of its sensory ganglion, renders painful an impression
which in health would be indifferent or even agreeable. Every
one’s experience teaches how much his tone of mind varies ac-
cording to his bodily states. The drunken man, at a certain
stage of his degradation, gets absurdly emotional; and the
general paralytic, whose supreme nervous centres are visibly
degenerate, is characterised by great emotional excitability, as
well as by intellectual feebleness. The general feeling of well-
being which results from a healthy condition of all the organs of
the body, which is indeed the expression of a favourably pro-
ceeding organic life, is known as the caenesthesis, and is some-
times described as an emotion: but it is not truly an emotion;
it is the body’s sensation or feeling of its well-being, and marks
a condition of things, therefore, in which activity of any kind
will be pleasurable—in which an idea that arises will be
pleasantly emotional, not otherwise than as bodily movement
is then pleasurable. On the other hand, the general feeling of
discomfort which follows upon a visceral disturbance, or some
other cause, is a condition in which activity of any kind will be
rather painful than otherwise; there is a restricted or hindered
personality, and an idea arising is apt to be gloomily emotional.
vi.] THE EMOTIONS. 155

It plainly amounts to the same thing, whether an excessive
stimulus acts upon nerve element when in a stable and
healthy state, and produces suffering; or whether a natural
stimulus acts upon it when in an enfeebled or unstable con-
dition, and similarly gives rise to suffering: in both cases,
there is, physically speaking, a disturbance of the equilibrium
of the nervous element, or a resolution of it into lower but
more stable compounds; or, psychologically speaking, there is,
in both cases, an idea excited which is attended with painful
emotional qualities—an idea unfavourable to individual expan-
sion, The pain which is occasioned is the cry of organic ele-
ment for deliverance. The greater the disturbance of nerve
element, however produced, the more unstable is its state; and
an instability of it, signifying, as it does, a susceptibility to rapid
molecular or chemical retrograde metamorphosis, furnishes the
most favourable conditions for the production of emotion, passion,
or commotion, as the term was of old. It is easy to perceive,
then, how it is that great emotion is exceedingly exhausting—
for the same reason, in fact, that repeated electrical discharges
by the gymnoius or torpedo produce exhaustion; it is easy to
perceive, also, that whatever cause, moral or physical, works an
exhausting or depressing effect upon an individual, inclines him
to become emotional.

The original nature of nerve element is, however, as nothing
in the determination of the special character of the higher
emotions, compared with its acquired nature as this has been
slowly organized by education and in relation to the cireum-
stances of life. Much discussion has taken place as to whether
an emotion is merely a feeling of pleasure or pain accompanying
a particular idea; whether, for example, benevolence is nothing
more than the pleasant feeling that accompanies the idea of
accomplishing the good of another, malice the feeling that attends
the idea of injuring another, and so on. But there is some
danger here of being confused or misled by words; it certainly
must be allowed that there is something in the emotion more
special than the general feeling either of pleasure or pain: such
feeling is present, no doubt, but it does not determine the special
character of the emotion; it is something superadded, which
determines only the agreeableness or disagreeableness of the
156 THE EMOTIONS. [onar.

emotion. It is, in reality, the specific character of the idea
which determines the specific character of the emotion; and
accordingly emotions are as many and various as ideas.(°) And
it has been before shown that the character of the idea is deter-
mined by the nature of the impression from without, and by the
nature, as it has been modified by a life experience, of the
reacting nervous centre: this now containing an organization
of ideas as its acquired nature, or as the expression of its due
development. How difficult it is to explain matters from a
psychological point of view, is easy to perceive; while we
are considering the relation of emotion to idea, they are both
concomitant effects of a deeper lying cause. As there are
subjective sensations, so also are there subjective emotional
states. It depends upon the nature of the fundamental ele-
ments, the internal reacting centre and the external impression,
whether in a given case we shall have a definite idea with little
or no emotional quality, or whether we shall have the emotional
quality so marked that the idea is almost lost in it. The hemi-
spherical cells are confessedly not sensitive to pain; but they
have a sensibility of their own to ideas, and the sensibility
which thus declares the manner of their affection is what we
call emotional. And as there may be a hyperesthesia or an
anesthesia of sense, so also there may be a hyperesthesia or an
aneesthesia of ideas.. Certainly there do not appear to be satis-
factory grounds either in psychology or physiology for supposing
the nervous centres of emotion to be distinct from those of idea.

As we justly speak of the tone of the spinal cord, by the
variations of which its functions are so much affected, so we
may fairly also speak of a mental or psychical tone, the tone of.
she supreme nervous centres, the variations of which so greatly
uffect the character of the mental states that supervene. And
as it appeared when treating of the spinal cord that, apart from
its original nature and accidental causes of disturbance, the
one of it was determined by the totality of impressions made
pon it, and of motor reactions thereto, which had been organized
n its constitution as faculties; so with regard to the supreme
rentres of our mental life, from the residua of past thoughts,
eelings, and actions, which have been organized as mental
‘faculties, there results a certain psychical tone in each indi-
v1.] THE EMOTIONS. 157

vidual. This is the basis of the individual’s conception of the
ego—the affections of which, therefore, best reveal his real
nature—a conception which, so far from being, as is often said,
fixed and unchanging, undergoes gradual change with the
change of the individual’s relations as life proceeds, Who-
soever candidly reflects upon the striking modification, or rather
evolution, of the ego, which happens at the time of puberty
both in men and women, will surely not find it hard to con-
ceive how the self may imperceptibly but surely change through
life. The education and experience to which any one is sub-
jected likewise modify, if less suddenly, not less certainly, the
tone of his character. By constantly blaming certain actions
and praising certain others in their children, parents are able so
to form their character that, apart from any reflection, these
shall ever in after life be attended with a certain pleasure ;
those, on the other hand, with a certain pain. Experience
proves that the customs and religions of different nations differ
most widely; what one nation views as crime another praises as
virtue ; what one nation glorifies in as a legitimate pleasure,
another reprobates as a shameful vice: there is scarcely a single
crime or vice that has not been exalted into a religious observ-
ance by one nation or other at one period or other of the world’s
history. The prayer of the Thug was a homicide, his sacrifice a
corpse. How much, then, is the moral feeling or conscience de-
pendent upon the due educational development of the mind !(°)
The manner in which music affects some people, producing a
lively feeling of immediate pleasure, calming mental agitation
and exalting the mental tone, and thereby indirectly much
affecting mental activity, affords an excellent example of a
marked effect upon the psychical tone by physical agency;
it might be adduced, if it were necessary, to attest the cor-
poreal nature of the process. Such sentiments as the love of
wife and the love of children, various as they are in kind and
degree in different persons, are not definite emotions so much
as the general tone of feeling resulting from certain relations in
life; they represent a mental state in which ideas in harmony
with the tone of mind will be attended with a pleasant emotion,
and discordant ideas with a painful emotion, just as harmony in
music produces pleasure and discord produces pain. So also of
158 THE EMOTIONS. [crap.

the gentle feeling of social propriety, which is easily recognised
in one who has it, and the absence of which cannot be con-
cealed, is indeed made more evident by the pretence of it;
there is not a definite emotion, but a disposition or tone of
mind with which certain thoughts, feelings, and actions har-
monize so as to occasion pleasure. The refreshing and invi-
gorating influence of some writers does not depend so much
on the actual sense of the words as upon the tone of mind
produced by them. Again, the higher esthetic feelings are
without question the result of a good cultivation, conscious
development having imperceptibly become a sort of instinctive
endowment, a refinement to which vulgarity of any kind will be
repugnant; they are the bloom of a high culture, and, like the
coenethesis, represent a general tone of mind which cannot be
described as definite emotion, but in which certain ideas that
arise will have pleasant emotional qualities. Reflect, again, on
the powerful effects which the aspects of nature produce upon
philosophic minds of the highest order. The vague mysterious
feelings which such minds have, as instinctive expressions of
their fellowship with nature, thrills of that harmonious sympathy
with events whereby they are transported with an indefinite
feeling of joy in view of certain of her glories, or oppressed by
a dim presentiment of evil under different relations—these are
vague psychical feelings that in reality connote the highest intel-
lectual acquisition; they are the consummate inflorescence of
the highest psychical development, the supreme harmonies of
the most exalted psychical tone. (")

It is most necessary clearly to realize how much, not the cere-
bral centres only, but the whole system of bodily nerves, are
concerned in the phenomena of the emotional life. The beatings
of the heart, the movements of respiration, the expressions of the
countenance, the pallor of fear, or the flush of anger, and the
effects upon all the secretions and upon nutrition—all these evince
with certainty that the organic life participates essentially in the
manifestation of emotion. Before definite paths of association of
ideas, and groups of ideas, have been organised through culture
and experience, every emotion tends to react directly outwards,
either upon the organs of the organic life or upon the instruments
of the animal life. In children and savages simple emotions are
vi] THE EMOTIONS. 159

observably easily excited, and as readily manifested in outward
display ; it is only when a strong character has been fashioned
that the power exists to retain the emotional energy within the
sphere of the intellectual life ; and even in the strongest character
it sometimes happens that an emotion, too powerful or too sud-
denly excited, will escape control. It has now been sufficiently
demonstrated, by observation and experiment, that the cerebro-
spinal system does exercise an influence over the ganglia imme-
diately concerned in the phenomena of the organic life; and it
is quite in accordance with physiological observation, therefore,
to admit that the commotion in the nerve element of the supreme
centres, which an emotion implies, will affect the nervous centres
of the organic life, and through them the organic movements, or
the more intimate processes of nutrition.* In fact, the experi-
ments of Pfltiger, Bernard, and others, on the influence of the
cerebro-spinal system over the small arteries; and those of
Lister, on the movement of the pigment granules in the stellate
cells of the frog’s skin,—may be said to have experimentally
demonstrated what has long been popularly observed of the
manner of action of the emotions. A joyous, hopeful, enthu-
siastic feeling has an enlivening influence on the bodily life:
when moderate, producing a quiet, equable effect ; but when
lively giving rise to more evident results, as brilliancy of the
eyes, an accelerated pulse, increased warmth, and an inclination
to laugh or sing. Though a moderate stimulation of the cerebro-
spinal system appears to favour or increase the action of the
organic centres, yet it admits of no question that an excessive
irritation of the higher centres produces an inhibitory effect upon
their functions; wherein, again, we may perceive a sufficient
reason of the disease in an organ which is sometimes the result
of a prolonged depressing passion, especially of depression in
its highest degree—hopelessness.t And because the weak

* It is hard to conceive how it should fail to do so, if it be true that nerves end
by an actual continuity of substance in the parts which they supply, as is now
maintained.

+ Lister says, as the result of his experiments on what Pfltiger calls inhibitory

-nerve phenomena (Proceedings of the Royal Society, No. xxxii. p. 867) “that one

and the same afferent nerve may, according to its operating mildly or energeti-
cally, either exalt or depress the functions of the nervous centres on which it
acts, It.is, I believe, upon this that all inhibitory influence depends.”
160 THE EMOTIONS. [cHar.

organ is ever the sufferer, because here, as elsewhere, to be weak
is to be miserable, the effect of a passion is generally experienced
in his affected organ by one who is the subject of any local
idiosyncrasy ; it more easily sympathises with the centric com-
motion. Passion, in its essential nature, really betokens the
sympathy of the whole nervous system; and a great disposition
to passion means a great disposition to such sympathy. It is
true that, in consequence of a certain elective affinity and of culti-
vation, the effects of an emotion are usually limited to a certain
group of muscles, or to some other definite activity; but the
less the culture, the more general are the visible effects of
emotion or passion: in the idiot an explosion of passion is
‘sometimes an explosion of convulsions.

But there is another important consideration with regard to
our emotions. When we fix the countenance in the expression,
or the body in the attitude, which any passion naturally occa-
sions, it is most certain that we acquire in some degree that
passion. In fact,as we complete our intellectual activity by
the participation of the sensory centres, thereby rendering our
abstract ideas definite through a sensory representation of them,
so in our emotional life any particular passion is rendered stronger
and more distinct by the existence of those bodily states which
it naturally produces, and which in turn, when otherwise pro-
duced, tend to engender it. There-can be little doubt that each
passion which is special in kind has its special bodily expres-
‘sion; this being truly an essential part of it. Mr. Braid found,
‘by experiment on patients whom he had put in a state of hyp-
notism, that by inducing attitudes of body natural to certain
passions he could excite those passions. We perceive, then,
how close is the sympathy or connexion between the bodily
system and the emotional or affective life, which supplies the
habitual impulsion to action; while the intellectual life which,
as deliberative or regulative, controls and directs the activity of
‘the individual, has the closest relations with the senses. From
want of attention to the essential intervention of the whole of the
bodily in the mental life—a neglect springing from the unjustifi-
able contempt of the body inherited from the theologists—the
physical expressions of our mental states have not been properly
studied. As the Indian savage surely tracks the footsteps of his
vi.] THE EMOTIONS. 161

enemy where the uneducated European eye can see no trace ; or
as the American hunter, by careful attention to the appearances
of the trees, guides himself safely through pathless forests in
which the greatest philosopher would lose his way and perish ;
so it is probable that any competent observer who devoted
himself to study scientifically, with patient care and sedulous
attention, the manners of a large number of persons, the different
expressions of their features and of their actions, might discover
a certain clue to their character, and often be able to read off
with ease their feelings and desires. It was the recognition of
the intimate connexion and mutual reaction between the pas-
sions and the bodily life that moved Bichat to locate them
as the ancients did, and in common language is now sometimes
done, in the organs of the organic life. But although there was
in this view the just acknowledgment of a truth, it was only
of part of a truth; for, in the first place, not the organs of the
organic life only, but those also of the animal life, are con-
cerned in the expression and production of passion ; and, in the
second place the feeling of the passion unquestionably takes
place in the brain. It is the display of its organic sym-
pathies. Consequently it is found that, as the effect of a
depressing passion is felt by the victim of a local idiosyn-
crasy in his weak organ, so inversely the effect of a weak
or diseased organ, is felt in the brain by an irritability or
disposition to passion, a disturbance of the psychical tone.
The phenomena of insanity furnish the best illustrations of
this sympathetic interaction.

The study of disordered emotions will naturally find a place
afterwards, when we come to treat of the pathology of mind.
Suffice it here to say that disordered emotion may act upon the
~animal life, the organic life, and the intellectual life. It may
grave itself in the lineaments of the countenance, or declare
itself in the habit of the body; it may initiate or aggravate
organic disease, producing, according to its duration, a transient
or lasting derangement, and it may temporarily obscure, or per-
manently vitiate, the intelligence. When the emotions are
disordered, as they are particularly in some forms of insanity,
and generally at the commencement of insanity, pleasure is felt
from objects and events which should naturally excite pain, or

M
162 THE EMOTIONS. [cnar.

pain from causes which should naturally occasion pleasure in
a healthy mind: scenes of disorder, excess, and violence, are
grateful to the perverted feelings; order and moderation irri-
tating and repugnant.

It may be thought, perhaps, that it would not be amiss if
something were now said of the difference between passion and
emotion, inasmuch as the terms have hitherto been used almost
indifferently. This, however, is scarcely necessary in dealing
only with their general nature, which is fundamentally the same ;
every so-called emotion, when carried to a certain pitch, becomes
a veritable passion. If it were thought well to distinguish them
in a special analysis of the particular emotions, as it doubtless
would be, the ground of distinction would be in the egoiséie or
altruistic character of them—names by which Comte distinguishes
respectively those feelings which have entire reference to. self
and those which have reference to the good of others. Spinoza,
whose admirable account of the passions has never yet been,
and certainly will not easily be, surpassed, only recognises three
primitive passions, on the basis of which all others are founded—
joy, sorrow, and desire. (a) Desire, he says, is the very nature
or essence of the individual, whence it is that the joy or sorrow
of each individual differs from that of another as the nature or
essence of one differs from that of another. (6) Joy is the passage
from a less degree of perfection to a greater degree of perfec-
tion, and accompanies, therefore, all actions that are called good.
(c) Sorrow is the passage from a greater degree of perfection to
a less degree of perfection, and accompanies all acts that are
called evil. It will easily be understood, from what has been
already said, how much the particular character of a passion
will depend upon the education ; how, according to the difference
cf his education and circumstances, one man may repent bitterly
of an act of which another boasts exultantly.

Here, again, it is rendered evident how impossible it is to
deal satisfactorily with the emotions by considering them only
as accomplished facts, and grouping them according to their
characters as we observe them in the adult of ordinary culti-
vation. We are driven by the psychological method to study
emotion under hopeless disadvantage ; for we are constrained to
examine the complexity of an advanced development instead of
vt] THE EMOTIONS. 163

following up, as is the true method, the genesis of emotion or
the plan of its development. In the classification of the animal
kingdom, the study of its plan of development is now acknow-
ledged to be the only valid method of determining the true rela-
tions between one animal and another: in like manner the inter-
pretation of the phenomena of mind cannot be rightly grounded
except on an analysis of their development. Whosoever aspires
to give an adequate account of the emotions should devote him-
self, then, to a careful investigation of their simplest manifesta-
tions in the higher members of the animal kingdom; to the
study of the different grades of their evolution in the savage
and the civilized person, in the child and the adult, the woman
and the man, the idiot and him who is in his right mind; to
the patient delineation of their special bodily expressions ; and
should patiently unfold that progressive specialization and in-
creasing complexity which prevail here as in every other depart-
ment of organic development. Like as ideas are blended, or
coalesce, and connected in groups and series so that, by complex
development, a character is formed, so are the feelings belonging
to the ideas and the desires accompanying them blended and
grouped in a corresponding complexity, and inclinations or: dis-
inclinations of every variety and complexity are thus formed as
a part of the character. Again, the desire naturally attaching
to a certain aim is often transferred after a time to the means
by which that aim is attained, so that there ensue in this way
manifold secondary formations: the end of wealth is to give
enjoyment and comfort; but how often does a passion for the
means oversway the end! By looking to a desirable end, an
act naturally very distasteful, but which is necessary as means,
may, by habituation, be rendered indifferent or even pleasing ;
and some consummate scoundrels are thus gradually fashioned,
themselves unaware of the grievous issue in which many slight
effects have insensibly culminated.*

* Nemo repente fuit twrpissimus is really the expression of the physical nature
of the growth of character.
“Custom

Constrains e’en stubborn Nature to obey ;

Whom dispossessing oft, he doth essay

To govern in her right ; and with a pace

So soft and gentle does he win his way, (That

M 2
164 THE EMOTIONS. [cuaP.

As it is in the individual, so it is through generations. The
internal organic adaptations which take place in correspondence
with differences in the external conditions of existence, are
sometimes observedly propagated through generations, and that
which was a conscious acquisition in the parent becomes more
or less an innate endowment of the offspring. It seems to
admit of little doubt that this law works in the improvement
of the human brain in the course of generations: as those who
migrate from their native land to other and different climes
do in course of time endow their progeny with an inherent
adaptability to the new conditions, so that they do not perish,
but flourish in them; or as the young fox or young dog inherits
as an instinct the cunning which its ancestors have slowly ac-
quired by experience; so the records which are available prove
that the brain of man has undergone considerable develop-
ment in the course of generations. Between the inborn moral
nature of the well-constituted civilized person and the brutal
nature of the lowest savage, all question of education and culti-
vation put aside, the difference as a physical fact is not less
than that which often exists between one species of animal
and another. The exalted ideas of justice, virtue, mercy—
which are acquired in the course of a true civilization, and
which the lowest savage has not—do, without doubt, add some-
thing to the nervous endowment of succeeding generations ; not
only is there in their constitution the potentiality of such ideas,
which there is not in the lowest savage, but there is generated
an instinctive quality of mind, an excellent tone of feeling,
which rebels against injustice of any kind; there is formed the
potentiality of a so-called moral sense. Thus it is that the indi-
vidual rightly developing in his generation is, by virtue of the
laws of hereditary action, ordaining or determining what shall
be pre-ordained or pre-determined in the original nature of the
individual of a future age. But are we then to lose sight of
the physical aspect of this development? Certainly not: the
-moral feeling betokens an improved quality, or higher kind of

That she unawares is caught in his embrace,
And tho’ deflowered and thralled nought feels her foul disgrace,”
Stanza of Gilbert West, quoted by Coleridge in his
Biographia Literaria,
v1] THE EMOTIONS. 165

nerve element, which ensues in the course of a due develop-
ment, and which may easily again be disturbed by a slight
physical disturbance of the nervous element. In the exaltation
of mankind through generations, in the progress of humanization,
so to speak, this height of excellence is reached: in the dete-
rioration or degeneration of mankind, as exhibited in the down-
ward course of insanity proceeding through generations, one of
the earliest evil symptoms is, as we shall hereafter see, the loss
of this virtue—the destruction of the moral or altruistic feeling.
Insane persons are entirely wrapped up in self, though the self-
feeling may take many guises.

The intimate and essential relation of emotions to the ideas,
which they equal in number and variety, is sufficient to prove
that the law of progress from the general and simple to the
special and complex prevails in their development. If such
relation were not a necessary one, it would still be possible
from a consideration of the emotions themselves to display that
manner of evolution. And the recognition of this increasing
specialization and complexity in the function compels us to
assume a corresponding development in the delicate organi-
zation of the nervous structure, although by reason of the
imperfection of our means of investigation we are not yet able
to trace a process of such delicacy in these inmost recesses to
which our senses have not gained entrance.

NOTES.

1 (p. 148).—* Notre Ame fait certaines actions et souffre certaines
passions ; savoir: en tant qu’elle a des idées adéquates, elle fait cer-
taines actions ; et en tant qu’elle a des idées inadéquates, elle soutire
certaines passions.” Spinoza, Des Passions, Prop. i.

2 (p. 150).—“Among so many dangers, therefore, as the natural lusts
of men do daily threaten each other withal, to have a care of one’s self
is so far from being a matter scornfully to be looked upon, that one
has neither the power nor wish to have done otherwise. For every
man is desirous of what is good for him, and shuns what is evil, but
chiefly the chiefest of natural evils, which is death ; and this he doth
by a certain impulsion of nature, no less than that whereby a stone
moves downwards.” —Hopses, vol. ii. p. 8,
166 THE EMOTIONS. [cuar:

5 (p. 150).—* Le désir, c’est Vappdctit, avec conscience de lui-méme.
Hl résulte de tout cela que ce qui fonde V’effort, le vouloir, l’appétit, le
desir, ce n’est pas qu’on ait jugé qu'une chose est bonne: mais, au
contraire, on juge qu’une chose est bonne par cela méme qu’on y
tend par l’effort, le vouloir, l’appétit, le désir."—Srinoza, Des Passions,
Schol. to Prop. ix.

* (p. 154).—“ But we must frankly admit, on consideration, that the
political rule of intelligence is hostile to human progression. Mind must
tend more and more to the supreme direction of affairs; but it can
never attain it, owing to the imperfection of our organism, in which
the intellectual life is the feeblest part ; and thus it appears that the
real office of mind is deliberative; that is, to moderate the material
preponderance, and not to impart its habitual impulsion.”—Comrs,
Positive Philosophy, vol, ii. p. 240.

® (p. 156).—“ For it is not his disputations about pleasure and pain
that can satisfy this inquiry ; no more than he who should generally
handle the nature of light can be said to handle the nature of par-
ticular colours ; for pleasure and pain are to the particular affections
as light is to particular colours.”—Bacon, De Augment. Scient.

“Autant il y a d’espéce d’objets qui nous affectent, autant il faut
reconnattre d’espéces de joie, de tristesse, et de désir; et en général
de toutes les passions qui sont composées de celles-ld, comme la fluc-
tuation, par exemple, ou qui en dérivent, comme l'amour, la haine,
Tespérance, la crainte,” &c.—Spinoza, Des Passions.

6 (p. 157).—“ Mais il faut en outre remarquer ici qu'il n’est nullement
surprenant que la tristesse accompagne tous les actes qu’on a continué
d’appeler mauvais, et la joie tous ceux qu’on nomme bons. On
congoit en effet par ce qui précéde que tout cela dépend surtout de
Véducation. Les parents, en blamant certaines actions, et répri-
mandant souvent leurs enfants pour les avoir commises, et au contraire
en louant et en conseillant d’autres actions, ont si bien fait que la
tristesse accompagne toujours celles-lA et la joie toujours celles-ci.
Lexpérience confirme cette explication. La coutume et la religion ne
sont pas les mémes pour tous les hommes: ce qui est sacré pour les
uns est profane pour les autres, et les choses honnétes chez un peuple
sont honteuses chez un autre peuple. Chacun se repent donc ou se
glorifie d’une action suivant l'éducation qu’il a reque.”—Spinoza, Des
Passions, p. 159.

" (p. 158).—Many illustrations might be adduced from Shakspeare’s

plays of the wonderful harmony between the highest human feelings
and the aspects of nature; some of these I have pointed out in an
v1] THE EMOTIONS. 167

essay on “ Hamlet” in the Westminster Review of January 1865. The
best known passage is that in the “ Merchant of Venice :”—

«Sit, Jessica. Look how the floor of heaven
Is thick inlaid with patines of bright gold.
There’s not the smallest orb which thou behold’st
But in his motion like an angel sings,
Still quiring to the young-eyed cherubin :
Such harmony is in immortal souls ;
But whilst this muddy vesture of decay
Doth grossly close it in, we cannot hear it.”

Again, Milton in his Arcades:

“ But else in deep of night, when drowsiness
Hath locked up mortal sense, then listen I
To the celestial Sirens’ harmony,

That sit upon the nine enfolded spheres,

And sing to those that hold the vital shears,
And turn the adamantine spindle round,

On which the fate of gods and men is wound,
Such sweet compulsion doth in music lie,

To lull the daughters of necessity,

And keep unsteady Nature to her law,

And the low world in measured motion draw
After the heavenly tune, which none can hear
Of human mould with gross unpuiged ear.”

Sir T. Browne, in his Religio Medici, says: “It is my temper, and
I like it the better, to affect all harmony: and sure there is music even
in the beauty and the silent note which Cupid strikes, far sweeter than
the sound of an instrument: for there is music wherever there is
harmony, order, or proportion ; and thus far we may maintain the
music of the spheres ; for these well-ordered motions, and regular paces,
though they give no sound to the ear, yet to the understanding they
strike a note most full of harmony. .... It is a hieroglyphical and
shadowed lesson of the whole world, and creatures of God; such a
melody to the ear, as the whole world, well understood, would afford
the understanding.” Tassages of like import might be quoted from
Goethe, Jean Paul, Humboldt, Emerson, Carlyle, and many other men

of genius.
CHAPTER VII.

POLITION.

“ Les hommes se trompent en ce point qu’ils pensent étre libres, Or, en quoi
consiste une telle opinion? En cela seulement, qu’ils ont conscience de leurs
actions et ignorent les causes qui les déterminent. L’idée que les hommes se
font de leur liberté vient done de ce qu’ils ne connaissent point la cause de leurs
actions, car dire qu’elles dépendent de la volonté, ce sont 14 des mots auxquels on
n’attache aucune idée. Quelle est en effet la nature de la volonté, et comment
meut-elle le corps, c’est ce que tout le monde ignore, et ceux qui élévent d’autres
prétentions et parlent des siéges de ]’4me et de ses demeures prétent a rire ou
font pitié.’—Sprnoza.

“En tout ce que je puis dire & ceux qui croient qu’ils peuvent parler, se taire, en
un mot, agir en vertu d’une libre décision de l’ame, c’est qu’ils révent les yeux
ouverts.” —Tbid,

T is strange to see how some, who confidently base their
argument for the existence of a God on the ground that
everything in nature must have a cause, are content, in their
zeal for free-will, to speak of the will as if it were self-deter-
mined and had no cause. As thus vulgarly used, the term Will
has no definite meaning, and certainly is not applicable to any
concrete reality in nature, where, in the matter of will, as in
every other matter, we perceive effect witnessing to cause, and
varying according as the cause varies.

Previous considerations must have sufficiently proved the
necessity of modifying the notion commonly entertained of the
will as a single, undecomposable faculty of constant and uniform
power ; for they have shown that under the category of voluntary
acts, as commonly made, are included very different kinds of
actions, proceeding from different nervous centres. A consider-
able proportion of the daily actions of life is confessedly due to
the automatic faculty of the spinal cord ; the sensory centres are
clearly the independent causes of other actions ; while many of
the remaining actions that would by most people be deemed”
CHAP. VIL] VOLITION, 169

volitional, are really respondent to an idea or emotion, This
just discrimination is, notwithstanding, entirely neglected by
those who take the metaphysical view of will; by them, as
usual, an abstraction from the particular is converted into an
entity, and thenceforth allowed to tyrannize in the most
despotic manner over the understanding. The metaphysical
essence thus created has no other relation to a particular or con-
crete act of will, than, using Spinoza’s illustration, stoneness to a
particular stone, ian to Peter or Paul.

It is obviously, then, of importance, in the first place, to get
rid of the notion of an ideal or abstract will unaffected by
physical conditions, as existing apart from a particular concrete
act of will, which varies according to physical conditions. When
a definite act of will is the result of a certain reflection, it repre-
sents physically an available or a liberated force, consequent on
the communication of activity from one cell or group of cells to
other cells or groups of cells within the cortical layers of the
hemispheres. Any modification, therefore, of the condition of
these centres may, and notably does, impede reflection, and
affect the resultant power of will—a power which, in reality, is
seen to differ both in quantity and quality in different persons,
and in the same person, according to the varying conditions of
the nervous substratum. On the other hand, speaking psycholo-
gically, the definite will is the final issue of the process of reflec-
tion or deliberation which a man’s life-culture has rendered him
capable of; it represents a conception of the result with desire,
such as have been determined by the character of the reflection.
A man can never will a virtuous end into whose reflection ideas
of virtue do not enter, nor can any one will a bestial act of vice,
whose appetites or desires have not been vitiated, and whose
mind is not familiar with lewd ideas. The will appears, then,
to be nothing but the desire, or aversion, sufficiently strong to
produce an action after reflection or deliberation—an action
that, as Hartley observes, is not automatic primarily or
secondarily.* (1) Since, then, it is generated by the preceding

» “ Appetite, therefore, and aversion are simply so called as long as they follow
not deliberation. But if deliberation have gone before, then the last act of it, if
it be appetite, is called wild ; if aversion, wnawillingness,””—HoBBEs.

“In a series of valuable artivles On the Nature of Volition, in the Psycholo-
170 VOLITION. [cHap.

association, it must needs differ greatly in quality and quantity,
according to the extent and character of the association, as this
has been established by- cultivation, or is temporarily modified
by bodily conditions. Every one can easily perceive this to be
true of the will of un idiot or a child, which is palpably a very
different matter from that of a well-cultivated adult; and he
must be very much blinded by metaphysical conceptions, who
fails to recognise the infinite variations in the power of will
which any given individual exhibits at different times or in
different relations. When one of the higher senses is wanting
in any one, he necessarily wants also the ideas, feelings, desires,
and will, which arise out of the perceptions of this sense. The
blind man cannot know the variety and beauty of colouring in
nature, nor can he will in regard to those external relations
which are revealed only through the sense of sight. Because,
however, he knows not what he lacks, he does not consider his
will inferior in quality, less complete, or less free. Were an
1dditional sense conferred upon any one, it would doubtless
soon teach him how much might yet be added to the will, how
ittle his boasted freedom is, and might, perhaps, make him
wonder much that he should ever have thought himself free:
When is it that man is most persuaded that he speaks or acts
with full freedom of will? When he is drunk, or mad, or is
lreaming. It may be a reflection, then, worth dwelling upon,
‘hat man thinks himself most free when he is most a slave ; but
it any moment, in whatever mood he be, he would affirm that
1e is free. A person when under the influence of drink judges
rery differently from what he does in his sober senses, but is
1e in his own estimation less free at the time? Passion noto-
iously perverts the judgment, warping it this way or that;
vut will any appeal to the man who is in a passion elicit

ical Journal for 1863, Mr. Lockhart Clarke enters into an able analysis of the
ifferent forms of volition, and shows that in each case the process consists in
ae co-operation of two of the psychical elements which together constitute our
ersonal integrity; namely the intellectual or regulative element, and the
sthetic or dynamic element, the latter being either a sensation, an appetite, or
motion. What are called “motives” to the “ will” consist of our various
msations, appetites, and emotions, when subjected to the judgment of the
nderstanding in deliberation. The “will,” therefore, as a peculiar power, comes
ito existence only at the time of acting, by the combination and co-operation of
s constituent elements.
vi] VOLITION. 171

from him a confession that he is not acting with perfect
liberty? Place the very same arguments before a man when he
is elated by some joyous, or depressed by some grievous event;
when he is in the full flow of vigorous health, or when he is
prostrate on the bed of sickness, or of death, and how different
would be his judgment upon them: but whatever others may
think of him, he will hold for certain the conclusion of the
moment, just as a man in his sleep is. fully persuaded of the
reality of his dreams. While the looker-on can often predict
how a madman will act under certain circumstances, with as
much certainty as he can predict an event conformable to a
known law of nature,—who thinks himself so free as does the
madman? Whence comes this false opinion? It arises plainly
from this: that consciousness reveals the particular state of
mind of the moment, but does not reveal the long series of causes
on which it depends. It is a deliberate fooling of one’s self to
say that actions depend upon the will, and then not to ask upon
what the will depends! It is as though, says Leibnitz, the needle
should take pleasure in moving towards the pole, not perceiving
the insensible motions of the magnetic matter on which it
depends. As in nature we pass from event to cause, and from
this cause again to an antecedent one, and so on till we are
driven to a great first cause, so, in the sincere observation of the
mind, we see that it is determined to will this or that by a cause
or motive, which again is determined by another, this again by
another, and so on till we have gone through the whole series of
desires, aversions, hopes, and fears—the sum of which is delibe-
ration—that have preceded the last appetite or aversion, which
we call an act of will. Those who fondly think they act with
free will, says Spinoza, dream with their eyes open.

Now, if the final reaction after deliberation, which we call
will, is, like other modes of reaction of nerve element previously
described, a resultant of a certain molecular change in a definitely
constituted nervous centre, then all the design exhibited in any
given act of will must, like the design displayed in the function
of the spinal cells, or the cells of the sensory centres, be a physi-
cal result of a particular and intimate constitution or organiza-
tion of nervous matter. In other words, the act of will which
is the final expression of a process of reflection must needs
L72 VOLITION. (crap.

sontain a conception of the end desired—such a conception as
yas been determined by the nature of the reflection ; the con-
seption of the result, or the design, in the act of will constituting,
n fact, the essential character of the particular volition. In
order that desire may become action for its gratification, a con-
sciousness of the result of the action is necessary—that is, a
sonception of the aim of it. The desire, therefore, gives the special
sapulse which is directed or regulated by reflection, and the par-
icular act of will is not the determining agent, but is the result
determined by the impulse acting in conformity with the concep-
tion of the aim to be attained. The design, then, which a looker-
on discovers in any act of will—and, be it remembered, there is
ao actual volition apart from the particular volition—will depend
upon the nature of the individual whom he is observing, as that
nature has been inherited, and subsequently developed by the
experience of life. The idiocy of any one, or his congenital
inability to adapt himself to external relations by correspondences
of internal cerebral reaction, is a physical fact: there is no design
in many of the idiot’s conscious acts, because such quality or
property has not been built up by cultivation as a faculty of the
supreme nervous centres, a congenital defect of constitution
having made such organization impossible ; in other words, the
idiot is, by defect of nature, incapacitated from acquiring reflec-
tion, and cannot, therefore, have in his mind the conception of a
result to be attained, cannot display conscious design. But the
design manifest in any voluntary act of the best cultivated mind
is likewise physical necessity: in consequence of reacting cerebral
adaptations to the varieties of external impressions, reflection
has, as already set forth, been organized as a development of the
supreme nervous centres, or, in other words, as a faculty of the
mind; and according to the extent and kind of the reflection
will be the completeness of the conception of the end to be
attained, or the degree of design discoverable in any act of will.
The particular volition and whatever it contains, whether of
folly or design, is a product of the organized residua of all
former like volitions, excited into activity by the appropriate
stimulus. For volitions, like sensations and ideas, leave behind
them their residua which are organized in the nerve centres,
and thus render future volitions of a like kind more easy.
vil] VOLITION. 173

In this sense only are we warranted in speaking of abstract
volition.

It has been necessary to lay stress upon this vague and trouble-
some question of design, because mistaken notions with regard
to it appear to have been at the bottom of much error in phi-
losophy. The design manifest in a mental act has been supposed
to evince a power which transcended or anticipated experience,
instead of one that actually conforms in its genesis to experience;
and the metaphysical conception of will as a fixed and undecom-
posable entity, in which was no variability nor the shadow of a
turning, is greatly indebted for its origin to that error. The
mischievous doctrine of final causes which Bacon, Comte, Spinoza,
Descartes, and others scarcely less great, all agree to have done
so much harm in philosophy, has sprung from erroneous views
of the nature of design. Supposing that the argument from
design as to the existence of will as a metaphysical entity were
pressed to its logical consequences, what must be the result?
Nothing less than this,—that the animal, with its marvellous
instinct of instant adaptation to the most complex and unfamiliar
conditions, is possessed of a higher immaterial principle than the
helpless child or the erring adult. We know right well, however,
that the instinct of the animal is sometimes positively traceable
to the acquired power of former generations; that it has been
observably built up in the constitution of the nervous centres,
and transmitted to succeeding generations as an innate endow-
ment. It is exactly the same with the design that is formed
within the term of an individual life, and which ever testifies to
the previous cultivation of the individual; the more cultivated
the mind and the more varied the experience, the better de-
veloped is.the will and the stronger its co-ordinating power over
the thoughts, feelings, and actions, not otherwise, in truth, than
as the co-ordinate reflex action of the spinal cord is developed
by experience and culture. Design, therefore, when its nature
is fairly analysed, so far from tending to make the will a fixed
metaphysical entity, goes really to prove that the will is an in-
sensibly organized result, of varying value, quantitative and
qualitative.

Having now adduced sufficient reasons to prove that the will
is not a self-generating, self-sufficing force of constant quantity,
174 VOLITION. [cHap,

but, on the contrary, a force varying in quantity and quality,
and, like every other natural force, determined by antecedent
causes, we may proceed to consider what power it actually has
in our mental and bodily life. It is manifestly ordained that
the will, as the highest mode of energy of nerve element, should
control the inferior modes of energy by operating downwards
upon their subordinate centres: the anatomical disposition of
the nervous system is in conformity with what psychological
observation teaches. But the undoubted fact, that the will of a
man can and does control inferior functions has led to a very
extravagant and ill-founded notion as to its autocratic power;
and it must be allowed that not a little windy nonsense has
been written concerning its authority. Assuredly it is no irre-
sponsible despot in any mind, but is ever most obedient where
it has most power; it conquers by obeying. Let us, then, con-
sider what the power of the will is (1) over the movements, and
(2) over mental operations, the two departments in which its
rule is felt.

1. (a) The will has no power whatever over certain move-
ments that are essential to the continuance of life. Not only do
such motions as those of the heart and the intestines go on
without any co-operation of the will and in spite of any inter-
vention on its part, but movements that are only microscopically
visible, such as to contractions of the small arteries, which are
of so great importance in nutrition, are not under its direct
influence. Nature has been far too prudent to rely upon such
an uncertain and comparatively late appearing force for the
movements essential to the continuance of life, or to admit its
capricious interference: let a man try to asphyxiate himself by
voluntarily restraining the respiratory movements, and he will
learn a lesson as to the impotency of will which he might use-
fully remember when studying mental phenomena. We say
nothing here of those insensible molecular movements of the
physiological elements which, like thermal oscillations, are yet
impenetrable to sense, but which are undoubtedly at the foun-
dation of all visible vital actions.

(6) The will has no power to effect movements that are con-
fessedly voluntary, until they have been very carefully acquired
by practice. Every one knows that the theory of a particular
vit] VOLITION. 175

skill of movement is a very different matter from the practice of
it, and that the complete capacity of accomplishing the act is
gained, not simply by desiring and willing it, but by patient
exercise and cultivation; the faculty of the movement is thus
gradually organized in the proper nervous centre. A special and
complex act, never hitherto attempted, will be as little likely to
be carried out, in obedience to the commands of the so-called
“ autocrat of the mind,” as a determination to fly.*

(c) When the will does dictate a movement, it is the event
which is determined ; it sets free, so to speak, the movement
which has been organized in the motor nerve centre; there is no
direct volitional control over the means by which the result is
effected; so that it may even happen, and does sometimes
happen, that in a man struck with a palsy of his limbs, all un-
aware of its impotency, the will commands a result which never
takes place. Questionless, in face of such an experience, some
would still not shrink from affirming that consciousness never
deceives. When the will dictates a certain event, its power is
propagated, first through certain nerves, and then through them
to certain muscles, in a manner of which we have no conscious-
ness whatever: all we do know is, that if we wish to select a
certain muscle, and put it singly in action, we have not the
power to do so, and that, if certain movements have been
habitually associated, it is a very hard matter to dissociate them
—a thing which a simple effort of the will certainly will not do,
but which a disease like chorea will sometimes do in spite of
the will.

2. The extent of voluntary power over the mental operations
is not nearly so great as is commonly assumed ; much the same
thing happening here as in its influence over movements. It
will not be difficult to understand how this should be so, if we
reflect that the immediate action of the will, even when dictating
movements, is not upon muscles, but upon the motor grey nuclei,
or the nervous centres of movement; that in both cases, there-

* “We know how slowly the child acquires the power of so balancing his

body as to hold it erect.” . . . . ‘‘ We observe how slowly the child learns to
perform, with the requisite precision, the contractions on which the operation of
walking depends.” .... “There is another very familiar instance, that of

learning to write."—J. Minn, Analysis of the Human Mind, pp. 271—273.
176 VOLITION. [cnar.

fore, the immediate operation is alike upon ganglionic cells,
which are, in- one case, the associated centres of ideas, in the
other the associated centres of movements. (?)

(a) As the formation of our ideas gradually takes place
through experience, and as the association between ideas is also
effected in accordance with experience, both processes being
based in the organic life and beyond the domain of consciousness,
it is plain that the will does not determine either the material of
thought or the laws of the interworking of ideas: it must accept
as accomplished facts, as organized results, the ideas and the
manner of their association. As with movements, so here, the
will has no control over the means by which it works; it cannot
dissociate firmly established connexions, nor can it determine a
new train of ideas without the first link of it being in the
thoughts ; and when the first link, however originated, is, so to
speak, grasped, the train of ideas initiated is not irregular and
alterable at will, but definite, in stern accordance with an order
and system previously established by cultivation.* It is true
that as it is with the power of will over movements, so it is
with its power over mental states—it is a power which may
be greatly enlarged and increased by exercise and cultivation.
While some persons seem quite incapable of regulating the
association of their ideas, and can hold to no subject consecu-
tively, others are distinguished by the mastery which they have
over the subject and course of their thoughts, by their powers of
dismissing what is frivolous or irrelevant, and of adhering singly
and steadily to the matter on which the mind is employed. The
will, however, always presupposes definite and fixed series of
ideas formed in the mind, series in which, without individual
co-operation, one idea must definitely and of necessity follow
another as one wave necessarily produces another as itself dis-
appears. There is an order or a necessity in the mental organi- ,
zation of a sane person, then, reflecting the order or necessity in

* ¢ Deliberation and investigation are like the hunting of a hound; he moves
and sniffs about by his own activity, but the scent he finds is not laid, nor the
trail he follows drawn by himself. The mind only begins a train of thinking, or
keeps it in one particular track, but the thoughts introduce one another suc-
cessively . . . . which shows they have a motion of their own independent of
the mind, and which they do not derive from its action, nor will lay aside upon
its command.”—Tvuckrr’s Light of Nature, vol. i. p. 14.
vir.] VOLITION. 177

the co-existence and succession of events in external nature ;
and the will can as little control the fundamental laws of the
one as it can those of the other. Certainly it is not absolutely
powerless in the mind, any more than it is absolutely powerless
in nature ; by recognition of the laws which govern mental deve-
lopment we can so arrange the conditions of their operations
as to produce secondarily considerable modification of effects ;
the will may thus avail itself of these laws for its own profit,
using their power in an enlightened manner to aid its develop-
ment : in the one case as in the other it conquers only by obeying.

True liberty, as Milton expresses it,—

“« Always with right reason dwells
Twinn’d, and from her hath no dividual being.”

(b) Thus we come to a second consideration in regard to the
power of the will: it is that those who so unduly exalt it
unwarrantably derive their arguments entirely from the self-
consciousness of a well-cultivated mind, and altogether neglect
the instances of its simplest manifestations. It is merely justice
to insist upon a reference to the earlier stages of development
of cultivated mind, or to mind in its least cultivated state, as
offering the simplest and most favourable instances for the
formation of a sound induction. ‘Will any one be so bold as to
maintain that there exists in the young child or in the idiot
volitional control over the thoughts? Is any one so ignorant of
the genesis of mind as to uphold the existence of true volition
in the earliest stages of mental development? The child notably
lives in the present, and its actions are direct reactions to the
feelings and ideas that are excited in its mind.

(c) But as the will cannot originate an idea or a train of
thought in the mind, so likewise it is unable sometimes to
dismiss one when desirous of doing so. A painful idea will, as
every one’s experience must have taught him, return again and
again into consciousness notwithstanding every effort of the will
to get rid of it, just as a movement may take place in spite of
the will. The command which a man has over his thoughts is
very different at different times, and one person may be able to
dismiss a troublesome reflection when another cannot for the
life of him do so. We can give no exact reasons for these
variations ; the causes of them lie deeper than consciousness can

N
178 FOLITION. [cnap.

reach or will control. So far, then, from the will being autocratic,
it is at the mercy of unknown conditions, which may seriously
affect at any moment its power or energy. Moreover, when an
unwelcome idea is dismissed from the mind, it is not done by a
simple despotic order of the will; but by fixing attention on
some other idea which arises—by maintaining the tension of it,
the latter is made consciousness ; and inasmuch as two ideas
cannot exist in consciousness at the same time, or at any rate
cannot co-exist in equal intensity, that implies the dismissal of the
former idea into the background and the initiation of a new cur-
rent of reflection—a current which, however, is not uncommonly
interrupted by the irruption of the old idea, which refuses to
become latent or dormant. Volitional control exercised over the
thoughts manifestly presupposes the existence of many ideas in
the mind, and the possibility of some of these latent ones arising
to influence those that may be active. Denken macht fret. What
power it is by which one idea calls up another we do not know,
but we do know that it is not by the will.

Locke is admitted to have made a great advance in psychology
when he demonstrated that there were no innate ideas in the
mind, but that all its ideas were formed by observation and
reflection. The necessary consequence of his demonstration
plainly is, what the foregoing considerations have shown, that
there is no inborn will in the human mind. It would be a very
difficult matter to fix that period in the child’s mental development
when volition might be acknowledged to have distinctly mani-
fested itself. Whence and when the first volition comes, would
indeed be perplexing questions if the will were admitted to be a
special faculty of the mind, distinct from other faculties, of con-
stant quality, and never falling below a certain level of energy.
Why is it that we are powerless to fix the time of the first
volition? Bevause the will is not one and constant, but infinitely
variable in quantity and quality, having many nervous centres,
and not having any existence apart from the concrete act. There
are in reality as many centres of volitional reaction in the brain
as there are centres of idea; and to assume one constant will is
a part of that metaphysical system of making abstractions into
entities by which also is made one understanding, one reason, and
the mind is mischievously parcelled out into faculties that have
vu.) VOLITION. 179

no existence in nature. It is utterly at variance both with psy-
chological analysis of the nature of will, and with physiological
observation of the constitution of the supreme nervous centres,
to assume a single nervous centre from which will proceeds; if
we must make a definite statement on so obscure a matter, it is
that every centre of idea may be a centre of voluntary reaction.
For consider this : although we describe the effect as ideomotor,
when an idea reacts directly outwards, yet if the energy of the
idea is not instantly so expended, but persists in the mind for a
moment, so as to produce a clearer consciousness of it before
passing outwards, and especially if there is some feeling or desire
attending it, then, when it does pass outwards, we commonly
describe the effect as volitional. As consciousness may, however,
exist in every degree of intensity, it is plain that we cannot defi-
nitely fix a stage at which ideational reaction may be supposed to
become volitional, nor determine the nature of the change which
then ensues. “The will and the intelligence are one and the
same thing,” is the corollary of Spinoza from his close reasoning.

Let us imagine the first appearing idea in the infant’s mind
to react outwards, and to leave, as it will do, a residuum in its
nervous centre; when the idea occurs again, there will be a
tendency to a similar reaction. Suppose, however, that the
action causes pain to the child, and thereupon a second idea is
formed in its mind, the energy of which is opposed to that of
the first. When the first idea appears again, it will, instead of
passing outwards at once, excite into activity the second idea,
which is inhibitory or preventive. That is the simplest case
of volition; the child has voluntarily refrained from doing
something, or voluntarily done something else; and the impulse
that has prompted the choice is not any abstract power, but
springs from that fundamental property of organic element by
which what is agreeable is sought, what is painful is shunned.
Bear in mind, when weighing volition, that there is often
more power demanded for preventing or inhibiting action than
for producing it. As ideas multiply in the mind, and groups or
series of ideas are associated, of course the process becomes
more and more complicated; the residua of volitions, like the
residua of sensations or ideas, remain in the mind and render
future volitions of a like kind more easy and more definite ;

N2
180 VOLITION. [cHAP.

abstract or general volitions, as it were, are formed as the repre-
sentatives of certain trains or groups of ideas, or as the expres-
sion of their due co-ordinate activity; and by their persistence
in the mind, when not in consciousness, and their interaction
there, the character of our thought, feeling, and action is
modified in a way which we cannot comprehend. Every one
must have felt that an act, which was at first disagreeable and
demanded a painful effort of will, may become, in fact invariably
does become, after several repetitions, much less disagreeable or
even an easy habit. Not only, however, does that particular
act lose its painful qualities, but all acts of a like kind are
made easier; and our manner of feeling with regard to them,
and even our judgment concerning them, are greatly modified.
Though we can give no explanation of the way in which we
are aided by the traces of past volitions, it is plain enough that
we are so aided; conscious acquisition becomes unconscious
power; and by an organic assimilation of some kind, even the
will becomes automatic in certain relations.

Three conclusions are then to be distinctly established from
the foregoing considerations: first, that the will is not an innate
and constant. faculty, but a gradual and varying organization ;
secondly, that wherever an afferent nerve passes to a cell or
series of cells in the cortical layers of the hemispheres, and an
efferent nerve issues from the cell or series of cells, there is the
possible or actual centre of a particular volition; and thirdly,
that volition or will, used in its general or abstract sense, does
not denote any actual entity, but simply expresses the due co-
ordinate activity of the supreme centres of: mental force, not
otherwise than as the co-ordinate activity of the spinal cord or
medulla oblongata might be said to represent its will—the
faculty in both cases being commonly an acquired one in man.
When the animal acts in answer to some stimulus with direct
and definite purpose, or, as we are in the habit of saying, in-
stinctively, it does so by virtue of an endowment of its nerve
centres which is original in it; but in the formation of human
volition we observe this power of intelligent action in gradual
process of acquirement—we witness an illustration of design in
the making; and if we only go far enough back through gene-
rations, the acquisition by the animals may sometimes be traced.
vat. VOLITION. 181

It would belie observation less to place an ideal entity behind
the innate instinctive impulse of the animal than behind the
gradually fashioned will of man.

To the fullest action of will in an individual two conditions
are obviously necessary: first, an unimpeded association of
ideas whereby one conception may readily call up another, and
complete deliberation ensue; and secondly, a strong personality
or character to give the decision between conflicting ideas and
desires. We shall say something of the second condition first.

The strong or well-formed character which a well-fashioned
will implies, is the result of a good training applied to a well-
constituted original nature; and the character is not directly
determined by the will, but in any particular act directly deter-
mines the will.* The way in which the will does operate upon
the character, or affect the ego, is indirectly by determining the
circumstances which subsequently gradually modify it; we may
place ourselves voluntarily in certain conditions of life, but all
the energy of the strongest will cannot then prevent some
degree of modification of character by them—cannot prevent an
equilibration taking place. In any future act of will the
altered character, or acquired nature, is expressed; and while
we, perhaps, all unaware of any change, strenuously uphold
our constancy, a looker-on clearly perceives the difference.
What we by a mental abstraction call the ego, is in reality a
combination in which are contained the residua of all former
feelings, thoughts, volitions—a combination which is continually
changing and becoming more and more complex. That it

* Common language, Tucker observes, implies two wills or more, opposing,
impeding, restraining, and mastering one another; when an inordinate passion
interferes with the prosecution of some design, we still regard it as a voluntary
result, because sensible of the instigation. ‘‘But if we listen to the common
discourses of mankind, we shall find them speaking of several wills, several
agents, in the same person, resisting, counteracting, overpowering, and control-
ling one another; hence the so usual expressions of the spiritual and carnal wills,
of the man and the beast, of self-will and reason, of denying our wills, subduing
our passions, or being enslaved by them, of acting unwillingly or against the
will, and the like. All which takes rise from a metonyme of the cause for the
effect ; for our actions, being constantly determined either by the decisions of our
judgment, or solicitations of our desires, we mistake them for the will itself; nor
is it a little confirmation of the will being actuated by motives, to find them so
intimately connected therewith, that a common eye cannot distinguish them
apart.”—Light of Nature, i. 547,
182 VOLITION. [orap.

differs at different times of life, and in consequence of different
external relations, those who would most zealously uphold its
so-called identity do unconsciously admit when they, acknow-
ledge that, by religious influence or otherwise, any one may
be made_“quite another man,” may be “converted,” or be
“regenerate.” The will of Saul of Tarsus was not the will
of Paul the apostle to the Gentiles. When the ego is trans-
formed in correspondence with changed external circumstances,
the changes are so gradual as to be imperceptible at the time;
but a rapid transformation of the ego may sometimes be effected
by a great event, internal or external—as, for example, when,
with the development of puberty, new ideas and impulses
penetrate the old circle of thought, and become constituent
parts of it, producing no little subjective disturbance until
the assimilation is completed and an equilibrium established.
When a great and sudden revolution in the ego is produced
by an external cause, it is most dangerous to the mental
stability of the individual, and very apt to become pathological :
nothing is more dangerous to the equilibrium of a character
than for any one to be placed in entirely changed external cir-
cumstances without his inner life having been gradually adapted
thereto ; and madness, when its origin is fairly examined, always.
means discord between the individual and his circumstances. He
who has unexpectedly received a sudden, great exaltation in life,
and is not made mad by his good fortune, cannot realize his new
position for some time, but gradually grows to it; he who, from
some subjective cause, believes that he has received a great
exaltation in life, while external circumstances are not correspon-
dent, is mad—the transformation of his ego being pathological.*

* Dr. Channing, in a sermon On the Evil of Sin, speaking of jthe absurdity of
the notion that in changing worlds we shall change our character, says :—‘‘In
the first place it contradicts all our experience of the nature and laws of the
mind. There is nothing more striking in the mind than the connexion of its
successive states. Our present knowledge, thoughts, feelings, characters, are the
yesult of former impressions, passions, and pursuits. We are this moment what
the past has made us, and to suppose that at death the influences of our whole
past course are to cease on our minds, and that a character is to spring up alto-
gether at war with what has preceded it, is to suppose the most important law or
principle of the mind to be violated, is to destroy all analogy between the present
and future, and to substitute for experience the wildest dreams of fancy. In
truth, such a sudden revolution in the character as is here supposed is to destroy
vir] = VOLITION. 183

The history of a man is the true revelation of his character ;
what he has done indicates what he has willed; what he has
willed marks what he has thought and felt, or the character of
his deliberations; what he has thought and felt, has been the
result of his nature then existing as the developmental‘ product
of a certain original construction and a definite life experience,
Objectively considered, the identity of the ego is neither more
nor less than the identity of the full-grown oak with the first
slight shoot from the acorn: subjectively considered, the strong
and sure conception which every one has of the ego, is not
surprising, inasmuch as it is the most frequently active idea,
being concerned with more or less consciousness in every event
of his life, being that to which every action has fundamental
reference. The fashioning of the will is the fashioning of the
character; and this can only be done indirectly by fashioning
the circumstances which determine the manner of its furmation.
But, however formed, it is the character which determines what
the judgment shall decide to be most elivible, the inc'ination ‘
prompt as most desirable, and the will effect. If it were pos-
sible for any one to enter thoroughly into the inmost character
of another person, and to become exactly acquainted with the
moving springs of his conduct in his particular relations of life,

“it would be possible not only to predict his line of action on
every occasion, but even to work him, free will notwithstanding,
like an automaton, by playing on his predominant passion,
interest, or principle.

Secondly, there is manifestly required for the free action of
the will an unimpeded ‘association of ideas, so that the due
materials for the formation of a sound judgment may be avail-
able. But the ease, completeness, and character of such asso-
ciation depend, as already shown, on the condition of the
nervous element, very slight disorders of which accordingly
quickly declare themselves in a deterioration of the will. As
the secondary automatic faculties of the spinal centres soon
suffer from any disorder of nerve element, and reveal their
suffering in the loss of co-ordinate power over the movements,
so in the loss of co-ordinating power over the ideas and feelings,

aman’s identity. The individual thus transformed can hardly seem to himself
or to others the same being. It is equivalent to the creation of a new soul,”
184 VOLITION. (cap.

in their irregular and independent reactions, is revealed the
deterioration of the will. And as, when the disorder of the
spinal centres is still greater, all co-ordination is lost and con-
vulsions ensue; so in the supreme ganglionic cells of the hemi-
spheres, when the disturbance is great, there is no co-ordination
of the thoughts and feelings, convulsive reactions of the cells
take place, and the individual is a raving lunatic, or a dan-
gerous one dominated by a few persistent morbid ideas. Voli-
tion is, as it were, resolved into the inferior constituents out of
which it is in the due course of things compounded, as a ray
of white light may be decomposed into several coloured rays ;
and in place of the definite, calm, co-ordinate activity of well-
formed will, there is the aimless, irregular, explosive display
of inferior activity. It is obvious, however, that even in the
sound mind the quantity and quality of the volition depend
upon the fulness of the reflection, and that any hindrance to
the due association of ideas will pro tanto affect the will: if
the particular volition were to be resolved by a retrograde
metamorphosis into its component elements, there would be an
explication or unfolding of all the ideas and desires which had
gone to form it; and going still further back in the analysis,
there would be a revelation even of those particular relations
in life which have helped to determine the individual’s definite
organization of ideas, the character of his ego.

It will be proper, before finishing with the consideration of
the will, to say something of the relations of the emotions to it.
Independently reacting, as an emotional idea tends to do, it so
far weakens the will; duly controlled and co-ordinated in reflec-
tion, as is the case after a just mental cultivation, it strengthens
the will. Before many ideas have been acquired, and their
multitudinous associations fixed, as in the young child; or
where the state of the development of the brain precludes in-
tellectual development, as in the idiot and in the animal,—the
emotions excited immediately expend their energy in outward
manifestation ; and when in the cultivated adult there exists,
from some cause, an unstable condition of nerve element, or
when the tension of the emotion or passion is exceedingly great,
it will also react directly outward in spite of the will: the law,
admitting this, would count it therefore no great crime for a
vu. ] VOLITION. 185

husband to have slain a man whom he had surprised in the act
of adultery with his wife. But whosoever takes careful note of
his own mental states may call to mind occasions on which
an emotion suddenly excited strongly prompted a particular
action, which he nevertheless withstood for. an instant, and
might, if necessary, have restrained altogether; but perceiving,
with quick intuition, that he might do well to manifest the
emotion, he afterwards allowed the action to take place. The
looker-on, perhaps, sees only an impulse and rashness; and yet
the rashness was in some sort deliberate—an indiscretion which
served the end when wiser plots might have failed. Emotion
was the real motive force, but an emotion acting under the
direction of reason, and, therefore, in accordance with prudent
insight into the external relations. The individual might have
done the same action in obedience to a calm resolution of the
will, and better so, perhaps, if he had been operating upon
inanimate objects; but in dealing with men it may sometimes
be that a prudent exhibition of feeling much aids the success of
the ends designed. Only let a man beware that, however he
impose upon others, he deceive not himself by his passion,
allowing it to obscure his reason, and pervert his judgment :
restrained within the supreme centres, it is apt to do that in
all minds, and sure to do so in weak minds; but, duly subor-
dinated and co-ordinated in reflection, it adds force to resolution.
Restrained passion, acting under the calm control of reason, is
verily a most potent force; it gives a white heat, as it were, to
the expression of thought, an intensity to the will.

An emotional person certainly often produces great effects in
the world, and especially such effects as are destructive of some
existing system or belief; it is, indeed, commonly their great
self-feeling that gives to the reformers their abandonment,
energy, and consequent success. But an evil often outweighing
these advantages is that there is no guarantee that they are
right ; for, necessarily one-sided, they see but a part of a truth.
It is certain that a great principle has often suffered seriously
from the hasty, violent, and ill-considered action of its sincere
and earnest advocates: adverse events or circumstances, which
they in their passion could not recognise, but which, as rational
beings, it behoved them to have recognised, have swept them
186 VOLITION. [cuar.

away, and the truth which they have been upholding has been
for a while the victim of their indiscretion. As in the mental
phenomena of the individual the power of reflection is often
best exhibited in the prevention of action prompted by feeling—
in an inhibitory function, so amongst men in the social state
the power of a good understanding is sometimes best shown by
not pressing an immature reform. But it is a very hard matter
for a reformer who feels strongly to perceive that what is theo-
retically desirable and right may also practically be undesirable
and wrong under existing social conditions ; he is apt to treat
adverse circumstances as if they were accidents or anomalies
in nature, having no right of existence, and thus more or less
wilfully shuts his eyes to the force of events on which he
proposes to operate, and which will, in any case, operate upon
his principle. He hurls a favourite principle, which may be a
very just one, into the world not sufficiently prepared for it,
not having reached the due level of its evolution, and which,
therefore, is necessarily hostile to it; and if his truth is oppressed
and seemingly extinguished by the opposition which it meets
with, then he is disheartened and complains, or is angry and
rails: he is like the boy sending his paper boat on the lake
the waters of which are lashed by a storm. However, it is not
vature which is wrong, if there be any wrong, but himself—the
reformer. The fact that he did not succeed proves that he did
not deserve to succeed; he has not rightly estimated the cha-
racter and weighed the force of circumstances which have been
too strong for his truth, and by a simple law of nature have, for
a time at least, quenched its light. A great advance can never be
superimposed upon a people miraculously ; in order to be per-
manent it must be a natural evolution from pre-existing events
—must grow out of them; and that which most effectually
demolishes an old error is not a passionate attack upon it by the
intensely feeling reformer, but a new and better creation, which
quietly undermines it so that it falls without trouble. Creation is
a far higher order of work than destruction ; it is the quiet, self-
contained activity of definite productive aim—in other words,
of will in its highest development—as opposed to the explosive
and dissipated play of an inferior and mostly destructive emo-
tional force. But as the calm intellectual contemplation of
VIL] VOLITION. 187

events, viewing all the relations of them, is attended with no
great spur to any particular activity, but marks an equilibration
between the individual and his environment, it is easy to under-
stand how excellent a thing to put the will in motion ina par-
ticular case is some feeling or desire of good to be attained or
of ill to be shunned, in order to establish an equilibration. Then
the will, enlightened by an adequate reflection upon all the co-
operating conditions, is able to act with a calm, steady, intel-
ligent and most potent energy.

The difference, in quality and immediate energy, between
the will which is urged by strong desire and the will which
proceeds from a calm and full reflection, is strikingly evident
in the character of the work done by two kinds of reformers.
Surveying the men who have exercised great effects on the
progress of mankind in this capacity, they appear broadly
divisible into two classes: the men of wide intellectual grasp,
vast knowledge, and serene energy, and the men of limited
vision, intense feeling, and impetuous energy—the extensive or
many-sided, and the intensive or one-sided men. The former,
taking a comprehensive survey of events, seeing in them the
simple operations of natural law, recognising the character and
the import of existing relations, and the true value of the pre-
sent question, often exaggerated by its immediate urgency, have
their feelings subordinated to their reason, and do not abandon
themselves to an unrestrained impetuosity. They may do great
work, but they do it, not like lightning, rapidly and tumultuously,
but like light, slowly, quietly, and silently ; their work is con-
structive, not destructive ; they are reformers of opinion rather
than of practice; and the fertilizing influence of their thought
is felt through many generations. The latter, on the other hand,
are possessed with a conviction so tremulous with intense self-
feeling that it seems the one important thing in the world, and
they are more or less blind to everything else ; they put all their
energy into explosive action, which, like lightning, is destructive ;
they are iconoclasts who beat down furiously the idols that are
worshipped in order to set up another in their places; they are
reformers of practice rather than of thought ; and though they
effect a great immediate practical result, they have little or no
fertilizing influence upon the intellectual development of the
188 VOLITION. [cuar.

future. The earnest desire which inspires their energy springs
from a basis of' strong self-feeling.

Without doubt the will is the highest force in Nature, the
last consummate blossom of all her marvellous efforts. The
natural product of the highest and completest reflection, it
represents the exquisitely and subtly adapted reaction of man
to the best insight into the relations in which he moves. Hence
the vast power of the human will witnessed in the lives of those
eminent men of practical genius who have exhibited its highest
evolution. They were in harmony with the current of events
among which they lived; co-ordinating in themselves the forces.
that were at work around them, they accomplished what the
world had at heart in that age. Thus the force which they dis-
played was a force not their own; the power of the universe was
behind them, and they became the organs of its manifestation.
If we reflect upon the way in which the social and intellectual
forces of an age are thus co-ordinated in the work of genius,
and again upon the manner in which the actions of the different
nerve centres of the body are subordinated and co-ordinated in
the manifestation of will,—how there are, as it were, a gathering
together and a concentration of different forces into one definite
mode of action, a unifying of their energies,—we may be able to
form a conception, by help of what we can thus observe, of the
mode of that exaltation or transpeciation of force and matter
throughout nature which we cannot follow through its inmost
processes.*

By the power of a well-fashioned will man reacts with
intelligent success upon the external world, brings himself into a
complete harmony with its surroundings, assimilates and incor-
porates nature, and thus carries forward its organic evolution.
The highest action of the will is therefore truly creative, for
in it is initiated a new development of nature; it adumbrates
the possibilities of mankind, as a rudimentary organ in a lower
species of animal obscurely foretells the higher species in which
it will have full development. If we ask whence comes the
impulse that displays itself in this. upward nisus, we can only
answer lamely that it comes from the same unfathomable source

* Transpeciation is a word used by Sir Thomas Browne which might be found
useful at the present day.
vit. ] ‘VOLITION. 189

as the impulse that inspires or moves organic growth throughout
nature.

NOTES.

1 (p. 169).—* Sixthly, the will appears to be nothing but a desire or
aversion sufficiently strong to produce an action that is not automatic
primarily or secondarily. At least it appears to me that the substitu-
tion of these words for the word will may be justified by the common
use of language. The will is, therefore, that desire or aversion which
is strongest for the present time. Since, therefore, all love and hatred,
all desire and aversion, are factitious and generated by association, 7.e,
mechanically, it follows that the will is mechanical also.”—Hartiey’s
Theory of the Human Mind, p. 205.

“ Appetite, therefore, and aversion, are simply so called as long as
they follow not deliberation. But if deliberation have gone before,
then the last act of it, if it be appetite, is called will, if aversion,
unwillingness. .... Neither is the freedom of willing or not
willing greater in man than in other living creatures. For where
there is appetite the entire cause of appetite hath preceded; and,
consequently, the act of appetite could not choose but follow: that is,
hath of necessity followed. And, therefore, such a liberty as is free
from necessity is not to be found either in the will of men or of
beasts. But if by liberty we understand the faculty or power, not of
willing, but of doing what they will, then certainly that liberty is to
be allowed to both, and both may equally have it, whensoever it is to
be had.” Hobbes, vol. i. p. 409.

“The whole sum of desires, aversions, hopes, and fears, continued
till the thing be either done or thought impossible, is that we call
Deliberation.” —Leviathan, vii.

2 (p. 176).—I extract the following remarks of Hume :—

1. “But do we pretend to be acquainted with the nature of the
human soul, and the nature of the idea, or the aptitude of one to pro-
duce the other? .. . . We only feel the event, namely, the existence
of an idea, consequent to a command of the will. But the manner in
which this operation is performed, the power by which it is produced,
is entirely beyond our comprehension.”

2. “The command of the mind over itself is limited as well as its
command over the body ; and these limits are not known by reason.
Ki One Will any one pretend to assign the ultimate reason of these
boundaries, or show why the power is deficient in one case, not in
another ?”
190 VOLITION. [cHap, vit.

3. ‘ Self-command is very different at different times... . . Can we
give any reason for these variations, except experience? Is there not
here, either in a spiritual or material substance, or both, some secret
mechanism or structure of parts, upon which the effect depends, and
which, being entirely unknown to us, renders the power or energy of
the will equally unknown and incomprehensible ?”

4, “The motion of our body follows upon the command of our
will. Of this we are every moment conscious. But the means by
which this is effected, the energy by which the will performs so
extraordinary an operation ; of this we are so far from being imme-
diately conscious, that it must for ever escape our most diligent
inquiry.”

After explaining that volition does not act directly on a limb itself,
but through certain muscles and nerves, through which the motion is
successively propagated, he asks—‘ Can there be a more certain proof
that the power by which this whole operation is performed, so far
from being directly and fully known by an inward sentiment or con-
sciousness, is to the last degree mysterious and unintelligible. Here
the mind wills a certain event; immediately another event unknown
to ourselves, and totally different from the intended, is produced.
This event produces another equally unknown; till, at last, through a
long succession, the desired event is produced.”—Inquiry concerning
the Human Understanding.
CHAPTER VIII.

MOTOR NERVOUS CENTRES OR MOTORIUM COMMUNE, AND
ACTUATION OR EFFECTION.

ee far we have been engaged in considering the formation

of the so-called mental faculties by the organization of
residua, as this takes place in the production of simple or pre-
sentative ideas out of sensory impressions,—that is, in apprehen-
sion ; in the production of representative ideas or conceptions by
abstraction from the simple ideas,—that is, in comprehension;
and in the production of volition as the result of the complex
interworking of desires and conceptions. But it is not man’s
function in life merely to think ; his inner life he must express
or utter in action of some kind. Consequently there are other
residua besides those already dealt with, which enter as con-
stituents into his mental life—the residua, namely, that are left
behind by movements or actions. The movements that are
instigated or actuated by a particular nerve centre do, like the
idea, leave behind them their residua, which, after several
repetitions, become so completely organized into the nature of
the nerve centre that the movements may henceforth be auto-
inatic. There is then, intervening between the volitional impulse
and the action, a department or repository of motor residua,
in which exist the immediate agents of movements—a region,
psychologically speaking, of abstract, latent, or potential move-
ments. If recourse be had to physiology, it is found that,
conformably with what psychological analysis teaches, there are
numerous special motorial nervous centres, or nuclei of ganglionic
cells, cerebral and spinal, from which motor nerves proceed,
and by the experimental irritation of which movements may
192 MOTOR NERVOUS CENTRES, [cmap.

be artificially excited. The term which we have taken leave to
use for the purpose of designating psychologically the common
centres of movement is the motortwm commune.

This region of motor residua, or, if we may venture so to
call it, this motorium commune, is related to conception on the
reactive side of human life, as sensation is on the receptive side.
As the residua of sensorial activity, as already seen, minister
and are necessary to a definite representative conception, so
the residua of motorial activity in their turn enter into concep-
tion, and are indispensable to its realization in action. It may
not be amiss, then, to take notice here, again, how the highest
mental action comprehends or contains the whole bodily life.
The sensory life enters essentially into conception ; the organic
life, as previously set forth, participates in the emotional quality
of it; and the motorial activity of the body is essential to its
due effectuation. How mischievously unjust, then, is the
absolute barrier set up between mind and body! How mis-
leading the parcelling out of the mind into separate faculties
that answer to nothing in nature!

What name may most properly be given to this neglected but
important motorial region of our mental life? The motor residua
that mingle in our conceptions have been called, in Germany,
motor intuitions (Bewegungs-anschauungen) ; but this description,
though admirably expressing their intervention in conception, is
perhaps too psychological to convey an adequate idea of their
physiological importance as the immediate agents or faculties of
all movements. The motor intuition, furthermore, intervenes
not alone between conception and respondent action, but also
between sensation and the motor reaction thereto, and even be-
tween the stimulus and the resultant reflex action; so that the
term intuition is not altogether suitable, and may perhaps pro-
duce confusion. More appropriately might this region of motor
residua be described generically as the department of actuation ;
a department containing the powers or faculties through which
the nervous centres, excited into activity, act upon the muscular
system, and, by thus uttering or expressing their energies, restore
the equilibrium. It contains the means by which will, idea, or
sensation actuates definite movements, or prevents their occur-
rence. To describe it as the locomotive faculty would bring us
vil. ] OR MOTORIUM COMMUNE. 193

to the inconsistency of calling locomotive that the aim of which
is often inhibitory or preventive of motion, and would scarcely
include the organic reflex movements.

However it be named, there can be no doubt that such a
region of mental activity exists, and that in it are contained,
predetermined and co-ordinated, the faculties of different groups
and series of movements. It is easy to perceive, then, why the
will can only determine the reswit—cannot determine the action
of a particular muscle, or the combined actions of certain
muscles which have not acted together before. All it can
do is to will the event, and thereupon the proper nerve-fibres
and muscles are put in action through the medium of the motor
intuition. If the result wished is a new, unfamiliar one, no
residua thereof from previous experiences existing in the motor
centres, then the will is unequal to the accomplishment of it;
there is not an exact and definite idea of the end to be effected,
the necessary motor intuition being wanting. After repeated
trials, the desired skill is firmly acquired, and the movement is
henceforth automatic, the motor intuition having been gradually
organized in the proper nervous centres: the result stored up
strictly corresponds with that which in other nervous centres we
describe as abstract idea. Here again we are taught that the
design manifest in any act of will is due to organic processes
similar to those which build up the design in the nerve
centres of sensori-motor action and of reflex action; it is only
because of its being attended with consciousness that we describe
the energy of one of these definitely organized residua in the
highest centre as a conception or notion of the result—speaking
psychologically rather than physiologically. But even here con-
sciousness disappears when the organization is complete.

In the animals the motor intuitions, like their other faculties,
are mostly innate. There are no distinct, clear conceptions
accompanying their instinctive actions; but obscure sensations
and feelings excite the motor intuitions, which then determine
the action of the proper muscles. In man, on the other hand,
although the faculties of certain co-ordinate movements do exist,
preformed in the nervous centres, the motor intuitions are
mostly acquired ; in this regard corresponding with the forma-
tion of his other mental faculties. Our ideas of distance, size,

0
194 MOTOR NERVOUS CENTRES, [crap.

and solidity furnish striking examples of the manner in which
we are indebted to our muscular intuitions, and of the difference
in respect of them between us and the animals. The young
swallow’s intuition of distance appears to be as perfect when it
begins to fly as it is after a life-experience ; but it is not so with
the young child, which cannot for some time tell how far off or
how near an object is. In the first instance, the child’s body
moves with the eyes, when these are fixed upon a light that is
moved about. After a few weeks the moving light is followed
by a motion of the head only; next the eye-ball itself is
turned also; and ultimately objects are followed with the eye
without any motion of the head. As this is going on, there is
acquired gradually a recognition of the distance of an object,
and the convergence of the axes of the eyes is seen to change
regularly and quickly with the distance of the object. Now it
is well known that the accommodation of the eyes to distance
takes place through a convergence of their axes and an accom-
modation of their lenses, two actions which are from the first
very firmly associated ; so much so that a congenital defect in
the lens is now recognised to be the frequent cause of squinting
in children. But these accommodating movements are not
determined by any act of will, nor are they within conscious-
ness; they are consensual movements in respondence to the
visual sensation, and strictly comparable with the instinctive
movements of the animals. It is not the visual sensation directly
which gives us the idea or intuition of distance, but the motor
intuition of the accommodating movement which, though un-
certain and confused at first in man, soon gets precision and
distinctness. In this example we have a type of that which
happens, with greater or less rapidity, in the case of every move-
ment in the body. The infant at first kicks out its leg—whether
from a so-called spontaneous outburst of energy, or by reason of
some organic or external stimulus, matters not—and bringing it
in contact with some external object, gets thereby a sensation,
in respondence to which, as in the consensual accommodation of
the eyes, adaptations of movements take place, and muscular
intuitions are more or less quickly and “completely organized.
Certain sensations and certain movements are thus associated,
and the residua of the muscular movements, or the muscular
viit.] OR MOTORIUM COMMUNE. 195

intuitions, are henceforth essential constituents of our mental
life, whether we are distinctly conscious of them or not. Con-
sider, if further illustration be needed, the gradual acquisition of
the complex movements of speech, and the intimate connexion
which they have with the formation of our conceptions. A
weak-minded person, or a person of low cultivation, often cannot
content himself with the mental representation of a word, or
clearly comprehend a question put to him, without bringing the
actual movement to his assistance; he must utter the word or
repeat the question aloud, in order to get his conception dis-
tinctly; the essential importance of the articulating movements
to conception is furthermore attested by the frequent deficiency
of them in idiots. It is most necessary, however, to guard against
the strong disposition which there is to look upon certain
movements, those of the eye and the tongue, as having a special
connexion with the mental life which other movements of the
body have not; they have a specially intimate connexion, but
not a special kind of connexion. Unwarrantably separating by
an absolute barrier the mind from the body, and then locating it
in a particular corner of the latter, as is commonly done, we are
prone to forget that in mental action the whole bodily life is
eomprehended—that every muscular intuition, therefore, has its
due place and influence in our mental life.

Another consideration which it is necessary to bear well in
mind is, that there is no fundamental difference in organic
nature between those motor intuitions that are original, or pri-
marily automatic, and those which are acquired in the natural
order of development, or are secondarily automatic. Between
the stimulus and the definite reflex action, whether innate or
acquired, between the sensation and its assemblage or succession
of muscular movements, the definite motor intuitions intervene
as necessarily as between the conscious conception and the
answering movement; though in the latter case only have we the
consciousness of effort or motive energy. That the former may
take place without consciousness, proves that the motor residua
have been definitely and adequately organized in the proper motor
centres ; so that so far from design implying consciousness, as
metaphysical psychologists have thought, consciousness altogether
vanishes when the design is firmly fixed in the nature of the

02
196 MOTOR NERVOUS CENTRES, [cuar,

nervous element. Consider only the manifold co-existent and’
successive movements of the many muscles of the tongue, the
palate, the pharynx, and the jaws, in mastication and deglutition
—complex movements which the will could never effect, of which
we have little or no consciousness, and before which human
ingenuity is mute—and it will be abundantly evident how much
we depend in our active life upon the region of motor intuitions.
But it should not be overlooked, it should indeed be prominently
held in remembrance, that these external motor manifestations.
only represent what is contained internally in the appropriate
nervous centres; that what is outwardly displayed exists in the
innermost; that every motor intuition is, consciously or uncon-
sciously, an essential part of the mental life.

The foregoing observations are greatly strengthened by certain
morbid phenomena, in which a variation of the circumstances
furnishes an excellent test of the principles enunciated. In
that condition which Mr. Braid called “hypnotism,” it has been
pointed out already that if the face or limbs of the patients are
placed in an attitude which is the normal expression of a certain
emotion, thereupon that emotion is actually excited; the motor
intuition immediately awakening the appropriate conception.
This is in accordance with what we frequently observe in watch-
ing the genesis of mind in young children, where it is plain.
that an attitude or gesture, unconsciously or involuntarily pro-
duced, sometimes awakens in the mind the correlative idea or
emotion, and where, on the other hand, every thought is imme-
diately translated intc some movement.*

The condition of disease known as aphasia, which has been
so much studied during the last few years, is especially interesting
in its bearing on the doctrine of motor intuitions. A person
loses the power of expressing his thoughts by articulate language ;.
and although in the majority of cases in which this happens
there is hemiplegia of one side, generally ,of the right, there
may be no paralysis at all. Moreover, in those cases in which
there is hemiplegia there is not any paralysis of the muscles of

* Vulpian (op. cit. p. 290) formularizes the general physiological law, that
every excitation of a nerve, at any point in its length, is transmitted immediately
and simultaneously both in a centripetal and centrifugal direction.
vu] OR MOTORIUM COMMUNE. 197

articulation; the loss of speech is not due to any defect in the
actual instruments of utterance. nor is the loss of power of
intelligent expression by speech owing in all cases, or entirely in
any case, to the loss of intelligence, though it is certainly true
that there is in many cases of hemiplegia some degree of mental
failure—some degree of enfeebled intelligence and of emotional
excitability. Intelligence, however, often fails or is lost without
loss of the power of speech; and there are said to be met with
occasional instances of the latter defect without any appreciable
loss of intelligence—instances in which the patient is able to
communicate his thoughts by gesture-language, or by writing.
It is important to bear in mind, in regard to this question, that
language consists essentially in the establishment of a definite
relation between the idea and the sign by which it is outwardly
manifested ; that it may be verbal, vocal, graphic, or mimic;
and that the general faculty of language includes all these
modes of expressing the thoughts. The persistence of these
other modes of expression, where the faculty of speech is lost,
proves that, notwithstanding the intelligence is most probably
decidedly weakened in all cases of aphasia, it is certainly not
weakened to such an extent that the loss of speech can be due
to the abolition of ideas. When, however, an aphasic person
cannot succeed in learning some language of signs so as to be
able to make himself understood, it can hardly admit of doubt
that he has either no ideas to express, or at any rate not suffi-
cient intelligence to learn a language which it is not difficult for
any person of common intelligence to acquire.

Where, then, does the immediate mischief in aphasia lie?
Is it not most probably in the centres of the motor residua
of speech, whereby the necessary motor intuitions fail, and the
patient cannot for the life of him bring to mind the words which
he wants to use, and perhaps uses, wittingly or unwittingly,
wrong words? The essential connexion and interaction between
the sign and the thought signified, between the centres of the
motor residua of speech and the centres of ideation, is cut off,
either by some interruption of the function of their internuntiant
fibres or by injury to the functions of the motor centres them-
selves; whence it is easily conceivable that a loss of power of
the ideas to play upon their appropriate signs will be occasioned
198 MOTOR NERVOUS CENTRES, [cHaP.

—an inability to utter by speech the thoughts, a loss of memory
of the appropriate words. The failure is not strictly mental, nor
is it strictly motor, but lies in that intermediate region between
mind and movement which is essential to the due performance
of both motor and mental functions; without which, indeed,
thought cannot attain to expression—cannot attain to know-
ledge of itself—movement cannot accomplish definite purpose.
“Herein lies the necessity of utterance, the representation of
thought,” says Heyse. “Thought is not even present to the
thinker, till he has set it forth out of himself. Man, as an
individual endowed with sense and mind, first attains to
thought, and, at the same time, to comprehension of himself,
by setting forth out of himself the contents of his mind;
and in this his free production, he comes to the knowledge of
himself, his thinking ‘I’ He comes first to himself in uttering
himself.”

Having regard, then, to the important, indeed the essential, part
which the motor intuitions play in the mental life, it is impossible
to conceive the loss of them taking place without secondary injury
to the ideational functions—to the intelligence ;. these may not
be primarily affected by the disease, but they cannot fail to suffer
secondarily. Even though the patient may not be himself aware
of any mental failure, and may feel convinced that it is only the
words to express his ideas that he lacks, yet it is not unlikely
that his condition resembles somewhat that of a person in a
dream, who fancies that he is thinking most logically, and
discoursing most eloquently, when his thoughts are confused
and his words incoherent. The history of cases of aphasia
prove that this is certainly so sometimes. It is easy to compre-
hend the disputes which arise among onlookers who endeavour
to test the intelligence in these cases: when the regular channel
by which intelligence expresses itself is closed, it must obviously
be very difficult to appraise accurately the degree of intelligence.
The simple questions which are usually put, for this purpose,
to aphasic patients certainly do not decide the question: a
demented person whose mental faculties were almost abolished,

-might answer sensibly when he was asked what he would do if
the room were on fire; and many patients in lunatic asylums
whose intelligence is in a very shattered state, are able to play
viit.J OR MOTORIUM COMMUNE, 199

cards and draughts skilfully. It is certainly quite possible for
an aphasic patient to make intelligent responses to simple ques-
tions and obvious suggestions when he has lost all power of
sustained and definite thought. And, apart from all theoretical
considerations, the evidence which exists at present is in favour
of the opinion that the intelligence is decidedly weakened in
aphasia.

There is one observation more to make before passing from
this subject. Some writers are in the habit of affirming that it
is in names we think, and that they are the indispensable
instruments of thought. “I therefore declare my conviction,”
says Max Miller, “whether right or wrong, as explicitly as
possible, that thought in one sense of the word, z.¢. in reasoning,
is impossible without language.” This sounds too absolute a
statement: the example of Laura Bridgman, who was deaf,
dumb, and blind, as her case is admirably described by Dr.
Howe, proves that a person may have human thought without
being able to speak; the instances of aphasic patients who can
express their ideas in writing point in the same direction; but
neither these instances, nor the case of Laura Bridgman, can be
used to prove that it is possible to think without any means of
physical expression. On the contrary, the evidence is all the other
way. Laura Bridgman’s fingers worked, making the initial move-
ments for letters of the finger-alphabet, not only during her
waking thoughts, but in her dreams. If we substitute for “names”
“the motor intuitions,” or take care to comprise in language all
the modes of expressing thoughts, whether verbal, vocal, writing
or gesture-language, then it is unquestionable that thought is
impossible without language. In man the tongue has been
almost exclusively appropriated for the expression of thought,
but there is no absolute reason why his fingers, hands, and arms
might not be used, like the antennz of ants, to express all the
results of mental action. The reasons why the tongue has been
specially selected for this purpose are obvious: first, because of
its connexion with the vocal organs, whereby its movements, in
conjunction with those of the lips, modify in a great variety of
ways the different sounds, and thus make audible language,
which is plainly on the whole more useful to man than visible
language ; secondly, because of the great variety and complexity
200 MOTOR NERVOUS CENTRES, [cuar.

of movements of which the numerous muscles of the tongue are
capable in so small aspace; and, thirdly, because the movements
of the hands are required for other purposes, while it is difficult
to perceive what other purpose the wonderful variety of the
tongue’s movements could have served, when it was not engaged
in the taking and mastication of food.

The influence of the motor department of mental action, the
region of actuation, might receive further illustration from the
phenomena of insanity and of certain convulsive diseases. It
scarcely admits of question that some of the delusions of the
insane have their origin in what may justly be called muscular
hallucinations: a disorder of the nervous centres of the muscular
intuitions generates in consciousness a false conception, or delu-
sion, as to the condition of the muscles, so that an individual
lying in his bed believes himself to be flying through the air,
or imagines his legs, arms, or head, to be separated from his
body, just as he has hallucinations of sense when the sensorial
centres are disordered.* In dreams we may sometimes ob-
serve the same kind of thing, as when from hindered respiratory
movements a person suddenly wakes up with the idea that he is
falling over a precipice. Illusory movements, or illusory posi-
tions, are the characteristic traits of vertigo; other subjective
sensations, such as noises in the ears, flashes before the eyes,
and painful sensations in the head, accompanying them. In
dreams, and also in drunkenness, there is no power of correcting
these subjective muscular experiences; and the brain or mind,
rendering them conscious, converts them into false conceptions
of space. Such muscular illusions, or hallucinations, can of
course only ensue -when the reaction of the disordered motor
intuition is into consciousness; if,as may happen, and commonly
does happen, the reaction takes place outwards, there are
irregular or convulsive movements, but no delusion is generated.
In fact, when the motorium commune is disordered, its morbid

* “T had some years since,” Dr. Whytt writes, “a patient affected with an
erysipelas in his face, who, when awake, was free from any confusion in his ideas ;
but no sooner did he shut his eyes, although not asleep, than his imagination -
began to be greatly disturbed. He thought himself carried swiftly through the
air to distant regions ; and sometimes imagined his head, arms, and legs, to be
separated from his body, and to fly off different ways.”—Obs. on Nature, Causes,
and Cure of Nervous, Hypochondriacal, and Hysteric Disorders. 1765.
VIII.) OR MOTORIUM COMMUNE. 201

function may be displayed in irregular or convulsive muscular
action, and, if the deterioration proceed far enough, in paralysis ;
or it may react upon the mental life, and give rise to disorder of
intelligence.

‘ The phenomena of convulsions, properly examined, will serve
to illustrate the existence and to exhibit the independent nature
of the motor intuitions. Every kind of movement which may be
normally excited by the will may occur as a convulsive act,
when, of course, there is no question of the exercise of will, and
when there is often an entire absence of consciousness. As the
individual in sound health must give intense attention in order
to isolate a certain muscular movement, which usually takes
place as a part of a complex series, and then cannot always
succeed, it is not surprising that there should often be more or
less co-ordination of movements in spasmodic or convulsive
muscular action, the design in the centres of motor intuition not
being entirely abolished. In cases of cerebral hemorrhage, it
sometimes happens that the articulating movements of single
sounds, or of a certain series of sounds, syllables, or words, are
produced without any mental act, or even against the will of
the patient. Romberg relates a remarkable case of what he calls
rotatory spasm in a girl ten years of age, and another case of
co-ordinated spasm in combination with chorea, which occurred
in a boy aged six, who was occasionally attacked with an irre-
sistible desire to climb in spite of every impediment; in the
intervals he was affected with chorea. Consciousness is not
always entirely abolished ; and then patients are able to give an
account of the impulse which instigates the movements, and
which they are unable successfully to resist. It is well known
that the idea of convulsions, whether excited by present percep-
tion or by memory, may express itself in convulsive movements
movements which, nevertheless, often display a considerable
amount of co-ordination. It is evident enough how, in a healthy
person, swallowing, coughing, and yawning are excited by the
observation of these acts in another; and as instances of simi-
larly produced morbid actions, Romberg adduces those dancing
epidemics of the Middle Ages, in which co-ordinate spasmodic
movements were notoriously excited in delicate women to an
extent and for a period such as the strongest man could not
202 MOTOR NERVOUS CENTRES, {owar.

have endured in health. It behoves us to keep in mind that as
so many of our co-ordinate actions are automatically done in
health, so there may be considerable co-ordinate automatic
action in disease.

There yet remain further important considerations. Let a
man have the will to command or effect a certain movement,
and a notion of the result desired, without any paralysis of
motor power, and he may still be impotent to perform the move-
ment. And why? Because there may be a paralysis of sensi-
bility in the muscles, by reason of which he has no means of
knowing what is the condition of the muscles of the part, the
instruments which he has to use—cannot tell whether they are
acting or not; he lacks that information which the muscular
sense should rightly afford him. In order that the will may
actuate a movement, there are necessary, then, not only a con-
ception of the end desired and a motor intuition of the muscular
movements subserving that end, but also a sense of the action of
the muscles. Any psychological arguments as to the value of
this guiding muscular feeling are rendered needless by patho-
logical experience, which plainly proves that, when the muscular
sense is paralysed, the movements cannot be performed except
some other sense come to the rescue. The sense of sight usually
does this: a woman whom Sir Charles Bell saw, who had lost
the muscular sense in her arm, could nevertheless hold her child
when she kept her eyes upon it; but the moment she turned
her eyes away she dropped the child. I have seen a similar
instance recently of a woman, epileptic in consequence of
syphilis, who had lost the muscular sense in her left arm, and
who did not know, except she looked at the limb, whether she
had got hold of anything with her hand or not; if she grasped
a jug, she could hold it quite well as long as she looked at it,
but if she looked away then she dropped it: she had no loss of
tactile sensation. In such morbid states the difference between
tactile sensation and the muscular sense is well marked. “ Olli-
vier details a case in which the patient had lost the cutaneous
sense of touch throughout the side in consequence of concus-
sion; at the same time he was able to form a correct estimate
of the weight of bodies with his right hand. The physician
observed by Marcet, who was affected with anzsthesia cutanea
vu]. OR MOTORIUM COMMUNE. 203

of the right side, was perfectly able to feel his patient’s pulse
with the fingers of the right hand and to determine its frequency
and force, but in order to determine the temperature of the skin
he was obliged to call in the aid of his left hand.” Anzsthesia
of the muscle, without loss of tactile power, does, according to
Romberg, invariably accompany the disease called tabes dorsalis,*
The eyes of patients so affected are their regulators or feelers,
and consequently their helplessness, when their eyes are shut, or
they are in the dark, is extreme; if told to shut their eyes while
in the erect posture, they begin to oscillate until they fall down,
unless supported. The skin remains sensitive except during the
last stage of the disease.

Romberg, Duchenne, and others have, moreover, described
similar morbid conditions in anemic and hysterical women,
which can hardly be called paralysis, as they are manifest only
in the night or when the eyes are shut: the patients can perform
movements, but these do not answer accurately to the will;
they are deceived as to the amount of force necessary to be put
forth, and sometimes cannot undertake the movement of a limb
without the help of sight. In these cases there is the desire to
effect a certain action, there is the motor intuition of the move-
ment necessary to the end desired, but there is wanting the
guiding sensation of the muscular sense ; and accordingly the
action cannot be done unless the sense of sight takes upon it
the function of the defective muscular sense.

What relation has the muscular sense to the motor intuition?
It is not an easy question to answer either from a psychological
or from a physiological basis. The relation appears to be not
unlike that which the sensation of a special sense has to the
corresponding idea: as the sensation of the special sense is
necessary to the formation of the idea, but, once formed, not

* It must be remembered that simple loss of muscular feeling is not Tabes
Dorsalis ; in this disease, the characteristic phenomenon is a loss of the power of
co-ordination of the muscles, and the morbid appearances are those of degeneration
of the posterior columns of the spinal cord—the motor repository or centres of
co-ordination of the movements of the limbs. Hence the disease is now more
properly called Progressive Locomotor Ataxy. Loss of muscular feeling is a
symptom that may occur in different diseases ; if another sense takes its place,
movements are still effected ; so that the power of movement, the repository of
motor residua, is not affected.
204 MOTOR NERVOUS CENTRES, [cwap,

necessary to its existence or function, so the muscular feeling
would seem to be an essential prerequisite to the formation
of the motor intuition, but, once formed, not necessary to its
latent existence, or indeed to its active function, provided only
another sense furnish the guiding information. Like other senses,
the muscular sense is receptive; it ministers to the building up
of the fundamental ideas of solidity, size, figure, and distance,
through the impressions which it receives from without. and
conveys inwards, and the subsequent internal adaptations which
take place; and in the outward intelligent reaction of the
individual upon external nature, by virtue of these ideas, it
furnishes the guiding feeling by which he is enabled to direct
the action and to regulate the amount of force applied in any
given case. How admirably eraduated is the application of force
by the skilful hand in delicate handicraft operations! How
clumsy and incapable is the beginner in such crafts until, by fre-
quent practice, the requisite motor intuitions have been acquired!
Consider how awkward any one is at so simple a matter as
winding up a watch even for the first time; and how quick,
easy, and certain the operation afterwards becomes. Observa-
tions made upon persons born blind prove that there is nothing
essential to the highest intellectual processes that may not be
acquired in the absence of sight, mainly through the muscular
feeling in combination with touch.

Because the muscular feelings gradually build up the motor
intuitions in accordance with the order, synchronous or succes-
sive, of our experience, it is not difficult to deceive them by
a new experience modifying or reversing that order. It is well
known that, if the middle finger be crossed over the fore-finger,
and a pea or a like round body be put between them, while
the eyes are turned away, there will be the sensations of two
bodies ; the impression on that side of the fore-finger which is
habitually associated in action with the thumb excites indepen-
dently its residua, and that side of the middle finger which is ac-
customed to act with the third finger excites also its residua ; and
the consequence is a feeling of two bodies which it requires the
evidence of another sense to correct. So closely and definitely,
however, are our different senses associated in their functions, that
they may, instead of aiding and correcting one another, as is their
vu] OR MOTORIUM COMMUNE. 205

proper function, sometimes actually help to deceive one another,
When the metal potassium was first shown to an eminent
philosopher, he exclaimed, on taking it into his hand, “Bless me,
how heavy it is!” and yet potassium is so light as to float on
water. The metallic appearance had suggested a certain resist-
ance, or the putting forth of so much muscular energy as
previous experience of substances having a similar look had
proved necessary ;, and for a moment the suggestion of the
visual sense overswayed the actual experience of the muscular
sense: the latter was deceived as the man is who voncludes
that a certain co-existence or succession in nature must always
exist because he. has observed it in a great many instances ; or
as, at the disinterment of a body suspected to have been
murdered, one of the spectators who fainted on account of the
bad smell was deceived ; for, when the coffin was opened, it was
found to be empty.

The perfect function of the muscular sense is not only of
essential importance to the expression of our active life, but, like
the function of any one of the special senses, it has its due part
in our mental life. In the general paralysis of the insane there
are two prominent characteristics : the first is the general para-
lysis in greater or less degree of the muscles of the body; and.
the second is the extraordinary delusions of grandeur. It isa
question well worth consideration, whether these characteristic
symptoms do not stand in some degree of causal connexion to
one another. A tailor who is suffering from general paralysis
will readily promise to make a magnificent waistcoat, and, if the
materials are supplied to bim, will at once set to work. It is
not improbable that, deceived by his quiet assurance, and know~
ing that to sew is his business, one may believe that he can make
the waistcoat. But, in a little while, it will be found that his
stitches are most unequal in size, and are placed in the most
disorderly way ; and it is made clear that, whatever he himself
may think, he certainly cannot sew. He has a sufficient desire
to accomplish the result, an adequate general notion of the end
desired, a full belief in his ability to effect it; but he fails
because his muscular feeling is very deficient, and because he
cannot regulate the action of the necessary muscles. That is
not all, however: as the sleeper, whose external senses are so
206 MOTOR NERVOUS CENTRES, [ctrap.

closed as to shut out the controlling influence of external objects,
often does in his dreams the most wonderful things, and finds
little or no hindrance to an almost miraculous activity, intel-
lectual or bodily; so the general paralytic, whose defective
muscular feeling cuts him off from the due appreciation of
external relations, has engendered in his mind the most extrava-
gant notions as to his personal power; he dreams with his eyes
open.* As we owe to the muscular sense the development of
our fundamental ideas of resistance, form, size, and space, it
will easily be understood that, when this sense is deficient
throughout the body, as in the general paralytic, there can
not’ be that intelligent accord between the inuer life and
the outward relations which, when in a perfect state, it main-
tains. Here, again, we perceive how impossible it is to separate
the mental from the bodily life ; how plainly, when we scan the
deeper relations of things in their genesis, there are displayed
the closest connexion and continuity of parts and functions.

To the action of the will, as already pointed out, a conception
of the result is essential, whether the volitional exertion be for
the purpose of causing a movement, of preventing or checking a
movement, or of dismissing a painful idea from the mind. When
a sensation excites a co-ordinate movement in so-called sensori-
motor action, we do not say there is a conception of the result,
because of the absence of consciousness; but at the same time
we must admit that there is a motor intuition of the result,—in
other words, that there is a definitely organized residuum in the
proper motor nervous centre which, as it were, implicitly con-
tains the movement. Now it is important to bear in mind that,
when the will excites that co-ordinate movement which a sen-
sation alone may do, as not unfrequently happens, it cannot
operate directly on the motor nerves, but must necessarily
operate through the medium of the same motor intuition as
that through which the sensation acts: in other words, the

* At the present time I have under my care a general paralytic who, occa-
sionally much excited, then believes that he is fighting great battles, and winning
great victories with his fists; he believes, too, that he wins immense sums of
money as wagers on his prowess. The disorder of his motoriwm commune enters
into his thoughts and engenders corresponding delusions. He is confined to his
bed or couch by reason of having lost one leg, or he would be a violent and

dangcrous lunatic.

Wise eel
Vut.] OR MOTORIUM COMMUNE. 207

movement in both cases proceeds directly from the motor ner-
vous centre in which the movement is latent. If we could
excite these centres artificially, not over-exciting and injuring
them, as in our gross experiments we necessarily do, then we
should not fail to set free the definite movements. Speaking
psychologically, the conception of the result becomes in the
execution of voluntary movements the motor intuition, and the
motor intuition excited into activity expresses itself in the
designed movement. Thus, then, it appears that, as in the action
of nature upon man, the stimulus which is not reflected in
the spinal cord passes upwards and excites sensation, and the
stimulus which is not reflected in sensori-motor action passes
upwards and becomes idea, and the stimulus which is not:
reflected in ideomotor action passes from cell to cell in the
hemispheres and excites reflection ; so in the reaction of man
upon nature, the force of the will passes downwards through the
subordinate centres in an opposite direction: the will involves
a conception of the result or a definite ideational action; the
conception of the result demands for its further transforma-
tion the appropriate motor intuition ; and the motor intuition,
in whatever motor centre, spinal or cerebral, it is organized,
demands for its due expression in movement the perfect function
of the muscular feeling, and the integrity of the motor nerves
and muscles. There is an orderly subordination of the different
nervous centres, a chain of means such as is revealed in every
department of nature. Viewing the different sciences, we per-
ceive that chemistry is dependent on physics, while physics
are independent of chemistry ; physiology is dependent on che-
mistry, while chemistry is independent of physiology ; social
science is dependent on physiology, while physiology is indepen-
dent of social science : and so the just analysis of our mental life
proves that sensori-motor action is dependent on reflex action,
while reflex action is independent of sensori-motor action ; ideo-
motor action dependent on sensori-motor action, while sensori-
motor action is independent of ideomotor action; the will
dependent on ideomotor action, while ideomotor action is in-
dependent of the will. These different epochs in the order of
development of the nervous system are represented by different
classes of the lower animals: and it is interesting to note that,
208 MOTOR NERVOUS CENTRES. [cHap. ViIr..

as in man there is a subordination of parts, and the will, as the
highest energy, controls the inferior modes of nervous energy,
so in the animal kingdom there is a subordination of kinds, and
the mind of man, as the highest development, controls and uses
the inferior minds of many of the lower animals.

If execution has been in any wise answerable to conception,
we have now said enough to prove the importance of that region
of mental activity in which dwell the motor residua, and which
may properly be named the region of actuation. We have only
to add that men differ much naturally as to the perfection of
this as of other mental faculties. There are some who, with
great intellectual power, never can attain to the ability of suc-
cessfully expressing themselves: and there are others, on the
other hand, who can pour forth endless talk with the most facile
fluency. The art of expression in speech, or in writing, or even
in eloquence of action, is one which, if there is not an innate
faculty for it, can never be acquired in its highest perfection :
unseen fetters hinder the full utterance, and lame execution falls
far short of ambitious conception: with the distinct conception
of what they would say, and the best will to say it, there is
something wanting in the region of actuation, whereby they are
prevented from doing justice to their thoughts, and are com-
pelled, like Moses, to delegate that function to others. “There
is Aaron: he shall be thy speaker, and thou shalt be to him
instead of God.” (Exodus iv. 16.)*

* And a greater than Moses or Aaron was so gifted with the faculty of
excellent expression, that it was justly said of Him that “ Never man spake as
this man speaks.”
CHAPTER IX.

MEMORY AND IMAGIN ATION.

“You tell me it consists of images or pictures of things. Where is this
extensive canvas hung up? or where are the numerous receptacles in which these
are deposited? or to what else in the animal system have they any similitude ?
That pleasing picture of objects represented in miniature on the retina of the eye
seems to have given rise to this illusive oratory. It was forgot that this repre-
sentation belongs rather to the laws of light than to those of life; and may with
equal elegance be seen in the camera obscura as in the eye; and that the picture
vanishes for ever when the object is withdrawn.”—-Dr. Darwin, Zoonomia.

eo Memory has not hitherto been specially treated of
as a faculty of the mind, its true nature has been none the
less discussed largely, though incidentally, in the foregoing pages.
It may be desirable, however, to bring together into one body
the fundamental facts concerning it. There is memory in every
nerve-cell, and, indeed, in every organic element of the body.
The permanent effects of a particular virus on the constitution,
as that of small-pox, or that of syphilis, prove that the organic
element remembers for the rest of life certain. modifications
which it has suffered ; the manner in which the scar on a child’s
finger grows as the body grows evinces, as Mr. Paget has pointed
out, that the organic element of the part does not forget the
impression that has been made upon it; and all that has so far
been said respecting the different nervous centres of the body
cannot fail to demonstrate the existence of memory in the nerve-
cells which lie scattered in the heart and in the intestinal walls,
in those that are collected together in the spinal cord, in the cells
_ of the sensory and the motor ganglia, and in the ideational cells
of the cortical layers of the cerebral hemispheres. The residua
by which our faculties, as already shown, are built up, are the
P
210 MEMORY AND IMAGINATION. [cHaP.

organic conditions of memory. These organized residua of the
cerebral centres, which, when excited into activity by some ex-
ternal impression, enable us to perceive distinctly, or apprehend
the object, appear, when excited by some internal cause, as
memory or recollection. When an organic registration has been
completely effected, and the function of it has become automatic,
we do not usually speak of the process as one of memory, because
it is entirely unconscious. Thus, for example, when a beginner
is learning his notes on the pianoforte, he has deliberately to call
to mind each note; but when, by frequent practice, he has
acquired complete skill in playing on that instrument, there is
no congciqus memory, but his movements are automatic, and so
rapid as to surpass the rapidity of succession of conscious ideas,.
As with such movements, so it is with many ideas, which are so
completely organized that they are automatically and quickly
performed in our mental life without conscious memory. (+)

The organic registration of the results of impressions upon our
nervous centres, by which the mental faculties are built up, and
by which memory is rendered possible, is the fundamental pro-
cess of the mental life. There can be no memory of that whereof
we have not had experience in whole or in parts; and nothing
of which we have had experience can be absolutely forgotten..
But it is most mischievous to regard mental phenomena as mere
pictures of nature, and the mind as a vast canvas, on which
they are cunningly painted. Such representation, as Darwin
well observes, belongs rather to the laws of light than to those of
life; the real process is one of organization, and is rightly con-
ceivable only by the aid of ideas derived from the observation of
organic development,—namely, the fundamental ideas of Assimi-
lation and Differentiation.

There is in mental development, then, the organic registration
of the simple ideas of the different senses; there is the assimila-
tion of the like in ideas which take-places in the production or
organic evolution of general ideas ; there is the special organiza-
tion, or differentiation, or discrimination, of unlike ideas; and
there is the organic combination of the ideas derived from the
different senses into one complex idea, with the further manifold
combinations of complex ideas into what Hartley called duplex
ideas, In fact, no limit is assignable to the complexity of
1x,] MEMORY AND IMAGINATION. 211

combinations which may go to the formation of an idea, Take,
for example, the idea of the universe. But how comes it
to pass that a new creation of the mind, to which nothing in
nature answers, is effected? By a similar organic process to
that by which like residua are blended, and general or abstract
ideas formed. There are no actual existences answering to our
most abstract ideas, which are, therefore, so far new creations of
the mind. In their formation there is a comparison of our ideas,
and a blending or coalescence of their like relations takes place
—the development of a concept, There is, as it were, an extrac-
tion of the essential out of the particular, a sublimation of the
concrete ; and, by the creation of a new world in which these
essential ideas supersede the concrete ideas, the power of the
mind is most largely extended. Although there is no concrete
object in nature answering to these abstract ideas, yet they are
none the less, when rightly formed, valid and real subjective
existences that express the essential relations of things, as the
flower which crowns development expresses the essential nature
ef the plant. Thus it is that we rise from the particular idea of
a man to the general idea of man, and then again to the abstract
idea of virtue; so that for the future we can make use of the
abstract idea in all our reasoning, without being compelled to
make continual reference to the concrete.* Herein, be it remem-
bered again, we have a process corresponding with that which
ministers to the production of our motor intuitions ; the acquired
faculty of certain co-ordinate movements by means of which
complicated acts are automatically performed, and we are able
to do, almost in the twinkling of an eye, what would cost hours
of labour if we were compelled on each occasion to go delibe-
rately through the process of special adaptation, is the equivalent,
on the motor side, of the general idea by which so much time
and labour are saved in reasoning: in both cases there is an
internal development in accordance with fundamental laws, and
the organized result is, as every new phase of development is,
a new creation. Creation is not by fits and starts, but it is con-
tinuous in nature.

* But it should not be forgotten, as it is so apt to be, that the meaning of the
general or abstract is to be sought in the concrete, not the interpretation of the

concrete in the general or abstract.

P2
212 MEMORY AND IMAGINATION. [omar:

These considerations are of importance in respect of the nature
of Imagination, which must ever be incomprehensible on the
mischievous assumption of ideas as pictures or images of things
painted on the mind. Though imagination is certainly depen-
dent on memory, is it not, it may be asked, more than reproduc-
tive,—is it not, in fact, productive? Productive, we reply, as to
form, but certainly only reproductive as to material. When any
one affirms that he can imagine something—as, for example,
some animal of which he has not had experience, what he does
is to combine into one form certain selected characters of dif-
ferent animals of which he has had experience; creating in
this way, as nature is continually doing, new forms out of old
material. When the artist embodies in ideal form the result of
his faithful observation, he has, by virtue of that mental procéss
through which general ideas are formed, abstracted the essential
from the concrete, and then by the shaping power of imagination
given to it a new embodiment. In every great work of art there
is thus an involution of the universal in the concrete: it is
pregnant in its meaning, yielding a wide range to the action
of another’s imagination when he contemplates it.. So it is
that high art does not express anything essentially evanescent :
it confers on the moment the stedfastness of eternity, repre-
senting the “snows of nature frozen into a motionless im-
mortality.” The man of science, who unlocks the secrets of
Nature by means of observation, experiment, and reflection, thus
systematically training his mind in conformity with Nature by
exact interrogation and faithful interpretation of her works, has
recourse, when he proceeds to react upon nature, to a scientific
imagination thus carefully cultivated, and is enabled to construct
wonderful works of art that are truly an advance upon, or a
development of, nature—new creations. What else then, funda-
mentally, is the true imagination but the nisus of nature’s
organic development displaying itself in man’s highest function ?
What is human art but nature developed through man? There
is going on a recreation of nature by human means, but nature
makes the means.* The productive or creative power of Imagi-

* “Vet nature is made better by no mean,

But nature makes that mean ; 80, over that art,
Which, you say, adds to nature, is an art
1x.] MEMORY AND IMAGINATION. 213

nation, which seems at first sight to be irreconcilable with
knowledge gained entirely through experience, is then at bottom
another, though the highest, manifestation of that force which
impels organic development throughout uature; and the imagi-
nation of any one either creates truly, or brings forth abortions
and monstrosities, aceording as the mind is well stored with
sound knowledge and has true concepts, or as it is inadequately
furnished with knowledge and has erroneous concepts—accord-
ing, in fact, as the individual is or is not in harmony with nature.
As imagination thus exhibits an evolution of the mental organi<
zation, so the well-grounded imagination of the philosopher or
the poet is the highest display of nature’s organic evolution,
and works, like nature, unconsciously.* (2)

How much of what we call memory is in reality imagination !
When we think to recall the actual, the concrete, it is often the
ideal, the general, that we reproduce ; and when we believe that
we are remembering, we are often misremembering, being in-
fluenced by the feelings of the moment, and unable to reproduce
the feelings of the past. The faculty by which we recall a scene
of the past, and represent it vividly to the mind, is at bottom
the same faculty as that by which we represent to the imagina-
tion a scene which we have not witnessed. “For davratecOu
and meminisse, fancy and memory, differ only in this, that
memory supposes the time past, which fancy doth not.” Me-
mory, indeed, has been called the grave of the past, imagina~
tion the womb of the future; but the grave of the past ever is
the womb of the future. How much of our perception even is
netually imagination ! The past perception unavoidably mingles
in the present act, prevents us often from discriminating minute
jifferences which exist, and thus causes us to perceive wrongly

That nature makes, . « . .

This i is an : art
Which doce mend nature—change it, rather: but
The art itself is nature.”—Winter’s Tale.

* All power is of one kind,” says Emerson, ‘‘a sharing of the nature of the
vorld. The mind that is parallel with the laws of nature will be in the current
f events, and strong with their strength.. One man is made of the same stuff of
vhich events are made; is in sympathy with the course of things ; can predict

hem,”
Q14 MEMORY AND IMAGINATION. [crar.

or observe incorrectly. What shall be admitted as a fact in
scientific observation, depends entirely upon the observer's pre-
vious knowledge and training. So strong is the disposition to
assimilate a present observation with a past perception, to blend
together the like in two ideas, that we are apt to overlook those,
special differences which demand a discrimination or organic
differentiation; there is, indeed, almost as great a danger of
hasty generalization in perception as there is in reasoning. Ifa
new observation will not easily assimilate with existing ideas,
there is a feeling of dissatisfaction and of positive discomfort,
and one is apt to pass the unwelcome fact by. But if a proper
mental training prevents such neglect, the fact is deliberately
appropriated or registered as a special fact, although small satis-
faction is felt in the martyrdom of thus registering it, isolated
as it appears; after a while, however, other observations cluster
about it, some blending with it, others connecting it with
ideas to which it seemed entirely unrelated, until this pariah of
the mind is found perhaps to fill up a gap in knowledge, and
organically to unite distant ideas. It is a most necessary habit
to acquire in the true cultivation of the mind, that of observing
accurately, of carefully noting minute differences, and of scru-
pulously registering them, so as to effect an exact internal
correspondence with external specialities.

As we perceive more accurately, so shall we remember more
correctly, judge more soundly, and imagine more truly. The
habit of hasty and inexact observation, the unwarranted blending
of residua that are not truly like, is necessarily the foundation
of a habit of remembering wrongly; and the habit of remem-
bering wrongly is of necessity the cause of an incorrect judgment
and erroneous imagination: exact internal correspondence to
external relations being the basis of an imagination true to
nature,—in other words, of a true organic mental oo
For these reasons, “the whole powers of the soul may,”
Hartley observes, “be referred to the memory, when Mins in
a large sense. Hence, though some persons may have strong
memories with weak judgments, yet no man can have a strong
gnepmtent with a weak original power of retaining and remem-
bering.” Infinite mischief and confusion have been caused by
the habit of speaking of ideas as if they were the mechanical
1x.] MEMORY AND IMAGINATION. 215

stamps of impressions on the memory, instead of as, what they
truly are, organic evolutions in respondence to definite stimuli ;
our mental life is not a copy but an idealization of nature, in
accordance with fundamental laws.

As organic growth and development take place in obedience
to the laws of nature, and yet constitute an advance upon them,
so it is with the well-cultivated or truly developed imagination,
which brings together images from different regions of nature;
yokes them together by means of their occult but real relations,
and, thus making the whole one image, gives a unity to variety :
there is an obedient recognition of nature, and there is a develop-
mental advance upon it. This esemplustic faculty, as Coleridge,
following Schelling, named it, is perhaps indicated by the Ger-
man word for imagination, namely, Hinbildung, or the one-making
faculty.* Its highest working in our great poets and philoso-
phers really affords us an example of creation going steadily on
as a natural process; and creative or productive activity is
assuredly the expression of the highest mental action: whosoever
has such capacity has more or less genius; whosoever has it not
will do nothing great, though he work never so hard. What an
amount has been unwisely written by the sedulous followers of
a so-called inductive philosophy in disparagement of imagination
and in favour of simple observation! “Men should consider,”
says Bacon, “the story of the woman in A‘sop, who expected
that with a double measure of barley her hen would lay two
eggs'a day ; whereas the hen grew fat and laid none.” It were
as wise in a man to load his stomach with stones instead of
food as to load his mind with facts which he cannot digest and
assimilate. It is in the great capacity which it has of assimi-
lating material from every quarter, and of developing in pro-
portion, that the superiority of genius consists ; and it is in the
excellence of its imagination, whether poetical, artistic, philo-
sophic, or scientific, that its superior energy is exhibited.

Because the least things and the greatest in Nature are indis-
solubly bound together as equally essential parts of the myste-
rious but harmonious whole, therefore the intuition into one

* More correctly, perhaps, Zin for en (in), and Bildung (formation, —internal
image, #.¢. imagination.
216. MEMORY AND IMAGINATION. [orar,

pure circle of her works by the high and subtile intellect of the
genius contains implicitly much more than can be explicitly
displayed in it. Hence it comes to pass at times that, in the
investigation of a new order of events by such an intellect, the
law of them will, as by a flash of intuition, explicitly declare
itself in the mind after comparatively few observations: the
imagination successfully anticipates the slow results of patient
and systematic research, flooding the darkness with the light of
a true interpretation, and thus illuminating the obscure relations
and intricate connexions. Therein a well-endowed and well-
cultivated mind manifests its unconscious harmony with nature.
The brightest flashes of genius come unconsciously and without
effort : growth is not a voluntary act, although the gathering of
food is.

Certainly the intuition of truth can never be the rule amongst.
men, inasmuch as the genius capable of intuition, so far from
being common, is a most rare exception amongst them. And
the result, however brilliantly acquired, can never be safely
accepted as lasting, until it has been further subjected to the
tests of observation, experiment, and logical reasoning,—until it
has undergone verification. The man of genius who has revealed
a great truth may probably, on some other occasion, promulgate
an equally great error. Happily his errors are indirectly most
useful; for the experiments and observations provoked and
directed by them, and prosecuted for the purpose of displaying
their instability, often lead to valuable discoveries. Mischief is
undoubtedly wrought by the rash promulgation of ill-grounded
theories on the part of those who have neither superior original
capacity, nor a mind well stored with the results of observation,
nor an imagination properly cultivated. It is the ignorant only,
however, whom such persons deceive: those who possess an
adequate knowledge of the subject can always recognise in the
unwarranted theory the exact amount of knowledge which its
authors have had, and the character of the defect in their reason-
ing. Those, again, who take a philosophical view of things, aud
look upon the progress of human knowledge as a development
that is going on continuously through the ages, will find it con-
formable to their experience of every other form of vital growth
that there should be, coincidently with advance, a retrograde
1x.] MEMORY AND IMAGINATION. 217

metamorphosis, degeneration or corruption of that’ which is not
fitted for assimilation, and which is ultimately rejected: as the
body dies daily as the condition of its life, so false theories and
corrupt doctrines are conditions of the progress of knowledge.*
That there is a deep distrust of hasty generalization is a mani-
festation of the self-conservative instinct ; it prevents the human
mind from being led astray by vain and windy doctrines, and
thus promotes a true development. It is not, however, in
the individual, where so much active change takes place in so
short a time, that the regular corruption and decay of false doc-
trines will be clearly perceived, but in the historical development.
of the race, where the gradual evolution of the mind may be
better traced, ;

Thus much concerning memory and imagination, which, when
properly examined, reveal, better perhaps than the analysis of
any other of the so-called mental faculties, the complex organi-
zation which mind really is. It remains only to add here, that
the manifold disorders to which memory is liable illustrate in.
the most complete manner its organic nature. Its disorders are
numberless in degree and variety; for there is not only every
degree of dulness, but there is met with every variety of partial
loss, as of syllables in a particular word, of certain words, places,
names. So various and numerous are its possible defects, that.
it has not yet been possible to reduce them to any system,
although it is probable that a careful classification of them
might be very useful: All that we can at present conclude
from them is, first, that memory is an organized product; and,
secondly, that it is an organization extending widely through the
cortical layers of the cerebral hemispheres. It is interesting to
observe that differences exist in different persons in the character
of the organic function which ministers to memory; one man,

.* I may make the following quotation from an article by me, on “ Recent
Metaphysics,” in the Journal of Mental Science, January 1866 :—‘“ As in the
growth and’ development of the body there is a correlative degeneration or retro-'
grade metamorphosis of organic element going on—a daily death in strict relation
with the activity of life; so in the organic growth of thought through the ages, ,
there is a corresponding decay, or corruption of erroneous doctrines—a death of
the false in strict relation with the growth of the true; thus healthy energy
throws off effete matter, which, in the very act of becoming effete, gives up force
that is available for the development of the living element of truth,” ;
218 MEMORY AND IMAGINATION. [cHap.

for example, has a good memory for particular facts, but is no
way remarkable for reasoning power, or is even singularly
deficient therein—the registration of the concrete impressions
taking place with the greatest ease, but the further digestion of
the residua not being accomplished ; another, on the other hand,
has no memory for particular isolated facts—they must have
some relation to ideas already appropriated, or must fall under
some principle, if he is to recollect’ them; the digestion of
residua is well effected, so that there exists a great power of
generalization. The latter is the memory of intellect; the
former is not unfrequently the memory of idiots.

Some flaw in the memory, some breach in its exquisite organi-
zation, is ever one of the first indications of a disorder or dege-
neration of nerve element. But its slight, early affections are
very apt to be overlooked, forasmuch as they do not reveal them-
selves in a conscious inability to remember something, but in an.
unconscious deterioration of the power of abstract reasoning,
and of the moral sense that is so closely connected therewith.
The most delicately organized residua, representing the highest
efforts of organic assimilation, are here the first to attest by their
sufferings any interference with the integrity of nerve element,
just as disorders of the finest associated movements of the spinal
cord are the first to declare the commencing degeneration of its
centres. Long before there is any palpable loss of memory in
insanity, even before an individual is recognised to be becoming
insane, there is a derangement of his highest reasoning and of
his moral qualities; his character is more or less altered, and,
as it is said, “ he is not himself.” If the degeneration of nerve
element proceeds, we witness successively every stage of declen-
sion in the disorder of the complex organization of the memory;
namely, manifest perversion of the higher social feelings, then
greater or less destruction of the organic connexions of ideas,
whence follows incoherence of thought, and, finally, general for-
getfulness, declining into complete abolition of memory.

It is not difficult to understand how it is that the old man
sometimes has a tenacious memory of the past, and can reason
tolerably correctly with regard to it, when he cannot duly appro-
priate and rightly estimate the present. The brain, like every
other organ of the body, suffers a diminution of power of activity
1x.] MEMORY AND IMAGINATION, 219

with the advance of age; it reacts to impressions with less and
less vigour and vivacity, and there is less and less capacity to
assimilate the influence of them, so that there are a dulness of
perception and an incorrect appreciation of events. Meanwhile,
however, the past is a part of the organic nature of the brain,
and may be sufficiently remembered, though perhaps with less
vivacity than formerly. It is easy, again, to perceive how it is
that children, like animals, live almost entirely in the present ;
they have no store of ideas organized in the mind which might
be called into activity to influence the present idea, and they react
directly to the impressions made upon them. The best possible
evidence of the gradual process of mental organization is indeed
afforded by the mental phenomena of young children; for the
residua of impressions not being completely organized, their
memory is fallacious, and, a firm organic association between
ideas not being established, their discourse is incoherent. The
old man and the child both fail in judgment: the former, because
he has forgotten more or less of the past, and has lost the
standard by which to measure the present perception, or because
he cannot take in accurately the present perception, and measures
it entirely by the past; the latter, because it has not yet any
past. By the necessity of the case almost, an old man becomes
conservative and the laudator temporis acti; for the evolution of
events goes on when his nature has ceased to assimilate and
develop; he has accordingly no sympathy with them, but, re-
treating within the shell of a calcified past, obstinately brands as
revolutionary what is truly evolutionary. How different with the
youth! The curtain of life rises, and he is fascinated with the
show ; his nature expands trustfully, and though he may often
mistake fleeting illusions for lasting truths, and come to no little
sorrow thereby, yet he assimilates, grows, and develops.
Lastly, it will not be amiss to bear in mind, in regard to the
organic nature of memory, that we cannot remember pain. It is
certainly possible to remember that we have suffered a particular
pain; but vividly to recall the pain as we can a definite idea
is not possible. And why? Because the idea is an organized
product which abides, while the disorganization or disturbance
of nerve element which pain implies, passes away with the
restoration of the integrity of the nerve centre. For the same
220: MEMORY AND IMAGINATION. [car

reason, we cannot easily or adequately recall a very powerful
emotion in which the idea or the form has been almost entirely
lost in the commotion—where, in fact, the storm among the
intimate elements has been so great as to be destructive of form:
Shakspeare’s words, “formless ruin of oblivion,” ’ admirably.
expressing the state of things. When we do strive to bring to
mind a particular sensation or emotion, it is by vivid representa-
tion of its cause, and consequent secondary excitation of it: we
remember the idea, and the idea generates the emotion or the
sensation. But the sensation of pain is a very different matter
from the sensation of one of the senses; it is the outcry of
suffering nerve element, and cannot be generated by any idea;
it is not the result of organization, but the token of disorgani-
zation, How, then, should it be accurately remembered ?

NOTES.

1 (p, 210),—“ The truth that memory comes into existence when the
connexions among psychical states cease to be perfectly automatic is in
complete harmony with the obverse truth, illustrated in all our expe-.
rience, that as fast as the connexions of psychical states which we form
in memory become, by constant repetition, automatic, they cease to be
part of memory. We do not speak of ourselves as remembering those
relations which become organically, or almost organically, registered ;
we remember those relations only of which the registration is not yet
absolute. No one remembers that the object at which he is looking
has an opposite side; or that a certain modification of the. visual
impression implies a certain distance ; or that the thing which he sees
moving about is a living animal. It would be a misuse of language
were we to ask another whether he remembers that the sun shines,
that fire burns, that iron is hard, and that ice is cold....... And
similarly, though, when a child, the reader’s knowledge of the meaning
of successive words was at first a memory of the meanings he had
heard given to them ; yet now their several meanings are present to
him without any such mental process as that which we call remem-
brance.”—Hzrpert Spencer, Principles of Psychology, p. 551.

2 (p, 213).—Jean Paul Richter, in one of his Letters, says: “The

dream is an involuntary art of poetry: and it shows that the poet.

works more with the bodily brain than another man. How is it that-

ete ss
1x.]. MEMORY AND IMAGINATION. 221.

no one has wondered that in the detached scénes of dreaming, he puts
in the mouth of the actors the most appropriate language, the words most
exactly characteristic of their nature ; or rather that they prompt him,
not he them? The true poet even is in writing only the listener, not
the. language-teacher of his characters. . . . . Victor’s observation that
the opponent of his dreams often put before him more difficult
objections than a real bodily one, may be made of the dramatist, who
can in no. manner be the spokesman of his company without a
certain inspiration, though-he is at the same time easily the writer of
thei parts. That dream-forms surprise us with answers with which
we ourselves have inspired them is natural; even when awake every
idea springs forth suddenly like a spark of fire, though we attribute it
to our attention ; but in dreams we lack the consciousness of attention,
and we must thus ascribe the idea to the figure before us, to which
also we ascribe the attention.” Again :—‘ Das Machtigste in Dichter,
welches seinen Werken die gute und die bése Seele einblaset, ist
gerade das Unbewusste.”—A esthetik.

Carlyle, whose writings exhibit in a marked degree the influence of
Jean Paul and Goethe, says of Shakspeare :—‘ Shakspeare is what
I call an unconscious intellect; there is more virtue in it than he is
himself aware of. His dramas are products of Nature, deep as Nature
herself. It is Nature's highest reward to a true, simple, great soul,
that he gets thus to be a part of herself. Such,a man’s works, whatever
he with utmost conscious exertion and forethonght shall accomplish,
grow up withal wnconsciously from the unknown deep in him, as the
oak-tree grows from the earth’s bosom, as the mountains and waters
shape themselves.”

Dr. Brown (Philosophy of the Mind, p. 200), when enumerating
what he calls the Secondary Laws of Suggestion, lays much stress on
constitutional differences in individuals—the differences of Genius,
Temper, or Disposition. The tendencies in some minds are wholly to
suggestions of proximity ; in other minds there is a powerful tendency
to suggestions of analogy. It is in this latter tendency to the new
and copious suggestions of analogy that the distinction of genius
appears to consist ; a mind in which it exists is necessarily inventive ;
“for all to which we give the name of invention, having a relation to
something old, but a relation to that which was never before suspected
or practically applied, is the suggestion of analogy.” There would be
nothing new if objects were to suggest only, according to proximity,
the very objects that had co-existed with them; but there is a
perpetual novelty of combination, when the images that arise after
222 MEMORY AND IMAGINATION. [cwap. 1x.

each other, by that shadowy species of resemblance which we are
considering, are such as never existed before together or in immediate
succession. Hence the rich figurative language of poetry—the
expressions of resemblances that have arisen silently and spontaneously
in the mind; hence the discoveries and inventions of ‘science, &c.
He goes on, too, to point out that this novelty of combination in
imagination cannot depend upon the will. It is absurd, he says, to
suppose that we can will directly any conception, since, if we know
what we will, conception must be already a part of consciousness.

“Hence, in proportion as the memory is enriched and provided
with materials, in the same proportion the rational mind, if backed by
a happy genius, will be able skilfully, felicitously, and approximately,
and agreeably to the truth, to distribute its analysis into series, to
adjust and conclude them, of many analytic conclusions again to form
new analyses, and in the end to evolve its ultimate analyses.”—
Swepensore’s Animal Kingdom, vol. ii. p. 348.

In a note he adds—“ This is corroborated by the common opinion,
that the knowledge and intelligence of an individual are in proportion
to the furniture of his memory. But it does not follow from this,
that a powerful memory is always accompanied with ability, or by an
understanding of equal grasp. For the faculty of reducing the con-
tents of memory to order is a fresh intellectual requisite. An edifice
is not built simply by the accumulation of implements, bricks, tiles,
and the materials. These and skill must be tasked to put all things
together in their places.”
PART IL

THE PATHOLOGY OF MIND.

CuarTeR I. On THE CaAvsEs oF INSANITY.
II. On THE Insanity oF Earty Lirg.
III. ON THE VARIETIES OF INSANITY.
IV. On THE PatwHotoey or Insanity.
V. On THE Diacnosis oF INSANITY.
VI. On THE Proenosis oF INSANITY.
VII. On THE TREATMENT OF INSANITY.

”

”

”

”?

ord

27
CHAPTER I.

ON THE CAUSES OF INSANITY.

HE causes of insanity, as usually enumerated by authors, are

so general and vague as to render it a very difficult matter

to settle in the mind what they really are. But it is hardly less
difficult, when brought face to face with an actual case of in-
sanity, and when there is every opportunity of investigation,
to determine with certainty what have been the causes of the
disease. It is a question, however, asked over and over again of
the physician by the members of an insane person’s family, who
appear sometimes more anxious to know what can have caused
the disease than to know what will cure it. The uncertainty
springs from the fact that, in the great majority of cases, there is
a concurrence of conditions, not one single effective cause, All
the conditions which conspire to the production of an effect are
alike causes, alike agents; and, therefore, all the conditions,
whether they are in the individual or in the circumstances in
which he is placed, which in a given case co-operate in the pro-
duction of disease, must alike be regarded as causes. When we
are told that a man has become deranged from anxiety or grief,
we have learned very little if we rest content with that state-
ment. How does it happen that another man, subjected to an
exactly similar cause of grief, does not go mad? It is certain
that the entire causes cannot be the same where the effects
are so different; and what we want to have laid bare is the
conspiracy of conditions, internal and external, by which a
mental shock, inoperative in one case, has had such serious
consequences in another. A complete biographical account of
the individual, not neglecting the consideration of his hereditary

Q
296 ON THE CAUSES OF INSANITY. [cmar.

antecedents, would alone suffice to set forth distinctly the causa-
tion of his insanity. If all the circumstances, internal and
external, were duly scanned and weighed, it would be found that
there is no accident in madness; the disease, whatever form it
might take, by whatsoever complex concurrence of conditions, or
by how many successive links of causation, it might be gene-
rated, would be traceable as the inevitable consequence of certain
antecedents, as plainly as the explosion of gunpowder may be
traced to its causes, whether the train of events of which it is
the issue be long or short. The germs of insanity are sometimes
latent in the foundations of the character, and the final outbreak
is the explosion of a long train of antecedent preparations.

When the causation of insanity may thus extend over a life-
time, it is easy to perceive how little is taught by specifying a
single moral cause, such as grief, vanity, ambition, which may
after all be, and often is, one of the earliest symptoms of the
disease. Do we not, in sober truth, learn more of its real causa-
tion from a tragedy like “Lear” than from all that has yet been
written thereupon in the guise of science? An artist like
Shakspeare—penetrating with subtile insight the character of the
individual, and the relations between him and his circumstances,
discerning the order which there is amidst so much apparent
disorder, and revealing the necessary mode of the evolution
of the events of life—furnishes, in the work of his creative
art, more valuable information than can be obtained from the
vague and general statements with which science, in its present
defective state, is constrained to content itself. Because of these
difficulties, I believe that I shall help to accomplish my task
of conveying distinct notions of the causation of insanity by
bringing forward in an appendix, as illustrations, the notes of
some cases, the histories of which I have thoroughly in-
vestigated. Before doing this, however, it is necessary to make
some general observations in order to establish certain principles,
and to prevent repetition afterwards.

It is the custom to treat of the causes of insanity as physical
and moral, though it is not possible thus to discriminate them
with exactness. Where hereditary taint exists, for example, and
is the cause of some defect or peculiarity of character which
ultimately issues in insanity, one person might describe the
‘1.] ON THE CAUSES OF INSANITY. 227

cause as moral while another would describe it as physical.
Certainly, where there existed manifest defective development
of the brain in consequence of inherited mischief, as in some
cases of idiocy, every one would agree as to its physical nature ;
but where there was no observable morbid condition in the
brain, and the evil only declared itself in a vice of disposition in
the individual, most people would consider it of a moral nature,
though really as certainly due to physical conditions as idiocy
confessedly is. In reality, every moral cause operates through
the physical changes which it produces; and in the great
majority of cases in which the cause has been pronounced moral
there has been something in the physical constitution by the co-
operation of which the result has been brought about. Life in
all its forms, physical or mental, morbid or healthy, is a relation ;
its phenomena result from the reciprocal action of an individual
organism and external forces: health, as the consequence and
evidence of a successful adaptation to the conditions of exist-
ence, implies the preservation, well-being, and development of
the organism, while disease marks a failure in organic adaptation
to external conditions, and leads, therefore, to disorder, decay,
and death, Now it is obvious that the harmonious relation
between the organism and the external world, which is the con-
dition of health, may be disturbed either by a cause in the
organism, or by a cause in the external circumstances, or by a
cause, or rather a concurrence of causes, arising partly from one
and partly from the other. When it is said that mental anxiety,
produced by adverse circumstances, has made any one mad,
there is implied commonly some infirmity of nerve element
inherited or acquired, which has co-operated: were the nervous
system in a state of perfect soundness, and in possession of that
reserve power which it then has of adapting itself, within certain
limits, to the varying external conditions, it is probable that the
most unfavourable circumstances would not be sufficient to dis-
turb permanently the relation, and to initiate mental disease.
But when unfavourable action from without conspires with an
infirmity of nature within, then the conditions of disorder are
established, and a discord, or madman, is produced.

From what has been said, it would seem that it cannot con-
duce to exact knowledge to maintain the violent distinction

Q 2
228 ON THE CAUSES OF INSANITY. (crap.

between physical and moral causes of insanity. This will appear
more plainly if we call to mind the conclusions established in
the First Part of this book. There it was distinctly shown that
thoughts, feelings, and actions leave behind them certain residua
which become organized in the nervous centres, thenceforth
modifying the manner of their development so as to constitute
an acquired nature; consequently, the moral manifestations
throughout life inevitably determine physical organization ; and
a slowly operating moral cause of insanity is all the while pro-
ducing physical changes in the occult recesses of the supreme
nervous centres of the mental life. In fact, the brain which is
exercised so habitually in a given manner as to acquire during
health a strong peculiarity or bias of action is sometimes more
liable to disorder in effect of this; and, when the disorder is pro-
duced by an independent cause, this bias or habit may aggravate
its effects. When insanity occurs as the consummate exaggera-
tion of a particular vice of character, as it sometimes does, the
morbid mental manifestations mark a definite habit of morbid
nutrition in the supreme nervous centres,—a gradually effected
modification of the mental organization. On the other hand, the
brain which is habitually exercised in the best possible way
acquires a strong and healthy habit of thought and volition
which counteracts the effects of a morbid cause.

I shall deal first with the consideration of those general con-
ditions which are thought to predispose in any way to insanity,
and which may be summed up as its remote or predisposing
causes. Of so vast a subject it is plainly impossible to treat
here in any but the most summary way ; to attempt to traverse the
wide field over which the predisposing causes of human degene-
racy extend would be to enter upon a survey of human history. _

Predisposing Causes—There are general causes, such as the -
state of civilization in a country, the form of its government and
its religion, the occupation, habits, and condition of its inha-
bitants, which are not without influence in determining the pro-
portion of mental diseases amongst them. Reliable statistical
data respecting the prevalence of insanity in different countries
are not yet to be had’; even the question whether it has
increased: with the progress of civilization has not been posi-
tively settled. Travellers are certainly agreed that it is a rare
1] ON THE CAUSES OF INSANITY. 229

disease amongst barbarous people, while, in the different civi-
lized nations of the world, there is, so far as can be ascertained,
an average of about one insane person in five hundred inha-
bitants. Theoretical considerations would lead to the expectation
of an increased liability to mental disorder with an increase in
the complexity of the mental organization: as there are a greater
liability to disease, and the possibility of many more diseases, in
a complex organism like the human body, where there are many
kinds of tissues and an orderly subordination of parts, than in a
simple organism with less differentiation of tissue and less com-
plexity of structure ; so in the complex mental organization,
with its manifold, special, and complex relations with the ex-
ternal, which a state of civilization implies, there is plainly the
favourable occasion of many derangements. The feverish activity
of life, the eager interests, the numerous passions, and the great
strain of mental work incident to the multiplied industries and
eager competition of an active civilization, can scarcely fail, one
may suppose, to augment the liability to mental disease. On
the other hand, it may be presumed that mental sufferings will
be as rare in an infant state of society as they are in the infancy
of the individual. That degenerate nervous function in young
children is displayed, not in mental disorder, but in convulsions ;
that animals very seldom suffer from insanity ; that insanity is
of comparatively rare occurrence among savages; all these are
circumstances that arise from one and the same fact—a want of
development of the mental organization. There seems, there-
fore, good reason to believe that, with the progress of mental
development through the ages, there is, as is the case with other
forms of organic development, a correlative degeneration going
on, and that an increase of insanity is a penalty which an increase
of our present civilization necessarily pays.

So far as facts are available for the determination of this
question, they confirm the foregoing theoretical considerations.
The sort of insanity most common amongst savages is imbe-
cility, or idiocy, for the same reason that idiocy is the most
common form of insanity in children: where the mind is not
developed, varied degeneration of it cannot take place, though
it may obviously remain morbidly arrested. It is plainly im-
possible, for example, that the most typical moral insanity
230 ON THE CAUSES OF INSANITY. [orap.

should occur where no moral development has taken place;
before the native Australian savage—who has not in his
language any words for vice or justice, nor in his mind any
such ideas as these words convey to an intelligent European—
could become morally insane, he must first be humanized and
then civilized ; development must precede retrograde meta-
morphosis, mental organization precede mental disorganization.
Another fact which deserves serious consideration is, that there
has undoubtedly been a very large increase of late years in the
number of the insane who have come under care and observa-
tion, The reports of the Lunacy Commissioners show that, on
the 1st of January, 1849, there were 14,560 patients in the
hospitals, asylums, and licensed houses of England and Wales;
that six years afterwards, on the 1st of January, 1855, there were
20,493 insane ; that ten years afterwards, on the 1st of January,
1865, there were 29,425 insane under certificates ; and that on
the 1st of January, 1866, the number had risen to 30,869. Now
it is certain that only a small proportion of this large increase is
to be attributed to an increase of insanity in the population ; it
is undoubtedly mainly owing (1) to the large number of cases,
formerly unreported, which more stringent legislation has
‘brought under observation ; (2) to the larger number of insane,
especially of paupers, who are now sent to asylums ; and (3) to
the prolongation of life in those who have been brought under
proper care. In fact, it might be said roughly, that the greater
part of this large increase in the insane population of England
and Wales is due to the facts that nowadays more people are
thought and declared mad than would formerly have been
thought so; that more persons are admitted into asylums,
where they live longer; and that fewer persons are discharged,
either by death or by being thought to have recovered, than
formerly. But, when all due allowance has been made for these
causes, it must be admitted that a steady increase of about
1,000 a year in the insane population of England and Wales
for the last seventeen years, does seem to point to an actual
increase in the production of insanity, and even to an increase
more than proportionate to an increasing sane population.

If we admit such an increase of insanity with our present
civilization, we shall be at no loss to indicate causes for. it.
L] ON THE CAUSES OF INSANITY. 231

Some would no doubt easily find in over-population the prolific
parent of this as of numerous other ills to mankind. In the
fierce and active-struggle for existence which there necessarily
is where the claimants are many and the supplies are limited,
and where the competition therefore is severe, the weakest must
suffer, and some of them, breaking down into madness, fall by
the wayside. As it is the distinctly manifested aim of mental
development to bring man into more intimate, special, and
complex relations with the rest of nature by means of patient
investigations of physical laws, and a corresponding internal
adaptation to external relations, it is no marvel, it appears
indeed inevitable, that those who, either from inherited weak-
ness or some other debilitating causes, have been rendered un-
equal to the struggle of life, should be ruthlessly crushed out as
abortive beings in nature. They are the waste thrown up by
the silent but strong current of progress; they are the weak
crushed out by the strong in the mortal struggle for develop-
ment; they are examples of decaying reason thrown off by
vigorous mental growth, the energy of which they testify.
Everywhere and always “to be weak is to be miserable.”

If we want a striking illustration of the operation of this
hard law, we may see it in the appropriation by man, the
stronger sex, of all the means of subsistence by labour, to the
almost entire exclusion of women, the feebler sex. Because,
however, women are necessary to the gratification of man’s
passions, indispensable to the comfort of his life, they are not
crushed out of existence, they are only kept in a state of sub-
jection and dependence. The woman who can find no opening
for her honourable energies in the present social system, is yet
willingly permitted to gain a precarious livelihood by selling
the charms of her person to gratify the lusts of her lord and
master. Under the institution of marriage she has the position
of a subordinate, herself debarred from the noble aims and
activities of life, but ministering, in a silent manner, to the
comfort and greatness of him who appropriates the labour and
enjoys the rewards. Practically, then, woman has no honour-
able outlook but marriage in our present social system : if that
aim is missed, all else is missed. Through generations her
character has been formed with that chief aim; it has been
232 ON THE CAUSES OF INSANITY. [cHaAP.

made feeble by long habit of dependence; by the circumstances
of her position the sexual life has been undesignedly developed
at the expense of the intellectual. Now, therefore, when the
luxuries thought necessary in social life are so many and costly
that marriage is much avoided by men, there is a cruel stress
laid upon many a gentle nature. In this disappointment of
their life-aim, and the long train of consequences, physical and
moral, which it unconsciously draws after it, there is, I believe,
a fertile source of insanity among women. It is not only that
women of the better classes, not married, have no aim in life to
work for, no opening for the employment of their energies in
outward action, and are driven to a morbid self-brooding, or to
an excessive religious devotion or a religious enthusiasm which
is too often the unwitting cloak of an exaggerated and un-
healthy self-feeling; but, through the character produced by
the position which they have so long held in the social system,
their organic life is little able to withstand the consequences of
an unsatisfied sexual instinct. Disturbances of all sorts ensue,
and social customs debar them from the means of relief which
men have both in active employment and in illicit sexual indul-
gence. Masturbation is undoubtedly sometimes provoked, and
aggravates the evil for which it was sought as a relief. Let it
not be supposed, however, that all these things take place con-
sciously in the woman’s thoughts, feelings, and actions: the
sexual passion is one of the strongest passions in nature, and
as soon as it comes into activity, it declares its influence on
every pulse of the organic life, revolutionizing the entire nature,
conscious and unconscious; when, therefore, the means of its
gratification entirely fail, and when there is no vicarious outlet
for its energy, the whole system feels the ill effects, and exhibits
them in restlessness and irritability, in a morbid self-feeling
taking a variety of forms, and sometimes in an act of self-abuse
which, on the first occasion, may be a sort of instinctive frenzy,
of the aim of which there is only the vaguest and most dim
notion.

Another way in which over-population leads to deterioration
of the health. of a community is by the overcrowding and the
insanitary condition of dwelling-houses which it occasions in
towns. Not fevers only, but scrofula, perhaps phthisis, and
1] ON THE CAUSES OF INSANITY.- 233

certainly general deterioration of nutrition, are thus generated
and transmitted as evil heritages to future generations: the
acquired ill of the parent becomes the inborn infirmity of the
offspring. It is not that the child necessarily inherits the parti-
cular disease of the parent, for diseases unquestionably undergo
transformation through generations; but it does often inherit
a constitution in which there is a certain inherent aptitude to
some kind of morbid degeneration, or a constitution destitute of
that reserve power necessary to meet the trying occasions of
life. Lugol found insanity to be by no means rare amongst
the parents of the scrofulous and tuberculous; and in one
chapter of his work on Scrofula treats of hereditary scrofula
from paralytic, epileptic, and insane parents. Schroeder van
der Kolk was also of opinion that a hereditary predisposition to
phthisis might develop into or predispose to insanity; and, on
the other hand, that insanity predisposed to phthisis. It is
certain that there are very intimate relations between phthisis
and insanity: one-fourth of the deaths in asylums are caused
by phthisis; and Dr. Clouston, who found that there is here-
ditary predisposition in 7 per cent. more of the cases of insanity
with tubercle than of the insane generally, has described a
certain form of insanity as phthisical insanity. Watching the
decay of a family, it is often seen that phthisis and insanity are
of frequent occurrence amongst its members; and when ex-
tinction of it occurs, when the last of the family dies, he not
seldom dies insane or phthisical or both. When we reflect that
a disease is not a specific morbid entity that, like some evil
spirit, has taken mischievous possession of the body, or of a
particular part of it, but a condition of more or less degenera-
tion from healthy life in an organism whose different parts con-
stitute one harmonious whole, it will be sufficiently evident that
a disease of one part of the organism will not only affect the
whole sympathetically at the time, but may lead to a more
ceneral infirmity in the next generation—to an organic infirmity
which shall be determined in its special morbid manifestations
according to the external conditions of life.

Perhaps one, and certainly not the least, of the ill effects
which spring from some of the conditions of our present civili-
zation, is seen in the general dread and disdain of poverty, in
234 * ON THE CAUSES OF INSANITY. [cHap.

the eager passion to become rich. The practical gospel of the
age, testified everywhere by faith and works, is that of money-
getting; men are estimated mainly by the amount of their
wealth, take social rank accordingly, and consequently bend all
their energies to acquire that which gains them esteem and
influence. The result is that in the higher departments of trade
and commerce speculations of all sorts are eagerly entered on,
and that many people are kept in a continued state of excite-
ment and anxiety by the fluctuations of the money market. In
the lower branches of trade there is the same eager desire. for
petty gains; and the continued absorption of the mind in these
small acquisitions generates a littleness of mind and meanness
of spirit, where it does not lead to actual dishonesty, which
are nowhere displayed in a more pitiable form than by certain
petty tradesmen. The occupation which a man is entirely en-
gaged in does not fail to modify his character, and the reaction
upon the individual’s nature of a life which is being spent with
the sole aim of becoming rich, is most baneful. It is not that
the fluctuations of excitement unhinge the merchant’s mind and
lead to maniacal outbreaks, although that does sometimes
happen ; it is not that failure in the paroxysm of some crisis
prostrates his energies and makes him melancholic, although
that also is occasionally witnessed; but it is that the exclu-
siveness of his life-aim and occupation too often saps the moral
or altruistic element in his nature, makes him become egoistic,
formal, and unsympathetic, and in his person deteriorates the
nature of humanity. What is the consequence? If one con-
viction has been fixed in my mind more distinctly than another
by observation of instances, it is that it is extremely unlikely
such a man will beget healthy children; on the contrary, it is
extremely likely that the deterioration of nature which he has
acquired will be transmitted as an evil heritage to his children.
In several instances in which the father has toiled upwards from
poverty to vast wealth, with the aim and hope of founding a
family, I have witnessed the results in a degeneracy, mental and
physical, of his offspring, which has sometimes gone as far as
extinction of the family in the third or fourth generation. When
the evil is not so extreme ag madness or ruinous vice, the savour
of a mother’s influence having been present, it may still be
1] ON THE CAUSES OF INSANITY. 235

manifest in an instinctive cunning and duplicity, and an
extreme selfishness of nature—a nature not having the capacity
of a true moral conception or altruistic feeling. Whatever
opinion other more experienced observers may hold, I cannot
but think, after what I have seen, that the extreme passion for
getting rich, absorbing the whole energies of a life, does pre-
dispose to mental degeneration in the offspring—either to moral
defect, or to moral and intellectual deficiency, or to outbreaks of
positive insanity under the conditions. of life.

Without going on to enumerate other causes which arise out
of our present civilization, and appear to favour the increase of
insanity, it will be sufficient to say that any condition that is
injurious to mental or bodily health, though it does not produce
insanity directly, may so far predispose to it in the next gene-
ration; determining in the present what shall be predetermined
in the future. But while giving due weight to this consideration,
it is necessary to bear in mind that an increase in the number
of insane persons in a country does not necessarily mean the
degeneracy of the people: the capability of development is the
capability of degeneration, and where the general progress is
going on actively the retrograde action in the elements must be
going on also: the particular is sacrificed to the general, “the
individual withers, and the race is more and more.” If this be
so, may we not then say that an increase of insanity is after all
a testimony of development, that a great apparent evil is but a
phase in the working out of good? may we not, indeed, ask with
the prophet, “Shall there be evil in a city, and the Lord hath
not done it?” *

Sex.—Esquirol and Haslam thought insanity to be of more
frequent occurrence among women than men, but authors are
now generally agreed that the converse is true. Esquirol omitted
in his calculations, as Dr. Thurnam has pointed out, to take into
account the preponderance of females in the population, and
moreover drew his conclusions from a comparison of existing
cases, instead of from cases occurring in the two sexes.— Female

* Amos iii. 6. Again, Isa. xlv. 7: “I form the light, and create darkness: I
make peace, and create evil: I the Lord do all these things.”

+ Of the excess of about 4 per cent of females in the population Esquirol was
aware ; “but he does not appear to have known that, from twenty to fifty years
236 ON THE CAUSES OF INSANITY. [cHaP.

patients accumulate in asylums more than males; for the pro-
portion of relapses is greater in them, and the probability of
death is less: general paralysis, which is particularly fatal, being
almost confined to men. Dr. Thurnam affirms men to be more
liable to mental disorder than women; and Dr. Jarvis came to
the same conclusion from an examination of the statistics of
different countries. Recently it has been said that the female
sex is more liable to suffer from hereditary insanity. If my ex-
perience were large enough to be of any value, it would give the
preponderance to the women : of 106 persons whom I admitted
into a lunatic hospital, there were 50 men and 56 women. This
result agrees closely with the statistics of the number of people
confined in asylums in England and Wales: on the lst of
January, 1855, there were in the hospitals, asylums, and licensed
houses 10,885 females and 9,608 males, and on the 1st of January,
1866, 15,437 females and 13,988 males—the numbers giving a
preponderance of from about five to six per cent.to women. On
whichever side, male or female, the uncertain difference lies, it
is probably inconsiderable. There is hardly sufficient ground to
maintain positively that there is by simple reason of sex any
inborn liability to insanity. The female sex is certainly the
weaker, and on this account will be more likely to suffer from the
adverse circumstances of life, especially in a complex social state
where it is precluded so much from active work, suffers from a
bad system of education, has so few resources, and is enfeebled
by dependence; it has moreover conditions which in some regard
favour disturbance in the revolutions effected in the system at
puberty, during pregnancy, by the puerperal state, and at the
climacteric period. These conditions, in concurrence with the
circumstances of female life, may possibly become the cause of
more frequent insanity amongst women; and one is the more
apt to think so when one calls to mind that causes which
undoubtedly act more frequently amongst men—intemperance
and other excess, for example—do not avail to notably increase
of age (when, in this country at least, insanity chiefly occurs for the first time),
there is a still greater excess of females ; an excess which is higher from twenty
to thirty years of age than it ds subsequently ; it being 12 per cent. from twenty
to thirty, 6 per cent. from thirty to forty, and 4 per cent. from forty to fifty,

years of age. Thus, assuming only a like liability of the two sexes to insanity,
we should expect to find a much greater number of cages amongst women.” —

Wreeenar iar Crninttann! TEcanattes ax Vue
1] ON THE CAUSES OF INSANITY. 237

the proportion of insanity amongst them. On the whole I
should be disposed to hold that, while the number of men and
of women who become insane appears to differ but little, as the
causes actually operate, there is in woman, by virtue of her sex,
a slightly greater predisposition to insanity than in man.
Education.—Next to the inherited nature which every one
has, the acquired nature which he owes to the circumstances of
his education and training is most important in determining the
character. I mean, not the education which is called learning
alone, but that education of the nature of the individual, that
development of the character, which the circumstances of his
life have determined. There are in every nature its particular
tendencies or impulses of development which may be fostered or
checked by the conditions of life ; and which, therefore, according
to their good or evil nature, and the external influences which
they meet with, may minister to the future weal or woe of the
individual—may lead to a stability of character which prevents
the mental equilibrium ever being seriously disturbed, or to such
an instability of character that the smallest adversity may destroy
it for ever. How often one is condemned to see, with pain and
sorrow, an injudicious education sorely aggravate an inherent
mischief! The parent not only transmits a taint or vice of
nature to the child, but fosters its evil growth by the influence
of a bad example, and by a foolish training at the time when
the young mind is very susceptible, and when the direction given
to its development is sometimes decisive for life. Where there
is no innate taint, evil may still be wrought by enforcing an
unnatural precocity, wherein is often planted the germ of future
disease. Parents who labour to make their children prodigies
of learning or talent often prepare for them an early death or
an imbecile manhood—*In pueritidé senex, in senectute puer.”
Parental harshness and neglect—repressing the child’s feelings,
stifling its need of love, and driving it to a morbid self-
brooding, or to take refuge in a world of vague fancies—is not
less pernicious than a foolish indulgence through which it never
learns the necessary lessons of renunciation and self-control.
The aim of a good education should be to develop the power
and habit of what the events of life will not fail to rudely
enforce—renunciation and self-control, and to lead to the con-
238 ON THE CAUSES OF INSANITY. [cirap,

tinued transference of thoughts and feelings into external actions
of a beneficial kind. By the habitual encouragement of self-
feeling, and by an egoistic development in all the relations of
life, a character may, by imperceptible degrees, be so framed
that insanity is the natural and consummate evolution of it,
while every step taken in such deterioration will so far pre-
dispose to insanity under adverse circumstances of life. It is by
the influence of a good education and a sound training that we
may expect, not only to neutralize a predisposition to insanity in
the individual, but to counteract that tendency to an increase
of mental disease in the community, which is attributable to
some of the concomitant evils of civilization. The external ad-
vantages of civilization should naturally lead to a better internal
culture, so that in its higher stages a remedy may be furnished
for some of the evils which it produces in its earlier stages.

It is hardly necessary to point out how ill adapted the present
system of female education is to store the mind with useful
knowledge, and to train up a strong character. It is peculiarly
fitted for the frivolous purposes of female life ; but that it is so
is its greatest condemnation. ‘Those who have seriously con-
templated,” Feuchtersleben remarks, “the female education of
our times (undoubtedly the partie honteuse of the moderns) will
find it, in this etiological respect, much more influential than
that of the other sex. It combines everything that can heighten
sensibility, weaken spontaneity, give a preponderance to the
sexual sphere, and sanction the feelings and impulses that relate
to it.” As the education of women is widened, deepened, and
improved, other and better resources will be discovered and
earnestly used, and the reaction of a higher mode of life on
female education and female nature cannot fail to be most
beneficial.

Religion —I have said that the practical religion of the day,
the real guiding gospel of life, is money-getting: the professed
religion is Christianity. Now, without asserting that riches are
not to be gotten by honest industry, it may be maintained that
the eager passion to get rich—honestly it may be, but if not,
still to get rich—is often inconsistent with the spirit of the
gospel professed. The too frequent consequence is, that life
heeomes a svstematic inconsistenev. ar an arcanized hunneriav
J ON THE CAUSES OF INSANITY. 239.

With a profession of faith that angels might adopt, there is too
often a rule of practice which devils need not disdain. I do not
speak here of those whose religion is a mere social observance,
which it beseems a man of respectability willing to stand well
with his neighbours to conform to. Such persons will, in all pro-
bability, belong to the Church of England, which is eminently
the religion of success in life and of a respectable social position ;
it does not demand any exhibition of zealous earnestness from,
nor does it impose any galling yoke upon, its members ; it desires
to avoid anything that is extreme, and insists only on the main-
tenance of the social proprieties; it is the established religion,
and, in close alliance with the governing classes, it aims at the
preservation of the established state of things. But it may be
questioned whether the Church of England really reaches the
poor and struggling, those who truly need a gospel of life. Those
of them who have any religion at all belong, for the most part,
to two religious bodies into which the two extreme parties in
the English Church insensibly merge—to Roman Catholicism
and Methodism. When, therefore, we have to consider a religion
really influencing life, when we have to weigh its effect on cha-
racter as predisposing or not to insanity, we have practically to
deal with Roman Catholicism, actual or abortive, or with Dissent
in some of its forms. I do not hesitate to express a conviction
that the excitement of religious feelings, and the moroseness of
the -religious life, favoured by some of the Dissenters, are
habitually injurious to the character, and sometimes a direct
cause of insanity. Young women who fail to get married are
apt to betake themselves fervently to religious exercises, and
thus to. find an outlet for repressed feeling in an extreme devo-
tional life; having of necessity much self-feeling, they naturally
fly to a system which expressly sanctions and encourages a habit
of attention to the feelings and thoughts—a self-brooding—and
which attracts to them the sympathy and interest of others.
This is not, nor can it-come to, good: as the man whose every
organ is in perfect health scarcely knows that he has a body,
and only is made conscious that he has organs when something
morbid is going on, so a healthy mind, in the full exercise of its
functions, is not conscious that it has feelings, and is only
awakened to self-consciousness by something morbid in the
240 ON THE CAUSES OF INSANITY. [cHap.

processes of its activity. To fly for refuge to the contemplation
of one’s own feelings and thoughts is in direct frustration of
the purposes of one’s being as an element in nature, and in the
direct way of predisposing to insanity. It is only in actions
that we truly live, and by our actions that we can truly know
ourselves. How mischievous, then, any encouragement of a
morbid self-feeling, religious or otherwise, is likely to be, it is
easy to perceive. Among the cases of mental disease that have
come under my care, there are some in which the cause of the
outbreak has been satisfactorily traceable to religious influence
injudiciously exerted. Not amongst Dissenters only, but amongst
those members of the High Church party in the Church of
England who are so much addicted to playing at Roman Catho-
licism, the most baneful effect is sometimes produced on women.
through the ignorant influence and misapplied zeal of priests,
who mistake for deep religious feeling what is really at times a
morbid self-feeling, arising out of an unsatisfied sexual instinct,
and what is many times accompanied by hysterical excitement,
and sometimes even by habitual self-abuse. The fanatic religious
sects, which every now and then appear in a community and
disgust it by the offensive way in which they commingle religion
and love, are really inspired by an uncontrolled and disordered
sexual instinct. They are compounds of systematic. knavery
and of vain folly verging on madness: on the one hand, the
cunning of a hypocritical rogue (who may, perhaps, have so
grown to the habit of his knavery as to deceive himself as well-
as others) using the weaknesses of weak women to minister to
his vanity or his lust under a religious guise; on the other
hand, an exaggerated self-feeling, rooted often in sexual passion,
which is fostered under a spiritual cloak, and drives its victim
on to madness or to sin. The holy kiss of love owes all its
warmth to the sexual impulse which inspires it, consciously or
unconsciously, and the mystical religious union of the sexes
leads directly to a less spiritual union.

The Roman Catholic religion cannot, I believe, be justly
charged with any such positive influence for evil on those who
have been born and bred up within its pale. On them its effect
is rather to arrest mental development by imposing the divine
authority of the Church, and thus keeping the mind in leading-
1] ON THE CAUSES OF INSANITY. 241

strings. The unquestioning faith demanded and accorded as the
habit of life is not calculated to predispose to insanity. But the
influence of Roman Catholicism, as represented by some of the
over-zealous perverts from the English Church, is in the highest
degree mischievous: it is a hotbed, fostering the weaknesses of
weak women, the morbid tendencies of those who are half insane,
and, too often, the evil impulses of the vicious. It becomes the
congenial refuge of those who are so afflicted with restless
passions, ill-regulated feelings, and selfish impulses, that they
are unable to conform long to their social duties and relations,
and are ever eager for change, excitement, and attention, at
whatever cost. Without doubt a hot religious perversion, and
the earnest display of a feverish religious zeal, are, in some
instances, really a phase in the manifestations of a morbid
disposition, not unlikely to pass at some time into actual mental
derangement.

The question of religion generally, apart from any particular
form of religion, as an agency influencing in a powerful manner
for good or evil the minds of men, and therefore predisposing or
not to mental degeneracy, I must leave untouched, not only be-
cause of the difficulty and the delicacy of the subject, but because
of the impossibility of doing justice to a matter of such tran-
scendent importance in a brief and incidental manner. It would
be necessary to attempt soberly and faithfully to estimate the
influence of religious belief, not upon any particular mind nor
at any particular time, but upon the common mind of mankind,
upon its development through time. Three great questions
would naturally present themselves for discussion :—First, what
influence a belief in the supernatural, as commonly entertained,
has had upon the growth and progress of human thought ;
whether the tendency of it has been to strengthen or to enervate
the intellect? Secondly, what has been the practical effect
worked on- the hearts of men by the fear of punishment and
the hope of reward after death ; whether their feelings and
desires have been beneficially affeeted, and how far affected, by
possibilities which always seem so far off; or whether, as some
argue, their feelings have thereby been deadened and their intel-
ligence blinded to the certain laws by which their sins, or errors,
or crimes, are always avenged in this world on themselves or on

R
242 ON THE CAUSES OF INSANITY. [cHar.

others? Thirdly, what has been the practical effect produced
on the character and conduct of the many by the belief that
through prayer they might obviate the effects of their own want
of foresight, or want of self-renunciation, and rely upon super-
natural aid where the will failed? It would be necessary also,
in considering the vast influence which the moral code incul-
cated by all religions has exerted upon the conduct of mankind,
to weigh the actual effect upon character of the profession of
moral maxims and precepts which have sometimes been too
exalted to be reconciled with the exigencies of practical life.
But these are all questions which we must now pass over.

In weighing the effect on the mind of any form of religion, it
is necessary to bear in mind that a person’s particular creed is
to some extent the result of his character and mode of develop-
ment. The egoist whose vanity and self-love have not, other
outlets of display will manifest his disposition in his religious
views and practice. The victim of a morbid self-feeling, or an
extreme self-conceit, will find in a certain religious zeal the con-
venient gratification of an egoistic passion, of the real nature
of which he himself is ignorant. Those who make it their
business to get rich by over-reaching and deceiving others, in-
variably end by over-reaching and deceiving themselves in the
sincere assumption of religious observances entirely inconsistent
with the tenor of their daily lives. "When such persons become
insane, we cannot truly say that religion has been the cause of
the disease, although it can admit of no question that the
mental degeneration, which has been the natural issue of the
mode of development of the character, has found circumstances
very favourable to its increase in the religious views and prac-
tices adopted.

Condition of Life.—The statistics hitherto collected with
reference to this point are of little or no value. Whether a
particular profession or trade favours the production of insanity,
is generally a question of the habits incidental to its pursuit,
—whether those who follow it live soberly and temperately, or
whether they are addicted to intemperance and riotous living.
On the whole, however, those who work with the head are more
liable to mental disease than those who work with the hand,
and they are less likely to recover when once attacked: the
1] ON THE CAUSES OF INSANITY. 243

more complex mental organization of the former, and the
greater activity of function, will render it conceivable how
this may be. The aristocratic or privileged classes of every
country have in their privileges the elements of corruption
and decay; and degeneracy of one sort or another is sure,
sooner or later, to become rife in them. There is grave reason
to suspect that insanity is of disproportionate frequency amongst
the aristocracy of this country. Other things being equal, it is
certain that insanity is more frequent amongst the unmarried
than amongst the married.

Age and Period of Life—tInsanity is rare before puberty,
although it is certain that every form of it, except general
paralysis, may occur even so early in life. Idiocy is the most
common form of mental defect in the early years of life; and
even the cases of mania met with occasionally in children
partake much of the character of idiocy, and might not im-
properly be described as examples of excited idiocy. The
mental organization has not been completely accomplished, and
the symptoms of its degeneration are therefore somewhat
uniform in character. Between the ages of sixteen and twenty-
five, insanity is far more frequent; but it is the most frequent
of all during the period of full mental and bodily development
—from twenty-five to forty-five—when the mental functions are
most active, and when there is the widest exposure to its causes.
The internal revolution which takes place in women at the
climacteric period leads to many outbreaks of a melancholic
insanity in them between forty and fifty. In the male there
appears to be a climacteric period between fifty and sixty, when
insanity sometimes supervenes. In old people symptoms of
mental derangement sometimes precede for a time softening of
the brain and dementia; an old man may be found to be keep-
ing a mistress in secret, or to be making foolish proposals of
marriage, when sensual impulses only mock extinct sexual
functions.

Hereditary Predisposition—The more exact and scrupulous
the researches made, the more distinctly is displayed the in-
fluence of hereditary taint in the production of insanity. It is
unfortunately impossible to get exact or accurate information
on this subject. So strong is the foolish feeling of disgrace

k 2
244 ON THE CAUSES OF INSANITY. [cHaP.

attaching to the occurrence of insanity in a family, that people,
not apt usually to say what is not true, will disclaim or deny
most earnestly the existence of any hereditary taint, when all
the time the indications of it are most positive; yes, when its
existence is well known, and they must know that it is well
known. To elicit an acknowledgment of the truth in some of
these cases would be as difficult a task as to elicit from an
erring woman a confession of her single frailty. Not even its
prevalence in royal families has sufficed to make insanity a
fashionable disease. The main value, indeed, of the many
doubtful statistics collected in reference to the question of the
frequency of hereditary taint is to prove that, with the increase
of opportunities of obtaining exact information, the greater is the
proportion of cases of insanity in which its presence is detect-
able. The proportion is put by some authors—as Moreau—as
high as nine-tenths, by others as low as one-tenth ; the most
careful researches agreeing to fix it as not lower than one-fourth,
if not so high as one-half. Of fifty insane persons, taken with-
out any selection, the family histories of whom I was able to
trace with considerable precision, there was strongly marked
hereditary predisposition—that is, there was the positive
evidence of an inherited predisposition to insanity—in fourteen
cases; while in ten more there was sufficient evidence of an
inborn defect of nerve element, not due to actual insanity in
any of the immediate ancestors, but to an infirmity acquired by
them in consequence of degenerative influences at work. Two
important considerations in regard to this question should have
full weight given them: first, that the native infirmity or taint
may be of very different degrees of intensity, so as, on the one
hand, to conspire only with certain more or less powerful ex-
citing causes, or, on the other hand, to give rise to insanity even
amidst the most favourable external circumstances; secondly,
that not insanity only in the parents, but any form of nervous
disease in them—epilepsy, hysteria, and even neuralgia—may
predispose to insanity in the offspring, as, conversely, insanity
in the parent may predispose to other kinds of nervous disease
in the offspring. Whatever, then, may be the exact number of
cases in which hereditary predisposition is positively ascertained,
it may, I think, be broadly asserted that, in the great maioritv
1] ON THE CAUSES OF INSANITY. 245

of cases, whether there has been observable madness or not in
father or mother, or some remoter relative, there has been some
constitutional instability or infirmity of nervous element in the
individual whereby he has been unable to rally against adver-
sity, and has broken down in insanity. Infinitely various as
the constitutional idiosyncrasies of men notably are, it is easy
to perceive how impossible it is that statistics should ever give
exact information concerning the causation of insanity ; here, as
in so many instances of their application, their value is that
they settle distinctly the existence of a certain tendency, so to
speak, which, once fixed, affords a good starting-point for further
and more rigorous researches: they indicate the direction of
future investigation.

Careful inquiries into the sundry and manifold causes of
nervous degeneration could not fail to attract attention to the
metamorphoses which diseases undergo in hereditary trans-
mission, as a matter demanding exact study. We certainly dis-
tinguish in our nomenclature the different nervous diseases, but,
as we actually meet with them in practice, the disorders of the
different nervous centres may occasionally blend, or combine, or
replace one another in a remarkable manner, so as to give rise
to varieties of disease intermediate between those which are
commonly regarded as typical. Now this circumstance, mani-
fest enough in individual life, is much more plainly displayed
when we trace the history and progress of nervous disease
through generations. If, instead of limiting attention to the
individual, we scan the organic evolution and decay of a family
—processes which, as in the organism, are sometimes going on
simultaneously—then it is made sufficiently evident how close
are the fundamental relations of nervous diseases, how artificial
the divisions between them sometimes appear. Epilepsy in the
parent may become insanity in the offspring, or insanity in the
parent epilepsy in the child; and chorea or convulsions in the
child may be the consequence of great nervous excitability,
natural or accidental, in the mother. In families in which there
is a strong predisposition to insanity, it is not uncommon to find
-one member afflicted with one form of nervous disease, and
another with another; one suffers perhaps from epilepsy or
chorea, another from neuralgia or hysteria, a third may commit
246 ON THE CAUSES OF INSANITY. [cHaP.

suicide, and a fourth become maniacal or melancholic.* General
paralysis is a disease which is usually the result of continued
excesses of one sort or another; but it may unquestionably
occur without any marked excesses, and when it does so there
will mostly be discoverable a hereditary taint in the individual.
More than this: an innate taint or infirmity of nerve element
may modify in a striking manner the mode of manifestation of
other diseases ; where it exists, gout flying about the body may
produce obscure nervous symptoms, so as greatly to puzzle the
inexperienced practitioner; and the syphilitic poison is similarly
apt to seize upon the weak part, and to give rise to severe
nervous symptoms. On the other hand, it can admit of no
question that a parental disease which does not specially affect
the nervous system, may, notwithstanding, be at the foundation
of a delicate nervous constitution in the offspring: phthisis,
scrofula, syphilis, probably also gout and diabetes, sometimes act
thus banefully. An interesting circumstance in connexion with
diabetes, which affords a certain argument in favour of its
nervous origin, is that it has been observed to occur in families
in which there existed a predisposition to nervous or mental
diseases, Again, it is a disease which appears to be sometimes
caused in man by mental anxiety, while it may be produced
artificially in animals by irritation of the floor of the fourth
ventricle and of other adjacent parts of the nervous system.
The interesting researches of Morel into the formation of
degenerate or morbid varieties of the human race have served to
furnish a philosophical view of the chain of events by which
causes that give rise to individual degeneracy continue their
morbid action through generations, and finally issue in the
extinction of the family. When some of the evil influences

* “YT saw very recently a boy, et 14, who was afilicted with extremely
severe tic, throwing his head sideways with an excessively abrupt gyratory
motion, and uttering a short sharp cry. I had seen him before during the
summer of 1860, and he then used to utter fierce cries every moment, without
his mind seeming to be in the least impaired. His eldest brother had for several
years suffered from facial spasm, characterised by grimaces during which all the
muscles of his face were violently convulsed. His father has been affected with
locomotor ataxy for the last twenty years. His paternal grandfather committed
suicide in a fit of monomania, and several of his relatives on his mother’s side
have been insane,”—TnroussEat, Citnical Lectures,
L] ON THE CAUSES OF INSANITY. 247

which notably give rise to disease—whether the poisoned atmo-
sphere of a marshy district, or the unknown endemic causes of
eretinism, or the overcrowding and starvation of our large towns,
or persistent intemperance of any kind, or frequent inter-
marriages in families, or any other of the sources of human
degeneracy—have engendered a morbid variety, the evil will,
unless counteracted by better influences brought to bear, increase
through generations, until the degeneration has gone so far that
the continuance of the species is impossible. Indeed, insanity
of what form soever, whether mania, melancholia, moral insanity,
or dementia, is but a stage in the descent towards sterile idiocy,
as may be experimentally proved by the intermarriage of men-
tally unsound persons for a generation or two, and as is some-
times demonstrated by the disastrous consequences of frequent
intermarriages in foolish families. Morel relates the history of
one family, which may be adduced as a typical example of the
course of degeneration proceeding unchecked, and which may be
summed up thus :—

First generation. —Immorality. Alcoholic excess. Brutal
degradation.

Second generation. — Hereditary drunkenness. Maniacal at-
tacks. General paralysis.

Third generation. — Sobriety. Hypochondria. Lypemania.
Systematic mania. Homicidal tendencies.

Fourth generation. — Feeble intelligence. Stupidity. First
attack of mania at sixteen. Transition to complete idiocy, and
probable extinction of the family.

In this degeneration going on through generations we have a
retrograde movement which is the opposite of that progressive
specialization, and increasing complexity of relation with the
external, which have already been described as characteristic of
advancing development. In place of sound and proper elements,
which may take their due place and perform their function har-
moniously in the social organism, there are produced morbid
varieties fit only for excretion. For, in truth, we may not im-
properly compare the social fabric to the bodily organism in this
regard: as in bodily disease there is a retrograde metamorphosis
of formative action, and morbid elements are produced, so in the
appearance of insanity in individuals we have examples of the
248 ON THE CAUSES OF INSANITY. [cHaAP.

formation of morbid varieties in the social organism, and the
evidence of a degeneration of the human kind. And as in the
body morbid elements cannot minister to healthy action, but, if
not got rid of, give rise to disorder, and even death ; so in the
social fabric morbid varieties are themselves on the way of
death, and if not sequestrated in the social system, or extruded
from it, inevitably engender disorder incompatible with its
stability. But, however much man may degenerate from his
high estate, he never really reverts to the exact type of the
animal, thongh he may sink lower than it : the so-called theroid
degeneration, spoken of by some writers, signifies no more than
a resemblance to the animals. As it is among plants, where
degeneration of species notably gives rise to a new morbid kind,
so it is in man: lunatics and idiots represent new morbid kinds:
the mighty are fallen, but the might is manifest even in the
wrecks.

Baillarger has confirmed what Esquirol had observed, that
insanity descends more often from the mother than the father,
and from the mother to the daughters more often than to the
sons. From a Report presented to the French Government by
M. Béhic, it appears that of 1,000 admissions of each sex into
French asylums, 264 males and 266 females had suffered from
hereditary predisposition to insanity; of the 264 males 128
inherited the disease from their father, 110 from the mother,
and 26 from both parents; of the 266 females, 100 inherited
from the father, 130 from the mother, and 36 from both parents.
Children born before the outbreak of an attack are less likely to
suffer than those born after an outbreak.

Thus much concerning the remote or predisposing causes of
insanity; it remains now to set forth the direct or proximate
causes of defect or derangement of the supreme centres of intel-
ligence. In doing this it will be most convenient, and in the
end most philosophical, to describe them under similar divisions
to those under which have already been grouped the causes of
disorder of the sensori-motor and spinal centres—in other words,

to treat of the causation of insanity from a pathological point
of view.
L] ON THE CAUSES OF INSANITY. 249

THE PROXIMATE CAUSES OF DISORDER OF THE IDEATIONAL NER-
VOUS CENTRES, THE SUPREME GANGLIONIC CELLS OF THE
CEREBRAL HEMISPHERES, THE INTELLECTORIUM COMMUNE.

1. Original Differences in the Constitution of the Supreme Ner-
vous Centres—It is most certain that there exist great natural
differences between different people in respect of the develop-
ment of their cerebral convolutions. In the lower races of men
these are visibly less complex and more symmetrical than in
the higher races ; the anatomical differences corresponding with
differences in intellectual capacity. Place a Bushman, with his
inferior type of brain, in the complex circumstances of civilized
life ; and though he may represent a high grade of development
of his lower type, he is to all intents and purposes, as Gratiolet
allows, an idiot, and must, unless otherwise cared for, inevitably
perish in the severe competition for existence. And if a person,
from some arrest of the natural development, is born amongst
civilized people with a brain of no higher order than the natural
brain of the Bushman, it is plain that he will be more or less of
an idiot; a higher type of brain, arrested by morbid causes at
a low grade of development, is brought to the level of a lower
type of brain which has arrived at its full development. As Von
Baer long ago pointed out, the actual position of a particular
animal in the scale of life is determined, not by the type alone,
nor by the grade of development alone, but by the product of
the type and the grade of development.

The principal varieties of defective brain met with may be
briefly indicated here as falling under one of the following
divisions :—

(a) There are idiots of the microcephalic type, in whom an
arrest of cerebral development has taken place, and a palpably
defective brain is met with in consequence. Malacarne was at
the pains carefully to count the lamine of the cerebellum in
idiots and in men of intelligence, and he found them to be less
numerous in the former than in the latter. Now, these lamin
are less numerous in the chimpanzee and the orang than in man,
and still less numerous in other monkeys; so far, therefore, there
is an approximation in some idiots to the simian type of brain.
250 ON THE CAUSES OF INSANITY. [cHaP.

Mr. Paget mentions an idiot’s brain in which there had been
a complete arrest of development at the fifth month of foetal life:
there were no posterior lobes, the cerebellum being only half-
covered by the cerebral hemispheres. Gratiolet found in the
brain of a microcephalic idiot, aged seven, the under surface of
the anterior lobes much hollowed, with great convexity of the
orbital arches, as is the rule in the monkey.* Mr. Marshall has
carefully examined, and described in an elaborate paper, the
brains of two idiots of European descent: the convolutions were
fewer in number than in the apes, individually less complex,
broader, and smoother—* In this respect,’ he observes, “ the
idiots’ brains are even more simple than the brain of the gibbon,
and approach that of the baboon (Cynocephalus) and sapajou
(Ateles).”+ Though he agrees with other observers that the con-
dition of the cerebra in the idiots is neither the result of atrophy,
nor of a mere arrest of growth, but consists essentially in an
imperfect evolution of the cerebral hemispheres or their parts,
dependent on an arrest of development, he points out the strong
grounds there are for inferring that, after the cessation of evolu-
tional changes, the cerebra experience an increase of size gene-
rally, or a mere growth of their several parts. Consequently the
cerebra are much larger than foetal cerebra in which the convo-
lutional development is at a similar stage; whilst the individual
convolutions themselves, though the same in number, are neces-
sarily broader and deeper. Not only is the brain-weight in
microcephalous idiocy very low absolutely, as the instructive
tables of Dr. Thurnam show, but the relative amount of brain
to body is “extraordinarily” diminished. Thus in the two idiots
described by Mr. Marshall, the proportion of brain to body was
only as 1 to 140 in the female, and as 1 to 67 in the male, the
normal proportions being as 1 to 33 and as 1 to 14 respectively.
It is not necessary that I quote more authorities to prove that
small-headed idiots have small brains, and sometimes even fewer
and more simple convolutions than the chimpanzee and the
orang; that man, thus made a morbid kind by an arrest of
development, is brought to a lower level than that of his nearest

* Anatomie comparée du Systeme Nerveux.
+ Philosophical Transactions, loc. cit.
E] ON THE CAUSES OF INSANITY. 251

related fellow animal.* A strict examination of the stories of
wild men, as of Peter the Wild-Boy, and the young savage of
Aveyron, has proved that these were really cases of defective
organization—pathological specimens.t
(6) In idiots or imbeciles of the Cretin type, where the morbid
condition is endemic, the defect seems to depend on certain
morbid changes which primarily affect the skull rather than the
brain. Injurious influences, affecting the general processes of
the bodily nutrition, prevent the normal growth of the bones,
and lead to a premature ossification of the sutures, and a con-
sequent narrowing of the skull at the part where this happens.
Secondary wide interference with the development of other parts
of the skull and compensating enlargements in other directions
follow the primary evil, and give rise to cranial deformities of
various kinds. Of necessity the natural growth of the brain is
hindered by those morbid changes ; and it is no wonder that
the deformed head of the Cretin is accompanied with a torpid
apathetic character and with great mental deficiency. As the
evil changes are commonly not manifest until a year or more
after birth, an objection might well be made to the description
of them as original defects; but whatever the nature of the
unknown morbid influence which is the cause of cretinism,
whether malarious or not, it can admit of no question that it
acts upon the mother perniciously, and predetermines the cre-
tinism of the child.
(c) It is obvious that an arrest of the development of the
brain occurring soon after birth may give rise to idiocy just as
certainly as an arrest occurring some time before birth. And
although an objection might here again be made to the de-
scription of such a defect as original, yet if we reflect that the
important development of the brain as the supreme organ of the
conscious life, as subserving the mental organization, does really

* Absence or defect of the corpus callosum has been sometimes met with after
death; and in most of the cases of this sort, there was some degree of mental
weakness or idiocy during life. Dr. Julius Sander has collected ten cases, which
appear to be all the cases hitherto recorded of this defect, and described them in
Griesinger’s Archiv. fir Psychiatrie und Nervenkrankheiten, b. i. 1868.

+ Observations on the deranged Manifestations of the Mind. By J. 8. Spurz-
heim, M.D. Also, Lectures on Man. By W. Lawrence, F.R.S.
252 ON THE CAUSES OF INSANITY. [cHaP.

take place after birth, we may admit a defect rendering such
development impossible, to be, though not congenital, practically
original. There are many idiots in whom the brain and body
appear to be well formed, while the mental development remains
at the lowest stage. Accidental affections of the brain arresting
its development after birth, while the rest of the body goes
through its normal growth, have occurred in some of these cases ;
epilepsy is not uncommonly such a cause of idiocy; but it is
impossible in some cases to assign any definite cause of the
arrest. Other idiotic creatures have the development of the
body as well as mind arrested : the extremest cases of this kind
are those in which there has been a complete cessation of growth .
at an early period of childhood, without any observable deformity.
Dancel has recorded the case of a girl, aged twenty-four, who had
developed normally up to the age of three and a half years, after
which no further growth took place until she reached eighteen
and a half years, her bodily and mental condition being that of
a child of three and a half years old. At twenty-one she in-
creased a little more in size, and then remained unchanged for
the rest of life. Baillarger exhibited, in May 1857, to the French
Academy of Medicine, a young woman aged twenty-seven, who
only had the intelligence and inclinations of a child four years
old, and who was about three feet high. I have seen a some-
what similar instance in an idiot boy. These extreme and
singular cases are well calculated to excite surprise and curiosity ;
they are, however, only the manifest consequences of a deficiency
in developmental power which is not unfrequently met with in
less marked degree, and which is actually witnessed in every
sort of degree. In any large idiot asylum there are to be found
some who, without any particular deformity, without any ob-
servable disease of brain or defective development of it, are
generally sluggish both in bodily and mental development ; their
size is small; their sexual development takes place late in life,
or perhaps does not take place at all; they often exhibit some
peculiarity of countenance, perhaps a squint ; in mental capacity
they are in advance of the true idiots, for they can learn a little,
are capable of remembering, and, perhaps, imitate cleverly : some
of them constitute the “show-cases” of the idiot asylum when
they are in it; and when they are not, they may become difficult
1.] ‘ON THE CAUSES OF INSANITY. 253

cases for medico-legal inquiry, in which the decision come to,
whatever it be, may be challenged not without reason. All the
concern that we have with them here is to draw from them the
certain conclusion that there may, by reason of unknown con-
ditions affecting nutrition, be every degree of imperfect develop-
ment of mind and body down to actual incapacity to develop
at all.

The causes of the defective cerebral development which is the
physical condition of idiocy are often traceable to parents.
Frequent intermarriage in families may undoubtedly lead to a de-
generation which manifests itself in individuals by deaf mutism,
albinonism, and idiocy.* Parental intemperance and excess, ac-
cording to Dr. Howe, hold high places as causes of convulsions,
idiocy, and imbecility ‘in children ; out of 300 idiots in the State
of Massachusetts, whose histories were carefully investigated, as
many as 145 were the offspring of intemperate parents.+ Here,
as elsewhere in nature, like produces like; and the parent who
makes himself a temporary lunatic or idiot by his degrading vice,
propagates his kind in procreation, and entails on his children
the curse of the most hopeless fate. Again, the natural term of
insanity proceeding unchecked through generations is, as Morel
has shown, sterile idiocy. When men wilfully frustrate the
noble purposes of their being, and selfishly. ignore the laws of
hereditary transmission, nature takes the matter out of their
hands, and puts a stop to the propagation of degeneracy.
During foetal life great fright or other mental agitation affect-
ing the mother, or irregularities and excesses on her part, and
during parturition injury to its head, may occasion a congenital
mental defect in the child. But many of the causes of idiocy
operate after birth up to the third or fourth year. They are
epilepsy, the acute exanthemata, perhaps syphilis, and certainly
starvation, dirt, and overcrowding.

When there are no such signs of degeneracy as to warrant
the mention of idiocy even in its mildest form, there is still
abundant room for physical causes of psychical defect, without
our being able to recognise them. The exceeding sensibility of

* On Consanguineous Marriages. By Arthur Mitchell, M.D.—Zdinburgh
Medical Journal, 1865.
+ Report on the Causes of Idiocy in the State of Massachusetts.
254 ‘ON THE CAUSES OF INSANITY. [cHAP.

nervous structure, whereby an impression made at one point is
almost instantaneously felt at any distance, is the sure testimony
of delicate, active, but occult movements of its molecules which,
like thermal oscillations or undulations of light, or the intimate
molecular conditions of colour, belong to that inner life of nature
that is still impenetrable to our most delicate means of investi-
gation, still inaccessible to our most subtile inquiries. "Who can
say what is the nature of those hidden molecular activities which
are the direct causes of our different tastes and smells? Could
we but ascertain what these intimate operations essentially are,
we might perhaps attain to some knowledge of the intimate
constitution of bodies; indeed it seems not improbable that in
the scientific cultivation and development of the senses of taste
and smell, as the eye, the ear, and the touch have been cultivated
and developed, we may ultimately gain some means of insight
into the inner recesses of nature.

A second reason why there may be numerous and serious
defects of nervous structure without its being possible to recog-
nise them, is based upon the infinitely complex and exquisitely
delicate structure of the cortical layers of ‘the hemispheres. It
would certainly be most unwarrantable to assume that the
physical paths of nervous function in the supreme centres may
not be actually obliterated without our being any the wiser, when
it was only yesterday, so to speak, that men succeeded, after
infinite patient research, in demonstrating a direct communication
between the different nerve-cells, and between nerve fibres and
cells. The obliteration of such a physical communication in the
supreme centres would simply render impossible a certain asso-
ciation of ideas, or the transference of the activity of the idea to
a nerve-fibre—the function and the expression of mind.

Thirdly, it must be admitted that, all question of defect of
physical structure put aside, the extremest derangement of
function might be due to chemical changes in nerve element
—changes which, in the present state of knowledge, are still
less discoverable in so complex a compound than physical
changes. Examine the cells of a man’s brain at the end of a day
of great mental activity, and at the beginning of a day after a
good night’s rest ; what difference would be detectable? None
whatever ; yet the actual difference is between a decomposition
1] ON THE CAUSES OF INSANITY. 255

and a recomposition of nerve element—between a capacity and
an incapacity of function.

It is beyond question, then, that there may be modifications of
the polar molecules of nerve element, changes in its chemical
composition, and defects in the physical constitution of nervous
centres, entirely undetectable by us, all of which do nevertheless
gravely affect function, and are thus most surely testified.

To affirm, then, that all men are born equal, as is sometimes
heedlessly done, is to make about as palpably untrue a propo-
sition as it is possible to make in so many words. There is as
great a variety of minds as there observably is of faces or of
voices : as no two faces and no two voices are exactly alike, so
are no two minds exact counterparts of one another. Men differ
greatly both in original capacity and in quality of brain. In
some there is the potentiality of great and varied development,
whilst in others there is the innate incapacity of any develop-
ment; and between the two extremes every gradation exists.
There are important differences also in the quality of the brain
in different people: in some the mental reaction to impressions
is sluggish and incomplete, and, without being idiots, they are
slow at perception and stupid; in others, the reaction, though
not quick, is very complete, and they retain ideas very firmly,
although they are slow at acquiring them; in some, again, the
reaction is rapid and lively, but evanescent, so that, though
quick at perception, they retain ideas with difficulty ; while in
others, that just equilibrium between the internal and external
exists by which the reaction is exactly adequate to the impres-
sion, and the consequent assimilation is most complete. These
natural differences in the taking up of impressions plainly hold
good also of the further processes of digestion and combination
of idea, which in the progress of mental development follow
upon the concrete perception. It is easy surely to perceive that
we have, as original facts of nature, every kind of variation in
the quality of mind and in the degree of reasoning capacity.

So long as we are unable to discover any explanation of the
causation of a fact which yet seems to stand out very distinctly,
it is wonderful how difficult it is to accept it heartily, how easy
indeed it becomes to overlook it habitually ; but as soon as we
have attained to a knowledge of its cause and relations, then the
256 ON THE CAUSES OF INSANITY. [cuap.

recognition of it becomes a part of our habit of thought and per-
ception: it has entered into our mental organization. Because
it has been the fashion to look upon an individual as if he
were the product of an independent creative act, and a self-
sufficient being—because men commonly look not beyond a
single link in the chain of causation—therefore it has been
impossible hitherto to uproot the erroneous notion, explicitly
declared or implicitly held, that each one is endowed by nature
with a'certain fixed mental potentiality of uniform character.
But now that observation reveals more and more clearly every
day how much the capacity and character, bodily and mental, of
the individual is dependent upon his ancestral antecedents, it is
impossible to deny that a man may suffer irremediable ill through
the misfortune of a bad descent, Each one is a link in the chain
of organic beings, a physical consequent of physical antecedents;
the idiot is not an accident, nor the irreclaimable criminal an
unaccountable casualty ; the laws of causality have sway here
as elsewhere in nature. It cannot, therefore, but be of the
utmost importance, when tracing the causation of insanity, to
weigh closely the elements of the individual character.

Viewed on its physical side, as it rightly should be viewed, a
predisposition to insanity means nothing less than an actual
defect or vice of some kind in the constitution oz composition of
the nerve element of which the mental phenomena are functional
manifestations ; there is an instability of organic composition
which is the direct result of certain unfavourable physical ante-
cedents. The retrograde metamorphosis of mind, manifest in the
different kinds of insanity, and proceeding as far as actual ex-
tinction in extreme examples of dementia, is the further physical
consequence of the hidden defect of constitution or composition _
of nerve element. It is easy enough, no doubt, to point on the
one hand, to the nervous substance of the infertile idiot’s brain,
and on the other hand, to that of the philosopher's, and to main-
tain that the kind of organic element of which they are con-
stituted is the same, as it certainly appears to be; but so long
as we have no exact knowledge of the constitution of nerve
element, such an assertion is an unwarrantable assumption ;
and, while the functional effects are so vastly different in the
two cases, there are the most valid reasons for contradicting it.
1] ON THE CAUSES OF INSANITY. 257

The conclusion, then, at which we have arrived is, that when
an individual is, by reason of a bad descent, born with a pre-
disposition to insanity, he has a native constitution of nerve
element which, whatever name may be given to it, is unstable
or defective, rendering him unequal to bear the severe stress of
adverse events. In other words, the man has the insane tempera-
ment ; he is liable to whimsical caprices of thought and feeling ;
and, although he may act calmly and rationally for the most part,
yet now and then his unconscious nature, overpowering and sur-
prising him, instigates eccentric or extravagant actions ; while
an extraordinary and trying emergency may upset his stability
entirely. If it were thought desirable to give a name to this
temperament or diathesis, as in algebra we employ a letter to
represent an unknown quantity, it might properly be described
as the Diathesis spasmodica or the Neurosis spasmodica; such
names expressing very well an essential character of the tem-
perament,—that is, the tendency to independent and spasmodic
action on the part of the different nervous centres. There is, in
fact, some inherent instability of nervous element, whereby
the mutual reaction of the nerve-cells in the higher walks of
nervous function does not take place properly, and due consent
or co-ordination of function is replaced by irregular and purpose-
less independent reaction outwards : there is, as it were, a loss of
the power of self-control in the individual nerve-cell, an inability
of calm self-contained activity, subordinate or co-ordinate, and
its energy is dissipated in an explosive display, which, like
the impulsive action of the passionate man, surely denotes an
irritable weakness. Here, as elsewhere, co-ordination of function
signifies power, innate or acquired, and marks exaltation of
organic development. Assuredly the worst of all tyrannies is
the tyranny of a bad organization, the best of all inheritances
the inheritance of a good descent.

Is it not very plain, then, how impossible it is to do full justice
to any individual, sane or insane, by considering him as an
isolated fact? Beneath his conscious activity and reflection
there lies the unconscious inborn nature which all unawares
mingles continually in the events of life—the spontaneity
whence spring the sources of desire and the impulses of action ;
for the conscious and the unconscious, like warp and woof,

8
258 ON THE CAUSES 0 INSANITY. [cHAP.

together constitute the texture of life. No one, be he ever so
cunning in dissimulation or crafty in reticence, can conceal or
misrepresent himself; in spite of art his real nature reveals
itself in every movement of the part which he plays, in every
pulsation of his life. The inborn nature constitutes the founda-
tion upon which all the acquisitions of development must rest,
the substratum in which all conscious mental phenomena are
fundamentally rooted. When it is radically defective, no amount
of systematic labour will avail to counterbalance entirely the
defect: it were as hopeless to attempt to rear the massive struc-
ture of a royal palace upon foundations dug only for a cottage as
to impose the superstructure of a large, vigorous, and complete
culture upon the rotten foundations which an inherited taint of
nerve element implies: something will always be wanting, some
crack in the building will discover the instability of the founda-
tions, even when the whole structure does not fall “in ruin
hurled.” Any mental philosophy which takes no notice of the
foundations of the character, but ignores the important individual
differences of nature, does not truly reflect the facts, and cannot
fail to be a provisional and transitory system. It is guilty, in
fact, of the same error as that into which an introspective
psychology falls, when, isolating the particular state of mind, and
neglecting the antecedent conditions upon which it has followed,
it pronounces the will to be free; by isolating the individual,
and forgetting that he is but a link in the long chain of nature’s
organic evolution, it transforms him into an abstract and im-
possible entity, and often judges his actions with a most unjust
judgment.

2. Quantity and Quality of the Blood.—The grey centres of
the brain, and especially the cortical layers of the hemispheres,
are well known to be richly supplied with blood-vessels, even
when comparison is made with the notably abundant supply of
the spinal centres. The ideational cells demand for the due
exercise of their functions a rapid renewal of arterial blood, and
there is obviously an active interchange of some kind con-
tinually going on between the blood and the nervous elements.
The quantity and quality of the blood, therefore, circulating
through the supreme centres, must affect their functions in an
important manner, especially as they are the most sensitive
1.] ON THE CAUSES OF INSANITY. 259

elements of the body in this regard. When the most skilful
chemist is unable to detect anything unusual in the atmosphere
of a room in which are many people, a delicate woman may get
a headache and actually faint away. Send through the brain of
‘any one blood charged with carbonic acid, and destiny could not
doom him not to die; whilst a mixture of air and carbonic acid
in certain proportions, inspired like chloroform, will, like it, act
as an anzsthetic, paralysing consciousness.

When there is a rapid flow of healthy blood through the
supreme cerebral centres, a quick interchange goes on between
the nerve-cells and the blood, and the excitation and inter-
action of ideas proceed with great vivacity. The effect of active
thought is to produce such a determination of blovd, which in
turn is the necessary condition of the continuance of the active
function. But when a natural determination of blood degene-
rates into a greater or less stasis or congestion, as it may easily
do when intéllectual activity is too much prolonged, or when
congestion is otherwise produced, then there is an inability to
think ; confusion of thought, emotional depression and irrita-
bility, swimming in the head, disturbance of sight and of hearing,
testify to a morbid condition of things. It is striking how com-
pletely a slight congestion of the-brain may incapacitate any one
for mental activity, and how entirely the strong man is prostrated
thereby: an afflicting stagnation of ideas accompanies the stagna-
tion of blood; and he, heretofore so strong and confident, realizes
in vivid affright on how slight a thread hangs the whole fabric
of his intellect. If the morbid state should, instead of remaining
passive, or passing away altogether, become active, as it does
when actual inflammation occurs, then the functional activity of
the cerebral cells becomes most irregular and degenerate; the
co-ordination of function maintained in health is lost, as that of
the spinal cord is under like circumstances, and a wild and in-
coherent delirium witnesses to the independent and, if we might
so speak, convulsive action of the different cells: the delirious
ideas are the expression of a condition of things in the supreme
centres which is the counterpart of that which in the spinal
centres utters itself in spasmodic movements or convulsions.
With the destruction of that co-ordination of function which
volition implies the will’ is necessarily abolished; and such

82
160 ON THE CAUSES OF INSANITY. [cuap.

yurposeless or dangerous acts as the delirious being executes are
lictated by the morbid ideas that automatically arise. Some
vith inconsiderate haste speak of this degenerate activity in its
satlier stages as increased mental activity, as they also speak of
ictive inflammation as increased vital action; not otherwise
ihan as if convulsions were accounted the sure signs of strength,
or as if the tale of an idiot, because it is full of sound and fury,
shough signifying nothing, were the safe index of a high mental
ictivity. Dr. Mason Cox pointed out long ago that in certain of
she insane the pulse in the radial and carotid arteries sometimes
differed, being soft and weak in the former when full and hard
in the latter. Of no small interest, in relation to the influence
of the supply of blood to the brain, are the vigour and renewal
of action sometimes imparted by an attack of fever to a brain
enfeebled by chronic insanity; patients in an advanced state of
insanity even becoming quite rational for a time during fever,
and relapsing after its subsidence; or a demented patient, who
usually exhibits no spark of intelligence, then quickening into
a certain mental activity.*

Since the time of Hippocrates it has been known that when
there is too little blood in the brain symptoms are exhibited
similar to those which are produced by a congestion of blood:
pains and swimming in the head, confusion and incapacity of
thought, affections of the senses and of movement, occur in

* Examples of such revival of cerebral functions during fever have been related
by various authors. The following may suffice here :—“ The following case,
related to me by a medical friend, will serve to show that even in idiocy the mind
may be rather suppressed than destroyed. A young woman, who was employed
as a domestic servant by the father of the relater when he was a boy, became
insane, and at length sunk into a state of perfect idiocy (dementia). In this con-
dition she remained for many years, when she was attacked by a typhus fever;
and my friend, having then practised some time, attended her. He was sur-
prised to observe, as the fever advanced, a development of the mental powers.
During that period of the fever when others are delirious, this patient was
entirely rational. She recognised, in the face of her medical attendant, the son
of her old master whom she had known so many years before ; and she related
many circumstances respecting the family, and others which had happened to
herself in her earlier days, But, alas! it was only the gleam of reason ; as the
fever abated, clouds again enveloped the mind; she sank into her former de-
plorable state, and remained in it until her death, which happened a few years
afterwards.” —Deseription of the Retreat near York, p. 187. By Samuel Tuke.
1813,
1] ON THE CAUSES OF INSANITY. 261

consequence of anemia of the brain as certainly as they do in
consequence of congestion. In both cases the due nutrition of
the nerve-cell, which is the agent of cerebral function, is greatly
hindered ; and much of the ill effect is similar though the cause
appears to be so different. In reality, however, the causes are
not so different when we proceed to analyse the conditions
comprised under the terms anwmia and congestion. In that
continued relation between the organic element and the blood
by which the due reparative material is brought and waste
matter carried away, it amounts to much the same thing whether,
through stasis of the blood, the refuse is not carried off and
reparative material brought to the spot where it is wanted,
or whether the like result ensues by reason of a defective blood
and deficient circulation: it is little matter to the inhabitants
whether the street is almost blocked, or whether its entrance is
almost closed, so long as free circulation is prevented. If the
carotid arteries of a dog be tied, and pressure be then made on
its vertebral arteries, as was done by Sir A. Cooper, the functions
of the brain are entirely suspended—the animal falls into a deep
coma, its respiration ceases in a few moments, and it appears to
be dead; but, if the pressure be removed from the vertebral
arteries, the manifestations of life reappear, and the animal regains
rapidly the integrity of its cerebral functions. Brown-Séquard
has made this experiment: he severed the head of a dog from
its body, and, at the expiration of about eight or ten minutes,
when all traces of excitability had disappeared in the medulla
oblongata and the rest of the encephalon, he made, by means
of a suitable apparatus, repeated injections of defibrinated and
oxygenated blood into the carotid and vertebral arteries. At the
end of two or three minutes, after some irregular movements, he
found the manifestations of life reappear; there were visible,
in the muscles of the eyes and of the face, movements which
appeared to indicate that the cerebral functions were re-estab-
lished in the head separated from the body.

Temporary irregularities in the supply of blood to the supreme
nervous centres may, and often do, pass away without leaving
any ill consequences behind them; but when they recur fre-
quently, and become more lasting, their disappearance is by
no means the disappearance of the entire evil: the effect has
162 ON THE CAUSES OF INSANITY. [cHar.

vecome a cause that continues in action after the original cause
1as been removed ; and permanent mental disorder may be thus
istablished. Once the habit of morbid action is fixed in a part,
t continues as naturally as, under better auspices, the normal
vhysiological action. It is ever, therefore, of the first importance
io give timely heed to the earliest warning which morbid action
tives ; but it is of especial importance to do so in the case of
organic element so exceedingly susceptible and so exquisitely
lelicate as is nerve element.

A perverted condition of the blood quickly exercises a marked
»ffect upon the function of the supreme cerebral cells. The
nfluence of alcohol upon the mental function furnishes the sim-
glest instance in illustration of the action of a foreign matter
ntroduced into the blood from without: here, where each phase
of an artificially-produced insanity is successively passed through
n a brief space of time, we have the abstract and brief chronicle
of the history of insanity. The first effect of alcohol is to pro-
luce an agreeable excitement, a lively flow of ideas, and a general
activity of mind—a condition not unlike that which sometimes
precedes an attack of mania; then there follows, as in insanity,
the automatic excitation of ideas which start up and follow one
mother without order, so that more or less incoherence of thought
and speech is exhibited, while at the same time passion is easily
axcited, which takes different forms, according to the individual
temperament; after this stage has lasted for a time, in some
longer, in others shorter, it passes into one of depression and
maudlin melancholy, as convulsion passes into paralysis; the
last scene of all being one of dementia and stupor. The different
stages of mental disorder are compressed into a short period of
time because the action of the poison is quick and transitory ;
we have only to spread the poisonous action over years, as the
regular drunkard does, and we may get a chronic and enduring
insanity in which the scenes above described are more slowly
acted. The chronic insanity so produced has been called the
insanity of alcoholzzation : its most constant symptoms are hal-
lucinations of hearing, and sometimes of touch, leading to the
belief in persecution by spies, mesmeric action, magnetic in-
fluence, and like evil agencies ; the memory is usually much
enfeebled, the intellect dull, and the higher sentiments are
1.] ON THE CAUSES OF INSANITY. 263

blunted. Or, if death cuts short the career of the individual,
and puts a stop to the full development of the tragedy in his
life, we may still not be disappointed of seeing it played out in
the lives of his descendants ; for the drunkenness of the parent
sometimes observably becomes the insanity of the offspring,
which thereupon, if not interfered with, goes through the course
of degeneracy already described. It is worth while to take note
here how differently alcohol affects different people, according
to their temperaments, ever bringing forward the unconscious
real nature of the man: of one it makes a furious maniac for
‘the time being; another it makes maudlin and melancholic ;
and a third under its influence is stupid and heavy from the
beginning. So it is with insanity otherwise caused: the par-
ticular constitution or temperament, rather than the exciting
cause of the disease, determines the form which the madness
takes. An exact differential pathology would involve the know-
ledge of what constitutes individual temperament.

Many other poisons besides alcohol, as opium, belladonna,
Indian hemp, stimulate and ultimately derange the function of
the supreme cerebral cells. It is deserving of remark that the dif-
ferent nervous centres of the body manifest elective affinities for
particular poisons: while the spinal centres have a special affinity
for strychnine, the cerebral centres seem to be unaffected by it;
belladonna, on the other hand, seems rather to depress spinal
activity, but produces a great effect upon the centres of conscious-
ness, giving rise, at an early period of its action, to delirium
characterised by extreme delusions ; and Indian hemp concen-
trates its action mainly on the sensory centres, exciting remark-
able hallucinations. That medicinal substances do display these
elective affinities is a proof, at any rate, that there are important
though delicate differences in the constitution or composition of
the different nervous centres, notwithstanding that we are unable
to detect the nature of them. It may be also that there is shadowed
out in these different effects of poisons on the nervous system a
means which may ultimately be of use in the investigation of
the constitution of the latter. Though the rapid recovery from
the effects of these poisons proves that the combination which
they form with nerve element is temporary, it must be borne in
mind with regard to them, as with regard to alcohol, that the
264 ON THE CAUSES OF INSANITY. [cHap.

nervous system, when repeatedly exposed to their poisonous
influence, acquires a disposition to irregular or morbid action,
even when they are not present; so that more or less delirium,
hallucinations, and insanity are the results of their continued
abuse—they are efficient to initiate a degeneracy which then
proceeds of itself.

But the condition of the blood may be perverted by reason of
something bred in it, or by reason of the retention in it of some
substance which should rightly be excreted from it. Without
any change whatsoever having taken place in his external rela-
tions, the presence of bile in his blood may drive any one to
regard his surroundings and his future in the gloomiest light
imaginable ; he may know that a few hours ago things looked
quite differently, and may believe that in a few hours more they
will again have a different aspect, yet for the time being he is
the victim of a humour which he cannot withstand. Philosophy
is of no avail to him; for philosophy cannot remove that con-
dition of nervous element which the impure blood has engendered,
and which is the occasion of his gloomy feelings and painful
conceptions. Carry this morbid state of nervous element to a
further stage of degeneration, there ensues the genuine melan-
cholia of insanity. In like manner the presence of some urinary
product in the blood of a gouty patient gives rise to an irritability
which no amount of mental control can remove, though it may
succeed sometimes in repressing its manifestations. The mental
tone being, as already set forth, the expression of a physical
condition of nervous element, is beyond conscious determination
just as the delirium and convulsions of the patient dying from
uremic poisoning are beyond control. All writers on gout are
agreed that a suppressed gout may produce severe mental dis-
order, and that the sudden disappearance of a gouty swelling is
sometimes followed by an outbreak of insanity. Lord Chatham,
who was so great a martyr to that disease, had an attack of dis-
tressing melancholy lasting for nearly two years, from which he
only recovered after an attack of the usual gouty paroxysm. I
have recently seen two cases of severe melancholia in elderly
persons of the gouty diathesis, in which the best results followed
the treatment suitable to gout; and in one old lady, who was
deeply melancholic, rheumatism seemed finally to take the place
1.] ON THE CAUSES OF INSANITY. 265

of the mental unsoundness. It can admit of no question that
‘every degree of mental disorder, from the mildest feeling of
melancholic depression to the extremest fury of delirium, may
be due to the non-evacuation from the blood of the waste
matters of the tissues; but as we know very little at present
of the nature of those waste products of the retrograde meta-
morphosis, and of the different transformations which they
undergo before they are eliminated, we must rest content with
the general statement, and set ourselves in practice to prosecute
rigorous inquiries into the particular instances. The irregulari-
ties of menstruation, which are so common in insanity, are of
great importance in regard to this question: the return of the
menses at their due season not unfrequently heralds recovery ;
and, on the other hand, severe exacerbations of epilepsy and
insanity sometimes coincide with the menstrual period. In one
case of a demented epileptic under my care, the fits always came
on at the time of menstruation, and continued in severe form
during the progress of that function ; but there were commonly
no fits in the intervals: on the other hand, many cases are on
record, more or less like that well-known one related by Esquirol,
where an insane girl, whose menses had ceased for some time,
recovered her senses directly they began to flow.

When we reflect that the blood is itself a living, developing
fluid,—that, “burnished with a living splendour,” it circulates
through the body, supplying the material for the nutrition of
the various tissues, receiving again their waste matter and
carrying it to those parts where it may either be appropriated
and removed by nutrition or eliminated by secretion,—it is plain
that multitudinous changes are continually taking place in its
constitution and composition; that its existence is a continued
metastasis. There is the widest possibility, therefore, of ab-
normal changes in some of the manifold processes of its complex
life and function, such as may generate products injurious or
fatal to the nutrition of the different tissues. The blood itself
may not reach its proper growth and development by reason of
some defect in the function of the glands that minister to its
formation, or, carrying the cause still further back, by reason of
wretched conditions of life; there is in consequence a defective
nutrition generally, as in scrofulous persons, and the nervous
266 ON THE CAUSES OF INSANITY. [cHap.

system shares in the general delicacy of constitution, so that,
though quickly impressible and lively in reaction, it is irritable;
feeble, and easily exhausted. In the condition known as ane-
mia, we have an observable defect in the blood and palpable
nervous suffering in consequence; headaches, giddiness, low
spirits, and susceptibility to emotional excitement reveal the
morbid effects. Poverty of blood, it can admit of no doubt,
plays the same weighty part in the production of insanity as it
does in the production of other nervous diseases, such as hysteria,
chorea, neuralgia, and even epilepsy. The exhaustion produced
by lactation is a well-recognised cause of mental derangement ;
and a great loss of blood during childbirth has sometimes been
the cause of an outbreak of insanity. But while we can thus
detect an evil so manifest as a great loss of blood or a deficiency
of iron in the blood, there are good reasons to think that other
graver defects in its constitution or ‘development, of which we
can give no account, do exist and give rise to secondary nervous
degeneration. It is in this way probably that ill conditions of
existence,—as overcrowding, bad air, insufficient food, intem-
perance,—lead to defects of nervous development, or to actual
arrest. thereof, and thus produce mental as well as physical
deterioration of the race.

There is no want of evidence that organic morbid poisons,
bred in the organism or in the blood itself, may act in the most
baneful manner upon the supreme nervous centres. That these
organic poisons do act in a definite manner on the organic
elements, and give rise to definite morbid actions, is proved by
the symptoms of such diseases as syphilis and small-pox. Now,
tho general laws observable in the actions of morbid poisons
appear for the most part similar to those which govern the
action of medicinal substances; and as the Woorara poison
completely paralyses the nerves and does not affect the muscles,
or as strychnia poisons the spinal centres, and leaves the cere-
bral centres unaffected, so it may be presumed that a particular
organic virus may have a predominant affinity for a particular
nervous centre, and work its mischievous work there. It is
certain that in some states of the constitution an organic virus
is generated in the blood, or elsewhere in the organism, which
almost instantaneously proves fatal to the life of nerve element,
1.] ON THE CAUSES OF INSANITY. 267

—which is, indeed, as surely, though not as quickly, fatal as
a poisonous dose of prussic acid. With what marvellous de-
structive force certain morbid materials bred in the blood, or
passing into it, may act, is shown, as Mr. Paget has pointed
out, in certain cases of so-called putrid infection in which the
patient dies after an injury or a surgical operation before there
has been time to feel the after-consequences, or in some cases
of malignant typhus where the virus is directly fatal to nerve
element before the fever has had time to develop itself. It is
easily conceivable that a virus which, when concentrated, pro-
duces fatal results, may, when acting with less intensity, give
rise to nervous derangement which stops short of death. The
syphilitic virus usually affects the nervous system more or less
severely at one period or other of its action; but in some
instances it appears to select the nervous system specially for
its pernicious influence, or to concentrate its action upon it, so
as to produce a hopeless insanity. There are cases on record
again, in which mental derangement has appeared as the inter-
mittent symptoms of ague ; instead of the usual symptoms the
patient has had an intermittent insanity in regular tertian or
quartan attacks, and has been cured by the treatment for inter-
mittent fever.* Sydenham observed and describes a species of
mania supervening on an epidemic of intermittent fever; con-
trary to all other kinds of madness, he says, it would not yield to
plentiful venesection and purging ; slight evacuations producing
the relapse of a convalescent, and violent ones inevitably render-
ing the patients idiotic and incurable. Griesinger directs special

* A young man in an agueish district suffered from five brief attacks of mental
derangement, one occurring every other day. The attacks began with an in-
describable feeling of pain in the region of the heart, and with strong pulsations
of the heart. This was the starting point of the delirium, from which the patient
recovered after a deep sleep. He was cured by quinine. A strong peasant,
aged thirty, who had never had ague though he lived in an agueish district, was
suddenly attacked with insanity. He believed himself to be Jesus Christ, and
those near him to be witches, and acted with violence towards them. His head
was hot; his eyes were red and wild; his pulse was quick and his tongue white.
After cupping and the application of ice to the head, he recovered, and for two
days remained quite sound in mind. On the fourth day, however, exactly at the
same time, he had a similar attack, and again a third, after three days more.
He was cured by quinine.—Die Pathologie und Therapie der psychischen Krank-
heiten. Von Dr. W. Griesinger.

 
268 ON THE CAUSES OF INSANITY. [oHar.

attention to cases in which mental disorder has occurred in the
course of acute rheumatism, the swelling of the joints mean-
while subsiding ; and Arnold has known cases of people subject
to frequent fits of gout who have had none while suffering from
an attack of insanity. The viruses of acute fevers, as typhus
and typhoid, may notably act in the most positive manner on
the supreme nervous cells, giving rise to an active delirium or
sometimes to a more or less enduring insanity ; and, where they
do not act directly at the height of the fever, they may still
predispose to an outbreak of insanity during the decline of the
acute disease. Not only may a morbid poison thus attack the
nervous system, or a part of it, but it should be borne in mind
that a particular virus will most likely produce its special effects,
not otherwise than as tea and coffee commonly produce wake-
fulness while opium produces sleep.

The earliest and mildest mental effect by which a perverted
state of blood declares itself is not in the production of positive
delusion or of incoherence of thought, but in a modification of
the mental tone. Feelings of discomfort or depression, of irri-
tability or uneasiness, testify to some modification of the statical
condition of nervous element ; and a great disposition to emo-
tional subjectivity is the psychical manifestation of this state.
It may exist in different degrees of intensity, from the slight
irritability or gloom which attends upon a sluggish liver, or the
greater irritability which the urea in the blood of the gouty
subject produces, to that profound depression which we describe
as melancholia, or that active degeneration of function which we
designate mania. Though there may be no active delusion, the
emotional perversion existing by itself, yet the ideas which arise
under such circumstances do not fail to experience the influence
of the morbid feeling, but are strongly tinctured by it; they are
obscure, or painful, or, at: any rate, not faithfully representative
of external circumstances. The morbid character of the depres-
sion lies, not in the depression itself, which would be natural or
normal so long as there was an adequate external cause of it,
but in its existence without any external cause, in the discord
between the individual and his circumstances. But as there is
an irresistible disposition in the mind to represent its feelings as
qualities of the external object, as in all our mental life we con-
1] ON THE CAUSES OF INSANITY. 269

tinually make this projection outwards of our subjective states,
it commonly happens after a while that the victim of an in-
ternally caused emotional perversion seeks for an objective
cause of it, and, thinking to find one, gets a delusion: being
in discord with the external, he establishes an equilibrium be-
tween himself and it by creation of a surrounding in harmony
with his inner life. The form which the delusion takes may be
a natural crystallization or condensation, so to speak, of the par-
ticular morbid emotion which prevails, or it may be suggested,
as it often is, by some prominent external event. What we
have to bear in mind with regard to the organic nature of the
delusion is, that a series of ideational cells have now entered
upon the habit of a definite morbid action; that the general
commotion of nerve element, which the emotional disturbance
implied, has now centred in a particular form of diseased action,
not otherwise than as general inflammatory disturbance’ of some
part of the organism issues in a definite morbid growth there.
For although a temporary emotional disturbance produced by
bad blood may completely pass away with the purification of
the blood, yet the prolonged continuance or frequent recurrence
of such morbid influence will inevitably end in the ideational
nerve-cell, as elsewhere, in chronic morbid action, which, once
established, is not easily got rid of. Thus, then, it appears that
the first effect of the chronic action of impure blood is to pro-
duce a general disturbance of the psychical tone or indefinite
morbid emotion ; and the further effect of its continued action
is to engender a chronic delusion of some kind—a systematiza-
tion of the morbid action. But a third effect of its more acute
action, as witnessed in the effects of acute fevers and of certain
poisons, is to produce more or less active delirium and general
incoherence of thought: the poison is distributed generally
through the supreme centres by the circulation, and, acting
directly upon the different cells, exeites ideas rapidly and with-
out order or coherence: the delirium is not systematic, and
there is good hope of its passing away. The approaches of this
sort of delirium in fever illustrate many of the phenomena of
insanity. First, there are wandering images or thoughts, known
to be unreal, and often described by the patient, who recognises
their character, as nonsense ; then there follows vague rambling
270 ON THE CAUSES OF INSANITY. [cHap.

talk, from which he may be aroused by talking to him, though
he falls back into it as soon as he has answered ; afterwards the
state of complete delirium comes on, when the mind is entirely
possessed by unreal images and false thoughts uncontrolled by
impressions from without. A general incoherence equally un-
systematized, but which never can pass away save with life
itself, is the natural issue of long-continued chronic morbid
action in the supreme centres: it is the chronic dementia fol-
lowing continued insanity, and marking mental disorganization.
I mention it here in order to render pathologically intelligible
the very different prognosis in acute dementia from that in
chronic dementia.

It is before all things necessary to keep stedfastly in view
that the relation between the supreme nervous centres and the
blood is fundamentally of the same kind as that between other
parts of the body and their blood supply, and that the dis-
ordered mental phenomena are the functional indications of
morbid organic action. Firmly grasping this just conception,
as we may do by calling to mind the mode of nutritive action
in other parts of the body, we get rid of the notion of a de-
lusion as some abstract, ideal, and incomprehensible entity,
and recognise it as the definite expression of a certain form of
morbid action in certain of the supreme centres, neither more
nor less wonderful than the persistence of a definite morbid
action in any other organ. If there is defective or disordered
nutrition of the brain, and some striking event or some powerful
shock produces a great impression on the mind, constraining it
into a particular form of activity—in other words, engrossing
its whole energy in a particular gloomy reflection—what more in
accordance with analogy than that this should take on a chronic
morbid action, and issue in the production of a delusion? Any
great passion in the sound mind notably calls up kindred ideas,
which thereupon tend to keep it up; and it is plain that the
morbid exaggeration of this natural process must lead to the
production of delusion.

3. Sympathy or Reflew Irritation —Like every other nervous
centre, or like any other part of the organism, the supreme
cells of the ideational centres may be deranged by reason of
a morbid cause of irritation in some other part of the body.
1] ON THE CAUSES OF INSANITY, 271

Why such morbid effect should be produced at one time and
not at another, or in one person and not in another, it is im-
possible to say, just as it is impossible to explain how it is
that a wound in the hand or elsewhere at one time gives rise
to tetanus and at another time to no such desperate conse-
quence, or why epilepsy should be caused by an eccentric irri-
tation in one case and not in another. “A fever, delirium, and
violent convulsions,” says Dr. Whytt, “have been produced by a
pin sticking in the coats of the stomach; and worms affecting
either this part or the intestines occasion a surprising variety
of symptoms.”* These effects were of old attributed to a
sympathy or consent of parts,—terms which were, though
equally void of any real explanation, quite as expressive as
the modern reflex irritation.

Amongst many other instances which might be quoted in
illustration of this manner of pathological action, a case recorded
by Baron Larrey is a striking example. A soldier, who had
been shot in the abdomen, had a fistulous opening on the
right side, which passed inwards and towards the left. When a
sound was introduced into this opening and made to touch the
deeper parts, immediately singular attacks supervened: first
there was a feeling of coldness and oppressive pain, then a con-
vulsive contraction of the abdomen and spasm of the limbs;
after which the man fell into a sort of somnambulism, and
talked incoherently, this stage ending after about thirty minutes
in a melancholy depression which from the time of the wound
had been habitual. Larrey attributed the hypochondria and
other nervous symptoms to the injury which the celiac axis
had suffered from the ball. The direct effect of the sympa-
thetic system upon the brain, which this case so strikingly
illustrates, Schroeder van der Kolk once verified in his own
experience.t After great mental exertion and an unaccustomed
constipation of a few days, he was attacked with a fever, for
which his physician, deeming it nervous, would not sanction
any purging. After a continuance of the fever for two days,

* Observations on the Nature, Causes, and Cure of Nervous, Hypochondriacal,
or Hysteric Orders. By Robert Whytt, M.D. 1765.

+ Die Pathologie und Therapie der Geisteskrankheiten auf Anatomisch-Physi-
ologischer Grundlage. Von J. L. C. Schroeder van der Kolk. 1863.
272 ON THE CAUSES OF INSANITY. {[cHap.

hallucinations of vision occurred ; he saw a multitude of people
around him, although quite conscious that they were only phan-
tasms. These continued for three days and increased, until he
got a thorough evacuation of a quantity of hardened feces from
his bowels, when all the morbid phenomena vanished in a
moment. A man who came under my observation, having
suffered for more than a year with profound melancholia, and
who had become greatly emaciated, passing at intervals pieces
of tape-worm, recovered almost immediately after the expulsion
of the whole of the worm by means of a dose of the oil of male
fern.* Many like cases are on record in medical books; but it
is not necessary to multiply instances in order to prove that
morbid action in some part or organ of the body may be the
cause of secondary functional and organic disorder of the
supreme nervous centres. It may be well to add, however,
that affections of the uterus and its appendages afford notable
examples of a powerful sympathetic action upon the brain, and
not unfrequently play an important part in the production of
insanity, especially of melancholia. M. Azam investigated the
histories of seven cases of lypemania with suicidal tendencies,
of one case of simple lypemania with dangerous tendencies,
and of one case of hysteromania. There were granulations of
the neck of the uterus in five cases; there was anteversion of
the uterus, with congestion of its neck and ulceration of the
inferior lip, in one case; in three cases there were fungous and
fibrous growths of the uterus; and in one case there was painful
engorgement of it with leucorrheea. Schroeder van der Kolk
relates the case of a woman profoundly melancholic, who suf-
fered at the same time from prolapsus uteri, and in whom the
melancholia used to disappear directly the uterus was restored
to its proper place ; Flemming relates two similar cases in which

* Griesinger has seen deep melancholia arise in an hysterical woman after
accidental wound of the eye by a splinter. Herzog relates an instance of insanity
after the operation for strabismus. Jérdens tells of a boy who was attacked
with furious insanity in consequence of a splinter of glass in the sole of his foot,
which disappeared directly it was removed.—Op. cit., p. 183.

“In two instances,” says Dr. Burrows, in his Commentaries on Insanity, “I
have known sudden mania originate from the irritation of cutting the dentes
sapientie.” .. . ‘* Violent nausea also from sea-sickness, continued for a few
hours, has produced mania in three instances within my knowledge.”
1] ON THE CAUSES OF INSANITY. 273

the melancholia was cured by the use of a pessary, in one of
them regularly returning whenever the pessary was removed ;
and I have in one instance seen severe melancholia of two
years’ duration disappear after the cure of a prolapsus uteri.
Instances are on record in which a woman has regularly become
insane during each pregnancy ; and, on the other hand, Guislain
and Griesinger mention a case respectively in which insanity
disappeared during pregnancy, the patient at that time only
being rational.* These are striking examples of a mode of reflex
action which is a continual function of the organic life both in
health and in disease. Perhaps the best opportunity of studying
the early stages in the genesis of melancholia is afforded by the
mental depression that commonly accompanies certain uterine
diseases. On the other hand, there is equally striking evidence
of this intimate sympathy of parts in the fact that morbid
states of organs favouring a certain mental disposition may
unquestionably be in turn caused by the latter when it is
primary and of long standing.

Perhaps the most instructive example of the intimate organic
sympathy of parts is afforded by the great mental revolution
which accompanies the development of the sexual system at
puberty—when there occurs, as Goethe aptly expresses it, “an
awakening of sensual impulses which clothe themselves in
mental forms, of mental necessities which clothe themselves in
sensual images.” The great moral commotion produced at this
period is the cause of an unstable equilibrium of mind, which,
if hereditary predisposition exist, may, without further auxiliary
cause, issue in insanity. In any case it constitutes a frame of
mind favourable to the action of other causes of mental de-
rangement. Dr. Skae is of opinion that a natural group or
family might be formed of the cases of insanity occurring at
the period of pubescence, and dependent apparently upon the
changes affecting the circulation and nervous system by the

* Shenck relates the history of a pregnant female, in whom the sight of the
bare arm of a baker excited so great a desire to bite and devour it, that she
compelled her husband to offer money to the baker to allow her only a bite or
two from his arm. He mentions another pregnant female, who had such an
urgent desire to eat the flesh of her husband, that she killed him and pickled the
flesh, that it might serve for several banquets. (Prochaska on the Nervous
‘System, Syd. Soc. translation.)

T
274 ON THE CAUSES OF INSANITY. [cHap.

development of puberty. He believes that the insanity then
occurring presents certain characteristic features, most com-
monly manifesting itself in the form of mania, sometimes
accompanied by epileptic fits.

It is uncertain whether the puerperal state acts as the occa-
sional cause of a maniacal outbreak by this kind of sympathetic
action, or whether it acts in some other way; but there can be
no doubt of the fact that a woman is sometimes attacked with
mental alienation during delivery, and that her child may fall a
victim to her frenzy. This form of puerperal insanity is different
from the’ insanity of pregnancy ; different again in regard of
causation from that which occurs a few days after delivery, and
which is then probably due to blood-poisoning; and more
different still from that mental disorder occurring some weeks or
months after, aud due seemingly to the exhaustion produced by
lactation, together with depressing moral influences. Under the
name of Puerperal Insanity have sometimes been confounded
the Insanity of Pregnancy, Puerperal Insanity, and Insanity of
Lactation. Of 155 cases of so-called Puerperal Insanity ad-
mitted into the Edinburgh Asylum, 28 or 18-06 per cent. were
cases of the Insanity of Pregnancy ; 73 or 47-09 per cent. were
cases of Puerperal Insanity proper; 54 or 34-8 per cent. were
cases of Insanity of Lactation. Now these varieties, differently
caused, present some differences of features.*

However it be that disorders of menstruation act, certain it is
that they may exercise great influence on the causation and the
course of insanity. Most women are susceptible, irritable, and
capricious at that period, any cause of vexation then affecting
them much more seriously than usual; some exhibit a dis-
turbance of character which almost amounts to disease ; and, in
the insane, exacerbations of the disease frequently occur at the
menstrual periods, In a few rare cases, a sudden suppression of
the menses has been followed by an outbreak of acute madness ;
but more frequently the suppression has occurred some time
before the insanity, and acted as one link in the chain of
causes. It should not be forgotten that suppression of the menses

* See a very careful paper in the Edinburgh Medical Journal, 1865, on the

Insanity of Pregnancy, Puerperal Insanity, and Insanity of Lactation, by Dr. J.
B. Tuke,
1] ON THE CAUSES OF INSANITY. 275

may in some cases be an effect of the mental derangement.
When menstruation ceases entirely at the change of life, a revo-
lution takes place in the system, favouring the production of
insanity in those predisposed to it, and sometimes sufficing to
produce it. Most women suffer some change of moral character
by the revolution which the whole economy of the constitution
undergoes at the change of life. The age of pleasing is past,
but not always the desire; and it is now that jealousy, extreme
religious ‘sentiments, and a propensity to stimulants are apt
to appear.

The earliest and mildest effect of sympathetic morbid action
will be, as it is with the effect of vitiated blood, to produce
a modification of the tone of nerve element, which is functionally
manifest in disordered emotion. But the continued operation of
the morbid cause will be apt to lead to a systematized disorder
in the supreme cerebral centres: in other words, to the produc-
tion of a delusion or of a definite derangement of thought, which
then is not always without discoverable relation to the primary
morbid cause. When, for example, a woman with morbid irrita-
tion of the sexual organs has salacious delusions, or with uterine
or ovarian disease believes herself with child by the Holy Ghost
or other supernatural means, the secondary derangement of the
cerebral éentres testifies to the special effect of the particular
diseased organ ; and when the disordered action forces itself into
consciousness, the interpretation given of it in the delusion wit-
nesses to the nature of the primary morbid cause. Dr. Skae has
proposed to make a special group of the cases of insanity asso-
ciated with ovarian and uterine disease ; one of the most common
symptoms presented by them being sexual hallucination. There
is the most perfect harmony, the most intimate connexion or
sympathy, between the different organs of the body as the ex-
pression of its organic life—a unity of the organism beneath con-
sciousness; and the brain is quite aware that the body has a
liver or a stomach, and feels the effects of disorder in any one of
the organs, without declaring it directly in consciousness. This
unconscious, but not unimportant, cerebral activity, which is
the expression of the organic sympathies of the brain, cannot
fail, when rightly appreciated, to teach the lesson, already much
insisted on, that every organic motion, visible or invisible,

T 2
276 ON THE CAUSES OF INSANITY. [cHap.

sensible or insensible, ministrant to the noblest purposes or to
the humblest aims, does not pass away issueless, but has its due
effect upon the whole, and thrills throughout the most complex
recesses of the mental life.*

Though the morbid sympathetic action of a diseased organ
upon the brain may be very considerable without any definite
affection of consciousness, yet when it reaches a certain intensity,
or when it is long continued, the effect thrusts itself into con-
sciousness, just as physiologically the idea does when its energy
reaches a certain tension; declaring itself in the sensational
centres by pain or some more special anomalous feeling, and in
the cognitional centres by emotional perversion or actual delu-
sion. It often happens that no information is given until the
primary and secondary mischief are far advanced, and it is then
only given indirectly ; for while there is entire unconsciousness
of the primary disease in the distant organ, and an entire un-
consciousness of the secondary morbid action in the brain, the
effect may nevertheless be positively attested by melancholia,
delusion, or some other form of mental disorder. Esquirol gra-
phically tells the story of a woman who thought she had in her
belly the whole tribe of apostles, prophets, and martyrs, and
who, when her pains were more than usual, railed at them for
their greater activity. After death, her intestines were found
glued together by a chronic peritonitis. I have recently seen a
patient suffering from chronic insanity, who fancies that he has
got a man in his inside, and who, when his bowels get much
constipated, as they are apt to do, makes the most desperate
attempts, by vomiting and otherwise, to get rid of him. After a
purgative, however, he is quite comfortable for a time, and his
delusion subsides into the background. In the insanity attended
with phthisis there are often delusions of suspicion which appear
to have their foundation in the anomalous feelings incident to

*

‘* Man is all symmetrie,
Full of proportion one limb to another,
And all to all the world besides,
Each part calls the furthest brother.
For head with foot hath private amity,
And both with moon and tides.”—Grorcz HERBERT.

“There is,” says John Hunter, ‘a connexion of the living principle in the powers
of one part with those of another, which might be called a species of intelligence.”
1.] ON THE CAUSES OF INSANITY. 277

the advance of the tubercle: one such patient under my care
fancied that he was maliciously played upon by secret fire, inter-
preting in this way the actual increase of bodily temperature
which occurs during the progress of phthisis; he also imagined
that a filthy disease had been produced in his mouth, the delu-
sion probably having its origin in the perversion of smell or
taste resulting from the disease. Not only is the remote patho-
logical effect of a diseased organ thus evinced by the occurrence
of some form of insanity, but,.as already pointed out, a special
effect of the particular morbid organ may be revealed in the
character of the delusion engendered. It is by virtue of this
sympathetic action that dreams sometimes have a truly prophetic
character in regard of certain bodily affections, the early and ob-
scure indications of which have not been sufficiently marked to
awaken any attention during the mental activity of the day, or
at any rate to do more than produce a vague and formless feel-
ing of discomfort; nevertheless they declare themselves in the
mental action of dreaming, when other impressions are shut out.
When the disease ultimately declares itself distinctly in our
waking consciousness, then the prophetic dream, the forewarning,
is recalled to mind with wonder. The return of a certain mood
of mind before an outbreak of recurrent insanity or of epileptic
fits, such as has been displayed before former attacks, and enables
an experienced person to predict with certainty what is coming,
and the recurrence of particular morbid ideas, feelings, and de-
sires during the insane outbreak, may be, and probably often
are, owing to a periodical revival of the morbid irritation in the
distant organ. There is abundant reason to believe that the brain
retains a memory of the impressions received from the organic
life, even when the impressions are morbid. In those women
whose mental dispositions are much affected sympathetically at
the menstrual periods, the same sort of feelings, susceptibilities,
caprices, and fancies recur. In this physiological and patho-
logical action may lie also the explanation of the fact before
stated, that the thoughts and feelings of dreams, not remembered
in the waking state, may still appear in and influence the course
of subsequent dreams. After all, however, the most striking
examples of this kind of action in its physiological form are met
with in the marvellous creations of dreams originating in states
278 ON THE CAUSES OF INSANITY. [cuap.

of the sexual organs*—“tensio phalli visé muliere nuda etiam
in insomnio”—these illustrating admirably the close sympathy
which prevails ; while numerous examples of this kind of action
in its pathological form are furnished by the salacious delusions
of certain of the insane in whom there is derangement of the
sexual system. In every large asylum are to be met with women
who believe themselves to be visited every night by their lovers,
or violently ravished in their sleep ; and in some of these, as in
St. Catherine de Sienne and St. Theresa, a religious ecstasy is
united with their salacious delusions. Indeed, a religious fana-
ticism carried to a morbid degree is not seldom accompanied by a
corresponding morbid lasciviousness ; while religious feeling of a
less extreme kind in some women, especially certain unmarried
and childless women, is very much a uterine affection.

Between the organic feelings just considered—the vital senses,
as they are sometimes called—and the lower special senses, there
exist the closest relations; in truth, they run insensibly into
one another. Thus the digestive organs have the closest sym-
pathy with the sense of taste, as we observe in the bad taste
accompanying indigestion, and especially perhaps in the avoid-
ance of poisonous matters by animals ; the respiratory organs
and the sense of smell are in like manner intimately associated ;
and the sense of touch has close relations with the ccenzesthesis.
In insanity we find these physiological relations hecome some-
times the occasions of delusions: derangement of the digestive
organs, perverting the taste, gives rise to the delusion that the
food is poisoned ; disease in the respiratory organs is sometimes
the cause of disagreeable subjective smells, which are thereupon
attributed to an objective cause, such as the presence of a dead
body in the room ; and more or less loss or perversion of sensi-
bility in the skin, which is not uncommon amongst the insane,
is frequently the occasion of extravagant delusions. A woman
whose case Esquirol relates, had complete anzsthesia of the sur-
face of the skin: she believed that the devil had carried off her
body. A soldier who was severely wounded at the battle of
Austerlitz considered himself dead from that time: if he were

“ “And as love and beauty stir up heat in other organs, so heat in the same
organs, from whatever it proceeds, often causeth desire and the image of an
unresisting beauty.” —HoBBEs.
1] ON THE CAUSES OF INSANITY. 279

asked how he was, he invariably replied, that “Lambert no
longer lives; a cannon-ball carried him away at Austerlitz.
What you see here is not Lambert, but a badly imitated
machine,”—which he failed not to speak of as 7. The sensi-
bility of his skin was lost. A striking instance of delusion in
connexion with defective sensibility occurred in an amiable and
amusing patient who was under my care suffering from general
paralysis. As the disease approached its end, the end of life, he
had severe epileptiform convulsions, which latterly affected the
left side only, and finally resulted in paralysis of that side.
But, though the power of movement and feeling were entirely
gone, there were frequent spasmodic twitchings of the muscles
and convulsive contractions so strong as to raise the arm and
leg of the paralysed side from the bed. The poor man had the
most singular delusions respecting these movements: he thought
that another patient, who was perfectly demented and harmless,
had got hold of him and was tormenting him, and accordingly,
without real anger, but with an energy of language that was
habitual to him, he thus soliloquized aloud :—* What a power
that damned fellow has over me!” Then after a severe convul-
sion,—“ He has got me round the neck, and you dare not touch
him, not one of you. Oh! but it is a burning shame to let a
poor fellow be murdered in this way in a public institution.
It’s that boy does this to me.” Told that he was mistaken, he
replied,—* You may as well call me a liar at once: he has got
me round the neck and he has me tight. Oh! it is a damned
shame to treat me in this way—the quietest: man in the house.”
Then after a while—*“It’s a strange power these lunatics have
over one. That boy is playing the devil with me: he stinks
worse than a polecat: he'll take my life, sure enough.” And so
on continually, until the stupor of death overpowered him.
Laudably anxious to give due weight to the perversions of
sensibility which are met with in insanity, Griesinger has made
five groups of mental disorder connected with different anomalies
of sensibility, and more frequently than not actually dependent
upon them. The first of these is the pracordial form, where
there are morbid sensation, sense of pressure, or pain about the
epigastrium, from which follow fear and mental anguish, with
corresponding ideas and habits of thought. The second is the
280 ON THE CAUSES OF INSANITY. [cHapP.

vertiginous form, in which some anomaly of muscular sensibility
exists. In the third, which he calls the puresthetical form,
there are anomalous sensations in different parts of the body,
attributed by the patients commonly to external machinations.
The fourth is the anesthetic form, in which absence of sensibility
is often the cause of self-mutilation. Lastly, there is the halluci-
natory form, which obviously needs uo further explanation here.
It is undoubtedly of great importance to bestow scrupulous
attention upon all the disorders of sensibility, as well as those of
nutrition and movement, which occur in the different sorts of
insanity ; to do so is an essential part of the physician’s duty. in
studying the natural history of the disease; but it is quite im-
possible to make perversions of sensibility alone the basis of a
system of classification. Such a classification could not fail to
have an extremely artificial character, and an entirely theoretical
foundation. All that it seems important to say here is, that
these pathological phenomena confirm in a striking manner the
observations made in the First Part of this work concerning the
comprehension in“the mental life of the whole bodily life.

The centre of morbid irritation which is so apt at times to
give rise to secondary disorder by reflex or sympathetic action
need not be in some distant organ; it may be in the brain
itself. A tumour, abscess, or local softening in the brain, may
nowise interfere with the mental operations at one time, while
at another time it produces the gravest disorder of them; and
it is not uncommon in abscess of the brain for the symptoms of
mental derangement, when there are any, to disappear entirely
for a time, and then to return suddenly in all their gravity.
‘When the motor, sensory, and ideational centres are not directly
implicated in the disease, they may continue their functions in
spite of it, and it does accordingly happen that they sometimes
do so even when there is the most serious mischief going on
in the brain; but they may at any moment be affected by a
sympathetic or reflex action, and a secondary abolition or de-
rangement of function may thus supervene without warning.
Instances now and then occur in which a sudden loss of con-
sciousness, or a sudden incoherence, or sudden mania, or even
sudden death, takes place where no premonitory symptoms have
indicated grave local disease of the brain.
1] ON THE CAUSES OF INSANITY. 281

Furthermore, it would appear that a limited disorder of the
ideational cells, such as is functionally manifest in the fixed
delusions of the so-called monomaniac, will not usually remain
without some effect upon the other elements in the supreme
centres. So delicately sympathetic and sensitive as nerve
element is, it is hard to conceive it possible that a centre of
morbid action should fail to affect, by direct or by reflex action,
neighbouring parts not immediately involved in the disease. As
a matter of observation it is certain that a greater or less dis-
turbance of the tone of the whole mind does commonly accom-
pany the limited delusions of a partial insanity; in fact, the
condition of things is that which has already been described as
the first stage of the affection of mind by other causes of its
derangement,—namely, a modification of the mental tone. This
baneful effect of a limited local disorder is in strict accordance
with the analogy of what we observe elsewhere. Hereafter we
shall have occasion to describe instances of the sudden and
entire transference of active disorder of one nervous centre to
- another ; for, as Dr. Darwin long ago observed, “in some con-
vulsive diseases a delirium or insanity supervenes and the con-
vulsions cease ; and, conversely, the convulsions shall supervene
and the delirium cease.” *

It is necessary here, as in the spinal, sensory, and motor
centres, to distinguish between the degrees of secondary patho-
logical disturbance to which a morbid cause may give rise. The
sudden way in which extreme mental symptoms appear, and the
equally sudden way in which they sometimes disappear, as in
abscess of the brain, prove that extreme derangement may be
what is called functional ; for it is impossible to suppose that
serious organic change has existed in such cases. Although,
therefore, the functional disorder necessarily implies a molecular
change of some kind in the uervous element, the change may be
assumed to be one affecting the polar molecules,.such as the
experiments of Du Bois Reymond and others have proved may

* In what is called metastasis of disease the primary disease disappears, whereas
in sympathy it remains in action. Old writers treat also of the conversion of
diseases—a very imperfectly cultivated department which is just beginning to
attract. attention again. Heberden suggests that madness, like gout, absorbs
other distempers, and turns them perfectly to its own nature.
282 ON THE CAUSES OF INSANITY. [cHapP.

rapidly appear and rapidly disappear. The induction of recog-
nisable temporary changes in the physical constitution and
function by experiments certainly warrants the belief in similar
modifications by causes which are not artificially produced, but
which are just as abnormal as if they were artificial. This
probable modification of the polar relations of nervous element,
which disappears with the removal of the cause, will not fail, if
too great or too prolonged, to degenerate into actual nutritive
change and structural disease, just as an emotion which observ-
ably often alters a secretion temporarily may, when long en-
during, lead to actual nutritive change in the organ. The longer
a functional derangement is allowed to continue, the more
danger is there of structural disease; and this serious change
once definitely established, the removal of the primary morbid
cause will not suffice to remove an effect which has now become
an independently acting cause.

4. Excessive Functional Activity—As the manifestation of
function is the waste of matter, it is obvious that, if the due
intervals of periodical rest be not allowed for the restoration
of the statical equilibrium of nerve element, degeneration of it
must take place as surely as if it were directly injured by a
morbid poison or a mechanical or chemical irritant. It is sleep
which thus knits up the ravelled structure of nerve element ;
for, during sleep, organic assimilation is restoring as statical
force the power which has been expended in functional energy.
The strongest mind, if continually overworked, will inevitably
break down; one of the first symptoms that foreshadows the
coming mischief being sleeplessness. That which should heal
the breach is rendered impossible by the extent of the breach.
Like Hamlet, according to Polonius’s fruitful imagination, the
individual falls into a sadness, thence into a watch, thence into
a lightness, and, by this declension, into the madness wherein he
finally raves. To provoke repose in him is the first condition of
restoration ; the power of it often closing the “eye of anguish,”
and curing the “ great breach in the abused nature” of nervous
element.

It is, however, when intellectual activity is accompanied with
great emotional agitation that it is most enervating—when the
mind is the theatre of great passions that its energy is soonest
1] ON THE CAUSES OF INSANITY. 283

exhausted. What has already been said as to the instability of
nerve element which a great emotional susceptibility implies,
will enable us to understand how this destructive effect is worked
out. When an exceedingly painful event produces great sorrow,
or a critical and uncertain event great anxiety, the mind is
undergoing a passion or suffering ; there is not an equilibrium
between the internal life and the external circumstances ; and
until the mind is able duly to react, the passion must continue,
—in other words, the wear and tear of nervous element must go
on. Painful emotion is in reality psychical pain; and pain
here, as elsewhere, is the outcry of suffering organic element—
a prayer for deliverance and rest. The same objects or events
do notably produce very different impressions upon the mind
according to the condition of it at the time—according as some-
thing pleasant or something unpleasant has just happened. If
there exist a temporary depression of the psychical tone by
reason of some misfortune that has happened, then an event,
which under better auspices would have been indifferent, will
excite painful emotion, and, calling up congenial ideas of a
gloomy kind, continue and add to the mental suffering, just as
reflex action increased by a morbid cause will in turn sometimes
ageravate the original disorder. If there be a lasting depression
of the psychical tone by reason of some morbid cause, then every
eyent is apt to aggravate the suffering, and one particularly un-
favourable event, or a series of painful events, may lead to the
degeneration of insanity. After a piece of good news, or after
a man has just drunk a glass of sound wine, the psychical tone
is such that there is a direct and adequate reaction to an un-
favourable impression, and the individual will not suffer. Herein
the supreme centres of thought do not differ from the inferior
nervous centres; when the spinal centres are exhausted, ex-
citability is increased, and an impression which under better
auspices would have produced no effect gives rise to degenerate
activity that displays itself in spasmodic movements—an ex-
plosion not unlike that which in the higher centre is manifest
as emotion, or as an ebullition of passion. Excess is, however,
a relative term; and a stress of function which would be
nothing more than normal to a powerful well-ordered mind, and
conducive to its health, might be fatal to the stability of a feeble
284 ON THE CAUSES OF INSANITY. [cHaP.

and ill-regulated mind in which feeling habitually overswayéd
reason, or even to that of a strong mind temporarily prostrate.
Thus it is that in examining into the causation of insanity in
-any case it is not sufficient to investigate only the series of
influences to which the individual has been subjected, but it
is necessary also to ascertain what capacity at the time he had
of bearing them.

It is evident from the foregoing reflections that, from a patho-
logical point of view, the so-called moral causes of insanity may
properly fall under the head of excessive stimulation or excessive
functional action: the mind is subject to a stress beyond that
which it is able to bear. Of necessity the depressing passions are
the most efficient causes of exhaustion and consequent disease :
grief, religious anxiety, disappointed affection or ambition, the
wounds of an exaggerated self-love, and, above all perhaps, the
painful feeling of being unequal to responsibilities, or other like
conditions of mental agitation and suffering, are most apt to
reach a violence of action by which the equilibrium is lost.
Great intellectual activity, when unaccompanied by emotion, does
not often lead to insanity ; it is when the feelings are anxiously
engaged that the mind is most moved and its stability most
endangered: on the stage of mind as on the stage of the world
the great catastrophes are produced by passion. Moreover,
when an individual has by a long concentration of thought,
affection, and desire on a certain aim or object, grown into
definite relations with regard to it, and made it, as it were, a
part of the inner life, a sudden and entire change, shattering
long cherished hopes, is not unlikely to produce insanity ; for
what is more fraught with danger to the stability of the strongest
mind than a sudden great change in external circumstances,
without the inner life having been gradually adapted thereto ?
Thence it comes that a great exaltation of fortune, as well as a
great affliction, rarely fails to affect for a time the strongest head,
and sometimes quite overturns a weak one; the strong mind
succeeding after a time in establishing an equilibrium between
itself and its new surroundings, which the feeble mind cannot
do. When depressing passion does not act directly as the cause
of a sudden outbreak of insanity, it may still act mischievously
by its long-continued evil influence on the organic life, and thus
1] ON THE CAUSES OF INSANITY. 285

finally produce mental derangement. It is not often that men
become insane, though they sometimes die, from excess of joy ;
and when one of the expansive passions, as ambition, religious
exaltation, overweening vanity in any of its Protean forms, leads
to mental derangement, it does not, like a painful passion, act
directly as the cause of an outbreak, nor indirectly by producing
organic disorder and subsequent insanity ; but it produces its
effects by degrees as an exaggerated development of a certain
peculiarity or vice of character.

A fatal drain upon the vitality of the higher nervous centres
may in certain cases be produced by the excessive exercise of
a physical function—by an excessive sexual indulgence, or by
continued self-abuse. Nothing is more certain than that either
of these causes will produce an enervation of nerve element
which, if the exhausting vice be continued, passes by a further
declension into degeneration and actual destruction thereof. The
flying pains and heaviness in the limbs, and the startings of the
muscles, which follow an occasional sexual excess, are signs of
instability of nerve element in the spinal centres, which, if the
cause is in frequent operation, may end in inflammation and
softening of the cord, and consequent paralysis. Nor do the
supreme centres always escape: the habit of self-abuse notably
gives rise to a particular and disagreeable form of insanity, cha-
racterised by intense self-feeling and conceit, extreme perversion
of feeling, and corresponding derangement of thought, in the
earlier stages; and, later, by failure of intelligence, nocturnal
hallucinations, and suicidal or homicidal propensities. The
mental symptoms of general paralysis—a disease notably pro-
duced sometimes by sexual excess—betray a degenerate con-
dition of nerve element in the higher centres, which is the
counterpart of that which in the lower centres is the cause of
the loss of co-ordination of movement and of more or less spasm
or paralysis. The great emotional excitability, the irritable fee-
bleness, of the general paralytic, no less than the extravagance
of his ideas, marks a degeneration of the ideational cells of the
supreme centres ; there is accordingly an inability to co-ordinate
and perform his ideas successfully, just as there is an inability
to perform movements successfully, because the spinal centres
are similarly affected. It is not usual, however, for sexual
286 ON THE CAUSES OF INSANITY. [cHarP.

excesses to produce insanity unless it be general paralysis ; they
rather tend to produce epilepsy or some kind of paralysis. Self-
abuse is a cause of insanity which would appear to be more
frequent and effective in men than in women. Apart from all
question whether the vice be so common among women, they
bear self-abuse, as they do sexual excesses, better than men.
On the other hand, privation of sexual function is more injurious
to women than on men.

5. Injuries and Diseases of the Brain and Nervous System not
necessarily, but occasionally, producing Insanity.—Injuries of the
head, when not followed by any immediate ill consequences,
may still lead to insanity through the degenerative changes
which they ultimately induce in the cortical layers of the hemi-
spheres.* Tnsolation notably acts perniciously on the supreme
cerebral centres, either by causing, as some imagine, acute hyper-
zemia and cedema, or, as is more probable, over-stimulation and
consequent exhaustion of nerve element. Abscesses and tumours
of the brain, cysticerci and effusions of blood, do not directly or
commonly produce mental derangement; when they do, it is
probably by a reflex or sympathetic action. Professor Gerhardt
mentions one case in which mental disorder was the first symptom
of an embolism, the paralytic phenomena following later; and in
a case, related by Dr. L. Meyer, chronic tubercular meningitis
gave rise to mental disorder. It has been already said that there
are instances on record in which insanity, like tetanus, has been
caused by peripheric injury ef nerve, obscure as the manner of
operation in such case undoubtedly is; and Dr. Darwin long ago

* Professor Schlager, of Vienna (Zeitschrift der k. k. Gesellschaft der Aerzte zu
Wien, xiii. 1857), has made some valuable researches regarding mental disorder
following injury of the brain. Out of 500 insane, he traced mental disorder to
injury of the brain in 49 (42 men and 7 women). In 21 cases there had been
complete unconsciousness after the accident ; in 16, some insensibility and con-
fusion of ideas ; in 12, simple dull headache. In 19 cases the mental disorder
came on in the course of a year after the injury, but not till much later in many
others, and in 4 cases after more than ten years. In most of the cases the
patients were disposed to congestion of the brain, excitement and great emotional
disturbance, from the time of the injury, on taking a moderate quantity of
‘spirituous liquor ; frequently there was singing in the ears, or difficulty of hearing,
or hallucination; and very commonly the disposition was changed, and the
patient was prone to outbursts of anger or excesses. The prognosis was very un-

favourable ; the issue in 7 cases was dementia with paralysis, while 10 went on to
death.
1] ON THE CAUSES OF INSANITY. 287

made the observation that mental derangement sometimes occurs
as the transference of disorder from the spinal centres.

Hysteria in some instances undoubtedly produces or passes
into insanity. An acute attack of maniacal excitement, with great
restlessness, pervérseness of conduct, loud and rapid conversation
—sometimes blasphemous or obscene, laughing, singing, or rhym-
ing, may follow the ordinary hysterical convulsions, or may occur
instead of these. Or the ordinary hysterical symptoms may
pass by degrees into a chronic insanity ; the patient losing more
and more self-control, becoming more fanciful about her health,
and more indifferent to what is going on around her; the body
becomes anemic and emaciated, and there are usually irregulari-
ties of menstruation. An erotic element is sometimes evinced in
the manner and thoughts ; and occasionally ecstatic states occur.
The symptoms are often worse at the menstrual periods.

Under this division of exciting causes of insanity must be
placed chorea and epilepsy, although what may be their exact
seats in the nervous system is yet uncertain. Chorea in the
adult is not unapt to terminate in insanity. It is necessary to
bear in mind that there are different sorts of insanity connected
with epilepsy. "When the fits have recurred frequently, and the
disease has continued for a long time, it undoubtedly produces
loss of memory, failure of mental power, and ultimately com-
plete dementia. Again, a succession of severe fits may be fol-
lowed by a condition of acute dementia which lasts for a short
time, or by an acute, violent, and most dangerous mania which
usually passes away in a few days. Not only may acute mania
thus follow epilepsy, but an attack of acute transitory mania—
a true mania transitoria—may take the place of the epileptic
paroxysm, representing a masked epilepsy. Lastly, in some cases
a profound moral disturbance, an irritability, moroseness and per-
version of character, lasting for months, with periodical exacer-
bations in which vicious or criminal acts may be perpetrated,
precede the appearance of the regular epileptic fits, which then
throw light upon the hitherto unaccountable moral perversion ;
it is another form of masked or suppressed epilepsy.

The caries of the bones of the skull, which is an occasional
effect of tertiary syphilis, may lead to destructive consequences
by extension of morbid action to important parts beneath. There
288 ON THE CAUSES OF INSANITY. [cHar.

are, however, other ways in which syphilis is now known to lead
to mental disorder: a syphilitic node formed on the internal
surface of the skull may occasion secondary mental disease of
a grave kind; and, again, syphilis may give rise to inflamma-
tion of the membranes of the brain, followed sometimes by a low
diffuse exudation in or between the membranes, or by a more
or less defined tumour (syphiloma) ; the result being a hopeless
dementia, with gradually increasing paralysis. The syphilitic
exudation sometimes, though rarely, takes place in the substance
of the brain itself; its starting-point then being the nuclei of
the connective tissue which exists throughout the brain, and the
destruction ‘of the nervous cells being secondary. But of this,
more hereafter.

CONCLUDING REMARKS.

An important but obscure question, of which little thought is
ever taken now, is not so much what is the cause of the insanity
as what is the cause of the particular form which the insanity
takes. The inborn temperament of the individual has certainly
great influence in determining the kind of mental disorder, the
same external cause giving rise to different forms of disease
according to the constitutional idiosyncrasy: the melancholic °
temperament will, it may be presumed, predispose to melancholic
insanity, the sanguine temperament to a more expansive de-
rangement. On the other hand, injury of the head will tend to
produce intellectual disorder rather than emotional depression,
while abdominal disease will favour the production of emotional
depression; for the organic conditions of the integrity of the
intellectual faculties are, as Miiller has observed, mainly in the
brain itself, but “the elements which maintain the emotions or
strivings of self, in all parts of the organism.” Furthermore, it
is plain that the degree of development which the mind has
reached must determine in no slight measure the features of its
disorder ; the more cultivated the mind the more various and
complex must be the symptoms of its derangement; while it is
not possible that the undeveloped mind of the child immediately
after birth should exhibit ideational disorder of any kind. Con-
sider what an infinitely complex development the cultivated
mind has been shown to be, and what a long series.of processes
rn] ON THE CAUSES OF INSANITY. 289

and what a variety of interworkings of so-called faculties even
its simpler conceptions involve ; it will then be easily under-
stood how great and varied may be the confusion and disorder
of its morbid action. The different forms of insanity represent
different phases of mental degeneration ; and in the disorgani-
zation, degeneration, or retrograde metamorphosis of the mental
organization—call the retrograde change what we will—there
will be exhibited the wreck of culture. The morbid mental
phenomena of an insane Australian savage will of necessity be
different from the morbid mental phenomena of an insane
European, just as the ruins of a palace must be vaster and more
varied than the ruins of a log hut. For the same reason the
insanity of early life always has more or less of the character of
imbecility or idiocy about it: as is the height so is the depth, as
is the development so is the degeneration. The development
of the sexual system at puberty, and the great revolution which
is thereby effected in the mental life, must needs often give a
colour to the phenomena of insanity occurring after puberty.
During the energy of mental function in active manhood mania
is the form of degeneration which appears most frequently to
occur, while as age advances and energy declines melancholia
becomes more common. Future researches will probably dis-
cover the definite causes of the special features of many of the
different forms of insanity in the bodily disorders which cause
them, or which are constantly associated with them, Then,
instead of a vague psychological classification of insanity, we
may hope to attain to an exact medical history of the different
forms of the disease, and to a scientific classification of them.
At present we are only on the threshold of positive inquiry.
Because no two people are exactly alike in mental character
and development, therefore no two cases of mental degenera-
tion are exactly alike. The brain is different in the matter of
its development from other organs of the body ; for while the
development and function of other organs are nearly alike in
different individuals, and the diseases of them accordingly have
a general resemblance, the real development of the brain as the
organ of mental life only takes. place after birth, and, presenting
every variety of individual function in health, presents also
every variety of morbid function: consequently, two cases of
U
290 ON THE CAUSES OF INSANITY. [oHar.

insanity may resemble one another in the general features of
exaltation or depression, or in the character of the delusion, but
will still have their special features. Insanity is not any fixed
morbid entity ; every instance of it is an example of individual
degeneration, and represents individual mental life under other
conditions than those which we agree to regard as normal or
typical. No more useful work could be undertaken in psychology
than an exact study of individwal minds, sound and unsound.
Still, although different cases will present their special details,
there is a wonderful sameness about insanity, a great lack of
invention; delusions repeat themselves in all lunatic asylums,
and any one who has studied well the patients in one large
asylum knows the general features of the madness of all ages
and of all countries, under all conditions and among all classes
of men.’ Productive, in the sense of creative, activity is the
highest function of the highest and healthiest mind.

Weigh carefully the manner of its causation, and it will appear
that mental derangement must be a matter of degree. There
may be every variety (a) of deficient original capacity, (6) of
deficient development of the mental organization after birth, and
(c) of degree of degeneration. Between the lowest depths of
madness, therefore, and the highest reach of mental soundness,
there will be infinite varieties shading insensibly one into
another—a very gentle gradient ; so that no man will be able to
say positively where sanity ends and insanity begins, or to
determine with. certainty in every case whether a particular
person is insane or not. The question of an individual’s respon-
sibility must then plainly be a most difficult one: there are
insane persons who are certainly responsible for what they do,
and, on the other hand, there are sane people who under certain
circumstances are as plainly not responsible for their actions.
A madman is notably capable of great self-control when his
interest specially demands it ; in the majority of cases he knows
full well the difference between right and wrong; but, knowing
the right, he is instigated by the impulses of his morbid nature
to do the wrong, and is not held in check by those motives
which suffice to restrain the sane portion of the community,

Again, the investigation made into the causation of mental
disease exhibits the necessity of taking wider views of its origin
1.] ON THE CAUSES OF INSANITY. 291

and import than is commonly done. Insanity marks a failure
in organic adaptation to external nature: it is the result and
evidence of a discord between the man and his surroundings: he
cannot bend circumstances to himself nor accommodate himself
to circumstances. The lunatic has not learnt, nor can he learn,
how much more noble, more conformable to Nature’s laws, it is
to merge his small individual discord in her harmonious unison,
than to spoil the latter by it. Now, whosoever, either from
inherited weakness of nature or from adverse circumstances, is
unequal to the predetermined impulse or nisus of evolution
which is immanent in mankind, as in every other form of organic
life, must fall by the wayside and be left stranded. For as in
the stupendous progression of the human race whole nations
drop away like dead branches from the living tree, so amongst
nations individuals decay and perish in crowds as the dead
leaves fall from the living branches. Nature indeed counts
individual life very cheaply: in the development of vegetable
and animal life she sacrifices numberless seeds and germs, of
fifty bringing but one to bear, and in the organic evolution of
mankind she sacrifices with like lavish profusion countless
thousands of individual lives :

“So careful of the type she seems,
So careless of the single life.”

It behoves us not to let these failures, these abortive minds,
pass away without learning the lesson which their history
conveys: they are instructive instances well fitted to teach the
causes of failure, and thus to indicate the method of a successful
adaptation to external nature. When he is thus brought into
harmony with nature, the development of the individual becomes
the consummate evolution of nature.

APPENDIX.

In order to illustrate more fully this chapter on the causation of
insanity, I append here the short notes of fifty cases, all of which were
under my care, and in which I laboured to satisfy myself of the con-
spiring causes of the mental disease :—

1. A captain in the army, and the only surviving son of his mother,
who was a widow. She suffered very much from scrofulous disease,

U2
292 ON THE CAUSES OF INSANITY. [cHaP.

and he was wasting away with phthisis. Mental state, that of demented
melancholia, with manifold delusions of suspicion. He was the last
‘of his family two brothers having died very much as he died. His
grandfather began life as a common porter, ultimately became partner
in a great manufacturing business, and, having amassed enormous
wealth, made a great display in London on the strength of it. His
high hopes of founding a family on the wealth which it was the sole
aim of his life to acquire have thus issued.

2. There was direct hereditary predisposition, and the temperament
was notably excitable through life. There was no evidence of excesses
of any kind, but there had been many business anxieties. The mental
disease was general paralysis.

3. An amiable gentleman, on the death of his wife, formed a
connexion with a woman of loose character. Continual sexual ex-
cesses, with free indulgence in wine and other stimulants, ended in
general paralysis.

4, A conceited Cockney, the son of a successful London tailor and
money-lender, strongly imbued with the tradesman’s spirit, and with
offensive dissenting zeal. Hopelessly addicted to masturbation, and
suffering from the disagreeable form of mental derangement following
such cause.

5. Two ladies of middle age, unmarried, and cousins. They both
suffered from extreme moral insanity, both revealing in their conduct
the tyranny of a bad organization. There was insanity in the family,
in one case the father being actually insane; and in both cases the
parents being whimsical, capricious, and very injudicious as parents.
A bad organization, made worse by bad training.

6. An unmarried lady, aged 40, addicted to the wildest and coarsest
excesses, though of good social position and of independent means ;
justifying in every respect her conduct, though it more than once
brought her to the gaol. Family history not ascertainable, but evidently
not good organization in her. No aim nor occupation in life, but
extreme egoistic development in all regards.

7. A publican, et. 31, had done little for some time but. stupify
himself with brandy in his own bar-parlour. The consequence was
furious mania and extreme incoherence: acute mania from continued
intoxication, not delirium tremens.—Recovery.

8. A woman, et. 47, of dark bilious temperament, who had endured
much from her husband’s unkindness and domestic anxieties, under-
went “the change of life,” and became extremely melancholic.—
Recovery.
1] ON THE CAUSES OF INSANITY. 293

9. Hereditary predisposition marked. First attack, et. 38, when
unmarried. Second attack, wt. 58, she having a few years before
married an old gentleman in need of a nurse. She was given to
taking stimulants, fancied herself ill, and must always be having the
doctor ; in fact, hypochondriacal melancholia gradually grew into
positive insanity.—Recovery.

10. A married lady, zt. 31, without children, and having great self-
feeling. She went on one occasion to a Methodist meeting, was much
excited by a violent sermon, and immediately went mad, fancying her
soul to be lost, and making attempts at suicide.—Recovery.

11. A young lady, et. 25, who had some anxieties at home, suffered
a disappointment of her affections. Black depression running into
acute dementia.—Recovery.

12. A married woman, et. 44, of dark bilious temperament, had
never had any children. At the “change of life” profound melan-
cholia came on.

13. A gentleman, aged 60, of fine sensitive temperament, whose
mother was said to have been flighty and peculiar, had himself been
noted for slight peculiarities. He became profoundly melancholic,
thinking himself ruined, and intensely suicidal. Refusal of food.
Everything taken, however, was vomited, and diagnosis of organic
abdominal disease, probably malignant, was made.—Death from ex-
haustion.

14. A bookseller, et. 41, temperate, of considerable intellectual
capacity, but of inordinate conceit ; advocated a general division of
property and other extreme notions. He ultimately got the notion
that there was a conspiracy against him on the part of the Govern-
ment, and tried to strangle his wife as a party to it. After two years
he died of phthisis, with many of the symptoms of general paralysis.
The bodily disease seemed to have conspired with a natural vice of
character, and thus to have made the mental derangement one of its
earliest symptoms.

15. A married man, et. 50, of anxious temperament. Profound
melancholia ; refusal of food. Second attack. Apart from the pre-
disposition established by a former attack, the cause seemed to be
great self-feeling, assuming a religious garb. Very fervent always in
devotion, but intense egoistic feeling ; entire reference of everything to
self, and natural‘inability to form altruistic conceptions.—Recovery.

16. A single lady, xt. 38, fancied herself under mesmeric influence,
in a state of clairvoyance, and had a variety of anomalous sensations.
Rubbed her skin till it was sore in places, bit her nails to the quick,
294 ON THE CAUSES OF INSANITY. [cuar.

scratched her face, &c. Quasi-hysterical maniacal exacerbations.
Irregularity of menstruation, and suspected self-abuse.—Recovery.

17. A lady, at. 45, but looking very much older, having had an
anxious life. Hereditary predisposition ; change of life ; melancholic
depression, passing into destructive dementia. Convulsions, paralysis,
death. Here softening of the brain was preceded for some weeks by.
mental symptonis.

18. Hereditary predisposition. Great intemperance. General
paralysis.

19, Habitual alcoholic excesses; pecuniary difficulties; mania.
After some years hemiplegia of right side, muscular power being
partially regained after a time. The patient lived for years thus.
Paralysis of long duration was the usual family disease and cause
of death.

20. Suicidal insanity in a married lady. Strong hereditary pre-
disposition to insanity. Exhaustion produced by lactation, and mental
depression, occasioned by the long absences of her husband from home.
— Recovery.

21. Third ot fourth attack of acute moaning melancholia in a
woman, aged 40. Intense self-conceit and selfishness natural to her.
Gastric derangement, and obstinately constipated bowels. Whenever
bodily derangement reaches a certain pitch, or adversity occurs, it
seems to upset the equilibrium of an ill-balanced mind, predisposed to
disorder by former attacks.—Recovery.

22. Gambling, betting, drinking, and sexual intemperance. General
paralysis.

23... A bad organization plainly—not due to insanity in family, but
to the absence of moral element. A life of great excitement, and
of much speculation in Australia. Alcoholic and sexual excesses (1).
General paralysis.

24, A widow, xt. 58, the daughter of one who had begun life as a
labourer at a coal wharf, but who made a great deal of money. He
was without education, so that his daughter, brought up as a rich
person, but without social cultivation, did not get opportunely married :
as it is expressed in the North, “she was too high for the stirrup, and
not high enough for the saddle.” When 50 years old, she married an
old gentleman, whose former manner of life had made a nurse needful
to him. He died, and left her the income of a large property for her
life. She now got suspicious of his relatives, to whom the property
was to revert on her death ; was harassed with her money, which she
did not know what to do with, but fancied others had designs on;
1] ON THE CAUSES OF INSANITY. 295

and finally went from bad to worse until, believing all the world was
conspiring against her, she got a revolver, and threatened to shoot her
fancied enemies.

25. The daughter of a common labourer, who had become very rich
in the colliery business, et. 32, single. Her father being dead she
was very wealthy ; she was without any real education, and very vulgar,
and spent the greater part of her time in drinking gin and reading
sensational novels. Great hereditary predisposition, not to insanity
only, but to suicidal insanity. Suicidal melancholia, with an in-
coherence approaching dementia.

26. A gentleman, aged 34. Steady, quiet drinking, on all pos-
sible occasions. The “ne’er-do-weel” of the family, having tumbled
about the world in Mexican wars and South American mines, and in
other places, as such persons do. Feebleness of mind and loss of
memory. An uncle had been very much the same sort of person, and
had died in an asylum.

27. A married woman, aged 49, gaunt, and seemingly of bilions
temperament. After a fever of five weeks’ duration, called “gastric,”
probably typhoid, acute maniacal excitement, violence, incoherence,
&c.—Recovery within a fortnight.

28. Dementia after epilepsy, the fits occurring at the catamenial
period. Brother maniacal, and sister without the moral element in
her disposition.

29. The young lady before mentioned as No. 11 was removed by a
penurious father from medical care before recovery was thoroughly
established, and in opposition to advice. The return to home
anxieties brought on an attack of acute mania, with gabbling of
endless incoherent rhymes.—Permanent recovery this time.

30. A warehouseman, aged 35, a Primitive Methodist, grievously
addicted to preaching. He had accomplished some self-education,
but had a boundless conceitf, and infinite self-feeling. Indigestion,
pyrosis, frequent vomiting after meals. Melancholia, with delusion
that he had committed the unpardonable sin, and endless moaning.
Most remarkable is the evidence of self-feeling in such patients—self-
renunciation not being a word that enters into their vocabulary. This
man, for example, though well aware that vomiting followed eating,
and sufficiently afflicted thereby, could not be induced to regulate his
diet voluntarily, but ate gluttonously, unless prevented.

31. A married woman, zt. 32, of stout habit of body, and
habitually locked secretions. The sudden death of a son brought
on severe moaning melancholia.
296 ON THE CAUSES OF INSANITY. (cuaP.

32. A single lady, aged 57, who had been insane for thirty years.
There was the strongest hereditary taint. :

33. A young man, extremely delicate, aged 22, had acute dementia,
following acute rheumatism. There was valvular disease of the heart,
with loud mitral regurgitant murmur.—Issue of the case unknown.

34, Slight hereditary predisposition, much aggravated by injudi-
cious education. A tradesman’s daughter, et. 24, brought up in idle-
ness. Domestic troubles and anxieties after marriage. Mania.—
Recovery.

35, A woman, zt. 30, Wesleyan, single. Suicidal melancholia
with the delusion that her soul is lost. Menstrual irregularity.
Extreme devotional excitement, with evidently active sexual feelings.
—Recovery.

36. A young woman, xt. 25, single, Wesleyan. Mania. Cause,
same probably as in the last case.—Recovery.

37. A respectable, temperate, and industrious tradesman, xt. 40,
Wesleyan, a teetotaller, and much superior to a vulgar wife. Second
attack. His father committed suicide; his brother is very flighty.
General paralysis.

38. A sober, hardworking, respectable bookseller, not given to
excesses of any kind, so far as was ascertainable. Slight hereditary
predisposition. General paralysis.

In both these last cases there was general paralysis in men who had
never been intemperate. In both, however, there were large families
of children, and the struggle of life had plainly been very anxious
and severe,

39. A woman, xt. 32. Acute mania came on two months after
childbirth.

40. A lady, et. 34, single, without other occupation or interest
than religious exercises. Suicidal melancholia, with the delusion that
she had sold herself to the devil. Amenorrhcea.—Recovery.

41, A married woman, xt. 40. Sudden outbreak of mania, after
going to a revival meeting. Amenorrhcwa,—Recovery.

42. A married man with a family, et. 52, a Dissenter, holding
an office of authority in his church, and most exact in his religious
duties. Secretly, he kept a mistress, however, and lived a rather dissi-
pated life. Outbreak of acute mania, with a threatening of general
paralysis.—Recovery ; for a time at any rate.

43, Acute mental annihilation in a young man about a year and a
half after marriage. One or two intervals of a few hours of mental
restoration.—Death in epileptiform convulsions. Softening of the
1] ON THE CAUSES OF INSANITY. 297

brain in extreme degree, but limited in extent. Excessive sexual
indulgence.

44, A married woman, et. 44, who has had several children, and
who has become insane after each confinement. Maniacal incoherence
and excitement, with unconsciousness that she has had a child.—
Recovery.

45. Hereditary predisposition. A Dissenter of extreme views,
narrow-minded, and bigoted. He was married when thirty-six years
old, and became melancholic a short time after the birth of his first
child.— Recovery. ,

46. Complete loss of memory, and of all energy of character, and
failure of intelligence, in a man, et. 36, single, from continual
intemperance in drinking and smoking, Has previously had two
attacks of delirium tremens.

47. An extremely good-looking young widow, who had been a
singer at some public singing-rooms, and the mistress of the proprietor
of them. Sexual excesses. General paralysis,

48. Attack of acute violent mania in a young surgeon, xt. 27.
Afterwards three days’ heavy stertorous sleep ; then seeming recovery
for twenty-four hours ; but on the next day recurrence of mania, fol-
lowed soon by severe epileptic fits.— Recovery.

49. Extreme moral perversion, with the most extravagant conceit
of self, and unruly conduct in a young man, a clerk. Alternations of
deep depression and suicidal tendency. Cause, self-abuse.

50. A single lady, aged 41, who, on her return from school when
fifteen years old, was queer, listless, and has always since been rather
peculiar. Hereditary predisposition. Acute melancholia, with the
delusion that she is lost because she has refused an offer of marriage
by a clergyman, such offer never having been thought of by him.
CHAPTER IL.

INSANITY, OF EARLY LIFE.

[’ the account previously given of the gradual evolution of the

so-called mental faculties be correct, the insanity met with
in children must of necessity be of the simplest kind ; where no
mental faculty has been organized no disorder of mind can well
be manifest. The kind of mental derangement displayed in
early life will in reality serve as a searching test of the value of
the principles already enunciated, and, if found to be in strict
accordance with them, will not fail to afford them strong sup-
port. While it is commonly thought sufficient to dismiss all
such instances as singular anomalies in nature, inexplicable, and
belonging to the regions of disorder—as though to call a thing
unnatural were to remove it from the domain of natural law—
any glimpse of law or order discernible in such confusion will
be so far a gain.

The first movements of the child are reflex to impressions
made upon it; but so quickly does sensorial perception with
motor reaction thereto follow upon these early. movements, that
we are not able to fix a distinct line between the reflex and
sensori-motor actions. The aimless thrusting out of the infant’s
limb brings it in contact with some external object, whereupon
it is probable that a sensation is excited. But it would appear
that the particular muscular exertion must be the condition of
a muscular feeling of the act; so that the muscular sense of
the movement and the sensation of the external object become
associated, and for the future unavoidably suggest one another ;
a muscular intuition of external nature is in fact thus organized,
and one of the first steps in the process of mental formation
accomplished. If we call to mind how, when discussing actua-
CHAP. I1.] INSANITY OF HARLY LIFE. BID

tion, it was shown, in the case of the eye fur example, that a
sensation was the direct cause of a certain accommodating move-
ment, and that the movement thereupon gave us the intuition of
distance, we may perceive how the organic association of a sen-
sation from without with a respondent or associated muscular
act, does by degrees impart definite intuitions of external objects
to the young mind, Suppose now that an infant becomes insane
immediately after birth, what sort of insanity must it exhibit?
The extent of mental disorder possible is clearly limited by the
extent of existence of mental faculty: which, as we have seen,
is almost nothing. In this regard the observed facts agree
with theory; when a child is, by reason of a bad descent or of
baneful influences during uterine life, born with such an extreme
degree of instability of nerve element that, on the first play of
external circumstances, its nervous centres react in convulsive
form, it mostly dies in convulsions. The diseased action is a
diseased action of the nervous centres of reflex action—those
which alone have at this time power of functional action; the
convulsions express the morbid condition of them, — might,
indeed, be said to represent the insanity of them’as insanity ;
on the other hand, truly represents sometimes a convulsive
action of the higher nervous centres.

Tt has been shown, however, that it is impossible, by reason
of the close connexion of sensorial action with reflex action in
the infant—the actual continuity of development which then
exists—to fix a distinct period during which its functions are
entirely reflex. It happens consequently that in the earliest
morbid phenomena of nervous centres there is commonly the
evidence of some sensori-motor disturbance. An impression
on the sense of sight, for example, is not quietly assimilated
so as to persist as an organized residuum in the proper nervous
centre, but immediately excites a reaction outwards of the un-
stable cells of the associate motor centres ; irregular and violent
actions prompted by sensations attest the disorder of the sen-
sorial and corresponding motor centres, as convulsions testify to
the disorder of the centres of reflex action. The phenomena of
a true sensorial insanity are intermixed with the morbid mani-
festations of the lower nervous centres; to every impression
made upon the infant there is irregular. and violent reaction,
300 ° INSANITY OF EARLY LIFE. [cHar.

sensori-motor and reflex. Instances of such morbid action so
soon after birth are certainly rare; nevertheless they do some-
times occur, and have been recorded. Crichton quotes from
Greding a well-known case of a child which, as he says, was
raving mad as soon as it was born. “A woman, about forty
years old, of a full and plethoric habit of body, who constantly
laughed and did the strangest things, but who, independently of
these circumstances, enjoyed the very best health, was, on the
20th January, 1763, brought to bed, without any assistance, of a
male child who was raving mad. When he was brought to our
workhouse, which was on the 24th, he possessed so much strength
in his legs and arms that four women could at times with diffi-
culty restrain him. These paroxysms either ended in an uncon-
trollable fit of laughter, for which no evident reason could be
observed, or else he tore in anger everything near him,—clothes,
linen, bed furniture, and even thread, when he could get hold of
it. We durst not allow him to be alone, otherwise he would
get on the benches and tables, and even attempt to climb up the
walls. Afterwards, however, when he began to have teeth he
died.” It is certainly remarkable that a child so young should
have been able to do so much; and those who advocate innate
mental faculties might well ask how it is possible under any
other supposition to account for such an extraordinary exhibition
of more or less co-ordinate power by so young a creature. Two
considerations should be borne in mind with regard to this case:
first, that the mother of the child was herself peculiar, so that
her infant inherited an unstable condition of nerve element, and
consequently a disposition to irregular and premature reaction on
the occasion of an external stimulus; and secondly, that there
does, as previously set forth, exist in the constitution of the
nervous system the power of certain co-ordinate automatic acts,
such as correspond in man to the instinctive acts of animals.
Many young animals are born with the power of immediately
co-ordinating their muscles for a definite end, and the human
infant is not destitute of the germ of a like power over voluntary
muscles, while it has complete the power of certain co-ordinate
automatic acts; it is conceivable, therefore, that, without will,
and even without consciousness, there may be displayed by it, in
answer to sensations, actions which, like those of this insane
un] INSANITY OF EARLY LIFE. 301

infant, have more or less semblance of design in them.* By
reason of the morbid condition of nerve element we have a
convulsive manifestation of the innate co-ordinate faculty—
irregular, violent, and destructive movements, and the premature
and extravagant exhibition of acts which would be natural in
a more restrained form at a later stage of normal development,
such, for example, as “uncontrollable fits of laughter without
any evident reason.’*+

As the earliest stages of the infant’s mental development cor-
respond in a general way with the permanent condition of mind
of those animals all the actions of which are reflex and sensori-
motor, it is no wonder that the phenomena of infantile insanity
should be comparable with those of animal insanity. In both
cases the morbid phenomena are mainly referable to disorder of
the sensorial and associate motor nervous centres; so that we
might almost describe the insanity as sensorial. The elephant,
usually a gentle enough creature, is subject at certain seasons to
attacks of furious madness, in which it rushes about in the most
dangerous way, roaring loudly, and destroying everything within
its reach; and other animals are now and then affected with
similar paroxysms of what might almost be called an epileptic

* be

That they do this by instinct, something implanted in the frame, the
mechanism of the body, before any marks of wit or reason are to be seen in them,
I am fully persuaded ; as I am likewise that nature teaches them the manner of
fighting peculiar to their species ; and children strike with their arms as naturally
as horses kick, dogs bite, and bulls push with their horns.”—MAaNDEVILLE’S
Fable of the Bees, vol. ii. p. 352.

+ ‘The youngest person whom I have seen labouring under mania,” says Sir
A. Morison, “ was a little girl of six years old, under my care in Bethlehem
Hospital. I have, however, frequently met with violent and unmanageable idiots
of a very tender age.” Dr. Joseph Frank records having seen, on a visit to St.
Luke’s Hospital, in 1802, a case of mania occurring at the age of two years.—
Lectures on Insanity, by Sir A. Morison, M.D. In the Appendix to one of the
Reports of the Scotch Lunacy Commissioners, mention is made of a girl aged six
years, who was said to be afflicted with congenital mania. She was illegitimate,
and her mother was a prostitute. She could not walk, paraplegia having come on
when she was a year old ; she was incoherent, and subject to paroxysms of violent
passion ; at all times very intractable ; slept little, and ate largely. Dr. Spurz-
heim (Observations on Derangement of Mind) views all such cases as partial idiots
from birth. The cerebral organization at so early an age is, he adds, so delicate
that it does not bear severe morbid affections without losing its fitness for mental
development, and endangering life. Indeed, it might fairly be said of the cases of
insanity in very young children, that some are examples of intellectual deficiency,
the rest examples of moral perversion or deficiency, with or without excitement. .
302 INSANITY OF EARLY LIFE. [cHAP.

fury. There is far more power in the insane elephant than in
the insane infant, and it is able to do a great deal more mischief;
but there is really no difference in the fundamental nature of
the madness; the maddened acts are the reactions of morbid
motor centres to impressions made on morbid sensory centres ;
and the whole mind, whether of the infant or of the animal,
is absorbed in the convulsive reaction. The morbid phenomena
of mind strictly confirm in this regard the principles which are
established by an inductive study of the plan of development
of mind.

The moment we have recognised the existence of sensorial
insanity, we become sensible of the value of the distinction.
Not only does it furnish an adequate interpretation of the violent
phenomena of the insanity of the animal and of the infant, but
it alone suffices to explain that desperate fury which sometimes
follows a succession of epileptic attacks. When the furious
epileptic maniac strikes and injures whatsoever and whomsoever
he meets, and, like some destructive tempest, storms through a
ward with convulsed energy, he has no notion, no consciousness,
of what he is doing ; to all intents and purposes he is an organic
machine, set in the most destructive motion ; friend or foe alike
perish before him; all his energy is absorbed in the convulsive
explosion, And yet he does not rage quite aimlessly, but makes
more or less definite attacks upon objects : he sees what is before
him and destroys it ; there is some method in his madness; his
convulsive fury is more or less co-ordinate. These desperate
deeds are respondent to morbid sensations; there often exist
terrible hallucinations, such as blood-red flames before the eyes,
loud roaring noises or imperative voices in the ears, sulphurous
smells in the nostrils; any real object which does present itself
before the eyes is seen with the strangest and most unreal
characters ; lifeless objects seem to threaten his life, and the
pitying face of a friend becomes the menacing face of a devil;
his movements therefore do not answer to the realities around
him, but to the unreal surroundings which his disease has
created.* There exists for the time a true sensorial insanity,

* An epileptic, under my care, usually a mild and gentle being, used to become
a most violent and dangerous maniac after a series of fits, and to commit terrible
destruction. He thought at these times that he was fighting for his life against
a lion,
it} INSANITY OF BARLY LIFE. 303

the higher nervous centres being in abeyance; and after the
frantic paroxysm is over there is complete forgetfulness of it as
there is forgetfulness of sensorial action in health. There are
necessarily points of difference between this epileptic fury and
infantile insanity, arising out of the residua, sensory and motor,
that have been acquired and organized through experience in
the nerve centres of the adult: the residua in the sensory ganglia
of the adult render possible those special hallucinations which
the infant cannot have; while the residua in the motor centres,
which are the condition of the secondary automatic faculties,
render possible a degree and variety of violence which the infant,
possessing only such germs of co-ordinate automatic power as
are original, must needs fall short of.

No one who has observed himself attentively when suddenly
awaking out of sleep but must have noticed that he has had at
times hallucinations both visual and auditory. He has heard a
voice, which no one else could hear, distinctly say something,
and on reflection only is convinced that the words were subjec-
tive; or he has waked up in the night and seen around him the
objects of his dream, and been positively unable for a time to
discriminate between the real and the unreal,—has perhaps laid
down and gone to sleep again without successfully doing so.
When the integrity of nerve element has been damaged, whether
by reason of continued intemperance or from some other cause,
these half-waking hallucinations acquire a vivid reality, and
leave behind them a painful fecling in the mind. If we could
imagine this temporary condition to last some time, and our
actions to be in accordance with our hallucinations, then we
should get a conception of what is the real state of things in
sensorial insanity.

After a child has lived a few years, the residua of its sen-
sations have been so far organized in their proper nervous centres
that on the recurrence of a sensation it has a definite character :
in other words, the child has acquired the power of definite
sensory perception. Suppose now that some morbid cause, such
as a deranged condition of the blood, excites to activity these
slumbering or quiescent residua, there will then be a subjective
sensation or hallucination, which may remain as such, or lead to
an answering motor reaction. In dealing with sensorial insanity
304 INSANITY OF EARLY LIFE. ° [cuap.

it is necessary then to bear in mind, as was done when treating
of the physiology of sensation, both the receptive and the reactive
side. A violent and convulsive reaction may mask all other
features of the disease, and give it an epileptiform character; or
the active sensory residua may persist in consciousness as hallu-
cinations, giving rise, if they give rise to any answering move-
ments, to such as are rather of a choreic character.

A variety of insanity in children, then, which we may next
consider, is that form of sensorial insanity in which hallucina-
tions occur, and in which the motor reactions are not epilepti-
form but choreic. There is some reason to think that temporary
or fugitive hallucinations are not uncommon in infancy, and
that the child stretching out its hand and appearing to grasp at
some imaginary object is deceived by a subjective sensation.
The excitation of the latent residua of sensation takes place
from some internal cause, and bodily states thus give rise to
temporary hallucinations in children, without there being any
positive disease. Experimental proof of this manner of origin is
not wanting: Dr. Thore describes the case of an infant, aged
fourteen months and a half, which had accidentally been poisoned
by the seeds of the Datura stramonium ; hallucinations of sight
occurred, as shown by the motions of the child, which seemed
to be constantly seeking for some imaginary objects in front of
it, stretching out its hands and clinging to the sides of the
cradle in order to reach them better.* The most remarkable
examples of such condition of hallucination is afforded, how-
ever, by that form of nightmare which some children suffer so
much from: they begin shrieking out in the greatest terror
without being awake, though their eyes are wide open; they
tremble with fright, and do not recognise their parents or others
who attempt to calm them; and it is some time before the
paroxysm passes, and they can be pacified. They are for the
time possessed with a vivid hallucination, which terrifies them
beyond measure, and which does not readily subside; in the
morning, however, they know nothing of their fright, but have
forgotten it as the somnambulist forgets his midnight walk, or
as sensation is commonly forgotten. Strictly speaking, however,

* Annales Médico-Psychologique, 1849.
11] INSANITY OF EARLY LIFE, 305

it is not proper to say that they have forgotten their mental
state, because the activity was all the while sensorial; and, as
there was no conscious perception, as the child did not perceive
that it perceived, there could be no conscious memory, The
undoubted and not uncommon existence of this state of vivid
hallucination in children, when the matter has certainly passed
beyond ordinary dreaming, will serve to prove how possible it
is that children may have, when awake, positive hallucinations.
Some who have written upon this subject have thought such a
thing entirely impossible or exceptional, having been misled by
the ill-grounded assumption that a hallucination must have
some necessary connexion with a delusion. Certainly it must
be, and it is, rare to meet with positive delusion in young chil-
dren, inasmuch as at that time idea has not been fashioned in
the mind; but the moment a child has acquired a definite sen-
sation, it is possible for it to have a hallucination,

It is in strict conformity, then, with physiological principles,
as well as with pathological observation, to affirm the existence in
children of a variety of sensorial insanity, which is characterised
by hallucinations, most frequently of vision, and sometimes by
answering irregular movements. Fits of involuntary laughter
are often notable in such cases: the laugh, or rather smile, of
the infant is an involuntary sensori-motor movement before it
has any notion of the meaning of the smile, or any consciousness
that it is smiling; consequently we meet with the irregular and
convulsive manifestation of this function as one of the expres-
sions of a morbid state of things. Dr. Whytt relates the instance
of a boy, aged 10, who, in consequence of a fall, had’ violent
paroxysmal headaches for many days. After a time there
occurred “fits of involuntary laughter, between which he com-
plained of a strange smell and of pins pricking his nose; he
talked incoherently, stared in an odd manner,” and immediately
afterwards fell into convulsions. He recovered on this occasion,
but two years afterwards was similarly attacked: he had severe
headache, saw objects double, and suffered from a severe pain in
the left side of his belly, confined to a spot not larger than a
shilling; “sometimes it shifted, and then he was seized with
fatiguing fits of involuntary laughter.” Ultimately he reco-
vered partially, but never completely.* It is always desirable,

* Op. cit. p. 144.
x
306 INSANITY OF EARLY LIFE. [CHAP.

in cases of hallucination in children, to make a close examina-
tion of the state of the general sensibility ; for perversions or
defects of it will frequently be found both where there are
corresponding perversions of a choreic character on the motor
side and where there is no evidence of motor disorder. Because
this form of sensorial insanity is often found associated with
more or less evidence of chorea, and because, as compared with
the previously illustrated epileptiform variety, it has relations
not unlike those which chorea has to epilepsy, it may be de-
scribed as the choreic variety of sensorial insanity.

Perhaps no more fitting opportunity than the present will
present itself for reference to the singular state of somnambulism,
the phenomena of which illustrate in a strikin, manner that
independent action of the sensorial and corresponding motor
centres which plays so important a part in the early mental
life of the child, and so large a part in the daily life of the
adult. An individual appears to be fast asleep, and yet executes
complicated acts of some kind which he could hardly do, and
certainly could not do better, if he were awake; his highest
nervous centres are in partial abeyance, and yet his movements
are as skilful as if they were under the cognizance and control
of these supreme centres.. But the man’s senses are not entirely
asleep, and the organized motor reactions to impressions on these
senses are not asleep: he is a sensori-motor being, and very much
in the position of one of those lower animals that are destitute
of cerebral hemispheres, and which notwithstanding are exceed-
ingly active in their movements; or very much in the position
of a child before the higher centres of idea have come into action.
Recently there has come under my observation a striking instance
of somnambulism in a young woman suffering from consumption,
who has on many occasions risen from her bed in the night, gone
through a sustained series of rather difficult acts, and returned
to bed without ever knowing what she had been doing ; in the
morning after such feats, however, she feels general aching in
the limbs, exhaustion, and prostration, such as from her descrip-
tion of her suffering would appear to be very like that which
follows an epileptic fit in the night. One example of what she
did in her sleep may be adduced here: she was engaged in
quilting a petticoat for a lady, and after a good day’s work went
11} INSANITY OF EARLY LIFE. 307

to bed at night, intending in the morning to get up early and
finish it; but, when the morning came, she was so weary and
prostrate that she felt quite unable to rise; she called her
mother, therefore, and told her to say, should the lady send for
her petticoat, that she was so ill that she had not been able to
finish it. The mother, wishing to see how much still remained
to be done, fetched the petticoat, when it was found to be
finished : the poor gir] had been up in the night, and, seen of no
one, had completed her task. Soon the long day’s task of life
will be over with her, and she will sleep well where no troubles
more can reach her, and no dreams of work or sorrow disturb
her slumbers.

If it were possible to induce artificially a temporary disorder
in the sensory and corresponding motor centres of the somnam-
bulist, such as would give rise to hallucinations and answering
motor reactions, while his higher centres remained in abeyance,
he would in reality be put, according to the degree of disorder,
either in the condition of the child suffering from what has been
described as the choreic variety of sensorial insanity, or in the
condition of the man who, after a succession of epileptic fits, is
attacked with furious sensorial insanity. Suppose, however,
that after a moderate disorder had been artificially excited in the
somnambulist’s sensorial centres, such as might engender hal-
lucinations, his higher centres of cognition were to awake to
activity,—what would be the result? Hither he would be im-
posed upon by the false sensations, and his thought thus share in
the disorder of his sense; or his reflection would discover the
subjective nature of the hallucination, and he would then be
very much in the position of the well-known Nicolai, of Berlin,
and of others, who, like that bookseller, have suffered from hal--
lucinations of the nature of which they were quite conscious.
Every one who has observed himself with attention must have
been conscious of occasions when a suddenly occurring hallu-
cination has caused him to make a quick respondent movement,
which, recognising the hallucination, he has discovered to be un-
necessary. But it is different with a very young child, which, if
it is affected with hallucination, must believe in it; it cannot
correct sense by reflection, because the higher nervous centres
have not yet entered on their full function. Hallucinations

x2
308 INSANITY OF EARLY LIFE. [cHAP.

may, therefore, exist temporarily in children without indicating
any serious disturbance ; the organic residua of sensation being
quickened into activity by an internal cause, before any distinct
perception of the cause of the sensation has been formed.

Thus far, then, it is certain that hallucination may occur
in a child before it has acquired a definite idea, With each
succeeding presentation of an object to the child, however, the
impressions made on the different senses become more and
more combined, so that an idea of the object is at last organized
in the higher ideational centres; there is a consilience of the
sensory impressions into an idea, which henceforth makes it
possible for the child to think of the object when it is not present
before the senses, or to have a definite and adequate perception
of it when it is. As development proceeds, one idea after
another is thus added to the mind until many simple ideas have
been organized in it; but for a long time these ideas remain
more or less isolated and imperfectly developed; there are no
definite associations between them, and the child’s discourse is
consequently incoherent; there is not moreover a complete or-
ganization of residua, and its memory is consequently fallacious.
Children, like brutes, live in the present; their happiness or
misery being dependent upon impressions made upon the senses :
their actions are direct reactions to impressions; the idea or
emotion excited does not remain in consciousness and call up
other ideas and emotions, but it is directly uttered in outward
action. Such a condition of development, which is natural to
the child before the fabric of its mental organization has been
built up, and to the animal in which the state of the nervous
system renders iurther development impossible, would, were it
met with in an Luropean adult, represent idiocy, or an arrest of
mental development from morbid causes.

So soon as a definite idea has been organized in the child’s
mind a delusion is possible. But as ideas are at first com-
paratively few in number, and as they are very imperfectly
associated, a derangement of the function of their centres must
be characterized by a very incoherent delirium. Divers morbid
ideas will then spring up without coherence; and the morbid
phenomena, wanting system, will correspond, not so much with
those which in the adult we describe as mania, as with those
u.] INSANITY OF EARLY LIFE. 309

described as delirium. In the mania of the adult there is com-
monly a systematized derangement, some coherence between the
morbid ideas, some method in the madness; whereas in the
delirium from fever or other cause, ideas spontaneously arise in
consciousness in the most incoherent way: in the young child the
ideas are equally incoherent by reason of the absence of an
organic association between the residua. Let us proceed then to
test these principles by an examination of such facts as are
available.

As a morbid idea in the child’s mind has, by the nature of
the case, but a small range of action upon other ideas, it will
tend to utter itself by its other paths of expression; namely, by
a downward action upon the sensory ganglia or upon the move-
ments. When it acts downwards upon the sensory ganglia it
gives rise to a hallucination ; and in such cases, as may easily be
imagined, it will not always be possible to determ!ue whether
the hallucination is really secondary or primary—wucther it is
engendered indirectly through the agency of the morvid idea or
directly by the excitation of the sensory residua by some organic
cause. When a child of only a few years old sees figures of
some kind on the wall, which have no real existence, but dis-
appear with apparently as little reason as they came there, the
hallucination is most likely owing to some organic cause affect-
ing directly the sensory ganglia. But when a child of eight or
nine years old, whose head has been wickedly filled with foolish
and dangerous notions concerning the devil and hell, suddenly
sees the frightful face of a devil appear and threaten to eat him
up, and shrieks in terrified agony, then the hallucination is un-
doubtedly secondary to the wilfully implanted delusion. In a
few moments the phantasm disappears, and the child regains its
composure. This sort of idea-produced hallucination doubtless
occurs frequently enough in those nightmares of children already
mentioned.

This secondary generation of hallucinations again is strikingly
illustrated by the occurrence of phantasms before the eyes of
certain precocious children; these appear to be visible represen-
tations of the thoughts that are passing through their minds:
what they think, that they actually see. Accordingly a sort
of drama is evolved before their eyes, and they live for the

 
310 INSANITY OF EARLY LIFE. [cHAP.

time in a scene which is purely visionary as though it were
quite real. “ What nonsense are you talking, child?” the
mother perhaps exclaims ; and thereupon the pageant vanishes.
In delicate and highly nervous children, affected with mesen-
teric tubercle—and, perhaps, also with meningeal tubercle—
it sometimes happens that great anxiety is caused to the
mother by the strange way in which, during the night, when
outer objects are shut out by the darkness, they will talk as
if they were surrounded by real events, or, as the mother
perhaps puts it, as if they were light-headed. They are dream-
ing while they are awake; though the outer world is shut
out, the morbid deposit within acts as an irritating stimulus
to the ganglionic nervous centres, and thus gives rise to an
automatic activity of them. Such hallucinations may un-
doubtedly be fugitive events in the history of any child en-
dowed with a highly nervous temperament, as in William
Blake, the engraver, and may not denote any positive disease ;
but if the habit grows upon the child by indulgence, and the
phantasms are regularly marshalled into a definite drama,—as,
for example, was the case with Hartley Coleridge—then a
condition of things is initiated which will in all likelihood
ultimately issue in the degeneration of some form of insanity.*
For it is not the natural course of mental development that
ideas, so soon as they are fashioned in the mind, should operate
directly downwards upon the sensory ganglia, and thus create a
visionary world; but, on the contrary, it is necessary in the
progress of mental development that ideas should be completely
organized within the centres of consciousness, and act upon one
another there; that thus, by the integration of the like in per-
ceptions and the differentiation of the unlike, accurate con-
ceptions of nature should be formed and duly combined in the
mental fabric; and that the reaction upon external nature should
be a definite, aim-working, volitional one. Men like Hartley
Coleridge cannot possibly have a will, because the energy of

* “Blake's first vision was said to be when he was eight or ten years old; it
was a vision of a tree filled with angels. Mrs. Blake, however, used to say—
‘ You know, dear, the first time you saw God was when you were four years old,
and He put His head to the window and set you screaming.’ ”—Gricurisi’s
Life of Blake,
11.] INSANITY OF EARLY LIFE. 311

their supreme nervous centres is prematurely expended in the
construction of toy-works of the fancy; the state of things
corresponding in some sort with that which obtains in the
spinal centres when, by reason of an instability- of nerve
element, direct reactions take place to impressions, so that
definite assimilation and acquired co-ordination are rendered
impossible. In both cases an arrest of development, commonly
the forerunner of more active disease, is indicated ; in both cases
there is the incapacity for a true education. The precocious
imagination of childhood should always be restrained as an
actual danger, not fostered as a wonderful evidence of talent ;
the child being solicited to regular intercourse with the realities
of nature, so that by continued internal adaptation to external
impressions there may be laid up in the mind stores of material,
and that, by an orderly training, this may be moulded into true
forms, according to which a rightly-developed imagination may
hereafter work in true and sober harmony with nature.

The difference between funcy and imagination, as Coleridge
has very aptly remarked, corresponds with the difference be-
tween delirium and mania. The fancy brings together images
which have no natural connexion, but are yoked together by
means of some accidental coinvidence; while the imagination
combines images seemingly unlike by their essential relations,
and gives unity to variety. Now the precocious imagination of
a child, which sometimes delights foolish parents, cannot pos-
sibly be anything more than lying fancy; and this, for exactly
the same reason that the insanity of children must be a delirium,
and cannot be a mania—the incomplete formation of ideas and
the absence of definitely organized associations between them.
Those who like to speak of faculties of the mind may cer-
tainly maintain that fancy and imagination are fundamentally
the same faculty; if so, they should bear in mind that fancy
indicates the faculty working wildly and often mischievously,
without adequate material and without due training, and that
imagination represents the working of the faculty when duly
supplied with proper material and justly developed by a proper
training. In like manner, those who consider closely and with-
out prepossession the fundamental meaning of the character
which the delirium of children has, will not fail to recognise in
312 INSANITY OF EARLY LIFE. [cHar.

it the strongest evidence of the gradual organization of our
mental faculty ; the fancy of the sane, and the delirium of the
insane, child both testify to the same condition of things—
that which the habitual incoherence. of a child’s discourse also
evidences.

In order to exhibit clearly the manner of action. of morbid
idea in children, and to educe therefrom a physiological lesson,
its operation has been somewhat artificially separated from other
morbid phenomena which usually accompany it. In young
children it is practically rare to meet with disorder confined to
the supreme nervous. centres; the other centres are almost
certain to participate more or less markedly in the morbid
action. In chorea, for example, besides the disordered move-
ments which are its common characteristic, there are often
hallucinations marking disorder of the sensorial centres, and
motiveless weeping or laughing, or acts of mischief and violence,
marking disorder of some of the higher motor centres ; there are
furthermore in some cases mental excitement and incoherence,
which may pass into maniacal delirium, and end fatally, or into
chronic delirium, and end in recovery. The different centres
sympathize with one another; and, according as they minister
to ideation, sensation, or movement, express their disorder in
delirium, hallucination, or spasmodic movements.

Let us now proceed, then, to arrange in groups the different
forms of insanity that are actually met with in children.

1. Monomania, or Partial Ideational Insanity.— When a
morbid idea or delusion reacts downwards, but not upon the
sensory ganglia in the way described, its action is upon the
movements, and it is realized in some particular act. Is this
kind of monomania ever met with in children? Certainly it
is; and, as might be predicted from a consideration of the
child’s mental development, chronic ideational insanity will
commonly be of this partial kind. It admits of no question
that the desperate sort of monomania which is manifest in a
powerful impulse to some act of violence—the kind of disease
in which the morbid idea attains to such a nisus for outward re-
‘action as to become an irresistible impulse—is met with occa-
sionally in children. Examples of children thus possessed with
an uncontrollable impulse are given by Esquirol: in one case, a
1] INSANITY OF LARLY LIFE. 313

child, of only five or six years old, made repeated attempts to
kill its stepmother, who had always treated it kindly; in another
case, a child was afflicted with a never-resting impulse to steal
without having need for, or making any use of, what it had
stolen; another child was ever striving with a perverse diligence
to set fire to whatever it could; and another displayed a per-
sistent longing desire for self-destruction—a genuine suicidal
monomania, These are indisputable instances of what have
been designated homicidal monomania, kleptomania, pyromania,
and suicidal monomania ; they commonly indicate more or less
intellectual and moral imbecility springing from a strong here-
ditary predisposition to insanity; the fountain of the child’s
being having been poisoned at its source. Let the psychologist
explain them how he will, they are in strict conformity with
physiological observation ; and their occurrence at so early a
period of life,where some morbid taint, inherited or acquired, can
usually be traced, is a strong argument in favour of the prin-
ciples already laid down. Children, again, have thought them-
selves possessed by the devil, who moved them to perpetrate
the strangest acts; and at the time of the Crusades, when the
Western world was infected with a fanatical enthusiasm for
delivering the Holy Sepulchre from the hands of the infidels,
the infection of the madness spread through a host of children,
who marched off to Jerusalem “to deliver the sepulchre of the
Lord,” many of them perishing miserably on the way, others of
them being sold as slaves, and none of them reaching their
goal.

2. Choreic Delirium, or Chorete Ideational Insanity—There is a
choreic delirium sometimes met with in children, which appears
to be the exact counterpart of the choreic spasms that occur.
What is sufficiently striking, even to an ordinary observer of
this delirium, is its marked incoherence, and its manifestly
automatic character. Jt seems as if the cells or groups of cells
of the primary centres had been dislocated from their con-
nexions, and as if each cell, or group of cells, were acting on its
own account, giving rise thereby to a sort of mechanically re-
peated and extremely incoherent delirium. A boy of about
eleven years of age, who came under my care, was, after a slight
and not distinctly described sickness, suddenly attacked with
314 INSANITY OF EARLY LIFE. CHAP.

this form of delirium; he moved about restlessly, throwing his
arms about and repeating over and over again such expressions
as—‘The good Lord Jesus,” “They put Him on the cross,”
“They nailed His hands,” &c.: it was impossible to fix his atten-
tion for a moment; for he turned away, wandered aimlessly
about, pointing to one hand and then to the other, and babbling
his incoherent utterances. So far as could be made out, there
was considerable insensibility of the skin over certain parts of
the body. In two days, after appropriate treatment, the delirium
passed off, and the boy was quite himself again. I have lately
seen an interesting case of insanity in a girl, et. fourteen, who is
lively, pretty, and intelligent. She suddenly jumps up in a
paroxysm of excitement, exclaiming, “ Mother, I’m dying!” and
begins praying frantically in a mechanical manner. The
paroxysm lasts for three or four hours, and leaves her pale, cold,
exhausted, and trembling like a leaf. A brother died after being
similarly afflicted. The mother suffered for months at one time
from speechless melancholia, and nearly all her family have died
from phthisis. She has had fourteen miscarriages and three
children, this girl being the only one left; when carrying her
she had a terrible fright from seeing one child accidentally killed,
and the child was born affected with constant choreic move-
ments, which continued until six months after birth. Before
the paroxysms of mental excitement came on, she had been
subject to periodical attacks of depression with much weeping ;
and all her life she has suffered more or less from pain in the
head, especially in the left temple.

Dr. Bucknill relates the case of a boy, aged twelve, who was
admitted into the Devon Asylum, and who had been affected all
his life to some extent with chorea. A few days before admis-
sion he had attempted to hang himself, and there was the mark
made by the rope upon his neck. On admission, he was acutely
maniacal, attempted to dash his head against the walls, and,
when put in the padded room, lay on the floor, crying—* Oh, do
kill me! Dash my brains out! Oh, do let me die!” He kicked
and bit the attendants, and tried in every way to kill himself:
his head was hot, his pulse quick, he refused food, and did not
sleep. He completely recovered under proper treatment after a
few days.
11.] INSANITY OF EARLY LIFE. 315

These cases will suffice as illustrations of choreic mania: it
is only necessary to bear in mind that—as with choreic move-
ments, so with choreic insanity—examples of every degree of
convulsive violence and incoherence are met with. Hallucina-
tions of the special senses and perversions of general sensibility
frequently also accompany the delirium.

3, Cataleptoid Insanity—Another form which insanity may
take in childhood is that of a more or less complete ecstasy ;
and this may be appropriately described as the cataleptoid
variety. It generally occurs in young children: the little
patient lies perhaps for hours or days seemingly in a sort of
mystical contemplation, with limbs more or less rigid, or fixed
in strange postures ; sometimes there is insensibility to impres-
sions, while in other instances vague answers are given, or there
is actual incoherent raving; there may be sudden bursting out
into wild shrieks. These attacks are of variable duration, and
are repeated at varying intervals: they would seem to repre-
sent a sort of spasm of certain nervous centres, so that for the
time being the body becomes an automatic instrument of their
activity, while all voluntary power is in abeyance. While, on
the one hand, there are intermediate conditions between this
form of disease and chorea, its attacks, on the other hand, some-
times alternate with true epileptic seizures, and at other times
pass gradually into them. In a girl who came under Dr. West’s
treatment at the age of ten years and ten months, there had
been first an attack of general convulsions without any obvious
cause, when she was eight years old. Afterwards she was sub-
ject to oecasional attacks of great excitement of behaviour, and
for six months there was a sort of cataleptic state in which she
stood immoveable for one or two minutes, staring wildly or
fixedly, and murmuring unconnected words that had reference
to any object which she might happen to see. About eleven
months from the commencement of these attacks their character
changed ; they became truly epileptic, the child’s conduct in the
intervals between the seizures, though sometimes quite reason-
able, having mostly something insane about it.* The example

* Ueber Epilepsie, Blédsinn und Irrsein der Kinder, von Charles West,
M.D.—Journal fiir Kinderkrankhetten, vol. xxiii. 1854. See also a paper by
M. Delasiauve in Annales Médico-Psychologique, vol. vii. 1855.
316 INSANITY OF EARLY LIFE. [cHap.

may serve to illustrate how closely related are disorders of the
different nervous centres in children, as well as to show the
hybrid nature of the diseases presented, and the artificial
character of the divisions usually made between them.

4, Epileptic Insanity—Not only are the different forms of
epilepsy met with in children, but the different forms of in-
sanity that occur in connexion with epilepsy are also exhibited
in early life. ‘The petit mal sometimes lasts for many months
in children, and then passes into regular attacks of convulsive
epilepsy ; the usual effect of which is to produce loss of memory
and more or less dementia. In the case of a young girl, aged
eight years, of good physical conformation, who came under my
care, there seemed to have been produced by epilepsy an arrest
of mental development at the sensorial stage: she was a most
mischievous little machine, never resting, but seizing, or attempt-
ing to seize, whatever she saw ; nowise content with what she
caught hold of, but throwing it down directly she had got it,
and struggling for something else; not amenable to correction
or instruction, and demanding the whole energies of one person
to look after her. She was an automatic machine incited by
sensory impressions to mischievous and destructive acts.

As in adults, so in children, an attack of violent mania, or a
Juror transitorius, may precede, or take the place of, an attack of
epilepsy, representing in reality a masked epilepsy. Children
of three or four years old are sometimes seized with sudden
attacks of violent shrieking, desperate stubbornness, or furious
rage, when they bite, tear, and destroy whatever they can; these
seizures come on periodically, and may either pass in the course
of a few months into regular epilepsy, or may be found to alter-
nate with epileptic attacks ; they are a sort of vicarious epilepsy.
Morel has met with two cases in which children fell into con-
vulsions and lost the use of speech in consequence of a great
fear ; afterwards a maniacal fury, with tearing, destroying, and
continual turbulence, occurred: in one case, the child being
ten years and a half old, epilepsy followed; in the other child,
aged five years, it did not.* One of the boys in a school was

* Traité des Maladies Mentales, 1860, p. 102. He relates another case of
a girl, et. 11, who had furious maniacal attacks, during which she attempted
to kill her mother, and injure her sisters, and who finally recovered.
11} INSANITY OF EARLY LIFE. 317

attacked in the night, without evident cause, with a sudden
furor transitorius: he rushed wildly up and down the dormitory,
speaking loudly but inarticulately, so that another of the pupils
got up to quiet him; but he seized the latter with great violence,
and, but for the interference of others, would have strangled him.
With some difficulty he was got to bed; a true epileptic attack
followed; and in the morning he knew nothing whatever of
what had happened, but felt weary and exhausted.*

Again, in children as in adults, regular attacks of maniacal
excitement may follow epilepsy. Many such instances are on
record; but I shall content myself here with a singular example
of insanity, more cataleptoid perhaps than epileptic, following
convulsions, which is quoted by Griesinger from Kerner :—
Margaret B., et. 11, of a passionate disposition, but a pious,
Christian child, was, without any previous illness, seized on
January 19th with convulsive attacks, which continued, with
few and short interruptions, for two days. So long as the con-
vulsions lasted the child was unconscious, twisted her eyes,
made grimaces and strange movements with her arms: from
the 21st January a deep bass voice, proceeding from her kept
repeating the words, “They are praying for thee.” When the
girl came to herself, she was wearied and exhausted, hut knew
nothing of what had happened, only said that she had dreamed.
On the evening of the 22nd January another voice, quite
different from the bass one, spoke incessantly while the crisis
lasted—for half an hour, an hour, or several hours; and was
only now and then interrupted by the former bass voice regu-
larly repeating the recitative. The second voice manifestly
represented a different personality from that of the girl, dis-
tinguishing itself in the most exact manner, and speaking of
her in the third person. In its utterances there was not the
slightest confusion nor incoherence observable, but all questions
were answered by it coherently. What, however, gave a dis-
tinctive character to its expressions was the moral or rather

* Ueber Mania Transitoria, von Dr. Ludwig Meyer. Virchow’s Archiv, vol. viii.
art. ix. He relates another case of a boy, et. 18, who was subject to periodical
attacks of fury, followed by epileptic convulsions, and who often had the furious
maniacal excitement without the convulsions, illustrating the transition of mania
transitoria into epilepsy.
318 INSANITY OF FARLY LIFE. [uHAP.

immoral tone of them—the pride, arrogance, scorn and hatred
of truth, God, Christ, that were declared. “I am the Son of
God, the Saviour of the world: me ye shall worship,” the former
voice frequently repeated. Scorn of all that is sacred, blasphemy
against God and Christ, violent dislike of everything good, and
extreme rage at the sight of any one praying, or even of hands
folded as in prayer, expressed by the second voice—all these
might well betray the work of a strange spirit possessing her,
even if the pious voice had not declared it to be the voice of
a devil. So soon as this demon spoke, the countenance of the
girl changed in the most striking manner, and assumed a truly
demoniacal appearance. She ultimately quite recovered, a voice
crying out—* Get thee out of this girl, thou unclean spirit.”

5. Mania.—Although the delirium of childhood commonly
occurs in connexion with some form of convulsive disease, yet
it is possible for it to occur from other recognised causes of
mania; in children these usually are blows on the head, in-
testinal worms, and onanism. It is certainly surprising how
greatly tolerant of injury the young brain is; children will
recover without any bad symptoms from an injury which would
inevitably prove fatal to the adult: in one severe case of fracture
of the skull in a child, which came under my observation, the
bones loosely grated as in a bag under the scalp, whilst the
child’s head was held, and yet it recovered without any severe
symptoms. Under the name of Monopathie furieuse Guislain
describes maniacal attacks in a young girl et. 7, which were
due to caries of the nose following a blow. Other like cases are
recorded by Haslam, Spurzheim, Frank, Burrows, Perfect, and
Friedreich.* The most striking example of mental derangement
in children which Morel ever met with was in a little girl et. 11,
who, after the sudden disappearance of a disease of the skin,
exhibited choreic symptoms, and soon afterwards those of true
maniacal fury. She tried to kill her mother, and had nearly
drowned one of her sisters by throwing her into a pond: in her
paroxysms she displayed a strength almost incredible, and it
is scarcely possible to communicate an adequate idea of the

* See also a paper “ On the Psychical Diseases of Early Life,” in the Journal
of Mental Science, 1859, by Dr. Crichton Browne.
11.] INSANITY OF EARLY LIFE. 319

destructive tendencies of the little being. She recovered after a
fever, when all medical treatment had failed. Certain acute
diseases, as for example typhus, may of course give rise to
delirium in the child just as in the adult.

6. Melancholia.—This form of depression is met with in
children both with and without definite delusion or morbid
impulse. Without doubt children differ naturally in liveliness
of disposition ; but it sometimes happens that depression arrives
at such a pass even in very young children as to constitute a
genuine melancholia. In such case the child whines and wails
on all occasions ; whatever impression is made upon it seems to
be followed by a painful feeling. The mother brings it for
medical advice; for, as she complains, it thrives not, it rests not
either by night or day, it is continually crying, and nothing
calms it; there is no living with it, and she is almost worn out
with anxiety. Such symptoms mark a constitutional defect of
nerve element, whereby an emotional or sensational reaction of a
painful kind follows all impressions; the nervous or psychical
tone is radically infected with some vice of constitution, so that
every impression is painful; and, according to my experience,
the cause of the defect in a great many instances is inherited
syphilis. At any rate remarkably beneficial results often in such
cases follow the treatment for hereditary syphilis. No doubt,
however, other causes besides syphilis may give rise to a like
morbid condition of nerve element.

With the deep melancholic depression there may be asso-
ciated, in older children, a distinct delusion of some kind. A
boy who from his fifth year had been rather peculiar in his
behaviour, standing still occasionally without apparent reason in
the street and not moving again without considerable pressure,
was, when aged twelve, afflicted with positive melancholia and
delusions of suspicion. He was extremely depressed, and his
manner indicated the greatest fear: he was prone to weep
constantly, and was in great dread of his fellow-scholars and of
his teacher, all of whom, he thought, suspected him of anything
wrong that happened to be done—if a theft were committed, he
was sure that he was suspected to be the thief. He was restless
at night, and often sighed and uttered unconnected words in his
sleep. In five weeks he was said to have recovered, but there
320 INSANITY OF EARLY LIFE. [cuap,

still remained eccentricities of conduct: if he kicked a stone, he
must return to kick it twice more; if he spat once, he must
spit twice more; if he had written a word incorrectly, he must
repeat the correction. Of these peculiarities he was quite con-
scious, and struggled against them, but without avail; after great
restlessness and mental disquietude he was ultimately obliged
to give way to them.* In other like cases, morbid notions with
regard to religion may be the exponents of the emotional dis-
turbance of psychical tone.

Perhaps the most striking form in which the melancholia
of children manifests itself is by suicide. So strange and
unnatural a thing does it seem that a child of eight or nine
years of age should, world-weary, destroy its own life, that one
is apt to consider the fact inexplicable. Such act of suicide
is certainly done sometimes under a sudden impulse from the
dread of punishment or after the infliction of punishment, or it
is perhaps deliberately resolved upon in a state of sadness and
depression consequent upon continued ill-treatment by a brutal
schoolmaster or parent.f Falret mentions the case of a boy of
eleven years of age, who was driven by the ill treatment of his
teacher into such a state of melancholia that he determined to
starve himself, and made repeated attempts at suicide by drown-
ing. This premature disgust of life will most often be found to
be the result of some ancestral taint, by reason of which the
child’s nervous constitution is inherently defective, and disposed
to perverted feeling and irregular reaction. The question of
hereditary taint is in reality the important question in an
examination of the insanity of early life.

7. Affective Insanity, or Moral Insanity—In the majority of
instances the affective insanity of early life might justly be
described as hereditary ; but there are some cases in which
the morbid condition of nerve element which manifests itself
in extreme moral perversion is not inherited but observably
acquired by reason of vicious habits of self-abuse. It is not
correct, therefore, to describe all cases of so-called moral insanity
in children as examples of hereditary insanity. I prefer using

* Trrsein bei Kinder, von Dr. Beckham.

+ Etude sur le Suicide chez les Enfants, par Durand Fardel.—Annales
Médico-Psychologique, 1855.
11] INSANITY OF EARLY LIFE. 321

the word affective to the word moral, because the latter term is
very vague, and implying, as it does, a consciousness, is often
inappropriate, and always objectionable; the affective life, or
feeling, on the other hand, mirrors the real nature of the indi-
vidual. The term affective insanity will, therefore, appropriately
express the fundamental vice of nerve element in such case.

The examples of affective insanity in early life fall naturally
into two divisions: (a) the first includes all those instances
in which there is a strange perversion of some fundamental
instinct, or a more strange appearance of some quite morbid
impulse; and (6) the second division comprises all those cases
of systematic moral perversion in which there often seems to
the onlooker to be wilful wickedness. The former might be
described as the instinctive variety of affective insanity; the
latter as moral insanity proper.

(a) Instinctive Insanity.—What are the inborn instincts of
mankind? The instinct of self-conservation, which is truly the
law of the existence of living matter as such, and the instinct
for propagation which provides for the continuous existence
of life, and is, therefore, in some sort a secondary manifesta-
tion of the self-conservative instinct. Now the instinct of self-
conservation is manifested not only by individual organic
element, humble or exalted, but it is manifest in all the
phenomena of vitality, conscious or unconscious: it is, as
already seen, at the foundation of all the passions, which are
fundamentally determined according as impressions produce
gratification of self or are painful to self. Children are of

necessity extremely selfish; for it is the instinct of their being

to appropriate from without, to the end that development may
take place: a baby is the only king, as has been said, because
everybody must accommodate himself to it, while it accom-
modates itself to nobody. Associated, however, as necessarily
correlate with the instinct of appropriation whereby what is
grateful to self is assimilated, is plainly a destructive or repul-
sive instinct or impulse whereby what is not grateful to self is
rejected, got rid of, or destroyed. The infant rejects the mother’s
breast if from some cause, internal or external, the milk is not
grateful to it; by crying and.struggling it strives to get rid of

‘a painful impression which may happen to be affecting it, as the
Y
322 INSANITY OF BARLY LIFE. [CHAP.

Gregarina shoots away-from a stimulus, or as a snail retracts its
protruded horns when they are suddenly touched ; and when it
is a little older, it destroys or attempts to destroy what is not
pleasing to it. To talk about the purity and innocence of a
child’s mind is a part of that poetical idealism and willing
hypocrisy by which man ignores realities and delights to walk
in a vain show. The purity and innocence of the child’s mind,
in so far as they exist, testify to the absence of mind; the
impulses which actually move it are the selfish impulses of
passion. “A boy,” says Plato, “is the most vicious of all wild
beasts ;” or again, as it has been put, “a boy is better unborn
than untaught.” By nature sinful above everything, and despe-
rately wicked, man acquires a knowledge of good through evil ;
his passions are refined and developed through wider considera-
tions of interest and foresight; the history of mental develop-
ment begins with the lowest passions, which circulate as an
under-current in every life, and frequently come to the surface
in a very turbulent way in many lives. Evil is good in the
making as vice is virtue in the making. “I cannot praise,”
continues Milton, after saying that we know good by evil, “a
fugitive and cloistered virtue, unexercised and unbreathed, that
never sallies out and sees her adversary, but slinks out of the
race where that immortal garland is to be run for, not without
dust or heat. Assuredly we bring not innocence into the world,
we bring impurity much rather: that which purifies us is trial,
and trial is by what is contrary..... That virtue therefore which
is a youngling in the contemplation of evil, and knows not the
utmost that Vice promises to her followers, and rejects it, is but
a blank virtue, not a pure; her whiteness is but an excremental,
adventitious whiteness.”

When insanity is met with in the young child, we observe
what we do in the adult under the same circumstances—
passion in all its naked deformity and in all its exaggerated
exhibition. The instincts, appetites, or passions, call them
as we may, manifest themselves in unblushing, extreme, and
perverted action; the veil of any control which discipline may
have fashioned is rent; the child is as the animal, and reveals
its animal nature with as little shamefacedness as the monkey
indulges its passions in the face of all the world. As in the
1] INSANITY OF EARLY LIFE. 323

child of three or four years old there is as a rule only the
instinct of gratifying itself, involved in which is the effort to
reject or destroy what is not agreeable, its disease, if it become
insane, will be exhibited in a perverse and unceasing appro-
priation of whatever it sees, and in destructive attacks upon
whatever it can destroy. Refuse it what it grasps at, and it
will scream, bite, and kick with a frantic energy: give it the
object which it is striving, for, and it will smash it if it can: it
is a destructive little machine which, being out of order, lays
hold of what is suitable and what is unsuitable, and subjects
both alike to its desperate action. Haslam reports a case of
this kind in a girl, aged three and a quarter years, who had
become mad at two and a half years of age, after inoculation for
small-pox. Her mother’s brother was, however, an idiot, though
her parents were sane and undiseased. This creature struggled
to get hold of everything which she saw, and cried, bit, and
kicked if she was disappointed. Her appetite was voracious, and
she would devour any sort of food without discrimination ; she
would rake out the fire with her fingers, and seemed to forget
that she had been burnt ; she passed her urine and feces any-
where. She could not be taught anything, and never improved.*

The most striking manifestation of the destructive impulse
which sometimes reaches such an extreme degree in the madness
of childhood is afforded by the instance of homicidal impulse,
“A girl, aged five years, conceived a violent dislike to her step-
mother, who had always treated her kindly, and to her little
brother, both of whom she repeatedly attempted to kill.” t
Here there was a sort of conscious design apparent in the act ;
but it is obvious that the further back in mental development
we go, the less of conscious design will there be in the morbid
manifestation of the inborn impulse. Moreover, in the case of
homicidal impulse in a young child, the consciousness of the
end or aim of the act must at best be of a very vague and
imperfect kind: it is driven, by an impulse of which it can give
no account, to a destructive act, the real nature of which it
does not appreciate; a natural instinct being exaggerated and
perverted by disorder of the nerve-centre. The character of

* Observations on Madness.
+ Esquirol, Traité des Maladies Mentales.

¥ 2
B24 INSANITY OF EARLY LIFE. [cHa:

the morbid manifestation is often determined by accidents «
external circumstances; the child is driven by an automati
impulse to kill its stepmother as it would strive to kill a canar
bird or to destroy crockery ware, the impulse being as muc
its master as the convulsion of its limb is in chorea. Man
cases, again, are on record of older children who have displaye
a hideous and uncontrollable propensity to acts of cruelty an
destruction, practised on such creatures as were not too powerft
to be their victims.

Because of the variety of forms which the morbid manife:
tations of perverted instinct may take, it sometimes happer
that a young child very much resembles a monkey in its conduc
as it does in its wizened and old-fashioned face. It may di
play a wonderful talent for mimicry, a precocious skill in lyir
with all the ease of an instinct, and a positive faculty for thievir
which is quite natural to it. Of the best thieves as of the be
poets it may in truth be said that they are born, not mad
Though we are apt to look on such precocious viciousness :
singular and inexplicable, a little reflection will show that und
conditions of disease it is just as natural in the child as it is:
the monkey under conditions of normal development.

Thus much concerning those phenomena of insanity in chi
dren that spring from the perversion of the self-conservati
impulse. Let me now say a few words concerning the perve
sion of the instinct of propagation. It is necessary first to gua:
against a possible objection that this instinct is not manifest t:
puberty, by the distinct assertion that there are frequent mar
festations of its existence throughout early life, both in anima
and in children, without there being any consciousness of tl
aim or design of the blind impulse. Whosoever avers othe
wise must have paid very little attention to the gambols
young animals, and must be strangely or hypocritically oblivio
of the events of’ his own early life. It is at puberty that t'
instinct makes its appearance in the consciousness of man, al
thereupon generates knowledge of its aim, and craves mea
of gratification ; in like manner as, in the course of developme
through the ages, the blind procreative instinct which is i
manent in animal nature finally undergoes a marvellous evoluti
within human consciousness.
11, } INSANITY OF EARLY LIFE. 325

As we have exhibitions of this blind impulse in the healthy
child, it is quite natural to look for exaggerated and perverted
manifestations of it in the insane child. These we do not fail to
meet with: while the enthusiastic idealist is greatly shocked by
disgusting exhibitions of unnatural precocity in children of three
or four years of age, and exclaims against them as if they were
unaccountable and monstrous, they are not without interest to
the scientific observer, who sees in them valuable instances on
which to base his generalizations concerning man, not as an ideal
but as areal being. In the Philosophical Transactions for 1745
is the account of a boy, aged only two years and eleven months,
who displayed a remarkable sexual precocity. Esquirol quotes
the case of a girl, aged three years, who was constantly putting
herself into the most indecent attitudes, and used to practise the
most lascivious movements against any piece of furniture, At
first the parents thought nothing particular of it, but finding the
practice continued, and of unmistakeable significance, they tried
every means in their power to prevent it, but without avail. In
church or anywhere at the sight of an agreeable object there
was the same abandoment, ending in a general spasm. The
child confessed to a positive pleasure from the acts, continued
them as she grew up, and, though ultimately married, was a
regular nymphomaniac. The greatest salacity was always mani-
fested from the beginning to the end of Spring.* Other similar
examples of this sort of instinctive insanity might easily be
adduced. ‘The afflicted child has no true consciousness of the
import of its precocious acts ; certain attitudes and movements
are the natural gesture-language of certain internal states ; and
it is little more than an organic machine automatically impelled
‘by disordered nerve-centres.

(b) Moral Insanity—This variety of affective insanity might
‘be illustrated by numerous examples of all degrees of severity,
ranging from what might, not without reason, be described as
viciousness to those extremer manifestations which pass far
beyond the bounds of what any one would call wickedness. In
the spring of 1827, Dr. Prichard was asked to see the daughter
of a farmer, in some members of whose family insanity existed.
She was a little girl, aged seven, and was described as having

© £29 also Morel’s “ tudes Cliniques sur les Maladies Mentales.” 1852.
326 INSANITY OF EARLY LIFE. (cual

been quick at apprehension, lively, affectionate, and intelligen
A great change, however, took place in her conduct: she becam
tude, vulgar, abrupt, and perfectly unmanageable; doing n
work, running about the fields, and, if rebuked, very abusive an
extremely passionate. Her appetite was perverted so that sh
preferred raw vegetables to her proper food; and she woul
sleep on the cold and wet ground rather than upon her bec
Her parents had no control over her, and she was persistent!
cruel to her sisters, pinching them when she could do so withou
being observed. She had a complete knowledge of persons an
things, and recollected all that she had learned. Her eye
glistened brilliantly ; the conjunctiva was reddened; her hea
was hot, her extremities were cold, and her bowels disordered
there was a disagreable odour of the body. Dr. Prichard too.
her into his own house, as she was getting worse at hom«
“ At this time she had taken to eat her own feces, and to drin
her urine, and she would swear like a fishwoman and destro
everything within her reach; yet she was fully conscious ¢
everything she did, and generally appeared to know well the
she had done wrong.” After doing something wrong she woul
exclaim, “ Well, Mrs. H., I have done it. I know you will b
angry ; but I can’t help it, and I could not let it alone unt
I had.” Among her pleasures was that of dirtying herself a
frequently as she had clean clothes ; indeed, “she would rarel
pass her excrements into the proper place, but reserved thez
for the carpet of the sitting-room, or for her own clean clothes.
“ At other times she was so far conscious of her situation as t
cry bitterly, and express her fears that she would become lik
her aunt, who was a maniac. In addition to all these ind:
cations she had stolen everything which she thought would t
cared for, and either hid or destroyed it ; and swore in languag
which it is difficult to imagine that such a child could eve
have heard.” There was no fixed idea which influenced hc
conduct ; she acted “from the impulse of her feelings, and thes
were unnatural, and perverted by disease.” After two mont
she recovered.*

Haslam relates the following case of a young gentleman, age

* On the Different Forms of Insanity in relation to Jurisprudence. By J. ¢
Prichard, M.D. 1842.
11.] INSANITY OF EARLY LIFE. 327

ten, in whose ancestors no insanity was admitted. ‘When only
two years old, he was so mischievous and uncontrollable that he
was sent from home; and until he was nine years old he con-
tinued “the creature of volition and the terror of the family,”
and was indulged in every way: he tore his clothes, broke what-
ever he could break, and often would not take his food. Severe
discipline was tried, but.in vain; and the boy was ultimately
sent to a lunatic asylum. There was deficient sensibility of the
skin. He had a very retentive memory with regard to matters
which he had witnessed, but was attracted ouly by fits and
starts, so that he would not learn: he was “the hopeless pupil
of many masters,” breaking windows, crockery, and anything else
which he could break. Whenever the cat came near him he
plucked out its whiskers with wonderful skill and rapidity, say-
ing, “I must have her beard off,” and then commonly threw the
animal on to the fire or through the window. He was quite
insensible to kindness, and never played with other boys. “Of
his own disorder he was sometimes sensible: he would often
express a wish to die, for he said very truly, ‘God had not made
him like other children ;’ and when provoked he would threaten
to destroy himself.” No improvement took place. A case in
some regards similar is quoted by Moreau from Renaudin, under
whose care it was :—A boy, whose intelligence and behaviour
were usually of an ordinary character, was subject every now and
then to a positive mania of acts, without any mental incoherence.*
When these attacks came on him he was quite incorrigible, and
in consequence of them he had been expelled from different
schools. After several unsuccessful trials at discipline, he was
at last sent to an asylum. There he answered quite intelligently,
but wept and was silent when spoken to about his bad conduct:
pressed upon this subject, he said that he could not help it.
The interesting circumstance was that there was a complete in-
sensibility of the skin at the time of the attacks of irresistible
violence, and that, in his docile and affectionate intervals, the
sensibility of the skin was natural. The acts of violence were
of so extreme a character that, says the reporter, “we were able
to satisfy ourselves that they might go as far as murder.”

These examples may suffice as illustrations of a form of

* Moreau’s Psychologie Morbide, p. 313.
328 INSANITY OF EARLY LIFE. + [ CHAP.

disease which undoubtedly occurs in early life, and which,
indeed, is more readily acknowledged when it is met with in
such young children than when it is met with in the adult.
The extreme acts of precocious wickedness seem so inconsistent
with the immaturity of childhood that they are readily accounted
unnatural, and are attributed to disease. However, to call them
the result of disease is not to explain them, nor to cancel the
need of an explanation ; and to designate them unnatural is not
to remove them from the domain of natural law. Whosoever
scrupulously traces these acts as the necessary consequences of
certain coefficient causes implied in the vitiated constitution of
the nerve element of the child, and thus banishes, as he must
do, the notion of witting and wilful vice, will be prepared to
recognise the possibility of like physical conditions in the adult
being the agents in producing like morbid effects. Instead of
dismissing a thing from the mind after labelling it as unnatural
or morbid, without being at the pains to attach any definite
meaning to such words, it is most necessary to strive to get
precise ideas as to its nature and causation, so that in the event
of a similar effect being at some time observed, there may be
light thrown upon the hidden causes and true relations, in place
of vague or unfounded assumption agreeable only to ignorant
prejudice.

There are children of a defective mental capacity not reaching
the degree of idiocy, or even of positive imbecility, whom it is
very difficult to know what to do with sometimes. They are dull,
heavy, stupid, appear careless, indifferent, and as if they will not
try to learn anything, and display low or vicious tastes ; when
sent to a respectable school, they are commonly after some time
sent home again as impracticable. Their inability to learn looks
very much like stupidity and obstinacy, when it is really the
result of disease, and marks a certain measure of imbecility. It
is sometimes the misfortune of boys of this sort to be sent, after
failing at the usual schools, to some one who advertises for
unruly pupils, and who represents himself as possessed of some
specific for managing and training them. A few years since a
boy of this kind was said to have been flogged to death by his
master, who was put upon his trial for manslaughter, was found
guilty, and received a severe sentence, Without doubt the poor
1t.] INSANITY OF EARLY LIFE. 329

boy was harshly and cruelly used, but there are medical reasons
for thinking that the case was not quite so bad as it was repre-
sented in the public papers. Dr. Wilks has expressed an
opinion to this effect, grounding it on the fact that in some of
these cases of half imbecility there is an abnormal quantity of
serum in the ventricles of the brain, and that death may some-
times take place suddenly in consequence of the increase of the
fluid beyond a certain amount. In the case referred to an un-
usual quantity of serum was found in the ventricles of the brain
after death ; and the medical man called for the prosecution
gave it as his opinion that this was the result of the treatment
to which the boy had been subjected, and the probable cause of
death, In reality, the condition of things may have been the
cause of the youth’s stupidity, and so his death have been occa-
sioned by a punishment which would not have seriously injured
a healthy child. Although this would not be a justification of
the punishment, it would still absolve the schoolmaster from
some portion of his culpability. When we reflect on the pos-
sible state of things in the brain, it will be obvious that no good,
but much mischief, will be done by harsh measures: kindness
and encouragement, good diet and regular habits, proper bodily
exercise and the regular control of some judicious person, will
be the best means to employ. Above all things, it is necessary
to forego attempts to make such defectively organized beings
attain to a degree of mental development which they are by
nature incapable of; they should be put to some humble occu-
pation for which they are fitted.

There is another class of boys who cause great trouble and
anxiety to their parents and to all who have to do with them.
Afflicted with a positive moral imbecility, they are inherently
vicious; they are instinctive liars and thieves, stealing and
deceiving with a cunning and a skill which could never be
acquired ; they display no trace of affection for their parents, or of
feeling for others ; the only care which they evince is to contrive
the means of indulging their passions and vicious propensities.
Intellectually, they are certainly defective also, for they usually
read no better when they are sixteen years old than a healthy
child of six years of age would do; and yet they are very acute in
deception and in gratifying the desires of their vicious natures.
330 INSANITY OF EARLY LIFE. [cua

Passionate, selfish, cruel, and sometimes violent, they are intok
rable at home; and if they are sent to school, they are sure t
be expelled. When they belong to the lower classes, they fin
their way to prison many times; indeed, they contribute the:
quota to the criminal population of the country: when the
belong to the better classes, there is nothing for it but to see
out some firm and judicious person who, for suitable remunera
tion, will take care of them, keep them out of mischief, anc
while checking their vicious propensities, will try to discove
and foster any better tendencies which they may have in then
The resemblance of these beings in moral character to the lowes
savages, and even to monkeys, is not without interest.

What is of the utmost importance to be borne in mind i
regard to all cases of affective insanity, and especially of tha
variety which we have described as moral insanity, is the ques
tion of hereditary taint. As the nature of man has been slowl
developed into that which it now is by a progressive fashionin
through generations, so by a retrograde descent may it pass back
wards to a lower stage: the degeneration which the individuz
who becomes insane without having had any predisposition t
insanity represents, may observably become the inherent defec
or taint of the nervous element of his progeny, so that th
acquired or, as it were, accidental irregularity of the parer
determines a natural predisposition to irregular, perverse, an
discordant acts in the offspring. The progress of organic develoy
inent through the ages is a progressive internal specialization 1
relation to external nature ; the human organism, as the highes
organic development, has the most special and complex relation
with the external; and the highest mental development, as th
supreme development of the human organism, represents th
completest expression of the most special and complex harmon
between man and nature. Now this harmony will plainly b
destroyed, and a discord produced instead, by that inherer
defect of nerve element which an hereditary taint implies; fc
it implies, as we have seen, a predisposition to discordant actio1
Accordingly, there is witnessed in the infant, long before an
' responsibility attaches to its acts, either a congenital inabilit
to respond to external impressions, whereby idiocy of greate
or less degree is the consequence, or a degenerate state of nerv
uJ INSANITY OF EARLY LIFE. 331

element, whereby the natural assimilation of impressions and
the fitting reaction to them are seriously interfered with. In
the latter case there is a positive defect in the composition or
constitution of nervous element; its degeneration means the
loss of its Kind and the existence of an inferior kind ; accord-
ingly its fundamental self-conservative impulse, as living matter
of specific quality, is abolished. The strange perversions of the
child’s appetites and instinctive strivings plainly reveal this ;
for, instead of displaying an aversion from what is injurious
and rejecting it, the young creature positively seizes with eager
appetite what is most baneful. In all the degrees and kinds of
healthy life we witness in operation the attraction of what is
suitable to growth and development and the repulsion of what is
unsuitable : in the lowest forms of life we describe them simply
as attraction and repulsion, or assimilation and rejection ; as we
rise higher in the scale of life the attraction becomes appetite
and the repulsion becomes aversion ; higher still the attraction
is desire or love, the repulsion is dislike or hate, although if there
is any character of uncertainty about the event, hope and fear
are used to express the opposite strivings; and the last and
highest development of these fundamental impulses is willingness
and unwillingness, But in the child born with a strong predis-
position to insanity there is a want of this pre-established har-
mony between the individual constitution and external nature :
the morbid creature devours with eager appetite the greatest
trash, and rakes out the fire with its fingers ; it desires passion-
ately and frantically struggles for what is detrimental to it, and
rejects or destroys what is suitable and should, were it rightly
constituted, be agreeable; it loves nothing but destructive and
vicious acts, which are the expressions of an advanced degrada-
tion, and hates that which would further its development, and
is necessary to its existence as a social being. By reason of
its physical constitution it is a fundamental discord in nature ;
and all its perverse reactions are the utterances of a gradually
proceeding course of deterioration whereby it ultimately goes to
destruction : it cannot assimilate nature, and nature will therefore,
sooner or later, assimilate it. Meanwhile, us a diseased element
in the social organism, it must be isolated or removed for the
good of the organism.
332 INSANITY OF EARLY LIFE. [cua

As the mad acts of the insane infant or child mark a d
generate state of nerve element, so the degenerate creatu)
itself represents a degenerate variety or morbid kind of huma
being. However low a human being may fall or be brough
he never reverts to the type of any animal; the fallen majest
of mankind being manifest even in the worst wrecks. Ce
tainly there may sometimes be a general resemblance to o1
of the lower animals, but the resemblance is never anythir
more than a general and superficial one; all the special diffe
ences in mental manifestations are still more or less apparen
just as all the special differences in anatomical structure sti
remain. The idiot, with hairy back, may go on his knees an
“bah” like a sheep, as did one of which Pinel tells; but as I
does not get the wool and conformation of the sheep, so |
does not get its psychical characters: he is not adapte
for the relations of the sheep, and, if placed in them, wow
surely perish, and he does exhibit unconscious traces of adapt
tion to his relations as a human being which the best develope
animal never would. So also with regard to man’s next of ki
the monkeys: no possible arrest of development, no degradatic
of human nature through generations, will bring him to tl
special type of the monkey: a degenerate kind of human beir
may be produced, but it is a morbid kind, wanting the instine
of the lower animals, and the unconscious upward aspirations :
their nature, as well as the reason of man and his conscioi
aspirations. It is a very rare thing, for example, to meet amor
idiots with that instinctive discrimination of poisonous matte
which beasts have; on the other hand, it is very common :
meet among them with that perverted craving for improper «
injurious food, which is in reality the unconscious display |
nature’s effort to extinguish a morbid variety, and which,
for charitable interference and fostering care, would soon accon
plish its aim.

Man exists in an intimate correlation with nature at i
present stage of development—is, as it were, the outgrowth ;
this stage of its evolution, and therefore flourishes well und
the existing conditions: the monkey, on the other hand, is n
in harmony with the complexity of surrounding nature, and
rapidly becoming extinct, the stronger species surely supersedir
11] INSANITY OF EARLY LIFE. 333

it. If it were desired to bring man to the monkey level, it would
be necessary that the latest mighty changes in nature should be
undone, and that condition of things restored which prevailed
ages before man appeared, and of which the monkey was the
natural outgrowth. While, then, the monkey type, and every
other pure animal type, represent stages in the upward develop-
ment of nature, the ¢heroid degenerations of mankind are patho-
logical specimens, which, not being serviceable for development,
- are cast off by the stream of progress, and are on their way to
destruction for re-issue by nature under better form. Let them
not pass by in their decay, however, without their uses, that we,
profiting by the experiments which their failures afford, may
form for ourselves true generalizations suited to the successful
conduct of life, and therein to the promotion of nature’s develop-
ment. By such examples, nature teaches how best to promote
the progress of humanization.

Do not the foregoing considerations render it sufficiently
intelligible how it is that we sometimes witness such a precocity
of seeming vice in the insane infant or child? Innate in its
human constitution is the potentiality of a certain develop-
ment, the latent power of an actual evolution which no monkey
ever has; in it is contained as by involution, or implicitly
comprehended, the influence of all mankind that has gone
before. When, therefore, such a being is insane, there is not
only an individual creature, but there is human nature, in per-
verse action, in retrograde metamorphosis: there are actualized
in a morbid display certain potentialities of humanity, and
accordingly there are presented exhibitions of degenerate human
action, which, so far as regards the individual infant, seem to
mark prematurity of vice. Humanity is contained in the indi-
vidual; and in these strange morbid displays we have an
example of humanity undergoing retrograde resolution. What-
ever act of vice, folly, crime, or madness one man has perpetrated,
there is in every man the potentiality of perpetrating ; if it were
not so, why repeat the decalogue? In the sense of anything in
nature being self-determined and self-sufficing, there is no indi-
viduality : as in one word are summed up ages of human culti-
vation, so in one mortal are summed up generations of human
existence. Both in his knowledge and in his nature each one is
334 INSANITY OF EARLY LIFE. (CHAP. i

the inheritor of the acquisitions of the past—the heir of all tl
ages. Take the word which represents the subtile and, as it wer
petrified thought of a high mental culture, and trace back wit
analytical industry its genesis,—resolve it into its elementary pr:
duction,—what a succession of human experiences is unfolded
What a gradual process of growth, rising in speciality and con
plexity up to that organic evolution which the word now mark
is displayed! Take, in like manner, the individual being, an
trace back through the long records of ages the antecedent stey
of his genesis, or observe rather the resolution of his eéssentii
human nature as it is exhibited in the degenerate acts of tk
insane child—in this experiment thus obtruded on the attentio
by nature—and there will then be no cause for surprise at phi
nomena which the young creature could never have individual]
acquired, and which, so far as its conscious life is concerne:
appear strangely precocious and inexplicable. There is tk
rapid undoing of what has been slowly done through the age
the irregular morbid manifestation of faculties which have bee
tediously acquired, the formless ruin of carefully fashioned forn

It will not be amiss to add that the phenomena of the insanit
of early life, examined with scrupulous fidelity, confirm in tk
fullest and most exact manner the general physiological an
pathological principles which throughout this work it has bee
the aim to establish, enforce, and illustrate,
CHAPTER IIL
VARIETIES OF INSANITY.

dieesere are certain mild forms of Insanity, or rather certain
eccentricities of thought, feeling, and conduct, which scarcely
reach the degree of positive insanity, yet not unfrequently cause
great difficulty when the question of legal or moral responsibility
is concerned. Many people who cannot be called insane,
notably have what may be called the insane temperament,—in
other words, a defective or unstable condition of nerve element,
which is characterised by the disposition to sudden, singular,
and impulsive caprices of thought, feeling, and conduct. This
condition, in the causation of which hereditary taint is commonly
detectable, may be described as the Diathesis spasmodica, or the
Neurosis spasmodica.

1. The Insane Temperament, or Neurosis spasmodica—It is
characterised by singularities or eccentricities of thought, feel-
ing, and action. It cannot truly be said of any one so consti-
tuted that he is mad, but he is certainly strange, or “ queer,” or,
as it is said, “not quite right.” What he does he must often
do in a different way from all the rest of the world. If he
thinks about anything, he is apt to think about it under strange
and novel relations, which would not have occurred to an ordi-
nary person; his feeling of an event is unlike that which other
people have of it, He is sometimes impressionable to subtile and
usually unrecognised influences; and now and then he does
whimsical and apparently quite purposeless acts. There is in
the constitution an innate tendency to act independently as an
element in the social system, and there is a personal gratification
in the indulgence of such disposition, which to lookers-on seems
to mark great self-feeling and vanity. Such an one, therefore, is
336 VARIETIES OF INSANITY. [cra

deemed, by the automatic beings who perform their duties in tl
social system with equable regularity, as odd, queer, strange, «
not quite right. He is certainly not unlikely to break dow
. some time or other into actual insanity.

This peculiarity of temperament, which undoubtedly predi
poses to insanity, does nevertheless in some instances bord:
very closely upon genius; it is the condition of the talent or w
which is allied to madness,-only divided from it by thin pa:
titions. The novel mode of looking at things may be an actu
advance upon the accepted system of thought; the individu
may be in a minority of one, not because he sees less than, «
not so well as, all the world, but because he happens to sé
deeper, or to be favoured with a flash of intuitive insight. H
may differ from all the world, not because he is wrong, and a
the world is right, but because he is right, and all the worl
is wrong, Of necessity every new truth is at first in a min
rity of one; it is a rebellion against the existing system «
belief; accordingly the existing system, ever thinking itself
finality, strives with all the weight of its established organ
zation to crush it out. But by the nature of things that mu,
happen, whether the novelty be a truth or an error. Aft
all, it is only through the appearance of rebels in the socii
system that progress is effected; and precisely because indiv
duality is a reproach, and sneered at as an eccentricity, is it we
for the world, as Mr. J. S. Mill has pointed out, that indiv
duality or eccentricity should exist.* It may be advisable to s
this matter forth at greater length, to the end that we may,
possible, get a just conception of the real relation of certai
sorts of talent to insanity.

The genius is always recognised to be in the van of his ax
in that wherein he is in advance, he necessarily differs from h
age, and is often enough therefore pronounced mistaken, unprai
tical or mad: in that wherein he agrees with his age, he is nece:
sarily not original; and so appears the truth of an observation «
Goethe, that genius is in connexion with its century only by i
defects—that in which there is not genius, Certainly the or
ginality of a man of true genius will grow out of the existir
system, may be traced as a genetic evolution of it; he is ther

* Essay on Liberty.
ru. ] VARIETIES OF INSANITY. 337

fore in radical connexion with his century; but the more
advanced his development, the more he will outshoot and
differ from his age. Accordingly, many a man of genius—who
has appeared before his time, or, in other words, before the
social organism has reached that stage of evolution repre-
sented by him—has been forgotten, having most likely been
thought more or less mad in his lifetime; and the person who
usually gets most reputation, and whose name is made to mark
‘an epoch in development, is he who systematizes and definitely
sets forth—that is, brings into illuminated consciousness—the
method which mankind has for some time been instinctively or
unconsciously pursuing. A Bacon and a Comte, being in reality
not much in advance of their centuries, but having eyes to
discern the tendencies of development, and a capacity of co-
ordinating knowledge, are those who get the most honour.
But even these men are not honoured so much by their own age
as by a posterity which has developed up to their level. We
never know how high the mountain is until we get some distance
from it.

An inherent disposition of nervous constitution, rendering a
man dissatisfied with the existing state of things, and impelling
him to novel strivings, is really an essential condition of ori-
ginality: to suffer greatly and to react with corresponding force,
is a means of dragging the world forward at the cost of individual
comfort. Consider, however, what an amount of innate power
aman must have in order to do that, without himself sinking
under the huge weight of opposition! Many earnest and in-
tense reformers, whose vital energies have been absorbed in the
promulgation of a truth, which was perhaps an important one,
have notoriously broken down in face of the crushing force of
the organized opposition. They have been so abandoned to their
idea, so carried away by it, so blind to the force of the circum-
stances with which they have had to contend, so one-sided and
fanatical, as to be almost as inconsiderate of the manifold rela-
tions of their surroundings as actual madmen are; accordingly
they have often been called, and sometimes perhaps were, mad.
Certainly their failures prove that they had not sufficient insight,
patience, and capacity for the task which they had undertaken :
that they did not succeed, was because they did not deserve to

Zz
338 VARIETIES OF INSANITY. [on

succeed. Whatever the will, there was not in their nature t
capacity to establish an equilibrium between themselves a
external conditions. They could not mould circumstances agre
ably to their wishes; they could not accommodate themselv
to circumstances; they were inevitably, therefore, the victims.
It is undoubtedly true, that where hereditary taint exists ir
family, one member may sometimes exhibit considerable geniy
while another is insane or epileptic ; but the fact proves no mc
than that in both there has been a great natural sensibility
nervous constitution which, under different outward circu!
stances, or internal conditions, has issued differently in the t
cases. Now we may properly look at the functional manifest
tions of unstable nerve element from two different aspects—fir
as regards the reception of impressions; and, secondly, as 1
gards the reaction outwards. In the first case, for example, 1
may have one who is equal to the ordinary events of a calm li
but who, possessing no reserve power, is unequal to the strain
a calm self-renunciation, and breaks down under the stress
adverse events. And yet his extreme nervous susceptibility m
render him capable of slighter shades and more subtile delicaci
of feeling and thought than a more vigorously constituted bei
is. The defect, then, is in some respects an advantage, althou,
a rather perilous one, for it may approach the edge of madnes
such men as Edgar Allan Poe and De Quincey illustrate tl
great subtlety of sensibility amounting almost to disease, and
far give some colour to the extravagant assertion of a Fren
author (Moreau de Tours), that a morbid state of nerve eleme
is the condition of genius. It should not be lost sight
however, that any one so constituted is nowise an exam]
of the highest genius; for he lacks, by reason of his gre
sensibility, the power of calm, steady, and complete meni
assimilation, and must fall short of the highest intellectr
development, Feeling events with a too great acuteness, he
incapacitated from the calm discrimination of the unlike
them, and the steady assimilation of the like, by which t
integration of the highest mental faculties is accomplished,—
which, in fact, the truly creative imagination of the greatest pc
and the powerful and almost intuitive ratiocination of the great«
philosopher are fashioned. His insight may be marvellous
nn] VARIETIES OF INSANITY. 3839

subtile in certain cases, but he is not sound and comprehensive.
Although it might be said, then, by one not caring to be exact,
that the genius of an acutely sensitive and subjective poet denoted
a morbid condition of nerve element, yet no one, after a moment’s
calm reflection, would venture to speak of the genius of such as
Shakspeare, Goethe, and Humboldt, as arising out of a morbid
condition.* The impulse which instigates these men to their
superior striving, is not so much one of dissatisfaction as one of
non-satisfaction—a craving, in fact, for appropriation; the in-
ternal potentialities display their endeavour towards realization
through the concurrence of suitable external impressions by a
‘feeling of want, a craving, or an unsatisfied instinct—not other-
wise than as the lower organic elements manifest their sense of
hunger, or as the sexual instinct reveals its want at puberty.
The difference between the desires which are the motives to
-action of the highly-endowed, well-balanced nature of the genius,
and the desires which instigate the eccentric and violent acts of
the incipient madman, is indeed very much like the difference be-
tween the natural feeling of hunger in the healthy organism, and
the perverted appetite for garbage and dirt which the hysterical
person occasionally displays. In the former case the aspiration
is sound, and directed towards perfecting a harmony between the
individual and nature; in the latter, it is unsound, and tends to
the production of an irreconcilable discord. The good organiza-
tion hardly needs a long training ; it will make the means of its
own best training by the operation of its excellent affinities; and
it will thus, directly or circuitously, attain to its complete deve-
lopment. The bad organization, on the other hand, can only be
saved by training; if left without a continued watchful control,
its natural affinities will surely drag it downwards to destruction.

A no less important difference between the highly-endowed
nerve element of the genius and the morbid nerve element of
the hereditary madman will be apparent when we look to the

* “So far from the position holding true, that great wit (or genius, in our
modern way of speaking) has a necessary alliance with insanity, the greatest wits,
on the contrary, will ever be found to be the sanest writers. It is impossible for

“the mind to conceive of a mad Shakspeare. The greatness of wit, by which the
poetic talent is here chiefly to be understood, manifests itself in the admirable
balance of all the faculties. Madness is the disproportionate straining or excess
of any one of them.”—Sanity of True Genius, by Charles Lamb.

Z2
340 VARIETIES OF INSANITY. jouar

yoactive, instead of the receptive, side. The difference is no
unlike that which there is between a quiet aim-working voli
tional act and a spasmodic movement. The acts of the geniu
may be novel, transcending the routine of the established systen
of thought and conduct; but, however original and startlin;
they may appear to those who are, as it were, automatic element
in the social organization, they contain, consciously or uncon
sciously, well-formed design: there are in them an intuitiv
recognition of and an intelligent respondence to outward rele
tions ; in other words, they are aim-working for the satisfactio
of an inherent impulse, which operates none the less wisel
because there may not be a distinct consciousness of its natuz
and aim. Inspiration is the exact opposite in this regard c
habit or custom—that “tyrant custom” which so completel
enslaves the whole manner of thought and action of the majorit
of men: in the inspiration of a great thought or deed there :
the sudden starting forth into cousciousness of a new combin:
tion of elements unconsciously present in the mind ; these havin
been steadily fashioned and matured through previous experienc
On the other hand, the acts of the person who has the evil her
tage of an insane temperament are purposeless, irregular, and aii
at the satisfaction of no beneficial desire; they tend to increa:
that discord between himself and nature of which the purpos
less acts are themselves evidences, and they must ultimately er
in his destruction.

T have thus lingered upon the relations which a form of tale:
bears to insanity, in order to exhibit, if possible, the position
each in the social organization. In both cases there may be ¢
uncommon deviation from the usual course of things; but -
one case there is the full recognition of the existing organizatic
as the basis of a higher development, a fusing of the pa
through a new mould into the future; in the other, there is
capricious rebellion, as the initiation of a hopeless discord.
man of deep insight and comprehensive view may penetra
beneath the masks of things, and see into the real nature of mai
of the delusions set up by common consent to be worshippe
but he stills finds a real truth and meaning beneath the fleeti:
phenomena, and he accepts with equanimity the present, not
the end, but as means to an end, perceiving in it the prophe
un] VARISTIES OF INSANITY. 341

of a completer future: he can subordinate his self-hood to the
system, works quietly and sincerely in his sphere, and is moved
by no passion springing from offended self-feeling to set the
world violently right. The man of great self-feeling, on the
other hand, may with penetrating insight recognise the incom-
pleteness, inadequacy, or vanity of many existing phenomena,
but he is too apt to find the whole ridiculous, not having
sufficient perception to discern the degree of truth which lies in
all these apparent shams; he deems himself thoroughly emanci-
pated when he is actually the unconscious slave of an extra-
vagant self-feeling, by reason of which he is made angry with the
comedy of life, or passionately earnest to set the world right
with a onesided vehemence : there is the reaction of a great self-
love which incapacitates its possessor, or rather its victim, from
subordinating his personality to the laws of the existing organi-
zation. Has not Goethe, as usual, admirably put this truth in
the words, “The man of understanding finds almost everything
ridiculous ; the man of reason hardly anything” ?

Where the heritage of the insane temperament exists, it will
of course depend much on the internal bodily conditions and the
external circumstances of life whether the mischief shall remain
latent or issue in positive insanity. Under favourable circum-
stances it may declare itself only in harmless eccentricities and
singular caprices; but if the individual is placed under condi-
tions of great excitement,-or subjected to a severe mental strain,
the inherent propensity is apt to display itself in some impulsive
act of violence. The great internal disturbance produced in
young girls at the time of puberty is well known to be an
occasional cause of strange morbid feelings and extraordinary
acts ; and this is especially the case where the insane tempera-
ment exists. In such case also irregularities of menstruation,
always apt enough to disturb the mental equilibrium, may give
rise to an outbreak of mania, or to extreme moral perversion
more afflicting to the patient’s friends than mania, because seem-
ingly wilful. The stress of a great disappointment, or any other
of the recognised causes of mental disease, will meet with a
powerful co-operating cause in the constitutional predisposition.
On this matter, however, enough has already been said when
treating of the causation of insanity.
545 VARIETIES OF INSANITY. [CHA]

It remains only to add here—what should never be lost sigk
of—that a morbid hereditary taint frequently impresses it
stamp on the individual’s character and conformation in a muc
more decided manner than by eccentricities of conduct whic
are compatible with considerable talent. There is often
nervous and excitable manner, a peculiar or awkward gait, rest
less behaviour, or impulsive and whimsical conduct ; oddities c
dress and demeanour, capricious likes and dislikes, a lack
power of sustained thought, and abrupt transitions in convei
sation are also frequently witnessed. “This fatal heritage,
Esquirol wrote, “is painted upon the physiognomy, on th
external form, on the ideas, the passions, the habits, the incli
nations of those who are the victims of it.” In more extrem
cases the physiognomy has not the regularity and harmony c
beauty ; there is, perhaps, an irregular conformation of th
head; a vicious implantation of the ears, or a deformity c
one or both of them, is not uncommon; convulsions may occu
in early life, or there are tics and spasmodic movements i
after life; the walk is uncertain, vacillating in extreme cases
and there is sometimes a disproportion between the limb:
Arrest of development of the sexual organs is not very uncom
mon; slight diseases readily take on a fatal character, so littl
is the power of vital resistance ; and the mean duration of lif
among those strongly marked by this fatal heritage is less tha:
the average. There are corresponding peculiarities of disposi
tion: Morel, of Rouen, to whom we are most indebted for th
scientific investigation of this subject, describes these victim
as purely instinctive beings; they display instinctively certaiy
remarkable talents, as for music, drawing, calculation, or exhibi
a prodigious memory for details; but they are incapable o
sustained thought and sworle—dhey cannot bring anything to
steady perfection, “ do not know that they “now, do not thin!
that they think ;” and under any great strain they are almos
certain to break down into desperate insanity, or to explode i:
an act of extravagant violence. It is strange what a remarkabl
musical talent may co-exist with the extremest imbecility. Ihay
lately seen a little girl, xt. five, imbecile by birth by reason c
hereditary degeneracy, who cannot speak a word, who scream
frightfully, and who is so mischievous and destructive that sh
ut] VARIETIES OF INSANITY. 343

cannot be left alone for a minute; yet she can hum correctly
many tunes—her mother counts as many as twenty. As the
result of his elaborate researches, Morel comes to the conclusion
that “in the inferior varieties of degenerate beings a like physical
type is to be observed amongst all the individuals that compose
these varieties, and a certain conformity in their intellectual and
moral tendencies. They betray their origin by the manifestation
of the same character, the same manners, the same temperament,
the same instincts. These analogies establish amongst degene-
rate individuals under the same causes the bond of a patholo-
gical relationship.” Forget not that between the extreme forms
of this degeneracy and those slight eccentricities compatible with
high talent there are to be met with cases marking every shade
of the long gradation.

Closely allied to the insane temperament is that which exists
in those hysterical women, mostly under thirty years of age, who
are the favourite subjects of mesmeric experiments or of reli-
gious imposture, and who commonly exhibit some peculiarity
of nervous constitution, such as catalepsy, paralysis, somnam-
bulism, or spasmodic affections. They have no well-formed will
of their own, and they become the easy victims of ideas forcibly
presented to them by others. Their spasmodic temperament,
unfavourable to the proper co-ordination of ideas and feelings,
is eminently favourable to the morbid exaggeration of some feel-
ing or idea and to spasmodic movements. A further conse-
quence of this bad organization is manifested in some of these
cases by a strangely perverted or defective moral nature.
Certain women exhibit a desire for imposture which approaches
a moral insanity: they will undergo extraordinary sufferings
and privations, in order to substantiate some outrageous fraud
which they are practising ; openly refuse all food for weeks, in
order to produce the belief that they live without food; drink
what urine they clandestinely pass, in order to have it thought
that they never make water; and burn or blister their arms and
bodies with some corrosive fluid, in order to fabricate a peculiar
skin-disease. The religious ecstatics of the Middle Ages were
doubtless of this class ; and the miraculous stigmata which they
exhibited not less fictitious, When the vagaries of hysteria
affect the mind rather than the body, as they are apt to do
344 VARIETIES OF INSANITY. [CHAP.

where the insane temperament exists, they occasion the most
extraordinary symptoms.

Thus much concerning those peculiarities of temperament
which do not reach the degree of positive insanity, although
they strongly predispose to it. I shall now go on to treat of the
different varieties of actual mental disease from a symptomato-
logical point of view. On a general survey of the symptoms
of these varieties it is at once apparent that they fall into two
well-marked groups: one of these embracing all those cases in
which the mode of feeling or the affective life is chiefly or solely
perverted—in which the whole habit or manner of feeling, the
mode of affection of the individual by events, is entirely changed;
the other, those cases in which ideational or intellectual derange-
ment predominates. More closely scanning the character and
course of the symptoms, it will be seen that the affective disorder
is the fundamental fact; that in the great majority of cases it
precedes intellectual disorder; that it co-exists with the latter
during its course ; and that it frequently persists for a time after
this has disappeared. Esquirol rightly then declared “moral
alienation to be the proper characteristic of mental derange-
ment.” “There are madmen,” he says, “,in whom it is difficult to
find any trace of hallucination, but there are none in whom the
passions and moral affections are not perverted and destroyed.
I have in this particular met with no exception.” To insist upon
the existence of delusion as a criterion of insanity is to ignore
some of the gravest and most dangerous forms of mental disease.
All writers on insanity, whatever their theories of mental action,
are driven by observation of cases to describe certain varieties
of the two great primary divisions of melancholia and mania—
namely, a melancholia simplex, or melancholia without delusion,
and a mania sine delirio, These are truly very important
varieties; because it is in them, especially in the mania sine
delirio, that dangerous impulses to homicide, or suicide, or other
destructive acts, are apt to arise.

2. Affective Insanity.—Insanity of Feeling and Action—The
feelings mirror the real nature of the individual; it is from their
depths that the impulses of action spring; the function of the
intellect being to guide and control. Consequently when there
is perversion of the affective life, there will be morbid feeling |
u1.] VARIETIES OF INSANITY. 845

and morbid action; the patient's whole manner of feeling, the
mode of his affection by events, is unnatural, and the springs of
his action are disordered ; and the intellect is unable to check or
control the morbid manifestations, just as, when there is disease
of the spinal cord, there may be convulsive movement, of
which there is consciousness, but which the will cannot restrain.
In dealing with this kind of derangement, it will be most con-
venient, as in the investigation of the insanity of early life, to
distinguish two varieties—impulsive or instinctive insanity, and
moral insanity proper.

(a) Impulsive Insanity.—Fixing their attention too much
upon the impulsive act of violence, to the neglect of the funda-
mental perversion of the feelings which really exists, many
writers have unwittingly helped to increase the confusion and
uncertainty which prevail with regard to these obscure varieties
of mental disorder. Already it has been pointed out, at
sufficient length, that the first symptom of an oncoming insanity
commonly is an affection of the psychical tone,—in other words,
a perversion of the whole manner of feeling ; and what we have
here to fix in the mind is that the mode of affection of the
individual by events is entirely changed: this is the funda-
mental fact, from which flow as secondary facts the insane
impulses, whether erotic, homicidal, or suicidal. The effect of
the abnormal condition of nerve element is to alter the mode of
feeling of impressions: in place of that which is for the indi-
vidual good being agreeable, and exciting a correspondent desire
to acquire it, and that which is injurious being painful, and
exciting an answering desire to eschew it, the evil impression
may be felt and cherished as a good, and the good impression
felt and eschewed as an evil. There are not only perverted
appetites, therefore, but there are perverted feelings and desires,
rendering the individual a complete discord in the social organi-
zation. The morbid appetites and feelings of the hysterical
woman and the singular longings of pregnancy are mild examples
of a perversion of the manner of feeling and desire, which may
reach the outrageous form of morbid appetite exhibited by
the pregnant woman who killed her husband and pickled his
body in order to eat it. The sexual appetite may exhibit strange
and painful perversions, which again of necessity involve the
346 VARIETIES OF INSANITY. [ouae.

destruction of all those finer. feelings of affection and propriety
in the social system that are based upon it; for it is impossible
that natural and healthy love should co- -oseist with morbid lust.
The morbid perversion of feeling may be general, so that all
sorts and conditions of abnormal feelings and desires are exhi-
bited, or it may be specially displayed in some particular mode,
so that one persistent morbid feeling or desire predominates.
In the latter case we have such instances of madness as those
in which there is a persistent morbid desire to be hanged, and
the victim of the diseased feeling is actually impelled to a homi-
cidal act to satisfy his unnatural craving ; or, again, such insanity
as that of the father or mother who kills a child with the sincere
purpose of sending it to heaven. The act of violence, whatever
form it may take, is but the symptom of a deep morbid per-
version of the nature of the individual; a diseased state which
may at any moment be excited into a convulsive activity, either
by a powerful impression from without producing some great
moral shock, or by some cause of bodily disturbance such as
intemperance, sexual exhaustion, masturbation, or menstrual
disturbance. There are women, sober and temperate enough at
other times, who are afflicted with an uncontrollable propensity
for stimulants at the menstrual period; and every large asylum
furnishes examples of exacerbation of insanity or epilepsy coin-
cident with that function. In fact, where there is a condition
of unstable equilibrium of nerve element, any cause, internal
or external, exciting a certain commotion, will upset its stability,
just as occurs in the case of the spinal cord under similar circeum-
stances. By his acts, as well as by his speech, does man utter
himself; gesture-language is as natural a mode of expression as
speech; and it is in insanity of action that this most dangerous
form of affective insanity is expressed—most dangerous, indeed,
because so expressed.

Amongst numerous examples that might be quoted of this
form of insanity, in order to illustrate different uncontrollable
impulses—suicidal, homicidal, erotic, or of other kind—it shall
suffice here to adduce three cases, all of which came under my.
observation and treatment. The first is an instance of irresistible
suicidal impulse :—

A married lady, aged thirty-one, who had only one child a few
ut.) VARIETIES OF INSANITY. 347

months old, was for months afflicted with a strong and per-
sistent suicidal impulse, without any delusion or any disorder
of the intellect. After some weeks of zealous attention and
anxious care from her relatives, who were all most unwilling
to send her from among them, it was found absolutely necessary
to send her to an asylum; so frequent were her suicidal attempts,
so cunningly devised, and so determined. On admission she was
very wretched because of her frightful impulse, and often wept
bitterly, deploring the great eer and trouble which she caused
to her friends. She was quite rational, even in her great horror
and reprobation of the morbid propensity; and all the fault
that could possibly be found with her intellect was, that it was
enlisted in the service of the morbid impulse. She had as
complete a knowledge of the character of her insane acts as
any indifferent bystander could have, but she was completely
powerless to resist them. Nevertheless, her attempts at suicide
were unceasing. At times she would seem quite cheerful, so as
to throw her attendants off their guard, and then would make
with quick and sudden energy a pre-contrived attempt. On one
occasion she secretly tore her night-dress into strips while in
bed, though an attendant was close by, and was detected in the
attempt to strangle herself with them. For some time she
endeavoured to starve herself by refusing all food, and it was
necessary to feed her with the stomach-pump. The anxiety
which she caused was almost intolerable, but no one could
grieve more over her miserable state than she did herself.
Sometimes she would become cheerful and seem quite well
for a day or two, but would then relapse into as bad a state
as ever. After she had been in the asylum for four months,
she appeared to be undergoing a slow and steady improvement,
and it was generally thought, as it was devoutly hoped, that one
had seen the last of her attempts at self-destruction. Watch-
fulness was somewhat relaxed, when one night she suddenly
slipped out of a door which had been carelessly left unlocked,
climbed a high garden-wall with surprising agility, and ran off
to a reservoir of water, into which she threw herself headlong.
She was got out before life was quite extinct; and after this
all but successful attempt she never made another, but gradually
regained her cheerfulness and her love of life. Her family
348 VARIETIES OF INSANITY. [cuap.

was saturated with insanity. In face of such an example
of uncontrollable impulse, what a cruel mockery it is to
measure the lunatic’s responsibility by his knowledge of right
and wrong !

Cases belonging to the same class as the foregoing, but in
which the impulse was homicidal, have been recorded by many
different observers. The following example occurred in my
practice:—An old lady, aged seventy-two, who had several
members of her family insane, was afflicted with recurring
paroxysms of convulsive excitement, in which she always made
desperate attempts to strangle her daughter, who was very kind
and attentive to her, and of whom she was very fond. Usually
she sat quiet, depressed, and moaning, because of her condition,
and was apparently so feeble as scarcely to be able to move.
Suddenly she would start up in great excitement, and, shrieking
out that she must do it, make a rush upon her daughter that
she might strangle her. During the paroxysm she was so
strong, and writhed so actively, that one person could not hold
her; but after a few minutes of struggling she sank down quite
exhausted, and, panting for breath, would exclaim, “There,
there! I told you; you would not believe how bad I was.” No
one could detect any delusion in her mind ; the paroxysm had all
the appearance of a mental convulsion ; and had she unhappily
succeeded in her frantic attempts, it would certainly have been
impossible to say honestly that she did not know that it was
wrong to strangle her daughter. In fact, it was because of her
horrible propensity to so wrong an act that she was so wretched.
It is a sufficiently striking commentary on the present state of
the English law to add that, had this patient succeeded in
taking her daughter’s life, sentence of execution must have been
passed, and might have been carried into effect, notwithstanding’
she was so entirely insane and irresponsible.

In the Report of the Morningside Asylum for 1850, Dr. Skae
relates a somewhat similar case of a female who was tormented
with “a simple abstract desire to kill, or rather (for it took a
specific form) to strangle,” without any disorder of the intellec-
tual powers, and who “deplored, in piteous terms, the horrible
propensity under which she laboured.” The existence of this
kind of disease is placed beyond doubt by the concurrent testi-
11.] VARIETIES OF INSANITY. 349

mony of all those whose practical knowledge of insanity gives
weight to their opinions and authority to their words; the denial
of it on theoretical grounds derived from the deliverances of a
sane self-consciousness is most unwarrantable. In some of those
who are afflicted with this most distressing form of mental
disease, the only fault that can be found with the intellect is,
that it is enlisted in the service of the morbid propensity—that
it is governed by it, instead of governing it. :

The next case may serve to illustrate a multitude of insane
acts, without corresponding intellectual disorder: there was not
the impulse to any particular insane act, but there were various
perverted feelings and many impulses to different strange and
foolish acts. A young lady, aged twenty-nine, of good appear-
ance and manners, and well connected, was, after long patient
trial at home, sent to an asylum. From the age of twenty-two
there had been a tendency to lowness of spirits without apparent
cause. Lately she had become worse, and was now described as
wilful, impulsive, passionate, and as having lost all affection for
her parents, though formerly most affectionate and amiable. Her
habit of body was sluggish, the circulation being languid and
the extremities often cold and livid; menstruation was very
irregular. She complained of feeling strange, quite unlike herself,
and ill, and would buy all kinds of queer compounds at the
chemist’s, and take them; sometimes she wrapped a wet sheet
round her body, and then put her clothes on over it. She enter-
tained a very high opinion of her talents, and was exceedingly
vain, seeming to think herself a peculiar person, and angrily
complaining that she was treated most shamefully if her inclina-
tions were anywise thwarted. And her inclinations were peculiar,
and suddenly manifested: she would all of a sudden scale a high
garden wall and run off into the fields, or sit down by the road-
side when walking out, and refuse to move for a long time, or
stand still in the middle of the road, or jump up in the middle of
the service and walk out of church. She was continually writing
letters to her parents, relatives, and people whom she did not
know, complaining of her confinement, sometimes angrily, at
other times humorously. Usually the letters were not finished,
but broken off abruptly, sometimes in the middle of a sentence,
and sent for posting: one was addressed to “Tout le Monde.”
350 VARIETIES OF INSANITY. [cHar
The letters often contained very clever and vigorous remarks,
but the sentences were rarely ‘connected, each one being, as it
were, an independent shot; as the thought came automatically
into the mind, so it was automatically expressed. Now and then
she would refuse to take any food for a day or two, and at other
times would eat far more than was good for her. She always
exhibited extreme religious feeling, was fond of distributing tracts
as she went along the road, and would sometimes read to the
unfortunate patients who were more severely afflicted ; notwith-
standing which benevolence, however, she would, if she had not
the exact seat at church which she might happen to desire, burst
into tears and sob with passion, or rise up in the midst of the
service and walk quietly out; at other times she would not move
after the service was over, notwithstanding all the entreaties and
reproaches of those who attended upon her. Adjured beforehand
to behave properly, she would promise to try to do so; remon-
strated with at the timé of her extravagances, or after she had
‘indulged in them, the reply usually was that her motives were
not understood; although when in a better mood she confessed
that she was a great trouble, acknowledged the attention which
she received, and said that she was prompted by Satan; some-
times she wished heartily that some one would give her a good
beating so as to rouse her from her apathy. If any reason was
given for her impulsive deeds at the time, it usually was that “it
was revealed to her” that she was to do so; and it is remarkable
that, though usually overcome with languor, and looking as if
scarcely able to move, she would, when the impulse seized her,
scale a high brick wall with a cat-like agility, though she seemed
to have no definite notion what she was going to do when she
had got over, and had run for a certain distance. In all her
conduct she exhibited an odd combination of reason of thought
and of dementia of action ; a stranger conversing with her would
hardly have discovered that her mind was at all affected; but
any one living with her for a time could not fail to perceive how
exceedingly insane she really was. In truth, it would not be
inappropriate to describe the case as one of Dementia sine
delirio; with good natural endowments and general correctness
of thought there was an insanity of feeling and of action evinc-
ing fundamental derangement of her mental nature. Although
11.] VARIETIES OF INSANITY. 351

hereditary taint was denied, yet it ultimately turned out that
two other near relatives were in confinement, and incurably
insane—a fact which might have been predicted with some
confidence from the character of her disease. The idea which
arose in the mind as the motive impulse of her singular deeds
came not by any regular process of conscious association ; it
appeared as the result of cerebral activity in the recesses of
the unconscious mental life; the unconscious nature, as so
often happens in every one’s life, surprised and overpowered
the conscious life. The idea thus starting automatically into
sudden activity appeared to her verily as a revelation from
heaven or an impulse from Satan; and the action which it
dictated was scarcely more within control than the sudden spasm
of chorea, or the convulsion of epilepsy.

The foregoing cases may be accepted as typical examples of
different forms of impulsive insanity. In each of them there was
a strong hereditary taint, as indeed there commonly is in this
convulsive form of: mental disease; but other causes may give
rise to a similar morbid state without any hereditary taint being
positively detectable. Irregularities of menstruation sometimes
produce severe disorder of nerve element, giving rise in one per-
son to hysterical convulsions or hysterical mania, in another to
epilepsy, and in another to violent suicidal or homicidal impulse.
A woman who was in the deepest despair because she was
afflicted with the idea that she must murder her children, and
frequently ran actively up and down stairs so as to endeavour
to drive away the idea by producing exhaustion, perfectly
recovered on the return of the menses, which had stopped. “We
have, amongst others,” says Dagonet, “observed a patient who
was seized at each menstrual period with violent impulses.
Under the influence of this disposition she had killed her three
children a short time before her arrival at Stephansfeld.”* The
degeneration of nerve element induced by habits of self-abuse, or
by great sexual excesses, sometimes manifests itself in the dan-
gerous form of impulsive insanity. Lallemand relates several
striking cases in which patients suffering from spermatorrhcea
were afflicted with painful homicidal and suicidal impulses.

The most desperate examples of homicidal impulses are

* Traité Hlémentaire et Pratique des Maladies Mentales, par H. Dagonet, 1862.
852 VARIETIES OF INSANITY. [cuar.

undoubtedly met with in connexion with epilepsy. Sometimes
an attack of mania notably precedes an epileptic fit or a series
of epileptic fits ; but it is not so clearly understood that the mental
derangement so occurring may have the form of profound moral
disturbance with homicidal propensity, but without manifest
intellectual derangement. A shoemaker was subject to severe
epileptic fits, and was often furious for a while immediately after
them ; but in the intervals he was sensible, amiable, and indus-
trious. One day, when in the gloomy and morose frame of
mind that often foretells an attack of epileptic fits—a condi-
tion which corresponds with what is described as mania sine
delirio—he met the superintendent of the asylum, to whom he
was much attached, and suddenly stabbed him to the heart. He
had not had a fit for three weeks, but in the night following his
homicidal deed he had a severe fit, and for some time the attacks
continued to be frequent and severe. In such cases, as indeed
in the above case, there are often sudden and vivid temporary
hallucinations. Again, the mental disorder which sometimes
takes the place of an epileptic attack, being in fact a masked
epilepsy, nay appear as simple impulsive insanity. A peasant,
aged twenty-seven, had suffered from epilepsy since he was
eight years old; but when he was twenty-five the character of
his disease changed, and instead of epileptic attacks he was
seized with an irresistible impulse to commit murder. He felt
the approach of his outbreak sometimes for days beforehand,
and then begged to be restrained in order to prevent a crime,
“When it seizes me,” he cried, “I must kill some one, were it
only a child.” Before the attack he complained of great weari-
ness ; he could not sleep, felt much depressed, and had slight
convulsive movements of his limbs.*

The connexion of homicidal insanity with epilepsy is a sub-
ject of extreme importance from a medico-legal point of view,
and one which has only lately received the attention which it
deserves ; it will not be amiss, therefore, to give additional ex-
amples; and to give them in the words of those who have re-
lated them. The first case is one mentioned by Dr. Burrows.

“ A very sober, quiet, and industrious man, et. thirty, subject

* De la Folie considérée dans ses Rapports avec les Questions Médico-judiciaires,
par C. C. H. Mare.
U1] VARIETIES OF INSANITY. 300

to occasional fits of epilepsy, who had lately been much inclined
to religious devotion, was sitting calmly reading his Bible, when
a female neighbour came in to ask for a little milk. He looked
wildly at her, instantly seized a knife, and attacked her and
then his wife and daughter. His aim appeared to be to decapi-
tate them, as he commenced with each by cutting on the nape
of the neck.” He was secured, remained maniacal for three
days, and then recovered, “but never had the least recollection
of the acts he had committed. Nine years have since elapsed
without a recurrence of the epilepsy, or disturbance of his
mental faculties.” *

Griesinger relates the following example of the explosion of
the epileptic awra, not in the usual epileptic seizure, but in
terrible violence :—

“A man who was a brandy drinker lay in a room with his
five children, who were that morning asleep. It came into his
mind that he must then destroy the children; but how could
it be most conveniently done? He said, ‘It rose into my head
like foam ; it went through the chamber like a shot, or like a
strong gust of wind; a strong odour of marjoram filled the
chamber and took away my senses; my thoughts vanished, so
that I sank down. He soon rose again, however, seized an axe,
and hacked right and left among the children, three of whom
fell victims to his violence. If nothing else had been known
than the deed and these details furnished by himself, the
epileptic might almost with certainty be recognised ; but the
medical investigation revealed actual and well-defined epileptic
attack.” t

Dr. Skae describes the instructive case which follows :—

“One of the patients admitted afforded a highly instructive
and interesting example of homicidal and suicidal impulses
without any intellectual derangement or delusions. His case is
classed among those of epileptic mania ; for although he never
suffered from an epileptic fit propaly so called, he laboured
under symptoms which closely approached to those of an epi-
leptic seizure of the milder form known as the petit mal. He
described a feeling like the awra epileptica, beginning at his toes

* Commentaries on Insanity, p. 156,
+ Introductory Lecture—Journal of Mental Science, 1836.

AA
354 VARIETIES OF INSANITY. [cHap,

and rising gradually upwards to his chest, producing a sense of
faintness and constriction, and then going up to his head, and
giving rise to a momentary loss of consciousness. This aura
was accompanied by an involuntary jerking—first of the legs,
then of the arms. It was at the times when he suffered from
these attacks that he felt impelled to commit some act of
violence to others or to himself. On one occasion he attempted
to commit suicide by throwing himself into the water; more
frequently the impulse was to attack others, and was at one
time accompanied by such impetuous violence that it required
the strength of several men to restrain him. He deplored his
malady, of which he spoke with great intelligence, giving all
the details of his past history and feelings, His attacks, which
had been frequent and severe at about the age of sixteen years,
had for a long time almost disappeared, but had lately recurred
at intervals, until it was found necessary to send him to the
asylum. Sleeplessness and constipation almost invariably pre-
ceded his seizures. The state of the patient was greatly im-
proved by the use of bromide of potassium and other remedies,
and, with the exception of one or two very transient and slight
attacks, he has kept well for some months,.”*

Professor Trousseau cites several instances out of an endless
number of cases that he has seen, in which the vertigo of epi-
lepsy was followed by transitory fury during which violence was
done without any recollection afterwards of what had happened,
Indeed, he asserts that “sudden and irresistible impulses are of
usual occurrence after an attack of petit mal, and pretty frequent
after a regular convulsive fit.” t

Because the general perversion of the whole manner of feeling
which exists in all these cases has commonly been so completely
overlooked, attention being fixed exclusively on the morbid
act, a great resistance has been excited in the public mind to
the admission of what seemed to be the dangerous theory of
instinctive insanity. The word “instinctive,” again, is not well
chosen ; it naturally seems absurd to imply that there is in man
an instinct to commit homicide or suicide. Moreover, it is quite
evident in some cases of impulsive insanity that there is present

* Report of the Edinburgh Asylum, 1866.
+ Lectures on Clinical Medicine. By A. Trousseau,
TIL] VARIETIES OF INSANITY. 355

in the mind of the sufferer the idea that he must kill some one ;
the idea arises involuntarily in a mind whose affective nature is
profoundly deranged, and becomes convulsive; he is conscious
of the horrible nature of it, struggles to escape from it, and is
miserable with the fear that it may at any moment prove too
strong for his will, and hurry him into a deed which he dreads,
yet cannot help dwelling upon. So desperate sometimes is the
fear of yielding to the morbid impulse, so intense the horror of
doing so, and so extreme the mental suffering, that a mother,
afflicted with the impulse to kill her child, has killed herself to
prevent a worse consummation. It happens, sometimes, that
the patient succeeds in controlling the morbid idea for a time,
calls up other ideas to counteract it, warns his probable victim
to get out of the way, or begs earnestly to be himself put under
some restraint; but at last, perhaps from a further deterioration
of nervous element through bodily disturbance, the morbid idea
acquires a fatal predominance; the tension of it becomes ex-
cessive; it is no longer an idea the relations of which the mind
can contemplate, but a violent impulse into which the mind is
absorbed, and which irresistibly utters itself in action. As
showing how artificial are the divisions commonly made between
different kinds of insanity, and as illustrating at the same time
the state of the affective life in impulsive insanity, it may not
be amiss to remark here, that while we should describe the pro-
foundly depressed patient struggling with his morbid idea as
suffering from melancholia, we usually designate his disease
impulsive insanity when he is hurried into action by the in-
tensity of the morbid idea. The fact that a person so afflicted
can, and sometimes does, resist the diseased idea or impulse,
causes many to think, and some to argue, that it might always
be successfully resisted. In reality, however, it is a simple
question of the degree of morbid degeneration of nerve element,
whether the idea shall remain in consciousness and be under
subjection, or become uncontrollable and realize its energy in
action. By an act of the will a person may prevent involuntary
movement of his limbs when the soles of his feet are tickled,
but the strongest will could not prevent spasmodic movements
‘of the limbs when the excitability of the spinal cord is increased
by strychnia or disease. It is impossible, however, that true
AA 2
356 ‘VARIETIES OF INSANITY. [crar.

-conceptions of mental disease can be acquired until men cease
to regard its phenomena entirely from a psychological point of
view, and consent to study them by aid of the established prin-
ciples of physiology and pathology. The despair of any one
writing upon mental diseases at present is, that he cannot
convey just and adequate ideas of them by any care or labour
of expression so long as men will judge them by the revelations
of sane self-consciousness. Such practice is not one whit less
absurd than it would be to form conclusions with regard to con-
vulsions on the basis of the recognised power of the will over
voluntary movements.

Once more let it be distinctly affirmed, that the disordered
condition of nerve element, of which the morbid impulse to a
violent deed is so marked a symptom, is not less certainly
evidenced by a general perversion of feeling or of the affective
life. It is the violence and suddenness of the outward reaction
in impulsive insanity which mask the less patent symptoms of
affective derangement.

(0) Moral Insanity.—Here the moral perversion is very
evident and cannot be overlooked, while the outward acts of the
individual are less convulsive in their manifestations, and answer
more exactly to the morbid feelings and desires, than is the case
in impulsive insanity. Hence it is so difficult to induce the
public to entertain the idea that moral insanity is anything
more than wilful and witting vice. Much as the assumption of
it as a disease has been reprobated, there can be no doubt that
all the eminent men who have studied insanity, and whose
authority we habitually accept, are entirely agreed as to the
existence of a form of mental disorder in which, without any
hallucination, illusion, or delusion, the symptoms are exhibited
in a perverted state of those mental faculties usually called the
active and moral powers, or included under feeling and volition
—the feelings, affections, propensities, temper, habits, and con-
duct. As, however, feeling is more fundamental than cognition,
the intellectual activity cannot be entirely unaffected, though
there may certainly not be any positive delusion: the whole
manner of thinking and reasoning is tainted by the morbid
self-feeling through which it is secondarily affected. . The
patient may judge correctly of the relations of external objects
111.] VARIETIES OF INSANITY. 357

and events, and may reason very acutely with regard to them;
but no sooner is self deeply concerned, his real nature touched
to the quick, than he displays in his reasoning the vicious in-
fluence of his morbid feelings and an answering perversion of
conduct: he cannot truly realize his relations, and his whole
manner of thought, feeling, and conduct in regard to himself is
more or less false. The social fabric is held together by moral
laws; but we have here a being who, by reason of his inability
to recognise them, is outlawed from the social domain. In a
great many cases, where this disordered condition of mind is
met with, it will be found to precede an outbreak of unques-
tioned insanity—indeed, we might almost say that in more or
less marked form it precedes nearly every attack of insanity ;
while in other cases it will be found to be a condition persisting
for a time after all the intellectual derangement of an attack of
madness has disappeared. The disappearance of hallucination
or delusion only becomes a sure sign of convalescence when
the patients return at the same time to their natural healthy
feelings.

When moral insanity is thought to exist by itself, and to con-
stitute the disease, as it certainly may do, it would be quite
unjustifiable to assume that a particular vicious act or crime, or
a series of vicious acts, proved its existence ; in the previous
history of the patient there will be evidence of a sufficient cause
of disease having been followed by an entire change of manner,
of feeling, and acting; the vicious act or crime will be logically
traceable through a chain of symptoms to disease as cause, as
the acts of the sane man are traced to or deduced from his
desires and motives. “There is often,” says Dr. Prichard, who
first called attention to this form of mental derangement, “a
strong hereditary tendency to insanity ; the individual has pre-
viously suffered from an attack of madness of a decided cha-
racter; there has been some great moral shock, as a loss of
fortune ; or there has been some severe physical shock, as an
attack of paralysis or epilepsy, or some febrile or inflammatory
disorder, which has produced a perceptible change in the habi-
tual state of the constitution. In all these cases there has been
an alteration in the temper and habits,”*

* A Treatise on Insanity and other Disorders of the Mind. By J.C. Prichard, M D.
358 VARIETIES OF INSANITY. [[orar.

When compelled to give an opinion touching a particular case
of suspected moral insanity, it is of importance to bear in mind
that the individual is a social element, and to have regard there-
fore to his social relations. That which would scarcely be
offensive or unnatural in a person belonging to the lowest strata,
of society—and certainly nowise inconsistent with his relations
there—would be most offensive and unnatural in one holding
a good position in society, and entirely inconsistent with his
relations in it: words which, used in the latter case, would
betoken grave mental disorder, may be familiar terms of address
amongst the lowest classes. Between individuals, as elements
in the social organism, there is in this regard a difference not
unlike that which there is between the different kinds of organic
elements in the bodily organism; it is important, therefore, to
have in remembrance the individual’s social relations when
dealing with moral insanity, as we regard the very different
relations of an epithelial cell and a nerve-cell when dealing with
structures so far apart in the scale of life. As it is chiefly in
the degeneration of the social sentiments that the symptoms of
moral insanity declare themselves, it is plain that the most
typical forms of the disease can only be met with in those who
have had some social cultivation.

The following cases, which came under my observation and
treatment, may stand here as examples of a mental perversion
which it would seem impossible to describe as other than moral
insanity :—

Miss A. B., aged thirty-eight, was the only child of indulgent
parents who were in high social position and wealthy. Her
father was harmlessly insane, nearly imbecile, and it was ne-
cessary, after every means of controlling her at home had been
tried in vain, to send her to an asylum. She was completely
given over to drinking spirits when she could get them, and
would bribe the servants or any one else she could bribe to buy
spirits for her ; nor was she capable of any self-restraint in other
regards, making no scruple to indulge whatever passion she
found means of indulging. When excited she was extremely
violent in conduct, and on more than one occasion threatened
her father’s life with a pistol. When she could not get spirits,
she was abusive, mischievous, quarrelsome, full of complaints
m.] VARIETIES OF INSANITY. 359

of the injustice done to her, and truly intolerable. In the
asylum she was the cause of endless disturbances; continually
making complaints against the attendants, ingeniously per-
verting and exaggerating real facts so as to make of them
monstrous iniquities, doing the most mischievous things for
the sole purpose of giving trouble and annoyance to the
servants, and delighted with her success; sometimes she would
refuse to take her food, and at the same time would bribe the
attendant to secrete it for her so that she might take it with-
out any one else knowing. Removed from the asylum, partly
in consequence of her manifold complaints, she was tried at
home unsuccessfully, then sent back to the asylum, where she
went on just as before, removed again after a time, sent to
a different asylum, taken away from that, and sent again to
another ; indeed, her wanderings were many, and she was the
hopeless patient of every doctor who had the misfortune to
have anything to do with her.

Miss C. D., et. forty-five, was a cousin of the above patie
and also of good social position. Her appearance was anything
but attractive; she was withered, sallow, blear-eyed, with an
eminently unsteady and untrustworthy eye. So improper and
immoral was her conduct, that she was obliged to live apart from
her family in lodgings; for she seemed incapable, in certain
regards, of any control over her propensities. Whenever she was
able, she left her lodgings to spend days together at a brothel
with a common fellow, whom she supplied with money, frequently
pawning her clothes for that purpose, When at home, she
generally lay in bed for most of the day. No appeal was of any
avail to induce her to alter her mode of life. She was prone
to burn little articles, impulsively throwing them into the fire,
saying that she could not help it, and then cutting and pricking
her own flesh by way of penance. Now and then she would all
of a sudden pirouette on one leg, and throw her arms about ;
and, with like sudden impulsiveness, would not unfrequently
break a pane of glass. When reasoned or remonstrated with
about her foolish tricks, she professed to feel them to be very
absurd, expressed great regret, and talked with exceeding plausi-
‘bility about them, as though she was not responsible for them,
but was an angel in difficulties, which she could not overcome.
360 VARIETIES OF INSANITY. [cuar.’

It was of no use whatever speaking earnestly with her, for she
admitted her folly to a greater extent than accusation painted it,
and spoke of it with the resigned air of an innocent victim.
Her habits were unwomanly, and often offensive. The more
sensible of the other patients amongst whom she was, used to
get very angry with her, because they thought that she could
behave better if she would. “One can bear with Miss ;
because, poor girl, she does not know what she does, and cannot
help it; but Miss knows quite well what she is about, and
I am quite sure she can help it if she likes,” was the style of
complaint made against her. And there could be no doubt that
she did know perfectly well what she was about, but her un-
conscious vicious nature, ever prompting, surprised and over-
powered conscious reflection, which was only occasional.

Miss , et. forty, was respectably connected, and was
herself possessed of sufficient property to enable her to live
independently. She had a sister confined in an asylum. For
a long time she had been utterly given over to intemperance,
and lost to all sense of propriety ; she was abandoned to sexual
indulgence, and cared not with whom, and more than once had
been sent to prison for her irregularities. Her natural feelings
and affections were entirely perverted, and she wrote angrily and
abusively to her brother, who had at last been compelled to
take steps to have her taken care of, telling him that she was
under the protection of an officer, and that she would let him
know that she was a gentleman’s prostitute. Of truth she
seemed quite unable to form a conception, while lies, mischief,
and vice were congenial to her nature. When prevented from
indulging her vicious propensities, she would lie all day on the
sofa, asserting that she was too ill to do anything, even to take
a walk, and insisting that she ought to have every sort of
delicacy. In her moods of excitement, she would sometimes
talk of people plotting against her, and of herself being guided
by the ruling planets; but there was no positive intellectual
disorder detectable, though there was a painful state of extreme
and hopeless moral alienation.

It is quite certain that these three women, so lost to all sense
of the obligations and responsibilities of their position, could
not restrain their immoral extravagances and perverse acts for

 

 

 
1i1.] VARIETIES OF INSANITY. 361

any length of time; punishment had no effect, except in so far
as it was a restraint for the time being. All of them knew
quite well the difference between right and wrong, but no motive
could be excited in their minds to induce them to pursue the
right and eschew the wrong ; their conduct revealed the tyranny
of an unhappy organization ; its natural affinities were for evil ;
the world’s wrong was their right. The ruling planets, by which
one of them in her angry moods professed to be guided, were
not, therefore, an absolute fiction, for therein was expressed the
fate made for her by a vicious organization. For a like reason
such patients feel no shame, regret, nor remorse for their conduct,
however flagrantly unbecoming and immoral it may have been,
never think that they are to blame, and consider themselves ill-
treated by their relatives when they are interfered with. They
are examples illustrating the retrograde metamorphosis of mind.
The moral feeling has been slowly acquired in the course of
human cultivation through generations as the highest effort of
mental evolution; and in the course of family degeneration, we
find its loss mark a stage in the downward course. The victims
of such vice or defect of nature cannot be fitted for social inter-
course. Friends may remonstrate, entreat, and blame, and
punishment may be allowed to take its course, but in the end
both friends and all who know them recognise the hopelessness
of improvement, and acknowledge that they must be sent to an
asylum. This, or a control equal to that enforced in such an
establishment, is the only treatment applicable to them; for
they are so viciously constituted that they could not be different
uuless by being born again.

It is where hereditary taint exists that we meet with the most
striking examples of this kind of insanity, and those which often
cause such great difficulties in medico-legal investigations. There
is the strongest aversion on the part of the public to admit that
an extreme hereditary taint may be a not less certain cause of
defect or disease of mind than an actual injury of the head;
and yet it is the fact. The hereditary predisposition to insanity
signifies some unknown defect of nervous element declaring
itself in a disposition to irregularities in the social relations ;
the acquired infirmity of the parent has become the natural
infirmity of the offspring, as the acquired habit of the parent
362 VARIETIES OF INSANITY. [cHAP.

animal observably becomes sometimes the instinct of the off-
spring. Hence comes the impulsive or instinctive character of
the phenomena of hereditary insanity, the actions being fre-
quently sudden, unaccountable, and seemingly quite motiveless,
Appeal calmly to his consciousness, the individual may reason
with great intelligence, and seem nowise deranged; leave him
to his own devices, or place him under conditions of excitement,
his unconscious life appears to get the mastery, and drives him,
to immoral, extravagant, and dangerous acts. He perpetrates
some singular act of eccentricity because all the world will
censure it, or even commits a murder for the sole purpose of
being hanged. It is worse than useless for a sound mind to
attempt to fathom the mad motives which spring up in a mad-
man’s mind; it is most unjust to measure his actions by a
standard based upon the results of an examination of sane self-
consciousness : to do so is simply to attempt to make coherence
and incoherence, order and disorder, equivalent. Only long
experience and careful study of actual cases of mental disease
will suffice to give any sort of adequate notion of what a
madman really is.

When there is no hereditary taint detectable in a case of
so-called moral insanity, it is necessary to traverse the whole
physical and mental life of the patient, by a careful research inta
his previous history, and scrupulous examination of his present
state. It will be of great moment to ascertain whether there
has been any previous attack of insanity; for it sometimes
happens that after one or two attacks of melancholia with
suicidal tendency, from which recovery has taken place, the
patient has an attack of genuine moral insanity, which may
finally pass into intellectual disorder and dementia. The ex-
tremest example of moral insanity which I have seen was in an
old man aged sixty-nine, who had been in one asylum or another
for the last fifteen years of his life. He had great intellectual
power, could compose well, write tolerable poetry with much
fluency, and was an excellent keeper of accounts. There was
no delusion of any kind, and yet he was the most hopeless aud
trying of mortals to deal with, Morally he was utterly de-
praved; he would steal and hide whatever he could, and several
times made his escape from the asylum with marvellous
u.] VARIETIES OF INSANITY. 363

ingenuity. He then pawned what he had stolen, begged, and
lied with such plausibility that he deceived many people, until
he finally got into the hands of the police, or was discovered, in
a most wretched state, in the company of the lowest mortals in
the lowest part of the town. In the earlier part of his insane
career, which began when he was forty-eight years old, he was
several times in prison for stealing. In the asylum he was a
most troublesome patient. He could make excellent sugges-
tions, and write out admirable rules for its management, and
was very acute in detecting any negligence or abuse on the part
of the attendants, when they displeased him ; but he was always
on the watch himself to evade the regulations of the house, and,
when detected, he was most abusive, foul, and blasphemous in
his language. He was something of an artist, and delighted to
draw abominable pictures of naked men and women, and to
exhibit them to those patients who were addicted to self-abuse.
He could not be trusted with female patients, for he would
attempt to take indecent liberties with the most demented crea-
ture. In short, he had no moral sense whatever, while all the
fault that could be found with his very acute intellect was, that
it was entirely engaged in the service of his depravity. It may,
no doubt, be thought that he was a desperately wicked criminal,
and that his proper place was the prison. But the prison had
been tried many times, and tried unsuccessfully. And there
was another reason why prison-discipline could not rightly be
permitted to supersede asylum treatment. At long intervals,
sometimes of two years, this patient became profoundly melan-
cholic for two or three months, refused to take food, and was as
plainly insane as any patient in the asylum. It was in an
attack of this sort also that his disease first commenced.

In other cases of moral alienation there will be found to have
been more or less congenital moral defect or moral imbecility ;
maniacal exacerbations of positive moral insanity occurring
perhaps at puberty, perhaps at the menstrual periods, perhaps
after severe disappointment. Again, moral insanity may occur
after acute fevers, after injury to the head, after some form of
brain disease; in some instances it is the first stage of mental
degeneration consequent on self-abuse ; now and then it occurs
in consequence of a severe moral shock as the forerunner of
364 VARIETIES OF INSANITY. {cHap.

more marked insanity ; and it not unfrequently precedes general
paralysis. But the disease with which it is most commonly
found in conjunction is epilepsy: a so-called masked. epilepsy
sometimes appears in attacks of positive moral insanity of
variable duration and of periodical recurrence, the attacks
perhaps coming on regularly for months before the charac-
teristic convulsions make their appearance; or extreme moral
perversion may immediately precede epilepsy; or again, the
epileptic convulsions may cease, and attacks of moral insanity,
with more or less maniacal excitement, take their place. There
can be no question in the minds of those who have studied
mental diseases that certain unaccountable criminals belong to
the class of epileptics.*

Thus much concerning this second variety of affective insanity
—Moral Insanity Proper. Whatever name it may ultimately
be thought best to give it, there can be no doubt of the necessity
of recognising in practice the existence of such a form of disease.
If, indeed, the evidence drawn from its own nature and causa-
tion were insufficient, the fact that it is often the immediate
forerunner of the severest mental disease might suffice to teach
its true pathological interpretation. When, therefore, a person
in good social position, possessed of the feelings that belong to a
certain social state, and hitherto without reproach in all the
relations of life, does, after a cause known by experience to be
capable of producing every kind of insanity, suddenly undergo a
great change of character, loose all good feelings, and from being
truthful, temperate, and considerate, become a shameless liar,
shamelessly vicious, and brutally wicked, then it will certainly
be not an act of charity, but an act of justice, to suspect the
effects of disease. At any rate it behoves us not to be misled in
our judgment by the manifest existence in such a patient of a
full knowledge of the nature of his acts—of a consciousness, in
fact, of right and wrong; but to remember that disease may
weaken or abolish the power of volition, without affecting con-
sciousness. Fortified by this just principle, we shall be far
better prepared for a right interpretation of the facts of a

* Morel, D’une Forme de Délire suite d’une Surexcitation nerveuse se rat-
tachant & une Variété non encore décrit d’fipilepsie: 1860. J. Falret, De Btat
Mentale d’fpileptiques.
It.) VARIETIES OF INSANITY. 365

particular case than when biassed or blinded by the opposite
most false principle.

3. Ideational Insanity—Under this general name may be
included those different varieties of insanity usually described as
Mania or Melancholia : the unsoundness affects ideation, and is
exhibited in delusions and intellectual alienation. Cases of
ideational insanity are easily recognised to be of two principal
kinds, according to the character of the accompanying feeling:
in one kind there is great oppression of the self-feeling with
corresponding gloomy morbid idea; in the other there is excite-
ment or exaltation of the self-feeling, with corresponding lively
expression of it in the character of the thoughts or in the conduct
of the patient. The former cases belong to Melancholia ; the
latter to Mania, acute or chronic. Again, on looking at cases
of ideational insanity, it is easily seen that there is general in-
tellectual derangement in some, while in others the alienation
seems to be confined to a small number of fixed ideas; so that
we might make a division of ideational insanity into (a) general
and (0) partial. If we did so, then partial ideational insanity
would really correspond with what Esquirol called Monomania,
though not with what is now usually called so; for under that
name was included by him not only partial mania accompanied
by an exciting or gay passion, but also partial intellectual in-
sanity accompanied by a sad and oppressive passion ; the latter
he sub-distinguished as Lypemania, but it is now commonly
known as Melancholia. Whether this is wisely done may admit
of considerable doubt: there are met with in practice as many
varieties of emotional perversion as there are varieties of morbid
ideas, different patients exhibiting every degree and kind of
passion, from the rapture of the exalted monomaniac to the deep
gloom of the profound melancholic ; accordingly it is not always
possible, under the present nomenclature, to determine satis-
factorily whether a particular case belongs to monomania or to
melancholia. Certain cases of melancholia do in point of fact
furnish the best examples of monomania. Another reason
against the present classification is that there are cases of acute
melancholia in which the excitement and the derangement of
ideas and conduct are so great that they run insensibly into
acute mania, and might just as properly be called so: they are
366 VARIETIES OF INSANITY. [cHaP.

examples of acute ideational insanity, but whether they are
classified as maniacal or melancholic is very much a matter of
caprice or accident.

A third objection to an adherence to the present artificial
classification is, that it has unquestionably fettered observation,
and hindered the faithful study of the natural history of insanity.
The different forms of affective insanity have not been properly
recognised and exactly studied because they did not fall under
the time-honoured divisions; and the real manner of commence-
ment of intellectual insanity in a disturbance of the affective
life has frequently been overlooked. It is true that Guislain
and Griesinger have pointed out that a melancholic stage of de-
pression almost invariably precedes an outbreak of mania; there
can be no doubt that the sequence is traceable in very many
cases; but it cannot be admitted, as some would have it, in
every case. What has been overlooked even by those who have
not overlooked the preliminary affective derangement is, that
there is not only (a) a melancholic perversion of the affective life
preceding intellectual derangement, but that there is also (6) a
maniacal perversion of the affective life, so to speak,—an affec-
tive insanity which is of an excited or expansive kind, in which
the individual’s self-feeling is greatly exaggerated or morbidly
exalted. It is a maniacal disorder of the feelings, sentiments,
and acts, without delirium, and it is expressed chiefly as the
corresponding affective melancholia is, not in delusion but in the
conduct of the patient. Though frequently following a brief
stage of melancholic depression, this condition is sometimes
primary. It is displayed in a great change of moral character:
the parsimonious person becomes extravagant, the modest man
presumptuous and exacting, the affectionate parent thoughtless
and indifferent ; there is great liveliness of manner, or a restless
activity as of one half-intoxicated ; an overweening self-esteem
is very evident ; and an extravagant expenditure of money, an
excessive sexual indulgence, or other intemperance, is common.
The tone of the mental nature is profoundly deranged; the
foundations of the mental being are shattered; and the patient
is often practically less fitted for his relations in life than at a
subsequent stage of the disease, when matters have gone further
and the morbid action is systematized in definite delusions, In
Lr] VARIETIES OF INSANITY. 367

some cases there may be less exaltation manifest, while the per-
version of the affective life is more marked,—in other words,
the moral alienation more extreme; this condition being perhaps
best witnessed in that profound moral derangement which some-
times precedes a series of epileptic fits, or takes the place of an
epileptic fit. The premonitory symptoms presented by insane
epileptic patients, before a fit or a succession of fits, may be of
a melancholic or of a maniacal nature, corresponding in this
regard with the premonitory symptoms of an attack of mania.
Certain epileptics, before the convulsive seizures, are moody,
sullen, morose, irritable and quarrelsome; the patient who at
other times is pleased with any notice or attention, will then
perhaps get into a violent and dangerous fury if spoken to;
others suffer from slowness of ideas, failure of memory, phy-
sical and moral prostration; while others again are unusually
animated, loquacious, active, display exaggerated notions of
their physical and moral well-being, and become at times
even maniacal. It is worthy of note too, in relation to the
vivdi hallucinations which sometimes arise in mania sine
delirio and become the causes of desperate acts of violence,
that similar vivid hallucinations foretell in some cases the
epileptic attack.

So soon as we have recognised the existence of a deep perver-
sion of the feelings, sentiments, and acts, having a brisk maniacal
rather than a gloomy melancholic character, and preceding in
some cases the outbreak of intellectual derangement, we fail not
to perceive how closely it is allied to, or rather how fundamen-
tally identical it is with, those stages of insane degeneration
already described as varieties of affective insanity. In fact, the
Mania sine delirio of Pinel, the Monomante raisonnante ou sans
délire of Esquirol, the Monomante affective of the same author,
and the Moral Insanity of Prichard,—all are varying phases of
this affective disorder, which, continued, usually ends in positive
intellectual disorder or dementia. Though an earlier stage of
mental degeneration than intellectual insanity, it is really, from
a social point of view, a more dangerous form of mental disease ;
for its natural tendency is to express itself, not in words, as
ideational insanity does, but in actions. It is a condition in
which dangerous hallucinations and dangerous impulses are
368 VARIETIES OF INSANITY. [cHap.

both apt to arise suddenly and to hurry the patient into some
desperate act. Once more then let it be repeated, that man
is not only a consciously active being, but also an uncon-
sciously active being; and that, although the unconscious
mental function is, in the state of perfect bodily health, sub-
ordinated to the directing power of the will, yet, when disease
has disturbed the harmony of parts, the unconscious activity
displays its effects independently of the will or even of con-
sciousness.

For the foregoing reasons, I hold that it would conduce to
greater precision of knowledge, and would be followed by some
valuable practical results, if the present artificial classification,
which is not really in conformity with nature, and which as-
sumes a fictitious exactness, were considerably modified. If a
broad division were made of insanity into two classes, namely,
insanity without positive delusion and insanity with delusion—
in other words, into affective insanity and ideational insanity ;
and if the subdivisions of these into varieties were subsequently
made—would not the classification, general as it may appear,
and provisional as it should certainly be deemed, be for the
present preferable to one which, by postulating an exactness
that does not exist, is a positive hindrance to an advance in
knowledge? It will be necessary to clear the ground of old
incumbrances before attempting to lay the-foundation of a better
structure; and it will be desirable to encumber it as little as
possible until the materials for a new and natural classification
have been collected. One desirable result of great practical
consequence—medico-legally—could not fail to follow the modi-
fication of the received classification; that is, the adequate
recognition of those serious forms of mental degeneration in
which there are no delusions. I have ventured, accordingly, in
a former publication, to put forward the following arrangement;
and I use it here, not as a complete and positive scientific classi-
fication, which can only be a devout imagination for some years
to come, but as a convenient scheme for treating of the symp-
tomatology of mental diseases : *—

* Article “Insanity,” in Reynolds’s System of Medicine, vol. ii. See note on
‘* Classification” at the end of the chapter.
111.] VARIETIES OF INSANITY. 369

I, AFFECTIVE OR PATHETIC II], IDEATIONAL INSANITY.
INSANITY,

1, MantacaAL PERVERSION oF THE 1, GENERAL.
AFFECTIVE LIFE. MANIA SINE a. Mania. Acute and
DELIRI0. b. Melancholia. Chronic.

2. MeLancuontic Depression wirH- 2. PARTIAL
out Dr.usion. SrmpLe MELAn- @. Monomania.
CHOLIA. 6. Melancholia.

3. MoRaL ALIENATION Proper. Ap- 8. DEmEnTrA, primary and secondary.
proaching this, but not reaching . GENERAL PARALYSIS.
the degree of positive insanity, is 5. Ip1ocy, including Impecruiry.
the INsanE TEMPERAMENT.

~

The cases of so-called impulsive insanity, which for practical
purposes has just been illustrated separately, will really fall
under one or other of the above-mentioned varieties of affective
insanity: in all of them dangerous impulses are apt to arise,
and to express themselves in convulsive action; and where a
desperate impulse displays itself without any apparent affective
disorder, it is only that the outward violence masks the internal
derangement,

Whatever classification be adopted in the present state of our
knowledge of so obscure a subject, it must be provisional. What,
meanwhile, it is most important to bear in mind is, that the
different forms of insanity are not actual pathological entities,
but different degrees or kinds of the degeneration of the mental
organization,—in other words, of deviation from healthy mental
life; they are consequently sometimes found intermixed, replacing
one another, or succeeding one another, in the same person.
There is in the human mind a sufficiently strong propensity not
only to make divisions in knowledge where there are none in
nature, and then to impose the divisions upon nature, making
the reality thus conformable to the idea, but to go further, and
to convert the generalizations made from observation into posi-
tive entities, permitting for the future these artificial creations
to tyrannize over the understanding. A typical example of
madness might be described as one in which the disorder, com-
mencing in emotional disturbance and eccentricities of action—
in derangement of the affective life—passes thence into melan-
cholia or mania, and finally, by a further declension, into demen-
tia. This is the natural course, also, of mental degeneration when
proceeding unchecked through generations, Although then we

BB
370 VARIETIES OF INSANITY. * [orap.

may have the different stages passed through within the brief
space of a single life, this is not a sufficient reason why they
should not be distinguished and separately treated of; for not
only may a person suffer from one kind of mental derangement
without ever falling victim to another, but the different varieties
run their particular course, call for their special prognosis, and
require their special treatment.

(a) Partial Ideational Insanity.—This division will corre-
spond with that originally described as monomania by Esquirol,
and will include not only delusion accompanied by an exalted
passion, but also delusion accompanied by a sad and oppressive
passion—monomania proper and ordinary melancholia. In the
former an exalted self-feeling gets embodied in a fixed delusion,
or ina group of delusions, which fails not to testify an overween-
ing self-esteem ; itis clothed in a corresponding delusion of power
or grandeur, and the personality.of the patient, who may fancy
himself king, prophet, or divine, is transformed accordingly: in
the latter, the feeling of oppression of self becomes condensed
into a painful delusion of being overpowered by some external
agency, demonic or human, or of salvation lost through indivi-
dual sins. In both cases we have a partial ideational insanity—
in the one case with overweening esteem of self, in the other with
oppression of self—with fixed delusion or delusions upon one
subject or a few subjects, apart from which the patient reasons
tolerably correctly. Pathologically, there is a systematization
of the morbid action in the supreme cerebral centres—the esta-
blishment of a definite type of morbid nutrition in them.

A morbid idea, or a delusion, engendered in the mind and per-
sisting there, may be compared with a morbid growth in some
organ of the body, or with a chronic morbid action, which cannot
be brought under the correcting influence of the surrounding
healthy tissues, and restored to a sound type. Similarly, the
morbid idea does not, as in health, call up other ideas which
may supersede it, its energy being transferred, and itself becom-
ing latent or statical under the unconscious assimilating influ-
ence of the cerebral centres, so that the present is brought into
accord with the past, or with that mental organization which by
an abstraction we call the ego ; but the morbid idea is not assi-
milable, cannot be brought under the domain of the laws of the
1It.] VARIETIES OF INSANITY, 3871

surrounding healthy structures and made of the same kind with
the sound elements of the mental organization, is in entire con-
tradiction with the past, and remains unaffected by reflection,
because it cannot really enter into any reflection. Like a
cancer, or any other strange morbid growth, it continues
its own morbid life, and the whole conscious life may at any
moment be brought under its dominating influence: it represents
a partial automatic morbid action, like a spasm beyond the con-
trol of volition, though, like a spasm, not always beyond the
knowledge of consciousness. A young man, for example, who
had previously had a few epileptic fits, became extremely
melancholic, being possessed by the morbid idea that he was
to be murdered in his father’s house ; he made frequent attempts
to escape from it, and the precautions taken to prevent his escape
only served to strengthen his delusion.* Reasoning with him was
of no use, for the notion was not explicable on any reasonable prin-
ciples : if a looker-on could truly enter into the steps of the ob-
scure and tangled mental processes by which such a delusion was
generated, he would be as mad as the patient ; and if the patient
could appreciate the force of the reasoning by which the looker-
on proves the notion to be madness, why then he would not be
mad at all. It is the patient’s disease that he cannot: when the
constitution of his nerve element is such that an absurd delusion
of that kind can persist and not be corrected by the stored-up
results of past mental acquisitions—whether such as might be
consciously recalled, or such as existed as statical faculties inter-
working in unconscious assimilating action—then it is the sure
testimony of fundamental damage to the mechanism of mental
action; the consequences of which are a disorder and incohe-
rence of action inconsistent with, and therefore unintelligible to,
the experience of the sound mind. The very fact that such a
notion is not self-annihilating is evidence of a fundamental dis-
order, which, if it should not actually prepare us to look for, at
any rate should make us receive without surprise, any further
irrational exhibition by the patient. Hence also it is that if we
admit the false premisses of the madman’s delusion, he cannot
follow us in rational deductions from them ; he does not generally,
as Locke supposed, reason correctly from false premisses; he is

* Cazauvieh, De la Monomanie Homicide. 1836,
BB 2
372 VARIETIES OF INSANITY. [cHap.

not logically ‘mad ; the sound and the unsound parts of his being
are mixed up in his conduct ; his whole manner of action is more
or less inconsistent and incoherent, and betrays the disease of
which the delusion is a symptom. In vain do men pretend that
the mind of the monomaniac is sound apart from his delusion :
not only is the diseased idea a part of the mind, and the mind,
therefore, no more sound than the body is sound when a man
has a serious disease of some vital organ, but the exquisitely
delicate and complex mechanism of mental action is radically
deranged: the morbid idea could not else have been engendered
and persist. The mind is nof unsound upon one point, but
an unsound mind expresses itself in a particular morbid
action. Moreover, when the delusion is once produced, there
is no power of drawing a sanitary cordon round it, and thus, by
putting it in quarantine as it were, preserving all other mental
processes from infection: on the contrary, the morbid centre
reacts injuriously on the neighbouring centres, and there is no
guarantee that at any moment the most desperate consequences
may not ensue. That was precisely what did happen in the case
which we have taken for illustration: the young man, whose
father was a butcher, becoming calmer after a time, and being
thought trustworthy, was permitted at his own request to be
present at the slaughter of an ox; but when all was finished, he
did not wish to return home. His friends, however, pressed him,
and two of them, taking him by the arm in a friendly manner,
accompanied him towards his home ; but, just as he approached
the door of his house, he suddenly drew out a butcher’s knife
which he had concealed; and stabbed to the heart one of them,
fleeing immediately to the forest, where he passed the night.
Next morning he went to the house of a relative who lived
some distance off, and said that he had run away from home, as
they wished to kill him there. In this case the homicidal act
had a discoverable relation to the delusion, although a very
insane one; but in some cases of monomaniacal delusion there
is no relation whatever discoverable between the delusion and
the act of violence, while in others the patient may subsequently
make known a most absurd and incoherent connexion which the

most sagacious looker-on would never have suspected, and cannot
understand.
un] VARIETIES OF INSANITY. 373

The signification of a persistent delusion in the mind, in
regard to those intimate organic processes on which rests the
integrity of mental action, is threefold: first, the fact of the
delusion betokens a fundamental disorder in the organic pro-
cesses of the mental organization as the condition of its exist-
ence, the extent of such disorder being nowise necessarily
limited to its production ; secondly, the existence of a morbid
area in the midst of numerous most sensitive nervous centres,
which are connected in the most delicate, intimate, and complex
manner, will tend to produce by sympathy, infection, or induc-
tion, or reflex action, call it as we may, some derangement in
them ; and, thirdly, the automatic activity of the morbid centre,
reaching a certain intensity, may become an uncontrollable im-
pulse, and, irresistibly uttering itself, hurry the patient into an
insane action instigated by it. In other words, psychologically
speaking, the existence of a delusion indicates fundamental dis-
order of mental action—radical insanity; secondly, the delusion
reacts injuriously upon other mental phenomena, interfering
secondarily with correct ratiocination, or due co-ordination of
function, and predisposing to convulsive mental phenomena ;
and, thirdly, while it cannot be subordinated to reflection, the
individual may at any moment be subordinated to it, and act
under its instigation. The mind, then, which suffers from
positive ideational insanity, however seemingly partial, is, being
unsound, not to be relied upon, nor to be held responsible ; disease
is going on in it, and it does not depend upon the individual’s
wishes or will what course it shall take or what height it shall
reach, any more than the health of a man bodily sick depends
upon the desire which he may have to rise, take up his bed
and walk.

Certainly, in some cases of so-called monomania or partial
ideational insanity, there does appear to be but little evidence of
insanity apart from the particular morbid ideas; but such cases
are generally met with in an asylum, where the patient is re-
moved from those particular relations in which the moral
perversion might be expected to display itself, and where the
quiet regularity of life and the absence of all exciting impressions
favour the latency of the affective insanity. Allow those patients
who are so calm and serviceable in the asylum to return to active
3874 VARIETIES OF INSANITY. [cHar.

life, and to be subjected to the strain of trying circumstances, or
the stress of adverse events, and they soon suffer from attacks of
general excitement, if they do not perpetrate acts of dangerous
violence ; even in the asylum they have now and then their
bad times, in which they are morose, uncertain, and excitable.
Nothing is more surprising to the inexperienced person than
the extreme passionate excitement and utter irrationality, when
they do break out, of these monomaniacs, whom he has hitherto
regarded as quite sensible apart from their delusion, and as
harmlessly interesting perhaps by reason of it. They will mostly
tolerate with great composure the annoyances of their fellow-
patients, because they look down upon them with pity as mad ;
but once let them be offended and excited, it is rendered very
plain how unstable and dangerous is their state of mind.

It is necessary to guard against the mistake of supposing the
delusion to be the cause of the passion, whether painful or gay,
that may accompany partial ideational insanity, In cases of
simple melancholia there may be no delusion: the patient’s
feeling of external objects and events may be perverted so that
he is conscious of being strangely and unnaturally changed ;
impressions which should be agreeable or indifferent are painful ;
he feels himself strangely isolated, and cannot take any interest
in his affairs; he is profoundly miserable and shuns society,
perhaps lying in bed all day. All this while he may be quite
conscious of his unnatural state, and may strive to conceal it
from his friends. Suddenly, it may be, an idea springs wp in
his mind that he is lost for ever, or that he must commit suicide,
or that he has committed murder and is about to be hanged;
the vast and formless feeling of profound misery has taken form
as a concrete idea—in other words, has become condensed into
a definite delusion, this now being the expression of it. The
delusion is not the cause of the feeling of misery, but is engen-
dered of it,—is precipitated, as it were, in a mind saturated with
the feeling of inexpressible woe; and it takes different forms
according to the degree of the patient’s culture, and the social,
political, and religious ideas prevailing at the particular epoch.
In some cases it is striking how disproportionate the delusion is
to the extreme mental anguish, the patient assigning the most
ridiculously inadequate cause for his gloom: one man under my
11.] VARIETIES OF INSANITY, 375

care, whose suffering was very great, said that it was because he
had drunk a glass of beer which he ought not to have done, and
another man was, as he thought, lost for ever because he had
muttered a curse when he ought to have uttered a prayer. With
him who believes that he is doomed to infinite and eternal
misery, it is not the delusion but the affective disorder that is
the fundamental fact; there cannot be in the finite mind an
adequate or definite idea of the infinite or the eternal; and the
insane delusion of eternal damnation is but the vague and futile
attempt to express an unutterable real suffering. In all these
cases of melancholia the deep sense of individual restriction
which exists, the wretched feeling of the oppression of self, is in-
terpreted as due to some external agency; and as the existence
of any passion notably intensifies an idea that is congruous with
it, the delusion ultimately attains great vividness. So with
regard to other passions, whether excited by some external event
or some internal commotion; when vehement and long con-
tinued, they are apt to end in some positive delusion. The vain
petson who cherishes an ambitious passion may after a time be
so entirely possessed by it that he is unable to see things as they
really are, and his overweening self-esteem terminates perhaps
in the delusion that he is emperor, king, or even divine. The
essential nature of the delusion will depend upon the special
nature of the passion in which the individual’s self-feeling
is engaged, but the particular form which it assumes will depend
greatly upon the education and upon the circumstances of life in
which he has been placed. Thus the vain and ambitious person
who has had a religious training will assume a character in
accordance with his sentiments, and will deem himself a prophet
favoured of heaven, or even Jesus Christ; the politician will be
a prime minister, or some great political character; the man of
science will have solved the problem of perpetual motion, or will
be the victim of complicated and ingenious persecution by means
of electricity. When witchcraft was generally believed in, the
insane frequently fancied themselves to be tormented by witches;
but since the police have been established, they often believe the
police to be in pursuit of them. At the time when Napoleon
was setting up and pulling down kings, many people were ad-
mitted into French asylums who believed themselves to be kings
376 VARIETIES OF INSANITY. [cHaP.

nd emperors; and Esquirol thought that he could have written
he history of the French Revolution from the character of the
usanity which accompanied its different phases. The insanity
f any time will be a more or less broken reflection of the
haracter of the events that happen in it.

When a vague morbid feeling of a painful nature gets defi-
itely embodied in a fixed delusion, the patient is often less
ifficult to deal with, perhaps less miserable, than when the
ffective derangement predominates and is occasionally mani-
asted in morbid ideas, or is manifested in transient and changing
elusions. One of the most difficult and distressing cases to
ave to do with in practice is that of a wife possessed with
rorbid feelings of jealousy of her husband; a passion which,
icreasing to an insane degree, breaks out under excitement
ato the most absurd and unfounded accusations and violent
ehaviour, ending finally—it may be at the change of life—in
xed ideational insanity. The monstrous imaginings, the foul
ceusations, the obscene language and violent conduct, some-
ames displayed in such cases before there is any fixed intel-
:ctual derangement, are truly most surprising. These paroxysms
f maddened jealousy are sometimes brought on by an excessive,
ad perhaps secret, indulgence in stimulants, and they are not
nlikely to occur at the menstrual periods.

The following briefly reported cases may serve as illustrations
> partial ideational insanity, and of the foregoing observa-
ons :—

C. K., et. thirty-six, married, had always been of an extremely
digious character and of exemplary behaviour. After he had
xen married for about a year, his present illness began with
meral depression of feeling and with the involuntary appearance
: his mind of blasphemous ideas in spite of all his efforts to
roid them ; he was greatly afflicted by this state of things, his
oom incteased, and at last he concluded that “he had done it,”
-namely, committed the unpardonable sin. Here we perceive,
‘st, a morbid affection of nerve element revealed in the emo-
onal depression, then an automatic and spasmodic activity of
rtain ideational cells manifest in the involuntary and irrepres-
ble ideas that arose, and finally the concentration or systema-
zation of the morbid action into a definite delusion. The patient
un] VARIETIES OF INSANITY. 377

was further very hypochondriacal, and fearful that he should die
soon; but, although his heart’s action was very feeble, and his
pulse remarkably slow, there was no evidence of organic disease ;
and it appeared that the feebleness of cardiac action was due to
the depressing effects of the morbid idea upon the organic func-
tions, all which shared more or less in the prostration. His
reasoning powers were, however, nowise affected apart from his
delusions ; he was fully alive to all business relations, and would
converse intelligently and even cheerfully on indifferent matters.
But the moment his attention was no longer diverted from his
own suffering and otherwise engaged, the morbid idea returned
in all its force, entirely occupied consciousness, his countenance
became overcast, and he—just now so cheerful—presented the
characteristic dejected appearance of profound melancholy. He
lived, as it were, two separate lives—as a sound, reasonable
being, and as a morbid automatic being; he was quite aware of
his affliction, and could reason about it as a man might reason
about a peculiarity of his character or a particular conformation
of his body, though he could not be persuaded of its true nature;
but, so soon as the train of mental activity excited by external
events was past, the morbid idea became consciousness. He
was made so miserable by it that he more than once attempted
suicide. Herein we have an example of what is sometimes called
the correct reasoning of the monomaniac from false premisses ;
believing that he has committed the unpardonable sin, and that
his soul is for ever lost, he does that which may soonest precipi-
tate the result which he so much dreads. An uncle had been
similarly afflicted, and had died insane.

Intelligently as this patient could talk, and rational as he ap-
peared, apart from his delusion, it would not be correct to pro-
nounce him perfectly sensible under such limitation. There was
no sufficient reason in his intellectual disorder why he should not
have continued his business, but he could not do so; he could not
take interest in that, in his family, or in anything else but him-
self ; every impression was more or less painful to him, his whole
manner of feeling being perverted, and he sought therefore to
avoid society and to be alone. At times, too, his anguish in-
creased to a veritable acute paroxysm, and then he looked very
helpless and insane. Now the case which follows, very similar to
78 VARIETIES OF INSANITY. [CHAP.

1e foregoing in general symptoms, illustrates, by an important
lditional symptom, a dangerous feature in some of these cases.

J. B., et. fifty-one, married, had made a small fortune by his
wn energies, and had brought up a family respectably. He was

stout, hard-faced, big-browed man, of surly appearance and
ielancholic temperament. Of the Wesleyan persuasion, he had
lways been very attentive to his religious duties; indeed, reli-
ious devotion was said to be the cause of his illness, which
srtainly began with doubts as to his religious state. He became
loomy, morose, and depressed, and took to his bed five weeks
revious to his being sent to an asylum. He would not get up,
owever much entreated: why should he? He was dying, and
1ere was no salvation for him, for his soul was lost. He slept
rly and ate well, though he professed at times that he could
ot eat. In the asylum he was listless, gloomy, and exceedingly
verse from exertion of any kind, always maintaining that he was
ying. “It’s of no use, I tell you, doctor, asking me how I am:
ou know I’m dying.” Apart from the delusions as to his soul
ad his body, he was intellectually rational, although his affective
fe was much perverted. After a month’s residence, there was
me improvement in his state; he walked outside the grounds
gularly after having been on the first occasion forced to go; he
as more cheerful too, and would talk a little. It was thought
iat he was going on very favourably. One night, however, with-
it any warning, he suddenly started out of his bed, rushed at a
indow, through which it would have been thought impossible
iat a man of his size, or indeed of any usual size, could have
ot, struggled through it, and fell from a height of twenty feet,
rtunately on his feet, so that he was only grievously shaken.
-e was, however, in a state of fearful excitement, fancying that
1e world had come to an end, writhing, and crying frantically,
Let me go, let me go!” Like sudden desperate paroxysms
‘ized him periodically for the next three weeks; after which
2 began to improve. He became talkative, cheerful, and inter-
sted in his family, though maintaining for a time, for the sake
“ consistency seemingly, that he was no better, and only employ-
ig himself when he thought that no one was observing him. In
iree months more he was discharged quite recovered.

In these cases, when the melancholic anguish has reached a
IIr.] VARIETIES OF INSANITY. 376

certain intensity, it appears to be a matter of accident whether
the convulsive explosion is expressed in some act of violencc
directed against the patient's own life or against the life o:
another, although it may be expected that, if the delusion is one
of persecution by others, the violence will be displayed against
the supposed enemies.

The following case further illustrates the acute attacks of
paroxysmal anguish that supervene in the course of chronic
melancholia or ideational insanity with depressed passion :—

Miss F., eet. forty-one, appeared to be as strong-minded and
good-natured a lady as could be met with. Her manner was
abrupt and decidedly energetic, and she is described as having
always been a little queer. The melancholy for which she was
finally sent to an asylum was said to have come on seven months
before, in consequence of a supposed offer of marriage which she
thought she had refused—in reality, none such was ever made.
She now believed that she was lost for ever in consequence of
this refusal; she wrung her hands in her extreme distress, and,
with a face tense with anguish, exclaimed that “she had done
it ;” “that she was so near Zion’s gate.” But her mental state
varied much, and varied suddenly. One day she would be in
the greatest mental agony, rolling on the floor, writhing and
twisting herself into the strangest forms, as though in her anguish
she would tie her body into knots: on another day her delusion
seemed to have retired into the background, and she was calm,
natural, conversed most sensibly, and employed herself indus-
triously. No one who saw her only in those calmer periods
could conceive how unspeakably insane she was in her acute
paroxysms. In her calmer moods, when not engaged in any
occupation or conversation, and when apparently unnoticed, she
might be observed to wring her hands, and to repeat in an under-
tone, “ Good God!” When her attention was called, on these
occasions, to what she was saying and doing, she was often quite
unconscious of it. And that might teach us that the morbid
manifestations were of an automatic or reflex character, and that
it is possible for such morbid phenomena, under certain bodily
conditions, to attain a convulsive character, without conscious-
ness of them at the time, and without memory of them after-
wards. The psychologist would be a bold, as he certainly would
30 VARIETIES OF INSANITY. [cHaP.

. an ignorant and mistaken man, who should assert that the
mzy might have been controlled because there was usually a
rsistence of reason. It were as just to assert that the reflex
nvulsive action of a spinal cord poisoned by strychnia must
: controllable, because the ordinary reflex acts of a healthy
rd are so.

It is noteworthy, in some of these cases, how sudden and com-
ete may be the change from the deepest anguish and despair
-a state of perfect calm and sanity. Thus one of my patients,
ho suffered from acute melancholy, who usually wandered about
oaning grievously, or sat weeping profusely, and who had made
‘veral attempts against her own life, awoke one morning seem-
igly quite well, rational, cheerful, and wonderfully pleased at
ar recovery, remaining so for the rest of that day. Next morn-
ig, however, she had entirely relapsed, and it was some months
efore she finally recovered. Again, Griesinger mentions the case
f a woman with melancholia and delusions as to loss of property
ad persecution, who for the space of a quarter of an hour was
uite herself, and then relapsed. Such cases are of interest in
xgard to the pathology of the disease, as they would seem to
rove that there is no serious organic disease so far—that the
ondition of nerve element is a polar modification which may
yon pass away, not unlike, perhaps, the electrotonic state that
1ay be artificially produced in nerve.

Miss S., at. twenty-two, was rather a good-looking young
idy, though with an irregularly formed head, and a deformity
f one ear, and with a strangely wandering and occasionally
acant look, Her family is saturated with insanity, and the
resent is said to be her third attack. She is surcharged with
rief, moaning continually, and weeping so abundantly as to
urprise one how she can raise so many tears. She exclaims
hat she is utterly estranged from God, and sobs as though her
ittle heart must break. Notwithstanding this extreme exhibition
f mental suffering, one could not, on carefully observing her,
nut conclude that she was not really so miserable as she looked,
hat her distressing actions were in great part automatic. And
here was truth in the instinctive suspicion; for in the midst of
he most violent sobbing, she would sometimes, on the occasion
if a ludicrous or sarcastic observation, look up quite calmly,
1] VARIETIES OF INSANITY. 88

speak quietly, and even smile for a moment, and thereupc
relapse instantly into her extreme grief. She was quite co1
scious of her state, and threw all the blame of it upon her friend
who, she said, ought to have subjected her to proper restrai
and discipline, instead of indulging her in every way, as they he
done. Previously to being sent from home she had been vei
wilful and impulsive, sometimes starting out of the house, ar
saying that she must kill herself. After being in the asylum f
a few days she became calm and composed, spoke quite rationall
and professed herself very well contented with her position, ar
with the course which her friends had taken on her behalf. Ar
yet, while wearing this cheerful and contented manner, she w:
secretly posting letters to her friends full of the bitterest cor
plaints, moanings, and reproaches, sentence after sentence :
them beginning, “Oh God!” Reminded of her inconsistenc
she sank into the deepest self-accusation and abasement, said s]
was utterly wretched on account of her deceitfulness and wicke
ness, which she could not help, and that she was lost for eve
And, indeed, she could not help it. She was sincerely cheerf
in her new relations when engaged in conversation, or in son
occupation, but when she sat down to write home the old fee
ings returned, and the old automatic morbid activity broke o
Ultimately she recovered, the morbid tension gradually subsidin
and finally disappearing in the entirely changed relations. Th
example enables us to understand, in some sort, how it is th
murderers in an asylum sometimes appear to be unconscious
what they have done, and, if they are conscious of their crin
never think they are to blame; for the automatic activity of the
morbid nature has surprised them, and when they reflect up:
the act of violence, if they do so, it is as upon an act done |
some one else.

The foregoing cases will suffice to illustrate partial ideation
insanity, although they all fall under that division of it usual
called melancholia. In conversing with patients so afflicted,
is impossible to avoid being surprised at the strange discord
incoherence which their mental character exhibits: they a
often, as it were, double beings—a rational and an insane bein
the two beings cannot be brought into intercommunication a1
beneficial reaction upon one another, for the persistence of t.
182 VARIETIES OF INSANITY. [cHap.

elusion implies the cutting off of such interaction; as conscious
ianifestations they are independent, isolated. One day the
ound being is in predominant or exclusive action; another
ay, the unsound being; on different occasions one might say
—“Now I am talking with the rational being; now with the
rorbid being.” Herein we have the explanation of the doubt
rhich such patients sometimes have of themselves; they are
ot confident at times, and appear only to half believe in
aeir delusion, because they are not then under its entire
rfluence: their rational nature is in predominant action, and
aey act in their relations as if their delusion really was a
elusion. It would be a mistake, however, to put any reliance
n such seeming hesitation: let the delusion be excited into
stivity, all doubts vanish, and the sound being is brought into
angerous bondage to the unsound being.

In a complete account of partial ideational insanity, whether
xcompanied by a gloomy or a gay passion, the effects of the
alusion should be considered—as was done when considering
lea physiologically—first, upon sensation ; secondly, upon the
cocesses of nutrition and secretion; and, thirdly, upon the move-
ents or general conduct of the patient. As the delusion is
metimes the final effect of a morbid organic stimulus result-
ig from bodily disease, so it in turn, however caused, reacts
juriously on the bodily nutrition and on sensibility. The
tter is commonly much affected in melancholia. There may
> general or partial diminution or perversion of the sensibility
‘ the skin, or a local complete loss thereof; and complaints of
ecordial anguish and of strange epigastric or abdominal sensa-
yas testify to the perversion of organic sensibility. A burning
‘heavy pain on the top of the head, or running down the spine,
ypears to cause much suffering in some cases. These com-
aints, causeless as they may seem, are not always without
ynificance. Illusions aud hallucinations of the special senses
e frequent: one patient, believing himself lost, sees the devil
his room, another smells a corpse in his room, a third tastes
‘ison in his food, a fourth hears voices which revile and accuse
m, or which suggest impious thoughts and instigate violent
eds—it may be to imitate Abraham and sacrifice his child.

The hallucinations of hearing which occur are evidently some-
m11.] VARIETIES OF INSANITY. 88

times owing to the fact that the patient perceives as voices th
morbid thoughts that arise automatically in his mind. Sir E
Holland mentions the case of a gentleman who believed in an
acted upon the reality of illusive sounds and conversations, an
was necessarily treated as deranged, but who after a while x
covered so far as to recognise and treat them as delusion
When he was asked: how he had come to regard them in th’
sensible light, he said that it was partly by his never discoverin
any person in the places where the voices had come, but chiefl
by finding himself able, on trial, to suggest the words whic
were thus seemingly uttered by some one external to himsel
The ideas excited by some morbid cause, not coming into actio
through the regular train of association, and being strange an
novel to the individual, appear as if they belonged to and wel
suggested by some person external to himself. Hence som
patients complain bitterly that their thoughts are perceive
taken up, and replied to by other persons before they are cox
ceived by themselves; their lives are made wretched and i
tolerable to them by this mysterious system of espionaye an
persecution. A similar thing happens in dreams: the replic
and arguments of the person with whom the dreamer speaks ai
really his own replies and arguments, though he fails to recogni:
them ; but the unusual suggestion and irregular association of h
ideas, giving them a strange and independent character, maki
them appear to belong to some one else; there is no.co-ordin:
tion of them, and the will is therefore in abeyance. Now tl
habitual co-ordination of the thoughts, feelings, and desires
the basis of the individual character—of personal identity
accordingly when it is lost, a person loses the consciousness |
his identity. The special interest of the case mentioned by S
H. Holland lies in its illustration of the gradual recovery of tl
power of co-ordination evinced by the patient’s trial to suggest
himself the words which were seemingly uttered by another, ar
thus to bring back the riotous elements of the mind under tl
domain of regular law.

The general depression of tone in melancholia is felt throug]
out the processes of nutrition, although not usually in observab
proportion to the great apparent suffering. So vast indeed do
_ this seem in some cases that the wonder is that organic life cé
i84 VARIETIES OF INSANITY. [cHar.

0 quietly on. However, digestion mostly fails, and in a few
ases an obstinate sickness occurs after food ; constipation often
ecomes troublesome ; the skin loses its freshness, and gets sallow
ry, and harsh; the temperature of the body is lowered, and the
xtremities are cold; the pulse is feeble, sometimes very slow,
nd even intermittent; the respiration is slow, moaning, and
iterrupted by frequent and long-drawn sighs ; the urine is in
yme cases abundant in quantity and very pale in colour; the
ienstruation is generally irregular or suppressed. Everything
idicates the depressing influence of the gloomy morbid idea on
1e organic life. There is usually a great want of sleep, although
atients are apt to assert that they have not slept when they
sally have, so little has been the feeling of refreshment there-
om. They are often tormented by vivid and painful dreams,
1eir delusions pursuing them in their restless and unrefreshing
umbers. Refusal of food, which is common and sometimes very
arsistent, may be due to other causes besides the want of
ypetite and general sluggishness of nutrition: it may be in
msequence of a fear of poison in the food, or of a delusion
iat the intestines are sealed up, or in order to die by starvation,
> in fancied obedience to a voice from heaven. It is of no
ttle practical importance to realize how much the refusal of
od, and the delusions which instigate it, are sometimes aggra-
ited in melancholia when the tongue is coated and the diges-
on out of order. A lady who was under my care refused food
itirely for a week at the beginning of her illness, under the
slief that her throat was completely closed up; and the refusal
as only overcome gradually by persistence on the part of her
tendants. Afterwards, during her illness, whenever the diges-
gn was disordered, the old delusion became active, and the
fusal of food returned in the old way: that cured, these
sappeared.
There is the same depressing influence exerted upon the
luntary movements; these, like the ideas, are sluggish gene-
lly, and the conduct of the patient accords with the character
‘his mental state. In an extreme form of melancholia known
melancholia with stupor, Mf. attonita, where the mind is
itirely possessed with some terrible delusion, the patient sits
stands like a statue, and must be moved from place to place ;
1.] VARIETIES OF INSANITY, 385

the muscles are generally lax, or some of them are fixed in a
cataleptic rigidity ; the patient, as if in a trance or as one only
partially awake, scarcely seems to see or hear; consciousness of
time, place, and persons is lost; and the bodily wants. and
necessities are alike unheeded. Between this condition at one
end of the scale, and those cases at the other end in which there
is an acute utterance of the internal agony in gesture-language,
though this is usually of a somewhat uniform or even monotonous
character, there are of course cases representing every sort of
intermediate stage. But where there is the most activity of
movement in melancholia it is confined to the expression of the
mental suffering, or to the common attempt to escape from it
by suicide: there is an extreme aversion for the most part to
exercise, employment, and activity of a beneficial kind.

In monomania proper, where the delusion is attended with an
exalted feeling, its effects upon sensibility, nutrition, and move-
ment are different. There appears to be no real diminution of
general sensibility, though the sensations are not always attended
te, on account of the excited mental state; but hallucinations
ef the special senses, especially of hearing, are by no means
uncommon, and they appear both as occasional consequences and
occasional causes of the delusion, which in any case they fail
not to strengthen. There is not usually any notable interference
with the processes of nutrition. The behaviour of the patient
eften expresses with sufficient distinctness the character of his
delusion: one may reveal his exalted notions in his gait, manner,
and address, while another is not satisfied with the capabilities
of ordinary language to express the magnificence of his ideas,
but invents new and mysterious signs whieh, unintelligible to
every one else, have wonderful meaning for him. A third makes
perhaps sweeping plans and projects, enters upon vast under-
takings, and sometimes goes through an immense amount of
patient and systematic work in perfecting some impossible
scientific invention.

The courses which melancholia and monomania run respec-
tively are different. In melancholia remissions are common,
but complete intermissions rare. It is striking in some cases
how suddenly a great change may take place: Griesinger, as
already said, quotes one case in which there was a perfectly lucid

cc
86 VARIETIES OF INSANITY. [crap.

iterval for the space of a quarter of an hour; and I have more
1an once seen a melancholic go to bed cheerful and seemingly
wite well, and yet awake in the morning as bad as ever. It
‘never safe to trust to these sudden conversions from gloom to
aeerfulness. When recovery does really take place, as it does
1 half or even more than half of the cases of melancholia, it
; usually gradual, and takes place within from four to twelve
1onths from the cormmencement of the disease. After twelve
1onths a favourable result, though’ less probable, is still not
opeless, for there are instances on record in which recovery has
iken place after the disease has lasted years. Of the cases that
o not recover, about half decline into mental weakness or com-
lete dementia, the rest remaining chronic or ending in death.
hough death may take place in consequence of refusal of food
1d exhaustion, it is often due to intercurrent disease, phthisical,
irdiac, or abdominal, and most often to phthisis. It was in
ielancholics who had died after long refusal of food that
uislain met with the most frequent instances of gangrene of
re lung. I have met with it in one such case.
The course of monomania, once established, is very seldom
ywards recovery. The reasons of this are not far to seek: in
1e first place, monomania is often secondary to mania or melan-
aolia, and represents therefore a further degree of mental
sgeneration than these diseases ; and in the second:place, when
is primary, the fixed delusion is commonly the exaggeration
> some fundamental vice of character, and has been slowly
aveloped. Whether primary or secondary, the fixed delusion
iarks the establishment of a definite type of morbid action of
chronic nature, such as is not easily got rid of in any organ of
1e body, much less in an organ so delicate as the brain. Never-
ieless recovery does sometimes take place under the prolonged
fluence of systematic moral discipline, or after some great
iock to, or change in, the system—whether emotional, or pro-
aced by some intercurrent disease, or occurring at the climacteric
sriod. As a general rule it may be said that recovery does not
‘ke place when a fixed delusion has lasted for more than half a
zar. When it does not, the disease remains chronic, or passes
ito dementia: the more the exaggerated self-feeling which under-
2s and inspires the delusion wanes, and the more this, losing
11.) VARIETIES OF INSANITY. 387

its inspiration, becomes a mere form of words, the nearer the
case gets to incoherent dementia.

The reason why the prognosis is so much more favourable
in partial ideational insanity with depression than in partial
ideational insanity with exaltation, though sufficiently set forth
already, might be roughly stated thus: that in the former the
system is painfully sensible of its infirmity, depressed thereby,
and feels the need of amendment, while in the latter it is
abundantly satisfied with its condition, gay, and not sensible of
anything to amend.

(b) General Ideational Insanity—This division will include
all those cases of intellectual alienation which are commonly
described under mania, as well as many cases of general intel-
lectual disorder in which, notwithstanding the excitement, the
evidence of much mental suffering leads to their being placed
under melancholia. In fact, it is not possible in practice to
draw the line of distinction between acute mania and acute
melancholia, which often blend, follow one another, or run into
one another, in a way that defies exact division ; for although
we may properly say that there is in acute mania an excitement
or exaltation of the self-feeling, the expression of which takes
place chiefly in the actions of the patient, who sings, dances,
declaims, runs about, pulls off his clothes, and in all ways acts
most extravagantly, yet there may be equal excitement and
restlessness of action in a patient who believes himself be-
witched or lost, while another, exalted and furious one day,
shall be frenzied with anguish next day. They all, however,
agree in being examples of acute ideational insanity. In most
cases, before the actual outbreak, there is, as already set forth,
a premonition of it—a precursory stage of depression, of shorter
or longer duration, sometimes so brief as to escape notice ; upon
which follow increased excitability, sleeplessness, restlessness,
extravagance of behaviour, rapid flow of ideas imperfectly or
strangely associated or entirely incoherent, and hallucinations
and delusions of various kinds. A similar brief period of unac-
countable depression sometimes precedes the outbreak of a fever:
it is the projected shadow of the coming calamity. The con-
dition of excitement may last for some time as an acute disease,
and then pass away, and recovery take place ; or it may degene-

cc 2
88 VARIETIES OF INSANITY. [cHap.

ite into a chronic state, in which there is a persistent incoherence
ideas, and permanent delusions and hallucinations exist. The
st stage of declension or degeneration is that of dementia, in
hich uot only the organized coherence of ideas in the supreme
mtres is destroyed by disease, but most of the very centres of
leas themselves are disorganized and rendered incapable even
* morbid function: in the extremest cases of dementia there is
ot the capability even of a delusion, so disorganized by the
.orbid degeneration is “that noblest garment of organization in
hich the soul is clad.”

Instead of entering into a general description of the symptoms
? acute mania and melancholia, I shall give an example of
ich of these forms of ideational insanity, interposing such
ymmentaries as may appear necessary to elucidate the cha-
iter of each, and to convey just ideas of its nature, symptoms,
ad course.

W. P. was a merchant, of great originality of thought and
aergy of character, who became insane, after making a con-
derable fortune entirely by his own abilities. His mother had
ied insane. After slight depression, and certain transactions in
usiness, which rather astonished his friends as being opposed
» his usual manner of doing things, he broke out into eccen-
icities and extravagances of behaviour, with which was asso-
iated an unaccustomed liveliness; in fact, he acted very much
3 if he were intoxicated, turning certain pictures with their
ices to the wall, putting chairs in queer positions, walking
bout the garden bareheaded and singing: altogether he
ppeared joyous, and was eccentrically industrious. If spoken
‘ith, he was lively, witty, original, and satirical, laughing with
laugh of peculiar harsh and metallic ring, which he could not
ave imitated when in health: still he could control himself
wa time, and speak with a marvellous assumption of calmness
“he pleased. There was so far no pusitive insanity of thought,
1ough there was great insanity of accion : his condition might
e said to represent an acute form vu: that stage of disease which
as already been described as ‘:e mildest form of hereditary
isanity, Degeneration 1-oceeding, however, he became in a
ay or two much worse: he raved incoherently in conversation,
‘as violent in action, and not amenable to control; his lan-
im] VARIETIES OF INSANITY. 389

guage was obscene and disgusting, his behaviour not less so;
and he represented very completely the condition of a furious
maniac, whose habits were of the filthiest kind: he mastur-
bated with frenzied energy, and eagerly licked up the secretion,
swallowed his urine, and painted himself with his feces, chanting
a wild chant the while, or talking in rapid incoherence. In all
this extremity of fury, however, there were plainly evinced on
his part a certain consciousness of his extravagances and a capa-
bility of modifying his actions in certain regards, which could
not fail to give his conduct the semblance of wilful defiance and
witting offence to the feelings and opinions of those who had to
do with him. As the energy of this stage somewhat subsided,
various delusions—as that he was made the victim of medical
experiments by night and by day, but especially by night—
were exhibited: the strange disease-produced feelings, nowise
conforming to the order of his previous experience, and a
vague feeling of being the automatic agent of morbid acts not
his own, were interpreted as the results of external malicious
agencies, as they were plainly not within the domain of his
conscious life and voluntary control. This condition of things
lasted for more than a week, after which, as the maniacal fury
and delusions disappeared, there ensued a state of the pro-
foundest moral disturbance. He was possessed with a great
hatred to all those who were especially his friends ; was sullen,
morose, and gloomy ; represented, in the unfairest way, every-
thing which had been done to control him—and he had an
excellent memory of what had been done—as a violent cruelty ;
misrepresented any kindness or act of attention from his rela-
tives; refused his food or took it most capriciously; and,
although all positive delusions seemed to have vanished, yet he
appeared to look upon others as responsible for all his sufferings
and extravagances. One might reason with him, but even if he
acknowledged 'the justice of the arguments, which he sometimes
did, it was-a hypocritical affectation ; for to another he would
immediately afterwards set forth his unparalleled grievances in
the most perverse and untrue manner—more untrue because he
so completely twisted and perverted some little truth. When
well, he had always displayed a scrupulous regard for truth.
There was no intellectual incoherence, but marvellous ingenuity :
390 VARIETIES OF INSANITY. (cHar.

he could assume such an appearance of calmness and logical
moderation in his complaints, accusations, and statements as
would deceive the- very elect. And he actually succeeded in
imposing upon an influential friend, who, himself a most honour-
able man, waS so much influenced by the calmness and coherence
of his stories, and by the plausible way in which he accounted
for all his peculiarities, as consequences of the position in which
he was placed, or slurred them over, that he represented in the
strongest possible manner to his immediate relatives the injustice
of keeping him longer under any sort of restraint. Accordingly,
in this condition of imperfect convalescence, of unquestionable
extreme moral or affective insanity, and in opposition to medical
remonstrances, the patient was freed from all restraint: all the
people in his neighbourhood thinking that he had been most
unjustly confined. The consequence was, that in the course
of a few weeks he had so managed, or rather mismanaged, his
property—selling stock at great loss, and giving away large
sums of money under the most singular pretences—as to afford
an excellent harvest to the lawyers, and greatly to impoverish
his children. It was found absolutely necessary to place him
under restraint again, where he will remain doubtless for the
rest of his life. For although he was apparently quite rational
for three or four weeks at a time, yet the attacks of mania con-
stantly recurred, gradually becoming more prolonged and the
intervals of sanity less, until the disease acquired the character
of dementia. ;

In this case we may observe that the first stage of the de-
generation was a short period of unquiet and unaccountable de-
pression, which Guislain believed to occur in the great majority
of instances, and which not unfrequently precedes an ordinary
fever or other grave disease; it is, as it were, the gloom that
foreshadows a great calamity, the painful forefeeliny of the
coming storm. Afterwards there quickly followed a stage of so-
called exaltation, in which the patient seemed to be in an
exuberantly happy state, as though transported with some joyful
tidings, and perpetrated various extravagances of speech and
action as though from an overflow of life. Some have not
hesitated to describe this condition as one of increased mental
activity ; even Schroeder van der Kolk has fallen into what we
nt] VARIETIES OF INSANITY. . 391

cannot but consider this great error. The real state of the
patient is one of irritable weakness: he is unduly impressible,
abnormally excitable, and reacts in sudden impulses of feeling,
thought, speech, and action, which more resemble spasms than
anything else; he is entirely incapacitated for the calm recep-
tion and discrimination of impressions, the subsequent quiet
reflection, and final intelligent act of volition—the complete co-
ordination of mental action, which is implied in the highest
mental activity ; his words and actions are like the idiot’s tale,
“full of sound and fury, but signifying nothing.” The condition
of nerve element, which is the basis of this excitability, is a
reaction after the preceding depression, and it marks the com-
mencement of a degeneration which, if not checked, will go on
to the further stage of positive maniacal degeneration of mental
action, like as the reaction of other kinds of organic element
that have been chemically or mechanically injured passes into
inflammation and purulent degeneration: it is a state of insta~
bility of composition corresponding to that which is the con-
dition of the mildest forms of hereditary insanity, where, as
already pointed out, such striking exhibitions of particular
talents sometimes occur.

Striking in this case was, what is often observable in other
cases, the metallic ring of the strangely altered voice. This
maniacal change in the tone of voice, which is apt to grate so
harshly on the sensibilities of those unaccustomed to hear it,
testifies not less surely than the deranged thought, perverted
sensibility, and furious conduct to the profound and general dis-
turbance of the nervous system. “When a man is a lunatic,”
says Dr. Bucknill, “he is a lunatic to his finger ends:” he is
alienated from himself both bodily and mentally. I cannot
help making the remark here, that in almost every disease, but
especially in insanity, there are a great many.. unobtrusive
symptoms in which nature speaks that are almost entirely over-
looked, attention being so much fixed on a few prominent symp-
toms. In insanity, for example, there is not only the changed
tone of the voice, but there are peculiarities in the expression
of the countenance, in the look of the eye, in the posture of the
body: these constitute the physiognomy of the disease, and
deserve the most exact study. I think it not impossible in
392 VARIETIES OF INSANITY. [cHaP.

many cases to determine from such signs not only whether the
patient is suicidal, but in what degree he is suicidal—whether
at any rate there is a desperate impulse that, like an evil fate,
governs the patient and waits and watches for opportunities, or
whether a fluctuating impulse is excited to activity by oppor-
tunities. Again, there are great diversities in the character of
what we confound under the general name‘of pain, as well as in
the character of those manifold modifications of sensibility which
fall short of pain, all which have their specific meanings had we
‘but the knowledge to interpret them. Two circumstances, note-
worthy in many cases of insanity, were marked in the case
under consideration: these were, the peculiar indescribable odour
of the patient—the bouguet de malades of lunatic wards—and
the intensely offensive character of the intestinal excretions.
Manifestly there is some unknown chemical change produced in
the ‘excretory functions by the profound nervous disturbance,
not otherwise than as seeretions are observably altered in com-
position by passion ; and the result attests, as other effects just
mentioned do, the essential interaction of the mental life in ‘the
whole bodily life, and the impossibility of separating, save in
thought, mental and bodily phenomena. It behoves us there-
‘fore to carry with us to the investigation of any case of insanity
a deep sense of the importance of scrupulously studying every
sign of physical disturbance, motor, sertsory, or nutritive, as well
as the prominent mental symptoms.

The third stage of degeneration exhibited by the patient was
that of acute maniacal fury ; of which it is not necessary to say
more than to point attention to the evidence of the persistence
of a certain amount of self-consciousness, and the occasional
manifestation of a certain power of self-control for a moment.
This is the more necessary because of the foolish eriterion of
responsibility sanctioned by English law, or rather by English
lawyers. Certainly this patient, at all but his very worst
moments, and perhaps even then, was conscious of what he was
doing at the time, as he had an exact and complete memory of
it afterwards, and'was quite aware that it was disgusting and
offensive to those around him ; he had even some power of self-
control at times, as he would not‘do ‘before me what he would
do before attendants ; so that if the legal criterion of responsi-
1] VARIETIES OF INSANITY. 393

bility had been strictly applied to his actions, this man, suffering
the extremity of maniacal disease, would not have escaped
punishment. As the maniacal fury subsided and delusions
appeared, the disease becoming more chronic, we might say: that
a fourth chronic stage was passed through—a stage characterised
by the persistence of ideational disorder; that is, not only of
morbid ideas, but of the morbid association of ideas, after ex-
‘citement of conduct had ceased. From this the patient soon
passed into the fifth, well-marked stage of affective insanity, a
condition which usually lasts for some time after ideational dis-
turbance has disappeared. The result of his premature removal,
while so suffering, affords an excellent illustration of the truth
of the observation of Esquirol, that the disappearance of hallu-
‘cination or delusion is only a certain sign of convalescence when
the patients return to their natural and original affections. At
the earlier period of the disease there succeeled to this stage an
interval of apparently perfect sanity befire the supervention of
a new attack, but as time went on this interval became less
evident, and at last was omitted altogether; so that, instead of
‘a recurrent mania, there was a continued mania esta) lished,
with regular stages of exacerbation and decline, an! a steady
declension towards the last stage of all, that of dementia, took
place.

Now if we choose to suppose, .as we might not unfairly do,
each of the stages of disease gone throuch by this patient to
exist in some individual, and to constitute his permanent state
—if we conceive in fact the progress of degeneration through
generations instead of through the individual life—then we may
form a tolerably correct idea of the varying forms of general
ideational insanity that are met with. In one person the fury
of action may be most marked; in ‘another, the delirium of
thought, chronic or acute; and in a third there is a predominance
of the affective disorder. If we eliminate the element time in
considering the course of mental disease, and do not suffer our
thoughts to be constrained by it, we may certainly be enabled to
get more correct views of the relations which the different forms
bear to one another; the events of generations and of the
individual life are brought together within the same compass
of time, and pass in procession before the imagination, as it were,
394 VARIETIES OF INSANITY. [cHaP.

on the same theatre: a morbid stage, which might scarcely be
noticed or might be entirely passed over on account of its
rapidity and briefness in the individual, will be distinctly
evolved in the progress extending through generations; and a
phase of disease which might have an exaggerated importance
or an independent character assigned to it in the generation will
receive its right interpretation by a consideration of the course
of the disease in the individual. Had this principle been at all
times clearly apprehended, it may be justly questioned whether
any one would have been found to doubt or misinterpret those
obscurer forms of mental disease that have been the cause of so
much unprofitable contention and angry feeling.

A form of most acute mania, which runs a rapid course, de-
serves particular attention, both on account of the rapidity of
its course, the gravity of the prognosis, and the special treat-
ment demanded. It is really an acute maniacal delirium rather
than a systematized mania, the délire aigué of French authors,
and is characterised by great excitement, entire incoherence,
apparent unconsciousness of what is going on around, and ex-
treme restlessness ; the course of the disease being swift either
to. recovery or to death. The following example will serve to
illustrate it :—A cook in a gentleman’s family, whose age was
not known, though plainly between forty and fifty, was rather
suddenly attacked with acute mania. Nothing was known of
her previous history, but she had heen considered by her fellow-
servants to be a little peculiar, and she had suffered from a
chronic erysipelatous inflammation of one leg, which had dis-
appeared a short time before her attack of insanity. She had
been ill seven days when admitted into the hospital, and during
the whole of that time had been noisy, violent, and utterly
incoherent; and she had taken no food for several days. On
admission her state was one of the extremest maniacal excite-
ment: she was noisily incoherent, stripped off her clothes, rolled
on the floor, was unconscious of the calls of nature, and seem-
ingly unconscious also of what was said or done to her; she
was continually spitting frothy and sticky saliva, and the look
of her countenance was horrible and heartrending. She could
not be got to take food, and it was with the greatest difficulty
that beef-tea, eggs, and brandy wére. administered to her. at
1] VARIETIES OF INSANITY. 395

frequent intervals. Morplia made her sick, and did not make
her sleep. This went on night and day for a week, when she
was reported to have become quiet; but it was the quiet of
complete exhaustion. Her pulse was so feeble and rapid that it
could not be counted, though up to the moment of the collapse
she had been as excited, as noisy, as restless as ever, and shé
still rolled on the floor, tossing her arms about and pulling at
her clothes. Next day the heart beat feebly 160 times in a
minute, so far as could be made out where no exact examination
was possible, and with a certain undulatory action which raised
the suspicion of pericarditis; but there was no increase of
cardiac dulness, The skin was hot and dry; there was extreme
jactitation ; and she drank fluids eagerly, as she had never done
before. I thought there was some abdominal tenderness on
pressure, but could not be sure of it. Next day she was clearly
sinking fast, and muttered words which so far as could be made
out were a request for holy water: she was a Roman Catholic.
Pressure on the abdomen now produced evident shrinking. On
the following day she died. On examination of the body after
death, the pericardium, when opened, was found not to contain
a drop of fluid; its surface was dry, rough, and markedly in-
jected, and its substance seemingly thickened generally, and
certainly so in parts by oblong patches of lymph of old stand-
ing. There were similar layers of lympl on the heart, the sub-
stance of which was pale and flabby, and its cavities were full
of blood, mostly uncoagulated. The intestines were almost
universally of a rosy red hue, which on closer inspection was
seen to be due to injected vessels. The arachnoid was slightly
clouded, like glass gently breathed upon, and streaked with a
delicate milky opacity along the lines of the vessels, while it
was bulged at the sulci by a clear serous fluid beneath. The
ventricles were filled with a similar fluid, which existed also in
considerable quantity at the base of the brain. On slicing the
brain numerous red spots were visible, and when the surface of
the cerebellum was exposed, it was seen to be strongly injected
in beautiful arborescent fashion. Had the examination been
carried further into the minute structure by a competent micro-
scopist, I doubt not that the ideational cells of the cortical
layers would have been found to be clouded and troubled like as
396 VARIETIES OF INSANITY. [crar.

the arachnoid was. The visible morbid appearances at any rate
were instructive and interesting, and afforded some compensa-
tion for the painful feeling of utter helplessness which one had
had in face of the disease during life. An obvious speculation
as to the cause of the disease could not fail to present itself:
that an erysipelas disappearing from the surface of the body
had selected for attack the arachnoid and other serous mem-
branes. ‘Though the issue was fatal in this case, it is not so in
all cases of acute maniacal delirium ; it is, however, a disease
which should unquestionably be regarded seriously, both on
account of its occasional intractableness, and on account of the
suddenness with which fatal exhaustion may supervene.
Puerperal mania does not present any special symptoms,
although the general features have usually something charac-
teristic. The skin is often ‘pale and cold, the pulse quick and
small; the features are pinched, and the patient stares wildly as
if there were hallucinations or illusions of vision; there are
extreme and noisy incoherence and sleeplessness; restlessness
and obscenity are not unfrequently marked features. It rarely
occurs at a later period than one month after confinement, and
usually before sixteen days have elapsed, the first confinement
being the most dangerous. The prospect of recovery is very
favourable. When it occurs after sixteen days from the confine-
ment, it is, Dr. J. B. Tuke observes, more likely to take a
melancholic form ; and he finds from his researches that it most
often occurs-where the labour has been complicated and difficult.
Hysterical mania may take a great variety of forms ranging from
all sorts of moral perversion and strange fancies about the health,
on which I have already touched, up to acute and raving mania ;
but the hysterical temperament causes all the forms to present
a certain family likeness. There is often an erotic character
displayed in the conduct or conversation of the patient, who is
by no means indisposed to refer to the troubles of her sexual or
uterine organs. Dr. Clouston ‘bas described.a :phthisical mania
which might be called a mixture of subacute mania and de-
mentia, being ‘sometimes like the one and sometimes like the
other. As the disease advances, the symptoms of dementia pre-
dominate, but the mental faculties are séldom entirely obscured ;
there are fitful flashes of intelligence, and in these patients more
11.) VARIETIES OF INSANITY. 397

often than in any other cases, there is increased manifestation of
intelligence immediately before death. If there be any single
tendency which characterises these cases, it is their suspicious
disposition ; indeed, the records of the Edinburgh asylum show
that nearly all the cases of monomania of suspicion were
phthisical. It appears, however, that the peculiar type of
mental derangement which Dr. Clouston calls phthisical mania
is after all only met with in about one-fourth of the cases in
which tubercle is found, and that he is compelled to limit the
term to those cases which died within five or six years after
becoming insane, and in which the development of the phthisis
andthe insanity were about contemporaneous. Moreover, the
alleged characteristics of the group, as thus limited, must be
admitted to be vague and indefinite.

I now proceed to relate the history of a case which would
usually be described as a typical example of acute melancholia,
because of the fixed mental suffering that accompanied the in-
coherence and excitement. It was of a very extreme kind, and
illustrates what an amount of consciousness may co-exist with
the most desperate insanity. A young woman, et. twenty-four,
whose parents were Dissenters in a respectable position, had been
religiously brought up ; she had been much engaged in Sunday-
school work, and had written several little tracts of more or less
merit, When first seen by me she was said to have been
ill for two months, but there was some probability that she had
suffered for a longer period. She was miserably restless and un-
happy, and wandered about moaning and exclaiming, “ My poor
father! My poor father!” She also spoke incoherently of the
house being burnt down, and of every one in it being lost ; and
she made several attempts at suicide. After a little while she
became still worse: she was much excited during the day, rush-
ing wildly at any door the moment it was opened, grasping at
the clothes of anyone who might enter, and clinging to them with
offensive tenacity ; and at night she slept not, tore to pieces bed-
clothes, nightdress, and whatever else she could tear, and plastered
herself and her chamber with her excrement. Day by day, she
seemed to get, if possible, worse and worse, gabbling auto-
matically some such sentence as “Let me see my poor father ;
‘et me kiss my poor father,” and making the most frantic rushes
398 “VARIETIES OF INSANITY. [cuar.

at any door that was opened, no matter where it led to. Night
was not the time for sleep, but for the awakening of a more dis-
gusting frenzy. Withal it was clear that, notwithstanding her
terrible and distressing excitement, she knew what she was doing,
and could. control herself in some measure for a time; she did
not like, for example, to be put in seclusion, and the threat or
employment of that means of treatment had a calming effect
upon her. On the whole, there was certainly an appearance of
wilfulness in the worst acts of this poor woman, whom an
ordinary observer would have pronounced the maddest person
that he could imagine: she was perfectly conscious whether she
was doing what she should do or should not do; and if a
sufficiently powerful motive was excited, she could sometimes
restrain the automatic utterance of her convulsive frenzy. Had
the supremely absurd question whether she knew the difference
between right and wrong been put to a medical witness in her
case, the reply, so far as rational answer could be made to
irrational question, must needs have been that she did. In
many like instances of hereditary insanity nothing is more clear
than the persistence of consciousness with the most extreme in-
sanity of action. In this case, the so-called asylum ear,* which
is ever of evil augury, appeared first on one side and then on
the other, and the end was the natural end of such cases,—
namely, dementia: the fury had raged out, and the calm of
mental extinction followed: by making a desert of the mind
there was made peace. As in the natural order of events con-
vulsion is the forerunner of paralysis, so maniacal fury is the
natural forerunner of dementia in the regular course of mental
degeneration.

In this case there is notable a feature which is observed also
in most other cases of acute melancholia, and which, indeed,
constitutes a point of difference between it and acute mania;

* The “Insane ear”—Hzmatoma auris, or Othematoma—is produced by an
effusion of blood under the perichondrium, which is stripped from the cartilage, or,
as some hold, by an effusion within the cartilage. It may remain some time in the
cystic stage, absorption finally taking place, and the ear becoming dry and shrivelled.
When it- appears, the prognosis is very unfavourable. Some have attributed it
to a traumatic cause, but. its gradual manner of coming on, its symptoms, and
duration, are widely different from those of a contusion. Dr. Stiff, who has inves-
tigated its nature most carefully, believes that there is no foundation for supposing
it to be produced by injury.—“Hematoma auris,” Brit. and For. Review, 1858.
ut. } VARIETIES OF INSANITY. 399

it is the monotonous and apparently automatic character of the
expression of the disease, whether in the delirious ideas or in
frenzied actions. We know not why it should be so, but so it
is, that the most excited melancholics exhibit far less variety in
their delusions and conduct than the acute maniac. The more
activity of movement there is, however, in melancholia, as the
expression of the mental suffering, the more acute the utter-
ance of the agony in gesture-language—in the wringing of the
hands and the writhing of the body—the nearer does the case
approach mania.

In the insanity of pregnancy the symptoms are as a rule of a
melancholic type; and in no other form of the disease is: the
suicidal tendency stronger. There is not uncommonly a con-
siderable amount of moral perversion, so that the patient acts in
a way which she would be heartily ashamed of if she were well.
The insanity of lactation also most often has the melancholic
form, with determined suicidal attempts. In both forms the
outlook is favourable.

It is striking how complete in most cases of general ideational
insanity is the memory of the past during the attack, and of all
that has happened during the attack after it has passed off; but
in other instances, especially those of acute maniacal delirium,
the patient forgets altogether the events of his madness, like
as a dream is forgotten, though he may remember them again
during a subsequent outbreak. Immediately ‘before a second
attack it sometimes happens that thoughts and feelings displayed
on the occasion of a first attack, but latent since, will reappear,
so that even attendants are able to recognise the evil presage
and to predict the outbreak, Here, agai, we perceive a re-
semblance to what happens sometimes in» epilepsy. The aura
forerunning an epileptic’ attack may be mental, consisting in the
recollection of a fact, or the reproduction of an idea, which on
a former occasion preceded.or accompanied the fit. “Many
persons,” Dr. Jules Falret observes, “ who have become epileptic
after ‘strong moral emotions or intense terror, see again in
mind, or before their eyes, on each succeeding seizure, the
painful circumstances or the dreadful scene which produced their.
complaint.” *

* De I’fitat mental d’Bpileptiques.”
400: VARIETIES OF INSANITY. (cu.

Hallucinations of the different senses are common enou
in acute mania and melancholia, and illusions still more s
but both are usually of a fleeting and fluctuating charact
Patients hear voices address them, see persons that have :
real existence, or mistake for others those whom they really :
see, taste poison in their food, smell strange odours, or fe
unaccountable shocks, which they attribute to electricity
witchcraft. Some have thought that the long endurance of t
great expenditure of energy in acute insanity may be owing
a perversion of the muscular sense, by reason of which the tm
state of the muscles is not declared in consciousness. There ci
be no doubt that the centres of motor residua are very mu
disordered, just as the centres of ideas are: a patient lying in h
bed fancies, therefore, that he is moving, or that his limbs a
flying through the air; he has motor illusions and hallucination
and the muscular sense is so perverted that it cannot mal
known the real state of the muscles, and help to correct by i
perception the deluded motor intuition. Even where there
no actual illusion of movements in acute insanity, the rapidit
confusion, and incoherence of them attest not less certainly tl
derangement of the motor centres ; the movements are not wille
nor do ideas of them consciously precede their accomplishmen
but the motor intuitions, excited into activity by disease, instigai
them the moment they rise ; not resting there, moreover, thes
earry their morbid activity into the intellectual life, and aid an
abet the morbid work going on in the ideational centres.

Considering the great and continued agitation, mental an
bodily, and the loss of sleep, in acute insanity, the bodil
functions are very little affected. In the early stage, whe
there is perhaps some febrile disturbance, the pulse may be
little quicker, but it is afterwards scarcely accelerated. Th
temperature of the body is slightly, if at all, increased in ord
mary cases; but in cases of a typhoid type, where there a1
sleeplessness, restlessness, gradual wasting, and where the ter
dency is to death from exhaustion, it may be raised from 3 t
5 degrees above the natural standard.* In the insanity occu
ring after acute disease, Dr. Weber found only a slight increas

* Report on the Devon County Asylum for 1865,
rt] VARIETIES OF INSANITY. 401

of temperature, although this had been considerably raised
during the previous acute disease, and immediately rose again
on the occasion of a relapse.* When the temperature rises
notably in a case of insanity, we may then justly suspect an
attack of some other disease, or a tendency to fatal exhaustion ;
in either case the prognosis is made serious. The skin may
be dry and harsh, but it is often moist, and of offensive
odour. Dr. Sutherland thought he had discovered an excess of
phosphates in the urine: were this true, it might bé sup-
posed to testify, like the slight increase of temperature, to an
abnormal disintegration of tissue; but the researches of Dr.
Addison have not confirmed the statement.f Constipation is
common, but in some cases there is an obstinate relaxation
of the bowels; not unfrequently, however, these act quite
regularly.

What explanation can be offered of the fact that maniacs do
for so long a time continue an unceasing activity, without any,
or with very little, sleep? Some have thought that there was
an actual excess in the production of nerve power by the
exhaustion of which, under ordinary circumstances, sleep is
produced. But if there were an excess of production, it must
take place at the cost of something, there must be an excess of
consumption of nerve element: expenditure of power must be
balanced by a corresponding supply in the maniac as in the
sane person, or as in the steam-engine. Is this supply in the
maniac supposed to take place from the blood without sleep ?
If so, where is the necessity of sleep in order that a similar
restoration may take place in health? The proffered explana-
sion, when analysed, becomes no explanation at all, but an
issumption of the impossible. The question to be considered
8 the kind of power displayed by the maniac: it is surely not
in excess of power, but the more demonstrative display of an
nferior power, many equivalents of which only balance one
squivalent of the higher power of a rightly controlled and co-
wrdinated mental and bodily activity. Convulsion is not

* On the Delirium during the Decline of Acute Diseases, by Hermann Weber,

ul. D.—Med.-Chir. Transactions, 1865.
+ On the Urine of the Insane.—Brit. and For. Review, 1865.

DD
402 VARIETIES OF INSANITY. [cHap.

strength ; nor is a maniac strong-minded because twenty men
cannot reason with him, nor strong-willed because the strongest
man cannot hold him. If we bear these considerations in mind,
and at the same time reflect on the mental prostration which
follows an attack of acute mania and the permanent mental
feebleness which is produced by many such attacks, we shall
see our way to something like an adequate explanation of the
maniac’s ceaseless and sleepless activity.

Acute insanity is not often regularly progressive in its course ;
remissions usually take place, and sometimes there are complete
intermissions, or so-called lucid intervals. "When the attacks
occur at regular or irregular intervals, as they are apt to do
in the sympathetic mania connected with amenorrhea, they
constitute a periodic or recurrent insanity; and when a melan-
cholic and maniacal excitement alternates with some approach to
regularity, we get what some French writers have called folie
circulatre, or folie & double forme. Since the time of Esquirol
there has been in France an ambition to discover a new variety
of insanity, and to coin a new name for it; but the verbal dis-
tinctions have not often stood the test of exact observation.
The duration of acute insanity may be for hours or months,
and recovery may be sudden or gradual. A furor transitorius
lasting for a few hours or days, and accompanied sometimes by
vivid hallucinations and destructive tendencies, has been attested
by so many trustworthy observers, that it is impossible to
doubt its occasional occurrence; the outbreak is comparable,
indeed, with an attack of epilepsy, in connexion with which it
often occurs, and, well considered, is no more wonderful nor
inexplicable.* Recovery, when it does take place, usually

“ Numerous instances of such transitory fury are on record, and might be
quoted. The following is an example :—“ A sober and industrious shoemaker
got up early one morning as usual to go to his work; soon after his wife was
struck with his wild look and incoherent talk. He seized a knife, and rushed at
his wife, who escaped. The neighbours had great difficulty in seizing and dis-
arming him, for he defended himself with the knife. His face was flushed, his
pulse full and frequent, and his body covered with perspiration. In the afternoon
he became calm, and slept heavily. When he awoke in the evening he was quite
himself, and reanembered nothing of what had passed.”—CazauviEH, De la Mono-
mantie Homicide, 1836. See also Virchow’s Archiv, vol. viii. p. 192; Ueber
Mania Transitoria, by Dr. Ludwig Meyer and cases in Mare’s work, De la
Folie considérée dans ses Rapports avec les Questions M. édicojudiciaires,
11] VARIETIES OF INSANITY. 403

occurs within the year, and sooner and oftener in the melan-
cholic than the maniacal form; it is rare after two years have
passed ; indeed, the longer the disease lasts, the worse is the
prognosis, which is always unfavourable in the recurrent form,
and where there is an alternation of melancholic and maniacal
excitement. When recovery does not take place, the disease
passes into chronic insanity, or into dementia, or ends fatally.
Death may be due to exhaustion, or to some accidental disease,
such as pleurisy or pneumonia. It cannot truly be said that
acute insanity predisposes to diseases of the respiratory organs,
but these certainly seem to occur with considerable frequency,
and gangrene of the lung has many times been met with after
death, especially, according to Guislain, in those who have long
refused food. When maniacal exhaustion proves fatal, it some-
times does so suddenly and unexpectedly, leaving in the mind
an anxious feeling of doubt whether a more energetic treatment
might not have prevented death, or, if energetic treatment has
been employed, whether that has not had something to do with
hastening the fatal issue.

After the acute symptoms of an outbreak of insanity have
subsided without recovery taking place, the chronic disease
exhibits the most varied features, according to the nature of the
original cause, and the extent and degree of mental degeneration.
When the disease has been produced by a moral cause, there is
usually considerable intellectual power apart from the delu-
sions, or even manifested in the display of them ; the case may
then properly fall under partial ideational insanity. When the
disease has been produced by a physical cause, or has followed
a severe attack of acute insanity, there is often a great loss of
mental power, together with delusions, some general feebleness,
and incoherence; the morbid action has spread through the
mental organization, and the case might be referred to one of
the groups of dementia. Between dementia and what is described
as chronic mania, the difference is only one of degree of degene-
ration, and examples perpetually occur that render the establish-
ment of any definite line of division impossible. On the one
hand, then, chronic insanity runs insensibly into monomania
or melancholia; on the other, into dementia. The principles
which guide the prognosis in these forms of mental disease will

DD 2
404 VARIETIES OF INSANITY. | CHAP.

apply to it. To give an account of chronic insanity would be
simply to describe, in tedious and useless detail, the physical
and mental characteristics of numerous individual cases. It is
important only to bear in mind, that an excellent memory and.
much intellectual power may co-exist with numerous extravagant
delusions. A lady under my care, who fancied that not an event
in Europe happened which had not some hidden relation to her
and her affairs, who detected a plot against herself in the meeting
of a cabinet or in the movements of a court, who heard voices
from the ceiling, and who used terrible language in her frequent
outbursts of excitement, had a most exact memory of all her
affairs, and an acute judgment regarding them. It was only
because she could not control her conduct, but threatened with
a loaded pistol the lives of those whom she thought to be her
enemies, that it became necessary to put her under care and
control. Pe

4, Dementia.—It is the natural termination of mental degene-
ration, whether going on in the individual or through gene-
rations ; it is accordingly in the great majority of cases chronic,
and secondary to some other form of mental disease. It may,
however, be both acute and primary.

Acute dementia, lasting for a few hours or days, sometimes
follows a serious attempt at strangulation or drowning, or a
series of epileptic fits; and in one case which came under my
observation, there was strong reason to believe that a masked
epilepsy appeared in that guise. A man of epileptic visage, and
said to have had “fits” occasionally, was suddenly, after what
was called a slight faintness, but what possibly was an epileptic
vertigo, affected with a blank confusion of mind, entire inco-
herence, and complete inability to recognise anybody or any-
thing—to remember the past or to appreciate the present; he
was, in fact, completely demented. So he remained for a few
days, and then got quite well. Again, the insanity which some-
times occurs after certain acute diseases, as typhus and typhoid
fevers, pneumonia, acute rheumatism, may take the form of
acute dementia. Lastly, it appears to be sometimes brought on
suddenly by a great moral shock; and it now and then occurs
in young men and women as a primary disease of unknown
causation, though connected in some way probably with dis-
111] VARIETIES OF INSANITY. 405

turbed sexual function. A pale, delicate, fragile, blue-eyed young
lady, et. twenty-five, came under my care after being ill for a
week. She had not taken food, and was much exhausted. Her
vacant wandering eyes were devoid of all intelligent perception,
and her countenance was blank and expressionless. There was
a restless, agitating movement to and fro of the body generally,
and of the head in particular, with a low monotonous moaning.
She was speechless, and it was impossible to elicit any kind of
response, or to fix her attention. She took no food but what
was forced into her mouth, and was inattentive to the calls
of nature. Before three months were over she recovered under
suitable treatment. She had suffered some disappointment of.
her affections; menstruation had ceased; and acute dementia
followed. Another somewhat similar case was that of a young
gentleman, et. nineteen, of pale, delicate appearance, with large
prominent grey eyes. He had for some time been worked rather
hard in an office, and had not quite satisfied his friends with his
mode of life out of it, when one day he was suddenly attacked
with a quasi-hysterical attack of incoherence, There was blank
confusion of mind; he neither uttered nor expressed otherwise
anything indicating ideas in his own mind, and he showed no
sign of understanding what was said by others. There were
occasional periods of confused excitement. He took no food but
what was forced upon him, and he was inattentive to the calls of
nature. Recovery took place within a month.

Dr. Skae describes a sexual insanity taking the form of acute
dementia, met with both in the male and female sex, but more
frequently in the latter, and connected, he believes, with the
effect produced on the nervous system by sexual intercourse. I
have known one case in which a gentleman was attacked with
acute and furious mania, of a transitury nature, after each act of
sexual intercourse. The transitory mania was no doubt com-
parable to an epileptic attack, which may occur in a similar
way, and may also, as already seen, when masked, appear as
furor transitorius or as acute dementia.

These examples will serve to show the character of acute
dementia, and to indicate the favourable character of the prog-
nosis. The mental functions are abolished for the time by
reason of some severe shock to their nerve centres; the expres-
406 VARIETIES OF INSANITY. [cHar.

sionless countenance of the patient, his passive attitude of body,
perhaps an occasional aimless and confused excitement, ‘his
inability to understand what is said, or to say anything which
can be understood, and a loss of sensibility—all mark the
abeyance of mental function. If a restoration does not soon
take place, as in most cases it does, there is danger lest the
disease pass into chronic and incurable dementia. It is hardly
necessary to say that senile dementia, though primary, does
not get well.

Chronic dementia is the form of dementia which we most
often meet with, and we meet with every degree of mental
decay in different cases. It is observed that after a very severe
attack of acute insanity the evil effects are many times visible
for a while in a certain condition of mental weakness without
actual intellectual disorder. The force of the character seems to
have been sapped, and, though perception appears to be suffi-
ciently acute, there is some want of power of reflection; the
finer feelings, moral and esthetic especially, are gone; the
physiognomy has lost its highest expression, and the individual
gives the impression of a certain childishness of manner. This
feebleness may gradually pass off as time goes on and strength
is regained, or it may be more or less apparent for the rest of
life. In the latter case, recurring attacks of positive insanity
are apt to come on at uncertain intervals, and to issue finally in
complete dementia. In a lady under my care, who had suffered
from an attack of acute insanity when only fifteen years old,
the development of the mind seemed to have been completely
arrested; twenty years afterwards she had quite the appear-
ance, manner, and mental character of a girl of fifteen; and
though she had during that period three more acute attacks
of derangement, these resembled in character those that occur
in early life rather than such as are usually met with in
adults. Between this mild form of mental weakness at one
end of the scale, and the extremest examples of dementia,
in which mental power is almost obliterated, at the other end,
there are met with in practice cases marking every shade of
the gradation.

Most of the permanent residents in asylums, those who con-
stitute the greater part of the insane population of the country,
mu] VARIETIES OF INSANITY. 407

are persons who, after mania, monomania, or melancholia, have
subsided into a state of greater or less feebleness and incohe-
rence of mind. They represent in undistinguishable varieties
the shattered wrecks of the mental organization. Three main
groups of them may perhaps be made. The first will consist of
those who exhibit a few striking delusions which seem to be
automatically expressed ; for the strong self-feeling which under-
lies or inspires the delusions of partial ideational insanity has
faded away, and they are no longer full of self-assertion, nor
eager and earnest about their opinions. They quietly give
utterance to the most extravagant delusions, as if they were the
most ordinary truths, and, when under proper care, only get
excited for a time when these are opposed or attacked. The
paths of mental association are broken up, so that the delusions
are cut off from any active influence upon such mental functions
as are left, and all real interest in the past or the present is
abolished. The actions of the patient exhibit a corresponding
imbecility. Many of them are incapable of employing them-
selves in any useful way; a few may be induced to continue
their former occupation, or to do a little work of a manual kind ;
while the industry of others is confined to gathering stones,
sticks, and pieces of paper. Strange propensities of all kinds
are exhibited,—as, for example, to stand or crouch in a par-
ticular corner, to walk backwards and forwards for a certain
distance on a particular piece of ground, or to ornament fan-
tastically the person with feathers or flowers. The mood of
mind may be surly and depressed, or brisk and exalted, or
placid and cheerful; it appears to be determined in great
measure by the previous disposition of the patient. Hallu-
cinations and illusions of the most extreme kind are frequent.
A woman under my care used to think she ate different people
in her food, and when she saw them alive still could not be per-
suaded that she had not eaten them; another woman may
lovingly nurse as her long dead child a lump of wood decked in
rags; a third person, whose singular movements seem unac-
countable, is busy spinning sunbeams into threads ; a fourth con-
tinues violent, movements of his arms in order to prevent his
blood from coming to a standstill. The bodily health is usually
good, the patients frequently improving in this regard as the
408 VARIETIES OF INSANITY. [cHar,

active symptoms of mania or melancholia subside into the calm
of dementia.

In a second group of cases there is a more general incoherence
or craziness, without any particular delusions, but with greater
external activity. Although there are no distinct delusions
manifest, there are evident, in the patient’s incoherent babblings
or his senseless parrot-like repetition of certain words, traces of
such as existed in the maniacal stage. The morbid degeneration
has advanced so far, that not only are the paths of association in
the mind broken up, but the centres of ideas are themselves
disorganized. Consequently there is an entire incapacity of
fashioning into ideas the impressions made upon the senses, as
well as a complete loss of memory; in extreme cases there is
the incapacity even of a distinct and fixed delusion. There is
sometimes an entire indifference to what is going on around,
and there may be a remarkable insensibility to pain; or there
are occasional violent outbreaks of incoherent passion and fury ;
or there may be even desperate homicidal violence. J. B. was a
demented patient, utterly incoherent, who walked about mut-
tering to himself; no one could make out what he was muttering
about, for no intelligible answer could ever be got from him,
yet every one who had had any experience of him had a lively
and well-grounded dread of him. Without giving the slightest
warning beforehand, he used, from time to time, to rush suddenly
upon some one, and deal him a savage blow, or make a furious
attempt to strangle him; so sudden and dangerous were these
attacks that nothing would induce an attendant to sleep in the
same room with him. H. P., again, was a heavy, wild-looking,
hopelessly demented woman, who usually laughed vacantly when
spoken to, and seemed not to comprehend anything that was
said ; every now and then, however, she used to begin, without
any evident reason, to shriek and howl fearfully, and to stamp
on the ground furiously, her whole body being agitated by a
convulsive paroxysm. ‘This fit of agitation would often issue in
a murderous attack made on some one with the rush of an
avalanche, while at other times she would fall down, and lie
shrieking and kicking for some minutes ; after which she
with mechanical drawl, murmur, “I beg pardon,”
sorry ;” not a few homicidal lunatics belong to this

would,
“T'm very
group. The
1] VARIETIES OF INSANITY. 409

predominant mood is different in different cases: some are gay,
happy, and prone to laugh and chatter; others are gloomy, and
display the mimicry of sorrow ; while others, again, are malicious,
spiteful, and addicted to a purposeless mischief with a monkey-
like cunning and persistence. The loss of memory is great:
some have lost all remembrance of their former lives, their
friends, and their own names; whilst others, who perhaps forget
instantly the last thing said, can reproduce the distant past with
considerable fidelity. The bodily health is usually good, and the
bodily functions are well performed; some of these patients
indeed get fat, and remain so till an outbreak of excitement and
agitation, to which they are periodically liable, reduces them.
The physiognomy is blank and expressionless, especially when
the patient is addressed ; it is often also prematurely aged.

Lastly, there is a group of demented patients in whom the
mind is almost extinguished: who have to be fed, moved,
clothed, and cared for ; who evince little or no sensibility ; whose
only utterance is a grunt, a whine, or a cry; and whose only
movements are to rub their heads or hands. Of the three degrees
of dementia they represent the worst—the lowest state to which
it is possible for a human being to sink. Their existence is,
indeed, little more than vegetative; and if they are not carried
off by pneumonia, tubercle, or some other disease, as they often
are, they die from effusion on the brain, serous or hemorrhagic,
or from atrophy of the brain, or from the effects of accident, to
which, through their apathetic helplessness, they are much
exposed.

Though secondary dementia may last for a long time, it is
impossible that recovery should take place. The condition,
habits, and conduct of patients suffering from it may often be
much improved by proper care and control, but their mental
decay will generally go on increasing unto the end. When
death takes place, it is sometimes due to effusion on the brain,
or. to atrophy of it; or it is produced by accidental disease, as
tubercle or pneumonia.

Now that we have sketched the progress of mind through the
gradual processes of its growth and development to the full evc-
lution of its highest faculties, and have traced the steps of its
degeneration and decay to its lowest degradation in apathetic
410 VARIETIES OF INSANITY. [cHar.

dementia, we may once more call attention to the analogy between
mental and spinal function. Bearing in mind that the functions
are mental in one case, and in the other motor, the results of
degeneration will admit of an unstrained comparison. When
the spinal functions suffer, there is first a loss of power of
co-ordinating the movements of the limbs,—in other words, a
certain motor incoherence; when the degeneration has gone still
further, there is spasmodic or convulsive muscular action, a con-
dition heralded by twitchings and slight spasms at an earlier
stage; last of all, when things have got to the worst, comes
paralysis. So with regard to the morbid manifestations of dis-
eased mind : there is first a loss of power of co-ordinating the ideas
and feelings, a certain incoherence of mind; at a more advanced
stage there are convulsive mental phenomena, or fixed morbid
ideas, comparable to motor spasms or convulsions; and, lastly,
there is extinction of mental function in dementia, as there is
extinction of motor power in paralysis. If I have so far failed,
however, to display how entirely untenable is the metaphysical
conception of mind when brought face to face with facts, and to
make evident how necessary it is to study the highest mental
phenomena inductively by aid of the light which a knowledge
of the simplest phenomena affords us, no amount of iteration
now will avail to counterbalance a failure, the cause of which
must lie not so much in the difficulty of the subject, great as
that is, as in the defective manner in which it has been treated.
5. General Paralysis —It is a form of mental disease which,
being marked by certain distinctive symptoms, it is necessary to
describe separately. In the great majority of cases there are
singularly exalted notions, extravagant delusions of wealth and
grandeur, accompanying a gradually increasing general paralysis
of the muscular system. But as cases undoubtedly occur in
which there are no such exalted delusions, it is impossible to fix
upon the character of the delusion as distinctive of the disease ;
in fact, all forms of hypochondria, melancholia, mania, and inco-
herence, may be met with in general paralytics. The essential
difference recognisable at the commencement of general paralysis
is a mental weakness ; the intellectual powers, and especially the
memory, being notably enfeebled, which is not the case at the
commencement of ordinary melancholia and maniacal states.
mt.] VARIGTIES OF INSANITY. 411

Accordingly it is necessary to define it as a form of insanity
characterised by a progressive diminution of mental power, and
by a paralysis which gradually increases and invades the whole
muscular system.

It has an interest above that attaching to other forms of mental
disease in the fact that it selects its victims commonly from the
better classes of society, and selects, again, those who seem to be
buoyant with health, and at the full height of their energy; so
fatal is it, too, that it may be truly said of those once attacked
by it, that “in the midst of life they are in death.” The most
frequent cause of it is thought to be intemperance, alcoholic or
sexual; but it not unfrequently occurs where there has been no
reason to suspect anything of the kind. Then, however, some
sort of hereditary taint is likely enough to be present. Two of
the best marked examples of the disease which I have seen
occurred in teetotallers, who never had been addicted to alcoholic
excess; in both of them, however, there was hereditary taint;
both of them had undergone the struggles and anxieties springing
from a large family and a moderate business; and in both there
was some reason to suspect enervating marital excess. General
paralysis is emphatically the disease of manhood, for it is hardly
ever met with before thirty or after sixty: the fact agrees well
with the supposition that the sole cause of the disease may
sometimes lie in the agitation and anxieties incident to the most
active period of life. Women seldom suffer from general para-
lysis: they are not subjected to such severe mental activity as
men are; they do not suffer so easily from sexual excess; and
they are not so much addicted to alcoholic intemperance.

It has been a poitit of dispute amongst some writers, whether
the mental symptoms precede the paralysis, or whether the latter
appears first—whether the insanity is primary, or whether the
paralysis is the primary and main affection, the insanity
secondary and accessory. There can be no doubt in the minds
of those who simply observe cases without prejudice, that the
mental symptoms are witnessed in many cases before there is
any trace of paralysis visible; and that in other cases the
mental disorder appears simultaneously with the motor disorder.
Whether instances do not occasionally occur in which the
paralytic phenomena appear first, I cannot undertake to say
412 VARIETIES OF INSANITY. [cHAP,

positively ; Leidesdorf has related the history of one case in
which the earliest symptoms were spinal, the disease actually
beginning in the cord, and one or two similar cases are on record.
In 51 out of 86 cases that were carefully watched by Parchappe,
the paralysis and mental disorder were simultaneous; in 27
cases the paralysis was subsequent; and in 8 the precedence
could not be determined. Before asserting in a particular case
that there is no evidence of paralysis, it will be well to observe
the patient when emotionally excited, or after a sleepless night ;
then there may be exhibited a trermulousness about his speech
which is not at all visible when he is perfectly. calm and
collected.

The motor symptoms are first evident in the tongue, which
has to execute so many delicate and complex movements with
such exact precision, and especially in the articulation of words
abounding in consonants, where the most complex co-ordination
is necessary ; when the patient speaks earnestly, he does not
articulate clearly, and there is a certain pause or indecision in
his utterance, as if there was a difficulty in bringing out the
word; in some cases the speech is slower, more deliberate, with
a strong accentuation of and a lingering on the syllables, as if
the patient were speaking with great? consideration. When the
tongue is put out, which it is with some difficulty, there may be
a fibrillar quivering of its muscles, but it is not pulled to one
side. There is a tremulousness also in the muscles of ex-
pression when they are put in action, especially in those of the
lips, which quiver as in one just about to burst into tears, The
tone of the voice is often altered ; it becomes harsher and loses
its various shades of expression, though the change may hardly
be recognisable by one who has not known the patient before
his illness, or hardly perceptible to one who has, unless he is
very attentive. These symptoms are more evident when there is
any mental excitement. An inequality in the size of the pupils
is often an early symptom, but it is not a characteristic one; it
is sometimes present in other forms of insanity, and it is not
always present in general paralysis. In some cases the pupils
are contracted to a pin’s point. A transitory squint is observed
occasionally at the commencement of the disease, and at a later
period a slight ptosis of the upper eyelid. As the disease ad-
tr | VARIETIES OF INSANITY. 418

vances, the muscles of the limbs and trunk are affected; in
walking, the feet are not quietly raised and firmly planted on the
ground; the patient easily stumbles at a step, or on uneven
ground, and, if asked suddenly to turn round when going
straight forward, he staggers like a drunken man. Nevertheless
he may be energetic in walking, setting about it earnestly, as
if it were his business, and pleased with his performance of
it; he does not want muscular power, but the power of using
his muscles; he is unaware of his deficiencies, and commonly
thinks himself wonderfully well and strong. Precise co-ordi-
nation of movement, such as is necessary for writing, sewing, and
like acquired automatic acts, is lost. At the outset of the
disease it is sometimes very difficult for one unacquainted with
the patient before his illness to perceive anything peculiar in his
walk. "When no symptoms of paralysis are detected, there may
be something stiff, proud, abrupt about it; the steps shorter and
quicker, and the foot being set down more sharply. Like the
mental symptoms, the motor symptoms may disappear almost
entirely for a time. Dr. Westphal describes two groups of cases
according to the different motor disturbances manifested by
them : those belonging to the first group have the peculiar walk
of tabes dorsalis ; it is uncertain, swaying, the feet being raised
abruptly, thrown forward and brought down forcibly on. the
ground. In such cases he believes that the motor disorder pre-
cedes the mental symptoms. In the second group, instead of
the forcible and jerking raising and throwing forward of the feet,
these are raised very little from the ground, so that the walk is
rather shuffling, and the patients go as if they were on slippery
ground; their movements are slow and helpless, and they do not
fall when their eyes are shut. In these cases, he believes that
the motor disorder follows the mental symptoms.* As the
disease. advances, the articulation becomes less distinct; the
walk more and more tottering; the knees fail; the patient fre-
quently tumbles, and finally is unable to get up at all. The
contractility of muscles for the electric stimulus is retained. At
last the primary automatic or reflex movements fail ; the pupils
become dilated, but unequal in size; the sphincters lose their
power, and the patient may be choked by a lump of food stick-

* “Allgemeine Progressive Paralyse der Irren :” Griesinger’s Archiv, Band I.
414 VARIETIES OF INSANITY. [cHap.

ing in the pharynx and blocking up the opening of the larynx,
‘or even getting into the larynx. Transitory contractions of an
arm or leg occur sometimes, and a grinding of the teeth is not
uncommon in the last stages of the disease.

Cutaneous sensibility appears to be diminished in the early
stages, and towards the end it is sometimes almost lost. There
‘are, however, occasional transitory conditions of extreme hyper-
esthesia of parts, so that the patient shrieks out in agony. The
muscular sense is especially affected, so that the sufferer, having
lost all power of executing the more delicate and complex move-
ments, is quite unaware of his impotence, and deems himself not
less skilful than when at his best state. The special senses are
not usually affected until near the end, when smell and taste are
‘diminished or lost, and vision fails. One patient under my care,
who at times used to fancy himself blind, had vivid hallucina-
tions in the night; on one occasion he had a glorious vision
of angels descending from heaven on ladders of gold, and, on
another, an agonizing vision of his own wife in the act of
adultery. A great increase of sexual desire and an excited
display of it are not unfrequent at the beginning of the disease,
but there is not corresponding sexual power; and this is soon
quite lost.

The mental disorder is generally marked by an exaggerated
feeling of personal power and importance, out of which arise
eorresponding delusive ideas. After a transient depression,
perhaps, there takes place a marked change of character and
habits: the patient exhibits unwonted perversities of feeling and
conduct, such as surprise and grieve his friends; he breaks out
into sexual excesses quite foreign to his usual sober character,
or orders numerous valuable articles of all descriptions which he
does not need and cannot pay for, or steals what strikes his
fancy. Another displays considerable mental excitement; he is
busy with wide-reaching projects and speculations, indifferent
to the stern realities, and in all ways eager and ready to accom-
plish the impossible : like one in a dream, he is not limited by
external conditions of time and space, from which in truth he is
cut off almost as effectually as if he were dreaming with his eyes
open ; accordingly he finds no hindrance to a miraculous activity:
A third exhibits a lack of his former energy: he is painfully
111.) VARIETIES OF INSANITY. 415

troubled about little things, dull and confused in his thoughts,
and demented in behaviour. As the mental disorder increases,
it generally issues in incoherence and extravagant delusions as
to personal power and grandeur: “The miserable sufferer who
can scarcely support his tottering body avers that he has the
might and vigour of Hercules; while industriously hoarding up
pieces of rag, paper, or glass as articles of value, he will sign a
cheque for countless millions, or make an easy present of New
York; maintaining that he can command a king to do his
pleasure, in the same breath he begs piteously to be allowed to
go to his own humble home; or, with sexual power extinct,
boasts exultantly that a princess shall be his wife and princes
be born of his loins. An extreme loss of memory is in striking
contrast with the semblance of exaltation: the patient forgets
entirely how long he has been in confinement, or denies angrily
that he has a wife, though recognising her gladly when she
visits him.”* Delusions of a terrific character, with accom-
panying great emotional depression, are found to prevail steadily
throughout the course of some cases of general paralysis; and a
day of great melancholic depression now and then intervenes in
the course of the exalted form. By some writers a class of
patients has been described who present in physiognomy and
habit of body a mixture of stupidity and of the deepest depres-
sion, and exhibit delusions of as definite a character as the
delusions of grandeur : they think themselves bodily transformed
in whole or in part; that their body has enlarged immensely ;
that their eyes cannot see, their ears cannot hear; that their
throat is sealed up so that food does not enter their body.
There is in their symptoms marked evidence of great mental
weakness or dementia. Dr. Clouston has observed that cases
of general paralysis commencing with melancholia, and even
exhibiting suicidal tendency and refusal of food, will be chiefly
found among the phthisical. He believes that there is an inti-
mate relationship between the general paralysis with depression
and tuberculosis. A regular decline of intelligence, without
any marked delusions—in fact, a gradually increasing stupidity
from the first—is the course of one variety of general paralysis
by no means of frequent occurrence. Outbreaks of great excite-
* Article “Insanity,” Reynolds’s System of Medicine, vol. ii.
416 VARIETIES OF INSANITY. [cHaP.

ment and violence during the progress of the disease frequently
occur: during them the temperature of the head was observed
by L. Meyer to be raised, and afterwards the mental decay is
found to be increased. Dr. Westphal, however, has denied any
connexion between these attacks of excitement and the increase
of temperature, pointing out that in most of Meyer’s cases some
other disease co-existed which would itself raise the tempe-
rature. “As the disease approaches its end, the end of life, the
dementia is extreme, and the face becomes an expressionless
inask, across which now and then flickers the broken ripple of a
smile, or it is fixed in a ghastly sardonic grin; but even in the
last stage of mental disorganization, when the capability of a
distinct delusion is gone, the muttered words may be about gold,
and carriages, and millions of money.”

General paralysis is a disease of special pathological interest
because of the co-existence of mental and motor disorder, not
as an accidental circumstance, but as a constant occurrence.
The patient loses the power of performing both ideas and move-
ments, and gradually gets worse and worse until he dies. There
is a certain analogy between drunkenness and general paralysis
which Bayle was the first to point out; the embarrassed speech,
the vacillating walk, the exalted ideas, and the mixture of
stupidity being common to both conditions. Many times in the
course of this work I have laid stress on the manner in which
movements enter into our intellectual life, and on the close
analogy between ideas and motor intuitions; and now I cannot
refrain from calling particular attention to the phenomena of
general paralysis as confirmatory of the views enunciated. That
the nervous centres of ideas are disordered is plain enough, but
it is equally plain that something more than these centres is
affected ; for we get all kinds of morbid ideas in other forms of
insanity, without any interference with motor power. Nor are
the muscles themselves at all affected: the patient has not lost
muscular power, but intelligent power over the muscles. In
fact, what is further diseased is the region of the motor intuitions
or actuation—the nervous centres in which the motor residua
are organized. In progressive locomotor ataxy the motor centres
are diseased, but then it is only the spinal centres, and the mind
is quite clear: in general paralysis, however, those motor residua
m1] VARIETIES OF INSANITY. 417

are affected which are in the closest relations with the intel.
lectual life, indeed essential to complete intellectual action—the
motor residua of speech, those which words in their intellectual
meanings as symbols or signs of the ideas imply. One of the
earliest symptoms of general paralysis is the difficulty noticed in
giving fit outward expression to the ideas, by reason of some
affection of the motor intuitions which are the internal equiva-
lents of the words externally audible. But the mischief does
not end there: not only does the morbid state of the motor
centre lead to a difficulty of expression by the appropriate move-
ments, but the diseased motor intuition enters into the intel-
lectual life, and, in conjunction with morbid ideas there, gives
rise to all sorts of extravagant and outrageous delusions as to
personal power. Now it is well known that, when a delusion is
fixed in the mind, the evidence of the senses does not avail to
correct it—it is a morbid product, not in relation with the
surroundings, but creating its own surroundings: in general
paralysis the possibility of correction by the influence of external
circumstances is made more hopeless, is in fact practically cut
off, by the failure of the muscular sense; thereby, indeed, the
avenue by which are acquired the notions of the size, form, and
position of objects in space is closed, and the patient is left an
easy prey to the internal disorder.*

The course of general paralysis is towards death, though not
steadily so. Under proper treatment a great improvement takes
place in the early stages, and the disease appears sometimes to
be arrested. A few cases of actual recovery have been put on
record; and, whether the recovery in such cases has been per-
manent or not, there can be no question that there have been in
exceptional cases intermissions of such length that the disease
has lasted for ten years or more. On the whole, however, it

* It may be considered tolerably certain that we could not think without some
means of physical expression, though thought is possible without speech.
Laura Bridgman’s fingers moved both during her waking thoughts and her
dreams. Children who have learnt to speak, and afterwards become deaf, lose by
little and little all they have learnt, unless great pains is taken with them.
Note, again, how frequently deficiency of speech and movement accompanies the
incapacity of thought in idiots. It is not difficult, therefore, to believe that
the gradual failure of the power of movement in general paralysis may aggravate
the mental disorder and decay.

EE
Al8 VARIETIES OF INSANITY. [cHar,

must be pronounced irregularly progressive, its duration being
usually from about a few months to three years. In the more
advanced stages sudden attacks of loss of consciousness with
epileptiform convulsions are frequent, after which the paralysis
and mental decay are both found to have increased. These epi-
leptiform or apoplectiform attacks consist of slight or deeper
losses of consciousness, with or without convulsions, disappearing
generally in a short time; sometimes paralysis of one side may
occur, with convulsions of the same side, or contraction of one
arm or leg. It has been observed by Dr. Saunders that the
temperature of the body in general paralysis is generally one or
two degrees below the average, but that it rises during the accesses
of maniacal excitement, falling again as calmness returns.
During the so-called congestive attacks, when there is complete
coma or epileptiform convulsion, there is generally a considerable
rise of temperature: in one case the temperature was for some
time 98°, but it rose an hour after one of these attacks to 105°,
and next day to 106°, the patient dying in thirty-six hours from
the commencement of the attack.* “In the last miserable stage
of all, when life flickers before expiration, large sloughing bed-
sores form, notwithstanding the best care, and diarrhcea or pneu-
monia hastens the long-expected ending.” T

In the following chapter it will be seen how well the
morbid appearances found in the bodies of those who have
died from general paralysis agree with the symptoms exhibited
during life.

* Report of the Devon County Asylum for 1864, See also the note on the
temperature of the insane, p. 146.
+ Article “Insanity,” op, cit,
au] VARIETIES OF INSANITY. 419

NOTE ON CLASSIFICATION.

The classification. of mental diseases now generally adopted in Ger-
many is a modification of that proposed by Esquirol, and is as follows :—

I, Die Diepressionzustinde, I. Conditions of Depression.
1. Die Hypochondrie, 1. Hypochondria.
2. Die Melancholie. 2. Melancholia,
II. Die Exaltationzustiinde. Il. Conditions of Exaltation.
1. Die Tobsucht. 1. Acute Mania.
2. Der Wahnsinn. 2. Monomania.
III. Die psychischen Schwiichezu- III, Conditions of Mental Weak-
stande. ness. =
1. Die Verriicktheit. 1. Craziness or Incoherence.
2. Der Blédsinn. 2. Dementia or Fatuity.
3. Idiotismus und Cretinismus. 8. Idiocy and Cretinism.
IV. Der paralytische Blodsinn. IV. Paralytic Dementia.
Die allgemeine Paralysie der Irren. General Paralysis of the Insane.

It is easy to point out the defects of this classification ; but it- is
not so easy to propound a better one. The fact that more than fifty
different systems of classification have been devised, is sufficient proof
of the dissatisfaction felt, and of the difficulties encountered in
making areal improvement, Hitherto no other classification has found
favour with any one but its ingenious author. The principal and
most evident objection against the received system is, that it is vague
and artificial, because it embraces in the same class forms of disease
sufficiently distinct to warrant separate description, and because there
are many forms of mental disease which, presenting the characters of
two or more of the different classes, might be placed in one or the
other, or cannot be placed satisfactorily in either. It cannot be denied
that this is a well-grounded objection ; that it is so, however, is owing
to the imperfect state of our knowledge. The same cause vitiates all
other classifications that have been proposed. What is wanted now is
an exact observation of the causes, the symptoms, bodily and mental,
and the course of all the different forms of mental disease, and an
accumulation of such observations ; so that we may arrive at a natural
history of the disease, and be able ultimately to arrange the manifold
varieties in natural groups or families, each according to its kind.
Instead, then, of four or five classes having characters so vague and
general that a knowledge of them conveys very little definite infor-
mation, we may perhaps hope to have numerous groups or families, each.
having certain characteristic features, a knowledge of which will instruct

EE2
420 VARIETIES OF INSANITY. [cHar.

us as to the causation, course, probable termination, and suitable treat-
ment of a particular case belonging to the family. For what is the
question which occurs to the practical physician when he sees a case of
insanity, and is asked to give his opinion concerning it? What has
been the cause, and what the natural history, of the disease, up to its
present stage% Is it hereditary? Is it associated with epilepsy ; or
caused by masturbation? Or is ita case of general paralysis? In-
stinctively putting to himself questions of this kind, and drawing
upon the stores of his experience for information respecting the natural
course and termination of insanity so caused or so associated, he is
able to give something like a definite answer to the anxious inquiries
made of him concerning the origin, course, duration, and termination
of the disease,

Dr. Skae has proposed and sketched out an arrangement in groups
of the different varieties of mental derangement. “My proposition,”
he says, “is this, that we ought to classify all the varieties of insanity,
to use a botanical term, in their natural orders or families ; or, to use
a phrase more familiar to the physician’s ear, that we should group
them in accordance with the natural history of each.” Why, he asks,
should we attempt to group and classify the varieties of insanity by
the mental symptoms, and not, as we do in other diseases, by the
bodily diseases, of which those mental perversions are but the signs?
The answer, we fear, is only too obvious: because in a great many
cases of insanity there is yet no recognisable bodily disease to become
the basis of a classification. This being so, a symptomatological classi-
fication is the only classification practicable, though we may dislike it
ever so much ; it becomes a natural classification, which, if it be made
with care, will most likely not be abolished entirely, but rather deve-
loped, by future discoveries. The groups which Dr. Skae, fully
recognising the difficulties of the subject, proposes, are twenty-five ;
and I shall now briefly indicate them.

The jirst natural group is idiocy, including imbecility under all its
various forms and degrees. To this class must be referred a large
number of cases of moral idiocy and imbecility, many of which are
mixed up in the present system of classification as monomaniacs of
various sorts, eg., cases of instinctive cruelty, destructiveness, and
theft. “Many of our most noted kleptomaniacs have had that
tendency from childhood, and have been moral imbeciles.” He would
refer all those cases of insanity, which are but the development and

aggravation of a congenital moral perversion, or want of balance, to
the class of congenital moral imbeciles,
un] . VARIETIES OF INSANITY. 421

The second natural group is that of epdleptics. As a disease of
childhood, epilepsy arrests the development of the brain, and is asso-
ciated with idiocy and imbecility. Afterwards, it is associated with
maniacal paroxysms, monomania, dementia, or total fatuity.

The third natural family is that of the masturdators, It is charac-
terised by a series of symptoms easily recognised — the peculiar
imbecility and sly manner of the youthful victim ; the suspicion, and
fear, and suicidal impulses, and palpitations, and scared look, and
feeble body of the old offenders, passing gradually into dementia or
fatuity.

The fourth group is formed of the insanity occurring at the period
of pubescence, and apparently dependent upon the changes affecting the
circulation and nervous system by the development of puberty.

Satyriasis and nymphomania constitute the next two groups.

The seventh group is that of hysterical mania—certainly a well-
marked natural order.

Closely allied to the last group is that of sympathetic mania, con-
nected with amenorrhea, or dysmenorrhea, commonly assuming a
recurrent or a periodic form, frequently with maniacal attacks, and not
unfrequently passing into. chronic mania or dementia.

Sexual mania includes a form of insanity occasionally met with both
in the male and female sex, but more frequently in the latter, developed
immediately after marriage, and connected with the effect produced on
the nervous system by sexual intercourse. It usually presents itself
in the form of acute dementia.

The insanity of pregnancy, puerperal mania, and the insanity of
lactation form three distinct groups.

Climacteric insanity, occurring at the change of life, manifests itself
as a monomania of fear, despondency, remorse, hopelessness, passing
occasionally into dementia.

Another group consists of cases of insanity associated with ovarian
or uterine disease, and of which one of the most common symptoms is
sexual hallucination. It is, par excellence, the insanity of old maids.

The next natural order is senile insanity, beginning occasionally as
mania or melancholia, but more frequently during its whole course
presenting the features of dementia.

Phthisical mania is a form of insanity which Dr. Skae believes to
present characteristic features and a natural history which can be well
made out. It has been described by Dr. Clouston in the Journal of
Mental Science for 1863.

The insanity following blows on the head, ¢rawmatic mania, ane
422 VARIETIES OF INSANITY. [cHaP.

that following sunstroke, present their distinctive characteristics, and
may be described and defined by their natural history.

Syphilitic mania is a distinct form of insanity associated with
syphilis.

Delirium tremens, and its allied disease dipsomania, are referred to
special natural orders.

General paralysis of the insane has been more completely studied
than any other form of insanity, so that, there is no need to do more
than mention it here.

Metastatic mania includes all those cases following the sudden sup-
pression of an accustomed discharge, or eruption, or erysipelas, &c.

The cases which remain and cannot be referred to any of these
groups Dr. Skae would class under the general term of idiopathic
insanity, divisible into two varieties, sthenic and asthenic: sthenic, com-
bined with distinct symptoms of vascular action, occurring in persons
of robust health, and brought on most commonly by causes exciting
the emotions and passions ; asthenic, when combined with symptoms
of anemia, emaciation, feeble pulse, &c., and brought on by such
causes as exhaustion, want of sleep, grief, anxiety, starvation, fever.

These, then, are Dr. Skae’s twenty-five natural orders or families,
each of them to be considered as a separate disease, of which mental
derangement is the most salient feature—“a disease presenting a certain
variety and kind of mental symptoms, varying in ditferent cases, and
at different times in the same case, but still varying within certain
limits only, so as to give to each variety its own special psychological
character, sufficiently marked and peculiar to make out a distinct
physiognomy for each group.”

This method of classification would certainly be of great practical
value, could it be thoroughly worked out, as it has already been done
in part by some of Dr. Skae’s pupils. But it is obviously a classifi-
cation of which it is much more easy to sketch the outlines than to fill
up the details, and which looks better in outline and promise than
probably it would ever do in actual accomplishment. In fact, it may
well be doubted whether the endeavour to work it out in detail would
not disclose its artificial character, and be the worst service any one
could do to it as a method of classification, valuable as such an
attempt would be as acontribution to our knowledge of insanity.. The
objections against it which suggest themselves are: first, that the
picture of the characteristic features of each group or family appears
to be overdrawn ; that in practice we do not find them so well defined as
they are represented to be; that the physiognomy of the mental de-
11.} VARIETIES OF INSANITY. 423

rangement of each of the groups does not really present characteristic
features or a special psychological character; that one of these special
causes, which is made the basis of a natural order, may really produce
quite different kinds of mental derangement, accurding to the parti-
cular temperament or idiosyncrasy of the individual, or according to
some other circumstances of which we know little or nothing. And
this brings us to the second objection: that under the term idvopathic
Dr. Skae Jets in all the vagueness and all the defects of the old
classification ; for beneath the mysterious word there is no knowledge
hidden ; there is no definite cause, nor definite course, nor definite
duration, nor definite termination for the manifold varieties of insanity
included under it; nor are there any characteristic features distin-
 guishing the varieties of idiopathic insanity from some of the forms
of insanity included under the other so-called natural groups or families,
The practical outcome of the objections would be then: first, the
inconstancy of the psychological characters of the different groups, and
the consequent impossibility of distinguishing those of one group from
those of another ; and, secondly, the necessity of treating of idiopathic
insanity exactly as writers have hitherto treated of insanity generally.
In fact, the proposed classification, so far as it carries out its method,
applies only to cases of insanity caused by, or associated with, certain
bodily disease other than brain-disorder; whereas many cases of
insanity are examples of brain-disorder only, other bodily derange-
ments, if present, being accidental coincidences or consequences.
Suppose an emotional shock to produce an attack of idiopathic in-
sanity in a young woman, and after a time a suppression of the menses
to take place: will the insanity so caused present such peculiar fea-
tures as will enable us to distinguish it from sympathetic mania con-
nected with amenorrhea, or, indeed, from two or three others of the
so-called natural groups? There can be no doubt of the distinctive
“characters of some of these groups, and that they ought to receive
separate description in any treatise on insanity. But that is not the
point in discussion here: the question now is whether there are
groups numerous enough and sufficiently characteristic to form the
basis of a new system of classification, or whether their proper place
is as varieties of the classes or orders in the old system. Surely a
classification which is applicable only to certain varieties of mental
disease, and which must, in dealing with a great proportion of cases,
have recourse to’ the system which it discards, stands condemned
for, the present as a system of classification. Whatever may be the
case in the future, it cannot but be admitted that, in the present state
424 VARIETIES OF INSANITY. ({cHap.

of knowledge, a treatise on insanity must deal generally with the
symptomatology of the principal forms, and afterwards proceed to
enumerate and delineate the special groups—must describe the class
first, and then descend to the orders and varieties. The class of
mania includes certain well-defined orders, but there are none of
these orders which have not characters in common with the class, such
as enable us to recognise them as belonging to it, and to distinguish
them, by the general characters of the class, from other forms of
insanity included under another class, For these reasons, amongst
others, I have thought it best in the foregoing chapter to treat
generally of the symptomatology of the principal forms of insanity,
leaving the practical points connected with the different varieties to
be dealt with in the chapters on Causation, Diagnosis, Prognosis,
and Treatment. I have done so, however, not without considerable
doubt and reluctance, because I think it probable that future
researches, by accumulating observations, will supply a more exact
and complete medical history of the different varieties of insanity
than we have now, and therein furnish the materials for a positive
and truly scientific classification in the direction indicated by
Dr. Skae.

M. Morel, of Rouen, has propounded a classification of mental
diseases according to their apparent causes—an etiological classifica-
tion. Though it is unquestionably imperfect, leaving a large number
of cases unprovided for in its classes, and ascribing to insanity pro-
duced by a particular cause special features which are not easily
recognised in practice—in fact, like Dr. Skae’s classification, making
artificial groups to suit the demands of the system—yet I think it
well to give a brief summary of it here, because of the positive
scientific spirit which has evidently instigated it.

First Grour.—Hereditary insanity.

Ist Class.—It includes patients who have a congenital nervous tem-
perament in consequence of hereditary causes, and who easily become
insane under influences which, but for the hereditary taint, would not
give rise to insanity.

2nd Class.—It includes those who, in consequence of hereditary
taint, display their insanity in acts rather than in words—in eccen-
tricities, incoherence, irregularity, and often extreme immorality of
conduct.

3rd Class.—It includes those who exhibit innate insane propensities
to various forms of crime—to theft, incendiarism, a vagabond life, &.
Their physical degeneration is marked by malformation of the head or
1] VARIETIES OF INSANITY. 425

ears, smallness of stature, sterility, &c. They come between the third
class and that which follows.

Ath Class,—It includes imbeciles and idiots.

Szconp Group.—lInsanity produced by toxzc influences.

1s¢ Class.—It includes those cases in which insanity has heen occa-
sioned by the regular use of alcohol, opium, and other narcotics ; also
those cases in which lead, mercury, and phosphorus have produced
special forms of delirium.

2nd Class.—Under this class come the cases produced by the influ-
ence of an insufficient or a bad form of nourishment—ergotism, caused
by bad rye, and pellagra.

3rd Class.—It includes cases produced by marshy influences, or by
certain geological conditions—cases of cretinism.

Tarp Grovup.—Insanity produced by the transformation of other
nervous diseases.

1st Class.—It includes insanity which has been caused by hysteria.

2nd Class.—It includes insanity connected with epilepsy.

3rd Class.—It includes cases of hypochondriacal insanity, divisible
into at least two varieties: first, simple hypochondria, where the
patient is continually occupied with his health, and is scarcely actually
insane ; secondly, a variety in which the patients think themselves
subject to persecutions, and perhaps commit crimes in order to attract
public attention.

Fourts Group.—Idiopathic insanity.

1st Class.—It includes cases of the progressive enfeeblement, or the
abolition of the intellectual faculties, following chronic diseases of the
brain or of its membranes.

2nd Class.—It includes general paralysis.

Firta Grovp.—Sympathetic insanity. It includes all cases in
which a morbid condition of some other part of the body than the
brain is the cause of the insanity—the cases in which insanity follows
fever, or pneumonia, or uterine disease.

Sixta Grovup.—Dementia. Though here departing entirely from
the principle of his method, Morel thinks that this will not suffer by
making a separate group of those who have fallen into dementia.
“Whatever may have been the primitive form of their affection, they
constitute a large family, all whose members present common cha-
racters.”

Assuredly this last group opens a very wide trap-door in the floor of
Morel’s system of classification, and forces us back upon the old system
426 VARIETIES OF INSANITY. [cHaP.

in no little disorder. Itis not necessary here, however, to enumerate
the obvious objections against an etiological classification generally,
and against the one above mentioned in particular. Much of what
has been urged against the method of arrangement proposed by Dr.
Skae might be repeated here ; and if we compare the two methods, and
observe how facts, which are made leading characteristics in the
divisions of the one, are left without consideration in the other, we
cannot help coming to the conclusion that they are both fundamentally
defective, though we may at the same time acknowledge in both the
evidence of an excellent scientific spirit. Morel’s method is, on the
whole, of a more ambitious character, but of less practical worth, than
that of Dr. Skae. In the chapter on the causation of insanity will be
found various facts and reflections beariny directly on the principles of
both methods, and weighing against the practicability of their present
adoption.

NOTE ON THE TEMPERATURE IN INSANITY.

While this sheet was passing through the press, Dr. Clouston has
published in the Journal of Mental Science for April 1868, some
important inquiries concerning the temperature of the insane. His
conclusions are :—

“1. The temperature of the body is higher in the insane than in
the sane.

2. The temperature is highest in phthisical mania, yradually falling
in the following order:—General paralysis, acute mania, epilepsy,
melancholia, mania, mild dementia, and complete dementia.

3. Dementia is the only form of insanity whose average tempera-
ture is below health.

4, The great characteristic of all the forms of insanity is that the
difference between the morning and evening temperature is much less
than in health, and this is owing to the rising of the evening tem-
perature, and not to the lowering of the morning temperature as
compared with the healthy standard.

5. This rising of the evening temperature, as compared with the
morning, is in the exact ratio of the death-rate among the various
forms of insanity, finding its acme in general paralysis.
t11.] VARIETIES OF INSANITY. 427

6. In general paralysis, the average evening temperature is higher
in every case than the morning temperature (the observations being
taken over a sufficient period).

7. In phthisical patients the temperature is high, and is especially
high in the acute forms of the disease, but the latent forms cannot
be certainly diagnosed by thermometric observation.

8, The evening temperature of every form of insanity (even complete
dementia) is higher than the evening temperature of health.

9. The greatest differences in different individuals labouring under
the same form of insanity are found in general paralysis, epilepsy, and
acute mania. In the first named a difference of 8-7° has been found.

10. Excitement in a patient is almost always attended by an in-
creased temperature as compared with depression or quiescence. This
difference averages 2°2° in periodic mania with long periods, and 1:1°
in periodic mania coming at shorter intervals. In general paralysis
there may be a difference of 5:8° in the same individual in different
‘stages of the disease.

11. An epileptic fit depresses the temperature at first, and then
tends to raise it a little, but it makes a difference whether the patient
sleeps or wakes after the fit.

12. The epileptiform fits of general paralysis are always followed
by a greatly increased temperature, lasting for several days, and they.
may in this way be distinguished from ordinary epileptic fits.

13, The average temperature falls as the patients get older, but the
fall takes place chiefly in the morning temperature.

14. The average frequency of the pulse in the various forms of
insanity corresponds with the mean temperature, but the rise in the.
evening temperature has no corresponding rise in the evening pulse.”
CHAPTER IV.
THE PATHOLOGY OF INSANITY.

Co proceeding with the description of those morbid

appearances which have been met with in insanity, it will
be well to have regard to certain preliminary considerations of a
general character. Already the absence of any physical appear-
ances where psychical disorder has existed, has been dwelt upon
at some length. A patient dies in a raving madness, and there is
no reason disclosed by pathological observation why he should
have died. Is it a right inference, then, that nerve element does
not subserve mental function, or is not affected when function
is affected? Certainly not: at present we know nothing what-
ever of the intimate constitution of nerve element and of the
mode of its functional action, and it is beyond doubt that im-
portant molecular or chemical changes may take place in those
inner recesses to which we have not yet gained access. Where
the subtlety of nature so far exceeds the subtlety of human
investigation, to conclude from the non-appearance of change to
the non-existence thereof would be just as if the blind man
were to maintain that there were no colours, or the deaf man
to assert that there was no sound. Matter and force are neces-
sary co-existents, and mutually suppose one another in human
thought ; and to speak of change in one is of necessity to imply
change in the other. We cannot write the order of the variable
winds or of the shifting clouds, but we are none the less certain
that both clouds and winds have an order which they cannot
disobey, and which we shall some time discover; and so like-
wise we have the fullest confidence that in due time a means will
be discovered of penetrating the yet inscrutable recesses of nerve
life, and of making known the physical conditions of its func-
CHAP. IV.] THE PATHOLOGY OF INSANITY. A429

tional manifestations. The mechanism of nervous function is
now a region of uncertainties and obscurities ; it is the destined
field, therefore, of future discoveries.

There are numerous facts available to prove that the most
serious modifications in the constitution of nerve element may
take place without any knowledge of them otherwise than by
the correlative change of energy. After severe and prolonged
mental exertion there inevitably comes exhaustion, which may
be so great that the brain is utterly incapacitated for further
function ; a large increase of phosphates in the urine testifies to
the disintegration of nerve; the individual is, so far as power of
active life is concerned, almost a nonentity; and yet neither
microscopist, nor morbid anatomist, would succeed in discover-
ing any difference between the nerve substance of that man’s
brain and the nerve substance of the brain of one who, after due
rest and nutrition, was prepared for a day of vigorous activity.
The sudden shock of a powerful emotion may produce instanta-
neous death, just as a stroke of lightning may, and perhaps in
the same way; but neither in one case nor in the other may
there be any detectable morbid change. If the electric fish be
persistently irritated so as to be made to give forth shock after
shock, the excessive expenditure of energy leaves it utterly
exhausted, and it can will no more shocks until rest and nutri-
tion have restored its power; the nervous centres have plainly
undergone some modification, though we know not the nature
of it. Instead of arterial blood send through the brain blood
heavily charged with carbonic acid, and the victim of the ex-
periment must inevitably die; but who can tell the secret
change that has been produced in the composition of the nerve
element? Without killing a man outright, it is possible, by
causing him to breathe a mixture of one part of air and three
parts of carbonic acid, to render him as insensible to pain as if
he had inhaled chloroform ; but it is the gross result only that
is recognisable by our senses. In this regard, however, the ex-
periments of Lister on the early stages of inflammation are of
some interest; for he showed that carbonic acid produced a
direct sedative effect upon the elements of the tissue, paralysing
for the time their vital energies; the effect being transient, and
the tissue recovering its energy after a considerable time, The
430 THE PATHOLOGY OF INSANITY. [cHap.

experiment brings us to the individual elements of the tissue,
but not to the more intimate changes that take place in it. The
difference may obviously be the difference between life and
death, and yet there may be no appreciable physical or chemical
change. As regards the morbid appearances met with in cases
of insanity, there can be no question that the instances in which
they are not found are becoming less frequent as investigation
becomes more searching; and those who are best capable of
judging, and best qualified by acquirements to give an opinion,
are those who are most certain of the invariable existence of
organic change. It is known that when a morbid poison acts
on the body with its greatest intensity there are fewer traces of
organic alteration of structure found than when the poison has
been of a milder character and has acted more slowly ; and so
likewise organic change of nerve element in insanity, appreciable
by the imperfect means of investigation which we now possess,
may justly be expected only when the degeneration has been
long continued.

1. Physiological Researches into Nervous Function—The im-
portant researches into the physiology of nerve which have been
made during the last few years, will help to render conceivable
the existence of organic change which, though undetectable, can-
not be doubted. It is, indeed, of the first moment that a distinct
idea of nervous activity as dependent on physical and chemical
processes should be formed. Because nerve is looked upon as
ministering to mind, the exalted and indefinite conception of
mind has reflected on nerve functions a sort of spirituality and un-
reality, and has, consciously or unconsciously, caused them to be
set apart from the category of like organic processes. The meta-
physically minded have not been content to declare the mind to
exist independently of all the physical processes which determine
the mode of its manifestations, but they have actually imposed
metaphysical conceptions on nervous function as the instrument
of so exalted a mission. However, the regions of the wonderful
are becoming less and less as science advances its lines; and
there has now been found in the electric stream a means of
partially penetrating the hitherto unapproachable secret of ner-
vous function. With the perfecting of this means, which may
justly be expected in the course of time, it cannot be doubted
1v.] THE PATHOLOGY OF INSANITY. 431

that the knowledge of nervous activity will follow as surely as
the knowledge of the heavens followed the invention of the
telescope.

In the endeavours made to elucidate the mechanism of nervous
action, it has already been clearly proved that time is as essen-
tial an element as it is in the motions of the heavenly bodies.
A definite period of time is necessary for the propagation of a
stimulus from the peripheric ending of a nerve to its central
ending in the brain ; and when the stimulus has arrived at the
brain, a certain lapse of time, about one-tenth of a second, takes
place before the will is able to transmit the message to the
nerves of the muscle so as to produce motion. This time-rate
of conduction varies in different persons, and at different, periods
in the same person, according to the degree of attention; if the
attention be slight, the period is longer and less regular, but if
the attention be active, then the period is very regular. But,
whether the attention be great or little, a certain time must
elapse from the moment of irritation of a sensory nerve to the
resultant contraction of muscle; and a message from the great
toe to the brain will take an appreciably longer time than a
message from the ear or face. The time-rate of propagation,
again, is greatly dependent upon the temperature of the nerve ;
cold very much diminishes it, so that the speed may be ten
times less in a cold than in a normal nerve; and in a cold-
blooded animal, like the frog, the rate is only about 80 feet
in a second, while in man it is about 180 feet in the second.
It was Haller who first proposed to measure this speed of
nervous action, and he made a calculation of it in man, which
was not very far from the truth; but after him no one seems to
have attempted the task, and Miiller even pronounced it impos-
sible, because the time seemed infinitely little and unmeasur-
able. In experiments on frogs poisoned with opium or nux
vomica, he could not perceive the slightest interval of time
between the stimulus applied and the resulting muscular con-
traction. Helmholtz has since shown in the most brilliant
manner that Miiller was mistaken, and has, by means of a very
ingenious and delicate mechanism, measured the time which
elapsed between the stimulus applied and the reflex contraction:
he found, too, that the stimulus required a much longer time
432 THE PATHOLOGY OF INSANITY. [cHaAP.

proportionately to pass through the cells of the spinal cord than
to pass along the motor and sensory nerves concerned. The rate
of conduction by nerve is then not only measurable, but it is
comparatively moderate—less even than the rate at which sound
travels. Instead of nervous action being due to the instan-
taneous passage of some imponderable or psychical principle,
conduction by a nerve depends upon some modification of its
molecular constitution, for the accomplishment of which a cer-
tain time is essentially requisite.

Although no such researches into the cerebral centres as those
made into the conditions of conduction by nerve have been
made, we may not unfairly apply the analogy to psychical
activity. At any rate, there can be no question that there is a
considerable variation in the time in which the same mental
functions are performed by different individuals, or by the same
individual at different times. Such variations may depend upon
original constitution, or they may be due to transitory conditions
of the psychical centres. ‘There is,” says Locke, “a kind of
restiveness in almost every one’s mind. Sometimes, without
perceiving the cause, it will boggle and stand still, and one
cannot get it a step forward; and at another time it will press
forward, and there is no holding it in.” The oppression of
mental suffering is notably attended with great sluggishness of
thought, the train of ideas seeming to stand still, and even per-
ception being imperfect. In some forms of mental disease this
defective association is well marked, whilst in others a certain
sort of association is wonderfully quickened, so that ideas follow
one another without restraint, or like-sounding words are strung
together in the most incoherent rhymes. In many cases of
affection of the brain, as in recovery from apoplectic seizure, a
considerable time must elapse between a question asked of the
patient and his reply: there is, as it were, a sluggishness of the
mind, which perceives and reacts more slowly than is natural.*

* “ Every one must have noticed the slowness, as well as difficulty, with which
the tongue is put out, the eyelids raised, or words uttered by patients in a semi-
comatose state. It seems as if a certain time were needed, either for concentration
or transmission of nervous power, before the intended action can be begun;
while so much labour is necessary in pursuing it, that I have repeatedly observed

perspiration breaking out from the continued effort to raise a palsied arm, and an
exhaustion to follow, such as might ensue in health upon violent muscular exercise
1v.] THE PATHOLOGY OF INSANITY. 4388

Such facts, proving beyond all question that the rapidity and
success of mental processes are dependent upon the physical
condition of the supreme nervous centres, prove also that time
is an essential element in every mental function. The time-rate
of the function is probably the measure of the molecular activity
which is the condition of it.

But there are yet more important physiological discoveries,
which may help us towards some conception of the physical
conditions of mental activity. The researches of Matteucci and
Du Bois Reymond into the electrical relations of nerve have
shown that there are currents of electricity engendered in nerve,
as in other animal structures, which are constantly circulating
in it. When the nerve is active there is a diminution of its
proper current, and the needle of a galvanometer connected with
it then exhibits a negative variation. It has been supposed by
Matteucci that there is a rapid succession of electric discharges
from nerve and muscle during activity; but, although that
assumption is very doubtful, and altogether ignored by Du Bois
Reymond, there can be no doubt that the negative variation of
the needle of the galvanometer marks a decrease in the electro-
motive force of the nerve, and that this decrease is in some way
“intimately related to that molecular change in the interior of
the nerve, which, when it reaches the muscle, will produce con-
traction, or when it reaches the brain, will be received as sensa-
tion.” It is to be borne in mind that every minute particle of
nerve acts according to the same law as the whole nerve; the
current, therefore, which a piece of nerve produces in a circuit
of which it forms part, must be considered only as a derived
portion of incomparably more intense currents circulating in the
interior of the nerve around its ultimate particles. There is thus
certain evidence, not only of the electro-motor properties of
nerve, but of a modification of these during functional activity :
such modification again testifying to an intimate change at any
rate in the polar molecules of the nerve.

But there are yet further considerations. Ifa cénstant gal-

of the whole body. How striking the contrast here to that instant and free effort
vy which action is evolved almost simultaneously to all sense with the external
mpression producing it, though various mental and bodily operations actually
ntervene,”—Si1r H. HoLuand, Chapters on Mental Physiology.

‘ FF
434 THE PATHOLOGY OF INSANITY. [cHap.

vanic current be passed through a portion of nerve, it is found,
that not the tract of nerve only which lies between the poles
but an extra-polar portion or tract also is put into what is called
an electrotonic state. Pfliiger has, in fact, shown that the nerve
immediately falls into two zones, in one of which, namely, at the
negative pole, the excitability of the nerve is increased; in the
other, namely, at the positive pole, the excitability is diminished.
The former state he has called Katelectrotonus—the latter, A nelec-
trotonus. A given tract of nerve is excited, therefore, through
the production of katelectrotonus and the disappearance of
anelectrotonus, but not through the disappearance of katelec-
trotonus and the appearance of anelectrotonus. Now, the con-
duction of a stimulus along the nerve is found to be delayed by
the electrotonic condition of it in the polarized tract; and this
delay passes to complete stoppage of conduction when the elec-
trotonic condition reaches a certain degree, or oversteps it. The
diminution of conducting power takes place both in the neigh-
bourhood of the negative pole and in the neighbourhood of the
positive pole; so that the nerve-tract near the positive pole of
an electrotonic nerve is distinguished by a decrease of direct
excitability, and by retardation of. the speed of conduction; the
nerve-tract near the negative pole, on the other hand, undergoes
an increase of direct excitability, and a retardation of conducting
power. These changes all agree in increasing with the increasing
strength of the stream, with the increase in the time of its
closure, and with the decrease of the distance of the nerve-
tracts concerned from the poles. Such are the broad results of
Pfliiger’s admirable investigations: what conclusions do they
seem to point to? Considering that the states of excitability
are of an opposite kind at the positive and negative poles, and
considering further the sort of change which is notably produced
in soft conductors by an electric stream, it is a natural inference
that the physical and chemical changes of which the retardation
of conduction is a result are quite different at the negative from
what they are at the positive pole—in a certain regard, opposite:
between the poles there being a centre of indifference at which
one kind of change passes into the other. If this be so, then it
is not impossible, perhaps not improbable, that the exciting
operation of a galvanic stream through a nerve may lie in the
v.] THE PATHOLOGY OF INSANITY. “A385

chemical effects which the stream calls forth in the soft conductor
through which it passes: the intrapolar tract of nerve behaving
in every regard like polarized moist conductors, the qualities of
which are more altered by the stream the nearer the tracts
affected are to the two poles. The molecular process of exci-
tation in the nerve, the passage out of the excitable into the
excited condition, would then be the effect of this electrolysis ;
and the electric excitation would resolve itself into a definite
form of chemical stimulus, which, like the process of giving off
hydrogen during the closure of a stream, appears only at the
negative pole. The analogy of the process of excitation with a
product of electrolysis is not weakened by the fact that a certain
time is required by a nerve, after it has been in an electrotonic
state, before it recovers its full power of conduction.* Still it
would be unwarrantable, in the present state of knowledge, to
assume any such comparison as exact: its use is rather as an
illustration from the known, in order to assist us to some kind
of conception of the unknown. Chemistry must supply the
groundwork of a physiology of nerve element, and on its pro-
gress the physiologist must wait ; but for the full exposition of
the complex phenomena of nerve function there will be needed
wider science than chemistry is ever likely to furnish.

The results so far obtained prove clearly enough that nervous
function is not to be embraced in any metaphysical conception,
or dismissed as inexplicable, but that it is a matter for positive
scientific investigation. The conducting function of nerve is
shown to be a measurable process of molecular movement; the
proper electrical current of nerve is diminished during its
excitation, and its intimate molecular constitution modified ;
and there are grounds for supposing that the electric excitation
of nerve results from some definite chemical change. The
relation between chemical force and electric force is probably
‘nowhere more intimate than in the phenomena of nervous
action, could we only unfold their real nature.

It has been shown that with nerve as with muscle the chemi-
cal reaction becomes acid after activity, owing to the production
seemingly of lactic acid; and the results of the waste of nerve

* Amold von Bezold, Untersuchungen tiber die Electrische Erregung at

Nerven und Muskeln. 1861.
FF2
436 THE PATHOLOGY OF INSANITY. [cHap.

-element during function are found to resemble very much those
which are produced by the waste of muscle: they are such as
result from the retrograde metamorphosis of the highly vital
tissue, and seem to fall under two classes, one of which repre-
sents the series of fatty acids, the other that of aromatic bodies.
These facts are of interest in connexion with what is known of
the similar electrical relations of nerve and muscle. By means
of the thermo-electrical apparatus Becquerel and Breschet have
shown that a muscle rises one degree in temperature during con-
traction; the production of heat being due to the oxidation
which then goes on, as the investigations of Ludwig—proving
that the arterial blood which passes through a muscle in a state
of contraction is almost completely deprived of its oxygen—and
the nature of the waste products of oxidation found in muscle
after contraction, indicate with sufficient clearness. During
muscular contraction, then, there is not only motion, but there
is an evolution of heat, together with a modification of the elec-
trical currents of muscle and a certain chemical action; and
any comprehensive theory of muscular action must be able to
show how these are related to each other. The observations of
Heidenhain, so far as they go, would certainly indicate that the
amount of chemical action was in proportion to the sum total
of latent energy made “actual” during contraction.* Iam not
aware that like investigations have been made into the chemical
history of nerve during the exercise of function; but one may
fairly assume, both from the like electrical properties and from
the like products of the retrograde metamorphosis, that an
absorption of oxygen and an evolution of heat are part of an
undoubted chemical action. Again, then, the appeal is to the
chemist to make known the nature of the intimate chemical
changes.

I have adduced the foregoing physiological considerations to
the end that they may furnish the groundwork of a just concep-
tion of the pathological phenomena: they are valuable not so
much for what they actually reveal as for what they point to;
and they are certainly indispensable to the formation of a con-
sistent theory capable of binding together the many scattered

* Mechanische Leistung, Wirmeentwickelung und Stoffumsatz bei der Muskel-
thitigkeit, von Rudolf Heidenhain.
1v.] LHE PATHOLOGY OF INSANITY. 437

facts In nerve pathology at present known, and for directing
the course of future research. At the outset they prove that,
so far from its being wonderful that there are no visible morbid
appearances in some cases of insanity, the wonder really is that
such should have been expected, It has been calculated that
a distinct sensation of smell is produced by zytoq gr. of sul-
phuretted hydrogen, by zpdoq gt. of bromine, by ysyho0 gt.
of oil of resin, and by even a still smaller quantity of musk ;
and yet men familiar with these facts have thought it no incon-
sistency to look with the naked eye for the physical condition of
delicate psychical disorder.

2, Individuality of Nerve Element.—Not only have the elec-
trical properties of nerve element and the intimate chemical
changes during its function been hitherto entirely disregarded
by those who have written on the pathology of insanity, but it
would be no injustice to assert that nerve element itself, ag
a living entity, has been almost ignored. The main stress has
always been laid upon the blood-vessels, as if they were the
primary agents in initiating and keeping up cerebral disorder.
But the truth is that the first step in insanity often is, as it is
in inflammation, a direct change in the individual elements of
the tissue, the change in the blood-vessels being entirely
secondary. Take, for illustration, the early steps of inflam-
mation; by the interesting observations of Professor Lister it
has been made evident that, in the case of mechanical or che-
mical injury to some part, the elements of the tissue are directly
injured; that they are brought to a lower state of life, and their
functional activity impaired; as a consequence of the injury the
elements are brought nearer to the condition of ordinary non-
living matter and the corpuscles of the blood exhibit a tendency
to stick together in the neighbourhood of the damaged part,
just as they do when brought into contact with ordinary matter
after being withdrawn from the body. The dilatation of the
vessels is produced indirectly through the nervous system,
Observation of the effects of irritants upon the pigment-cells
of the frog’s skin confirmed these views: Mr. Lister found that
irritants applied in such a mild form as to cause little or no
derangement of the blood did nevertheless produce a certain
degree of loss of power in the part to which they were applied ;
438 THE PATHOLOGY OF INSANITY. (CHAP.

for there took place a diffusion of the pigment in the cells—
“the visible evidence of diminished functional activity accom-
panying, if not preceding, the earliest approaches to inflam-
matory congestion,” and corresponding with arterial dilatation.
Experiments with carbonic acid proved that it had a powerful
sedative effect upon the tissues, paralysing their vital energies
so as to give rise to intense inflammatory congestion, which,
however, was transient; even in amputated limbs, in which
there was of course no circulation, the tissues recovered after
its action, so that, as the restoration of the action of cilia sepa-
rated from the body might indicate, the “tissues possess, inde-
pendently of the central organ of the nervous system or of the
circulation, or even of the presence of blood within the vessels,
an intrinsic power of recovery from irritation, when it has not
been carried beyond a certain point.”* From which researches
it plainly appears that the earliest condition of inflammation is
more or less complete suspension of functional activity in the
elements of the tissue, whatever be the cause; and it is evident
also that the walls of the blood-vessels are more or less deprived
of their vital endowments when inflammation is established, as
they then allow fibrine to pass readily through, though they
repel it in health. These experimental results definitely esta-
blish the correctness of views long maintained by those philo-
sophical pathologists who gave due weight to such phenomena
as the immediate effects of mechanical and chemical injury of a
part, the growth of blood-vessels in the primordial development
of parts, and the increased action of one kidney and the sequent
increased afflux of blood when the other is destroyed or rendered
incompetent. t

Bearing well in mind the foregoing observations touching the
intrinsic action of the tissues, it will not be difficult to perceive
how damage to the nerve elements of the brain, however
caused—whether from overwork, or emotional anxiety, or some
poison in the blood, or direct injury—may immediately declare
itself in disordered function: the nerve element is brought to
a lower state of life, and manifests its deviation from the normal

* On the Early Stages of Inflammation, by J. Lister, F.R.S. Philosophical
Pransactions, vol. xxxi., 1858.

+ General Pathology, by J. Simon, F.R.S.
1v.] THE PATHOLOGY OF INSANITY. 439

state by a disturbance of function. And as in inflammation a
determination of blood and an adhesion of its corpuscles follow
the local mischief, so here a disturbance of the circulation inevi-
tably follows, and in its turn becomes the cause of further
mischief. One may perhaps perceive also how it is that, when
there is an innate feebleness of nerve element in consequence
of hereditary taint, insanity is produced by causes that would
have no such baneful effect upon a soundly constituted brain.
The knowledge now acquired of the state of the cerebral
circulation during sleep goes to prove the importance of the
nerve element as individual. It has for long been the
fashion to assert that there was an increased quantity of
blood in the brain during natural sleep, notwithstanding that.
Blumenbach had noticed in the trepanned skull of a man that
the brain sank during sleep, and swelled up with blood when he
awakened ; but the investigations of Mr. Durham, who removed
portions of the skull in different animals, have distinctly shown
that there is considerably less blood in the brain during sleep,
its substance then becoming paler and sinking down, while it
immediately swells up and becomes turgid with blood when
the animal awakes.* If, mindful of the ancient maxim, ubi
stimulus ibt flucus, we fix attention on the individual nerve
element as the active cause to which the supply of blood is to
some extent secondary, it will be seen why the quantity of blood
is diminished in the brain during sleep. The actively flowing
stream ministers to the functional energy of the cerebral centres;
but, as such function implies a waste of organic element, there
must needs be a period of suspension of activity, during which
renovation may take place. The function of the brain, therefore,
as an organ of animal life, is suspended by recurring periods of
sleep: the organic life of the brain, however, like organic life
2lsewhere, does not sleep, but by the restoration of the wasted
or exhausted element, lays up a store of latent energy to be
nade “actual” in future function. The supply of blood answers
io these different states, being active when the energy is great,
noderate when it is in abeyance. If the thoughts of any one
* Guy’s Hospital Reports. Dr. Hammond, in an article on “ Sleep and In-

omnia,” in the New York Medical Journal, vol. i. 1865, confirms Mr. Durham’s
Xperiments, and gives the observations of previous authors, af
440 THE PATHOLOGY OF INSANITY. [cmar,

wishing to go to sleep are active, there is a rapid flow of blood
through the brain, and he cannot get to sleep; the stimulus of
activity acts as a cause of the determination of blood, and this in
its turn tends to keep up the activity. Some persons under these
circumstances have a certain power of inducing sleep in spite of
the difficulty : by concentrating the attention on some particular
mental representation, and steadily checking every tendency to
revert to the exciting ideas, the excitation of the nervous centres
ministering to these subsides, the circulation becomes less active,
and the individual passes into sleep, though it is probably not
very sound. Indeed, it were well to bear in mind that there
exists great diversity in regard of the extent and degree of
sleep, one sense being sometimes more deeply involved than
another, or the same sense differently at different times. All
that we are directly concerned with here, however, is the con-
firmation which the phenomena of sleep afford of what has been
said of the primary action of nerve element as individual.

If it were desirable to multiply arguments in favour of the
foregoing views of the relation of the nerve element to the cir-
culation, one might instance the effects of its direct and rapid
exhaustion. By putting any one, for example, on the rack,
mentally or bodily, it is possible to produce as great nervous
exhaustion in one hour as would be ordinarily produced by a
day of vigorous activity ; the result whereof notably is irresis-
tible sleep. A man will sleep on the rack in the intervals of the
application of the torture. Carry the exhaustion still further,
the power of recovery in nerve element which, as in all organic
element, is an intrinsic property, is abolished, and the sleep that
occurs is the sleep from which there is no waking—the sleep
that rounds off the dream of life.

When a dog is poisoned with strychnia, it may happen that
there are no appreciable morbid appearances in the animal’s
body; but if there are any, they are such as congestion of the
spinal cord, aneurismal dilatation of the capillaries, and perhaps
small effusions of blood in the grey matter. Now the congestion
or effusion of blood in such case is plainly a secondary result
of the intensely morbid activity of the nerve elements upon
which the strychnia directly acts. Here, in fact, is the abstract
and brief chronicle of what happens in many cases of insanity.
rv.] LHE PATHOLOGY OF INSANITY. 441

Transfer the convulsive action from the spinal nerve-cells to the
cortical cells of the hemispheres, the result is an acute and violent
mania, in which the furious morbid action of the directly poisoned
nervous centres initiates an acute determination of blood. Let
the disease be supposed to become chronic, the congestion of the
blood-vessels may become chronic also. The common error has
been to discover the pathological cause of the insanity in the
congestion, in spite of the observation that it was not the way of
congestion, otherwise caused, to give rise to insanity. In what
is described as Mania transitoria, it sometimes happens that an
individual falls with great suddenness into a violent fury, in
which perhaps he evinces dangerous, destructive, and even
homicidal tendencies: his face is flushed, his head hot, and there
is plainly an active determination of blood to the brain. After
a short time the attack subsides, and the man is himself again,
scarcely conscious of what has happened. There is no good reason
to look upon the rush of blood in such case as the active agent
in the production of the fury ; but there is the strongest possible
reason to believe it secondary to the violent and degenerate
action of the nerve centres; the attack is, in truth, an epilepsy
of the cerebral centres, and the congestion takes place not other-
wise than as it takes place in the spinal cord poisoned by
strychnia. To the formation of correct views of the pathology
of insanity it is most necessary that this order of events should
be distinctly realized.

At the same time it is important not to overlook the fact that
extraneous disturbances in the circulation, quantitative or quali-
tative, may be the direct cause of disorder of the cerebral centres,
Whatever interferes with the regular supply of the proper ma~-
terial to be by them assimilated, and the regular removal of the
waste products of functional action, so far predisposes to disease,
and will specially do so where there is any innate disposition to
morbid action or any prostration, otherwise caused, of nerve
element. In his Lumileian Lectures, Dr. Todd much insisted
upon what Andral had pointed out—namely, that an anemic
condition is favourable to the production of delirium and of
coma. The delirium which sometimes occurs at the end of acute
specific diseases, when the fever is over, and lasts for a few days,
has been attributed to acute cerebral anemia, but it seems
442, THE PATHOLOGY OF INSANITY. [cHar.

probable that in this case the great nervous exhaustion is the
more important agent; the delirious activity of the nervous
centres being the evidence of an exhaustion which, carried
a little further, becomes coma, or extinction of functional
action. That congestion or inflammation of the brain may
produce serious disturbance of its functions is known to
every one; but it is well worth considering how rarely conges-
tion of the brain, originating in causes outside itself, gives rise
to delirium or insanity. It is because of a diminution in the
functional power of the nerve element itself, because this has
been brought to a stage nearer to the condition of non-living
matter, that the adherence of the blood-corpuscles and the stag-
nation of the blood take place; and under such circumstances
we may understand how little fitted the nervous element is to
contend with the difficulties that are gathered around it. It is
weak, and it is consequently miserable; evils cluster around it,
and threaten to quench its life; it has more difficult work to do,
and yet it is less able to do it; it responds, therefore, as weak-
ness always does, with a convulsive or delirious energy, and, if
circumstances continue very unfavourable, its activity is extin-
guished. May we not, then, perceive how it is that the abstrac-
tion of blood by some means from the labouring part may be
beneficial in certain cases? The aim is to put the suffering
part as nearly as possible in that condition in which it is during
natural sleep—in a condition of rest; and the recovering power
which, as we have seen, exists in the elements of a tissue, will
then be under the most favourable conditions for restoring the
natural state of things.*

One more consideration shall serve to exemplify the impor-
tance of the individual nerve element in the production of
insanity. To surgeons it is well known that after an injury
erysipelas and phlebitis, which are blood-diseases, are most apt

* Morel mentions the case of a man, aged fifty-five, who was hemiplegic after
cerebral hemorrhage. His intelligence was sound, but he was morose and
irritable, and weary of life. Periodically, however, he was subject to attacks,
in which he complained of blood rising to the head; his heart beat violently ;
the fingers of the paralysed side contracted ; he was unspeakably dejected at
first, saying that he was lost; then became furious, threw himself on his wife or
children, and several times attempted suicide. Blood-letting and cold to the
head produced immediate calm.—Traité des Maladies Mentales, p. 138,
tv.] THE PATHOLOGY OF INSANITY. 443

to appear at the seat of the injury. And a true eruptive fever
will do the same. Mr. Paget relates, for example, how he cut a
boy for the stone, who became very ill, and seemed in danger of
his life; but soon a vivid red eruption appeared at and about
the wound. This was measles, earliest and most intense at the.
seat of the injury, just as erysipelas might have been. He has
seen a similar event in a case of injured and inflamed knee with
scarlet fever, and Dr. William Budd has recorded a case of small-
pox which appeared most intensely over a bruise of the nates.
In like manner, the nerve element, when weak by nature, or
weakened by accident, is liable to be seized on by a morbid
poison: it is the weak part, and therefore the sufferer. But
more than that: the greatest stress has been laid, throughout
this work, on the fact that traces or residua of every mental act
are left behind by it, modifying henceforth the nature of the
element which subserved the particular function ; and indications
were given that every organic element, and not that of the brain
only, manifested this kind of memory. Hence it comes to pass
that any tissue which has been subject to a particular morbid
action is more liable to take on that kind of action again,—has,
in fact, a sort. of acquired aptitude for it. Now this is most true
of the brain, for the residua left behind by previous acts consti-
tute almost the very nature of the elements subserving mental
action. The weighty bearing, therefore, which previous habitual
mental states have in the production of insanity, is revealed in
this law not less surely than the predisposition to a second
attack of insanity which a former attack induces. The event in
each case is an illustration of a law of organic growth and
action to which nervous element is subject in common with
other organic elements of the body. Plainly, only by fixing
attention on the individual nerve element can the shadow of a
conception be formed of the manner of that degeneration which
reveals itself by insanity.

3. Reflex Pathological Action or Pathological Sympathy—In
discussing the causation of insanity, the general features of this
kind of morbid action have been set forth; and when I come to
enumerate the morbid appearances met with in the bodies of the
insane, the statement of the relative frequency of disease of
different organs will find its proper place. Here I take occasion
444 THE PATHOLOGY OF INSANITY. [cHap,

only to adduce certain observations with regard to the striking
manner in which diseased action of one nervous centre is some-
times suddenly transferred to another. This fact, which has
lately attracted new attention, was long since noticed and com-
mented on by Dr. Darwin :—“ In some convulsive diseases,” he
writes, “a delirium or insanity supervenes, and the convulsions
cease ; and, conversely, the convulsions shall supervene, and the
delirium cease. Of this I have been a witness many times a
day in the paroxysms of violent epileptics ; which evinces that
one kind of delirium is a convulsion of the organs of sense, and
that our ideas are the motions of these organs.” Miss G., one
of his patients, a fair young lady, with light eyes and hair, was
seized with most violent convulsions of her limbs, with out-
rageous hiccough, and most vehement efforts to vomit. After
nearly an hour had elapsed this tragedy ceased, and a calm,
talkative delirium supervened for about another hour, and these
relieved each other at intervals during the greatest part of three
or four days. “After having carefully considered this disease,”
he says, “I thought the convulsions of her ideas less dangerous
than those of her muscles,” and thereupon he adopted such
treatment as resulted in the young lady’s recovery. In another
case, which came under his observation, “ these periods of con-
vulsions, first of the muscles and then of the ideas, returned
twice a day for several weeks.” “Mrs. C.,” again, “ was seized
every day, about the same hour, with violent pains in the right
side of her bowels, about the situation of the lower edge of the
liver, without fever, which increased for an hour or two, till it
became totally intolerable. After violent screaming she fell into
convulsions, which terminated sometimes in fainting, with or
without stertor, as in common epilepsy ; at other times a tempo-
rary insanity supervened, which continued about half an hour,
and the fit ceased.”* I quote these observations of Dr. Darwin

* Zoonomia, vol. i, pp. 25, 26. Brodie relates the case of a lady who suffered
for a year from persistent spasmodic contraction of the sterno-cleido-mastoid ;
suddenly it ceased, and she fell into a melancholy; this lasted a year; after
which she recovered mentally, but the cramp of the muscle returned, and
lasted for many years. In another case of his, a neuralgic condition of
the vertebral column alternated with true insanity.—Lect. on certain Local
Nervous A ffections,

Dr. Burrows mentions similar cases: one “in a very eloquent divine, who was
1v.] THE PATHOLOGY OF INSANITY. 445

with great satisfaction, because they have reference to what has
only lately received due attention, and because they are examples
of enlightened observation, such as lie scattered through his
great work. Indeed, a candid inquirer cannot but allow that
the sagacious views of Dr. Darwin and Dr. Whytt, concerning
the reflex or sympathetic action of the nervous system in
disease, would add something of value to the more exact know-
Jedge of the subject which exists at the present day.

When treating of the insanity of early life, it was pointed
out how commonly the morbid actions of the different nervous
centres were intermixed, or replaced each other ; it is, in fact, in
early life that this indistinguishable blending of nervous dis-
eases, which afterwards become distinct, is most evident. Still,
marked examples do now and then occur in the adult; and it is
not an uncommon thing for the practical physician, watching
the phenomena of actual disease of the nervous system, to have
to admit the existence of strangely hybrid forms. The most
interesting example, perhaps, of the transference of morbid
action, or of the morbid action of one nervous centre being
vicarious of that of another, is presented sometimes in the course
of epilepsy. Instead of the usual attack of the peculiar convul-
sions, there is a sudden maniacal fury, which has been described
in France as epilepsie larvée—latent or masked epilepsy. A
young surgeon, strong and well-made, came under my care in a
violent state of maniacal delirium. He had served during the
Crimean war, and on his return had entered into partnership,
and become engaged to a relative of his partner. Anxious on
this account, and for pecuniary reasons, he had not been as
temperate as he should have been; and he had had two epileptic
fits at a considerable interval one from the other. On his
return one day from seeing his patients, he complained of a pain
in his back, and of a feeling of cold, and talked flightily. Next
morning he appeared well, and was very anxious to know what
he had said on the previous evening ; but in the course of the
day he became wildly maniacal, extremely incoherent, and very
violent. So he remained for two days, when he was brought to
the hospital in a strait-waistcoat. After admission he was

always maniacal when free from pains in the spine, and sane when the pains
returned to that site.’—Commentaries on Insanity.
446 THE PATHOLOGY OF INSANITY. [onap,

quiet but confused, and seemed quite unaware of what position
he was in; in the afternoon he slept for three hours—his sleep
deep, almost stertorous. On awaking he had three very severe
epileptic fits in quick succession, after which a long period of
comatose unconsciousness followed. On the next day he was
quite composed and rational, but very weary ; on the day after
another acute attack of maniacal delirium occurred, from which,
after a free purge, he recovered, without any other epileptic fit,
In this case we may, I think, fairly believe that there was a true
epileptic insanity taking the place of epileptic convulsions.

But there are cases, as M. Morel has pointed out, in which
an epileptiform neurosis exists for a long period in an unde-
veloped or masked form, and gives rise to a variety of madness
which is differently described as maniacal fury, or periodic
mania, or instinctive mania, homicidal or suicidal, or moral
insanity. In such cases, after some months, or even years,
distinct epileptic attacks make their appearance, and supply the
interpretation of the previously obscure insanity.

It is a characteristic of the nervous system, a property by
which its internuncial function is accomplished, that the influ-
ence of an impression made at one spot is quickly communicated
to a more distant part. How this takes place we know not;
and, therefore, it matters not much whether we ascribe it to a
sympathy or consent of parts, or to an induction, or an infection,
or to a reflex action, or connote it by any other term which, like
an algebraic symbol, may serve to express an unknown quantity.
It is utterly impossible to account for its operation in disease
at one time and not at another: “Thus, what reason,” asks
Dr. Whytt, “can be given why sometimes, after cutting off an
arm or leg, those muscles which raise the lower jaw should be
affected with a spasm, rather than other muscles?” There is
nothing very singular, however, in this ignorance; no one knows
how it is that the irritation extends from the stimulated spot of
a sensitive plant, the Mimosa pudica for example, so that the
whole leaf contracts, and perhaps neighbouring leaves also con-
tract; no one knows how the induction of electricity actually
takes place, nor how it is that, when a point in a muscle is
stimulated, the contraction extends along the fibre, nor how the
interior of a nerve is actually altered when it is put into an
Iv.] THE PATHOLOGY OF INSANITY. 447

electrotonic condition. It is none the less certain that important
molecular modifications do take place in those inner recesses
of nature which, are impenetrable to our senses, and that they
declare their insensible motions in sensible results. There is
some reason to hope, however, that further researches into the
electrical relations of nerve may throw light upon these pheno-
mena of sympathetic or reflex morbid action. Call to mind for
a moment what is the state of a nerve during excitation. There
is then a molecular change of its interior, and the proper elec-
trical currents are diminished, while chemical action of some
kind takes place: this happening in the interior of a gland,
must needs modify its invisible molecular processes, and the
modification may finally be expressed in a palpable change in
the secretion; in the interior of a muscle the modified mole-
cular activity induced will issue in a manifest contraction; in a
sensorial centre the modification will declare itself in a sensa-
tion ; and if the molecular agitation, or whatever else we call it,
affect a part which does not secrete, which is not sensitive,
which has no power of contraction, it may still, nay, it must,
give rise to some intimate nutritive change. Suppose a morbid
centre of irritation in some abdominal organ, with which the
brain is in sympathetic organic relation, to give rise to persistent
excitation of the intercommunicating nerve, it is certainly not
more wonderful that disturbance of cerebral activity should be
produced, than that reflex movement should follow the stimula-
tion of a centripetal nerve. But disturbance of the intimate
processes of the supreme cerebral functions is neither more nor
less than disorder of the organized basis of thought, the fabric
of mind. According to the degree of morbid derangement
induced, therefore, will there be either a disturbance of the
mental tone and a general painful consciousness, or a positive
perversion of ideas and an incoherence of thought.

It is most necessary to bear in mind the different ways in
which sympathetic or reflex phenomena may be displayed ; it
would appear that, wherever there is continuity of nerve-struc-
ture, there is the possible agency of such action. It is true that
the term, reflex action, is commonly used to denote the trans-
ference of excitement from a sensory to a motor nerve; but
there is no reason to doubt that the reflexion may sometimes
448 THE PATHOLOGY OF INSANITY. [cat

take place in the opposite direction—from the motor to th
sensory nerve. The severe pain felt along the spine after sudde1
and violent coughing, or after irregular contraction of the ceso
phagus, the tickling in the throat after long speaking, and thi
increase of facial neuralgia by muscular exertion, have beer
adduced as examples of that mode of transference.* These ar
instances of heterogeneous sympathy, as it has been called; bw
the sympathy may be shown also by nerves of the same kind
—that is, it may be homogeneous : pain in the knee often indi
cates disease in the hip-joint ; facial neuralgia is produced by
toothache ; or the pain of toothache may be felt in the opposite
tooth to that which is carious. When one eye is covered, the
pupil of the other dilates, which Henle attributes to the influence
of the darkness diffused transversely from one nervous centre
to the other. Ollivier has related the case of a person whose
left leg and side had been rendered almost entirely insensible
below the injury by a wound in the spinal cord of the neck:
still, when the skin of this left leg was pinched, the patient had
a sensation at the corresponding spot of the opposite side.
Motion admits of sympathetic affection as well as sensation ;
amongst other examples, Henle quotes from Melchior the result
of cutting the internal rectus of the eye; if this muscle be cut
through on one side, the eye is a little turned out; if both
internal recti are cut, then both eyes are strongly turned out.
Again, the muscles of a paralysed limb in a hemiplegic patient
will sometimes contract during some emotional or even voluntary
act in which symmetrical muscles of the opposite limb take
part. Of diminution or paralysis of movement by sympathetic
action, there are examples in the dilatation of the blood-vessels
in inflammation and in paraplegia from nephritis, When
mental emotion causes the knees to shake, there is the mani-
festation of a transference of effect from one nervous centre to
another, as there is also when different impressions on the mind
instantly give the eyes either a dull, a lively, or a fierce look.
To these old and familiar examples of reflex action have now to
be added the effects which it is proved to produce upon nutri-
tion and secretion, both by direct action of nerve upon the

* Henle, Handbuch der Rationellen Pathologie, 1846.
Iv.] THE PATHOLOGY OF INSANITY. 449

elements of the tissue, and indirectly through the blood-
vessels.

After these preliminary general considerations, so necessary
to the just appreciation of the morbid appearances that are met
with in insanity, I now proceed to the enumeration of the results
of pathological observation and to the discussion of their nature,
In dealing with them it will be convenient to adopt a threefold
division: 1, of those gross morbid products such as tumours,”
abscesses, cysticerci, &c. which, if they do affect the hemi-
spherical cells, commonly do so indirectly; 2, those direct
results of morbid action which are microscopically or otherwise
discoverable in the structure of the supreme centres; and 3,
those morbid conditions of other organs that have been fre-
quently met with in the bodies of the insane.

1. Morbid Products, such as Tumour, Abscess, Cysticercus, &e.—
Perhaps one of the most frequent observations which one has
to make in the case of cerebral abscess or tumour, or often in
softening, is the absence of symptoms of mental disturbance.
The fact may at first seem striking, because the presence of so
much disease might scarcely be thought compatible with the
undisturbed function of the brain as the organ of mind.
After giving a careful report of ten cases of tumour of the brain,
Dr, Ogle calls attention to the fact that, “in no case was there
during life anything of the nature of mental imbecility, or any
symptom of the various phases or forms of insanity.”* An
examination of the cases furnishes a sufficient reason for the
non-affection of the intelligence : in none of the ten was there
any recognised implication of the nervous centres of intelligence
by the morbid action ; the mischief was more or less central,
and the hemispherical ganglia continued their functions, as they
well might, in spite of it. If there is one thing which patho-
logical observation plainly teaches, it is the slight irritability
of the adult brain; the gradual growth of the tumour allows
the brain to accommodate itself to the new conditions; anda
closely adjacent nervous centre may be entirely undisturbed in
fanction until the morbid action actually encroaches upon it.
Not disease in the interior of the brain, but disease of the

* Journal of Mental Science, July 1864: Cases of Primary Carcinoma of the

Brain.
GG
450 THE PATHOLOGY OF INSANITY. [cHaP.

membranes covering it, is most likely to produce disorder of
the intelligence ; because in the latter case the morbid action
is in close proximity to the delicate centres of intelligence, and
seriously interferes with their supply of blood. An observation,
therefore, which Dr. Ogle makes as the result of an analysis of-
his ten cases is not without interest: it is that in no case was
‘there anything like arachnitis in connexion with the various
growths. Whatever be the explanation, there can be no doubt
of the fact that a large tumour may exist in the brain, or that
a considerable amount of the brain substance may soften and
undergo purulent degeneration—the pus even becoming incap-
suled—without the presence of a single symptom to lead us to
suspect the existence of disease in the brain.** It has even
happened that a patient in hospital, who has complained only of
general debility and utter inability to exertion, has been sus-
pected of feigning and accused of indolence because there were
no marked symptoms of disease, when a sudden and quick
death has proved at the same time the existence of an abscess
of the brain and the injustice done to the sufferer.t

Certainly it does sometimes happen that mental disturbance
accompanies disease in the brain, even though the mischief is
quite central. Two things will commonly be observable with
regard to the mental symptoms in such cases :—(1) that they
are intermittent, so that they may disappear altogether for a
while; and (2) that they have the character either of an in-
coherent delirium, or of greater or less mental imbecility.

(1) The entire disappearance for a time of all symptoms of
mental disorder plainly indicates the absence of any serious
organic structural change in the nervous centres which directly
minister to the manifestations of mind; for, if such change
existed, the recovery could not possibly be so sudden and com-
plete. The disturbance of the cortical cells is in reality
secondary : it is a reflex functional result of the primary morbid
action that is going on in the neighbourhood ; and it may con-
sequently come on suddenly or pass away suddenly. This is a

* For examples of extensive injury to the brain, without mental disturbance,

see a paper by Dr. Ferriar in the first volume of the Memoirs of the Literary
and Philosophical Society of Manchester.

+ Ueber Gehirnabscesse, von Prof. Dr. Lebert, Virchow’s Archiv, vol, x. 1856,
1v.] THE PATHOLOGY OF INSANITY. A451

far more probable explanation of the transitory disorder than
the assumption of a sudden vascular congestion, of which there
‘is commonly no sign, and of the absence of which there are
commonly many signs. Why such reflex effect is produced
in one case and not in another, or why it is not permanent when
once produced, we are no more able to say than we are why
a like eccentric irritation should in one case give rise to tonic
spasm, and in another to clonic spasm, and in a third to no
spasm at all. The complete intermission of symptoms does at
any rate strongly favour an explanation which recent researches
_into the electric relations of nerve render conceivable.

(2) Not less favourable to the interpretation of the mental dis-
order as a reflex effect is the character of it; for it is manifest
either in (a) great mental feebleness or imbecility, deepening
into extreme dementia in the last stages; or (6) in delirium,
That we do not usually meet with any of the recognised forms
of insanity is a fact of some interest and importance ; indicating,
as it does, the existence of different organic conditions from those
which exist in cases of true insanity. A systematized mania or
melancholia represents a certain organized result of abnormal
character, a definite morbid action—the organization, if you will,
of disorder ; it marks the persistence of a certain mental power,
though wrongly directed, a certain co-ordination of action, though
morbid action: the incoherent delirium, or mental imbecility,
with which we have now to do, indicates, on the other hand, a
general disturbance of the supreme centres of intelligence, with-
out any systematization of the morbid action; the delicate fabric
of thought is strangely shattered by the communicated shock,
and the individual elements of the noble organization of mind
are suddenly prostrated. Hence, though the delirium may be
very active, it is commonly extremely incoherent, exhibiting an
entire absence of co-ordination ; it is the automatic expression
of the fluttering action of the ganglionic cells of the hemispheres
irritated into action, from without. So also with regard to the
imbecility, when the mental disturbance has that form: it is a
general weakness without any definite character, wanting the
wrecks of systematic delusions which are usually met with in
the dementia following mania or melancholia. The want of
definite character, as well as the intermittence, tends to prove

@G2
452 THE PATHOLOGY OF INSANITY. [on

that there is no definite morbid action going on within t
supreme centres of consciousness; that the mental disorder
like the general epileptiform convulsions which occur in loc
diseases of the brain, not the direct result of the disease, bul
secondary or reflex effect.

When the local disease directly implicates the supreme cent)
of intelligence, there may be extreme mental disorder, althou
it is remarkable how intermittent the symptoms even then som
times are. The following example may serve for illustration :
A young man, et. twenty-four, suffered from frequent and seve
periodic pains in the head, weakness of vision, anxiety, extre1
feeling of debility and loss of power in the limbs; there w
also confusion of thought. After a time he was seized with
maniacal attack ; had hallucinations of balls of fire falling abo
him ; thought himself pursued by monstrous forms ; and was ve
violent. After an excitement of three days and nights withc
sleep, he fell into a deep sleep which lasted for twenty-four hou
and from which he awoke quite conscious, with no remembrar
of his previous excitement. Again after a time headache cai
on, with noise in the ears, and more or less paralysis of t
voluntary muscles ; the maniacal excitement recurred, becomi
more continuous, and the paralysis and mental stupor increas
One day he could neither stand nor move his arms; but afte:
tranquil night he could do both quite well, and could retu
intelligent answers to questions. In the evening he was age
restless and excited ; after which he became comatose, and dii
Numerous cysts of cysticercus cellulosus were found in the bra
five of them being fixed to the inner surface of the dura ma
and the rest dispersed throughout the grey matter. By far t
greater number were found in the grey layers of the hemispher
being collected here and there into dense groups. In anotl
case, in which twelve cysticerci were found after death in t
brain, the symptoms were those of gradually increasing demen
with paralysis.

It is necessary to bear in mind, however, that there may
considerable disorder or destruction of a part of the corti
layers of the hemispheres without any mental suffering, It
well known that a person may lose a part of his brain, andy
not exhibit any mental disorder; and portions of the hemisphe
rn] THE PATHOLOGY OF INSANITY. 453

ay be cut away without the patient feeling it, though he is
ily conscious. There is, in fact, great reason to think that one
emisphere may sometimes do the work of the whole brain; the
nly consequence being an earlier exhaustion by exercise, and, per-
aps, a greater irritability. This being so, it is easy to perceive
ow direct encroachment by disease on the hemispherical grey
ayers Inay in some cases be unattended with any mental disorder.

2. Morbid Appearances in the Brain and Membranes.—The
irect results of morbid action in the brain, discoverable by the
aicroscope or otherwise, certainly do not admit of very de-
inite description. Some are ready to deny that the post-mortem
ppearances in the insane throw any light on the nature of the
lisease ; and the belief affords a comfortable excuse for shirking
aborious and tedious investigation. Schroeder van der Kolk,
iowever, held a different opinion: “More than thirty years’
Xperience,” he says, “has led me to an entirely opposite
ipinion, and I do not remember to have performed, during the
ast twenty-five years, the dissection of an insane person, who
lid not afford a satisfactory explanation of the phenomena
‘bserved during life. On many occasions, I was able accurately
o foretell what we should find.”*

The broad result established by pathological observation
indoubtedly is, that the morbid changes most constantly met
vith after insanity are such as affect the surface of the brain,
ind the membranes immediately covering it. Of these changes
here is no need of discussion to prove that those in the layers
if the cortical substance are the principal and essential. The
‘vidence of more or less inflammation of the membranes, and
specially a milky opacity of the arachnoid, is commonly enough
net with in the bodies of those who have not died insane.
Jertain observations of Schroeder van der Kolk enable us to
verceive how this may happen. In the first place, he has
emarked that adjacent parts of different structure are not
eadily attacked by inflammation in equal degree: the inter-
costal muscles, for example, are almost unaffected when acute
ostal pleurisy exists; the muscular wall of the intestine is
carcely affected in peritonitis ; and the heart substance remains
ound, notwithstanding acute pericarditis and exudation into

* On the Minute Structure and: Functions of the Medulla Oblongata, p. 281.
454 THE PATHOLOGY OF INSANITY. [cHaP.

the pericardium. So it is with the pia mater; congestion, in-
flammation, and effusion may take place in it, while the brain
itself i8 not implicated, and exudation between the arachnoid and
pia mater may accordingly be found after death, when there has
been no mental derangement during life. In the second place,
it is necessary to bear in mind the distribution of vessels in the
pia mater: Schroeder van der Kolk found that, while most of the
arteries pass down from it into the substance of the brain, and
are there distributed, the blood being brought back to the:
membrane by a corresponding series of veins, there are in
addition direct channels of cornmunication between the arteries
and veins in the pia mater.* In that arrangement there is
obviously a provision by which temporary disturbance of the:
circulation may leave the cortical layers of the brain unaffected,
the storm passing over them: but for such provision, one might.
wonder that any one escaped serious mental disturbance, con-
sidering the frequent changes in the cerebral circulation to:
which every one is subject, and the extreme sensibility of nerve
element. As it is, vascular disturbance does not remain entirely
without effect; though the hemispheres are not themselves:
sensitive to pain, they manifest their altered state by a feeling
of unusual irritability and a proneness to excitement and
passion ; and this is a condition of things which, as every one’s:
experience teaches him, is not so uncommon, but which mostyl
soon passes away with the physical cause of it.

There can be no question that the mind suffers when the:
inflammatory action in the membranes seriously implicates the
adjacent cortical layers; for, without claiming acute meningitis:
in evidence, the morbid appearances sometimes found after acute.
insanity afford sufficient proofs.t In France much attention has
been given to the morbid conditions of acute maniacal excite-.
ment or maniacal delirium; they are those of acute hyperemia
—namely, great injection of the pia mater with spots of ecchy-
mosis, more or less discoloration and softening of the cortical
layers—the discoloration being in red streaks or stains with.
spots of extravasated blood, and the softening being of a violet.

* Die Pathologie und Therapie der psychischen Krankheiten.
+ The case reported in chap. iii. p. 847, may be referred to for an account of
instructive morbid appearances in, acute insanity.
w.] ‘THE PATHOLOGY OF INSANITY. 455

or pink hue—and increase of the puncta vasculosa of the white’
substance. As patients do not commonly die suddenly in the’
acute stage of insanity, this pathological condition is not often
met with; and it is certainly not invariably met with when they
do die in the acute stage. If we call to mind what has already
been said of the relation of nerve element to the blood-supply,
it will be easy to understand how this may happen, as also how,
when hyperemia is met with, it is properly to be regarded, not
as direct cause of the mental disorder, but, if not as effect of it,
certainly as a concomitant effect of a common cause. With due
regard to this relation, it may on the whole be justly said, that
the visible morbid appearances of acute insanity are those of
acute hyperemia of the brain. There are no recognisable
differences between the morbid conditions of acute mania and
acute melancholia: in the latter form of disease it more fre-
quently happens that anatomical lesions are absent; and when
they are present, they have been said to mark less hyperemia
than exists in acute mania, and to be attended with more or less
serous exudation.

The cases of chronic insanity in which all anatomical lesions
are wanting are rare: the longer the insanity has lasted, the
more evident they usually are. In most instances there is some
amount of thickening and opacity of the arachnoid observable ;
and many of the more advanced cases exhibit some degree of
atrophy of the brain, especially of the convolutions, effusion into
the sub-arachnoid space, discoloration of the cortical substance,
and general hardening of the white substance. The pia mater
is sometimes found to’ be more or less firmly and generally
adherent to the surface of the brain, so that it cannot then be
stripped off without tearing the latter; and a finely granular
condition of the ependyma of the ventricles, with its frequent
adherence to the parts beneath, would seem to testify a previous
inflammatory condition : the granulations of the arachnoid, care-
fully described by Meyer, have probably a like interpretation.
Of the granulations of the ependyma of the ventricles, which
are certainly not peculiar to general paralysis, as M. Joire, a
French writer, has asserted that they are, Mr. Lockhart Clarke
says: “They consist of globular aggregations of the ordinary:
epithelial cells, which, in a natural or healthy state, are arranged’
456 THE PATHOLOGY OF INSANITY. [crar

side by side, and form a smooth or level surface on the floor o:
the ventricle. The tissue immediately subjacent, and whict
consists of exceedingly fine fibres proceeding from the tapering
ends of the epithelial cells, and running in various directions
was more abundant than usual ; and—as might be expected fro
the homologous relation of this part to that which surrounds the
spinal canal—it was interspersed with corpora amylacea, bu
certainly not to a corresponding extent.”* Though the adhesior
of the pia mater to the surface of the brain is most frequently;
met with in general paralysis, it is now and then witnessed ir
other forms of chronic insanity, particularly in insanity afte
epilepsy or drunkenness.

The morbid changes which are found most frequently ix
general paralysis, although in rare cases they are absent, arc
great cedema of the membranes, adhesion of the pia mater to the
surface of the brain, greyish-red local softening or discoloratior
of the cortical layers and superficial induration thereof, owing
to an increase of the connective tissue and a destruction of thi
proper nervous elements.t More or less atrophy of the whol
brain, particularly, however, of the convolutions, is common
‘and is accompanied with greater firmness of its substance
enlargement of the ventricles, and serous effusion. Diffus
pachymeningitis, effusion of blood into the membranes or th:
layers of exudations, as described by Virchow and Rokitansky
aud degeneration of the arteries, are not unfrequent. Th
degeneration of the nerve-substance from the increase of con
nective tissue has been proved by Rokitansky and others t
extend sometimes even to the spinal cord. Such morbid change
are certainly more evident in general paralysis than in am
other form of insanity, but they do not occur with uniform con
stancy, nor are they of uniform character; in some cases th
meningitis being most marked, in others the atrophy of th
brain, and in others the induration. Dr. Sankey has made ;
careful comparison of the morbid appearances met with it

* Beale’s Archives of Medicine, vol. iii.

+ Dr. Westphal has recently asserted that this increase of connective tissu
has never yet been satisfactorily demonstrated in the grey and white substance «
the brain; nevertheless he is very confident with regard to his own observatior
of the existence of this process of degeneration in the spiual cord !
v.] THE PATHOLOGY OF INSANITY. 457

fifteen cases of general paralysis with those met with in fifteen
cases of chronic insanity of other forms. The greatest difference
was in the frequency of effusion beneath the arachnoid, which
was found eleven times in the fifteen cases of general paralysis,
and three times in the other cases. Adhesion of the pia mater
to the grey matter occurred in eight of the general paralytics,
and in only one of the others. The convolutions were abnor-
mally open and wide apart. in nine of the cases of general
paralysis, and in three of the other cases; in eight of the former,
again, was there a dark discoloration of the grey matter, which
was met with in only three of the latter; the layers of the grey
matter were indistinctly marked in ten cases of general paralysis,
and in six of the other cases.* Plainly there are no morbid
appearances characteristic of general paralysis, although morbid
changes are more constant in it.

The late Schroeder van der Kolk has given a detailed descrip-
tion of several cases of what is commonly considered a very rare
affection, but which he thought by no means so uncommon—
namely, a diffuse inflammation of the dura mater, or idiopathic
pachymeningitis. It is, he thought, often overlooked, and con-
sidered to be rheumatic headache. The symptoms are intolerable
headache, delirium, sometimes calmer delusion, and coma; and
after death the dura mater is found to be extensively inflamed,
and more or less adherent to one or both hemispheres; the
inflammation has in some cases extended to the brain, which is
found to be softened. According to his experience, this affection,
where neither syphilis nor injury could be assumed as cause,
was not rare. A remarkable circumstance in regard to it is the
regular intermissions that occur in its course, the patient having
considerable intervals of apparent health.

On the authority of so eminent an observer as Schroeder van
der Kolk this idiopathic inflammation of the membranes must
be admitted; but it must also be allowed that the morbid
appearances described by him are very like those which have
since been described as almost pathognomonic of syphilis. A
diffuse fibrinous exudation of low form, glueing the membranes
to the brain substance beneath, has been held to be a charac-
teristic feature of syphilitic dementia. Instead of being diffused

* On the Pathology of General Paresis.—Journal of Mental Science, 1864,
458 THE PATHOLOGY OF INSANITY. [cmar.

the exudation is sometimes circumscribed, so as to have the
form of a tumour ; and it may then press into the brain-sub-
stance, causing softening immediately around it. Or, again, the’
gum-like exudation, or syphtloma, as it is called, may take place
as a diffuse infiltration or as a tumour within the substance of
the brain, the membranes being unaffected. Such is the morbid
product which recent researches have assigued to syphilis ; and,
according to Virchow, it consists, at the outset, like the: sub--
stance of granulations, of an exuberant growth of connective
tissue, its further development taking place in two directions:
(1) either the formation of cells predominates, and then the
intercellular substance is soft, jelly-like, mucous, or fluid, the
whole mass remaining jelly-like and coherent, or undergoing
purulent degeneration; (2) or the formation of cells is’ less
prolific, and the intercellular substance increases, so that the
fibres preponderate; the cells are spindle-shaped, or have the
stellate form of the cells of connective tissue, or the round form
of granulation cells. Ultimately yellow patches of fatty degene-
ration appear in it. There certainly is no character whereby’
this albumino-fibroid exudation can be distinguished as a specific
product, and every pathologist admits the difficulty of distin--
guishing it from tubercle. The starting-point of its formation
has been shown by Virchow to be the nuclei of the connective’
tissue and its equivalents; the proper elements of the organ
undergoing atrophy as the result of the hypertrophy of the con-'
nective tissue.* The form of insanity with which this syphiloma
is associated in its extreme stage is, as might be expected, a
miserable paralytic dementia.

Such are the morbid appearances met with in cases of insanity,.
a general summary of which, after Schroeder van der Kolk, may
here be added :—When the patient has died at the beginning of
acute insanity, and the pia mater is stripped off, the cortical
layer will exhibit unequal coloration ; certain convolutions being’
rosy, others pale. The differences are often detectable only’by
very careful observation ; they are the results of great congestion
or commencing inflammation, and are found more often in those’
who have died of typhus fever or after acute delirium than in’

* Virchow’s Archiv, vol. xv. p. 217 - Das Syphilom, oder die constitutionell-
syphilitische Neubildung, von E. Wagner. Archiv der Heilkunde, 1863.
1v.] THE PATHOLOGY OF INSANITY. 459.

insanity, because in it death seldom occurs at an early stage.
After a longer duration the disease appears to pass into a chronic’
inflammation. There is some difficulty in stripping off the pia-
mater, the vessels of which are strongly injected, from the sur-
face of the brain; and portions of grey matter are sometimes’
brought away with it. More or less exudation commonly occurs
between the arachnoid and the pia mater, and the former may
form .a thick, white, opaque layer, through which the con-
volutions are scarcely visible. After a still longer duration,
when dementia is thoroughly established, there is no longer any”
increase of vascular injection. The vessels are less full than
natural, and the pia mater may even in some cases be stripped
off with more ease than in health, a clear serous fluid flowing
away the while; the grey substance appears pale or anemic,
and somewhat atrophied ; and the vessels, especially at the base
of the brain, are beset with atheromatous patches. The dege-
neration extends into the ventricles, the lining membrane being
thickened, and sometimes covered with fine granulations, and
more or less fluid being effused into them. According to
Schroeder van der Kolk, the membrane “covering the corpora
striata is most thickened and cannot as a rule be stripped off
without tearing the commonly softened nerve substance be-
neath ;” this particular change being declared during life by’
paralytic symptoms, such as trembling of the lips, difficulty of.
articulation, and uncertain walk.

The morbid changes in acute insanity, so far as they have’
been discovered, are, then, such as indicate acute hyperzemia or’
inflammation. But whether any changes, and, if any, what
changes in the nerve-cells themselves accompany the signs of:
vascular disturbance, it is not possible to say positively. Certain
observers in Germany have recently spoken of such morbid.
changes ; they have described the cells as becoming clouded and
their contents troubled at first, then as having their nuclei in-:
creased, and finally as undergoing a rupture of their walls. The
later changes met with in the brain in chronic insanity seem
to resemble those which occur in other organs in consequence
of chronic inflammation and subsequent atrophy and fatty
degeneration...

Interesting observations have been made upon the~abselute:
460 THE PATHOLOGY OF INSANITY. [cHaP.

weight of the brain, and also upon the specific gravity thereof
in the insane; but further experiments on these points are yet
needed. Dr. Skae and Dr. Boyd have found the absolute weight
of the brain to be slightly increased in the insane, the increase
being greatest in mania and least in general paralysis. The
latter observer has discovered that in health the weight of the
left cerebral hemisphere almost invariably exceeds that of the
right by about one-eighth of an ounce.* The specific gravity of
the brain in the insane was found by Dr. Skae and Dr. Sankey
to exhibit an increase as compared with that in the sane; the
lowest specific gravity, though still above the average, occurring
in dementia, and the highest being met with in epilepsy. It
appears, however, that the mode of death influences the result.
Dr. Buckuill, who fixed the average specific gravity of the healthy
brain at 1:036, found that in paralysis of chronic character, com-
plicated with insanity, the specific gravity varied from 1:036 to
1:046; in paralysis terminating by coma it was 1:040, and in
some acute cases it rose as high as 1-052; and in paralysis ter-
minating by syncope or asthenia it varied from 1-036 to 1-039.
The increase was ascribable in some cases to a deposit of an
inert albuminous matter amongst the proper nervous elements,
and to the shrinking of them. This was perhaps a morbid state
not unlike that which has since been more fully investigated by
Professor Albers, and described by him as parenchymatous
infarction of the brain. It is often met with in typhus, and
sometimes in cases of insanity, and gives rise to the condition
described as cerebral sclerosis: the brain substance is found to
be more compact and consistent than normal, and on slicing it
the thin layers are tough and unusually elastic. This condition
has also been met with in imbecile children in whom irregular
nutrition of the cranium and the brain has probably ended in a
sub-inflammatory state. Scrofulous parenchymatous infarction
occurs sometimes in children and young people of scrofulous
habit, and according to its severity and extent gives rise to
different degrees of cerebral disorder, which may be arrested, or
may lay the foundation of future insanity. Meckel and others
have recorded instances of induration of the brain in the insane,

* This is not confirmed by the exact see Ons. of a Dre Tharsamy Journal
of Mental Science, April 1866. s
1v.] THE PATHOLOGY OF INSANITY. 461

but there was said to be no increase in the weight of the brain-
substance when compared with equal portions of healthy brain,
except in a slight degree in one or two examples. A fibrinous
or albumino-fibroid exudation amongst the proper nerve elements
is manifestly not an uncommon feature of the degeneration of
extreme insanity, and appears to be strictly comparable with the
result of what is described as chronic inflammation in other
organs, such as the liver and the spleen. What effect it has
upon the absolute weight and the specific gravity of the brain it
must be the aim of future observations definitely to settle. The
recent researches of Dr. Bastian on the specific gravity of the
brain prove that the specific gravity of different parts of the

. grey matter differs considerably in health ; so that in the experi-
ments hitherto made on the brain in insanity a most important
consideration has been overlooked.*

A general survey of the foregoing morbid appearances will
scarcely fail to leave a conviction of their adequate nature as
signs of severe cerebral disorder. Bearing in mind that the
vascular disturbance is, in the sequence of events, secondary to
the disordered action of the individual nerve elements, it is,
even when only slight, of great significance, and affords sufficient
evidence of primary disorder of the delicate nerve element.
When it is in a condition of healthy activity, the nerve-cell
maintains certain definite relations with its supply of blood;
but when, from some cause, its vital power is lowered and its
function disordered, immediately the relations with its sur-
roundings are changed; the blood flowing through the (so to
speak) infected districts feels the effect of the lowered vitality ;
the vessels dilate, and the blood-corpuscles manifest a tendency
to adhere to one another and to the walls of the vessels; the
abnormal vascular injection, not less than the maniacal excite-
ment, testifies indeed to the loss of the natural vital tension and
to the manifestation of an inferior activity. Carry the dis-
turbance yet further, or prolong it, and the evidences of vital
degeneration—in other words, of the resolution of higher into
lower forms of life—are still more marked. The increase of the
connective tissue, or the fibrinous exudation, with the atrophy

* On the Specific Gravity of the Human Brain.—Journal of Mental Science,
1866, ,
462 THE PATHOLOGY OF INSANITY. [cuar.

of the proper nerve elements, is as plain evidence of degeneration
as is the mental incoherence; and in the difference of dignity
between the nerve-cell and connective tissue corpuscle there
is a gap as great as that between sound mental activity and
dementia.

Recent microscopical examinations of the brain after insanity
have added something to our knowledge of its pathology. The
most constant result has been to establish the exuberant produc-
tion of connective tissue in long standing insanity, and especially
in general paralysis. It is now known that there is a homo-
geneous matrix ot connective tissue lying between and support-
ing the nerve elements of the brain, and continuous with the
ependyma of the ventricles; it appears to be very apt, under
certain circumstances, to undergo an undue increase, to the de-
triment of the proper elements of the part. The researches of
Rokitansky and Wed] into the morbid changes in general para-
lysis made known a more or less diseased state of the capillaries
of the cortical substance of the brain. There is a certain tor-
tuosity of the capillaries apparent in almost every case, this being
in some cases only a simple curve or twist, in others amounting
to a more complex twisting, and even to little knots of varicose
vessels. Dr. Sankey thinks that what Rokitansky and Wedl have
described as aneurismal dilatation is really such a varicose knot.
Round the capillaries and small arteries and veins there is often
a hyaline deposit of what is supposed to be embryonic connec-
tive tissue, beset with oblong nuclei; this afterwards becoming
more and more fibrous, so that the vessel may look like a piece
of connective tissue, in which granules of fat or calcareous matter
are occasionally seen. It appears that this growth of connec-
tive tissue may have its starting-point, not only from the nuclei
of the walls of the blood-vessels, but also from the proper nuclei
of the brain-substance. Asa consequence of its exuberant increase,
the nerve elements as well as the delicate capillaries are in-
jured or destroyed; “in the grey substance the ganglionic cells
appear inflated, their continuations are undoubtedly torn, and
the nerve-tubes penetrating the grey substance” are destroyed.
Rokitansky believes that this is not to be looked upon as an
imflammatory process, and it certainly is not so in the common
acceptation of the meaning of inflammation. It is important to
wv.) THE PATHOLOGY OF INSANITY. 463

be aware, however, as Lockhart Clarke and Mr. Robin have
pointed out, that in every healthy brain a great number of the
capillaries and small arteries are surrounded by secondary
sheaths, precisely similar in all essential particulars to those
which have been considered as morbid products in general
paralysis.* But Mr. Clarke has observed that the sheaths are
often less delicate in general paralysis ; they are thicker, more
conspicuous, and frequently darker than in the healthy brain ;
and sometimes, especially when the vessels are convoluted, they
appear as fusiform dilatations along their course. Moreover,
while in the healthy brain granules of hematoisin are commonly
scanty, and frequently absent altogether, they often abound in
general paralysis, scattered in some places, collected into groups
in others. In connexion with the hypertrophied tissue are
found amyloid corpuscles, colloid corpuscles, calcareous and fatty
granules—all the product of a retrograde metamorphosis going
on. There are, however, two ways in which retrograde products
are formed : first,there is a mal-nutrition, or a retrograde nutritive
process, whereby the vitality not being at the height necessary
to the production of the proper elements, there are engendered
from the germinal nuclei elements of a lower kind—connective
tissue instead of nerve; and, secondly, there is a retrograde
metamorphosis of the formed elements of the part. The process
is essentially one of vital degeneration, whether called inflamma-
tion or not; and when we consider the genuine meaning of the
pathological changes, they are seen to be in accordance with the
symptoms of mental decay.

The results of an elaborate examination of the morbid changes
ina case in which there was grey degeneration of the brain and
spinal cord, by Dr. E. Rindfleisch, may help us to a conception
of the meaning of the retrograde changes which take place in
disease. The patient had died from ¢abes dorsalis ; and in the
anterior tracts of the cord, in the fornix, corpus callosum, and
centrum ovale, the continuity of the healthy structure was inter-
rupted by numerous patches exhibiting different degrees of
degerieration, from a greyish pulp to sclerosity. In the main,
Rindfleisch confirms Rokitansky : the process of degeneration

* On the Morbid Anatomy of the Nervous Centres in General Paralysis of the
Insane, By J. Lockhart Clarke, F.R.S.—Lancet, September Ist, 1866.
464 THE PATHOLOGY OF INSANITY. [cHar

seemed to begin in the vessels, as their walls were enor
mously thickened by a number of cells and nuclei, and thei
diameter was increased; and this first stage he considers the
result of long enduring hyperemia. The neuroglia, or hyaline
connective tissue, next undergoes change, fibres being formed ix
the amorphous basis substance; the nerve fibres then suffer
atrophy, lose their medulla, and appear to consist of axis
cylinder and sheath, or of axis cylinder only. As they disappear
the connective tissue increases ; numerous single nuclei appeai
in it, as also groups of nuclei, which seem to proceed from the
division of a single nucleus. Round these groups a certain
quantity of finely granular substance collects, so that cell-like
bodies are formed, resembling the four-nucleated bodies described
in marrow by Kélliker and Robin. The fibres of the connective
tissue are formed out of the basis substance, Rindfleisch thinks,
but are probably developed in organic relation to the nuclei. At
a still further stage, retrogressive metamorphosis sets in: mole-
cules of fat appear in the ganglionic cells according to Virchow,
and as they increase they form granular bodies, which, how-
ever, Rokitansky holds to be produced from the fragments of
the medulla of the nerve fibres. So also is it, in Rindfleisch’s
opinion, with the amyloid corpuscles that are found: the
nucleated cells of the connective tissue go through the amyloid
degeneration ; and he has watched every stage of the transition
from the normal cell to the amyloid corpuscle. When by fatty
degeneration the greater number of nerve-cells have been con-
verted into a detritus capable of being absorbed, the fine elastic
fibres contract, get closer and closer together, and remain as the
constituent tissue of the cicatrix, which sometimes causes con-
siderable deformity ; whole sections of nerve substance having
been replaced by a relatively small quantity of an unyielding,
compact, dry tissue. There are then three principal stages in
the degenerative process :—(1) a change in the vessels, whereby
there must be a great hindrance to regular nutrition ; (2) atrophy
of nerve element, either in consequence of the interference with
its nutrition (Rindfleisch), or from the growth of connective
tissue (Rokitansky) ; and (3) the subsequent metamorphosis of
the connective tissue. *

* Histologisches Detail zu der grauen Degeneration von Gebirn u. Riickenmark,
von Dr. E, Rindfleisch.—Virchow’s Archiv, b. vi.
Iv.] THE PATHOLOGY OF INSANITY. 465

A very careful microscopical examination of the brains of
three idiots has been made by Wedl. The changes were such as
are usually met with in atrophy of the cortical layers. In the
pia mater and the convolutions there was local obliteration of
capillaries, thes¢ sometimes having the appearance of a dirty
yellowish band of connective tissue, which, like other connective
tissue, swelled up and lost its wavy lines in acetic acid. Other
thickenings in the capillaries of the cortical layers he describes
as colloid: these were knotty swellings in their course that were
unaffected by acetic acid. Atheromatous degeneration of arteries,
veins, and capillaries was more or less marked in all the cases.
Tn one instance the small arteries and veins, and the capillaries,
were affected with funnel-like dilatations, owing to a prolifera-
tion of nuclei that lay nestled in them; and a transparent basis
substance containing many oval nuclei surrounded the capillaries
for some distance. The ganglionic nerve-cells exhibited some
metamorphosis of their contents in all the three cases; the
change consisting in a condensation of the contents with dis-
appearance of the nuclei—a condition which called to mind the
colloid degeneration of the ganglionic cells of the retina.*

It appears, then, that an increase of connective tissue, with
atrophy and destruction of nerve element, so far from being
peculiar to general paralysis, is of common occurrence in cerebral
degeneration of long standing. There can be little doubt that
the morbid product which is thought to be the result of syphi-
litic disease is of like nature; and Billroth found a peculiar
gelatinous degeneration of the cortex of the cerebellum, which
he met with in one insane person, to consist of soft connective
tissue. This proliferation of connective tissue with destruction
of the nerve elements has at any rate been already observed in
dementia following on continued insanity, in general paralysis, in
syphilitic dementia, in tabes dorsalis, and in congenital idiocy.

Tt will be well to enumerate briefly the different kinds of
degeneration that have been met with in the brain after insanity, .
to the end that the nature of the retrograde changes may be
more evident :—

(a) There is in the most acute form of insanity an acute

* Histologische Untersuchungen iiber Hirntheile dreier Salzburger Idioten,
yon Dr. C. Wedl: Zeitschrift der K. K. Gesellschaft der Aerzte in Wien, 1863.

Hil
466 THE PATHOLOGY OF INSANITY. [cwar.

hyperemia, or an early stage of inflammatory degeneration. Dr.
Tigges has recently described an increase of nuclei in the gang-
lionic cells, and he believes the numerous scattered nuclei,
usually thought to belong to connective tissue, to have really
escaped from. ganglionic cells at a later stage of their inflam-
matory degeneration.*

(b) There is that degeneration which consists in the increase
of connective tissue and in the atrophy of the nerve elements.
Whether or not called sub-inflammatory, and described as the
result of a chronic hyperemia, is not of much moment so long as
we keep in mind the true relations of the organic element to the
supply of blood, and also the true degenerative nature of the
inflammatory process. It seems indeed to admit of small doubt
that an exudation of a hyaline substance into the parenchyma of
the brain may take place without any signs of active hyperemia
or inflammation, and without any of the products of inflam-
mation, the exudation afterwards undergoing more or less fibrous
transformation. The vitality of the part is not at the height
necessary for the due formation and nutrition of the higher
species of organic element, and organic elements of a lower kind
are produced. When the degeneration is greater and more
active, as it is in advanced inflammation, then elements are pro-
duced of a still lower kind, and incapable of any organization ;
they are the so-called exudation corpuscles and pus corpuscles,
which are met with in inflammatory or red softening, but not in.
the chronic morbid changes of insanity. Thus much for the
connective tissue degeneration.

(c) Fatty degeneration is a retrograde change very frequently
met with. It may take place either in the smaller vessels of
the brain, as in atheroma, or in the proper nerve elements, or in
the new morbid products. In what is known as white softening
of the brain, granular bodies are found which are composed
principally of fat, and which some hold to proceed from the
degeneration of the natural cells of the part, while others main-
tain that they originate in the morbid products.t In the retro-

* Zeitschrift fiir Psychiatrie, b. xx.

+ Dr. Meschede, in Virchow’s Archiv, 1865, describes the early morbid changes
in general paralysis as inflammatory, and the later changes as those of fatty and
pigmentary degeneration of the cells,
1v.] THE PATHOLOGY OF INSANITY. 467

grade metamorphosis of the hypertrophied connective tissue
already described, fatty degeneration takes place largely.

(d) Amyloid degeneration—It admits of no doubt that the
corpora amylacea, or little starch-like bodies, which are often
found in great numbers in the brain, are pathological products.
Wedl thinks that they should be ranked with the so-called
colloid corpuscles, and regarded as indicative of the increased
exudation which may take place without hyperemia. Rind-
fleisch, on the other hand, as already stated, believes that he
has traced their production by a gradual transition from the
nucleated cells of the connective tissue. Whatever be their
true mode of origin and exact nature, there can be no question
that they are products of a retrograde metamorphosis.

(e) Pigmentary degeneration has been met with in the gang-
lionic cells of the brain in senile atrophy, in dementia, and in
advanced general paralysis. Schroeder van der Kolk found the
cells of the medulla spinalis and oblongata to be darker and
more opaque in old age; and in one case of dementia after
mania, where there was partial paralysis of the tongue, the
ganglionic cells forming the nuclei of the hypoglossal nerves
were in a state of blackish-brown degeneration, so that he at
first mistook them for little points of blood. On more careful
examination, however, they were seen to be degenerated gang-
lionic cells, filled with granular dark brown pigment. Mr.
Lockhart Clarke has observed similar structural changes in
general paralysis. “These changes,” he says, “consist of an
increase in the number of the contained pigment-granules,
which in some instances completely fill the cell. In other in-
stances, the cell loses its sharp contour, and looks like an
irregular heap of particles ready to fall asunder.” In regard to
this form of degeneration, certain pigmentary changes that have
been described in the retina are not without interest. In what
is called—not very philosophically—Retinitis pigmentosa, there
are found scattered over the fundus oculi irregular figures of
deep black colour, consisting of pigment apparently in the
substance of the retina. A point of interest with regard to
these cases is, that they often occur in the same family, and are
accompanied by general imperfection of development. Grafe
has observed this degeneration to be often of hereditary occur-

HH 2
468 THE PATHOLOGY OF INSANITY. * [cHap.

rence; and Liebreich has pointed out that many subjects of the
defect are, like albinos, the offspring of marriages of consanguinity.
More or less imperfection of the mental faculties and arrested
development of the sexual organs usually co-exist; and the
concurrence of mutism and cretinism with Retinitis pigmentosa
is occasional. Pigmentary degeneration may surely be accepted
as no less certain a mark of retrograde pathological change in
the brain than it is in the retina.

(f) Calcareous degeneration—Granules of earthy matter are
common enough in connexion with the hypertrophied connective
tissue of long continued and extreme insanity. But cases have
also been described in which calcification of some of the gang-
lionic cells of the brain has been met with. Erlenmeyer found
the commissure of the optic nerves hardened by a deposit of
calcareous matter in the brain of a monomaniac who had died
with epileptiform convulsions. It had been first deposited
about the small arteries and in the connective tissue; and the
cells had afterwards been occupied and made opaque by fine
granules of what appeared to be phosphate of lime. Forster, in
his Atlas of Pathological Anatomy, describes calcified cells
found in the grey substance of the lumbar enlargement of the
spinal cord of a boy whose lower extremities were paralysed.
Heschl met with what he calls an ossification of cells in the
brain of a patient, aged twenty-six, who had died melancholic:
they were in the compact substance surrounding a small hemor-
rhagic cavity in the cortical part of the right cerebral hemisphere.
Hydrochloric acid dissolved the granular contents, and left the
cells with a pale outline in view.* Dr. Wilks believes certain
bodies which he found in the brain of a general paralytic, in
whom the small arteries were calcified, to have been ganglionic
cells that had undergone calcareous degeneration.- Not without
interest is it thus to observe, on a microscopical scale, a similar
degeneration to that which the whole organism must ultimately
undergo: as the body is formed out of the dust of the earth by
an upward transformation of matter and force, so by a retrograde
metamorphosis of matter and correlative resolution of force does
it,in parts and as a whole, return to the earth whereof it is made.

Those who duly weigh the pathological import of these dif-

* Schmidt’s Jahrhiich, 1863. + Journal of Mental Science, 1864,
1v.] THE PATHOLOGY OF INSANITY. 469

ferent sorts of degeneration, who reflect on the great gap which
there is between a calcareous granule and a nerve-cell in the
economy of nature, or between a connective tissue corpuscle and
a nerve-cell in the histological scale, must be constrained to
admit that the difference is not less great than the difference
‘between dementia and sound mental action, and can hardly
venture to assert that the morbid appearances throw no light
whatever on the nature of insanity. Even the slight signs of
hyperemia in recent insanity are of weighty significance if their
true relations are recognised, if they are viewed as results and
evidence of that degeneration of individual nerve element of
which the mental disorder is also result and evidence, if they
and the insanity are viewed as, what they often are, concomitant
effects of a common cause.

3. Morbid Conditions of other Organs—Amongst the most
frequent of local diseases met with in the insane, and amongst
the most frequently fatal, are diseases of the respiratory organs.

Diseases of the Lungs——Many insane of low, deteriorated con-
stitution, especially the demented paralytics, succumb to a diffuse
pneumonia of low type. ‘The usual symptoms, however, are
rarely marked, being masked by the madness; there is seldom
any cough, expectoration, or pain; no complaint is made ; there
may be little or no dyspnoea; and the only ground of diagnosis
lies in the physical signs. Gangrene of the lung was observed
by Guislain almost exclusively amongst the insane who had
refused nourishment and died of exhaustion, and in as many as
nine such cases out of thirteen; but it has been found since his
time that the disease is not limited to those who refuse food,
although especially frequent amongst them. In the Vienna
Asylum there were, out of 602 post-mortem examinations made
in three years, fifteen cases of gangrene of the lung. Pain,
cough, dyspnoea, and fever are often entirely absent ; there is
prostration, and the extremities are cold; the complexion is
dusky red, or cyanotic; the odour of the sputa and breath
becomes intolerably offensive ; extreme weakness is increased by
diarrhcea, and death follows within a period varying from ten
days to three weeks.

Almost every writer on insanity calls attention to the fre-
quency of phthisis pulmonalis among the insane, although there
470 THE PATHOLOGY OF INSANITY. [cuar.

is far from being an agreement as to the proportion of cases in
which it occurs. A careful comparison of the statistics of several
asylums by Von Hagen showed that on an average about one-
fourth of the deaths were attributed to phthisis; this proportion
really being about the same as that for the sane population
above fourteen years of age. Out of 1,082 deaths which occurred
in the Royal Edinburgh Asylum from the year 1842 to 1861,
phthisis was the assigned cause of death in 315, or in nearly
one-third (Dr. Clouston). In eight of the American asylums
the deaths from consumption were, according to Dr. Workman,
27 per cent. of the whole number of deaths. Dr. Clouston has,
however, proved by the examination of a series of carefully
made post-mortem examinations that phthisis was the assigned
cause of death in only 73 of 136 men, and in 97 of 146 women,
in whose bodies tubercular deposit was actually found,—that is,
in little more than half of those in whom tubercle really existed.
His conclusion is, that not only is phthisis a more frequently
assigned cause of death amongst the insane than amongst the
sane, but that tubercular deposition is about twice as frequent in
the bodies of the former as in those of the latter.

The relations of the phthisical to the mental disease are of
some interest : in a very few cases the outbreak of the insanity
seems to benefit the phthisis ; in a few more, where the phthisis
is chronic, an attack of insanity may be followed by the per-
manent disappearance of the phthisical symptoms, or attacks of
mania may alternate with exacerbations of the symptoms of
phthisis; but in the great majority of cases, the symptoms of
the lung disease are merely masked by the insanity, the deposi-
tion of tubercle going steadily on.

Diseases of the Heart.—Observers, agreed as to the frequency
of their occurrence, differ as to the proportion of cases in which
they are found: Esquirol found them in one-fifteenth of his
melancholic patients, Webster in one-eighth, Bayle in one-sixth,
Calmeil and Thore in nearly one-third. The most reliable ob-
servations of late years tend to lessen the exaggerated propor-
tion commonly assumed ; out of 602 post-mortem examinations
in the Vienna Asylum, affections of the heart were met with in
about one-eighth of the cases; and in some of these the disease
was very slight.
1v.] THE PATHOLOGY OF INSANITY. 471

Diseases of the Abdominal Organs.— More or less inflammation
of the intestinal mucous membrane is not uncommon among the
insane. It is at the bottom of that colliquative diarrhoea which
at last carries off many feeble patients, mostly those suffering
from paralytic dementia, but now and then even some who are
maniacal or melancholic. The chenged position of the colon
especially noted by Esquirol—the transverse portion of which
lies in the hypogastric region or in the pelvis—is not of any
real importance or of any special significance.

All sorts of disorders of one or more of the abdominal organs
have been met with in particular cases, but not in any constant
relation to any particular form of insanity. Rokitansky noticed
a considerable increase and induration of the cceliac axis in a
case of hypochondriasis with great wasting. Cancer of the
stomach, liver, or of some other part, has been discovered in
cases where there existed during life a delusion with regard to
some animal or man being present in the belly; in one case,
described by Esquirol, where delusions of this sort were most
extravagant, there was chronic peritonitis which had glued
together the intestines. Diseases of the sexual organs are, as
already pointed out, of some importance in the causation of in-
sanity. In the female, prolapsus of the uterus, fibrous tumour
of the uterus, ovarian cyst, &c. may in some few cases impart
to the insanity a sexual character, or become the conditions of
peculiar delusions ; but in other cases of like disease there may
be no sort of connexion traceable between the character of the
insanity and the particular disease. Remember only that, by
reason of the consensus of parts—the intimate connexion and
interaction between one organ and another as parts of an organic
whole—disorder of any organ must conspire with other predis-
posing or exciting causes to produce insanity.
CHAPTER V.

THE DIAGNOSIS OF INSANITY.

T might seem to be no difficult matter to determine when a
man’s mind is unsound, and yet the diagnosis is as difficult

in some cases as it is easy in others. So imperceptibly does
physiological function pass into pathological function through-
out the organism, that it is impossible to say where one ends
and the other begins in the case of any organ: disease is not
any mischievous entity that has taken possession of the body,
and must be driven out of it as the evil spirit was driven out
of the demoniac: it is simply vital action under other conditions
than those which we agree to call natural or typical. Unsound-
ness of mind is that degree of deviation from healthy mental
life which it is agreed by the common consent of mankind to
regard as morbid. That there should be extreme uncertainty in
deciding in particular cases, arises from the fact that various
acts which may be the results of insanity ‘may also be the acts
of vicious or criminal persons, in whom there is no reason to
suspect disease. It will not, however, suffice to make it the
positive criterion of insanity, that a man is unable to restrain
his actions ; for, in the first place, there are some criminals who
by reason of a bad organization cannot, in face of certain temp-
tations, control their actions ; and, in the second place, there
are persons unquestionably insane who are quite capable of con-
trolling their actions, if they have a sufficiently strong motive for
doing so: there are some insane persons who are really criminal,
on the one hand, and, on the other, there are criminals who are
really insane. The experience of those connected with prisons
proves, that weak-mindedness predominates in the criminal
cap. v.] THE DIAGNOSIS OF INSANITY. 473

population as a class. Mr. Bruce Thomson states that, in the
General Prison for Scotland, as many as one in nine, or nearly
12 per cent. were positively weak-minded, and that epilepsy is
found to prevail in much larger proportion among prisoners
than in the population at large.* Without doubt, there must at
times occur doubtful cases which it is uncertain whether to treat
as diseased or to punish as criminal. We are accordingly some-
times placed in a great difficulty, and driven to argue in a vicious
circle. Thus, we infer unsoundness of mind because of the
character of the acts; and, on the other hand, it is because we
think there is disease of mind that we pronounce the acts in-
sane. The fact is that every case should be examined on its
own merits ; the previous history of the patient and his present
symptoms being most carefully studied, and the opinion given
being founded on a calm and scrupulous consideration of all
circumstances of the case, physical as well as mental. Fur-
nished not merely with psychological theories, but with a
medical knowledge of the different varieties of insanity, based
on a large medical experience, we shall be in a position to
appreciate the importance of some symptoms, and to interpret
the meaning of others, which would escape the attention of
those who have not practically studied insanity, and thus at
any rate to throw some light on a doubtful case. It is certainly
far from evident that the popular opinion is correct which
assumes that a rough common sense is best suited to guide the
decision ; one cannot indeed but think that special study and
experience of the phenomena of obscure disease must furnish
better grounds for a just judgment concerning it than entire
ignorance can, Lord Westbury, speaking as Lord Chancellor, in
the House of Lords, before he fell from the height of place
which gave a factitious weight to any opinions which he ex-
pressed, thought it not unbecoming his high intellectual and
official position to condemn “ the evil habit which had grown
up of assuming that insanity was a physical disease, and not a
subject of moral inquiry,” and to affirm that it was not neces-
sary “that a man should have studied the subject of insanity
in order to form a conclusion whether a man was or was not a
lunatic.” Jt may well be doubted whether a Lord Chancellor
* Journal of Mental Science, October 1866.
ATA THE DIAGNOSIS OF INSANITY. [cHap,

ever before gave such complacent and dogmatic utterance to so
erroneous, mischievous, and unfortunate an opinion. It was
one which, falling in with and strengthening the current of
popular prejudice, was received with applause, and did consider-
able mischief, at the time, but which cannot fail to be remem-
bered with surprise in the future as a striking example of the
utter ignorance of the nature of mental disease displayed by
one of the greatest legal intellects of his day. But this is not
the place to criticize Lord Westbury, or to combat his opinions
respecting insanity ; we are concerned exclusively with insanity
as a physical disease, not with subjects of moral inquiry.

Acute mania is not likely to be overlooked, or to be con-
founded with any other disease. The only doubtful question in
regard to it will be in the event of an impostor attempting to
simulate it, or of a drunkard actually simulating it. Certainly
he must be a clever impostor who can simulate the wild restless
eye, the ceaseless movements, the quick fragmentary associations
of ideas, and the volubility of utterance of acute mania so as to
deceive an experienced observer; nor can he, however skilful
an actor, pass days without sleep, and even weeks with only a
few hours’ sleep, maintaining a continual activity, as the acute
maniac does. The skin in acute mania is dry and harsh, or cool
and clammy, but the skin of a pretender who tries to keep up
a prolonged muscular agitation will hardly fail to be hot and
sweating. Meningitis will be known from mania by its own
positive symptoms—by the premonitory rigors, when they occur,
the cephalalgia, the fever, the contracted pupil, and the intoler-
ance of light; by a muscular activity which is paroxysmal, not
continuous, and by frequent spasms and convulsions ; by the
acute severity and incoherent character of the delirium and by
the vivid illusions of the senses; and by the rapid progress of
the disease either to recovery or to death. Delirium tremens
will be distinguished by its own characteristic symptoms—the
muscular tremors, the peculiar fearful illusions and hallucina-
tions, the cold skin, feeble pulse, and the white and tremulous
tongue. But there are cases in which positive insanity is pro-
duced by drink, and they are sometimes the occasion of great
injustice being done by our legal tribunals: some persons who
have a strong predisposition to insanity, or who have been once
v.] THE DIAGNOSIS OF INSANITY. 475.

insane, or who have had a severe injury of the head at some
time, do actually become truly maniacal for a while after an
alcoholic debauch, or are rendered temporarily maniacal—being
probably thought drunk—by a very little liquor. Certain it is
that there are persons whom alcoholic intemperance does not
make drunk, but makes mad. In this condition vivid halluci-
nations are apt to arise, and the sufferer may perpetrate crime
not knowing afterwards what he has done, and certainly at the
time not knowing the nature of the act. On one occasion I was
asked to see in the gaol a respectable builder, who was under-
going imprisonment for a rape on a servant girl under fourteen
years of age, and I was never more convinced of anything in my
life than of the truth of the man’s assertion, that he remem-
bered nothing whatever of the crime which he had committed.
He had for some time heard voices speaking to him, which had
no existence out of his mind, and he had been continually
drinking for some days before the crime. There was no attempt
at concealment or deception ; he spoke with perfect candour ;
and he still heard voices speaking to him through the ventilator
of his cell, Many such instances have been recorded, and it is
high time they were recognised by those who preside over the
administration of justice: the common erroneous notion that if
a person becomes furious after intemperance he must be either
“mad drunk ” or at most have delirium tremens has unquestion-
ably worked much mischief. It admits of no doubt that the
effect of continued intemperance or of a debauch may be a
genuine acute mania, marked by active and violent delirium.
Chronic mania is the most likely to be feigned, and if feigned
with skill the imposture may deceive many. However, the
impostor generally “o’ersteps the modesty of nature,” and over-
acts his part; he is extreme in the extravagance of what he
says and does, while he falls short of his part in the emotional
expression of the maniacal countenance. Thinking that a
lunatic is widely different from a sane person, he exaggerates
and rants, and produces something not like a lunatic. He
pretends perhaps that he cannot remember things, as what day
follows another, or how many days there are in a week, that he
cannot add the simplest figures together, and acts foolishly and
answers stupidly where a real lunatic who was not an idiot
476 THE DIAGNOSIS OF INSANITY. [cHAP.

would act calmly and answer intelligently. For a person truly
insane to be as stupid as the pretender represents himself, he
must be completely demented. If a suggestion be made in-
cidentally of some symptom which he ought to exhibit, he may
adopt the hint. The history of the case, and especially of the
mode of occurrence of the disease and of the circumstances of
its development, will most materially aid the diagnosis. If there
be no previous history to be had, and if the patient refuse to con-
verse, a long observation may be necessary in order to come to a
decision. It is surprising how long an impostor will sometimes
persist: one man, of whom Dr. Bucknill tells, kept up the prac-
tice of insanity for more than two years, and then broke down
in his part; and another kept up the appearance of madness so
long that it is uncertain to this day whether he was really
insane or not. When a man feigns madness so perfectly as
to deceive an experienced observer, we may hold, I think, that
he is not far from being the character which he represents ;
for, unless there be a foundation of real madness beneath the
feigned phenomena, there will be some want of coherence in
them as a whole, and an incongruity with any known form of
mental disease.

Hysteria may notably simulate almost every known disease;
and when its vagaries are mental rather than bodily, it is no
easy matter to decide at all times whether the patient is hys-
terical or truly maniacal. The most reliable data to be guided
by will be found in the previous history of the case and the
symptoms which it presents; in the age, sex, and character of
the patient; and in the presence or absence of the ordinary
hysterical symptoms. A patient who complains of the globus
hystericus in her throat, and compares the morbid sensation to
the feeling of some animal fixed or growing there, is not insane
on that account, even though she can hardly be persuaded that
there is not some living thing there; but it must not be for-
gotten that a genuine mania, acute or chronic, may be occasioned
by or associated with hysteria. Not that this often occurs;
when hysteria passes into insanity some other cause usually co-
operates.

It is a difficult matter at times to detect partial ideational
insanity where the patient is suspicious and tries to hide it. In
v.] THE DIAGNOSIS OF INSANITY. 477

‘the countenance and bearing there may be some sign visible
which has its peculiar interpretation, and there are sometimes
peculiarities in the dress or actions which, when bottomed, open
up a secret mine of madness. Where there is no such guide for
the inquiry, it will be necessary to examine the patient carefully
but unobtrusively on all matters intimately touching himself;
anything singular in his expressions, or any obscure references,
being watched for and subsequently followed up. If he seems
to pass hastily over some subject, or entirely to avoid it, he may
be quietly pressed upon it. All this should be done in as quiet
and polite a manner as possible, without evincing too much
curiosity, so as to avoid offending his susceptibilities or exciting
his suspicions. Heinroth has said, and it is popularly thought,
that the insane will not deny their delusions, though they may
conceal them; that the evidences of their unsoundness will
appear when the subjects upon which they are deranged are
touched upon; but this is by no means true of all cases: some
will deny their delusions positively, or even explain them away
as jokes, when they suspect the acknowledgment of them would
be injurious. If the patient’s self-love is grievously wounded,
and he is made extremely angry, he may sometimes, notwith-
standing his suspicion, reveal his hidden delusions. Or if he be
induced to write, he may exhibit the plainest evidence of
insanity, though he has managed to conceal it successfully
through a long conversation. It is of course necessary to in-
stitute careful inquiry into the previous history, in order to
ascertain whether there is any hereditary taint, and what degree
of it; whether there has been any previous attack of insanity ;
and whether there has been any observed change of character
and habit, especially after some efficient cause of insanity. It
will sometimes happen that a patient at the outset suspects
that he may be thought mad, and is earnest and vehement
in accounting for his morbid feelings, and at great pains to
convince others that he is not mad. If a monomaniac believes
that he is watched by spies, followed by enemies, or otherwise
persecuted, he unquestionably is a dangerous lunatic ; for at any
moment he may become so impatient of his fancied wrongs as
to make a desperate attack on those whom he suspects of
injuring him. In some cases a sane person may be quite unable
478 THE DIAGNOSIS OF INSANITY. [cwap.

to detect any connexion between the act of violence and the
delusion ; and yet the connexion exists deep in the unfathom-
able incoherences of the diseased mind. The pity of it is that,
according to English law, where the connexion is not distinctly
evident—where the motives of a sound mind cannot be success-
fully applied to measure the impulses of a diseased mind—the
unhappy lunatic must be hanged if his act of violence has been
a murder, The monomaniac is not deemed responsible enough
in any case to make a will, however rational it may be on the
face of it, but he is deemed responsible enough to do murder
and to be hanged, however irrational the deed may be on the
face of it.

It is usually easy enough to recognise melancholia, as patients
afflicted with it do not care to conceal their unhappiness and
their delusions. Sometimes, however, a patient having despe-
rate homicidal and suicidal impulses will not only conceal
but positively deny their existence, in order to throw those
about him off their guard, and to get the means of indulging his
morbid propensities; and instances have happened in which
this simulation of sanity has been successful, and homicide or
suicide has been the result. Here a lawyer might argue that
the deliberate concealment of the morbid impulse was ample
proof of a knowledge of its nature, of a consciousness that it
was wrong, and there would be reason in the argument; but
when he proceeds to the further conclusion that the act is
therefore a crime, and the doer of it fully responsible, it is not
a logical inference, but a theoretical presumption, unfounded
and unphilosophical. It confounds consciousness of an impulse
or act with power of will over it, and ignores the most dangerous
and the most lamentable form of insanity. Another melan-
cholic, who cannot entirely conceal his disease, will attribute
his depression to the confinement which he is undergoing, and
will assert eagerly that he wotld be quite well at home. When
a patient has once exhibited homicidal impulse, it is necessary
to observe him carefully for a considerable time before coming
to the conclusion that it has left him: when a favourable occa-
sion offers, at an unexpected moment, the horrible propensity,
latent for some time and seemingly extinct, may burst forth in
violent action.
v.] THE DIAGNOSIS OF INSANITY. 479

It may be of importance to distinguish between hypochondria
and melancholia; for a person suffering from the former would
most likely be hanged if he committed murder, while the true
melancholic would probably be sent to an asylum. The hypo-
chondriac refers his sufferings to some bodily disorder, for which
there may be a very slight or no foundation in fact; he displays
an exaggerated sensibility in regard to all his organic processes,
or to some one of them in particular, so that he either has many
delusions respecting his health or his whole habit of thought
respecting it is delusional ; he is fond of talking of his sufferings,
and of consulting medical men; he evinces a great love of life,
and no disposition to commit suicide ; his intellect is sound, and
his feelings are not perverted, apart from questions touching his
health. The melancholic, on the other hand, attributes hig
suffermgs to some groundless extraneous cause, which either
operates from without or takes possession of his body and soul,
or both; so that he frequently has a single and fixed delusion;
his anguish is a mental anguish, and he asserts that medicine
can do him no good; he is often suicidal; his affective life is
profoundly implicated, and he is incapacitated from intellectual
activity notwithstanding there may be no marked intellectual
derangement apart from the delusion. Still it is true that
hypochondriasis may pass into true melancholia, as well as
co-exist with it, and a hypochondriacal depression, especially
when associated with some actual bodily disease, may rise to
such a pitch as to render the sufferer irresponsible for his acts.

A question sometimes arises in civil and criminal trials as to
the distinction between eccentricity and insanity, the attempt
perhaps being made to prove an eccentric person to be insane,
or to prove an insane person to be only eccentric. Now between
genuine eccentricity of character and insanity there is a wide
difference; the confounding of them can only proceed from a
slavish conformity to that fashion of thought and action through
which the original man of any epoch is so apt to be thought
mad. The truly eccentric man has a strong individuality, which
is expressed in all his doings, and stamps them clearly; he has
but little vanity, for he is emancipated from vulgar prejudice,
and heeds not the world’s praise or censure; he knows that
the world has ever censured great works at their birth, and
480 THE DIAGNOSIS OF INSANITY. _ [cHar.

would gladly have uprooted them during their early growth, and
is not therefore greatly moved by its multitudinous outcry; he
has broad and original views and great moral courage; he differs
from the majority, perhaps, because he has outgrown the habits

and superstitions to which it is in bondage. Such a man has’

nothing insane about him, nor is he ever likely to become insane.
There is, however, a weak affectation of eccentricity which is not
unlikely to end in madness: “ with it are infected certain feeble-
minded beings, often badly bred or badly trained, who are empty
of any true individuality, but inflated with an excessive vanity ;
who have a small intellect, which they use in the service of their
passions ; who do silly and eccentric things, not unconsciously
as the spontaneous expression of their nature, but out of a
morbid craving to attract notice; who represent a condition of
mental derangement that is the forerunner of insanity; who
when they are not given up to sexual excesses are often mas-
turbators.”

When called upon to give an opinion upon a case in which
vicious or criminal acts are supposed to indicate insanity, it is
necessary to go back carefully through the previous history, and
to search for any efficient cause of mental disease, such as great
moral shock, or physical injury, from which the vicious acts may
be logically traced through changes of character, feelings, and
habits. Has any marked change of character occurred after a
sufficient cause of insanity or after a former attack of undoubted
insanity? No one in his senses would assume vice or crime,
however extreme, to be positive proof of insanity; to connect it
with disease it must be traced back through a chain of morbid
symptoms, marking the existence of a cause more serious than
evil passion ; it is important, therefore, not to confine attention
to the prominent symptom, but to traverse carefully the whole
affective life, in order to discover the evidences of the perversion
of nature detectable in a case of true moral insanity, and to
connect the morbid change with an efficient cause of disease. It
is most necessary also to have careful regard to the social cir-
cumstances of the person, in order to give their proper weight to
the supposed indications of insanity. When a person in good
social position gets into the police-court for stealing some article
of trifling value, a suspicion cannot fail to arise as to his mental

SASS,
v.] LHE DIAGNOSIS OF INSANITY. 48]

state; and as a matter of fact it will probably be found on
examination that he exhibits other early symptoms of general
paralysis. In another case, an unaccountable perversion of
feeling and conduct may be finally explained by the occurrence
of epilepsy. In a third, perhaps a strong hereditary taint, hitherto
latent, has been observably brought into mischievous activity by
recognisable mental or bodily causes. Or there has been a notable
degree of imbecility, intellectual and moral, from birth; some
acts of instinctive cruelty, destructiveness, theft—of moral per-
version in all its forms, being truly the acts of moral imbeciles.

When the question of the existence of an irresistible im-
pulse is raised in any case of homicidal or other kind of
violence, it is above all things necessary to keep in view the
possibility of the person being afflicted with epilepsy, either
in the form of epileptic vertigo or in its convulsive form.
Assuredly the epileptic, who is not insane in the intervals
between his fits, must be considered amenable to the laws like
any other person. But if he has committed a murder without
any discoverable motive, without advantage to himself or to any
one else, without premeditation, openly, and in a way quite
different from that in which such a crime is usually committed,
then it would be an unjustifiable and cruel thing to take no
account of his unquestionable disease, and a barbarous act to
execute him as a common criminal. In such a case, says
Professor Trousseau, “I have the right of affirming before a
magistrate that the criminal impulse has been the result, admost
to a certainty, of the epileptic shock. I would say almost if 1
had not seen the fit; but if I myself or others had seen a fit or
an attack of vertigo immediately precede the criminal act, I
would then affirm most positively that the culprit had been
driven to the crime by an irresistible impulse.” But even though
no epileptic fit has preceded the violence, a motiveless and
entirely unaccountable crime in a person who has once had, or
is subject to, epilepsy should arouse attention to the possibility
of a maniacal attack having taken the place of the ordinary fit
—to the possibility of a masked epilepsy.

It is hardly necessary to say that homicidal insanity must not
be admitted in a case merely because a murder has been done
without. any discoverable motive. The celebrated instance of

11
482 THE DIAGNOSIS OF INSANITY. [cHAP.

Henriette Cornier, which is so frequently referred to as a pure
example of homicidal insanity, should certainly act as a warning
against a too hasty conclusion: it was not until years after she
had murdered her child and had been pronounced insane by the
highest medical authorities in Paris, that it was discovered that
the deed was done in order to be revenged on her lover who had
married another woman; and even now writers on insanity con-
stantly quote her case as an illustration of homicidal insanity,
without ever having heard of the motive finally confessed. If
there be any suspicion or allegation of homicidal insanity in a
particular case, the most careful inquiry should be made into the
previous history, in order to ascertain whether there has been
any former attack of insanity, whether there is a strong here-
ditary taint, whether there have been any epileptic fits, whether
there has been deep melancholic depression, or whether there is
evidence of monomaniacal delusion, obviously connected, or not,
with the act of violence. It is only in a comparatively few in-
stances that homicidal impulse exists by itself, and constitutes
the disease. Certainly it will be right to view with extreme
jealousy and suspicion any attempt to obtain the acquittal of a
murderer on the ground of insanity, when there is no evidence
procurable of mental unsoundness before or after the crime—
when, in fact, the crime itself is the only evidence adduced.
There is no difficulty about the diagnosis of general paralysis
after it has passed its earliest stage. “It is not always easy of
diagnosis before the physical signs appear; and yet a man may
at this stage get into trouble—get into the police-court, or get
married foolishly—entirely by reason of the disease. It is
necessary to weigh carefully the character of the act—whether
it is anywise explicable, or is motiveless and quite unaccount-
able—to mark well the state of the patient’s articulation under
excitement or after a sleepless night, and to attend to his happy
frame of mind and to the great exaggeration and general
extravagance of his conversation on all matters concerning
himself, even when there is no fixed and positive delusion.
General paralytics in the early stage sometimes speak so
extravagantly and absurdly regarding things which they have
seen, or events in which they have been concerned, that an
inexperienced person might be apt to put down the whole as a
v.] THE DIAGNOSIS OF INSANITY. 483

delusion. It is needful to bear in mind that there may be some
foundation of fact in what they say of themselves—that they
do not at first so much invent as outrageously exaggerate. It
is needful also to remember the alternations of calmness and
apparent sanity which occur in the early course of the disease.” *
If there be no extravagance of thought, and no delusions of
grandeur, at the outset of general paralysis, and especially if the
disease take that form in which there is a gradually increasing
feebleness of mind, great caution will be necessary before coming
to a conclusion. I have known a patient under these circum-
stances to be suspected of indolence and accused of imposture,
when he was really in the first stage of this most fatal
disease. The character of the articulation should be closely
observed, and any indication of weakness and confusion of mind,
of change of character and of increased irritability, should be
carefully noted ; if there be a certain hesitation and slowness of
speech, a loss of memory, and an appreciable confusion of ideas,
—if the patient be unable to do successfully some work which
at one time he could do with great ease-—and above all if there
be on his part an entire unconsciousness of these symptoms, and
perhaps a denial of them when they are pointed out to him,
then it is almost certain that he is the victim of incipient
general paralysis.

NOTE.

In an excellent chapter on the Diagnosis of Insanity in the Manual
of Psychological Medicine, Dr. Bucknill makes the following remarks
touching the mode of examining a patient :—“ After testing the
fundamental faculties, the attention, the memory and recollection,
and the judgment, which may be done by ordinary conversation on
any subject, it will be well to give up the idea of any metaphysical or
phrenological system of mind, and to conduct the further examination
upon a plan laid down upon the active duties and relations of life.
The patient may be led to give an account of his own powers of body
and mind, with reference to health, to exercise, diet, and study.
Thousands of delusions are entertained by insane people upon these
subjects. He may then be led to converse respecting his possessions,
his means of livelihood, and his hopes of advancement in rank or

* From the Author's article on Insanity in Reynolds’s System of Medicine, vol. ii,
112
484 THE DIAGNOSIS OF INSANITY. [cHaP. v.

property ; such conversation will open up the delusions of pride,
ambition, and acquisitiveness. He may then be led to converse of his
near relatives and friends, and especially respecting his birth and
parentage, stress being laid upon his belief whether his parents were
his actual and real parents. This inquiry will tend to open up any
delusions respecting imaginary greatness, and any perverted emotions
towards those who ought to be dear to him. The subjects of religious
opinion may then be introduced. The religious devotions and exer-
cises which he practises may be inquired into, with the reasonable
expectation of finding insane delusions on a subject which touches the
deepest sentiments of the soul. If the patient is an educated man, it
will be right to converse with him upon politics and science. If he
ean stand the test of a discriminating inquiry on these and similar
subjects, he certainly cannot be the subject of mania; and if he has
any delusions, he must either retain the power of hiding them, or they
must exist in some obscure corner of the brain, from which they are
little likely to influence, with any force, the opinions, the feelings, or
the conduct.”
CHAPTER VI.
THE PROGNOSIS OF INSANITY.

wet danger there is to life, and what probability there is of
recovery, are the two questions of almost equal moment
which press forward for determination in any case of insanity.
In respect of the first question, it may be said that, though
insanity certainly does upon the whole reduce the mean duration
of life, and much more so in its recent acute forms than in its
more chronic forms, yet it is not in the majority of cases a
disease directly dangerous to life. The French statistics of M.
Béhic, already quoted, show that of 17,167 deaths, 12 per cent.
occurred in the first month after admission into an asylum,
7 per cent. in the second month, 6 per cent. in the third month;
so that one-fourth of the total number of deaths occurred within
the first three months. General paralysis passes steadily to a
fatal ending in the great majority of cases, and usually so within
two years from its commencement. Now and then an instance of
recovery has been mentioned, but it has seldom been allowed to
pass unquestioned : the periods of calmness and lucidity which
intervene in the early part of its course have been too favour-
ably interpreted. Both acute mania and acute melancholia some-
times end fatally in a sudden manner by exhaustion, especially
where a persistent refusal of food has accompanied continued
excitement, agitation, and sleeplessness ; the prognosis in such
cases being very much infiuenced, for better or worse, according
as food is taken or not. In these cases an advanced age also
influences the prognosis unfavourably : acute excitement with
refusal of food in an old person, especially when the delirium
mounts up until all reflection is lost—until the mania becomes
the ego—is almost sure to be fatal. When the temperature of the
486 THE PROGNOSIS OF INSANITY. [cHap.

body rises some degrees above the natural standard, it is a
symptom of bad omen; for, though it may not indicate an im-
mediate fatal termination, it marks increasing organic mischief
that must before long end fatally ; in the attacks of excitement,
for example, which occur in the course of general paralysis,
the temperature rises, falling again as they pass off; and in
the recurring attacks of excitement in some cases of dementia,
where there appears to be an actual slow softening of the brain,
advancing by periodical starts, the temperature will rise some
degrees during the exacerbations, sinking afterwards to its
natural standard. It would cause no surprise if convulsions
ensued during any of these attacks, and death soon followed,
though they may go on being repeated for months before such
an end comes. Any indication of motor paralysis, or any kind
of hybrid epileptiform convulsion, or even a recurring subsultus
in the muscles of one arm, is of evil omen; but an attack of
genuine epilepsy, though unfavourable as regards the prospect of
recovery, is not so as regards life. Where there is nothing in
the disease itself to directly endanger life, the patient may still
die from exhaustion when a persistent steady refusal of food
has not been overcome. In melancholic patients afflicted with
suicidal impulse, as many of them are, an unremitting and
watchful care will be necessary to prevent a self-inflicted death.

What probability there is of recovery in a particular case will
depend greatly upon the duration of the disease, upon the cause
of it, and upon the form which it takes. As a general rule, the
more recent the outbreak the better is the chance of recovery;
the expectation of which, when proper treatment has been
-adopted from within three months from the commencement,
is about four to one, while it is hardly as much as one to four
after the disease has lasted twelve months. Undoubtedly there
do occur instances in which patients recover after being insane
for years, but they are exceptional: when a pathological habit
has been thoroughly established in the mind, it continues almost
as naturally as the normal] physiological habit. The hope of
recovery is entirely gone when the stage of secondary dementia,
incoherent or apathetic, has been reached.

Looking to the forms of mental disease, it will be found
that melancholia is the most curable, acute mania coming next
vu.J THE PROGNOSIS OF INSANITY. 487

in order. Recovery often takes place in simple melancholia in
the course of a few weeks or months; and it may sometimes
take place when the disease has lasted for years, if the surround-
ings be entirely changed, and some strong incentive to exertion
be supplied. When the maniacal fury is subsiding, the prospect
is good if the patient is sad and depressed, begins to inquire
about his family, friends, and business, and to evince other signs
of a return to his former feelings and interests; it is bad if the
feelings remain unmoved and the intellect is calm in its disorder
—if, in other words, there is evidence of the organization of
disorder. Liven the disappearance of intellectual derangement
is not a certain sign of recovery unless there is a return to the
old healthy feelings, and the patient is conscious that he has
been insane; if this happy change does not take place, a recur-
rence of the attack may be looked for. And a periodical recur-
rence of the attacks is of extremely unfavourable augury; the
attacks becoming longer, the intermissions briefer, and the
decline to dementia being often steadily certain. Still in-
stances do occasionally happen in which recovery takes place in
recurrent mania of long standing. I call to mind one marked
example in a patient who had been confined in an asylum for
upwards of three years, and on whom, as he was thought
incurable, a commission in lunacy had been held; he ultimately
escaped from the asylum, and got off to America; and after
some months returned to England, and took steps successfully
for superseding the judgment of the commission. It was not
till two years after this that he broke down again. He was a
man of very active mind and energetic character, and there
could be no doubt that the restraint, monotony, and idleness
of life in an asylum positively favoured the recurrence of the
maniacal outbreaks; which, on the other hand, were warded off
by the freedom,-variety, and bustle of an active life. Such an
instance might well raise a reflection respecting the value of the
mode of dealing with insanity according to the principles now in
fashion ; but let that pass for the present. A day of depression
and weeping intervening in the course of acute mania is of good
omen; but when attacks of mania and melancholia regularly

alternate, the prognosis is very unfavourable.
Chronic mania and monomania, once they are established,
488 {HE PROGNOSIS OF INSANITY. [omap.

allow very small hope of recovery. Jn rare instances it may
take place under the influence of systematic moral discipline, or
in consequence of some great shock to the system, which may
be due either to a strong emotional affection or to the effects of
some intercurrent disease. Where there is a fixed delusion in a
melancholic patient that the cause of his misery is in some
external agency, the prognosis is unfavourable; but it is more
favourable in the melancholic who attributes his suffering to
imaginary backslidings of his own. In like manner the homi-
cidal patient who believes himself the victim of persecution
seldom recovers, while the suicidal patient generally does
recover, particularly after some serious and all but successful
suicidal attempt. In moral insanity the prognosis is bad; the
symptoms commonly indicating the tyranny of a bad organiza-
tion. Acute primary dementia is in most cases curable by
proper treatment applied in due time. General paralysis is
incurable.

When insanity has been slowly developed, the prognosis is
less favourable than when it has been of sudden origin. The
reason of this will appear when we reflect that it is usually,
when slowly developed, produced as an exaggeration of some
peculiarity of character, and marks the establishment of a
definite type of morbid action of a chronic nature; but that,
when suddenly caused, it is produced by some severe moral or
physical shock, and may indicate no more than the disturbance
of the mental equilibrium. Fora like reason a frequent alterna-
tion of symptoms of active disease is more hopeful than a steady
persistence in a particular group of quiet symptoms. The
popular belief that hereditary insanity is not likely to get well
is not warranted by experience; but the disease is more likely
to recur than when it is not of hereditary origin. Jn the acute
mania sometimes produced by drunkenness the prognosis is
good; it is bad in those cases in which a continued steady
intemperance, associated sometimes with hereditary predispo-
sition, has resulted in mental weakness or dementia. After two
or three attacks of delirium tremens, the mind is sometimes
hopelessly weakened, the memory impaired, the moral feeling
blunted, and the energy of character lost; all that is left of
mental power is a considerable cunning.. When insanity has
vi] THE PROGNOSIS OF INSANITY. 489

been caused by habits of self-abuse or by sexual excesses, the
prognosis is unfavourable in all but the earliest stages. If reli-
gious excitement purely has been the cause of an outbreak,
recovery may be looked for with confidence ; but where religious
display is the garb which a pride or vanity of disposition has
assumed, the outlook is very unfavourable. Where disease of
brain, or injury of the head, or epilepsy, has been the cause of
the mental derangement, it is practically incurable; but where
it occurs during the decline of some acute disease, it is generally
soon curable. The prognosis is favourable in hysterical insanity;
it is even more favourable in puerperal mania and in the insanity
of lactation, and this though there may have been previous
attacks after confinements. Indeed, when two or three previous
attacks of insanity have been recovered from, there is always
good ground of hope of one more recovery, though the final issue
will probably be dementia. We may generally look for a happy
issue in the insanity of pregnancy, distressing as the derangement
is while it lasts. I have seen no reason to believe that parturition
exercises any specially favourable influence on the disease; in
one case, indeed, a lady became much worse after her confine-
ment, finally refusing food entirely, and dying of exhaustion. A
decidedly bad. symptom is a fixed hallucination, as is also a com-
plete preservation of bodily health along with a persistence of
the mental disorder: when there is palpable bodily disorder, as
digestive disturbance, anzemia, menstrual irregularity, there is
good hope that, with the restoration of bodily health, the mind
may be restored also. Climacteric insanity not unfrequently
terminates in recovery, though it is apt to last some time, but it
occasionally passes into dementia. When insanity is associated
with ovarian or uterine disease, it is not likely to get well unless
the ovarian or uterine affection can be cured. The prognosis is
favourable in metastatic insanity. where the derangement has
followed the suppression of an eruption or an accustomed dis-
charge. When insanity is associated with phthisis, the prognosis
is unfavourable both as regards recovery and as regards life ;
diseases of the respiratory organs, among which phthisis holds the
first place, are the diseases most fatal to the insane in asylums.
Senile insanity, whether beginning as mania or melancholia,
passes through all the stages of dementia. Recovery may be
490 THE PROGNOSIS OF INSANITY. [cuar,

looked for in pure syphilitic mania of recent origin; but when
the disease presents any symptoms of dementia or indications
of paralysis, the outlook is very gloomy.

The most favourable age for recovery is youth, the probability
of it diminishing with the advance of life, and few recovering
after fifty: as many as 86 per cent. of males, and 91 per cent.
of females, attacked with mania under twenty years of age,
recovered at the Somerset Asylum, according to Dr. Boyd’s
tables. The recoveries among women exceed those among men,
owing probably to the frequency and fatality of general paralysis
among men.

The broad conclusion which Dr. Thurnam came to on the
basis of his careful statistics was that, “as regards the recoveries
established during any considerable period—say twenty years—
a proportion of much less than 40 per cent. of the admissions is
under ordinary circumstances to be regarded as a low proportion,
and one much exceeding 45 per cent. as a high proportion.”*
The liability, however, to recurrence of the insanity after re-
covery from the first attack cannot, he thinks, be estimated at
less than 50 per cent., or as one in every two cases discharged
recovered. On the whole, then, he holds that of ten persons
attacked five recover, and five die insane sooner or later. Of the
five recoveries not more than two remain well during the rest
of their lives; the others have subsequent attacks, it may be
after long intervals, during which at least two of them die.
The apprehension, then, which the public have of persons who
have once been mad, as if they might at any moment relapse
into their malady, is natural and well founded. The suscepti-
bilities and the impulses of character which issued in the first
attack, remain the same—the personality is not changed; and
there is in addition the acquired aptitude generated by the
deranged function—an aptitude prone, under unfavourable cir-
cumstances, to become a habit.

In concluding this chapter I cannot forbear remarking that in
insanity, all question of the intrinsic nature of the disease put
aside, the prognosis is often materially influenced by extraneous
circumstances—the behaviour of those relatives and friends of
the patient who are most nearly interested in him. It admits

* On the Statistics of Insanity, by J. Thurnam, M.D.

1
vi.J THE PROGNOSIS OF INSANITY. 491

of no doubt that in some cases the eager impatience, the restless
anxieties, the meddlesome interference, and the disagreements
of friends thwart the best efforts of the physician. Sincere and
sound advice, founded on experience, is not adopted, or, if adopted,
not steadily followed; meanwhile that time in which there is
the best hope, and sometimes the only hope, from treatment
passes ; and the period of recovery is delayed, if the progress
of it be not permanently arrested. It is not an unwarrantable
assertion to make, that some insane persons have owed their life-
long mental affliction to the injudicious conduct of those to
whom they were most dear.
CHAPTER VII.

THE TREATMENT OF INSANITY.

C may be safely said that in no other disease are the difficulties
of treatment so great as they are in insanity; for they are not
only difficulties appertaining to the nature of an obscure disease,
but they are increased and multiplied by the social prejudices
attaching to it; by the frequent concealment and misrepre-
sentation, witting and unwitting, on the part of the friends of
a patient; by the unsatisfactory character and position of the
institutions especially established for the reception of insane
persons ; and, in some measure also, by the tendency of recent
lunacy legislation, which has suffered not a little from popular
panic and professional philanthropy. The practical result of
laws eagerly and hastily made under the influence of popular
excitement and clamour has unquestionably been in some re-
spects prejudicial to the true interests of the insane. The land
has been covered with overgrown and overcrowded asylums to
which almost the whole lunatic population of the country has
been consigned, while the greatest difficulties have been put in
the way of the early treatment of insanity. No one who has
had experience of the working of the Lunacy Acts in England
can feel altogether satisfied with the results. That there has
been a steady increase of 1,000 patients a year in the asylums
of England and Wales during the last fifteen years may be good
evidence of the close supervision exercised over them, but it is
not convincing evidence that all has been done which can be
done to secure the best medical treatment of those who are
curable and the greatest comfort of those who are incurable,

Tt would not be difficult to show that the iniquities practised
upon the insane in olden times, the countless unnecessary and
cHayY, Vil.] THE TREATMENT OF INSANITY. 493

cruel sufferings which they underwent, originated fundamentally
in the shame, horror, and dread of insanity which still infect the
public mind. Whether these unjust feelings were legacies from
that ancient superstition which looked on an insane person as
tormented with an evil spirit, in consequence of some great sin
coinmitted by him or his parents, it is needless to inquire here ;
suffice it to say that the cruel feelings of suspicion and fear
inspired a most cruel practice. To shut the insane up from gaze,
and, if possible, from memory, to be rid at any cost of their
offending presence,—that was the one thing to be done, and fit
implements were not wanting to do it. Consequently it happened
“that infinite cruelties grew up and flourished under the influence:
of false views and hostile feelings with regard to them; and
to be the victim of the most pitiful of diseases became a reason,
not for undergoing proper medical treatment, but for enduring
the severest punishments. The memory of this iniquitous
past is thought to justify, and certainly strengthens, the public
jealousy of asylums and of those who superintend them now;
they are weighted with an inherited odium; and a stringent
legislation, designed to mitigate the uneasiness of the public con-
science on account of the real horror of the insane which is
still felt, and to condone past sins, does not conduce altogether
to their best interests.

It is by no means an unnecessary thing to watch carefully
any public action taken in regard to the insane; for it is very
certain that the people have not been in times past, and are
not now, their true friends: the vulgar fear or horror of them
has always prevented that, and the social disgrace thought to
attach to insanity still prevents a genuine reform of opinion.
How often did Pinel appeal, and appeal in vain, to the authorities
before he was permitted to make the experiment of removing
the chains from a.few lunatics, and of treating them with kind-
ness and consideration! Against what an embattled phalanx of
obstructive prejudices, selfish indifference, and interested oppo-
sition did the humane system of treatment, the conception and
realization of which were not with the people but in spite of
them, win its slow way to general adoption in this country ! A few
earnest members of the medical profession, inspired by benevolent
feeling, but little aided from without, clung to the drooping
494 THE TREATMENT OF INSANITY. [cHar.

standard, and, animated with firm conviction and nerved by a
sublime determination, bore it onward to triumphant victory.
The names of Pinel and Conolly, the great and victorious cham-
pions of the humane reform, will ever be remembered with
gratitude and honour. But, alas! while men accept and praise
the reforms that have been accomplished, they fail not to oppose
and despise those which are to come. What a terrible outcry
is now raised by an alarmed and angry public when some poor
madman who has committed homicide in a paroxysm of his
frenzy is permitted to pass the remainder of his unhappy life in
confinement instead of being hanged forthwith! How many
veritable lunatics are year after year executed in obedience to
ignorant and unrighteous judgments inspired by the popular
prejudice! When the superintendent or proprietor of an asylum
sends a few of his patients to the seaside, to reside there for a
short time, how frequently does it happen that the whole neigh-
bourhood rises in rebellion, and hastens to protest against the
outrage thought to be practised upon it! And when the protest
has been unsuccessful, with what a singular consideration does
this public, so eagerly censorious of those who have the difficult
charge of the insane, behave with regard to them: it stares at
them, points at them, perhaps follows them at a distance, as
they take their walks, exactly as if they were so many wild
beasts, and no longer brothers, sisters, fathers, and mothers !
To be a lunatic, as public sentiment goes, is to be cut off socially
. from humanity. With such feeling prevalent with regard to the
insane, can it be thought possible that the treatment at present
sanctioned by general approbation should be the most just and
humane possible? The feeling is one that cannot be justified,
and the system which it inspires cannot be just. That system
is the system of indiscriminate sequestration—of locking up a
person in an asylum simply because he is mad.

Now I believe this practice to spring out of an unjust feeling,
as already said, and to be founded on a false priuciple,-as I shall
now endeavour to show. The principle which guides the present
practice is that an insane person, by the simple warrant of his
insanity, should be shut up in an asylum, the exceptions being
made of particular cases. This I hold to be an erroneous prin-
ciple, The true principle to guide our practice should be this,—
vit] THE TREATMENT OF INSANITY. 495

that no one, sane or insane, should ever be entirely deprived of
his liberty, unless for his own protection or for the protection
of society. Therefore, instead of acting on the general principle
of confining the insane in asylums, and making the particular
exceptions, we ought to act upon the general principle of de-
ptiving no one of his liberty, and of then making the numerous
exceptions which will undoubtedly be necessary in the cases of
insane persons, as in the cases of criminals. We imprison
criminals in order to punish them, to reform them if possible,
and to protect society from their vices: in dealing with the
insane, who are suffering from disease, there can be no question
of punishment, but we confine them in order to apply proper
means of treatment, and to cure them, if possible ; and, secondly,
to protect themselves and society from their violence. If any
one says that, on the admission of these principles, the practical
result as regards the insane would be very much what it is now
—for they would actually embrace so many of them that the
exceptions would be few—I confidently question the assertion ;
I venture, indeed, to affirm in opposition to it, that there are
many chronic and incurably insane persons, neither dangerous
to themselves nor to others, who are at present confined in
asylums, and who might very well be at large. But they are
kept in asylums because they have been once put into them;
because it is sometimes desirable that their existence should not
be known to the world; because they cost less there than they
would if in private houses; because they are well taken care of ,
there; because it is heedlessly taken for granted that it is no
injustice to confine them thus so long as they are mad; and for
many other like reasons. But the fundamental reason which
inspires all these other reasons, and without which they would
want firm root, is, that the world has grown to the fashion of
thinking that madmen are to be sequestrated in asylums, and
cannot now, with every desire to be sincere and unbiassed, con-
ceive the possibility of a different state of things. Even those
devoted men who laboured so well to effect the abolition of
restraint within asylums never dreamt of the abolition of the
restraint of asylums.

I know well the objections, some fanciful and some weighty,
that may be made to the doctrine just propounded. It may be
496 THE TREATMENT OF INSANITY. [cuaP

said that some insane persons go on very well in asylums who
would go on very badly out of them, and that it is not possible
to say exactly whether an insane person is dangerous or not.
The answer to that as an objection to the principle is threefold :
—First, that there are some insane persons at any rate to whom
it does not apply, some, however few they may be assumed to
be, of whom it can be said, with as much certainty as it can be
said of any experience in nature, that they are not, and never
will be, dangerous to themselves or others; secondly, that it is
not true that the difficulty or impossibility is so great and wide
as assumed by the objection, for practically there is no more
difficulty to an experienced person in deviding that a patient is
not dangerous to himself or others than in deciding that he is
thus dangerous—which is a thing which every physician who
has to do with cases of insanity must constantly do, and which,
with a few exceptions, he feels that he can do with perfect con-
fidence ; and, thirdly, that the objection might be valid if it were
proposed to leave the insane not in asylums without any sort of
care and control, which never was proposed, and that its whole
force, therefore, lies in an assumption which is an unfounded
one. It is a curious commentary upon this objection, that many
of the insane who are really most dangerous to others are not
sent to asylums now; they appear to be so slightly affected in
mind, exhibiting no incoherence nor frenzy, that the ordinary
practitioner will not certify that they are of unsound mind. A
melancholic mother, who is thought to be simply low-spirited
and is not interfered with, kills her children to save them, as
she supposes, from misery on earth, or to send them to happi-
ness in heaven. Or a man, having the delusion that he is
deceived and dishonoured by his wife, goes steadily about his
work, and is thought by his comrades to be only a little gloomy,
until some day, in a paroxysm of rage arising out of his delusion,
he murders his wife.* Another objection to the liberation advo-
cated will be, that the insane in private houses will not be so
well cared for as they are, nor have any more comfort than they
now have, in well-conducted asylums. The quarter from which

* In regard to the questions above raised, it would be interesting to have an
exact statement of the yearly proportion of murders by lunatics which are actually
done in asyluins.
vi] THE TREATMENT OF INSANITY. 497

this objection is urged taints it with suspicion : I never heard it
put forward but by those who are interested in the continuance
of the present state of things. Those who make it appear to
fail entirely to appreciate the.strength of the passion for libeity
which there is in the human breast; and as assuredly there are
but very few persons who would not infinitely prefer a garret
or a cellar for lodgings, with bread and water only for food,
to being clothed in purple and fine linen and to faring sump-
tuously every day as prisoners, I can well believe that all
the comforts which the insane person has in his captivity are
but a miserable compensation for his entire loss of liberty,—
that they are petty things which weigh not at all against the
mighty suffering of a life-long imprisonment. I would put
it to those who Jay stress on the comforts of asylums, whether
they sufficiently consider the discomforts of them, apart from
the imprisonment which they are by the nature of the case.
Is it not a common thing to hear from an insane person bitter
complaints of the associations which he has in the asylum,
and of the scenes of which he is an unwilling witness—scenes
which cannot fail to occur, notwithstanding the best classifica-
tion, where all sorts and conditions of madness are congregated
together? What, again, can be conceived more afflicting to a
man who has any intelligence and sensibility left, than the
vulgar tyranny of an ignorant attendant—a tyranny which the
best management cannot altogether prevent in a large asylum ?
And I might go on to enumerate many more of the unpreventible
‘miseries of life in an asylum which, when superintendent of
one, forced themselves painfully upon my attention, and often
made me sick at heart. What compensation do a few cheap
engravings hung on the walls of the rooms to make them look
cheerful, or the privilege of being present at a theatrical enter-
tainment where officials and their friends enjoy the gratification
of exhibiting their powers before an audience which listens
apathetically, afford for the loss of that which any one, however
low he may be fallen, prizes beyond all else—for the loss of his
liberty? Those who advocate and defend the present asylum
system should not overlook the disadvantages; they should not
forget that there is one point of view from which they who,
organize, superintend, and act, regard the system, and that there
KK
498 LHE TREATMENT OF INSANITY. [CHAP,

is another point of view from which those who are organized,
superintended, and suffer, view it. It is natural and justifiable
for one who has brought into excellent order a large institution,
and holds by his controlling mind its different parts in well-
balanced movement, to feel proud of his work, and to contem-
plate with satisfaction the thorough organization of the whole ;
but he should surely take much heed lest that very pride of
success and the strong interest which he feels blind him to its
demerits. This cannot fail to be more or less so, human nature
being what it is: should not a man most mistrust himself when
he is most satisfied with himself? Have not the most grinding
tyrannies which the world has ever seen been the best orga-
nized? It is necessary to pause before accepting this argument
of the comforts of asylums from those who superintend or keep
them ; the most sincere person cannot help being unconsciously
biassed in such case. I am not ignorant, however, of the fact
that there are some chronic lunatics who have been in asylums
for so many years that it would be no kindness now to remove.
them—who have indeed so grown to the habit of their lives that.
it would be cruel to make any change; but J hold that to be no
argument for subjecting any one else to the same treatment in
order to bring about the same result: it is not the past condition
but the future welfare of the insane that is the matter in hand.
Human nature is so constituted that it grows to the conditions
of life in which it is placed; but every one would admit it to be
a poor argument in favour of unjust confinement in prisons, that
a prisoner unjustly confined for years has been very unhappy
when released, and has prayed to be sent back to his cell and
to the mice with which he had made friends there. Another
objection will be, that if you subject a patient to systematic
control outside an asylum, you do actually deprive him of his
liberty quite as much as by putting him into an asylum. Sup-
pose this were granted, it is still open to us to maintain that he
would be happier amongst sane people, and under the circum-
stances of private life, than when surrounded by all degrees and
kinds of lunacy, and subjected to the monotonous routine and
oppressive regulations of an asylum. But I do not admit the
justice of the objection. Let it be clearly understood that I
am not advocating the placing an insane patient alone in a
vu] THE TREATMENT OF INSANITY. 499

cottage with one or. two attendants; in such case I readily
admit that he is subjected to the most odious kind of tyranny
and to a deprivation of liberty in its worst form—that he would
be a thousand times better off in a well-conducted asylum, and
certainly could not be worse off in the worst asylum. I am
arguing distinctly in favour of placing in private families cer-
tain chronic insane persons who are fitted for a more liberal
treatment, where after a time they become truly a part of the
family, and are considered in all its arrangements, not otherwise
than as a member of it afflicted with some incurable bodily
disease would be. In such case the loss of liberty is by no means
equal to that in an asylum, where the occasional indulgences of
a certain freedom granted only serve to lighten up the present
misery and to deepen the gloom of the outlook into the future.
All this, it may be said, is plausible in theory ; but, practically,
what is the actual condition of patients in private dwellings ?
Undoubtedly their condition in past years has not been what it
should be; no thought has been given to it by anybody; and
they have suffered from the erroneous views concerning insanity
which have prevailed in the public mind. But the same thing
happened in asylums at one time. They were abodes of cruel
suffering to the patients ; and many people, not wanting in kind
feeling, thought that they must continue so by the nature of the
case. But they are no longer so now; in them more enlightened
views with regard to insanity arose and spread, and a great:
practical reform has been effected, the completeness and excel-
lence of which have become a positive difficulty in the way
of any further reform in the treatment of the insane. Is there,.
then, let it be demanded, any insurmountable reason why simi-
larly enlightened views should not be inculcated on those who!
desire to receive single patients into their houses, and a similar
beneficial reform should not be effected? That there is not is
shown satisfactorily by the reports of the Scotch Deputy Com~
missioners in Lunacy on the condition of the pauper insane in
private dwellings in Scotland.* A few years ago these persons
* Righth Annual Report of the General Board of Commissioners in Lunacy

for Scotland, 1866. 3
‘Seo also an exhaustive and conclusive paper “On the Care and Treatment of
the Insane Poor,” by Dr. Mitchell, Deputy Commissioner in Lunacy for Scot.

land ; Journal of Mental Science, January 1868.

wow
500 THE TREATMENT OF INSANITY. [cnmap.

were in a wretched state, neglected and ill-treated in many
cases, and in no case having the care which their disease
demanded. Now, however, all this is changed: by the power-
ful agency of official instruction and inspection, systematically
exercised, all who have to do with them have been penetrated
with more enlightened views, and the condition of their charges
has accordingly been immensely improved—indeed, now leaves
little or nothing to be desired. The former evils sprang not so
much out of deliberate cruelty as out of want of knowledge on
the part of those who had concern or part in them.

If other facts were required to strengthen the argument, I
might point to the condition of the numerous Chancery patients
in England who are living in private houses. I have the best
authority for saying that their condition is eminently satisfactory,
and such as it is impossible it could be in the best asylum.
Every patient is visited once a quarter by one of the Chancery
visitors, who have the power of insisting upon his removal else-
where, if the accommodation and treatment are not satisfactory.
Nor would it be correct to attribute the success in these cases to
the large amount paid for the care of Chancery patients; for, in
the first place, though this is great in some cases, it is not so in
others, not being indeed so great as would be demanded for their
care in a good asylum; and, in the second place, the experience
of the Scotch Lunacy Board shows that many pauper patients
are well taken care of in private dwellings at less than one half
what the cost would be in a county asylum. The question is
plainly not altogether one of expense; the more it is candidly
considered, the more evident it becomes that its solution lies in
the promulgation of enlightened views, and in the will to realize
them in practice.

No one acquainted with the facts would deny that many of
the single patients in England who are not Chancery patients
are satisfactorily cared for, and are more comfortable than they
would be in asylums. In the village of Hanwell and its neigh-
bourhood, there are several single patients living with private
families, some Chancery patients, and others not, who are ex-
tremely well taken care of in every regard; what insurmount-
able impediment is there to that which is done successfully in
Hanwell being done in any other village in England? It would
vir.] THER TREATMENT OF INSANITY. 501

be difficult to assign any such. In order to develop this system,
however, it would be necessary to establish more frequent official
inspection ; for at present the single patients not under the juris-
diction of the Court of Chancery are only seen, on an average,
once a year by the Commissioners in Lunacy ; and the official
policy has not hitherto been to correct, improve, and develop
the system, but rather to discourage and abolish it as a perma-
nent and increasing means of providing for the insane. When
official views and practice have been modified and brought into
conformity with the stream of liberal thought, as we cannot
doubt that they surely will be, and when arrangements have
been made for a systematic and more frequent visitation of single
patients, then it cannot be doubted that the number of these
will rapidly increase, to their infinite comfort, to the pressingly
needed relief of our overgrown and overcrowded asylums, and to
the general advantage of the community.

For the reasons adduced, I cannot but think that future pro-
eress in the improvement of the treatment of the insane lies in
the direction of lessening the sequestration and increasing the
liberty of them. Many chronic insane, incurable and harmless,
will be allowed to spend the remaining days of their sorrowful
pilgrimage in private families, having the comforts of family life,
and the priceless blessing of the utmost freedom that is com-
patible with their proper care. The one great impediment to
this reform at present undoubtedly lies in the public ignorance,
the unreasoning fear, and the selfish avoidance of insanity.
When knowledge is gradually made to take the place of
ignorance, and familiarity banishes the horror bred of ignorance,
then will a kindly feeling of sympathy for the insane unite with
a just recognition of their own interests, on the part of those
who receive them into their houses, to secure for them proper
accommodation and good treatment; then also will asylums,
instead of being vast receptacles for the concealment and safe
keeping of lunacy, acquire more and more the character of
hospitals for the insane—they will become infirmaries for
liseased brains rather than the cemeteries of disordered in-
ellect ; while those who superintend them, being able to give
more time and attention to the scientific study of insanity, and
0 the means of its treatment, will no longer be open to the
502 THE TREATMENT OF INSANITY. [cHap.

reproach of forgetting their character as physicians, and degene-
rating into mere house-stewards, farmers or secretaries.*

Thus much respecting the chronic insane who are harmless
and incurable, and for whom the aim to have in view is to secure
the most comfortable provision for the rest of their lives. It
now remains to speak of the means to be adopted for the care
and treatment of the insane who are deemed curable. This
treatment is moral and medical, the two methods being properly
combined in every case. Again, it should be specially directed
to the character and circumstances of the individual case; it is
necessary to penetrate the individual character, in order to in-
fluence it beneficially by moral means, and to investigate care-
fully the concurrence of conditions that have issued in insanity,
in order, as far as possible, to remove them. Not the least of the
evils of our present monstrous asylums is the entire impossibility
of anything like individual treatment in them. It would not
be putting the matter fairly to point out the absurdity of two
medical men affecting to really treat seven or eight hundred
lunatics in an asylum, because the majority of them assuredly do
not require any medical treatment; but it is perfectly fair to
call attention to the uncertain chances of satisfactory treatment
which the small curable minority have under such circumstances.
To the medical officer these are not so many individuals, having
particular characters and particular bodily dispositious with
which he is thoroughly acquainted, but they are apt to become
so many lunatics, whom he has to inspect as he goes his round
‘of the establishment, as he inspects the baths and the beds; and
the only person perhaps really aware that each of them has an
individual character, is the attendant. Herein lies a reason why

* Of this reform my friend Baron Mundy, M.D. has long been the earnest and
unwearied advocate, having devoted to it, in a purely philanthropic spirit, many
years of energy, and a great part of his income. It is hardly necessary, perhaps,
to add that he has been sneered at as an enthusiast and ridiculed as utterly un-
practical. Surely a nobleman might have employed himself better than in taking
up such a cause at such a cost! Let me add, then, lest it be thought Utopian
in him, that Professor Griesinger of the University of Berlin, who by the ac-
knowledgment of all men stands in the front rank of those who have advanced,
not psychology alone, but medical science, and M. Morel of Rouen, whose repu-
tation is higher than that of any other alienist physician in France, have both
given their adhesion and support to the principles of the reform advocated by
Baron Mundy.
vur.] THE TREATMENT OF INSANITY. 503

the best possible treatment in some instances undoubtedly is to
‘ . remove a.patient from an asylum to the care of his own friends;

Wwould be called a spinner of theories o19fitive philosopher, Comte, re-
a builder of air-castles. Common sense fed, though there seemed every
is written on that forehead, and earnest- hanent lunatics in the asylum.
ness and integrity, sincerity and thor- |my experience, that one effect
oughness, are stamped on every feature manent lunatics: continually
ynd expression of the face. His top-head worst lunacy, certain patients
as well developed, especially in Benev- h its baneful inspiration, and
mee Veneration, Conscientiousness, And I can certainly call to
nd Firmness. He was honest in his hich T thoroughly believe that

purposes, persevering and thorough in , asylum was the salvation of
heir execution, respectful toward age

d whatever is superior and sacred,
nd kindly and sympathetical toward
e poor, the weak, and the ignorant.
€ was not a copyist ; had ways of his .
own, and Soe narued an oe line obscure ee ee
fom proposition to conclusion, from pur- ee eESn ee enee aN,
{ose to result. He was more kind than Tested at the outset. But the
fis We mean he was not one of Y hardly ever comes under the
‘hose mellow, smooth, soft-talking men 'Y their experience to treat: it,
.tho compromise and seem to agree with established, and the hope of re-
ontradictory propositions or opinions. »tracted means, is gone in some
le was ever ready to express himself rs. When the disease is well
feording to his convictions in a clear, not be rashly vigorous and
om and manly -way; was inclined ‘ng any sudden revolution, but
call things by their right names. He the hope of a gradual change
de his friends, not by compromising seages time is reckoned by hours
pth, but by showing himself kind and .ookoned by weeks and months.
we paves he could appreciate tal- , in. patient from the midst of
and sterling worth ; and those who h insanity has been produced
fre well endowed with those qualities t. There is always extreme
(emselves were attracted to him. He” . : . te
8 ambitious, energetic, courageous, eee ee eee se
‘fave, but had no hypocrisy, no artful- when ie sie an eae
8s, and not much love for property, 'b attention, and where he con-
1d should have had a little more of the Utbreaks of anger or fresh food
frit of economy. He was warmly go- ange in the surroundings will
al, a faithful friend ; had a thorough ‘or 1867, there is an instructive exaniple
‘earnest spirit directed by sound rd.
mse, practical judgment, and upright
itention,
‘Joseph A. Wrioht wae harn in Pannewlea
ia, abe

vefore all things necessary that
2fore the habit of a definite
1e mental organization. There

 

 
502

THE TREATMENT OF INSANITY.

[cHaP.

reproach of forgetting their charactey.as physicians, and degene:
rating into mere house-stewards,jfarmers or secretaries. ™wsmimmntins, 4

Thus much respecting the
and incurable, and for whom t
the most comfortable provisi
now remains to speak of the
and treatment of the insane
treatment is moral and medic:
combined in every case. Ag
to the character and circumst
necessary to penetrate the in
fluence it beneficially by more
fully the concurrence of condi
in order, as far as possible, to r
evils of our present monstrous
of anything like individual t
be putting the matter fairly 1
medical men affecting to rea
lunatics in an asylum, because
not require any medical treat
call attention to the uncertain
which the small curable minor:
To the medical officer these ar’
particular characters and pa
which he is thoroughly acquai
so many lunatics, whom he ha’
‘of the establishment, as he insy
the only person perhaps really
individual character, is the atte

* Of this reform my friend Baron M
unwearied advocate, having devoted to
years of energy, and a great part of his
to add that he has been sneered at as
practical. Surely a nobleman might ha
up such a cause at such a cost! Let 3
in him, that Professor Griesinger of t
knowledgment of all men stands in tt
not psychology alone, but medical scie
tation is higher than that of any othe
given their adhesion and support to t
Baron Mundy.

cha» SIGNS OF DREAMS, “‘
YR. Hammonn’s Quarterly Journal of Phy
tological Medicine and Medical Juri: i
contains a long communication on “ Drea
ing,” from which we extract the followin
“ Lively dreams are, in general, a sign of ¢
citement of nervous action; soft dreams, ,
sign of slight irritation of the brain, often, i
nervous fevers, announcing the approach of |
favorable crisis. Frightful dreams are a sig
of a determination of blood to the he
Dreams about fire are, in women, signs of i
pending hemorrhage. Dreams about blood aj
red objects are signs of inflammatory cn
tions. Dreams about rain and water are oftd
signs of diseased mucous membrane and drops:
Dreams of distorted forms are frequently a sig
of abdominal obstructions and disorders of ft
liver. Dreams in which the patient sees ai
part of the body especially suffering indic
disease in that part. Dreams about de
often produce apoplexy, which is connec
. with determination of blood to the h
The nightmare (tnqubus epithalies), with gr
_sensitiveness, isa siga of determination of bl
to the chest. ‘To thése” says Baron Von F
tersleben, ‘we may add that dreams of do|
after the bite of a mad dog, often precede’
appearance of hydrophobia, but may be o
the consequence of excited imagination.’ |
Forbes Winslow quotes several cases in “i
dreams are said to have been prognostic:
naud de Villeneuve dreamed one night thaj
black cat bit him on the arm. The next
an anthrax appeared on the part bitten.
patient of Galen’s dreamed that one of
limbs was changed to stone. Some days a
his leg was paralyzed. Roger d’Oxteyn, kni
of the company of Douglass, went to slee
good health; toward the middle of the
he saw in his dream a man infected with,
plague, quite naked, who attacked him
fury, threw him on the ground after a
perate struggle, and, holding him betwe
open thighs, vomited the plague into his mc
Three days after he was seized with the pl
and died. Hippocrates remarks that dra

    
 
   
   
  

 

in which one sees black specters are 4 I

 
vir.] THE TREATMENT OF INSANITY. 508

the best possible treatment in some instances undoubtedly is to
remove a patient from an asylum to the care of his own friends;
he may then recover, as the Positive philosopher, Comte, re-
covered, and as others have recovered, though there seemed every
likelihood of their becoming permanent lunatics in the asylum-
Indeed, I cannot help feeling, from my experience, that one effect
of asylums is to make some permanent lunatics: continually
living in the atmosphere of the worst lunacy, certain patients
seem to become impregnated with its baneful inspiration, and
after a time sink to the situation. And I can certainly call to
mind more than one instance in which I thoroughly believe that
the removal of a patient from an asylum was the salvation of
his reason.*

In dealing with insanity it is before all things necessary that
treatment should begin early, before the habit of a definite
morbid action has been fixed in the mental organization. There
is reason to think that, if the first obscure threatenings were duly
appreciated, and the proper remedial means at once adopted,
mary cases of insanity might be arrested at the outset. But the
mischief is that a case of insanity hardly ever comes under the
care of those specially qualified by their experience to treat it,
until the disease has been firmly established, and the hope of re-
covery, save from gradual and protracted means, is gone in some
cases, and all hope gone in others. When the disease is well
established, our treatment must not be rashly vigorous and
energetic, with the aim of effecting any sudden revolution, but
rather patient and systematic, in the hope of a gradual change
for the better. While in other diseases time is reckoned by hours
and days, it must in insanity be reckoned by weeks and months.

Moral Treatment.—* To remove the patient from the midst of
those circumstances under which insanity has been produced
must be the first aim of treatment. There is always extreme
difficulty in treating satisfactorily an insane person in his own
house amongst his own kindred, where he has been accustomed
to exercise authority, or to exact attention, and where he con-
tinually finds new occasions for outbreaks of anger or fresh food
for his delusions. An entire change in the surroundings will

* In the St. George's Hospital Reports for 1867, there is an instructive example
of this kind related by Dr. G. F. Blandford.
504 THE TREATMENT OF INSANITY. [cuar.

sometimes of itself lead to his recovery: if the patient is melan-
cholic, he no longer receives the impressions of those whom
having most loved when well he now most mistrusts, or con-
cerning whom he grieves that his affections are so much
changed ; if he is maniacal, he is not specially irritated by the
opposition of those to whose acquiescence he has been accustomed,
nor encouraged by their submission to his whims and their
indulgence of his follies.” A complete change of associations
gets rid of those thousand occasions of irritating and painful
contact with his relatives, which it is impossible to avoid while
their sympathies are so much excited, and his feelings so much
affected. Moreover, when recovery takes place, it is well that
his relatives should not themselves have exercised that syste-
matic control which may have been necessary, and which he
will not forget; to him there remains the memory of a humi-
liation, and he will generally not care to see again those who
have been the immediate agents or witnesses of it. Lastly, the
separation is often a real grief to the patient, and becomes an
inducement to other than morbid thoughts. Travelling may be
recommended in the early stages to those who can afford it, in
order to secure change of place and scene and a variety of new
impressions; or if the patient is not fit to travel, he should, in
most cases, be removed from his own home to another residence,
where he may be placed under the firm and judicious control of
persons of some cultivation, and where he may have systematic
medical treatment. If a patient suffering from commencing
melancholia can afford to travel accompanied by a sensible
friend or medical man, or even attendant, it would certainly
not be right to recommend that he should be sent to an asylum;
he will probably recover before he gets back home from his
travels. Insanity after fever, puerperal insanity and hysterical
mania, may usually be treated successfully without the aid of
an asylum. JI have never seen any advantage accrue from
sending to asylums at an early period of their disease those
whose minds suffer in consequence of habits of self-abuse; they
have no occupation there to occupy their attention; they cou-
tinue their vicious practice, and invariably sink to the situation.*

* “Tt is to be feared that many have been condemned to a state of insulation
from all rational and sympathising intercourse, before the necessity occurred for
vul.] THE TREATMENT OF INSANITY. 505

When they have arrived at a further stage of degradation, how-
ever, they are not fit for any other abode. The practice of
placing insane persons alone in a cottage under the control of
one or two vulgar attendants is certainly to be condemned
except as a temporary expedient: those who are permitted to
take on them the very responsible charge of controlling those
who are unable to take care of themselves should assuredly
have some social stake, and be in a position to lose something
by evil behaviour. If neither of the above courses can be
taken, or if the patient is furiously maniacal, or desperately
suicidal, or persistently refuses food, it will be necessary to send
him to a suitable asylum. And in choosing an asylum the main
guiding principle should be, other things being equal, to select
one in which medical treatment is a real feature.

No doubt the change by which asylums formerly in the
hands of non-professional men,—who kept them, as hotels are
kept, simply for profit,—have been placed in the hands of medical
men, has been a beneficial change; but it has not been without
corresponding detriment, nor has it exhausted the possibilities
of reform. There is not in a medical diploma any miraculous
talismanic power capable of changing human nature, and of pre-
serving it from the frailties incident to its pilgrimage through
life. And the inevitable tendency of making any one the medi-
cal proprietor and manager of a large establishment is to absorb
his attention and energy in the economical management of it, to
the neglect of his function as physician in a hospital for the
treatment of disease: the medical diploma is apt to become a
mere form, to be obtained, in the least troublesome manner, as
an essential prerequisite to getting a licence to keep lunatics,
while the scientific study and the scientific treatment of insanity
are not thought of at all, It may justly admit of question
whether the medical profession has gained anything by a change
that has had such a result, while it hardly admits of doubt that
the public has not gained as much as it might have done. I
cannot help thinking that it might be to the advantage of the
public and the medical profession if there were no such practice

so severe a lot. Diseased members have been amputated from the trunk of
society, before they have become so incurable or unsound as absolutely to require
separation.” —Zssays on Hypochondriasis. By J. Reid, M.D, 1823. ¥
506 THE TREATMENT OF INSANITY. [owap.

as now finds exclusive favour in England of making medical
men the proprietors of asylums, Of course it is most neces-
sary to insist on proper medical supervision and proper medical
treatment, but is there not sufficient reason to believe that these
might be equally well, if not better, secured by dissociating the
medical element entirely from all questions of profit and loss,
and allowing it the unfettered exercise of its healing function?
It would be a vast comfort to physicians practising in lunacy,
who are now forced to become proprietors of asylums in order
to have a field for practice. It would be a gain also to the
public ; for eminent and accomplished physicians would then
engage in this branch of practice who now avoid it, because it
involves so many disagreeable necessities.

Let who will keep the asylums, it is necessary that they exist.
To put an insane patient under such restraint is indispensable
in some cases; it may be the only way of adequately exercising
for him that control which he cannot exercise for himself, or the
best way of so exercising it as to promote early recovery; and
to let him distinctly understand that this is legally done will of
itself have a. beneficial effect. There should be no secrecy, no
deception about the matter, but all should be done openly and
firmly, in the spirit in which an act of obedience is inculcated
‘upon a child, and in any case inflexibly insisted upon. The
mystery still hanging about the treatment of madness is a relic
of the old and barbarous system of the past. It is extremely
objectionable if it can possibly be avoided, and in the majority
of cases it is entirely unnecessary, to entrap a patient into an
asylum ; but it is still worse to employ fraud to place him under
certificates, and then to leave him to be removed by attendants
without ever explaining to him that a change is to be made.
The melancholic who finds himself in an asylum has a real
grief to alternate with or perhaps take the place of his fancied
affliction, and the maniacal patient, feeling his wild spirit of
exultation to be rudely checked by the influence of a systematic
control, will often have more sober reflections aroused.

The patient having been removed from those influences which
have conspired to the production of the disease, and now tend
to keep it up, and having been made to recognise from without
a control which he cannot exercise from within, it remains to
vil.) THE TREATMENT OF INSANITY. 507

strive patiently and persistently by every inducement to arouse
him from his self-brooding or self-exaltation, and to engage his
attention in matters external—-to make him step out of himself.
This is best done by interesting him in some occupation, or in a
variety of amusements; and it will be done the more easily now
that the surroundings have been entirely changed. Steady
employment will do more than anything else in promoting
recovery ; with the insane, as with the sane, action is the best
cure for suffering. The activity of the morbid thoughts and
feelings subsiding in new relations and under new impressions,
more healthy feelings may be gradually awakened; and the
activity of healthy thought and feeling will not fail in its turn
further to favour the decay of morbid feeling. Goethe, in his
“Wilhelm Meister,’ makes some excellent observations con-
cerning the moral means of treating insanity. The means of
curing insanity, he says, are the same as those by which sane
men are prevented from becoming insane. Their self-activity
should be aroused ; they should be accustomed to order; the
idea that they have a being and destiny in common with many
others should be instilled into them ; they should be brought to
see that extraordinary talent, the greatest good fortune, and the
extremest misfortune are but small deviations from the ordinary.
Then madness will not creep into their minds; or if it does, it
will disappear by degrees. “For nothing brings us nearer to
madness than when we distinguish ourselves from others, and
nothing so much preserves the common understanding as living
in sympathy with many men.” If there is some fixed delusion,
it will do no good to enter upon any systematic argument
against it; there would be almost as much hope of an argu-
ment against the east wind or against a convulsion; but by
engaging the mind in other thoughts as much as possible, and
thus substituting a healthy energy for the morbid energy, the
force of the delusion will be most likely to abate, and finally to
die out. Besides, by denying the reality of what seems so very
real to the patient, he will lose confidence in your judgment,
and conclude that you do not understand his case. For the
same reason, it is a great error to ridicule or to treat lightly his
fancies, But, although it is of no avail to talk against a delu-
sion, it is important to avoid assenting to it: by quiet dissent,
508 THE TREATMENT OF INSANITY. [cHapP,

or a mild expression of incredulity when it is mentioned, the
patient should be made to understand clearly that he is in a
minority of one, and that, though a person in a minority of one
may perchance be a genius in advance of the rest of mankind,
it is infinitely more likely that he is a madman far behind it.
Above all things, there should not be any anger or scolding; for
the patient is inevitably excited and made worse by it. Firm-
ness, tempered with sympathy and kindness, will beget confi-
dence in and reliance on those who have the care of him, and
will arouse self-control in him. It may well be questioned
whether the practice of banishing all female nursing from the
male department of an asylum, and of leaving the patients
entirely to the care of men, is not prejudicial. An elderly
female nurse, of a kind and sensible disposition, could not fail
to be a great comfort to those of the patients who require gentle
and sympathetic attention, and might be expected often to exert
a very beneficial influence over them. Assuredly some would
yield to woman’s persuasion more readily and with a less feeling of
humiliation than to the dictates of an attendant of their own sex.
Medical Treatment.—A truly scientific treatment will be
grounded upon the removal of those bodily conditions which
appear to have acted as causes of the disease, and to’ be keeping
it up, and upon the general improvement of nutrition. The
morbid sensations in different parts of the body, which are so
commonly experienced in insanity, often spring from some real
bodily disorder, and tend to sustain the delusion or other de-
rangement of thought. They should obtain the careful atten-
tion which they deserve, for bodily disease is not always
detected easily, and is sometimes overlooked, in the insane;
the usual symptoms being very much masked, and they, like
animals, often making no intelligent complaint. It is necessary,
therefore, to pay particular attention to the physical signs of
disease: there may be no cough, no expectoration, when the
stethoscope or the thermometer reveals advancing phthisis,
General blood-letting is now abandoned in the most acute
and seemingly sthenic insanity, as not merely useless but as
positively pernicious. It is admitted that convulsion of mind
does not mean strength of mind, and is not likely to be cured
by draining off the life that is in the blood; violent symptoms
vit.] THE TREATMENT OF INSANITY. 509

may certainly be reduced for a time by blood-letting, but the
disease is very likely to become chronic, and to pass into de-
mentia. In some cases, in which there appears to be great
determination of blood to the brain, a local abstraction of blood
by means of leeches or cupping may be useful ; it should not
be done with any view of reducing the general strength, but
with the view of withdrawing blood from the overloaded vessels,
and of thus affording the opportunity of rest to the struggling
and suffering nerve element. In such case the aim is to imitate
nature, which diminishes the quantity of blood in the brain
during sleep.

The continued application of cold to the head by means of a
douche pipe, or a shower-bath, or by pouring cold water upon it,
while the patient lies in a warm bath, is sometimes successful
in calming excitement and in procuring sleep in acute insanity
of a maniacal type. Professor Albers has published the notes.
of some cases of excited melancholia, with dirty habits, destruc-
tive tendencies, and sleeplessness, in which much good was done.
by the prolonged use of a cold bath. The patients were placed.
for one hour or two hours, according to circumstances, in water
of the temperature of 54° Fahr.; the effect being to lower the
temperature of the body many degrees, to bring down the pulse:
until it was scarcely perceptible, to subdue excitement, and to
procure some hours of sleep when they were afterwards put to
bed. Such a means of treatment is obviously attended with
some peril, and should be used only with extreme caution. The
warm bath alone, taken for about half an hour, has a decidedly
soothing effect; and some have thought its efficacy to be in-
creased by the addition of a few handfuls of coarse mustard,
whereby a general redness of the surface of the body is pro-
duced. In France the warm bath has been used for eight or ten
hours at a time with professedly good results; and Leidesdorf
of Vienna has used for three or four hours, and in many cases,
with a marked tranquillizing effect, a bath constructed by Pro-
fessor Hebra, in which patients may be kept night and day at a
definite temperature. It is obviously necessary to avoid any
such use of the bath where the pulse is very feeble, and where.
there is anything like commencing paralysis; and it can be of
no avail in cases of chronic insanity.
510 THE TREATMENT OF INSANITY. [cHap,

The shower-bath or the cold douche may be administered
with advantage in some cases of melancholia where reaction
does not fail to take place properly afterwards, and in cases of
chronic insanity, with the purpose of rousing the patient and of
giving tone to the system; but its use should not be continued
for more than three minutes, and it should not be with the aim
of producing any special effect, but on the general principle of
improving the bodily health. The advocates of the Turkish bath
have vaunted its beneficial effects in insanity, as in every other
disease ; but no discrimination of the cases in which it is useful
has hitherto been made. J should be disposed to put more faith
in the use of the Russian vapour-bath, which might not im-
probably be of real service in some cases of mania and melan-
cholia, where the skin is dry and harsh, and its secretion
disordered. Packing in the wet sheet, after the hydropathic
fashion, and as recommended by Dr. Robertson of the Sussex
Asylum, is undoubtedly a useful remedial means in some cases
of acute excitement; it has not only a soothing effect of itself,
so that the patient will sometimes go to sleep in it, but, by
keeping a restless and excited patient quiet, it enables sedatives
to take effect when they would be perfectly useless if no such
means were used. On one occasion I was roused hastily to see
a girl who had suddenly been attacked with acute hysterical
mania, to the great consternation of the whole household, and to
the despair of the medical attendant, who could not get her to
take anything, or to remain quiet for a moment. She had torn
her night-dress to shreds, was tossing about on her bed cease-
lessly, and was quite incoherent. She was immediately packed
in the wet sheet, and a cloth dipped in cold water applied to the
head; and when this had been done, she took without any
difficulty a drachm of tincture of henbane, and after a short time
slept. In the morning all excitement had gone, though she was
confused in mind, and in a few days she was quite recovered.
The wet sheet should not be used for more than three hours at
a time, and should be changed once during that time. Thus it
has its true character as a means of medical treatment, and is.
not abused for purposes of mechanical restraint.

Counter-irritants are not much used in insanity. Schroeder
van der Kolk, however, thought he had seen beneficial results’

+
vit. | LHE TREATMENT OF INSANITY. 511

follow the application of strong tartar emetic ointment, or of a
blister to the shaven scalp ; and Dr. Bucknill recommends croton
oil to be rubbed into the scalp in the passage of acute into
chronic insanity or into dementia, and in chronic melancholy
with delusion. I have seen in one case a wonderful temporary
effect produced by a blister to the nape of the neck: a young
lady who had appeared demented for months, and who had not
spoken during that time, woke up out of her usual stupor the
day after a blister had been applied, and spoke as rationally as
she ever did in her life; next day, however, she was much
excited, and inclined to be violent, and after this subsided into
her mute stupor again. The same experiment was repeated on
another occasion with a similar result, save that her excitement
and violence were much greater than on the first occasion. Not-
withstanding the marvellous effect of the blister in this instance,
an effect which might well seem to indicate a valuable therapeu-
tical remedy, I have not been able to satisfy myself of much
permanent good ever having been done by blisters or setons in
insanity. If they are useful, they are most likely to do good in
melancholia with stupor and in acute dementia.

After errors of digestion and secretion have been duly attended
to, the diet of the insane should be good; and it will be desirable
in most chronic cases, and in acute cases of an asthenic type,
to allow a liberal use of wine. A liberal diet, suitable control,
and the moderate administration of stimulants, will do much of
themselves towards curing puerperal insanity and the insanity of
lactation. There can he little doubt that an attack of insanity
might sometimes be warded off by a generous diet and a free
use of wine ata sufficiently early stage. It is, at any rate, a
truth worthy of all acceptation, that energetic antiphlogistic’
treatment in the course of insanity is energetic mischief.
Leeches may be applied to the head, and a patient may be kept
on low diet, in order to subdue maniacal excitement, without
any other result than an increase of the excitement with the
increase of exhaustion, and the most active purges may be given,
and given in vain, to overcome an obstinate constipation, when
brandy and beef-tea, reducing exhaustion, will subdue excite-
ment, and a simple enema will produce full action of the bowels.
Active purgation, once so much favoured, is now quite eschewed
512 THE TREATMENT OF INSANITY. [cHap.

in all forms of insanity. The bowels may often be regulated by
dietetic means; and, if a purge is needed, a dose of aloes,
rhubarb, confection of senna, or castor-oil, will answer every
purpose; a moderate dose of the latter sometimes succeeding
where the most drastic purgatives fail. The present bodily state
of the patient, and the history of the causation of his malady,
must be weighed in determining whether wine is to be given or
not in the most acute stage; in cases of a sthenic type it may be
desirable to do little more than wait patiently until the fury of
the storm has passed, and then freely to give support.

Coming now to the more purely medicinal treatment of
insanity, we may speak first of the virtues of opium. This
drug is particularly useful in that state of mental hyperasthesia
which so often precedes an outbreak of insanity: when the
mental tone is so changed that almost every impression is felt
as painful, then opium, freely given, produces beneficial effects.
I have seen several cases in which a seemingly imminent attack
of severe melancholia has been warded off, and the patient re-
stored to tranquillity and health of mind, by the judicious use of
opium. When the acute symptoms of mania have subsided, and
a gloomy and morose mood of mind comes on, which in some
instances heralds recovery, but in other cases a recurrence of the
attack, then is a favourable time for the judicious administration
of opium. It is certainly useful, but has undoubtedly been
over-praised, in cases of simple melancholia, when it should be
given in doses of one or even two grains twice a day, and con-
tinued steadily for weeks, notwithstanding an apparent. want of
success at first. If it produces constipation, each dose may be
combined with a grain of aloine, or with two or three grains of
the extract of aloes, or with a quarter of a grain of podophyllin.
Where there is a fixed delusion of some standing, opium is of no
use except as an occasional expedient for procuring sleep. It
may be given with benefit in the mania caused by intemperance,
in the mania or delirium of nervous exhaustion, and in puerperal
mania; but it is not of the slightest use in acute idiopathic
mania, in melancholia with stupor, or in the attacks of acute
excitement that occur in the course of chronic mania and general
paralysis.

The subcutaneous injection of morphia is a valuable expedient
vit.] THE TREATMENT OF INSANITY. 513

to have recourse to where there is a refusal to take medicine,
and frequently operates more certainly, quickly, and effectually
than opium taken by the mouth, Not more than a quarter of a
grain should be injected to begin with, the quantity being sub-
sequently increased, if necessary. It is important, however, to
bear clearly in mind that neither opium by the mouth, nor
morphia hypodermically injected, will avail to quench the fury
of acute mania, and that successive injections of morphia, though
followed by brief snatches of fitful sleep, haye been followed
also by fatal collapse or coma..

In cases of great excitement, maniacal or melancholic, where
it is advisable to give opium, large doses of digitalis sometimes
produce good effects in tranquillizing the patient; it is a drug
which was much esteemed by some of the old writers on in-
sanity, and which, after having fallen into disuse for some time,
has now been restored to favour. The excitement abates, and
the pulse, falling in frequency, may, by repeating the dose, be
kept for some time at a standard below the average. In the
attacks of excitement which occur in the course of general
paralysis the effects of digitalis are excellent ; it had better be
given in doses of half a drachm of the tincture repeated two or
three times a day than in doses of one drachm or two drachms,
as some have advocated. Notwithstanding the present fashion
of large doses, and the disbelief in the cumulative action of
digitalis, I hold it to be the duty of a good physician to be ex-
ceedingly careful in his administration of so uncertain a drug.
I have certainly known an acute maniacal patient to drop down
and die in collapse, after taking repeated large doses of digitalis,
whether owing to the mania or to the drug must remain uncer-
tain ; and I believe that, though a patient who has taken large
doses of digitalis may be safe while he is lying down, he is some-
times in no small danger of fatal collapse if he starts up, or runs
about in an excited manner.

Hyoscyamus is much safer than digitalis; it is of no use in
small doses, but, in doses of a drachm or two drachms of the
tincture, it is a valuable sedative in insanity. Hydrocyanic acid,
in large doses, has been praised as being of wonderful efficacy,
but it has no specific virtue, and it appears to do good only
where there is some derangement of the stomach, not otherwise

LL
‘514 THE TREATMENT OF INSANITY. (cuar.

than as it does good where there is no insanity. Bromide of
potassium certainly appears to produce good effects in some cases
of insanity, especially when there is evidence of sexual excite-
ment; but in others, apparently similar, it appears to have
no effect whatever. I have tried it in cases of regularly
recurrent mania, moved to the experiment by the knowledge
of its good effects in epilepsy, with which recurrent mania
always seems to me to have some close relation or resem-
blance; and sometimes I have thought it do good and
sometimes to be quite useless. -Further trial of it, care
being taken that it is not adulterated, is certainly desirable.
In the mania which occurs in connexion with epileptic vertigo,
before the latter has gone so far as to permanently weaken the
mind, the administration of bromide of potassium certainly pro-
duces good results. Iodide of potassium is the drug indicated
in syphilitic mania. Tartar emetic will often calm for a time
the most furious maniac through the prostration which it pro-
duces, but it does no permanent good, if it does not do positive
mischief by favouring the passage of the disease into dementia ;
its employment for such purpose is rather a relic of the old
system of quieting a patient by some violent means or other
short of actually killing him. If mercury be ever useful, and
not mischievous, in the treatment of insanity, it is when given
in small doses of the bichloride in cases that are becoming
chronic, or where there is a suspicion of syphilis. To administer
mercury systematically in general paralysis, as has been done,
is as untenable in theory as it is undoubtedly pernicious in
practice.

When insanity has been caused by a suppression of the
menses, it will be desirable to endeavour to restore them by
means of aloes and iron; I have seen great benefit in some in-
stances from the use of aloes, iron, and strychnia, or of aloes,
opium, and strychnia, in pills. But when the suppression of the
menses has followed the outbreak of the mental derangement, as
it often does, then medicines given for the special purpose of
forcing menstruation will do mischief; the best treatment will
be that which alleviates the mental suffering and improves the
general health.

Tn all those cases of insanity in which tonics seem to be
vu] THE TREATMENT OF INSANITY. 515

demanded by the state of the bodily health—and they are the
majority of cases at one period or other of their course—iron
and quinine may be given; and one of the best ways of giving
them is in a mixture containing quinine, the tincture of the
sesquichloride of iron, and chloric ether. Cod liver oil and iron
appear to me to be very useful in the early stages of general
paralysis. In some cases it happens that an uncontrollable
diarrhcea sets in and carries the patient off, nothing availing to
check it: acetate of lead with opium and enemata of starch and
laudanum are most likely to be useful.

When insanity has become chronic, or when fixed delusions
are established, there is small hope of special benefit from drugs.
The general health being duly attended to, a systematic moral
treatment will be best adapted to restore health of mind. Where
there is persistent refusal of food, it must never be allowed to
continue so as to endanger the bodily health ; and if persuasion
and perseverance entirely fail, then the stomach-pump must be
used to administer food. But if there be digestive disturbance,
or if there be obstinate constipation, in conjunction with the
refusal of food, the removal of the bodily disorders will some-
times banish the refusal, even though it may be instigated by
positive delusion. Occasionally a woman may be induced to
take food by a man when she will not take it from one of her
own sex, or in like manner a man may take it from a woman.
In some cases, food will be taken by the patient when it is
placed near him, without anything being said. In most cases,
the steady and persevering trial of a good attendant will over-
come the refusal, and render force unnecessary. Those who are
suicidal should be carefully watched at all times, and especially
so on waking and getting up in the morning, when the thoughts
are gloomy, and the desperate impulse is apt to surprise and over-
power them. The monomaniac, who has delusions that he is
watched continually, or otherwise persecuted, must always be
deemed dangerous to others; for at any time he may become so
impatient of his sufferings as to make a fatal attack upon his
fancied persecutor. Those who suffer from moral insanity are

often very troublesome to deal with satisfactorily ; but it will

be worth while always to remember that one unequal to the

responsibilities and duties of the social position in which he
LL2
516 THE TREATMENT OF INSANITY. [cuap. VII.

was born may not on that account be unequal to the relations
of a much lower social stratum. It is not because a person
insists upon degrading or ruining himself that it is justifiable
to deprive him of his liberty by treating him as a lunatic. Very
little more can be done for those who from childhood have
manifested a moral and intellectual imbecility than to place
them where they will be properly controlled, kindly treated,
and well taken care of; they should certainly not be subjected
to the discipline of a stern schoolmaster who expects by severe
measures to implant better feelings and to awaken a brighter
intelligence in them. God has not given them understanding ;
and man cannot do it.
INDEX.
INDEX.

A.

Abdominal organs, diseases of, in the
insane, 471.

Abercrombie,
powers, 132.

Abscess of the brain, 280, 449.

Actuation, 191.

Addison, Dr., on the urine of the in-
sane, 401.

Affective life, maniacal perversion of,
366 ; melancholic perversion of, 366.

Age, influence of, on insanity, 243.

Ague, as a cause of insanity, 267.
bers, Professor, on cold baths in the
treatment of insanity, 509.

Alcohol, influence of, on the brain, 262,
a in the treatment of insanity,

1.

Alcoholization, insanity of, 262.

Amenorrhea, treatment of,
sanity, 514.

Anelectrotonus, 434.

Annelida, nervous system of, 84.

Aphasia, 196-199.

Arachnoid, granulations of, 455;
changes of, In insanity, 455.

Archencephala, 56.

Aristotle, 4, 5. 2

Arnold, on gout as a cause of insanity,
268.

Aspirations, 153. :

Asylums, abuse of, 495, 503; dis-
advantages of, 497 ; advantages of,
506.

on the intellectual

in in-

Ataxy, progressive locomotor, 203.
Ateles, convolutions of, 250.
Attention, 138.

Aura epileptica, 353, 399.

B.

Bacon, Francis, 4, 14, 28, 31, 34, 37,
38, 75, 97, 135.

Bacon, Roger, 4. . :
Bastian, Dr., on the specific gravity of
the brain, 461. : :
Baths, in the treatment of insanity,

509.

Bayle, on the analogy between drunken-
ness and ceonennl paralysis, 416.

Beckham, Dr., case of melancholia in a
boy, 320.

a Me Charles, on the muscular sense,

02.

Belladonna, influence of, on brain, 263.

Beneke, on mental residua, 39.

Berkeley, Bishop, on vision, 105, 121.

Bernard, on the influence of the cerebro-
spinal system on nutrition, 91.

Bezold, Arnold von, on the electrical
excitation of nerves, 435.

Bichat, on the seat of the passions, 21,

6.

ake, William, hallucinations of, 132,

10.

Blood, vitiation of, 89, 118, 262;
irregular supply of, 258, 441.

Blood-letting, in insanity, 442, 506.

Bosjesman, cerebral convolutions of, 54.

peas de malades, 392.

Braid, on hypnotism, 160, 196.

Brain, embryonic development of, 55,
56 ; organic sympathies of, 20, 21;
nutritive life of, 22, 23 ; convolutions
of, 53-55 ; differences in quality and
capacity of, 255; condition of, in
acute insanity, 395; abscess and
tumour of, 449 ; injury and disease
of, 450; loss of substance of, 452;
specific gravity of, 460 ; increase of
connective tissue of, 462; defective
development of, 250.

Bridgman, Laura, case of, 199.

Brown, Dr. T., on the physiology of
mind, 41; on the co-existence of
conceptions, 136 ; on secondary laws
of suggestion, 221. f

Browne, Sir T., on the harmonies of
nature, 167. .

Brown-Séquard, on the production of
rigor mortis, 89 ; on the production of
tetanus, 93 ; on reflex irritation, 119.

Bucknill, a case of insanity with chorea,
314; on the specific gravity of the
brain, 460; on the diagnosis of in-
sanity, 483 ; on counter-irritation in
insanity, 413.

161.
Bemanhy, import of, 8; study of, 29.
3
520

Burrows, a case of homicidal insanity
with epilepsy, 352; case of reflex in-
sanity, 119 ; case of mania from sea-
sickness, 272.

Burton, R. F., on the mental develop-
ment of the Indian savage, 145.

C.
Cabanis, on the secretion of thought,
4l

Cannabis Indica, action of, on sensory
ganglia, 263.

Carlyle, on unconscious intellect, 221.

Carpenter, Dr., on sensori-motor action,
49 ; on the seat of common sensation,

99.

Cazauvieh, case of mania transitoria,
402.

Cerebral convolutions, structure of, 60-
63; nerve-cells of, 60-63; vicarious
action of, 96; disease of, 453.

Cerebral hemispheres, 123.

Change of life, as a cause of insanity,
274.

Channing, Rev. Dr., on change of cha-
racter, 182.

Character, the, 181, 183.

Child, first movements of, 298 ; incohe-
rent discourse of, 308 ; fallacious me-
mory of, 808 ; delirium of, 308.

Chorea, as a cause of insanity, 287.

Civilization, influence of, on increase of
insanity, 229.

Clarke, Lockhart, on the structure of
the convolutions, 60; on volition,
169; on a granular condition of
the ventricles, 455; on pigmentary
degeneration of nerve-cells, 467.

Classification, note on, 420-426.

Climacteric insanity, 275.

Clouston, Dr., on phthisical mania, 396 ;
on the temperature of the insane,
426 ; on general paralysis, 415.

Cceliac-axis, case of injury of, 271.

Coenesthesis, 154.

Coleridge, Hartley, 310

Coleridge, 8. T., on essential idea, 43 ;
on the principle of individuation, 59 ;
on fancy and imagination, 311.

Colloidal matter, Graham on, 46.

Comte, on illusory psychology, 37;
Mill’s criticism of, 39 ; on impulse to
action, 154, 166.

Concept, development of, 211.

Conception, 132, 153.

Conditions of life, influence of, on in-
sanity, 242.

Connective tissue, morbid increase of,
462.

Consanguinity, infiuence of, on insanity,
253.

INDEX.

Consciousness, veracity of, 11; nature
of, 24, 25; introspective, 11-23 ;
seat of, 113 ; relation of, to ideation,
136, 139.

Consensus, 271, 471.

Convulsions, 87, 89 ; co-ordinate, 117,
201, 301 ; infantile, 299.

Cooper, Sir Astley, on cutting off sup-
ply of blood to brain, 261.

Cornelius, on the theory of vision, 104.

Corpora amylacea, 464.

Corpus callosum, defect and absence of,
251.

Counter-irritation, in the treatment of
insanity, 510.

Craving, 150.

Craziness, 408.

Cretinism, 251.

Crichton, case of infantile insanity,
308.

Custom, effect of, 163.

Cynocephalus, convolutions of, 250.

Cysticercus in the brain, 286, 452.

D.

D’Alembert, on Locke, 26.

Darwin, Dr., on sensori-motor acts,
121; on ideomotor movements, 129 ;
on action of idea on sensation, 131 ;
on rapidity of muscular action, 138,
147 ; on memory, 209 ; on the trans-
formation of nervous diseases, 444,

Degeneracy, Morel on, 246.

Degeneration, theroid, 248, 332 ; inflam-
matory, 466 ; connective tissue, 466 ;
fatty, 466; amyloid, 467; pigmen-
tary, 467 ; calcareous, 468.

Deliberation, 139.

Délire aigué, 394,

Delirium, difference of, from mania,
309, 311; intermission of, 450 ; tre-
mens, 474.

Delusions, production of, 269, 277 ; sus-
Picious, 276 ; salacious, 278 ; of gran-
a 415; mode of dealing with,

Dementia, acute, 404, 488 ; chronic,
406, 486 ; sine delirio, 350.

Descartes, on consciouness, 26.

Dee, nature of, 72-74, 80, 171-

Desire, 150, 153 ; Spinoza on, 166.
Despotism, 95. :
Diabetes, and insanity, 246.
Diagnosis of insanity, 472-484.
Diathesis spasmodica, 257, 335.
Digitalis, use of, in insanity, 513.
Discernment, 107.

Doctrines, corruption of effete, 216.
Dreaming, 277; Jean Paul on, 221.
INDEX.

Du Bois Reymond, on electrical currents
in nerves, 433. :

Durand-Fardel, on suicide in children,
320. 7

Dwellings, the insane in private, 499.

E.

Ear, the insane, 398.

Kecentricity, 336, 479.

Eestatics, religious, 343.

Education, influence of, on insanity,

. 2375 female, 238.

‘Hifection, 191.

Ego, conception of, 157, 181; trans-

. formation of, 182 ; identity of, 183.

Embolism, a case of, causing insanity,
286.

Emerson, 37, 213.

Emotion, 148-167; nerve-centres of,
124, 156 ; relation of, to idea, 148,
155 ; influence of condition of nerve
element on, 154-156 ; influence of,
on the organic and animal life, 158,
159 ; bodily condition of, 160; dis-
ordered, 161 ; egoistic and altruistic,
162 ; development of, 163, 165; re-
lation of, to will, 184, 185.

Epilepsie larvée, 445.

Epilepsy, a cause of idiocy, 252; a
cause of insanity, 287.

Esquirol, case of monomania in children,
313; case of homicidal impulse in a
little girl, 323 ; case of sexual pre-
cocity in a child, 325; on moral
alienation, 344.

Expression, different modes of, 197 ;
the art of, 208.

Eye, adjustment of, 104, 106.

_*#&z

Falret, Dr. Jules, on the epileptic
aura, 399. ;
Fancy and imagination, 311. .
Ferriar, Dr., on injuries of the brain,
9,

Fever, influence of, on insanity, 260 ;
intermittent, 267 ; delirium of, 269.

Fichte, 38.

Final causes, 75, 97,173: | | |

Flourens, on section of semicircular
canals, 107 ; on removal of the hemi-
spheres, 108. re

Folie circulaire, 402. :

Food, refusal of, in insanity, 384, 514.

Force, different kinds of, 68 ; mental,
68, 69 ; conservation of, 81, 115.

Form of matter, 75.

Frog, vivisections of, 72, 90.

521

G.

Ganglia, sensory, 48, 89; hemisphe-
rical, 123.

Genius, 35-37 ; and insanity, 336.

Gerhardt, case of embolism causing
insanity, 286.

Goethe, i, 34, 59, 69, 132, 341, 507.

Gout, as a cause of insanity, 264, 268.

Graham, on colloidal matter, 46.

Gratiolet, on the brain of an idiot, 250.

Gregarinida, structure of, 55.

Griesinger, on psychical reflex action,

° 96; cases of insanity with ague,

267 ; insanity with rheumatism, 268 ;
case of homicidal insanity with epi-
lepsy, 353.

Guislain, case of mania in a young
girl, 318 ; on the melancholic incuba-
tion of insanity, 390.

H.

Hematoma auris, 398.

Hallam, on the creation of man in the
image of the ape, 126.

Hallucinations, 118, 120, 132, 134;
muscular, 200, 400 ; sexual, 275 ; of
hearing and vision, 303, 383 ; in chil-
dren, 304, 309 ; idea produced, 309.

Hamilton, Sir William, on the con-
ditions of the veracity of conscious-
ness, 11 ; vague use of consciousness
by, 24; on obscure perceptions, 38.

Hartley, on secondary automatic mo-
tions, 83, 97 ; on ig and com-
plex ideas, 141 ; on language, 147 ;
on the will, 169, 189.

Haslam, case of destructive impulse in
a child, 323; case of moral imsanity
in a boy, 327.

Haschisch, 118.

Head, injuries to, causing insanity, 286.

Hearing, hallucinations of, 303, 383.

Heart, disease of, in the insane, 470.

Heidenhain, on the evolution of heat
during muscular contraction, 436.

Helmholtz, on the rate of conduction
by nerve, 431.

Hemispheres, cerebral, first appearance
of, 50 ; in amphibia, 50 ; in birds, 50;
in mammalia, 51; functions of, 51;
sensibility and insensibility of, 51
156 ; convolutions of, 53-55 ; remova:
of, 109’; limited action of each, 146,

Hereditary insanity, 330, 361 ; progno-
sis of, 488.

Hereditary taint, influence of, on spinal
cord, 86; on insanity, 243 ; charae-
ter of, 342. ;

Heyse, on the expression of thought,
198. :
522

Hobbes, on innate idea, 128, 145; on
language, 147; on the co-existence
of ideas, 147; on the care of self,
150, 165 ; on the will, 169, 189.

Holland, Sir H., 64; on co-existence
and sequence of conscious states, 136 ;
on slowness of thought, 431.

Homicidal impulse, 348, 351-356, 478,
481.

Howe, Dr., on the causes of idiocy, 253.

Humanity, retrograde metamorphosis
of, 333.

Humboldt, 9, 35.

Hume, on the constancy of mental
laws, 140; on innate ideas, 155;
on the will, 189.

Huxley, on the brain of a Bushwoman,
54; on the structure of the Gregari-
nida, 55.

Hydrocyanic acid, use of, in insanity,
513.

Hyoscyamus, use of, in insanity, 512.

Hypnotism, 160, 196.

Hypochondria, diagnosis of, 479.

Hypothesis, formation of, 133.

Hysteria, 287; with insane tempera-
ment, 343 ; diagnosis of, 476.

L

Idea, latent, 16, 139; innate, 126 ; as-
similation of, 18; nerve-centres of,
123 ; action of, on movement, 129, on
sense, 131, on nutrition and secretion,
135, on idea, 135, 139; organizing
power of, 134.

Idealization, 123, 127, 215.

Ideas, association of, 17, 137, 140 ; fun-
damental, 128; development of, 128,
139, 143 ; general and special laws of
association of, 141 ; duplex and com-
plex, 142.

Ideation, 51, 123 ; in the lower animals,

2

52.

Idiocy, causes of, 253.

Idiots, brains of, 55, 57, 249 ; senses of,
118.

Imbecility, intellectual, 328; moral,
329, 420 ; its treatment, 516.

Imagination, 209 ; relation to memory,
213; function of, 215; in children, 310.

Incoherence, 407 ; analogy between mo-
tor and mental, 410.

Individuation, principle of, 59.

Induction, 5.

Infant, earliest movements of, 71;
anencephalic, 71.

Insanity, causes of, 225 ; concurrence
of causes of, 226 ; physical and moral
causes of, 227, 284; predisposing
causes of, 228 ; increase of, 229, 330 ;

INDEX,

proximate causes of, 249 ; with inter-
mittent fever, 267 ; with rheumatism,
268 ; with gout, 264, 268 ; with ute-
rine disorder, 272, 448; knowledge
of right and wrong in, 290, 392,
477 ; varieties of, 335; of early life,
298-334 ; sensorial, 299, 301;
puerperal, 274, 396, 489; of lacta-
tion, 274, 489; of pregnancy, 274,
399 ; climacteric, 275, 421, 489 ; hys-
terical, 287, 396, 489 ; epileptic, 287,
302, 352, 421, 444, 489 ; syphilitic,
288, 489 ; choreic, 313 ; ovarian, 421 ;
cataleptoid, 315; sexual, 405, 421;
affective or moral, 320, 344, 356, 366 ;
instinctive or impulsive, 321, 345;
hereditary, 330; general ideational,
387; partial ideational, 312, 370;
periodic or recurrent, 402; idiopa-
thic, 422 ; feigned, 475; in animals, -
302; classification of, 868; patho-
logy of, 426-471 ; diagnosis of, 472
484 ; prognosis of, 484-490 ; treat-
ment of, 492 ; danger to life in, 485 ;
cases illustrating causation of, 291;
family treatment of, 499 ; individual
treatment of, 502-516 ; moral treat-
ao of, 503 ; medical treatment of,

Insolation, a cause of insanity, 256.

Tnspiration, 340.

Instinctive acts, 108.

Instincts, inborn, 321; acquired, 83.

Intellectorium commune, 100, 123 ;
causes of disorder of, 249,

Intestines, motions of, 57.

Intuitions, 127, 215; universal, 128 ;
motor, 192-196.

Irradiation of movements, 85.

Irritability of tissue, 57.

Irritation, reflex, 118, 270.

K.

Katelectrotonus, 434.
Kerner, case of epileptic insanity in a
child, 318.

L.

Lactation, insanity of, 274, 399; its
treatment, 511.

Language, organic growth of, 4, 127;
seat of, 125 ; signification of, 143,
147 ; character of, 199 ; importance
of, to conception, 198.

Larrey, Baron, case of injury of coeliac
axis, 271.

Lebert, on abscess of the brain, 450.

Leibnitz, on free actions, 25; on un-
conscious conceptions, 38.
INDEX.

Leidesdorf,on warm baths in the treat-
ment of insanity, 509.

Lister, Prof. J., on coagulation of the
blood, 46; on inhibitory nerve phe-
nomena, 159; on the early stages of
inflammation, 437.

Locke, on empirical psychology, 26 ;
on continuity in nature, 55.

Lungs, diseases of, in the insane, 469.

Lypemania, 365.

M.

Mania, 365, 387; transitoria, 287, 316,
402, 440; choreic, 314; in young
children, 301, 318; difference of,
from delirium, 309, 311; sine delirio,
348, 367; case of acute, 388 ; moral

erversion in, 389 ; condition of intel-
lect in, 391; state of consciousness
in, 392 ; puerperal, 396 ; hysterical,
396 ; phthisical, 396; memory in,
399; metastatic, 422; hallucina-
tions in, 400; temperature in, 400 ;
sleeplessness in, 401; excessive ac-
tivity in, 401 ; recurrent, 402 ; course
of, 403; chronic, 403 ; diagnosis of
acute, 474; of chronic, 475 ; prog-
nosis of, 487; treatment of, 508-
513.

Marshall, John, on the brains of two
idiots, 250.

Masturbation, 232 ; acause of insanity,
285, 422.

Matter, different kinds of, 68 ; form of,

5

Matteuci, on electrical currents in
nerve, 433.

Melancholia, 365, 374; in children,
319; simplex, 343; cases of, 376-
381 ; remissions, 380 ; hallucinations
in, 382, 400; with stupor, 384;
course of, 385; case of acute, 397 ;
diagnosis of, 478, 479 ; prognosis of,
486 ; treatment of, 512.

Membranes of the brain, disease of,
450, 453. :

Memory, 209; Dr. Darwin on, 209 ;
disorders of, 217 ; differences of, 217 ;
of old age, 219; of children, 219 ;
Swedenborg on, 222 ; organic nature
of, 209, 217. :

Meningitis, 474; a case of chronic
tubercular, causing insanity, 286.

Menstruation, influence of, on mind,
265, 274, 277, 341. _ 2

Mental action, material conditions of,
13 ; unconscious, 14-20, 32 ; residua

of, 89.
Mental force, 67,68 ; dependence of, 69.
Mercury, its use, in general paralysis,
614.

523

Metaphysics, neglect of, 8; not pro-
gressive, 9,

Metastasis, 281.

Method, metaphysical, 6; inductive,
6, 7; objective, 27-30; physiologi-
cal, 24, 27, 28 ; psychological, 39.

Meyer, Dr. Ludwig, on mania transi-
toria, 317; on the temperature in
general paralysis, 416.

Microcephalic idiocy, 249.

Mill, James, on sensation as a cause of
movement, 102; on ideation, 123 ;
on the senses, 129; on complex
ra. 142 ; on acquired movements,
175.

Mill, John Stuart, on the psycholo-
gical method, 39; on individuality,
336; on the co-existence of conscious
states, 136.

Milton, 69, 167, 177, 322.

Mimosa pudica, 72, 446.

Mind, inactive, 17; plan of develop-
ment of, 28; degeneration of, 29;
history of, 29; organization of, 33,
44; method of study of, 34; mate-
rial conditions of, 42, 44; essential
idea of, 43; time-rate of activity of,
431 ; ie ath conception of, 43,
67; pathology of, 223.

Mitchell, Dr. A., on consanguineous
marriages, 253 ; on the insane in pri-
vate dwellings, 499.

Monomania, 365, 370 ; in children, 312 ;
course of, 386 ; condition of intellect
in, 372.; diagnosis of, 476 ; prognosis
of, 487; treatment of, 515.

Monomanie raisonnante, 367.

Monopathie furieuse, 318.

Montaiens on the number of the senses,
1

Moral insanity, 356; cases of, 358-
364; with epilepsy, 364; diagnosis
of, 480; prognosis of, 488.

Moral sense, 157 ; acquisition of, 164 ;
loss of, 165.

Morel, on degenerate varieties, 246,
343 ; case of mania in a girl, 318;
characters of hereditary taint, 342 ;
on the classification of insanity, 424 ;
on épilepsie larvée, 445; on insanity
connected with epilepsy, 364.

Morphia, subcutaneous injection of, in
insanity, 513.

Motives, 150, 153.

Motorium commune, 100, 191.

Movements of intestines, 57 ; of heart,
57; of decapitated frog, 725; poten-
tial or abstract, 76, 114, 191; auto-
matic, 67, 72-79; secondary auto-
matic, 76, 97, 110; rhythmical, 81 ;
irradiation of, 85 ; sensori-motor, 102,
103, 108, 121; ideomotor, 126, 129 ;
524

voluntary, 175, 179 ; residua of, 191 ;
illusory, 200 ; sense of, 202.

Miller, on associate movements, 78 ; on
voluntary action, 113; on the organic
conditions of intellect and emotion,

288.
Mundy, Baron, M.D., on the family
treatment of the insane, 502.

N.

Nature, deification of, 1; superstitious
dread of, 1, 2; observation of, 2, 4;
subjective explanation of, 3 ; the har-
monies of, 158, 167.

Negro, brain of, 54.

Nerve-cells, 44, 47, 63; differences of,
60, 65; degeneration of, 67, 465;
irritable feebleness of, 86.

Nerve-centres, 48 ; co-ordination of, 57;
ideational, 58, 123 ; sensory, 58, 99 ;
tertiary or reflex, 51, 71-96 ; motor,
191; organic, 58 ; inhibitory action
of, 159.

Nerve-element, intimate constitution of,
64 ; instability of, 86; individuality
of, 436 ; intrinsic action of, 438, 442.

Nerve-fibres, function of, 47 ; connexion
with cells, 59, 61; rate of conduction
by, 429; electrical currents of, 432 ;
anelectrotonus of, 434; katelectroto-
nus of, 434 ; fatty degeneration of, 92.

Nervous function, physiological re-
searches into, 429; on waste pro-
ducts of, 436.

Nervous system, simplest type of, 47 ;
ante of, 48; different centres
of, 58.

Neurosis spasmodica, 257, 335.

Nicolai, case of, 307.

Nisus, the organic, 69, 212.

Novalis, on the passions, 152.

Nutrition, influence of cerebro-spinal
system on, 91.

O.

Opium, use of, in insanity, 512.
Organization, the conception of, 106,
210 ; Von Baer’s law of, 144, 165.

Othzmatoma, 398.
Over-population, influence of, on in-
crease of insanity, 232.

P.

Pachymeningitis, idiopathic, 456.
Paget, James, onrhythmical movements,
81; on memory, 209; on the brain

INDEX.

of an idiot, 250; on the effects of
the organic virus, 267. :

Pain, memory of, 219 ; psychical, 283 ;
diversities of, 392.

Paralysis, general, 205, 410 ; causes of,
411; symptoms of, 412-416 ; tem-

erature in, 416, 418; hallucinations

in, 414 ; course of, 417; epileptiform
attacks in, 418; morbid changes in,
456; diagnosis of, 482; prognosis of,
488 ; treatment of, 513, 515.

Passions, 148, 152, 160 ; Spinoza on
the primitive, 162.

Perception, sensory, 49, 113 ; ideational,
51, 113 ; loose use of word, 112.

Pfliiger, experiments on reflex action
in frog, 72; on the laws of reflex
movements, 85; case of reflex epi-
lepsy and neuralgia, 92; on reflex
movements during sleep, 96.

Philippeau, on nerve-fibres as conduc-
tors, 47; on removal of one hemi-
sphere, 146,

Phi onephy, Ionian school of, 2; meta-
physical, 235 ; inductive, 5.

Phthisis, as predisposing to insanity,
233 ; in the insane, 470.

ie aaa changes of, in insanity,

Pigeon, removal of hemispheres of, 109.

Pigment granules, movements of, 57.

Plato, 4, 5.

Poisons, morbid, 266.

Potassium, bromide of, in insanity, 514;

-_ iodide of, 514.

Precocity, sexual, 325.

Pregnancy, influence of, on insanity,
273 ; insanity of, 274, 399.

Prichard, Dr., case of moral insanity

a é child, 325 ; on moral insanity,

Prochaska, on the action of the sen-
sorium commune, 72; general law of
reflex action, 98.

Bees activity, 20, 186, 188, 212,

cee uteri, a cause of melancholia,

Protozoa, 45; movements of, 46.

Psychical pain, 283. :

Psychical tone, 156, 157; disturbance
of, 268, 281.

Psychology, empirical, 9; transcenden-
tal, 10; uncertainties and contra-
dictions of, 10; individual, 14;
method of, 24.

Pubescence, influence of, on mind, 152,
173 ; insanity of, 273, 421.

Puerperal insanity, 274, 488; treat-
ment of, 510.

eu state of, in general paralysis,
INDEX.

R.

Rat, removal of hemispheres of, 103.

Ratiocination, 139.

Reflection, 136, 138, 144, 159 ; uncon-
scious steps of, 137.

Reflex action, 72, 79, 90; laws of, 85 ;
increase of, 93.

Reflex irritation, 118, 270.

Reformer, the, 185, 187.

Religion, influence of, on insanity, 238.

Renaudin, case of moral insanity in a
boy, 327.

Residua, motor, 192, 193, 417; voli-
tional, 172, 179; ideational, 127,
210; sensory, 104, 106 ; spinal, 76.

Retinitis pigmentosa, 469.

Richter, Jean Paul, on creative ac-
tivity, 19; on dreaming, 223.

Hier mortis, 89.

Robertson, Dr., on packing in the wet
sheet, 510.

Bee, on co-ordinate convulsions,

8.

Sankey, Dr., on the specific gravity
of the brain, 460; on SeueTal pare,
lysis, 457.

Schiff, on the production of rigor mortis,
89; on degeneration of nerve-fibre,
93; on removal of the hemispheres,
108.

Schlager, on injuries of head causing
insanity, 286.

Schroeder van der Kolk, 63, 66, 79, 91,
101, 271, 453.

Sclerosis, cerebral, 459.

Scrofula, as predisposing to insanity,
233.

ee case of, causing mania,
272.

Sects, fanatical religious, 240.

Self, affections of, 150; case of, 150,
165.

Self-consciousness, incompetency of, 11-

Sensations, seat of common, 99; ab-
stract, 106 ; subjective, 65 ; associa-
tion of, 107.

Sense, the muscular, 202.

Senses, appearance of special, 49 ; edu-
cation of, 109, 121; defects of, 116 ;
excessive use of, 116 ; the vital, 278.

Sensibility, different kinds of, 50 ; emo-
tional, 51; muscular, 202; perver-
sion of, 279.

Sensorial insanity, 115, 117, 299, 301.

Sensori-motor action, 49.

Sensorium commune, 99; disorder of,
115.

525

ere ns excessive employment

ol,

Sexes, insanity in the, 235, 248.

Sexual excess, a cause of insanity, 285.

Sexual insanity, 405, 421.

Sexual organs, influence of, on mind,
152, 273, 278, 341.

Shaftesbury, 133.

Shakspeare, 167, 213, 226.

Shelley, 132.

Skae, Dr., case of homicidal insanity
with epilepsy, 353; on sexual in-
sanity, 405 ; on the classification of
insanity, 420 ; on the specific gravity
of the brain, 460.

Sleep, cerebral circulation during, 488 ;
in insanity, 384, 401 ; on mode of
procuring, in insanity, 508.

Socrates, 3.

Somnambulism, 306.

Speech, unconscious, 109, 111 ; loss of,
196-199.

Spencer, Herbert, on memory, 220.

Spinal cord, 71-80; exhaustion of,
84 ; nutrition of, 81, 93; constitution
of, 84; causes of disorder of, 86-94;
excessive stimulation of, 88 ; supply of
blood to, 89.

Spinoza, on final causes, 75, 80 ; on in-
voluntary action, 96 ; on the images
of dreams, 131; on the primitive
passions, 162; on desires, 166; on
the will, 168.

Stannius, on rigor mortis, 89.

Statistics, of insanity, 236; function

of, 245,

Stiff, Dr., on the asylum ear, 398.

Stigmata, 343.

Stimuli, organic, 109.

Suicide, in children, 320 ; suicidal im-
pulse, 346, 351.

Superstition, 1, 2.

Sutherland, Dr., on the urine of the in-
sane, 401.

Swedenborg, on memory, 222.

Sympathy, 90-92, 118, 270, 276, 281;
pathological, 443 ; heterogeneous,
448.

Synergy, 92, 447.

Syphilis, a cause of insanity, 288.

Syphilems, 288, 458; treatment of,
514.

TT
fee dorsalis, 203 ; morbid changes in,

Tapeworm, a cause of melancholia, 272.

Tartar emetic, use of, in insanity,
513.

Temperament, the insane, 257, 335;
influence of, in insanity, 288,
526

Temperature in insanity, 400, 416, 426,
486.

Tertullian, on belief in the impossible,
64.

Thalami optici, 100.

Thales, 2.

Thore, Dr., case of hallucination in a
child, 304.

Thumam, Dr., on the weight of the
brain, 54; on the proportion of in-
sanity in the sexes, 236 ; on the prog-
nosis of insanity, 490.

Todd, Dr., on the motor and sensory
centres, 99.

Tonics, use of, in insanity, 515,
Trousseau, on epileptic vertigo, 77; on
irresistible impulse in epilepsy, 354.
Tuberculosis, as predisposing to in-
sanity, 233; and general paralysis,

415.

Tucker, on the tisepplicntion of lan-
guage, 108; on the succession of
thoughts, 176 ; on will, 181.

ae rx. J. B., on puerperal insanity,
274,

Tuke, Samuel, case of fever in a de-
mented person, 260.

U.

Urine, in the insane, 401.
Uterus, disorders of, as causes of in-
sanity, 272.

Vv.

Valentin, on the seat of co-ordination
of movement, 79.

Varieties of insanity, 335-427.

Ventricle, increase of fluid in, 329;
granular condition of, 455.

Virchow, on syphiloma, 458.

Vision, theory of, 104 ; hallucinations
of, 303.

INDEX.

Vitality, theory of, 69. =

Volition, 144, 168-190; nerve-centres
of, 124, 180; abstract, 173, 180.

Volkmann, on reflex movements, 90 ;
on the symmetrical increase of sensi-
bility, 105. .

Von Baer, law of organic development,
144, 165 ; on grade of development,
249 ;

Vulpian, on nerve-fibres as conductors,
47; on locomotive harmony, 78 ; on
the seat of common sensation, 100;
on the removal of cerebral hemi-
spheres, 103, 124, 146.

W.

Wagner, on the weight. of the brain,
54; on syphiloma, 458.
Waller, on the degeneration of nerves,

93.

Wealth, passion for, 234,

Weber, Dr., on delirium during the
decline of acute diseases, 401; on
the temperature in insanity, 401.

West, Dr., case cf cataleptic insanity

assing Into epilepsy, 315.

V fy Gilbert, on the effect of custom,
163. :

Westbury, Lord, on insanity as a sub-

wot of moral inquiry, 473.
estphal, ,Dr., on general paralysis,
413, 416,

Whytt, Dr., on illusory movements,
200; on sympathy of organs, 271 ;
case of insanity in a boy, 305.

Wilks, Dr., on abnormal quantity of
fluid in ventricles, 329 ; on calcareous
degeneration of nerve-cells, 468.

Will, the freedom of, 168, 171 ; nature
of, 169 ; power of, 174, 188; not in-
nate, 178, 180; relation of emotions
to, 184, 185; creative, 188.

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