The Physiology and Pathology of Mind (2024)

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{{Template}}The Physiology and Pathology of Mind (1867) is a book by Henry Maudsley.

PREFACE TO THE SECOND EDITION.THERE HERE are only two observations which it seems necessary tomake by way of preface to this edition. The first is, that ithas not been my conscious desire or aim throughout the work todiscard entirely the psychological method of inquiry into mentalphenomena, although the earnest advocacy of the physiologicalmethod has, naturally perhaps, led some readers to assumesuch a design. Hitherto, it must be remembered, the latterhas hardly had any place, the former having been exclusivelyemployed, in the study of mind. Now it is obviously impossibleto set forth the fruitfulness and the rich promise of the physiological method, and to elevate it to its rightful position, withoutexposing the shortcomings and the barrennessof the psychological method, and degrading it to a lower rank than thatwhich it has unjustly usurped. The second observation is, thatthis 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, orentirely unwarranted, will have their justification, or the showof it, at any rate, in other parts of the book. It may not beamiss, then, to allege that an adequate criticism of the FirstPart cannot be made without some consideration of the SecondPart; and that in like manner the study of the Second orPathological Part cannot be undertaken to the best advantagewithout a previous study of the First or Physiological Part.This edition has been carefully revised, with the view ofremoving some inaccuracies, and contains additional matter, forthe purpose of elucidating certain obscurities, which occurredin the first edition. An index has also been added for convenience of reference.HANWELL, W.March 16h, 1868.THEPREFACE TO THE FIRST EDITION.HE aim which I have had in view throughout this workhas been twofold: first, to treat of mental phenomenafrom a physiological rather than from a metaphysical pointof view; and, secondly, to bring the manifold instructive instances presented by the unsound mind to bear upon theinterpretation of the obscure problems of mental science.Indeed it has been my desire to do what I could inorder to put a happy end to the " inauspicious divorce "between the Physiology and Pathology of Mind, and to effecta reconciliation between these two branches of the samescience. When I first applied myself, upwards of ten yearssince, to the practical study of insanity, having laid up beforehand some store of metaphysical philosophy, it was no smallsurprise and discouragement to find, on the one hand, thatthe theoretical knowledge acquired had no bearing whateveron, no discoverable relation to, the facts that daily cameunder observation, and, on the other hand, that writers onmental diseases, while giving the fullest information concerning them, treated their subject as if it belonged to a scienceentirely distinct from that which was concerned with thesound mind. This state of things could not fail to producean immediate mental disquietude, and ultimately to giverise to the endeavour on my part to arrive at some definiteconviction with regard to the physical conditions of mentalfunction, and the relation of the phenomena of the soundand unsound mind. Of that endeavour the present work isthe result. It can claim no more authority than what is dueto a sincere purpose faithfully pursued, and to such truth asmay be contained in it. The First Part, resting as it doesmainly on the physiological method of inquiry into mentalphenomena, will certainly not command the assent of thosePREFACE TO THE FIRST EDITION. viiwho put entire faith in the psychological method of interrogating self-consciousness; it must appeal rather to those whohave made themselves acquainted with the latest advancesin physiology, and with the present state of physiologicalpsychology in Germany, and who are familiar with the writings of such as Professor Bain, Mr. Herbert Spencer, Dr.Layco*ck, and Dr. Carpenter, in this country. The Second Partof the book may stand on its own account as a treatise onthe causes, varieties, pathology, and treatment of mentaldiseases, apart from all question of the proper method tobe pursued in the investigation of mental phenomena. Eventhose who advocate the psychological method of interrogatingself- consciousness do not insist on the application of it tothe scientific study of the madman's mind.In laying down the plan of this work, and in thus enteringupon a task not before systematically attempted, I could notfail to experience the serious disadvantage, not only of havingno guide to follow, but of being compelled by the scope of thework to deviate from the paths already made in metaphysics,physiology, and pathology respectively. In order to bringthe results of the cultivation of these different branches ofscience into any sort of harmony, it was plainly necessarynot to travel too far on paths which diverged more and morewith every step forward. For this reason I have passed bymany interesting questions which have long occupied a largespace in metaphysics, and have deliberately omitted manydiscussions which were at one time intended to form a partof the book. In like manner, it seemed desirable, when treating of the physiology of mental action, to omit anatomicaldescription of the nervous system, leaving the knowledge ofit to be obtained in a more complete and satisfactory formfrom books specially dealing with the subject. Lastly, thepathology of diseases of the nervous system generally, althoughthrowing much light on the pathology of mental diseases,could not find fitting place, and was after some hesitationsacrificed, in order to preserve the harmony of design, andto prevent the book growing to an immoderate bulk. Indeed,as may be easily conceived, it has been throughout far moredifficult 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 theproject, but not directly used, exceeding that which has beenactually used in its execution. I am fully sensible of thedisadvantages resulting from these omissions: an amount ofknowledge on the reader's part is taken for granted which hemay not have, and without which many things may appearobscure to him, and many assertions unwarrantable. It maywell be, too, that either the metaphysician, or the physiologist,or the pathologist, looking at the work from his particularstandpoint, will see reason to pronounce it defective. Whosoever will, however, be at the pains to compare the discordantresults of metaphysical, physiological, and pathological studiesof mind, remembering that they are actually concerned withthe same subject- matter, cannot fail to recognise and confess the uselessness of an exclusive method, and the pressingneed of combined action and of a more philosophical modeof proceeding. If the work now offered to the public besuccessful in its aim, it will make evident how indispensableis the method advocated, and how full it is of promise of themost fruitful results.In conclusion, I am glad to add a sincere expression of thanksto my friend Dr. Blandford, for his advice and assistanceduring the passage of the book through the press.THE LAWN, HANWELL, W.Feb. 5th, 1867.OFCONTENTSPIPART I.THE PHYSIOLOGY OF MIND.CHAPTER I.ON THE METHOD OF THE STUDY OF MIND.Aspects of nature terrible to man in the infancy of thought; whence supersti- tions feelings and fancies regarding nature. As these disappear metaphysical entities are assigned as natural causes, and man deems himself the measureof the universe. " Finally, the interrogation and interpretation of nature,after the inductive method, begin; fruitful results of this method. Is theinductive 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; noaccount 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 Physiological 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 1-40CHAPTER II.MIND AND THE NERVOUS SYSTEM.The term " Mind " used in different senses in its scientific sense as a naturalforce; 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 theimmediate 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 hom*ogeneous subThe differentiation of tissues in higher animals demands special means of intercommunication: the nervous system, at first very simple, substance.Χ 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 hemispheresand rudimentary ideation in fishes. Convolution of the grey matter of the hemispheres in the higher mammals, and corresponding increase of intelligence 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 thesame 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; (b)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 phenomena 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 ·CHAPTER III.THE SPINAL CORD AND REFLEX ACTION.Page 41-70Spinal 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 Pflüger'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 exercise, 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.Pflüger's laws of reflex movements. Causes of disorder of function of spinalcord: (a) original differences of constitution; (b) excessive action; (c) quantity and quality of the blood; (d) eccentric irritation; ( e ) 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 71-98CHAPTER 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 independent 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 thejust interpretation of sensation; assimilation and differentiation. Association of sensations. Sensori- motor acts both irregular and co- ordinate; of coordinate acts, some are primary automatic, others secondary automatic.Persistence of sensori- motor acts in animals after the removal of their cerebralhemispheres. 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;(b) 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 Page 99-122CONTENTS. xiCHAPTER V.THE SUPREME CEREBRAL CENTRES AND IDEATION.Cortical cells of the hemispheres the centres of Ideation. No certain knowledgeof the functions of different convolutions. Cortical cells the centres of independent reaction; of ideomotor movements, which may take place without will and without consciousness: illustrations. Notion of innate idea untenable. 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, voluntaryand involuntary, conscious and unconscious; (b) on the sensory ganglia, -physiologically, as a regular part of mental function; pathologically, in the production of hallucinations; (c) on the functions of nutrition and secretion:illustrations; (d) on other ideas: reflection or deliberation. Relation ofconsciousness 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 (a) the individual nature, (b) special lifeexperience. Need of an individual psychology. General laws of association ofideas. Concluding remarks on the illustration of Von Baer's law of progress,from the general to the special in development, afforded by the development of ideas Page 123-147CHAPTER 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. Coenæsthesis. 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 Page 147-167CHAPTER 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 ametaphysical 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. Thedesign in the particular volition is a result of a gradually effected mental organization: a physical necessity, not transcending or anticipating, but conforming with, experience. Erroneous notions as to the autocratic power of will. Its actual power considered ( 1) over movements, and ( 2) over themental operations. 1. Over movements: (a) no power over the involuntary movements essential to life; (b) 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 throughxii CONTENTS.As associations of ideas that are beyond its control, and sometimes not at all.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- mining it in the particular act. Relation of emotion to volition. Differencesin the quality and energy of the will. Will the highest force in nature; itshighest function creative-initiating a new development of nature.CHAPTER VIII.ON ACTUATION.Page 168-190Movements leave behind them residua in the motor centres, whence a repositoryof latent or abstract movements. Motor residua or intuitions intervene between motive and act, and are related to conception on the reactive side as sensation is on the receptive side. Actuation proposed for the psychologicaldesignation of this department. Motor intuitions mostly innate in animals,acquired in man. Illustrations from vision, speech, the phenomena of hypnotisin, paralysis, insanity, &c. Aphasia in its bearings on motor intuitions.Muscular hallucinations. Co- ordinate convulsions. The muscular sense; itsrelation 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 expressionof the will in action . Natural differences between different persons, in thepower of expression, by speech or otherwise Page 191-208CHAPTER 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 ofimagination 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 and 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 209-222PART 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 themoral 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 -- (a) imperfectly developed brains of the microcephalic type, ( b) cretinism, (c) arrest of development by disease, (d) the insane temperament, or neurosis spasmodica; ( 2) Quantity and quality of the blood--anæmia 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; ( 3 ) Reflex irritation or patholo gical sympathy-illustrations; (4) Excessive functional activity-overwork,CONTENTS. xiiiemotional agitation, depressing passions, physical exhaustion, &c.; (5) Injury and disease of the brain-abscess, tumour, tubercle, syphilis. Concludingremarks on the special causation of the different forms of insanity. Mentalderangement a matter of degree. Appendix of cases, illustrating the causation ofinsanityCHAPTER II.ON THE INSANITY OF EARLY LIFE.Page 223-297Insanity 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 withepileptic fury. The organiza- tion of sensory residua, and hallucinations of the senses: hallucinations notuncommon in infancy; examples. Choreic insanity and the phenomena of somnambulism. Organization of idea. Incoherent conversation and fallacious memory of children . Delusions. Resemblance between mania of childrenand the delirium of adults. Hallucinations produced by morbid ideas. The difference between fancy and imagination corresponds with the difference between delirium and mania. Forms of insanity met with in childrengrouped:-(1 ) Monomania, when there is a powerful impulse to some act of violence; (2) Chorcic 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) Affectiveinsanity—(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 thetype of any animal theroid degenerations of mankind are pathological speci- mens. Concluding remarks upon the seeming precocity of vice in some insane children Page 298-334CHAPTER 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 Ideational.2. Affective Insanity: (a) Impulsive-the nature of it described and illus- trated by examples; enumeration of its causes and exposition of its frequent connexion with epilepsy; (b) 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 acts not proof of moral insanity; its connexion with other forms of mental derangement and with epilepsy. 3: Ideational Insanity: (a) Partial, including monomania and chronic melancholia;(b) General, including mania and melancholia, chronic and acute. Modifiedclassification of mental diseases. The nature, varieties, symptoms, and courseof 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 intonervousfunction; time- rate of conduction; electro-motor properties of nerve,Xiv CONTENTS.and the changes produced by the electrotonic state; Katelectrotonus and Anelectrotonus; chemical changes produced by functional activity. 2. Indivi- duality ofnerve element considered: functional relation between the individualelement 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; 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 428-471CHAPTER V.THE DIAGNOSIS OF INSANITY.The difficulty of the diagnosis in some cases. Acute mania: diagnosis frommeningitis; 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-theimportant differences between them. The diagnosis of moral insanity andof irresistible homicidal impulse. The detection of general paralysis in its earliest stages. On the mode of conducting the examination of an insane patient Page 472-484CHAPTER 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 485-491CHAPTER VII.THE TREATMENT OF INSANITY.The difficulties in the way of treatment; the working of the Lunacy Acts; the 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, amusem*nts, &c. Medical treatment: warm and cold baths; blood- letting; counter-irritants; diet; stimulants: the use of opium; digitalis; hyoscyamus, hydrocyanic acid and bromide of potassium;tonics. Concluding remarks upon the treatment of chronic insanity.INDEX •Page 492-516 517PART I.THE PHYSIOLOGY OF MIND.CHAPTER I. ON THE METHOD of the STUDY OF MIND."" II. MIND AND THE NERVOUS SYSTEM.9999"9III. THE SPINAL CORD, OR TERTIARY NERVOUS CENTRES; OR NERVOUSCENTRES OF REFLEX ACTION.IV. SECONDARY NERVOUS CENTRES, OR SENSORY GANGLIA; SENSORIUMCOMMUNE.V. HEMISPHERICAL GANGLIA; CORTICAL CELLS OF THE CEREBRALHEMISPHERES; IDEATIONAL NERVOUS CENTRES; PRIMARYNERVOUS CENTRES; INTELLECTORIUM COMMUNE.VI. EMOTION.99 VII. VOLITION.,, VIII. MOTOR NERVOUS CENTRES OR MOTORIUM COMMUNE, AND ACTUATION OR EFFECTION... IX. MEMORY AND IMAGINATION.

THEPHYSIOLOGY AND PATHOLOGY OF MIND.THECHAPTER I.ON THE METHOD OF THE STUDY OF MIND." Ich sag' es dir: ein Kerl, der speculirt,Ist wie ein Thier, auf dürrer HeideVon einem bösen Geist im Kreis herum geführt,Und rings umher liegt schöne grüne Weide. "Faust.HE right estimate of his relations to external nature hasever been to man a matter of extreme difficulty and uncertainty. In the savage state of his infancy he feels himself so littlein the presence of nature's vastness, so helpless in conflict withits resistless forces, that he falls down in abject prostration beforeits various powers. The earth of a sudden heaves beneath histrembling feet, and his shattered dwellings bury him in theirruins; the swelling waters overpass their accustomed boundariesand indifferently sweep away his property or his life; the furioushurricane ruthlessly destroys the labour of years; and famine orpestilence, regardless of his streaming eyes and piteous prayers,stalks in desolating march through a horror-stricken people. Inthe deep consciousness of his individual powerlessness he fallsdown in an agony of terror and worships the causes of hissufferings: he deifies the powers of nature, builds altars to propitiate the angry Neptune, and, by offering sacrifices of thatwhich is most dear to him, even his own flesh and blood, hopesto mitigate the fury of Phoebus Apollo and to stay the dreadfulclang of his silver bow. Everything appears supernatural becausehe knows nothing of the natural; palsied with fear, he cannotB2ON THE METHOD OF [CHAP.observe and investigate; himself he feels to be insignificant andhelpless, while to nature he looks up with reverential awe asmighty and all-powerful. Reflect on the fearful feelings whichany apparent exception to the regular course of nature even nowproduces, on the superstitious dread which of a certainty followssuch unfamiliar event, and it will not be difficult to realize theextreme mental prostration of primitive mankind.Through familiarity, however, consternation after a while subsides, and the spirit of inquiry follows upon that of reverence;the prostrate being rises from his knees to examine into thecauses of events. Experience, sooner or later, reveals the uniformity with which they come to pass; he discovers more or lessof the laws of their occurrence, and perceives that he can byapplying his knowledge avoid much of the damage which hehas hitherto suffered-that he can, by attending to their laws,even turn to his profit those once dreaded physical forces. Nowit is that man begins to feel that he has a much higher positionin nature than in his infancy he had imagined; for a time helooks upon himself as belonging to the same order as the thingsaround him; and he emancipates himself in great part from thedominion of the priests in whom he had hitherto believed as thesacred propitiators of the gods whom his fears had fashioned.When his creeds are seen to spring from an imperfection of theintellect, the prayers founded on them are abandoned as markingan imperfection of the will.Thales of Miletus is said to have been the first who, in thisadvance amongst the Greeks, laid aside the priestly characterand stood forth as a pure philosopher; and those who immediately followed him, and constituted the Ionian school of philosophy, having an instinctive feeling of the unity between manand nature, did seek objectively for a first principle of things—the apxn-common to him and the rest of nature. This slow andtedious method was soon, however, abandoned for the easier andquicker method of deduction from consciousness: abstractionswere made from the concrete by the active mind; and theabstractions, being then projected out of the mind and convertedinto objective realities, were looked upon and applied as actualentities in nature. Anaximander, diving into his own mind andfinding something inconceivable there, gave to it the name of1. ງ THE STUDY OF MIND. 3the Infinite, and, transferring it outwards, was thenceforth quitecontent to pronounce it to be the true origin of all things; whilstPythagoras, going perhaps still further into the unmeaning, proclaimed numbers, which are mere arbitrary symbols, to be actualexistences and the essences of things. Thus it was that man,forgetful of his early humility, rose by degrees to the creationof the laws of an external world after the pattern of his ownthoughts: such motives as he felt to influence his own actionswere held also to be the principles governing the relations ofexternal objects: and natural phenomena were explained bysympathies, loves, discords, hates. As the child attributes lifeto the dead objects around it, speaking to them and thinkingto receive answers from them, so mankind, in the childhood ofthought, assigns its subjective feelings to objective nature, entirely subordinating the physical to the metaphysical: it is butanother form of that anthropomorphism by which the Dryadwas placed in the tree, the Naiad in the fountain, Atroposwith her scissors near the running life-thread, and a Sun-godenthroned in the place of a law of gravitation. As was natural,man, who thus imposed his laws upon nature, soon lost all hisformer humility, and from one erroneous extreme passed to theopposite: as he once fell abjectly down in an agony of fear, sonow he rose proudly up in an ecstasy of conceit.The assertion that man is the measure of the universe was thedefinite expression of this metaphysical stage of human development. But it was a state that must plainly be fruitless of realknowledge; there could be no general agreement among menwhen each one looked into his own mind, and, arbitrarily makingwhat he thought he found there the laws and principles of external nature, constructed the laws of the world out of the depthsof his own consciousness. Disputes must continually arise aboutwords when words have not definite meanings; and the unavoidable issue must be Sophistry and Pyrrhonism. This has been so;the history of the human mind shows that systems of scepticismhave regularly alternated with systems of philosophy. Fruitfulof empty ideas and wild fancies, philosophy has not been unlikethose barren women who would fain have the rumbling of windto be the motion of offspring. Convinced of the vanity of itsambitious attempts, Socrates endeavoured to bring philosophyB 24ON THE METHOD OF [CHA .down from the clouds, introduced it into the cities, and appliedit to the conduct of human life; while Plato and Aristotle,opposite as were their professed methods, were both alive to thevagueness of the common disputations, and both laboured hardto fix definitely the meanings of words. But words cannot attainto definiteness save as living outgrowths of realities, as the exactexpressions of the phenomena of life in the increasing specialityof human adaptation to external nature. As it is with lifeobjectively, and as it is with cognition or subjective life, so is itwith the language in which the phenomena are embodied: inthe organic growth of a language there is a continuous differentiation, first of nouns into substantives and adjectives, then ofthe latter into adjectives proper and nouns abstract; synonymesagain disappear, each getting its special appropriation, and superfluous words are taken up by new developments and combinations of thought. How, then, was it possible that a one- sidedmethod, which entirely ignored the examination of nature, shoulddo more than repeat the same things over and over again inwords which, though they might be different, were yet not lessindefinite? The results have answered to the absurdity of themethod; for, after being in fashion for more than two thousandyears, nothing has been established by it; " not only what wasasserted once is asserted still, but what was a question once is aquestion still, and instead of being resolved by discussion isonly fixed and fed. " ()Perhaps if men had always lived in the sunny climes of thesouth, where the luxuriance of nature allowed of human indolence, they might have continued vainly to speculate; but whenthey were brought face to face with Nature in the rugged north,and were driven to force by persevering labour the means ofsubsistence from her sterile bosom, then there arose the necessityto observe her processes and investigate her secret ways. Therewas an unavoidable intending of the mind to the realities ofnature; and this practice, which the exigencies of living firstenforced, became in the fulness of time with those who hadleisure and opportunity the disposition consciously to interrogateand interpret Nature. In Roger Bacon, we see the human mindstriving unconsciously, as it were, after the true method of(1) See Notes at the end of the Chapters.1.] THE STUDY OF MIND. 5development; while in the Chancellor Bacon, who systematizedthe principles and laid down the rules of the inductive philosophy, we observe it doing with design and method that whichit had hitherto been blindly aiming at. But as it is with theinfant, so was it with humanity; action preceded consciousness,and Bacon himself was the efflux of a spirit which prevailed andnot the creator of it. By thus humbling himself to obey, manhas conquered nature; and those plenteous "fruits and inventedworks" which Bacon confidently anticipated as " sponsors andsureties" for the truth of his method, have been reaped in therichest abundance.It seems strange enough now to us that men should not havesooner hit upon the excellent and profitable method of induction.How came it to pass that when they surveyed organic nature, asAristotle notably did, they failed to perceive the progress indevelopment from the general and simple to the special andcomplex, which is evident throughout it? Had they but formularized this law of increasing speciality and complexity in organicadaptation to external nature, then they had scarcely failed toapply it to conscious human development; and that would havebeen to establish deductively the necessity of the inductivemethod. Unfortunately, Aristotle stood alone; and it remainshis particular merit to have foreseen in some sort the value ofthe inductive method. Had he also consistently followed it inpractice, which he did not, there was an impassable hindranceto its general adoption, in the moral errors engendered by themetaphysical or subjective method, of which Plato was sopowerful a representative and so influential an exponent. Man,as the measure of the universe, esteemed himself far too highlyto descend to be the servant and interpreter of nature; and thiserroneous conceit not only affected his conception of his relation to the rest of nature, but permeated his social nature, andvitiated his whole habit of thought: the superstitious reverenceof the Greek who would put to death a victorious general becausehe had left his dead unburied on the field of battle, must haveprevented Aristotle from anatomical examination of the structureof the human body. The same errors are continually reappearingin human history: what happened in the Middle Ages may illustrate for us the habit of Greek thought; for at that time mistaken6 ON THE METHOD OF [CHAP.religious prejudice allied itself most closely with the metaphysical method which exalted man so much over the rest of nature,opposing most virulently the birth of positive science, whichseemed to threaten to degrade him; and for a time it was almostdoubtful which would win. Can we wonder, then, that theerroneous method was triumphant in Greece in the fourth century before Christ, when it is only recently in England, in thenineteenth century after Christ, that the barbarian's reverencefor a dead body has permitted anatomical dissection, and whenthe finger-bone of a saint, or a rag of his clothing, is still treasured up, in some parts of the world, as a most precious relicendued with miraculous virtues! The evil of the metaphysicalmethod was not intellectual deficiency only, but a correspondingbaneful moral error.The adoption of the inductive method, which makes man theservant and interpreter of Nature, is in reality the systematicpursuance of the law of progress in organic development; it isthe conscious intending of the mind to external realities, thesubmitting of the understanding to things-in other words, theincreasing speciality of internal adjustment to external impressions; and the result is a victory by obedience, an individualincrease through adaptation to outward relations, in accordancewith the so-called principle of natural selection. The mentalcapacity of one who is deprived of any one of his senses, whichare the inlets to impressions from without, or the gateways ofknowledge, is less than that of one who is in the full possession of all his senses; and the great advances in science haveuniformly corresponded with the invention of some instrumentby which the power of the senses has been increased, or theirrange of action extended. Astronomy is that which the eye hasbeen enabled to see by the aid of the telescope; the revelations ofthe inmost processes of nature have been due to the increasedpower of vision which the microscope has conferred; the extremely delicate balance has supplied to science a numericalexactness; the spectrum has furnished a means of analysingthe constitution of the heavenly bodies; and the galvanometeralready gives the most hopeful presage of important discoveriesin nervous function. Through the senses has knowledge entered;and the intellect has in turn devised means for extending the1.] THE STUDY OF MIND. 7action and increasing the discriminating exactness of the senses:there have been action and reaction and progressive specializationand complication thereof. The two aspects of this relation wedesignate, in their highest manifestations, as cognition andaction, or science and art.Thus much concerning the historical evolution of the inductive method. But now comes the important question, whetherit is available for the study of the whole of nature. Can weapply the true inductive and objective method to the investigation of psychical as well as of physical nature? In the lattercase, it has long received universal sanction; but in the study ofa man's mind it is still a question what method should rightlybe employed. Plainly, it is not possible by simple observationof others to form true inductions as to their mental phenomena;the defect of an observation which reaches only to the visibleresults of invisible operations, exposes us without protection tothe hypocrisy, conscious or unconscious, of the individual; andthe positive tendency, which no one can avoid, to interpret theaction of another mind according to the measure of one's own, tosee not what is in the object, but what is in the subject, frequently vitiates an assumed penetration into motives. If we callto our aid the principles of the received system of psychology,matters are not mended; for its ill-defined terms and vaguetraditions, injuriously affecting our perceptions, and overrulingthe understanding, do not fail to confuse and falsify inferences.It must unfortunately be added that, in the present state ofphysiological science, it is quite impossible to ascertain, byobservation and experiment, the nature of those organic processes which are the bodily conditions of mental phenomena.There would appear, then, to be no help for it but to have entirerecourse to the psychological method-that method of interrogating self-consciousness which has found so much favour at alltimes. Before making any such admission, let this reflection beweighed that the instinctive nisus of mankind commonly precedes the recognition of systematic method; that men, withoutknowing why, do follow a course which there exist very goodreasons for. Nay more: the practical instincts of mankind oftenwork beneficially in an actual contradiction to their professeddoctrines. When in the Middle Ages faith was put in the8 ON THE METHOD OF [CHAP.philosophy of the schools, the interrogation of nature by experiment was going on in many places; and the superstitious peoplethat believe in the direct interference of spirits or of gods, stilladopt such means of self-protection as a simple experience ofnature teaches. Man does not consciously determine his methodand then enter upon it; he enters blindly upon it, and at acertain stage awakes to consciousness. In the onward flowingstream of nature's organic evolution, life first becomes selfconscious in man: in the slumbering mental development ofmankind, it is the genius who at due time awakens to active consciousness the sleeping century. It would indeed go hard withmankind if they must act wittingly before they acted at all.Two facts come out very distinctly from a candid observationof the state of thought at the present day. One of these is thelittle favour in which metaphysics is held, and the very generalconviction that there is no profit in it: the consequence of whichfirmly fixed belief is, that it is cultivated as a science only bythose whose particular business it is to do so, who are engagednot in action, wherein the true balance of life is maintained, butin dreaming in professorial chairs; or if by any others, by theambitious youth who goes through an attack of metaphysics asa child goes through an attack of measles, getting haply animmunity from a similar affection for the rest of his life; orlastly, by the untrained and immature intellects of those metaphysical dabblers who continue youths for life. Asecond fact,which has scarcely yet been sufficiently weighed, is the extremefavour in which biography is held at the present time, and thelarge development which it is receiving.Let us look first at the import of biography. As the businessof a man in the world is action of some kind, and as his actionundoubtedly results from the relations between him and hissurroundings, it is plain that biography, which estimates boththe individual and his circ*mstances, and displays their reactions, can alone give an adequate account of the man. Whatwas the mortal's force of character, what was the force of circ*mstances, how he struggled with them, and how he was affected bythem, what was the life-product under the particular conditionsof its evolution:-these are the questions which a good biographyaspires to answer. It regards men as concrete beings, acknow----1.] THE STUDY OF MIND. 9ledges the differences between them in characters and capabilities,recognises the helpful or baneful influence of surroundings, andpatiently unfolds the texture of life as the inevitable result ofthe elements out of which, and the conditions under which, ithas been worked. It is, in fact, the application of positivescience to human life, and the necessary consequence of theprogress of the inductive philosophy. No marvel, then, thatbiography forms so large a part of the literature of the day, andthat novels, its more or less faithful mirrors, are in so greatrequest. The instincts of mankind are here, as heretofore, inadvance of systematic knowledge or method.On the other hand, the metaphysician deals with man as anabstract or ideal being, postulates him as a certain constantquantity, and thereupon confidently enunciates empty propositions. The consequence is, that metaphysics has never madeany advance, but has only appeared in new garb; nor can it intruth advance, unless some great addition is made to the inbornpower of the human mind. It surely argues no little conceit inany one to believe that what Plato and Descartes have not done,he, following the same method, will do. * Plato interrogated hisown mind, and set forth its answers with a clearness, subtlety,and elegance of style that is unsurpassed and unsurpassable;until then the very unlikely event of a better mind than hismaking its appearance, his system may well remain as theadequate representative of what the metaphysical method canaccomplish. Superseded by a more fruitful method, it is practically obsolete; and its rare advocate, when such an one isfound, may be said, like the Aturian parrot of which Humboldttells , to speak in the language of an extinct tribe to a peoplewhich understand him not. †But the method of interrogating self-consciousness may beemployed, and is largely employed, without carrying it to ametaphysical extreme. Empirical psychology, founded on direct"It would be an unsound fancy and self-contradictory, to expect that thingswhich have never yet been done can be done, except by means which have neveryet been tried. "-Nov. Org. Aphorism vi."There still lives, and it is a singular fact, an old parrot in Maypures whichcannot be understood, because, as the natives assert, it speaks the language of theAtures an extinct tribe of Indians, whose last refuge was the rocks of thefoaming cataract of the Orinoco. "-HUMBOLDT, Views of Nature, i. p. 172.10 ON THE METHOD OF [ CHAP.consciousness as distinguished from the transcendental consciousness on which metaphysics is based, claims to give a faithfulrecord of our different states of mind and their mutual relations,and has been extravagantly lauded, by the Scotch school, as aninductive science. Its value as a science must plainly rest uponthe sufficiency and reliability of consciousness as a witness ofthat which takes place in the mind. Is the foundation thensufficiently secure? It may well be doubted; and for thefollowing reasons: —(a.) There are but few individuals who are capable of attendingto the succession of phenomena in their own minds; such introspection demanding a particular cultivation, and being practisedwith any degree of, or pretence to, success by those only whohave learned the terms, and been imbued with the theories, ofthe system of psychology supposed to be thereby established.And with what success?(b. ) There is no agreement between those who have acquiredthe power of introspection: and men of apparently equal cultivation and capacity will, with the utmost sincerity and confidence, lay down directly contradictory propositions. It is notpossible to convince either opponent of error, as it might be in amatter of objective science, because he appeals to a witnesswhose evidence can be taken by no one but himself, and whoseveracity, therefore, cannot be tested. He brings forward thefactitious deliverances of his individual consciousness, but no factwhich is capable of being demonstrated to another mind.(c.) To direct consciousness inwardly to the observation of aparticular state of mind is to isolate that activity for the time, tocut it off from its relations, and, therefore, to render it unnaturalIn order to observe its own action , it is necessary that the mindpause from activity; and yet it is the train of activity that is tobe observed. As long as you cannot effect the pause necessaryfor self- contemplation, there can be no observation of the currentof activity if the pause is effected, then there can be nothingto observe. This cannot be accounted a vain and theoreticalobjection, for the results of introspection too surely confirm itsvalidity: what was a question once is a question still, andinstead of being resolved by introspective analysis is only fixedand fed. (2)

1. ] THE STUDY OF MIND. 11(d.) The madman's delusion is of itself sufficient to exciteprofound distrust, not only in the objective truth, but in thesubjective worth, of the testimony of an individual's self- consciousness. Descartes laid down the test of a true belief to bethat which the mind could clearly and distinctly conceive: ifthere is one thing more clearly and distinctly conceived thananother, it is commonly the madman's delusion. No marvel,then, that psychologists, since the time of Descartes, have heldthat the veracity of consciousness is to be relied upon only undercertain rules, from the violation of which, Sir W. Hamiltonbelieved, the contradictions of philosophy have arisen. On whatevidence, then, do the rules rest? Either on the evidence ofconsciousness, whence it happens that each philosopher and eachlunatic has his own rules, and no advance is made; or upon theobservation and judgment of mankind, to confess which is verymuch like throwing self-consciousness overboard - not otherwisethan as was advantageously done by positive science when thefigures on the thermometer, and not the subjective feelings ofheat or cold, were recognised to be the true test of the individual's temperature.It is not merely a charge against self-consciousness that it isnot reliable in that of which it does give information; but it isa provable charge against it that it does not give any accountof a large and important part of our mental activity: its lightreaches only to states of consciousness, not to states of mind.Its evidence, then, is not only untrustworthy save under conditions which it nowise helps us to fix, but it is of little value,because it has reference only to a small part of that for which itstestimony is invoked. May we not then justly say that selfconsciousness is utterly incompetent to supply the facts for thebuilding up of a truly inductive psychology? Let the followingreasons further warrant the assertion:-1. It is the fundamental maxim of the inductive philosophythat observation should begin with simple instances, ascentbeing made gradually from them through appropriate generalizations, and that no particulars should be neglected. How doesthe interrogation of self-consciousness fulfil this most just demand? It is a method which is applicable only to mind at ahigh degree of development, so that it perforce begins with those12 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 development, so that it ignores those simpler instances which give thebest or securest information. In this it resembles the philosopherwho, while he gazed upon the stars, fell into the water; "for if,"as Bacon says, " he had looked down, he might have seen the starsin the water, but, looking aloft, he could not see the water in thestars." (3) Where has the animal any place in the accepted systemof psychology? or the child, the direction of whose early mentaldevelopment is commonly decisive of its future destiny? Tospeak of induction where so many important instances are neglected, and others are selected according to caprice or the easeof convenience, is to rob the word of all definite meaning, andmost mischievously to misuse it. A psychology which is trulyinductive must follow the order of nature, and begin where mindbegins in the animal and infant, gradually rising thence to thosehigher and more complex mental phenomena which the introspective philosopher discerns or thinks he discerns. Certainlyit may be said, and it has been said, that inferences as to themental phenomena of the child can be correctly formed from thephenomena of the adult mind. But it is exactly because sucherroneous inferences have been made, that the mental phenomenaof the child have been misunderstood and misinterpreted, and¸that psychology has not received the benefit of the correctionwhich a faithful observation of them would have furnished. Itwas the physiologist who by a careful observation of the loweranimals, " having entered firmly on the true road, and submittinghis understanding to things," arrived at generalizations whichwere found to explain many of the mental phenomena of thechild, and which have furthermore thrown so much light uponthe mental life of the adult. The careful study of the genesis ofmind is as necessary to a true knowledge of mental phenomenaas the study of its plan of development confessedly is to anadequate conception of the bodily life.Again, it might be thought a monstrous mistake of nature tohave brought forth so many idiots and lunatics, seeing thatthe introspective psychologists, though making a profession ofinduction with their lips, take no notice whatever of the largecollection of instances afforded by such unwelcome anomalies.1.] THE STUDY OF MIND. 13Certainly it may be said, and no doubt it has been said, that themental phenomena of the idiot or lunatic are morbid, and do not,therefore, concern psychology. It is true that they do not concern a psychology which violently separates itself from nature.But it is exactly because psychology has thus unwarrantablysevered itself from nature-of which the so-called morbid phenomena are no less natural a part than are the phenomena ofhealth-that it has not sure foundations; that it is not inductive;that it has not received the benefit of the corrective instanceswhich a faithful observation of the unsound mind would haveafforded. In reality the phenomena of insanity, presenting avariation of conditions which cannot be produced artificially—the instantia contradictoria-furnish what in such matter oughtto have been seized with the utmost eagerness; namely, actualexperiments well suited to correct false generalization and toestablish the principles of a truly inductive science. The lawsof mental action are not miraculously changed nor reversed inmadness, though the conditions of their operation are different;and nature does not recognise the artificial and ill- starreddivisions which men, for the sake of convenience, and notunfrequently in the interests of ignorance, make.2. Consciousness gives no account of the essential materialconditions which underlie every mental manifestation, and determine the character of it; let the function of an individual'soptic ganglia be abolished by disease or otherwise, and he wouldnot be conscious that he was blind until experience had convinced him of it. On grounds which will not easily be shakenit is now indeed admitted, that with every display of mentalactivity there is a correlative change or waste of nervouselement; and on the condition of the material substratum mustdepend the degree and character of the manifested energy or themental phenomenon. Now the received system of psychologygives no attention to these manifold variations of feeling in thesame individual, which are due to temporary modifications of thebodily state, and by which the ideas of the relations of objectsto self and to one another are so greatly influenced . The qualityof the ideas which arise in the mind under certain circ*mstances,the whole character indeed of our insight at the time, is notablydetermined in great part by the feeling which may then have14 ON THE METHOD OF [ CHAPsway; and that feeling is not always objectively caused, but maybe entirely due to a particular bodily condition, as the dailyexperience of every one may convince him, and as the earlierphenomena of insanity often illustrate in a striking manner.Again, Bacon long ago set down individual psychology as wanting; and insisted on a scientific and accurate dissection of mindsand characters, and the secret dispositions of particular men, so"that from the knowledge thereof better rules may be framed forthe treatment of the mind." ( ) As far as the present psychologyis concerned, the individual might have no existence in nature;he is an inconvenience to a system which, in neglecting theindividual constitution or temperament, ignores another largecollection of valuable instances. As far as truth is concerned,however, the individual is of some moment, seeing that he oftenpositively contradicts the principles arbitrarily laid down by atheoretical system.When the theologist, who occupies himself with the supersensuous, has said all that he has to say from his point of view;when the jurist, who represents those principles which thewisdom of society has established, has in turn exhaustivelyargued from his point of view, -then the ultimate appeal in aconcrete case must be to the physician, who deals with the bodilylife; through his ground only can the theologist and jurist passto their departments; and they must accept their knowledge ofit from him: on the foundation of facts which the faithful investigation of the bodily nature lays, must rest , if they are to restsafely, their systems. Certainly it is not probable that this mostdesirable and inevitable result will come to pass in this day orgeneration; for it is not unknown how slowly the light of knowledge penetrates the thick fogs of ignorance, nor how furiouslyirritated prejudice opposes the gentle advent of new truth. Happily, it is certain that in the mortality of man lies the salvationof truth.3. There is an appropriation of external impressions by themind or brain, which regularly takes place without any, or onlywith a very obscure, affection of consciousness. As the variousorgans of the body select from the blood the material suitable totheir nourishment, and assimilate it, so the organ of the mindunconsciously appropriates, through the inlets of the senses, the1.] THE STUDY OF MIND. 15influences of its surroundings. The impressions which it thusreceives and retains do not produce definite ideas and feelings,but they nevertheless permanently affect the mind's nature; sothat as an individual consciously provides his food, and thenleaves the due assimilation of it to the unconscious action of theorganism, in like manner may he consciously arrange the circ*mstances in which he will live, but cannot then prevent theunconscious assimilation of their influence, and the corresponding modification of his character. Not only slight habits ofmovement are thus acquired, but habits of thought and feelingare imperceptibly organized; so that an acquired nature mayultimately govern one who is not at all conscious that he haschanged. Let any one take careful note of his dreams, and hewill find that many of the seemingly unfamiliar things withwhich his mind is then occupied, and which appear to be newand strange productions, are traceable to the unconscious appropriations of the day. There are other stories on record like thatwell-known one which Coleridge quotes of the servant-girl who,in the ravings of fever, repeated long passages in the Hebrewlanguage, which she did not understand, and could not repeatwhen well, but which, when living with a clergyman, she hadheard him read aloud. The remarkable memories of certainidiots, who, utterly destitute of intelligence, will repeat thelongest stories with the greatest accuracy, testify also to this unconscious cerebral action; and the way in which the excitementof a great sorrow, or some other cause, as the last flicker of departing life, will sometimes call forth in idiots manifestations ofmind of which they always seemed incapable, renders it certainthat much is unconsciously taken up by them which cannot beuttered, but which leaves its relics in the mind.It is a truth which cannot be too distinctly borne in mind,that consciousness is not co-extensive with mind. From thefirst moment of its independent existence the brain begins toassimilate impressions from without, and to react thereto incorresponding organic adaptations; this it does at first without• " A Lutheran clergyman of Philadelphia informed Dr. Rush that Germansand Swedes, of whom he had a considerable number in his congregation, whennear death, always prayed in their native language, though some of them, he wasconfident, had not spoken the language for fifty or sixty years. "-ABERCROMBIE,On the Intellectual Powers, p. 148.16 ON THE METHOD OF [ CHAP.consciousness, and this it continues to do unconsciously moreor less throughout life. Thus it is that mental power is beingorganized before the supervention of consciousness, and that themind is subsequently regularly modified as a natural processwithout the intervention of consciousness. The preconsciousaction of the mind, as certain metaphysical psychologists inGermany have called it, and the unconscious action of the mind,which is now established beyond all rational doubt, are assuredlyfacts of which the most ardent introspective psychologist mustadmit that self- consciousness can give us no account.4. Everything which has existed with any completeness in consciousness is preserved, after its disappearance therefrom, in themind or brain, and may reappear in consciousness at some futuretime. That which persists or is retained has been differentlydescribed as a residuum, or relic, or trace, or vestige, or again aspotential, or latent, or dormant idea; and it is on the existenceof such residua that memory depends. Not only definite ideas,however, but all affections of the nervous system, feelings ofpleasure and pain, desires, and even its outward reactions, thusleave behind them their residua, and lay the foundations of modesof thought, feeling, and action. Particular talents are sometimesformed quite, or almost quite, involuntarily; and complex actions,which were first consciously performed by dint of great application, become by repetition automatic; ideas, which were at firstconsciously associated, ultimately call one another up withoutany consciousness, as we see in the quick perception or intuitionof the man of large worldly experience; and feelings, once active,leave behind them their unconscious residua, thus affecting thegeneral tone of the character, so that, apart from the originalor inborn nature of the individual, contentment, melancholy,cowardice, bravery, and even moral feeling, are generated as theresults of particular life experiences. Consciousness is not ableto give any account of the manner in which these various residuaare perpetuated, and how they exist latent in the mind; but afever, a poison in the blood, or a dream, may at any moment recallideas, feelings, and activities which seem for ever vanished. Thelunatic sometimes reverts, in his ravings, to scenes and events ofwhich, when in his sound senses, he has no memory; the feverstricken patient may pour out passages in a language which he1.] THE STUDY OF MIND. 17understands not, but which he has accidentally heard; a dreamof being at school again brings back with painful vividness theschool feelings; and before him who is drowning every eventof his life seems to flash in one moment of strange and vividconsciousness. Some who suffer from recurrent insanity remember only, in their lucid intervals, the facts of former lucidintervals, and in their paroxysms the ideas, feelings, and eventsof former paroxysms. Dreams not remembered in the wakingstate may yet affect future dreams, appearing in them as vagueand confused recollections.It has been before said that mind and consciousness are notsynonymous; it may now be added, that the existence of minddoes not necessarily involve the activity of mind. Descartescertainly maintained that the mind always thinks; and others,resting on that assumption, have held that we must alwaysdream in sleep, because the mind, being spiritual, cannot ceaseto act; for non-activity would be non- existence. Such opinionsonly illustrate how completely metaphysical conceptions mayoverrule the best understanding: so far from the mind beingalways active, it is the fact that at each moment the greater partof the mind is not only unconscious, but inactive. Mental powerexists in statical equilibrium as well as in manifested energy;and the utmost tension of a particular mental activity may notavail to call forth from their secret repository the dormant energies of latent residua, even when most urgently needed: no mancan call to mind at any moment the thousandth part of hisknowledge. How utterly helpless is consciousness to give anyaccount of the statical condition of mind! But as statical mindis in reality the statical condition of the organic element whichministers to its manifestations, it is plain that, if we ever areto know anything of inactive mind, it is to the progress ofphysiology that we must look for information.5. Consciousness reveals nothing of the process by which oneidea calls another into activity, and has no control whatever overthe manner of the reproduction; it is only when the idea is madeactive by virtue of some association , when the effect solicits orextorts attention, that we are conscious of it; and there is nopower in the mind to call up ideas indifferently. If we wouldrecollect something which at the moment escapes us, confessedlyC18 ON THE METHOD OF [CHAP.the best way of succeeding is to permit the mind to workunconsciously; and while the consciousness is otherwise occupied, the forgotten name or circ*mstance will oftentimes flashinto the memory. In composition, the writer's consciousness isengaged chiefly with his pen and with the sentences which he isforming, while the results of the mind's unconscious working,matured by an insensible gestation, rise from unknown depthsinto consciousness , and are by its help embodied in appropriatewords.Not only is the actual process of the association of our ideasindependent of consciousness, but that assimilation or blendingof similar ideas, or of the like in different ideas, by which generalideas are formed, is in no way under the control or cognizance ofconsciousness. When the like in two perceptions is appropriated,while that in which they differ is neglected, it would seem to beby an assimilative action of the nerve- cell or cells of the brainwhich, particularly modified by the first impression, have anattraction or affinity for a like subsequent impression: the cellso modified and so ministering takes to itself that which is suitable and which it can assimilate, or make of the same kind withitself, while it rejects, for appropriation by other cells, that whichis unlike and which will not blend. Now this organic processtakes place, like the organic action of other elements of the body,quite out of the reach of consciousness; we are not aware howour general and abstract ideas are formed; the due material isconsciously supplied, and there is an unconscious elaboration ofthe result. Mental development thus represents a sort of nutrition and organization; or, as Milton aptly says of the opinionsof good men that they are truth in the making, so we may trulysay of the formation of our general and complex ideas, that it ismind in the making. When the individual brain is a well-constituted one, and has been duly cultivated, the results of its latentactivity, starting into consciousness suddenly, sometimes appearlike intuitions; they are strange and startling, as the productsof a dream ofttimes are, to the mind which has actually producedthem. Hence it was no extravagant fancy in Plato that he lookedupon themas reminiscences of a previous higher existence. Plato'smind was a mind of the highest order, and the results of itsunconscious activity, as they flashed into consciousness, might1.]THE STUDY OF MIND. 19well seem intuitions of a better life quite beyond the reach ofpresent will.But the process of unconscious mental elaboration is sufficiently illustrated in daily experience. In dreams some cancompose vigorously and fluently, or speak most eloquently, whocan do nothing of the sort when awake; schoolboys know howmuch a night's rest improves their knowledge of a lesson whichthey have been learning before going to bed; great writers orgreat artists, as is well known, have been truly astonished attheir own creations, and cannot conceive how they contrived toproduce them; and to the unconscious action of the mind isowing, most probably, that occasional sudden consciousness, whichalmost every one at some time has, of having been before inexactly the same circ*mstances as those which are then present,though the thing was impossible; but the action of the mindin the assimilation of events here anticipates consciousness,which, when aroused, finds a familiarity in them. Inventionsseem, even to the discoverers, to be matters of accident and goodfortune; the most voracious plagiarist is commonly the mostunconscious; the best thoughts of an author are always theunwilled thoughts which surprise himself; and the poet underthe inspiration of creative activity is, so far as consciousness isconcerned, being dictated to. If we reflect, we shall see that itmust be so; the products of creative activity, in so far as theytranscend the hitherto experienced, are unknown to the creatorhimself before they come forth, and cannot therefore be theresult of a definite act of his will; for to an act of will a conception of the result is necessary. " The character," says JeanPaul, speaking of the poet's work, " must appear living beforeyou, and you must hear it, not merely see it; it must, as takesplace in dreams, dictate to you, not you to it; and so much sothat in the quiet hour before you might perhaps be able to foretell the what but not the how. A poet who must reflect whetherin a given case he shall make a character say yes or no-to thedevil with him he is only a stupid corpse.'"If an inherited excellence of brain has conferred upon the individual great inborn capacity, it is well; but if he has not suchheritage, then no amount of conscious effort will completely make

• Aesthetik.

€ 220 ON THE METHOD OF [СПАР.up for the defect. As in the germ of the higher animal there isthe potentiality of many kinds of tissue, while in the germ of thelower animal there is only the potentiality of a few kinds oftissue; so in the good brain of a happily endowed man, there isthe potentiality of great assimilation and of great and varied development, while in the man of low mental endowment there isonly the potentiality of a scanty assimilation and of small development. But it is ridiculous to suppose that the man of geniusis ever a fountain of self-generating energy; whosoever expendsmuch in productive activity must take much in by appropriation;whence comes what of truth there is in the observation thatgenius is a genius for industry. To believe that any one, howgreat soever his natural genius, can pour forth with spontaneousease the results of great productive activity, without corresponding labour in appropriation, is no less absurd than it would be tobelieve that the acorn can grow into the mighty monarch of theforest, without air and light, and without the kindly influence ofthe soil.It has been previously said that mental action does not necessarily imply consciousness, and again, that mental existence doesnot necessarily involve mental activity: it may now be affirmedthat the most important part of mental action, the essential process on which thinking depends, is unconscious mental activity.We repeat, then, the question: how can self-consciousness sufficeto furnish the facts of a true mental science?6. The brain not only receives impressions unconsciously,registers impressions without the co-operation of consciousness,elaborates material unconsciously, calls latent residua again intoactivity without consciousness, but it responds also as an organof organic life to the internal stimuli which it receives unconsciously from other organs of the body. As the central organ towhich the various organic stimuli of a complex whole pass, andwhere they are duly co-ordinated, it must needs have most important and intimate sympathies with the other parts of theharmonious system; and a regular quiet activity, of which weonly become occasionally conscious in its abnormal results, doesprevail, as the consequence and expression of these organic sympathies. On the whole, this activity is even of more consequencein determining the character of our feeling, or the tone of our1. ] THE STUDY OF MIND. 21disposition, than that which follows impressions received fromthe external world; when disturbed in a painful way, it becomesthe occasion of that feeling of gloom or discomfort which does notit*elf give rise to anything more than an indefinite anticipationof coming affliction, but which clouds ideas that arise, renderingthem obscure, unfaithfully representative, and painful. Therapidity and success of conception, and the reaction of one conception upon another, are much affected by the state of this active.but unconscious cerebral life: the poet is compelled to wait forthe moment of inspiration; and the thinker, after great but fruitless pains, must often tarry until a more favourable disposition ofmind. In insanity, the influence of this activity is most marked;for it then happens that the morbid state of some internal organbecomes the basis of a painful but formless feeling of profounddepression, which ultimately condenses into some definite delusion. In dreams its influence is no less manifest; for he whohas gone to sleep with a disturbance of some internal organ mayfind the character of his dreams determined by the feeling ofthe oppression of self of which the organic trouble is the cause:he is thwarted, he is afflicted, he is at school again, or undersentence of death; in some way or other his personality isoppressed. Most plainly of all, however, does the influence ofthe sexual organs upon the mind witness to this operation; andit was no wild flight of " that noted liar fancy" in Schlegel, but atruly grounded creation of the imagination, that he representeda pregnant woman as being visited every night by a beautifulchild, which gently raised her eyelids and looked silently at her,but which disappeared for ever after delivery. * Whatever thenmay be thought of the theory of Bichat, who located the passionsin the organs of organic life, it must be admitted that he thereinevinced a just recognition of the importance of that unconsciouscerebral activity which is the expression of the organic sympathies of the brain.In dealing with unconscious mental activity, and with mindin a statical condition, it has been a necessity to speak of brain"In Schlegels-viel zu wenig erkanntem-Florentin sieht eine Schwangereimmer ein schönes Wunderkind, das mit ihr Nachts die Augen aufschlägt, ihrstumm entgegen läuft u. s. w. und welches unter der Entbindung auf immerverschwindet. "-JEAN PAUL, Aesthetik.22 ON THE METHOD OF [CHAP.and cerebral action, where I would willingly, to avoid offencethat might be taken thereat, have spoken, had it been possible,of mind and mental action; but it was impossible, if one was tobe truthful and intelligible, to do otherwise. When the important influence on mental life of the brain, as an organ of organiclife, comes to be considered, there are no words available forexpressing the phenomena in the language of the receivedpsychology, which, though it admits the brain to be the organ ofthe mind, takes no notice whatever of it as an organ. Let usbriefly add, then, what the relations of the brain as a bodilyorgan are.1. The brain has, as previously set forth, a life of relation;which may be properly distinguished into-( a) a relation withexternal nature through the inlets of the senses; and (b) a relation with the other organs of the body, through the nervoussystem distributed throughout the body. These have alreadybeen sufficiently dwelt upon here; they will receive fuller attention afterwards.2. But the brain has also a life of nutrition, or, if we might socall it, a vegetative life. In this, its true organic life, there is anutritive assimilation of suitable material from the blood by thenerve-cell; a restoration of the statical equilibrium being therebyeffected after each display of energy. The extent of the nutritive repair, and the mould which it takes, must plainly be determined by the extent and form of the waste which has been thecondition of the display of function: the material change orwaste in the nerve- cell, which the activity of an idea implies, isreplaced from the blood according to the mould or pattern of theparticular idea; statical idea thus following through the agencyof nutritive attraction upon the waste through functional repulsion of active idea. The elements of the nerve-cell grow to theform in which it energizes. This organic process of repair isnot usually attended with consciousness, and yet it may obtrudeitself into consciousness: as the function of any organ, whichproceeds, when all is well, without exciting any sensation, does,under conditions of disorder, give rise to unusual sensation or toactual pain; so the organic life of the brain, which usually passespeaceably without exciting consciousness, may under certainconditions thrust itself forward into consciousness and produce1.] THE STUDY OF MIND. 23anomalous effects. When this happens, the abnormal effect isnot manifest in sensation, for the hemispheres of the brain, asphysiologists well know, are not sensitive in that sense; but itis displayed in the involuntary appearance of emotional ideasin consciousness, and in consequent confusion of thought; thestatical idea becomes energy, not through the usual train of association, but by reason of the abnormal stimulus from the innerlife. Thus it is that the presence of alcohol, or some othersuch foreign agent, in the blood will excite into activity ideaswhich lie out of the usual path of association, which the utmosttension of consciousness would fail to arouse, and which thewill cannot repress nor control. Whosoever will be at the painsof attending to his own daily experience will find that ideasfrequently arise into consciousness without any apparent relationto those previously active; without, in fact, any possibility of explaining, quoad consciousness, why and whence they come. (5)To what has been before said of unconscious mental actionthis more may now be added-that the deep basis of all mentalaction lies in the organic life of the brain, the characteristic ofwhich in health is, that it proceeds without consciousness. Hewhose brain makes him conscious that he has a brain is not well,but ill; and thought that is conscious of itself is not natural andhealthy thought. How little competent, then, is consciousnessto supply the facts of an inductive science of mind! Pneumatology was at one time subdivided into theology, demonology, andpsychology; all three resting on the evidence of the inner witness. Demonology has taken its place in the history of humanerror and superstition; theology is confessedly now best supported by those who strive to ascend inductively from nature'slaw 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 ancientauthority and state. On what foundation can a science of mindsurely rest save on the faithful observation of all availableinstances, whether psychical or physiological?Why, however, it will naturally be asked, repudiate and disparage introspective psychology, now that it evinces some disposition to abandon its exclusive mode of procedure and to profitby the discoveries of physiology? Because the union, as desired24 ON THE METHOD OF [CHAP.by it, is an unnatural and unhallowed union, which can onlyissue in abortions or give birth to monsters; not otherwise thanas Ixion, designing impiously to embrace Juno, had intercoursewith the clouds and begat centaurs. It is not a mere skimmingof physiological text-books, and a superficial acquaintance withthe nature and functions of the nervous system, which will putmeaning into the vague and abstract language of psychology;that would simply be to subject physiology to the tortures ofMezentius-to stifle the living in the embraces of the dead; butit is a sound general knowledge of the whole domain of organization, at the head of which stands the nervous system, and thefinal achievement of which is mind, that is indispensably prerequisite to the formation of fundamentally true conceptions ofmental phenomena on a physiological basis. These conceptions,thus vitally impregnated, and the language in which they areexpressed, cannot be reconciled with the language of psychology,which, borrowed at first from observation of the senses, has nowbecome so abstract and been so depraved by its divorce fromnature, as to be empty of real meaning. Words! words! words!but what an aching vacuum of matter! The question betweenmodern physiology and the old psychology, is not a question ofeclectic appropriation by the latter of the discoveries of theformer, but a fundamental question of method of study.Such are the charges against self- consciousness whereon isfounded the conclusion as to its incompetency: they show thathe who thinks to illuminate the whole range of mental action bythe light of his own consciousness is not unlike one who shouldgo about to illuminate the universe with a rushlight. A reflection on the true nature of consciousness will surely tend to confirm that opinion. Whoever faithfully and firmly endeavours toobtain a definite idea of what is meant by consciousness, willfind it nowise so easy a matter as the frequent and ready use ofthe word might imply. Metaphysicians, faithful to the vagueness 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 metaphysician uses theword in two or three different senses in different parts of hisbook: Sir W. Hamilton uses it at one time as synonymous withmind, at another time as synonymous with knowledge, and at1.]THE STUDY OF MIND. 25another time to express a condition of mental activity. Thatthere should be such little certainty about that upon which theirphilosophy fundamentally rests must be allowed to be no smallmisfortune to the metaphysicians.What consciousness is will appear better if its relations beclosely examined without prejudice. It will then appear that itis not separable from knowledge; that it exists only as a part ofthe concrete mental act; that it has no more power of withdrawing from the particular phenomenon and of taking full and fairobservation of it, than a boy has of jumping over his own shadow.Consciousness is not a faculty or substance, but a quality orattribute of the concrete mental act; and it may exist in different degrees of intensity or it may be absent altogether. In sofar as there is consciousness, there is certainly mental activity;but it is not true that in so far as there is mental activity thereis consciousness; it is only with a certain intensity of representation or conception that consciousness appears. What else, then,is the so- called interrogation of consciousness but a self-revelation of the particular mental act, whose character it must needsshare? Consciousness can never be a valid and unprejudicedwitness; for although it testifies to the existence of a particularmental modification, yet when that modification has anythingof a morbid character, consciousness is affected by the taint andis morbid also. Accordingly, the lunatic appeals to the evidenceof his own consciousness for the truth of his hallucination ordelusion, and insists that he has as sure evidence of its reality ashe has of the argument of any one who may try to convince himof his error: and is he not right from a subjective standpoint?To one who has vertigo the world turns round. A man may easilybe conscious of freewill when, isolating the particular mentalact, he cuts himself off from the consideration of the causeswhich have preceded it, and on which it depends. "There is noforce," says Leibnitz, " in the reason alleged by Descartes toprove the independence of our free actions by a pretended livelyinternal sentiment. It is as if the needle should take pleasurein turning to the north; for it would suppose that it turnedindependently of any other cause, not perceiving the insensiblemotions of the magnetic matter. "* Is it not supremely ridicuEssais de Théodicée, Pt. I.26 ON THE METHOD OF [CHAP.lous that, while we cannot trust consciousness in so simple amatter as whether we are hot or cold, we should be content torely entirely on its evidence in the complex phenomena of ourhighest mental activity? The truth is, that what has very oftenhappened before has happened here: the quality or attribute hasbeen abstracted from the concrete, and the abstraction convertedinto an entity; the attribute, consciousness, has miraculously gotrid of its substance, and then with a wonderful assurance assumed the office of observing and passing judgment upon itsnature from a higher region of being. Descartes was in thiscase the clever architect; and his success has fully justifiedhis art while the metaphysical stage of human developmentlasts, his work will doubtless endure.That the subjective method-the method of interrogating selfconsciousness -is not adequate to the construction of a truemental 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 competentmen, be very useful. D'Alembert compares Locke to Newton, andmakes it a special praise to him that he was content to descendwithin, and that, after having contemplated himself for a longwhile, he presented in his " Essay" the mirror in which he hadseen himself; " in a word, he reduced psychology to that whichit should be, the experimental physics of the mind. " But it wasnot because of this method, but in spite of it, that Locke wasgreatly successful; it was because he possessed a powerful andwell-balanced mind, the direct utterances of which he sincerelyexpressed, that the results which he obtained, in whatevernomenclature they may be clothed, are and always will be valuable; they are the self- revelations of an excellently constitutedand well- trained mind. The insufficiency of the method used isproved by the fact that others adopting it, but wanting his soundsense, directly contradicted him at the time, and do so still.Furthermore, Locke did not confine himself to the interrogationof his own consciousness; for he introduced the practice-forwhich Cousin was so angry with him-of referring to savagesand children. And we may take leave to suggest that the mostvaluable part of Locke's psychology, that which has been alasting addition to knowledge, really was the result of the1.] THE STUDY OF MIND. 27employment of the inductive or rather objective method. * Naymore: if any one will be at the pains to examine into the historyof the development of psychology up to its present stage, he maybe surprised to find how much the important acquisitions of newtruth and the corrections of old errors have been due, not to theinterrogation of self-consciousness, but to external observation ,though it was not recognised as a systematic method. The pasthistory of psychology-its instinctive progress, so to speak-noless than the consideration of its present state, proves thenecessity of admitting the objective method.That which a just reflection incontestably teaches, the presentstate of physiology practically illustrates. Though very imperfect as a science, physiology is still sufficiently advanced toprove that no psychology can endure except it be based upon itsinvestigations. Let it not, moreover, be forgotten, as it is so aptto be, that the divisions in our knowledge are artificial; thatthey should be accepted, and used rather, as Bacon says, "forlines to mark or distinguish, than sections to divide and separate;in order that solution of continuity in sciences may always beavoided. " Not the smallest atom that floats in the sunbeam,nor the minutest molecule that vibrates within the microcosm ofan organic cell, but is bound as a part of the mysterious whole inan inextricable harmony with the laws by which planets move intheir appointed orbits, or with the laws which govern the marvellous creations of godlike genius. Above all things it is nownecessary that the absolute and unholy barrier set up betweenpsychical and physical nature be broken down, and that a justconception of mind be formed, founded on a faithful recognitionof all those phenomena of nature which lead by imperceptiblegradations up to this its highest evolution. Happily the beneficialchange is being gradually effected, and ignorant prejudice oroffended self-love in vain opposes a progress in knowledge whichreflects the course of progress in nature: the stars in theircourses fight for such truth, and its angry adversary might aswell hope to blow out with his pernicious breath the all-inspiringlight 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 objectively + De Augmentis Scientiarum, B. iv. .28 ON THE METHOD OF [ CHAP.•furnish the complete data of a positive mental science all thatit 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 ofour ignorance, and to maintain that physiology never will securelyfix the foundations of a mental science, just as it was easy to say,before the invention of the telescope, that the ways of the planetscould never be traced and calculated. The confident dogmatistin this matter might well learn caution from an instructiveexample of the rash error of a greater philosopher than he canclaim or hope to be:-" It is the absurdity of these opinions,"said Bacon, "that has driven men to the diurnal motion of theearth; which, I am convinced, is most false." What should fairlyand honestly be weighed is, that mind is the last, the highest, theconsummate evolution of nature's development, and that, therefore, it must be the last, the most complex, and most difficultobject of human study. There are really no grounds for expecting a positive science of mind at present; for to its establishment the completion of the other sciences is necessary; and,as is well known, it is only lately that the metaphysical spirithas been got rid of in astronomy, physics, and chemistry, andthat these sciences, after more than two thousand years of idleand shifting fancies, have attained to certain principles. Stillmore recently has physiology emerged from the fog, and thisfor obvious reasons: in the first place it is absolutely dependentupon the physical and chemical sciences, and must, therefore,wait for the progress of them; and, in the second place, its closerelations to psychology have tended to keep it the victim of themetaphysical spirit. That, therefore, which should be in thismatter 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 dealsonly with one ( I. ) division of the matter to which the objectivemethod is to be applied; there are other divisions not lessvaluable:-II. The study of the plan of development of mind, as exhibitedin the animal, the barbarian, and the infant, furnishes results ofthe greatest value, and is as essential to a true mental science asthe study of its development confessedly is to a full knowledgeDe Augmentis Scientiarum, B. iii .1] THE STUDY OF MIND. 29of the bodily organism. By that means we get at the deep andtrue relations of phenomena, and are enabled to correct theerroneous inferences of a superficial observation; by examinationof the barbarian, for example, we eliminate the hypocrisy whichis the result of the social condition, and which is apt to misleadus in the civilized individual.III. The study of the degeneration of mind, as exhibited in thedifferent forms of idiocy and insanity, is indispensable as it isinvaluable. So we avail ourselves of the experiments providedby nature, and bring our generalizations to a most searching test.Hitherto the phenomena of insanity have been entirely ignoredby psychologists and most grievously misinterpreted by the vulgar, because interpreted by the false conclusions of a subjectivepsychology. Had not the revelations of consciousness in dreamsand in delirium been constantly neglected by the professed inductive psychologists, truer generalizations must perforce havebeen formed ere this, and fewer irresponsible lunatics would havebeen executed as responsible criminals. Why those who put somuch faith in the subjective method do reject such a large andimportant collection of instances as dreams and madmen furnish,they have never thought proper to explain.IV. The study of biography and of autobiography, which hasalready been described as the application of positive science tohuman life, will plainly afford essential aid in the formation of apositive science of mind. Thus we trace the development ofthe mind in the individual as affected by hereditary influences,education, and the circ*mstances of life. Concerning autobiographies, however, it will not be amiss to bear in mind anobservation made by Feuchtersleben, that "they are only ofvalue to the competent judge, because we must see in them notso 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 beneglected by one who wishes to be thoroughly equipped for thearduous work of constructing a positive mental science. Theunhappy tendencies which lead to individual error and degeneration are those which on a national scale conduct peoples todestruction; and the nisus of an epoch is summed up in the30 ON THE METHOD OF [CHAP.biography of its great man. * Freed from the many disturbingconditions which interfere so much with his observation of theindividual, the philosopher may perhaps discover in history thelaws of human progress in their generality and simplicity, asNewton discovered, in the motions of the heavenly bodies, thelaw which he would in vain have looked for had he watched thefall of every apple in Europe. Moreover, in the language,literature, art, and the political, social and religious institutionsof men, there are important materials for the construction of ascience of mind.May we not then truly say that he only is the true psychologist who, occupied with the observation of the whole of humannature, avails himself not alone of every means which scienceaffords for the investigation of the bodily conditions whichassuredly underlie every display of function, conscious or unconscious, but also of every help, subjective or objective, whichis furnished by the mental manifestations of animal and ofman, whether undeveloped, degenerate, or cultivated? Here,as everywhere else in nature, the student must deliberatelyapply himself to a close communion with the external, mustintend his mind to the realities which surround him, and thus,by patient internal adjustment to outward relations, graduallyevolve into conscious development those inner truths which arethe unavoidable expressions of the harmony between himselfand nature. By diligent colligation of facts, patient observationof their relations, and careful consilience of inductions, he willattain to sound generalizations in this as in other departmentsof nature; in no other way can he do so. Of old it was thefashion to try to explain nature from a very incomplete knowledge of man; but it is the certain tendency of advancingscience to explain man on the basis of a perfecting knowledgeof nature.Having fairly admitted a method, it behoves us to take heedthat we are not too exclusive in its application. To this there isa strong inclination: even in the investigation of physical naturemen now frequently write of induction as Bacon himself never"When nature has work to be done, " says Emerson, " she creates a geniusto do it. Follow the great man, and you shall see what the world has at heart inthese ages. There is no omen like that. "1.] THE STUDY OF MIND. 31wrote of it. It might seem, from the usual fashion of speech,that the function of the mind was merely that of a polished andpassive mirror, in which natural phenomena should be allowedsimply to reflect themselves; whereas every state of consciousness is a developmental result of the relation between mind andthe impression, of the subject and object. What Bacon stroveso earnestly to abolish was that method of systematically lookinginto the mind and, by torture of self- consciousness, drawingthence empty ideas, as the spider forms a web out of its ownsubstance, that ill-starred divorce between mind and naturewhich had been cultivated by the Schoolmen as a method.What he wished, on the other hand, to establish was a happymarriage between mind and matter, between subject and object,to prevent the " mind being withdrawn from things farther thanwas necessary to bring into a harmonious conjunction the ideasand the impressions made upon the senses." * For, as he says,

• "Nos vero intellectum longius à rebus non abstrahimus quam ut rerum

imagines et radii ( ut in sensu fit) coire possint. " (Proleg. Instaurat. Magn. ) Thispassage, as usually rendered, is not intelligible; the translation in the text, if notliterally 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 asthe measure of things, while others, equally wrongly, " after having only a littlewhile turned their eyes upon things, and instances, and experience, then straightway, 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. Butwe, " he goes on, “ modestly and perseveringly keeping ourselves conversant amongthings, never withdraw our understanding, " &c. Mr. Spedding, in his admirableedition 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 imagesand 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 themthan is necessary to prevent the confusion of the images of things with theirradiation, a confusion similar to that we experience by our senses. " This is worsestill; ut possint coire means, certainly, " that they may come together, " not " thatthey may not mingle or may be prevented from mingling. " After all, the 95thAphorism furnishes the clearest and surest commentary on the passage-“ Thosewho have treated the sciences were either empirics or rationalists. The empirics,like ants, only lay up stores and use them; the rationalists, like spiders, spinwebs out of themselves; but the bee takes a middle course, gathering hermatter from the flowers of the field and garden, and digesting and preparing itby her native powers. In like manner, that is the true office and work of philosophy which, not trusting too much to the faculties of the mind, does not layup the matter, afforded by natural history and mechanical experience, entire orunfashioned in the memory, but treasures it after being first elaborated and32 ON THE METHOD OF [CHAP.the testimony and information of the senses have referencealways to man, not to the universe; and it is a great error toassert that the sense is the measure of things. But by hismethod of effecting, as completely as possible, a reconciliationbetween the subjective and objective, he hoped to have " established for ever a true and lawful marriage between the empiricaland the rational faculty, the unkind and ill - starred divorce andseparation of which has thrown into confusion all the affairs ofthe human family." The mind that is in harmony with the lawsof nature, in an intimate sympathy with the course of events,is strong with the strength of nature, and is developed byits force.Acontemplation of the earliest stages of human development,as exhibited by the savages, certainly constrains the admissionthat the conscious or designed co-operation of the mind in theadaptation of man to external nature was not great. The factis, however, in exact conformity with what has already beenasserted with regard to the nature and domain of consciousness;assuredly it is not consciousness, the natural result of a duedevelopment, which gives the impulse to development; thiscoming from a source that is past finding out--from the primevalcentral Power which hurled the planets on their courses, andholds the lasting orbs of heaven in their just poise and movement. In virtue of the fundamental impulse of its being,mankind struggles, at first blindly, towards a knowledge of andadaptation to external nature, until that which has been insensibly acquired through generations becomes an inborn additionto the power of the mind, and that which was unconsciouslydone becomes conscious method.It were well, then, that this idea took deep and firm rootdigested in the understanding. And, therefore, we have a good ground of hope,from the close and strict union of the experimental and rational faculty, whichhave not hitherto been united . " In the very place where the obscure passageoccurs, he says, after speaking of the inauspicious divorce usually made betweenmind and nature-" The explanation of which things, and of the true relationbetween the nature of things and the nature of the mind, is as the strewingand decoration of the bridal chamber of the Mind and Universe , the DivineGoodness assisting; out of which marriage let us hope ( and this be the prayerof the bridal song) there may spring helps to man, and a line and race ofinventions that may in some degree subdue and overcome the necessities and miseries of humanity. "1.] THE STUDY OF MIND. 33in our thoughts: that the development of mind, both in theindividual and through generations, is a gradual process of organization-a process in which Nature is undergoing her latestand most consummate development. In reality we do not failvirtually to recognise this in the case of language, whose organicgrowth, as we scientifically trace it, is the result of the unseenorganization of thought that lies beneath, and alone gives itmeaning. His own consciousness, faithfully interpreted, mightsuffice to reveal to each one the gradual maturing, or becoming,through which a process of thought continually goes in hismind. So has it been with mankind: at first there was aninstinctive or pure organic development, the human race struggling on, as the child does, without being conscious of its ego;then, as it reached a certain stage of development, it became, asthe youth does, exceedingly self- conscious, and an extravagantand unhealthy metaphysical subjectivity was the expression ofan undue self-feeling; and finally, as the happily developingindividual passes from an undue subjectivity to a calm objectivemanner of viewing things, so Bacon may be said to mark theepoch of a corresponding happy change in the development ofmankind. Let us entirely get rid, however, of the notion thatthe objective study of nature means merely the sensory perception of it; we see, not with the eye, but through it; and toany one who is above the level of the animal the sun is not abright disc of fire about the size of a cheese, but an immense orbmoving through space with its attendant planetary system atthe rate of some 400,000 miles a day. * Now, such is thewondrous harmony, connexion, and continuity pervading thatmysterious whole which we call Nature, that it is impossible toget a just and clear idea of one pure circle of her works withoutthat idea becoming most useful in flashing a light into obscureand unknown regions, and in thus aiding the conscious establishment of a further harmony of adaptation between man andnature. The brilliant insight or intuition of the man of genius,"We are deluded and led by the fallacies of the senses, for instance, to believethat it is the eye that sees, and the ear that hears; although the eye and the earare only the organs or instruments through which the soul perceives the modesof the ultimate world. " -SWEDENBORG, Animal Kingdom, ii . 336."Denn wo Natur im reinen Kreise waltet ergreifen alle Welten sich. "GOETHE, Faust.D34 ON THE METHOD OF [CHAP.who so often anticipates the slow result of systematic investigation, witnesses with singular force to that truth. Far wiserthan many of his commentators have been, Bacon accordinglyfailed not to appreciate clearly the exceeding value of idea inthe interpretation of nature.But if the due co-operation of the mind is necessary, if theharmony of subjective and objective was Bacon's real method, inthe prosecution of physical science, how much more useful mustthe just union of the empirical and rational faculties be in thestudy of mental science; the task then being to apply the ideasof the mind to the interpretation of the mind's processes ofactivity. It must assuredly be allowed that the light of one'sown train of thought is often most serviceable in interpreting themind of another; so much so, indeed, that one may know whatis passing therein with not less certainty, sometimes even withgreater certainty, than when it is actually uttered. In order tobe successful in this sort of intuition, however, not only goodnatural insight, but a large experience of life and men, is mostnecessary, else the most grievous mistakes may be made; here,as elsewhere, power is acquired by intending the mind to externalrealities, by submitting the understanding to things. Plainly,too, this objective application of our ideas to the interpretationof another mind is a very different matter from the deliberatedirection of consciousness to its own states, -that introspectiveanalysis of the processes of thought whereby, as before said, thenatural train of ideas being interrupted and the tension of aparticular activity maintained, an artificial state of mind is produced, and a tortured self-consciousness, like an individual putto the torture, makes confessions that are utterly unreliable. Thegenuine utterances of his inner life, or the sincere and directrevelations of the man of great natural ability and good training,are the highest truths -what Plato has written is of eternalinterest; but the contradictory anatomical revelations of internalanalysis by the professed psychologists are the vainest wordjugglings with which a tenacious perseverance has vexed a longsuffering 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 isno consciousness of the ego, so in the highest development of1.] THE STUDY OF MIND. 35humanity, as represented by these our greatest, there seems tohave been reached a similar unconsciousness of the ego; and theindividual, in intimate and congenial sympathy with nature,carries forward its organic evolution with a child-like unconsciousness and a child- like success.Before concluding this chapter it may be well distinctly toaffirm a truth which is an unwelcome one, because it flatters notthe self-love of mankind; and it is this, that there is all thedifference in the world between the gifted man of genius, whocan 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, " withmanifold motions making little speed: " it is the differencebetween the butterfly which flies and feeds on honey and thecaterpillar which crawls and gorges on leaves. Men, ever eagerto " pare the mountain to the plain," will not willingly confessthis; nevertheless it is most true. Rules and systems arenecessary for the ordinarily endowed mortals, whose business itis to gather together and arrange the materials; the genius, whois the architect, has, like nature, an unconscious system of hisIt is the fate of its nature, and no demerit, that the caterpillar must crawl: it is the fate of its nature, and no merit, thatthe butterfly must fly. The question, so much disputed, of therelative extent of applicability of the so- called inductive anddeductive methods, often resolves itself into a question as towhat manner of man it is who is to use them-whether one whohas senses only, who has eyes and sees not, or one who has sensesand a soul; whether one who can only collect so- called facts ofobservation, or one who can bind together the thousand scatteredfacts by the organizing idea, and thus guarantee them to be facts.What an offence to the chartered imbecility of industrious mediocrity 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, butrather instruments on which the melody of nature, like spheremusic, was made for the benefit and delectation of such as haveears to hear! That some so virulently declaim against theory isas though the eunuch should declaim against lechery it is thechastity of impotence.D 236 ON THE METHOD OF [CHAP.So rarely, however, does nature produce one of these mengifted with that high and subtile quality called genius-beingscarce, indeed, equal to the production of one in a century—andso self-sufficing are they when they do appear, that we, gratefullyaccepting them as visits of angels, or much as Plato acceptedhis super-celestial ideas, need not vainly concern ourselves abouttheir manner of working. It is not by such anxious troublingthat one will come; it is not by introspective prying into andtorture of its own self-consciousness that mankind evolves thegenius; the mature result of its unconscious development flowsat due time into consciousness with a grateful surprise, and fromtime to time the slumbering centuries are thus awakened. It isby the patient and diligent work at systematic adaptation to theexternal by the rank and file of mankind; it is by the conscientious labour of each one, after the inductive method, in that littlesphere of nature, whether psychical or physical, which in thenecessary division of labour has fallen to his lot-that a condition of evolution is reached at which the genius bursts forth.Tiresome, then, as the minute man of observation may sometimesseem as he exults over his scattered facts as if they were final ,and magnifies his molecules into mountains as if they wereeternal, it is well that he should thus enthusiastically esteem hiswork; and no one but will give a patient attention as he reflectshow 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 painfulsurprise of the man of observation , his jealous indignation andclamorous outcry, when the result at which he and his fellowlabourers have been so patiently, though blindly, workingwhen the genius- product of the century which he has helped tocreate, starts into life -when the metamorphosis is completed:amusing, because the patient worker is supremely astonished ata result which, though preparing, he nowise foresaw; saddening,because individually he is annihilated, and all the toil in whichhe spent his strength is swallowed up in the product which,gathering upthe different lines of investigation and thought, andgiving to them a unity of development, now by epigenesis ensues.We perceive, then, how it is that a great genius cannot come saveat long intervals, as the tree cannot blossom but at its due season.1.] THE STUDY OF MIND. 37But why should any one, great or little, fret and fume becausehe is likely soon to be forgotten? The genius himself, as individual, is after all of but little account; it is only as the birth ofthe travailing centuries that he exists, only so far as he is a truebirth 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 inmortal, he has become a mere name marking anepoch, and no longer an individual. Whosoever, in a foolishconceit of originality, strains after novelty and neglects thescattered and perhaps obscure labours of others who have preceded him, or who are contemporaneous with him; whosoever,over-careful of his individual fame, cannot carry forward hisown 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, butmore or less an abortive monstrosity: the more extreme he is asa monstrosity the more original must he needs be. *Viewing mental development, whether in the individual or inthe race, as a process of organization, as the consummate displayof nature's organic evolution, and recognising, as we must do,the most favourable conditions of such evolution to be the mostintimate harmony between man and nature, we may rightlyconclude, so far as concerns the rule of a conscious method ofinquiry, with the ancient and well-grounded maxim-" Learn toknow thyself in nature, that so thou mayest know nature inthyself. " (6)NOTES.1 (p. 4) . " Insomuch that many times not only what was assertedonce 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 "illusorypsychology, 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 anygrand and lasting thing been done? Who did it? Plainly not one man, but allmen it was the prevalence of, and inundation of an idea."38 ON THE METHOD OF [CHAP."pretends to accomplish the discovery of the laws of the human mindby contemplating it in itself; that is, by separating it from causes andeffects. " (Miss Martineau's Translation, p. 11. ) Again, he says: "Inorder to observe, your intellect must pause from activity; yet it is thisvery 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 instances which give the best or securest information, as is expressed,not inelegantly, in the common story of the philosopher, who, whilehe gazed upon the stars, fell into the water; for if he had lookeddown, he might have seen the stars in the water, but, looking aloft, hecould not see the water in the stars."-De Augment. Scient. B. ii.4 (p. 14) -Individual Psychology Bacon set down as wanting; heenforces its study, " so that we may have a scientific and accurate dissection of mind and characters, and the secret dispositions of particularmen may be revealed, and that from the knowledge thereof betterrules 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 notstudied (he even treats it as inconceivable) the Leibnitzian doctrine ofwhat has not been well denominated obscure perceptions or ideas—thatis, acts and affections of mind, which, manifesting their existence intheir effects , are themselves out of consciousness or apperception. Thefact of such latent modifications is now established beyond all rationaldoubt; and on the supposition of their reality, we are able to solvevarious psychological phenomena otherwise inexplicable. Amongthese are many of those attributed to habit. " (Sir W. Hamilton, inhis edition of Reid, p. 551.)"Ich sehe nicht, " says Leibnitz, "dass die Cartesianer jemalsbeweisen haben oder beweisen können, dass jede Vorstellung vonBewusstsein begleitet ist. " And again: -" Darin nämlich haben dieCartesianer sehr gefehlt, dass sie die Vorstellungen, deren man sichnicht bewusst ist, für nichts rechneten. Das war auch der Grund,warum sie glaubten, dass nur die Geiste Monaden waren, und dasses keine Seelen der Thiere oder andere Entelechien gebe." -Leibnitzals Denker. Auswahl seiner kleinern Aufsätze. By G. Schelling.Pp. 108 and 115.Fichte, in his Bestimmung des Menschen-" In jedem Momente ihrerDauer ist die Natur ein zusammenhängendes Ganze; in jedem Momente1.] THE STUDY OF MIND. 39muss jeder einzelne Theil derselbe so sein wie er ist, weil alle übrigensind wie sie sind; und du könntest kein Sandkörnchen von seinerStelle verrücken, ohne dadurch vielleicht alle Theile des unermesslichenGanzen hindurch etwas zu verändern. Aber jeder Moment dieserDauer ist bestimmt durch alle abgelaufenen Momente, und wirdbestimmen alle künftigen Momente, und du kannst in dem gegenwärtigen keines Sandkörne Lage auders denken als sie ist, ohne dassdu genöthigt würdest die ganze Vergangenheit ins Unbestimmtehinauf, und die ganze Zukunft ins Unbestimmte herab dir anders zudenken. "-Sämmtliche Werke, ii. 178.It is only right to add, that the fullest exposition of unconsciousmental action is to be found in Beneke's works. A summary of hisviews is contained in his Lehrbuch der Psychologie als Naturwissenschaft.6 (p. 37) .— Since this chapter was written, and, indeed, separatelypublished, Mr. J. S. Mill has made a powerful defence of the so-calledPsychological Method. In his criticism of Comte in the WestminsterReview for April 1865, and in his " Examination of Sir W. Hamilton'sPhilosophy," he has said all that can be said in favour of the Psychological Method, and has done what could be done to disparage thePhysiological Method. This he had already done many years ago inthe second volume of his " System of Logic, " and he is now onlyconsistent in returning to the charge. Nevertheless, the admirers ofMr. Mill may well experience regret to see him serving with somuch zeal on what is a so desperately forlorn hope. Physiology seemsnever to have been a favourite study with Mr. Mill-in none of hiswritings does he exhibit any indications of being really acquaintedwith it; for it is hardly possible to conceive that any one having aknowledge of the present state of this science, would disparage it ashe has done, and exalt so highly the psychological method of investigating mental phenomena. The wonder is, however, that he who hasdone so much to expound the system of Comte, and to strengthenand complete it, should on this question take leave of it entirely, andfollow and laud a method of research which is so directly opposed tothe method of positive science. Of course, I speak now strictly of themethod, not of Comte's application of it in his unfounded phrenological speculations, which are scarcely less wild and absurd than hisreligious delirium appears to be. However, though one may suspectMr. Mill to be unfortunate in his ignorance, or entirely mistaken inhis estimate, of the physiological method, one cannot fail to profit bythe study of his arguments on behalf of the psychological method,and by his exposition of its merits. By parading the whole force40 ON THE METHOD OF THE STUDY OF MIND.of the reasons in favour of it, he has exhibited , not so much itsstrength as its weakness, and has undesignedly given importantassistance to the physiological method. For the reasons why he hasnot been convincing, and why this chapter has been left unmodified,I may refer to the arguments set forth in a review of his " Examination of Sir W. Hamilton's Philosophy " in the Journal of MentalScience for January 1866. " Mr. Mill," it is there said, " has a highopinion 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 admitit to be true, and still ask whether it is a sufficient reason for ignoringthose important results of the physiological method of research whichbear vitally on psychology; whether, in fact, because a certain methodhas some worth, it can therefore afford to dispense entirely with theaid furnished by other methods."And again:-"The present complaint against Mr. Mill is that hetakes no notice of the effects of recent scientific conceptions on thequestions referred to philosophy; that he goes on exactly as he mighthave gone on if he had lived in the days of Aristotle; that at a timewhen a new method, highly fertile in fact and of more fruitful promise,was available, he persists in trying to do, by the old method, whatPlato, 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 availhimself of the new material and the new method, which his greatpredecessors had not in their day, he would have done what no otherliving 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 ofperceptionwhich act on it, and, as a part of nature, is itself an object of investigation purelyphysical. It is known to us only in the successive changes which constitute thevariety of our feelings: but the regular sequence of these changes admits of beingtraced, like the regularity which we are capable of discovering in the successivechanges of our bodily frame. There is a Physiology of the Mind, then, as thereis a Physiology of the Body-a science which examines the phenomena of ourspiritual part simply as phenomena, and from the order of their succession, orother circ*mstances of analogy, arranges them in classes, under certain generalnames; as, in the physiology of our corporeal part, we consider the phenomenaof a different kind which the body exhibits, and reduce all the diversities ofthese under the names of a few general functions. "-Sketch of a System ofPhilosophy ofthe Human Mind, by T. Brown, M.D.THEHE crude proposition of Cabanis, * that the brain secretesthought as the liver secretes bile, has been a subject of muchridicule to those who have not received it with outcries of disapprobation and disgust. Assuredly it is not an exact expressionof the facts; one may rightly admit the brain to be the principalorgan of the mind, without accepting the fallacious comparisonof mental action with biliary secretion. Here as elsewhere, confusion is bred by the common use of the word " secretion ” toexpress, not only the functional process but the secreted product,both the insensible vital changes and the tangible results ofthem. It is of great importance to try to fix, with as muchprecision as possible, what we mean by mind.In the first place, mind, viewed in its scientific sense as anatural force, cannot be observed and handled and dealt withas a palpable object; like electricity, or gravity, or any other

• "Nous concluons avec la même certitude que le cerveau digére en quelque

sort les impressions; qu'il fait organiquement la sécrétion de la penséc. ”—Rapportdu l'hysique et du Moral de l'Homme, par P. J. G. Cabanis.42 THE MIND [СНАР.of the natural forces, it is appreciable only in the changes ofmatter which are the conditions of its manifestation . Few, ifany, will now be found to deny that with each display of mentalpower 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 nervouselements of the brain. Chemical analysis of the so- called extractives of nerve testifies to definite change or " waste" throughfunctional activity; for there are found, as products of a retrograde metamorphosis, lactic acid, kreatin, uric acid, probably alsohypoxanthin, and, representing the fatty acids, formic and aceticacids. These products are very like those which are found inmuscle after its functional activity: in the performance of anidea, as in the performance of a movement, there is a retrogrademetamorphosis of organic element; the display of energy is atthe cost of the highly-organized matter, which undergoes degeneration or passes from a higher to a lower grade of being; andthe retrograde products are, so far as is at present known, verysimilar in muscle and nerve. While the contents of nerves,again, are neutral during rest in the living state, they becomeacid after death, and after great activity during life: the same isthe case also with regard to muscle. Furthermore, after prolonged mental exercise, the products of the metamorphosis ofnerve element, into the composition of which phosphorus enterslargely, are recognised in an increase of phosphates in the urine;while it is only by supposing an idea to be accompanied by acorrelative change in the nerve- cells that we can explain the exhaustion following excessive mental work and the breaking downof the brain in extreme cases. These things being so, what is itwhich in a physiological sense we designate mind? Not thematerial products of cerebral activity, but the marvellous energywhich cannot be grasped and handled. Here, then, is mademanifest a fallacy of the axiom propounded by Cabanis: it isplain that the tangible results of the brain's activity, the wastematters which pass into the blood for assimilation by tissues ofa lower kind, and for ultimate excretion from the body, mightnot less rightly be called the secretion of the brain, and be compared to the bile, than the intangible energy revealed in themental phenomena.11. ]AND THE NERVOUS SYSTEM. 43Secondly, it is most needful, in order to avoid confusion, toapprehend the exact signification of what is understood by mind,according to the common and vague use of the word. It isreally a general term acquired by observation of and abstractionfrom the manifold variety of mental phenomena: by such observation of the particular phenomena and appropriate abstractionfrom them we get, as an ultimate generalization, the generalconception, or the, so to speak, essential idea, of mind. Anillustration will help to exhibit what we mean. The steamengine is a complicated mechanism, of the construction andmode of action of which many people know very little, but ithas a very definite function of which those who know nothingof its construction can still form a sufficiently distinct conception; the co-ordinate, integral action of the steam-engine, aswe conceive it, is different from the nicely-adjusted mechanismor from the action of any part of it. But the function of theengine is dependent on the mechanism and on the co-ordinateaction of its parts, cannot be dissociated from these, and has noreal existence apart from them, though it may exist separatelyas a conception in our minds. By observation of the mechanismand appropriate abstraction we get the essential idea of thesteam-engine, a fundamental idea of it, which, as our ultimategeneralization, expresses its very nature as such, containing,as Coleridge would have said, " the inmost principles of itspossibility as a steam-engine." So likewise with regard to themanifold phenomena of mind; by observation of them andabstraction from the particular we get the general conception orthe essential idea of mind, an idea which has no more existenceout of the mind than any other abstract idea or general term.In virtue, however, of that powerful tendency in the humanmind to make the reality conformable to the idea, a tendencywhich has been at the bottom of so much confusion in philosophy, this general conception has been converted into an objective entity, and allowed to tyrannize over the understanding.A metaphysical abstraction has been made into a spiritualentity, and a complete barrier thereby interposed in the wayof positive investigation. Whatever be the real nature ofmind-and of that there is no need to speak here-it is mostcertainly dependent for its every manifestation on the brain44 THE MIND [CHAP.and nervous system; and now that scientific research is dailydisclosing more clearly the relations between it and its organ, itis plainly most desirable to guard against the common metaphysical conception of mind, by recognising the true subjectivecharacter of the conception and the mode of its origin andgrowth.A third important consideration is , that mental power istruly an organized result, not, strictly speaking, built up, butmatured by insensible degrees in the course of life. The brainis not, like the liver, the heart and other internal organs, capable from the time of birth of all the functions which it everdischarges; for while, in common with them, it has a certainorganic function to which it is born equal, its high specialcharacter in man as the organ of conscious life, the supremeinstrument of his relations with the rest of nature, is developedonly by a long and patient education. Though the brain, then,is formed during embryonic life, its highest development onlytakes place after birth; and, as will hereafter appear, the samegradual progress from the general to the special, which isexhibited in the development of the organ, is witnessed in thedevelopment of our intelligence. How inexact and misleading.in this regard, therefore, is any comparison between it andthe liver!Nevertheless, it must be distinctly laid down, that mentalaction is as surely dependent on the nervous structure as thefunction of the liver confessedly is on the hepatic structure:that is the fundamental principle upon which the fabric of amental science must rest. The countless thousands of nervecells which form so great a part of the delicate structure of thebrain, are undoubtedly the centres of its functional activity:we know right well from experiment, that the ganglionic nervecells scattered through the tissues of organs, as for examplethrough the walls of the intestines or the structure of the heart,are centres of nerve force ministering to their organic action; andwe may confidently infer that the ganglionic cells of the brain,which are not similarly amenable to observation and experiment, have a like function. Certainly they are not inexhaustiblecentres of self-generating force; they give out no more thanwhat they have in one way or another taken in; they receive1.] AND THE NERVOUS SYSTEM. 45material from the blood, which they assimilate, or make of thesame kind with themselves; a correlative metamorphosis offorce necessarily accompanying this upward transformation ofmatter, and the nerve-cell thus becoming, so long as its equilibrium is preserved, a centre of statical power of the highestvital 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 infact be said, represents statical thought, while thought represents dynamical nerve- cell, or, more properly, the energy ofnerve-cell.So far from discussing whether mind is the function of thebrain, the business which science now has immediately before it is the more special investigation of the conditions ofactivity of the ganglionic nerve- cell or groups of nerve- cells .If we look to those humbler animals in which nervous tissuemakes its first appearance, it is plain that the simple mode ofits existence in them allows of no other manner of proceeding;if we trace upwards the gradual increasing complication of thenervous system through the animal kingdom, it is evident thatsuch manner of proceeding is the only one to furnish thematerials of a comprehensive and sound induction; and if weduly weigh the results of physiological experiment and pathological research, it is no less certain that we must discardscientific investigation altogether in cerebral physiology, if wereject the ganglionic nerve-cell of the brain as a centre ofmental force.In the lowest forms of animal life nerve does not exist: theProtozoa aud many of the Zoophytes are destitute of any traceof nervous system. The most simple beings consist of a uniform,hom*ogeneous substance, by means of which all their functionsare executed. They are nourished without digestive organs;breathe without respiratory organs; feel and move withoutorgans of sense, without muscles, without nervous system.The stimulus which the little creature receives from withoutproduces some change in the molecular relations of its almosthom*ogeneous substance, and these insensible movements wouldseem to amount collectively to the sensible movement which it46 THE MIND [CHAP.makes; the molecular process in such case being not unlikethat which takes place and issues in the coagulation ofthe blood, when the fibrine is brought in contact, as somethink, with a foreign substance. " The perception of thestimulus by the creature is the molecular change which ensues,the imperceptible motion passing, by reason of the hom*ogeneity of its substance, with the greatest ease from elementto element of the same kind, as it were by an infection, oras happens in the sensitive plant; and the sum of the molecular motions, as necessarily determined in direction by theform of the animal, or by some not yet recognised cause, resultsin the visible movement. The recent researches of Graham intothe colloidal condition of matter have proved the necessity ofconsiderable modification in our usual conception of solid matter:instead of the notion of impenetrable, inert matter, we mustsubstitute the idea of matter which, in its colloidal state, ispenetrable, exhibits energy, and is widely susceptible to externalagents, " its existence being a continued metastasis. " This sortof energy is not a result of chemical action, for colloids aresingularly inert in all ordinary chemical relations, but a resultof its unknown intimate molecular constitution; and the undoubted existence of colloidal energy in organic substanceswhich are usually considered inert and called dead, may wellwarrant the belief of its larger and more essential operation inorganic matter, in the state of instability of composition in whichit is when under the condition of life. Such energy wouldthen suffice to account for the simple uniform movements of thehom*ogeneous substance of which the lowest animal consists;and the absence of any differentiation of structure is a sufficientreason of the absence of any localization of function and of thegeneral uniform reaction to different impressions. But it willbe observed that even the movements of these simplest creatures, in which there is not the least indication of the elements of a nervous system, are not entirely vague, confused,and indefinite; they present certain indications of adaptationto 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. 47of organization, which are met with as we ascend in the animalkingdom, the nervous tissue appears, but at first under a verysimple form. Its simplest type may be represented as two fibresthat are connected by a nerve-cell or a ganglionic group of nervecells; the fibres are apparently simple conductors, and might beroughly compared to the conducting wires of a telegraph, whilethe cell, being the centre in which nerve force is generated,may be compared to the telegraphic apparatus; in it the effectwhich the stimulus of the afferent or centripetal nerve excites , istransmitted along the efferent or centrifugal nerve, and thereinis displayed the simplest form of that reflex action which playsso large a part in animal life. * This type of structure is repeated through the complex nervous system of all the higheranimals. Cut across the afferent nerve, or otherwise interruptit* continuity, the impression cannot reach the centre; cut acrossthe efferent nerve, the central excitation is powerless to influencethe muscles or parts to which it is distributed. Not all the passionand eloquence of a Demosthenes could force its way outwards intowords, ifthe motor nerves of the tongue were cut across. Owingto the differences of kinds of tissue, and to the specialization oforgans in the more complex animal, there cannot plainly be thatintimate molecular sympathy between all parts which there is inthe hom*ogeneous substance of the simplest monad; the easymotion, as by an infection, from particle to particle, is not possiblein the heterogeneous body, where the elements are of a differentkind: accordingly special provision is required for insuringcommunication between different parts, and for co-ordinatingand harmonizing the activity of different organs. The animalThe 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 lingualnerve, the sensory nerve of the tongue, with the peripheral end of the cut hypoglossal, the motor nerve of the tongue. Stimulation of the central part of thelingual produced contractions of the tongue, such as normally follow stimulationof the hypoglossal. Thus it is proved that the end of a sensory nerve may beunited with the end of a motor nerve, and when the union is complete, excitationof the sensory may be transmitted to the motor fibres. Inversely, stimulationof the peripheral end of the hypoglossal produced evidence of pain. It wouldseem that the neurility is the same in all nerves; the difference of function beingdue, not to difference of physiological properties, but to difference of connexionof the fibres. See also Leçons sur la Physiologie Générale, et comparée du SystèmeNerveux, par A. Vulpian. 1866.48 THE MIND [СНАР.must be rendered capable of associating a number of distinctactions for definite ends. This function, necessitated by thephysiological division of labour, the nervous system subserves;and we might compare it to that which the gifted generalizerfulfils in human development: he grasps the results of thevarious special investigations which a necessary division oflabour enforces, brings them together, and elaborates a resultin which the different lines of thought are co-ordinated, and aunity of action is marked out for future progress. The nervoussystem effects the synthesis which the specialization of organicinstruments in the analysis of nature renders necessary; it isthe highest expression of that principle of individuation whichis the characteristic feature of life in all its forms, but mostmanifest in its highest. To this function it is well adapted,first, by the extent of its distribution, and, secondly, by itsexceeding sensibility, whereby an impression made at one partis almost instantly felt at any distance.With the increasing complexity of organization, which marksthe increasing speciality of organic adaptation to external nature,or, in other words, which marks an ascent in the scale of animallife, 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 conductors, while a development of special structures at their peripheral,and of special ganglionic cells at their central endings, revealsthe increasing speciality and complexity of function. Upon thespecial structures at the peripheral ends, which are, as it were,the instruments of analysis, depends the kind of the impressionmade; and by the nature of the nerve-cells with which the central end of the nerve is connected, the kind of impression thatis perceived and the character of the reaction thereto are determined. Accordingly, we find that, with the appearances of theorgans of the special senses, as we mount in the scale of animallife, there is a corresponding increase in the ganglionic centres,which, being clustered together, form the primitive rudiments ofa brain, and represent, in the main, those sensory ganglia whichin man lie between the decussation of the pyramids and thefloors of the lateral ventricles. It is not known with certaintywhen the different organs of the special senses severally make11.]AND THE NERVOUS SYSTEM. 49their first appearance, for they are at first very rudimentary; inthe starfish, which belongs to the humble Echinodermata, thereis at the extremity of each ray a small red spot which is said topresent the characteristics of a rudimentary eye; but whetherthis be so or not, it is certain that special structures, adapted tothe reception of particular impressions, as of light, of sound,of touch, render the higher animal capable of more numerous,special, and complex relations with external nature. There isa diffusion through the entire substance of the simplest creaturesof physiological properties which are specialized and localized inthe higher animals. *Not till we arrive as high as the fishes, and not then in thesingular Amphioxus, do we discover anything more in the brainthan sensory ganglia connected with the origins of nerves; sofar there is no trace of cerebral hemispheres, or of brain proper.It is plain then that the cerebral hemispheres are not essentialto sensation and the motor reaction to sensation; for they arealtogether wanting where both these functions are displayed ina lively and vigorous way. To the simpler relation between theindividual organism and external nature, which is denoted byreflex action, there now succeeds that more complex relationof sensory perception and sensorimotor reaction, as Dr. Carpenterhas called it; in place of reaction to a general stimulus, discriminations of impressions, and corresponding special reactions.by virtue of structures specially adapted, are witnessed. Thiscondition of the development of the nervous system , which isWhen a special sense fails in man, the general sensibility may partially replace it. " I have known several instances, " says Abercrombie, " of personsaffected with that extreme degree of deafness, which occurs in the deaf and dumb,who had a peculiar susceptibility to particular kinds of sounds, depending, apparently, on an impression communicated to their organs of touch or simple sensation. They could tell, for instance, the approach of a carriage in the streetwithout seeing it, before it was taken notice of by persons who had the use of alltheir senses. " On the Intellectual Powers. Kruse, who was completely deaf,nevertheless had a bodily feeling of music; and different instruments affectedhim differently. Musical tones seemed to his perception to have much analogywith colours. The sound of a trumpet was yellow to him; that of a drum, red;that of the organ, green; &c. —Early History of Mankind, by J. B. Tylor.his Reminiscences of the Opera, Mr. Lumley tells of a friend who used to comparethe voices of the different celebrated singers to different colours, distinguishingthem so. It is an old saying of a blind man, that he thought scarlet was like thesound of a trumpet.EIn50 THE MIND [CHAP .natural and permanent in so many of the lower animals, corresponds to that artificial state of things which may be producedexperimentally in a higher animal by depriving it of its hemispheres. The kind of function manifest is strictly comparable tothe early brief stage of the infant's mental life before the cerebralhemispheres have come into action, or to those phenomena ofmental life sometimes displayed by the adult, as for exampleby the somnambulists, when the influence of the cerebral hemispheres is suspended.Here let us make a reflection: how important it is clearly todistinguish and denote special features, which, being includedunder, or described by, a general term, are so commonly confounded. 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 besensible of a stimulus; the higher animal, with its special senses,to be sensible of light, or of sound, as the case may be; and, ifmade to suffer, to be sensible of pain; while it is common enoughto speak of man being sensible of pleasure, horror, or disgust,according to the nature of the active ideas. If we use the genericterm sensibility to express the fundamental reaction, as we mayperhaps properly do, it is highly important that we proceedfurther to distinguish by appropriate terms the special differences;the sensibility of pain is not the sensibility of sense, nor is thesensibility of the infusorial animalcule equivalent to either ofthese. So far we have taken pains to distinguish that form ofsensibility and reaction proper to the lowest animals, and whichmight be called irritability; that form of reaction, or reflexaction, which is the lowest expression of nervous function; andthat form of reaction to which the sensory ganglia minister, andwhich is rightly called sensorial.It is in fishes that the rudiments of cerebral hemispheres firstappear. In them they are represented by a thin layer or projection of nervous matter in front of the corpora quadrigemina,covering the corpora striata and the optic thalami; in theAmphibia, they have already increased somewhat in size; * inBirds, the corpora quadrigemina are pushed out to some extentThe Perenni-branchiate reptiles retain the fish character of brain all their lives; the Batrachians have it only during their tadpole state.E11.]ANDTHENERVOUSSYSTEM.51by their further increase; in the Mammalia, they begin to coverthe corpora quadrigemina, and, as we ascend in the scale of life,gradually increase backwards until, in some of the highermonkeys, and in man, they entirely cover the cerebellum.In this ascent through the series of vertebrate animals, it isfound that the relations of the sensory ganglia remain alikethroughout, the chief differences being differences in the relativesize of them. Their functions, as primary constituents of thebrain, may then fairly be counted the same in all the vertebrata,and indeed in all the animals in which they exist. As thehemispheres appear as secondary constituents-secondary, be itnoted, in the order of development, but primary in dignity-wemay rightly conclude their function to be secondary to that whichthe primary constituents or sensory ganglia fulfil. The impressions received by the sensory centres, when they do not reactdirectly outwards, as they may do where hemispheres exist, and asthey must do where hemispheres do not exist, are in fact passedonwards in the brain to the cells which are spread over thehemispheres, and there further fashioned into what are calledideas or conceptions. Here then we come to another kind of sensibility, with its appropriate reaction, to which a special nervouscentre ministers; and it is known as perception, or, more strictly,ideational perception. As the hemispheres have this function,and are not necessary to sensory perception, it is quite in accordance with what might be predicted, that, as experiments prove,they are insensible to pain, and do not give rise to any displayof that kind of feeling when they are injured. They have,agreeably to their special nature, a sensibility of their own tothe ideas that are fashioned in them; so that these may be pleasurable or painful, or have other particular emotional qualities.†

Observation of the mental phenomena of those animals inwhich cerebral hemispheres exist, fully confirms the foregoingview of their function and import. In Fishes there is the firstdistinct appearance of simple ideas, and of the lowest rudimentsof emotion; carp will collect to be fed at the sound of a bell,An animal—a hen, for example-which makes violent movements while theskin is being cut and the roof of its skull removed, remains quite quiet while itshemispheres are being sliced away bit by bit.+ Emotion is strictly, perhaps, the sensibility of the supreme centres to ideas.E 252 THE MIND [CHAP.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 thehemispheres, the manifestations of intelligence are much greater;the tricks which some of them may be taught are truly marvellous, and those who teach them know how much different birdsdiffer in intelligence and temper. Nor are simple emotionalexhibitions wanting amongst them; very evident at times is thefeeling of rivalry or jealousy in canaries, and there are undoubtedinstances on record in which an orphan bird has owed its life tothe kindly care of birds of a different species. * In Mammalia agradual advance in intelligence may be traced from very lowlymanifestations up to those highest forms of brute reason whichassuredly differ only in degree from the lowest forms of humanintelligence. Consider how plainly, in the dog, a conceptionoften intervenes between the sensation and the usual respondentmovement, so that the animal refrains from doing what it has astrong impulse to do; the impression has been passed on to thehemispheres, and their controlling action brought into play. Itis needless to speak of the various emotions, nay, the veritablemoral feeling, displayed by the dog and other domesticatedanimals. A single reflection will show, what anatomy mightlead us to predicate, how limited is the range of animal intelligence if the fox, cunning as it is, had but the sense to learn toclimb 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 grooveof thought, cannot originate anything; and, like not a fewscheming plotters, it wastes a great deal of low cunning inefforts which a little larger view of things would render quiteunnecessary.As we ascend through the Mammalian series, we find that notonly do the hemispheres increase in size by gradually extendingbackwards, but that the grey surface of them is further increasedby being thrown into folds or convolutions. While the lowerMammals are entirely destitute of such convolutions, these arepresent, as a rule, in simple forms in the Ruminantia andAnatomie comparée du Système Nerveux, par Leuret et Gratiolet.For examples of wonderful intelligence in different animals, I may refer to apaper by me on the Genesis of Mind in the Journal of Mental Science, 1862.II.] AND THE NERVOUS SYSTEM. 53Pachydermata; they are more fully developed in the Carnivora,and most fully developed in the apes and in man. It is truethat we cannot at present unfold an exact relation between thedevelopment of the convolutions and the degree of intelligencein different animals; for the brains of the ass, the sheep, andthe ox are more convoluted than those of the beaver, the cat,and the dog. But the relative size of the animals must be takeninto account in such comparison. The volume of a body suchas the brain, which increases in size, increases in greater proportion thanthe superficies, and the latter again in greater proportionthan the diameter. Now in each natural group or order ofMammalia, the head, but especially the capacity of the skull,has a certain relation to the body, a relation which remainspretty constant in different species; the head of the tiger orof the lion, for example, has about the same relation to thebody as that of the cat's head to its body, although the sizesof the animals are so different. It follows then that, thevolume of the brain of the tiger in relation to the size of thebody being the same as in the cat, the superficies of the brainis proportionately greater in the smaller animal; and that,consequently, in order to get a proportionate extent of greysurface in the larger animal, this must be convoluted in it, whenit may remain nearly smooth in the smaller one. If in twoanimals of equal size, and of like form of structure, the convolutions are differently fashioned, then it may be said withcertainty that one will be more intelligent than the other inproportion as its convolutions are more numerous and complicated, and the sulci deeper.That proposition is true of man. The intellectual differenceswhich exist between the Bosjesman, or the Negro, and theEuropean are attended with differences in the extent and complication of the nervous substance of the brain. Gratiolet hascarefully figured and described the brain of the Hottentot Venus,who was no idiot; and what is at once striking in the figure isthe simplicity and regular arrangement of the convolutions of thefrontal lobe; they present an almost perfect symmetry in thetwo hemispheres, " such as is never exhibited in the normalbrains of the Caucasian race," and which involuntarily recallsthe regularity and symmetry of the cerebral convolutions in the54 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 ofdevelopment: "it could be compared only with the brain of awhite who is idiotic from arrest of cerebral development."Moreover, the differences between it and the brain of the whiteare unquestionably of the same kind as, though less in degreethan, those which exist between the ape's brain and that of man,as Professor Huxley has distinctly pointed out. * Mr. Marshallhas recently examined a Bushwoman's brain, and has found likeevidence of structural inferiority; the primary convolutions,though all present, were smaller than in the European, and muchless complicated; the external connecting convolutions were stillmore remarkably defective; the secondary sulci and convolutions were everywhere decidedly less developed; there was adeficiency of the system of transverse commissural fibres; and insize, and in every one of the signs of comparative inferiority, " itleaned, as it were, to the higher quadrumanous forms."† Thebrain of the Negro is superior to that of the Bushman, but still itdoes not reach the level of the white man's brain; the weight ofthe male Negro's brain is less than that of the average Europeanfemale; and the greater symmetry of its convolutions, and thenarrowness of the hemispheres in front, are points in which itresembles the brain of the ourang-outang, as even Tiedemann,the Negro's advocate, has admitted.Among Europeans it is found that, other circ*mstances beingalike, the size of the brain bears a general relation to the mentalpower of the individual, although apparent exceptions to therule sometimes occur. The average weight of the brain in theeducated class is certainly greater than in the uneducated; andsome carefully- compiled tables in a valuable paper by Dr.Thurnam prove that, while the average brain weight of ordinaryEuropeans is 49 oz., in distinguished men it is 546 oz. Onthe 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 arrangementof the convolutions was most remarkable. -The Convolutions of the HumanCerebrum, by W. Turner, M. B. 1866.11.] AND THE NERVOUS SYSTEM. 55the parts being not only smaller, but less complex, and the convolutions in particular being simpler and less developed. Mr.Marshall found the convolutions of the cerebra of the two idiotswhich he examined to be fewer in number than in the apes, thebrains being in this respect more simple than the brain of thegibbon, and approaching that of the baboon. In fact, there aremicrocephalic idiots which present a complete series of stages ofdescent from man to the apes . As a general proposition, it iscertainly true that we find the evidence of a correspondencebetween the development of the cerebral hemispheres and thedegree of intelligence, when we examine the different races orkinds of men, as we do when we survey the scale of animal life .

As in the series of the manifold productions of her creativeart Nature has made no violent leap, but has passed by gentlegradations from one species of animal to another, and from thehighest animal to the lowest man, it is not surprising that theembryonic development of man should present indications of thegeneral plan. It admits of no question that man does, in thecourse of his development, pass through stages closely resemblingthose through which other vertebrate animals pass; and thatthese transitory conditions in him are not unlike the forms thatare permanent in the lower animals. There is a very close morphological resemblance between the human ovum and the lowestanimals with which we are acquainted, the microscopic Gregarinida; † in both, an outer membrane contains a soft semi-fluid" That there should be more species of intelligent beings above us, " saysLocke, "than there are of visible or material below us, is probable to me fromhence that in all the corporeal world we see no chasms or gaps. " But howcan 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 amore 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 whichis 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 germinalvesicle; 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 theanalogy 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 allthe higher animals commence their existence. "-Lect. on Comp. Anat. 1864.56 THE MIND [CHAP.substance, at one end of which is a delicate vesicle, having in ita solid particle or spot. At the earliest stages of its development no human power can distinguish the human ovum fromthat of a quadruped; and, as it proceeds to its destined end,it passes through similar stages to those through which othervertebrate embryos pass. That which is true of the whole bodyis true also of the development of the brain. The brain of thehuman fœtus 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 corporaquadrigemina; and in front again of this, the vesicle of the thirdventricle, which contains also the thalami optici, and which, asdevelopment proceeds, becomes covered, as do the corpora quadrigemina, by the backward growth of the hemispheres in front ofit. At this stage the human brain resembles the fully- formedbrain of the fish, more closely the brain of the foetal fish, in thesmall proportion which the cerebral hemispheres bear to theother parts, in the absence of convolutions, in the deficiency ofcommissures, and in the general simplicity of structure. Aboutthe twelfth week of embryonic life there is a great resemblanceto the brain of the bird: the cerebral hemispheres are muchincreased in size, and arch back towards the thalami optici andthe corpora quadrigemina, though there are still no convolutions,and the commissures are very deficient. Up to this time thecerebral hemispheres represent no more than the rudiments ofthe anterior lobes; they do not yet completely cover the thalamioptici, nor indeed pass the grade of development which is permanent in the Marsupial Mammalia. During the fourth andearly part of the fifth month, the middle lobes develop backwards and cover the corpora quadrigemina; and, subsequently,the posterior lobes sprout out, so to speak, and gradually extendbackwards so as to cover and overlap the cerebellum. It wasupon the erroneous assumption that the posterior lobes werepeculiar to man, that Professor Owen grounded his division ofthe Archencephala; but it has now been proved unquestionablythat the posterior lobes exist in the apes, and that in some ofthem they extend as far back as they do in man. It is easy toperceive, then, that an arrest of development of the human brain11. ] AND THE NERVOUS SYSTEM. 57may leave it very much in the condition of an animal brain;and it is found in some cases, as a matter of fact, that congenitalidiots 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 cosmography of himself, all the different modes of nervous functionare exhibited in the workings of his organism. The so- calledirritability of tissue, whereby it reacts to a stimulus without thehelp of nerve, may be of the same kind as that molecular energyof matter manifest in the movements of the humblest animal:whether the nerve ends outside the sarcolemma of muscle, orwithin it, there can be no doubt that it is not distributed toevery part of the sarcous element; and, at any rate, when allnervous influence is withdrawn, an energy still exists sufficientto produce rigor mortis of the muscle. The simplest mode ofnervous action in man, comparable to that of the lowest animalsthat possess nerve, is exhibited by the scattered ganglionic cellsbelonging to the sympathetic system, which are concerned incertain organic processes. The heart's action, for example, isdue to the ganglionic cells dispersed through its substance;Meissner has recently shown that nerve- cells disseminatedthrough the tissues of the intestines govern their motions; andLister thinks it probable that cells scattered in the tissues preside over the contractions of the arteries, and even the remarkable diffusion of the pigment granules which takes place in thestellate cells of the frog's skin. The separate elements of thetissue are co- ordinated by the individual nerve cells; and theseco-ordinating centres, again, are found to be under the control ofthe cerebro- spinal centres. In the spinal cord the ganglionicnerve-cells are collected together, and so united that groups of

It has furthermore been recently maintained by Bilharz and Kühne, thatthe nerves pass by continuity into the muscular substance, as in the electricorgans of the fishes they pass continuously into the protoplasm of the electricplates. The controversy respecting the manner in which nerves end in musclesseems, then, likely to terminate in the conclusion that they do not end at all, butpass by continuity of substance into the sarcous elements. The observations ofKühne and Rouget prove that the nerve fibre, reduced to its axis cylinder,penetrates the sarcolemma, and is lost. The nervous filaments of insects cannotsometimes be distinguished from the other elements by means of the microscope.Pfliger has discovered that the nerves to the glands penetrate the walls of the cells, and, as he believes, end in the nuclei.58 THE MIND [CHAP.them become independent centres of combined movements inanswer to stimuli; this arrangement representing the entirenervous system of those animals in which no organs of specialsense have yet appeared. Still higher in the scale of the nervoussystem, the sensory ganglia, formed of multitudes of speciallyendowed cells, are clustered together, and form a very importantpart of the brain of man, while in many animals, as alreadyseen, they constitute the whole of the brain. In the cerebralhemispheres there is a still greater specialization of structurewith corresponding exaltation of function; and, conformably toits highest degree in man, there are in him the highest and themost complex manifestations of mental function. In the humanorganism, then, is summed up the animal kingdom, whichactually presents us with a sort of analysis of it; for in thefunctions of man we observe, as in a microcosm, an integrationand harmonious co-ordination of different vital actions whichare separately displayed by different members of the animalkingdom.In dealing with the function of the nervous system in man,it is, then, most necessary to distinguish the different nervouscentres:-1. There are the primary centres, or ideational centres, constituted 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 betweenthe decussation of the pyramids and the floors of the lateralventricles.3. There are the tertiary nervous centres, or centres of reflexaction, constituted mainly by the grey matter of the spinal cord.4. There are the organic nervous centres, as we might callthem, belonging to the sympathetic system. They consist ofa set of ganglionic bodies distributed mainly over the viscera,and connected with one another and with the spinal centresby internuntiant cords.Each distinct centre is subordinated to the centre immediatelyabove it, but is at the same time capable of determining andmaintaining certain movements of its own without the intervention of its supreme centre. The organization is such that adue independent local action is compatible with the proper11.] AND THE NERVOUS SYSTEM. 59control of a superior central authority. The ganglionic cell ofthe sympathetic co-ordinates the energy of the separate elements of the tissue in which it is placed, and thus representsthe simplest form of a principle of individuation; * through thecells of the spinal centre the functions of the different organiccentres are so co-ordinated as to have their subordinate butessential place in the movements of animal life, -and hereinis witnessed a further and higher individuation; the spinalcentres are similarly controlled by the sensory centres, andthese, in their turn, are subordinate to the controlling action ofthe cerebral hemispheres, and especially to the action of thewill, which, properly fashioned, represents the highest displayof the principle of individuation. The greater the subordination of parts in any animal, the higher and the more perfect itis. Were it not well if man in his social life could contrive toimitate this excellent organization?Most important and varied functions having been assigned tonerve-cells, it may be asked, On what evidence do the statementsrest? On the evidence of anatomical investigation, experimentsupon animals, and physiological and pathological researches.(a) Anatomical Evidence.—It is certainly not possible to traceevery nerve fibre to its connexion with a cell, and till lately nosuch connexion had been distinctly seen; but it has now beenobserved in many instances, and most investigators believe thatneither in the brain nor in the spinal cord does there exist anisolated apolar nerve-cell; such, if supposed to be seen, beingin reality one which has had its processes torn away, or notbeing a nerve- cell at all, but a connective tissue corpuscle.This is an inference which has scarcely less certainty than anobserved fact; it is not necessary, as Goethe has said, to travelround the world in order to feel sure that the heavens areeverywhere 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, Goethegoes on to say:-"Je unvolkommener das Geschöpf ist desto mehr sind dieseTheile einander gleich oder ähnlich, und desto mehr gleichen sie dem Ganzen.Je volkommener das Geschöpf wird, desto unähnlicher werden die Theile einander.Je ähnlicher die Theile einander sind, desto weniger sind sie einander subordinirt.Die Subordination der Theile deutet auf ein volkommeneres Geschöpf. ”60 THE MIND [CHAP.Granting the constant connexion of the fibre with the cell, arethe ganglionic cells so numerous and so arranged as to render itconceivable that they can adequately minister to the manifoldand complex manifestations of our mental life? Most certainlythey are: Mr. Lockhart Clarke's careful and valuable researchesinto the structure of the cortical layers of the hemispheresreveal a variety, delicacy, and complexity of constitution suchas 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, willindicate exactly how the complexity of physical structure agreeswith the complexity of mental function:---"In the human brain most of the convolutions, when properlyexamined, may be seen to consist of at least seven distinct andconcentric layers of nervous substance, which are alternatelypaler and darker from the circumference to the centre. Thelaminated structure is most strongly marked at the extremity ofthe posterior lobe. In this situation all the nerve- cells are small,but differ considerably in shape, and are much more abundant insome layers than in others. In the superficial layer, which ispale, they are round, oval, fusiform, and angular, but not numeThe second and darker layer is densely crowded withcells of a similar kind, in company with others that are pyriformand pyramidal, and lie with their tapering ends either towardthe surface or parallel with it, in connexion with fibres whichrun in corresponding directions. The broader ends of the pyramidal cells give off two, three, four, or more processes, which runpartly towards the central white axis of the convolution and inpart horizontally along the plane of the layer, to be continuous,like those at the opposite ends of the cells, with nerve fibresrunning in different directions.rous." The third layer is of a much paler colour. It is crossed,however, at right angles by narrow and elongated groups ofsmall cells and nuclei of the same general appearance as thoseof the preceding layer. These groups are separated from eachother by bundles of fibres radiating towards the surface fromthe central white axis of the convolution, and together withthem form a beautiful fan-like structure."The fourth layer also contains elongated groups of small11.] AND THE NERVOUS SYSTEM. 61cells and nuclei, radiating at right angles to its plane; but thegroups are broader, more regular, and, together with the bundlesof fibres between them, present a more distinctly fan-likearrangement."The fifth layer is again paler and somewhat white. It contains, however, cells and nuclei which have a general resemblance to those of the preceding layers, but they exhibit only afaintly radiating arrangement."The sixth and most internal layer is reddish-grey. It notonly abounds with cells like those already described, but contains others that are rather larger. It is only here and therethat the cells are collected into elongated groups which give theappearance of radiations. On its under side it gradually blendswith the central white axis of the convolution, into which itscells are scattered for some distance."The seventh layer is this central white stem or axis of theconvolution. On every side it gives off bundles of fibres, whichdiverge in all directions, and in a fan-like manner, towards thesurface through the several grey layers. As they pass betweenthe elongated and radiating groups of cells in the inner greylayers, some of them become continuous with the processes ofthe cells in the same section or plane, but others bend round andrun horizontally, both in a transverse and longitudinal direction(in reference to the course of the entire convolution), and withvarious degrees of obliquity. While the bundles themselves areby this means reduced in size, their component fibres becomefiner in proportion as they traverse the layers towards the surface, in consequence, apparently, of branches which they give offto be connected with cells in their course. Those which reachthe outer grey layer are reduced to the finest dimensions, andform a close network with which the nuclei and cells are inconnexion." Besides these fibres, which diverge from the central whiteaxis of the convolution, another set, springing from the samesource, converge, or rather curve inwards from opposite sides, toform arches along some of the grey layers. These arciform fibresrun in different planes-transversely, obliquely, and longitudinally--and appear to be partly continuous with those of thedivergent set which bend round, as already stated, to follow a62 THE MIND [CHAP.similar course. All these fibres establish an infinite number ofcommunications in every direction between different parts ofeach convolution, between different convolutions, and betweenthese and the central white substance."The other convolutions of the cerebral hemispheres differfrom those at the extremities of the posterior lobes, not only by thecomparative faintness of their several layers, but also by theappearance of some of their cells. We have already seen that,at the extremity of the posterior lobe, the cells of ALL the layersare small and of nearly uniform size, the inner layer only containing some that are a little larger. But, on proceeding forwardfrom this point, the convolutions are found to contain a numberof cells of a much larger kind. A section, for instance, takenfrom a convolution at the vertex, contains a number of large,triangular, oval, and pyramidal cells, scattered at various intervals through the two inner bands of arciform fibres and the greylayer between them, in company with a multitude of smallercells which differ but little from those at the extremity of theposterior lobe. The pyramidal cells are very peculiar. Theirbases are quadrangular, directed towards the central white substance, and each gives off four or more processes which runpartly towards the centre to be continuous with fibres radiatingfrom the central white axis, and partly parallel with the surfaceof the convolution to be continuous with arciform fibres. Theprocesses frequently subdivide into minute branches, which formpart of the network between them. The opposite end of thecell tapers gradually into a straight process, which runs directlytowards the surface of the convolution, and may be traced to asurprising distance, giving off minute branches in its course, andbecoming lost, like the others, in the surrounding network.Many of these cells, as well as others of a triangular, oval, andpyriform shape, are as large as those in the anterior grey substance of the spinal cord."In other convolutions the vesicular structure is again somewhat modified. Thus, in the surface convolution of the greatlongitudinal fissure, on a level with the anterior extremity of thecorpus callosum, and therefore corresponding to what is calledthe superior frontal convolution, all the three inner layers ofgrey substance are thronged with pyramidal, triangular, and oval11.] AND THE NERVOUS SYSTEM. 63cells of considerable size and in much greater number than in thesituation last mentioned. Between these, as usual, is a multitudeof nuclei and smaller cells . The inner orbital convolution, situatedon the outer side of the olfactory bulb, contains a vast multitudeof pyriform, pyramidal, and triangular cells, arranged in veryregular order, but none that are so large as many of thosefound in the convolutions at the vertex. Again, in the insula,or island of Reil, which overlies the extra-ventricular portionof the corpus striatum, a great number of the cells are somewhatlarger, 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 inthe superficial and deep layers the cells are rather small, themiddle layer is crowded with pyramidal and oval cells of considerable and rather uniform size. But not only in differentconvolutions does the structure assume, to a greater or lessextent, a variety of modifications, but even different parts ofthe same convolution may vary with regard either to thearrangement or the relative size of their cells." Between the cells of the convolutions in man and thoseof the ape tribe I could not perceive any difference whatever;but they certainly differ in some respects from those of thelarger Mammalia-from those, for instance, of the ox, sheep,or cat. "*Schroeder van der Kolk has found a different structure of thegrey substance of the convolutions in the anterior and posteriorlobes of the dog and the rabbit: in the anterior lobes of therabbit there are bundles of fibres, with cells, mostly tripolar,between them; in the posterior lobes there is a regular series ofpedunculated cells, which are placed close to one another, likeorgan pipes; there are also single larger cells. As the result ofhis investigations, continued through an industrious lifetime, hestates 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 RoyalSociety, vol. xii. 1863. I regret the mistake the less, as it has been the occasion of my receiving, from Mr. Clarke's own pen, the above clear and concisedescription of his latest researches.64 THE MIND [CHAP.do exist; " microscopical investigation has established this inthe completest manner.'” 亲Although there are observable differences in the size and configuration of the cells of the cortical layer, as of the cells ofother centres, yet it is clear that we cannot at present penetratethose intimate special differences in constitution or compositionwhich the variety of their functions implies. These essentialdifferences are not such, indeed, as the microscope is ever likelyto reveal; for they probably depend on the intimate chemicalcomposition, and are not likely, even if we could isolate cells asrequired, to be disclosed until chemistry has arrived at a microscopical application, or until some means has been discovered ofpenetrating the molecular constitution of nerve element. Thosewho may be disposed to think it impossible that such importantconstitutional differences should exist in so small a compass,might reflect with advantage on the various undetectable conditions which may confessedly exist in the minutest organicmatter; as, for example, in the delicate microscopic spermatozoon, or in the intangible virus of a fever. And yet it is fromthe conjunction of a minute spermatozoon with a minute germinalvesicle that are produced the muscles, vessels, nerves, and brain-the intellectual organs of a Socrates or a Cæsar. Consider,again, the infinite littleness of the odorous particles that affectthe smell, and, more wonderful still, the marvellous discriminating susceptibility of sense to these undetected agents.The exquisite minuteness and consummate delicacy of theoperations going on in the most intimate recesses of natureare even more striking and wonderful than the vastness andgrandeur with which the astronomer is concerned. What theimmensity is to the astronomer or geologist," says Sir H.Holland, " such are these infinitely small dimensions of matterin space to the physiologist." Of what may happen in a worldinto which human senses have not yet found means of enteringwe are no better entitled to speak than the blind man is to talk ofthe appearance of objects. In such matter it would be more wiseto adopt Tertullian's maxim, “ Credo quia impossibile est," thanDie Pathologie und Therapie der Geisteskrankheiten auf AnatomischPhysiologischer Grundlage. Von J. L. C. Schroeder van der Kolk. 1863.11.] AND THE NERVOUS SYSTEM. 65that which is so much favoured by the conceit of human ignorance-that a thing is impossible because it appears to beinconceivable.(b) Experiments on Animals have distinctly proved the differences between the functions of the ganglionic cells that constitutethe principal different nervous centres; but such results willmore properly find their place afterwards. Let it suffice here tosay that the sight of an animal may be destroyed by injury toits corpora quadrigemina as surely as by burning out its eyes.Nothing, however, has yet been done by experiments towardsdistinguishing the functions of different convolutions.(c) Physiological Evidence. -The study of the plan of development of the nervous system through the animal kingdom, withthe corresponding progress in complexity of function, undoubtedlyfurnishes the best testimony in favour of differences in theconstitution and function of the nerve- cells. That evidence hasalready been sufficiently set forth.The hopeless vanity of all discussions concerning infinite orabsolute truth might well have been made manifest by thisphysiological reflection: that our perception of external natureis the effect which the object produces, through an adaptedmedium, in certain of our central nerve-cells, an effect on whichwe can exercise no influence. Excite that condition of thecentral cell otherwise than by the stimulus from without, theperception does not fail to ensue: a blow on the eye producesflashes of light; on closing the eyes after looking at the sun aspectrum of it remains, which, as it slowly fades away, may bebrightened and darkened alternately for a time by pressing theeye and removing the pressure; a disturbance of the circulationin the auditory ganglia gives rise to noises in the ears in fact,all the senses may be excited subjectively. The reason isevident because the perception depends upon the special natureof the central cells and the mechanism by which the stimulusis conveyed to them. The idea in the mind is the result of anaction excited in the nerve centres; the external impression notbeing conveyed to them, but exciting the physiological propertyof the nerve, its neurility, which thereupon gives rise in themto the special effect. Accordingly, the effect of any stimulus.capable of affecting one of the special senses is of the same kindF66 THE MIND [CHAP.as that produced by its proper stimulus: thus the effect of theelectric stimulus on the optic ganglia is to cause a sensation oflight; on the olfactory nerves, some kind of smell; on the gustatory nerves, some kind of taste. This is as clear evidenceas any one can desire of specific differences between nerve- cellswhich to the eye often appear exactly alike. That man is bynature thus limited to the reception of certain special impressions through a few avenues, proves how limited must behis knowledge at the best: it may well be that there are manythings in nature of which he has not, and cannot have, anykind of knowledge; and that a new sense conferred upon himmight alter the whole aspect of the universe.What is true of the cells of the sensory ganglia is probablyno less true of the cells of the higher centres of intelligence.There is reason to assume differences, not merely between theganglionic cells of one lobe of the brain and those of another, butalso between one cell or group of cells and another cell or groupof cells. The law of progress from the general to the specialin organic development does not, it may be presumed, cease itsaction suddenly at the cerebral hemispheres. The philosopheris not, it is true, in possession of more senses than the savage;but he unquestionably has more numerous and complex convolutions, and, therefore, many more ganglionic cells in theprimary centres of intelligence. By intending his mind to therealities of external nature he acquires information through thesenses, but his intelligence reacts advantageously upon thesenses; he constructs instruments which extend their power ofobservation, thus acquires, as it were, new artificial senses, sothat hitherto obscure relations of external nature are disclosed tohim, and he attains to more special and complex relations therewith. Ifin the nervous centres cortical cells of a higher qualitythan the savage has, do not answer to this increased specialityand complexity of external relations, it is contrary to all theanalogy of organic development, as it is also an unintelligiblefreak of nature to have crowded the hemispherical ganglia withnerve-cells which are merely repetitions of one another.-(d) Pathological Evidence. -This will be brought forward indetail at a later period. Let it suffice here to say, thatSchroeder van der Kolk can venture to assert that he never11.] AND THE NERVOUS SYSTEM. 67failed to discover pathological changes in insanity, and that,when intellectual disorder especially has existed, he has foundthe cortical layer under the frontal bones to be darker coloured,more firmly connected with the pia mater, or softened; in melancholia, on the other hand, where the feelings mainly are excitedor depressed, the pathological changes were found principallyin the convolutions of the upper and hind lobes. In old agewhen the memory fails, he thinks that the cells of the corticallayers are visibly atrophied. The very many and various disorders to which the memory is liable, failures of every possibledegree and character, which can only be described by being givenin detail, surely indicate in no uncertain way the different natureof different cells in the cortical layers of the hemispheres.Thus much, then, by way of setting forth facts which will noteasily be discredited . What is the unavoidable conclusion?That no true scientific result can possibly proceed from thevague and general employment, without further discrimination,of mental action to embrace phenomena of such manifestlydifferent nature. If the psychologists had duly minded the oldbut wholesome maxim, that whosoever distinguishes well teacheswell, they might have found in the revelations of self- consciousness , when interpreted without bias, those distinctionswhich an investigation of the physiology of the nervous systemin man and animals establishes beyond all question. But themetaphysical conception of mind, the abstraction made into anentity, has overridden all discerning observation, and, confounding well-marked differences in a vague obscurity, has constructeda loose system of undefined words in place of an exact and positive science of facts. Instead of mind being, as assumed, awondrous entity, the independent source of power and self- sufficient cause of causes, an honest observation proves incontestablythat it is the most dependent of all the natural forces. It is thehighest development of force, and to its existence all the lowernatural forces are indispensably prerequisite.It is most needful, if we would avoid hopeless confusion andoften-made error, once for all to form a just and definite conception of what we mean by mental force, and of its position innature. To deal with mind apart from the consideration of thematter through the changes of which it is manifested is truly noF 268 THE MIND [CHAP.less vain and absurd than it would confessedly be to attempt tohandle electricity and gravitation as forces apart from the changes.in matter by which alone we knowthem. As there are differentkinds of matter, so there are different modes of force, in the universe; and as we rise from the common physical matter in whichphysical laws hold sway up to chemical matter and chemicalforces, and from chemical matter again up to living matter andits modes of force, so do we rise in the scale of life from thelowest kind of living matter, with its corresponding force orenergy, through different kinds of histological elements, withtheir corresponding energies or functions, up to the highest kindof living matter and corresponding mode of force with which weare acquainted, viz . nerve element and nerve force. But, whenwe have arrived at nerve element and nerve force, it behoves usnot to rest content with the general idea, but to bestow pains onthe patient and careful discrimination of the different kinds ofnerve- cells in the nervous system, and to study their differentmanifestations of energy. So only shall we obtain the groundwork of a true conception of the relations of mind and thenervous system.The chief feature to be noted in this upward transformationof matter and correlative metamorphosis of force is, that theexaltation or transpeciation on each occasion represents anincreased speciality of elements, and a greater complexity ofcombinations, in a smaller space: all exaltation of matter andforce is, as it were, a concentration thereof. As one equivalentof chemical force corresponds to several equivalents of inferiorforce, and one equivalent of vital force to several equivalents ofchemical force; so in the scale of tissues the higher kind represents a more complex elementary constitution, and a greaternumber of simultaneously acting forces, than the kind of tissuebelow it in dignity. If we suppose a higher tissue to undergodecomposition, or retrograde metamorphosis of its matter, withwhich must necessarily coincide a resolution of its energy intolower modes, then we might say that a single monad of thehigher tissue, or one equivalent of its force, would equal in valueseveral monads of the lower kind of tissue, or several equivalentsof its force. The characteristic of living matter is the complexity of combinations and the variety of elements in so small11.]AND THE NERVOUS SYSTEM. 69a compass that we cannot yet trace them; and in nerve structurethis complication and concentration is carried to its highestpitch. Nervous tissue with its energy is, therefore, dependentfor its existence on all the lower kinds of tissue that have preceded it in the order of development: all the force of naturecould not develop a nerve-cell directly out of inorganic matter.The highest energy in nature is really the most dependent; inthe fact that it is so dependent, that it implicitly contains theessence or abstraction of all the lower kinds of energy, lies thereason of the powerful influence which it is able to exercise overall the lower forces that are subservient to its evolution. As theman of genius implicitly contains humanity, so nerve elementimplicitly contains nature. *What is the progress or nisus that is manifest on surveying nature as a whole? Is it not the struggle to arrive atconsciousness, to attain to self-communion? In the series ofher 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 ofhuman feeling, every philosopher who apprehends and revealsa hitherto unobserved relation in nature, is, each in hisplace, aiding the onward progress; in his art nature isundergoing evolution; in him the world is, more or less ,regenerate."To whom the winged hierarch replied:-O Adam, one Almighty is, from whomAll things proceed, and up to Him return,If not depraved from good, created allSuch to perfection, one first matter all,Indued with various forms, various degreesOf substance, and in things that live, of life;But more refined, more spirituous, and pure,As nearer to Him placed, or nearer tending,Each in their several active spheres assigned,Till body up to spirit work, in bounds Proportioned to each kind. So from the rootSprings lighter the green stalk, from thence the leavesFor the further development of this view of life, I may refer to an articleon the " Theory of Vitality," in the British and Foreign Med. - Chir. Review,October 1863.70 THE MIND AND THE NERVOUS SYSTEM. [CHAP. 11.More aery, last the bright consummate flowerSpirits odorous 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 soulReason receives, and reason is her being,Discursive, or intuitive; discourseIs 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; ORNERVOUS CENTRES OF REFLEX ACTION.MITTING for the present any mention of the organic OMITTI nervous centres of the sympathetic system-first, becausethey minister chiefly to the organic life, and very little isdefinitely known about them; and, secondly, because somethingwill be said of them incidentally when treating of the Passions-we go on to show forth the functions of the spinal cord. Itis not a conducting organ only, but contains many independentnerve centres. A large part of human activity notably takesplace without any voluntary control, or even without any consciousness on the part of the individual; and of these unconscious or involuntary actions a great part is as plainly due tothe independent power of reaction which the ganglionic cells ofthe spinal cord have. If it be cut across at a spot below wherethe respiratory nerves are given off, all sensation and motorpower are lost in the parts of the body below the section. Butif the sole of the foot be then tickled with a feather, the leg isdrawn up, though the man is unaware of it unless informed byothers of what has happened. Such automatic action of thespinal cord, manifest enough in the actions of man, but still moreso in those of the lower animals, may be illustrated both fromthe 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 fœtus within themother's womb, or the movements of many of the lower animals,they are simply reflex to impressions, and take place withoutwill, or even without consciousness. The anencephalic infant, inwhich absence of brain involves an absence of consciousness,not only exhibits movements of its limbs, but is capable also of72 THE SPINAL CORD, OR [CHAP.the associated reflex acts of sucking and crying. A decapitatedfrog, to the thigh of which acetic acid has been applied, makescertain movements for the purpose of wiping off the acid; andif the head of a frog, which is clinging to the female at the seasonof copulation, be cut off, the animal still holds her fast; nay, ifits paw be afterwards cut off, clings to her with its bloody stump.The spinal cord is plainly, then, not only a centre of irregularreflex movements, but it is also a centre of co- ordinate or so-calleddesigned actions. Pflüger wetted with acetic acid the thigh of adecapitated frog over its internal condyle; it wiped it off withthe dorsal surface of the foot of the same side: he thereupon cutoff 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 atfirst is, by an eccentric sensation, would have wiped it off againwith the foot of that side, but of course could not. After somefruitless efforts, therefore, it ceased to try in that way, seemedunquiet, " as though it were searching for some new means," andat 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 itagainst the side of its body. So much was Pflüger impressed bythis wonderful adaptation of means to an end in a headlessanimal, that he actually inferred that the spinal cord, like thebrain, was possessed of sensorial functions. Others, who wouldscarce admit the supposition to be true of man, have thoughtthat it might be so of some of the lower animals. Instead ofrightly grounding their judgment of the complex phenomena inman on their experience of the simpler instances exhibited bythe lower animals, they applied to the lower animals their subjective misinterpretation of the complex phenomena in man. ( ¹ )It is obviously quite possible to draw another inference fromPflüger's experiment: that the so- called design of an act doesnot necessarily witness to the co-existence of will, forethought,or consciousness; that actions " having the semblance of predesigning consciousness " may, nevertheless, be unattended withconsciousness. * No doubt there is a definite purpose in theVery interesting, in relation to this matter, are Prochaska's observations,published in 1784:-" Cum itaque precipua functio sensorii communis consistatin reflexione impressionum sensoriarum in motorias, notandum est quod istareflexio rel animâ insciâ rel vero anima conscia fiat." He gives numerousexamples, often given since by other authors, and adds:-" Omnes istæ actiones111.] TERTIARY NERVOUS CENTRES, ETC. 73movements which the maimed frog makes, as there is definitepurpose in the movements of the anencephalic infant's lips, or inthe respiratory movements of man or animal; but in all theseinstances the co-ordinate activity is the result of an innate nervousconstitution, an original endowment of the nervous centres.Accordingly we see that the frog which has lost its legs acts as ifthe limbs were still there, which, were there intelligent consciousness, it plainly should not, and only employs other means whenthe irritating action of the stimulus continues unaffected by itsefforts . As the movement which takes place in the sensitiveplant-the Mimosa pudica-when it is irritated, is not limited tothe spot where the irritation acts, but extends, if this be sufficientlyintense, to the whole plant; or, as in certain morbid states of thehuman organism, the continuance of an irritation, which at firstonly causes slight reflex action, may produce a more general involuntary reaction, or convulsions; so in the frog, the enduringstimulus, which has not been affected by the customary reflexmovement, now gives rise to those further physiological movements which would have been made use of had the creaturestill possessed its brain. In the constitution of the spinal cordare implanted the capabilities of such co-ordinate energies; andthe degree of the irritation determines the extent of the activity.There takes place an irradiation of the stimulus. But this happenswithout consciousness; and all the design which there is in themovement is of the same kind as the design which there is inthe 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 treegrow up into heaven; the particles of the crystal aggregate aftera certain definite plan, and thus strictly manifest design.we, then, to assume that, because of the design, there is consciousness in the forming crystal or the growing tree? Certainlynot; and yet it is to such extreme conclusion that the argumentsof those who look upon the so- called design of an act as testifyingto consciousness logically lead. The design of an act is nothingelse but the correlate in the mind of the observer of the law ofAreex organismo et physicis legibus sensorio communi propriis fluunt, suntque prop.terea spontaneæ et automaticæ. "-Commentatio de Functionibus SystematisNervosi, p. 88. 1784. It must be remembered that Prochaska included thespinal cord under the sensorium commune.74 THE SPINAL CORD, OR [CHAP.the matter in nature; and each observer will see in any eventexactly that amount of design which he brings with him thefaculty of seeing.Much fruitless theory would have been avoided if the realnature of design had been kept distinctly in mind. The notionthat the soul works unconsciously in the building up of theorganism, which has at different times been so much in fashion ,rests entirely upon the assumption that an intelligent principleor agent must be immanent in organic matter which is goingthrough certain definite changes. But if in the formation of anorgan, why not also in the formation of a chemical compoundwith its definite properties? The function is the necessary resultof a certain definite organic structure under certain conditions,and in that sense must needs minister to the furtherance of itswell-being. But an organic action, with never so beautifullymanifest a design, may, under changed conditions, become asdisastrous as it is usually beneficial; the peristaltic movementsof the intestines, which serve so essential a purpose in the economy, 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? Therepair of a ruptured urethra will, instead of restoring the integrity of the canal and then ceasing, go on, with a final purpose singularly and obstinately mischievous, to produce an obliterationof the canal, unless human art come to the rescue. M. Bert hasmade many extremely interesting experiments on grafting partscut 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 ofanother rat; it took root there, and went through its normalgrowth. Where was the design of its going through its regulardevelopment there? Or what, in the adoption and nutrition ofthis useless member, was the final purpose of the so- called intelligent vital principle of the rat on which the graft was made?Whatever design we recognise is really an idea that is graduallyformed in our minds from repeated experiences of the law of thematter, a law which acts necessarily, fatally, blindly. Any otherkind of design can exist only in the creative mind; and into thequestion of what exists there science cannot enter. Those whowould rashly venture to do so might call to mind and weigh the111.] TERTIARY NERVOUS CENTRES, ETC. 75sagacious remark of Spinoza, that the idea of a perfect God isincompatible with the conception of such working after anaim, " because God would then desire something which Hewas without."It will not be amiss to take note here of the very differentway in which we are in the habit of regarding dead matter andliving matter. In dead matter the form is looked upon as theattribute of the matter, whereas, on the other hand, in livingbodies the matter is treated as the attribute of the form ininorganic nature the matter is the essential thing, in the organiccreation the form is all in all. But to neglect the exact consideration of the conditions and combinations of matter, asdetermining organic form, is not less mischievous than it is toconcentrate all attention upon the matter in inorganic nature. *What are inseparably joined together in nature let us not vainlyattempt to put asunder. Mindful of this maxim we shall notbe so much tempted to fall back upon that vague and shiftingdoctrine 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 themore advanced sciences, still works injuriously in biology, whereso much is yet recondite and obscure. (2) The human understanding can indeed best impose its own rules on nature therewhere the truth is most inaccessible and least known. Not onlydoes it in biology look for a final cause answering to its own.measure, but, having found this, or created it, proceeds straightway to superadd its own attribute of consciousness, so thatwherever evidence of design is met with, be it only in thefunction of the spinal cord of a decapitated frog, there consciousness is assumed. Is it not a marvel that no teleologist hasyet been found to maintain that the final cause of the moon isto act as a " tug" to the vessels on our tidal rivers?There can be no difficulty in admitting that the spinal cord isan independent centre of so-called aim-working acts that are notattended with consciousness. It is the centre, however, not onlyof co-ordinate action the capability of which has been implantedin its original constitution, but also of co-ordinate action theIndeed, the chemists are now discovering how much the qualities of substances are determined by different molecular arrangements of the same atoms.76 THE SPINAL CORD, OR [CHAP.power of which has been gradually acquired and maturedthrough individual experience. Like the brain, the spinal cordhas, so to speak, its memory, and must be educated; the reaction.which it displays, in consequence of a particular impressionconveyed to it from without, does not vanish issueless, leavingthe ganglionic cells unmodified after its force has been expended.With the display of energy there is a coincident change or wasteof nerve element; and, although a subsequent regeneration orrestoration of the statical equilibrium takes place by the quietprocess of nutrition, yet the nutritive repair, filling up the losswhich has been made, must plainly take the form made by theenergy and coincident material change. Thereby the definiteactivity is to some extent realized or embodied in the structureof the spinal cord, existing there for the future as a motorresiduum, or as, so to speak, a potential or abstract movement;accordingly there is thenceforth a tendency to the recurrence ofthe particular activity-a tendency which becomes stronger withevery repetition of it. Every impression which is made leavesbehind it, therefore, its trace or residuum, which is again quickenedinto activity on the occasion of an appropriate stimulus; thefaculties of the spinal cord are thus gradually formed and matured.When a series or group of movements are, after many voluntaryefforts, associated, they notably become more and more easy, andless and less separable, with every repetition, until at last theyare firmly fixed in the constitution of the cord, become a part ofthe faculty of it, and may be accomplished without effort or evenwithout consciousness: they are the secondary or acquired automatic acts, as described by Hartley. (3 ) In this way walking becomes so far a reflex or automatic act that a man in a profoundabstraction may continue to walk without being conscious wherehe is going, and find himself, when he is aroused from his reverie,in a different place from that which he intended to visit. Inthat form of epilepsy known as the petit mal, an individualsometimes continues automatically, whilst consciousness is quiteabolished, the act which he was engaged in when the attackseized him a shoemaker used frequently to wound his fingerswith the awl as he went on with his work during the attack,and on one occasion walked into a pond of water during thesuspension of consciousness; and a woman whom Schroeder11.]TERTIARY NERVOUS CENTRES, ETC. 77van der Kolk knew, continued eating or drinking, or the occupation she was about, being quite unconscious on recovery of whathad happened. Trousseau mentions a young amateur musiciansubject to epileptic vertigo, who sometimes had a fit lasting forten or fifteen seconds whilst playing the violin. Though hewas perfectly unconscious of everything around him, and neitherheard nor saw those whom he was accompanying, he still wenton playing in time during the attack. The same author alsomentions an architect who had long been subject to epilepsy,and did not fear to go up the highest scaffoldings, though perfectly aware that he had often had fits while walking acrossnarrow planks at a pretty considerable height. He had never metwith an accident, although, when in a fit, he ran rapidly over scaffoldings, shrieking out his own name in a loud and abrupt voice.Aquarter of a minute afterwards he resumed his occupation andgave his orders to the workmen; but unless he was told of it, hehad no idea of the singular act which he had been committing.In fact, if any one attends to his ordinary actions during the day,it will be surprising how small a proportion of them are consciously willed, how large a proportion of them are the resultsof the acquired automatic action of the organism . It is sufficiently evident that the faculties of the spinal cord are, for themost part, not inborn in man, but gradually built up by virtueof experience and education; in their formation they illustratethe progress of human adaptation to external nature.Certainly the capability of certain associated voluntary movements, or the germ of such capability, does appear to exist as aninnate endowment of the spinal cord even in man, whilst inthe lower animals it is very evident. As the young animal,directly it is born, can sometimes use its limbs with completeeffect, or as the infant, previous to any experience, is capable ofthat association or catenation of movements necessary to crying,breathing, or coughing, so likewise does there appear to be, asMr. Bain argues, the germ of a locomotive harmony in the• " The condition of such persons may be compared to somnambulism, or to whathappens in the case of certain persons who answer questions during sleep, but donot recollect anything when they wake up. "-TROUSSEAU, Clinical Lectures,vol. i . p. 59.The Senses and the Intellect, 2d ed. It has long been distinctly recognisedas a general law that when a moderate stimulus excites several motor nerves,78 THE SPINAL CORD, OR [CHAP.original conformation of the nervous centres of man. Not onlydoes the analogy of the lower animals favour the belief in theoriginal existence of such an associating link, but the tendencyto an alternate action of the lower limbs, and of the two sidesof the body, observably precedes any acquisition of experience.There is, furthermore, a proneness to the involuntary associationof the motions of corresponding parts of the two sides of thebody; and, as Müller has observed, the less perfect the action ofthe nervous system in man, or the less developed volition is , themore general are the associate movements. It would be a fruitless task, however, to attempt to fix the value of this pre-established arrangement in man, where it is obviously at best rathera potentiality than an actuality; and, for all practical purposes,we must view the faculties of his spinal cord as acquired byeducation. The child certainly has the capability of learning towalk, but the actual process of learning involves the expenditureof much time and energy, and represents a progressing development of the spinal cord: it is the faculty thereof in the making.Of course it is not to be supposed that the spinal centres ofthemselves ordinarily suffice for all the complicated movementsof walking, although they may do so: all that is claimed is, thatthey are the automatic centres of certain associate movements,which have been acquired, and which constitute a large part ofour daily action. *these are physiologically connected: first, inasmuch as all the fibres going to aparticular muscle are simultaneously excited, so that partial movement of themuscle does not take place; secondly, as the regular reflex activity implicatessuch muscles as are functionally co- ordinated, the associated action of whichproduces certain physiological effects -e.g. coughing, sneezing, swallowing. Inthe electric fish, the malapterus, the nerve going to the electric apparatus is atfirst a single fibre which divides and subdivides in its course, until it furnishes asmany branches as there are electric plates; so that the creature cannot isolate apart 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 thevanity, of attempting to treat such questions satisfactorily from a psychologicalpoint ofview. The locomotive harmony is the result of the connexions of certaincells and groups of cells in the spinal cord. " Si l'homme, le lapin, le moineau, le pigeon, ne marchent pas dès leur naissance, c'est uniquement à causedu développement incomplet des divers organes, et surtout, sans doute, des centresSi l'enfant naissait en présentant un degré de développement égal àcelui qu'offre le cochon d'Inde, il marcherait dès le premier jour. "-VULPIAN (op.cit. ), p. 529.nerveux.

• Schroeder van der Kolk, after saying that the production of harmonized

III.] TERTIARY NERVOUS CENTRES, ETC. 79This power of co-ordinate action, which the spinal centresacquire by assimilation of the influence of the individual'ssurroundings and respondent reaction thereto, is plainly a mostuseful, as it is a most necessary, provision of nature. For if anact became no easier after being done several times, if the careful direction of consciousness were necessary on every occasionto its accomplishment, it is evident that the whole activity of alifetime might be confined to one or two deeds- that no progresscould take place in development. A man might be occupied allday in dressing and undressing himself; the washing of hishands or the fastening of a button would be as difficult to himon each occasion as to the child on its first trial; and he wouldfurthermore be completely exhausted by his exertions. Forwhile secondary automatic acts are accomplished with comparatively little weariness-in this regard approaching the organicmovements, or the original reflex movements-the consciousefforts of the will soon produce exhaustion. A spinal cord without memory would simply be an idiotic spinal cord incapable ofculture —a degenerate nervous centre in which the organizationof special faculties could not take place. It is the lesson of agood education so consciously to exercise it in reference to itssurroundings that it shall act automatically, in accordance withthe relations of the individual in his particular walk of life.The phenomena of secondary automatic action are well fittedto exhibit the mode of origin and nature of what we call design.It is here observably an acquisition that is gradually organizedin respondence to particular experience and education; representing as it does the acquired nature of nerve element, its manifestation is the simple result of the constitution of the materialsubstratum, just as the properties of any chemical element arethe unavoidable result of its nature. That means are adapted tomovement is due to the ultimate connexion of certain groups of ganglioniccells in the spinal cord, goes on to say-" It has always been incomprehensibleto me, how any one could ever have referred it ( co - ordination ) to the cerebellum. If the cause of this co-ordination lay in the cerebellum, no horizontalreflex movements could take place in a decapitated frog. "-On the MinuteStructure of Spinal Cord and Medulla Oblongata, p. 72. The supposition thatthe cerebellum is the sole centre of co- ordination is now, in fact, abandoned asuntenable. There never was any real scientific evidence to support it, while therewas positive evidence against it (See Versuch einer physiologischen Pathologieder Nerven, von G. Valentin, 1864, vol. ii. p. 68.)80 THE SPINAL CORD, OR [CHAP.the production of an end in the phenomena of life, is but anotherway of saying that what we please to call life exists; for ifmeans were not adapted to an end, there could plainly be noend; and if we choose to assume a certain result to be the endof certain means, then we are but saying that, according to ourexperience, certain combinations of matter have certain definiteproperties. In the building up of the secondary automatic faculties of the spinal centres, we are thus able to trace through thecourse of its formation in individual life that design which wemeet with fully formed in the innate faculties of so manyanimals; but which even in that case has been, as we shall hereafter see, gradually organized through generations. If it be saidthat the gradual building up by education of this embodieddesign into the constitution of the nervous centres is itself anevidence of design, then we can only answer, that such proposition is merely a statement in other words of the fact thatthings exist as they do, and add the expression of a convictionthat science cannot enter into the councils of creation. Thegrowth of a cancer until it kills the body, or of a vice until itruins the mind, are neither more nor less evidence of design.Should these considerations not be satisfactory to the teleologists, it will be sufficient to recall to them the already givenobservation of Spinoza, and to congratulate them on their powerof diving into "the mysteries of things as if they were God'sspies." Were it not well, however, that they should condescendto humble things, and unfold to us, for example, the final causeof the mammary gland and nipple in the male animal?As the faculties of the spinal cord are built up by organization, so must they be kept up by due nutrition. If not sopreserved in vigour, if exhausted by excesses of any kind, theill effects are manifest in degenerate action; instead of definiteco-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 ofthe nerve centres, serve no good end, but have strangely forgottentheir 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-inother words, fulfil the law which necessitates them.111.]TERTIARY NERVOUS CENTRES, ETC. 81

probable that the rhythmical organic movements, such as thoseof the heart, of respiration, of the cilia, are due to a rhythmicalnutrition; that is, "a method of nutrition in which the acting partsare, at certain periods, raised, with time-regulated progress, to astate 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 takesplace, and the time of each occurrence of the movement represents the time-rate of nutrition. But the spinal centres areequally dependent on nutrition for the maintenance of theirfunctions; the structural or chemical change produced by theordinary activity of the day must be repaired during a period ofcessation of action. This restoration most likely takes placeduring sleep; and there is some reason to believe that theperiodical action of the spinal centres is, like rhythmical organicmovement, dependent upon, or closely related to, the time-rateof nutrition. The unconscious quiet manner in which the automatic action of the spinal centres is performed, though in oneway or another the work is continuous during waking, mightseem at first sight to render no cessation of action necessary;but a little reflection shows that here, as elsewhere, the expenditure of force must be balanced by a corresponding supply. If norest be allowed, the exhaustion is evinced, first, in an inability toaccomplish successfully the most delicate or complex associatedmovements in a loss, that is, of design; then in tremblingincapacity, which, if the degeneration increases, may pass on toactual spasmodic movements and finally to paralysis. Thereinwe have sure evidence that the constitution of the nerve element has suffered from the drain of activity.A reflection which occurs, in considering the nervous mechanism by which the action and reaction between the individualand nature take place, is as to the disproportionate exhibition offorce by the organism to the force of the simple impression whichmay happen to be made upon it. How, with due regard to theprinciple of the conservation of force, do we account for thisseeming generation of energy? In the first place, the central

• Croonian Lecture before the Royal Society, 1857.

G82 THE SPINAL CORD, OR [CHAP.ganglionic cell is not a simple impassive body, which merelyreflects or passes onwards a received current of activity, withoutaffecting it or being affected by it: on the contrary, it is thecomplexly constituted, supremely endowed centre in which forceis released or evolved on the occasion of a suitable stimulus; andthat which is perceived, as it were, in the spinal cord is not theactual impression made upon the afferent nerve, but it is theeffect produced in the particular central nerve cell or cells.Is it not plain enough howthis force or energy is evolved, or, asit were, unfolded in the cell? Bythe disturbance of the staticalequilibrium of an intensely vital structure; by a change of thematerial into lower kinds, or a degeneration of it, and a correlative resolution of its force into lower modes and larger volumetrical display. There is not any actual generation of force;there is a transformation of the high quality of latent forcewhich the nervous monad implies into actual force of a lowerquality and larger display. Consider what has been previouslysaid as to the nature of nerve element and its position in theuniverse it will then be sufficiently evident what manner ofprocess it is that takes place. Slowly and, as it were, laboriously,by a steady appropriation and ascent through many gradationsof vitality, does organic element arrive at the complex andsupreme nature of nerve structure; quickly and easily doesnerve element give back force and matter to nature, in therapid resolution which the accomplishment of its functionimplies. (*)

Thus much concerning the inherent force of the spinal cord asa nervous centre. In the second place, bear in mind the natureof its acquired faculties, and the great expenditure of force madeupon its education. In the registration of impressions madeupon it, in the assimilation of their residua, there is slowlyembodied a quantity of energy as an organic addition of power;force is being stored up in the gradual organization of itsfaculties. The exhaustion which we feel from our efforts toacquire any particular skill of movements, as in learning todance, the labour given to the frequent voluntary repetition ofthe stimulus and adapted reaction thereto, until by practice thedefinite relation has been established, and the desired skillacquired;-these testify to the expenditure of so much forceIII.] TERTIARY NERVOUS CENTRES, ETC. 83which has been laid up as statical power in the constitution ofthe ganglionic cells of the cord, rendering possible for the futurea group of associated movements in answer to a moderate and, asmight often seem, disproportionate stimulus from without. Likethe brain, the spinal cord lays up good store of power in itsmemory. Man's life truly represents a progressive developmentof the nervous system, none the less so because it takes place outof the womb instead of in it. The regular transmutation ofmotions which are at first voluntary into secondary automaticmotions, as Hartley called them, is due to a gradually effectedorganization in the proper centres; and we may rest assured ofthis, 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 issometimes distinctly transmitted to the progeny as a heritage,instinct, or innate endowment, furnishes a striking confirmationof the foregoing observations. Power which has been laboriouslyacquired and stored up as statical in one generation manifestlyin such case becomes the inborn faculty of the next; and thedevelopment takes place in accordance with that law of increasing speciality and complexity of adaptation to externalnature which is traceable through the animal kingdom, or, inother words, that law of progress from the general to the specialin development which the appearance of nerve force amongstnatural forces and the complexity of the nervous system of manboth illustrate. As the vital force gathers up into itself inferior forces, and might be justly said to be a development ofthem, or as in the appearance of nerve force simpler and moregeneral forces are gathered up and concentrated in a more specialand complex mode of energy; so again, a further specializationtakes place in the development of the nervous system, whetherwatched through generations or through individual life. Notby limiting our observation to the life of the individual, however, who is but a link in the chain of organic beings connecting the past with the future, shall we come at the fulltruth; the present individual is the inevitable consequence ofhis antecedents in the past, and through the examination of thesealone do we arrive at the adequate explanation of him.Itbehoves us, then, having found any faculty to be innate, not toG284 THE SPINAL CORD, OR [CHAP.rest content there, but steadily to follow backwards the line ofcausation, and thus to display, if possible, its manner of origin.This is the more necessary with the lower animals, where somuch is innate.And now, having done with the general functions of the spinalcord as an aggregation of independent nerve centres ministeringto the animal life, let us add that they were distinctly recognisedby the physiologist long before the anatomist was in a conditionto give the physical explanation. It is only recently that thenerve fibres which pass to or from the spinal cord have beenproved to be connected with the unipolar, bipolar, and multipolar cells of its grey substance; and this so plainly as to justifythe belief that an isolated apolar nervous cell does not exist inthe spinal cord or brain.* For the conveyance of an impressionto the grey centres, and for the passage of the reacting forceoutwards, there is thus revealed a definite physical path, alongwhich the current of activity travels. From the cells withwhich nerves are connected, again, other processes go to joinneighbouring cells, and thus, forming a connecting path betweenthem, enable them to act together: hundreds of ganglioniccells are yoked together by such anastomoses, and, functionallyco-ordinated thereby, represent the centres of innervation ofcorresponding systems of motor nerves. By similar anastomosesthe ganglionic cells of different nervous centres are connected,and thus a means is afforded for the communication of theactivity of one centre to another. A consideration of thenervous system of the Annelida will assist in the conceptionof the physiological nature of the spinal cord. In those humblecreatures the central nervous system consists of a ganglionicapparatus, each ganglion of which is united to that which precedes it, and that which follows it, by longer or shorter nervousconnexions. Now the spinal cord of the Vertebrata may beconsidered as an analogous ganglionic apparatus, the connecting cords of which are not seen by reason of the coalescenceof the ganglia. From a physiological point of view, therefore,the grey substance may be considered as formed of distinctsegments, each segment consisting of a group or association ofThe connexions of fibres with cells have been observed most plainly in thelamprey by Owsjannikow, and by Bidder and his pupils of the Dorpat School.III.] TERTIARY NERVOUS CENTRES, ETC. 85cells, and having connected with it the roots of two anteriormotor and two posterior sensory nerves. Many, therefore, arethe channels by which the activity excited in the nerve- cellby the stimulus of the efferent nerve may be disposed of itmay at once be reflected on an efferent nerve, and pass intomuscular motion; or it may pass to other interconnected cells,and, acting thus upon a system of nerves, produce associatedmovements, either such as proceed from the cord nearly on thesame level as the afferent nerve enters, or from a different level;or, lastly, it may pass upwards, and excite the higher functionallyco-ordinated centres.To Pflüger belongs the merit of having first attempted tosystematize the laws of the reflex movements. They are:-1. The law of simultaneous conduction for one-sided reflex movements. When a reflex movement takes place only on one sideof the body in consequence of a stimulus, it is always on thesame side of the body as the irritation of the afferent nerve; thereason being probably that the motor nerves proceed from ganglionic cells which are in direct connexion with the stimulatedafferent nerves. -2. The law ofsymmetry ofreflex action. Whena stimulus has produced reflex movements on one side, and itscontinuance or its further extension in the spinal cord producesmovements ofthe opposite side, then the corresponding musclesonly of this side are affected. This is owing, no doubt, to thecommissural system, which connects together the correspondingganglionic cells of the two halves of the cord.- 3. The unequallyintense reflex action of the two sides in the event of both beingaffected. When the reflex action is stronger on one side thanupon the other, the stronger movements take place upon the sideof the irritation. -4. The law of irradiation of reflex action, bywhich an extension of reflex action takes place from the nervesin which it first appears to neighbouring ones, owing to thecommunications between the different systems or groups of ganglionic cells. When the excitation of an afferent cerebral nerveis transferred to motor nerves, we observe that the roots of bothsorts of nerves are placed nearly upon the same level in thecentral organ, or that the motor nerve lies a little behind orbelow, never in front of or above, the afferent nerve. If thereflex action spreads further, the way of irradiation is downwards86 THE SPINAL CORD, OR [CHAP.to the medulla oblongata; stimulation of the optic nerve, forexample, produces contraction of the iris. In the spinal cordthe primarily affected motor nerve lies nearly on the level of thestimulated sensory nerve. But if the reflex action spreads, thenit passes upwards towards the medulla. When the irritationhas arrived at the medulla, then it may pass downwards again.-5. The reflex action produced by the irritation of a sensorynerve can only appear in three places, whether one- sided oroccurring on both sides of the body. (a) It appears in themotor nerves which lie nearly on the same level with theexcited sensory nerve. ( b) If reflex action implicates the motornerves on a different level, these motor nerves are constantlysuch as spring from the medulla oblongata: tetanus and hysterical convulsions, in consequence of local irritations, furnishexamples. (c) The reflex action affects the muscles of the bodygenerally; the principal focus of irradiation thereof being themedulla oblongata.I proceed next to indicate briefly the causes which affect thefunctional activity of the spinal cord:-1. As an original fact, the ganglionic cells may have a greateror less stability of composition. It sometimes happens that achild is born with so great a natural instability of nerve element,that the most violent convulsions ensue on the occasion of veryslight irritation. Or the evil may be less serious, and the individual may be equal to the ordinary emergencies of a quiet,favourably spent life; but there is an absence of that reservepower necessary to meet the extraordinary emergencies andunusual strain of adverse events. When, therefore, an unaccustomed stress is laid upon the feeble nerve element, it isunequal to the demand made upon it, and breaks down into arapid degeneration. This innate feebleness is evinced by anexcessive irritability; it is truly an irritable weakness; and itsmost common cause is an unfortunate inheritance, the curse ofa bad descent. Any sort of disease of the nervous system in theparent seems to predispose more or less to this ill condition ofthe child, the acquired deterioration of the parent becoming theinborn organic feebleness of the offspring.The degeneration of nerve element in the ganglionic cellsreveals itself in a disturbance of the co-ordinate or aim- workingIII.] TERTIARY NERVOUS CENTRES, ETC. 87activity which, as we have already seen, marks the highestdevelopment of its function. Convulsions are the sure signsof a weakness or lowered vitality of nerve element,-a defectwhich, though we cannot yet ascertain its exact nature, certainlyimplies an unstable equilibrium of the organic constitution. Eachcentral nerve-cell exists in close relations, physical and physiological, with other nerve-cells; when, regardless of these relations, it reacts directly outwards on its own account, it is verymuch like an individual in a social system who, by reason ofmadness, is unable to maintain his due social relations.Not only may an excess of irritability be a defect in the natureof the ganglionic cell, but this may be defective also by reasonof a great insensibility of nature and a want of power of assimilation. In congenital idiots the central cells of the cord doplainly sometimes partake of the degeneracy of the brain, andare idiotic also; they are incapable of receiving impressionswith any vividness, and of retaining the traces or residua ofsuch as they do receive, -incapable of education. Spasms ofthe limbs, sometimes limited to the toe, to one arm or leg, atother times more general; contractions of a foot, or of the kneesto such degree as to make the heels touch the buttocks; morefrequent still, paralytic conditions of varying degree and extent,atrophied limbs, now and then indulging in convulsive movement; all these morbid states are met with in idiots, and,though in part attributable to the brain, are certainly in partdue to degeneration of a spinal cord utterly oblivious of itsdesign or final purpose in the universe. In some caseswhere the morbid degeneration is not so extreme, it is notimpossible to teach such combinations of movements as arenecessary for the common work of life. It may be observedincidentally that the ease and rapidity with which those idiotswho 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 anindependent nerve centre; for they display its functions in acase in which the influence of the cerebral hemispheres is almostexcluded.2. The functional action of the spinal ganglionic cells maysuffer from the too powerful or prolonged action of an external88 THE SPINAL CORD, OR [СНАР.stimulus, or from an activity continued without due intervalof rest. The molecular degeneration or waste, which is thecondition of functional activity, must be repaired by rest andnutrition; 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 highlyvital structure by assimilation of matter of a lower quality, it iscertain that, notwithstanding the best innate constitution, deterioration must ensue as surely as a fuelless fire must go out.In that degeneration of the spinal cord which sometimes occursin consequence of masturbation or great venereal excess, one ofthe first symptoms is a loss of co-ordinating power over themotions of the legs-a loss, in other words, of that which is thelast organized faculty of the spinal centres. The startings of thelimbs, and the partial contractions of certain muscles whichmay follow, do not evince increased power, as some have heedlessly fancied, but are the indications of lowered vitality; theyare the incoherent manifestations of a degenerate instability ofnerve element. When such a morbid condition of things isbrought about, there is necessarily a failure in the power of theganglionic cells to receive and assimilate impressions: hence itis that in general paralytics, in whom the memory of each independent nervous centre is decayed, there is not only an inabilityto accomplish successfully the actions to which they have beenaccustomed as, for example, an inability of a tailor, whom fromhis conversation one would deem quite capable of his work, tosew; but there is also the impossibility of teaching them newcombinations of movements. In other sorts of lunatics this isoften possible: though mentally much degenerate, and actuallylost for ever to the world, they may by persevering training bemade useful in certain simple relations to which they grow andreact as automatic machines, their own cerebral hemispheres notinterfering; the general paralytics, in whom the disease hasadvanced so far as to affect the cord, cannot thus be utilized.3. The supply of blood and the condition of it are manifestlyof the greatest consequence to the welfare of the spinal cells.The grey matter of the cord is very richly supplied with capillaries, to the end that there may be a quick renewal of bloodministering to the active interchange that goes on between theIII.] TERTIARY NERVOUS CENTRES, ETC. 89ganglionic cell and the nutrient fluid; the enormous consumption of force in nervous function demands such an abundance ofsupply. When the supply of blood is suddenly cut off, as inthe well- known experiments of Stannius, Brown- Séquard, andSchiff, the nervous activity is presently paralysed, and rigormortis of the muscles ensues. When the supply of blood issoon restored to a part in which rigor mortis has taken place,as in Brown-Séquard's experiment of injecting warm bloodinto the stiffened arm of an executed criminal, the musclespresently regain their contractility, and the nerves their irritability. As a complete cutting-off of the blood is paralysis ofnerve element, so a deficiency of blood, or of material in it fittedfor the nutrition of nerve, is to the extent of its existence a causeof degeneration or instability of nerve element. Such deterioration is exhibited by cachectic and anæmic persons in a greatirritability, and in a disposition to spasms or convulsions -anacquired condition not unlike that which is sometimes inherited.The state of the blood may be vitiated by reason of thepresence of some foreign matter which, whether bred in it orintroduced from without, acts injuriously, or as a direct poisonon the individual nerve- cells. Strychnia notably so affects themthat, on the occasion of the slightest stimulus, they react inconvulsive activity; while the woorara poison, on the otherhand, produces a sort of stupor, or coma, and paralyses allactivity. Moreover, if a sufficiently large quantity of strychniabe introduced under the skin of a frog, the effects may closelyresemble those produced by the woorara poison; death takingplace without any, or with only very feeble, convulsions. Opium,which usually produces coma in man, produces convulsions infrogs. We might, were it needful, accept these different effectsof poisons, which are alike positively injurious to the integrity ofnerve element, as evidence that convulsions do not mean strength,are not the result of an increase in the proper vital activity ofparts, but the result of degenerate vital action, and the forerunners of paralysis. These vegetable poisons indicate also, bytheir different effects, the fine differences of composition in theganglionic cells of the central nervous system; they are themost sensitive reagents in this regard which we yet possess.There is reason to believe that the presence of too much blood90 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 accompany anæmia may certainly be produced also by congestion,or hyperæmia. However, this matter will be more properlyand more fully considered when we come to the pathologyof 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 aso-called sympathetic or reflex action. Volkmann has observedmovements to be produced in the limbs of a decapitated frog bystimulation of the intestinal canal; the results being much moreevident if the animal has previously been poisoned with strychnia.The convulsions which sometimes take place during teething inchildren, or owing to the presence of worms in the intestines, arefamiliar examples of such secondary effect upon a susceptiblegrowing nervous system. It is necessary to distinguish twokinds of effects of this reflex action-or, perhaps, differentdegrees of the same kind of effect-namely, a reflex functionalmodification and a reflex nutritive modification.The irritation of a decayed tooth may, as is well known, giverise to a contraction of the muscles of one side of the neck, orto a violent facial neuralgia, or to blindness or deafness, allwhich presently disappear upon the removal of the cause ofmischief. A functional derangement only has existed so far.But the irritation of a bad tooth produces a greater and morelasting effect, when, as does now and then happen, an abscess inthe glands of the neck takes place in consequence of it, andremains an incurable fistula until the removal of the scarce suspected cause. The nutritive derangement has been caused andkept up by the reflex irritation. It must certainly be allowedthat the functional disorder, when it alone seems to exist, doestestify to some kind of change in the molecular relations of theganglionic cells; but as the abnormal modification vanishes themoment the real cause of mischief, the bad tooth, is gone, it isscarcely possible to view the disturbed function as evidence ofany serious chemical or organic derangement in the nerve- cells.With the continuance of the cause of irritation, the functionaldisorder undoubtedly may, and is liable to, pass into disorder of111.] TERTIARY NERVOUS CENTRES, ETC. 91nutrition. The relations of these different degrees or kinds ofderangement to the morbid cause are such that we might notunfairly represent the sole existing functional derangement asdue to a modification of the polar molecules of the nerve element, while the abnormal nutrition may be supposed to markan actual chemical change in its constitution.Thus, inAgain, as the spinal centres minister both to our animal lifeand 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, assubserving the animal life, exists, the functional derangementwill probably be not continuous but intermittent.epilepsy, it appears as if the reacting centres must be graduallycharged until they reach a certain tension or instability, whenthe statical equilibrium is destroyed, and they discharge themselves violently. Something of the same kind takes place in thepoisonous action of strychnia: a dog so poisoned will fall downin convulsions, but, according to Schroeder van der Kolk,they cease after a time, and the animal seems to be perfectlywell; even for so long as an hour it may be touched or strokedwithout harm; after which the susceptibility again becomes sogreat, that by simply blowing upon the skin convulsions arereproduced. When, on the other hand, the function of thespinal centres, as ministering to the organic life, is deranged,then the morbid effect will not unlikely be continuous. Theexperiments of Lister, showing that the movements of thegranules in the pigment cells of the frog's skin are under thecontrol of the spinal system, and the investigations of Bernard,agree to prove that the cerebro-spinal axis not only regulatesthe contractions of the small arteries, but directly influencesthe organic elements engaged in nutrition and secretion. Themoment food is introduced into the mouth there is a flow ofsaliva and of gastric juice. Numerous examples have been ofold quoted of distant modifications of nutrition in consequenceof some irritation of a centripetal nerve: a large secretion ofextremely acid gastric juice has been cured by the extirpation ofThey have, however, a continuous action upon the voluntary muscles inmaintaining their tonicity, as also upon the sphincters in keeping up their contraction.92 THE SPINAL CORD, OR [CHAP.painful piles; ptyalism is sometimes produced by neuralgia, aslachrymation frequently is by neuralgia of the fifth nerve; irritation of the uterus, or of the skin of the breasts, or of the mucousmembrane of the vagin*, will sometimes give rise to the secretionof milk; and menstruation may follow irritation of the ovaries,or the application of warm poultices to the breasts. We witnessphenomena due to this reflex nutritive action again in the sympathy which one eye so often exhibits with disease of the other;in the congestion of the eye or the actual amaurosis which sometimes accompanies severe neuralgia; in the paraplegia due todisplacement or disease of the uterus; and in many otherinstances too numerous to be mentioned. * Pflüger quotes fromDieffenbach a striking case, which admirably illustrates theeffects of an eccentric irritation upon the spinal cord. A younggirl fell upon a wine-glass, and cut one hand with a piece ofthe broken glass; for years afterwards she suffered from violent.neuralgic pains and emaciation, with contraction and completeuselessness of the hand. She was afflicted also with severeattacks of epilepsy. On cutting through the cicatrix of the oldwound, a minute splinter of glass, which had wounded the nerve,was detected; the nerve was also thickened and hardened. Afterremoval of the glass, the neuralgia and epilepsy disappeared, andthe girl recovered the entire use of her hand.5. Lastly, the severance of the connexion between the brainand the ganglionic cells of the spinal cord seems in some degreeto affect their function. When a nerve is cut across in the livingbody, the peripheral end soon undergoes fatty degeneration, whilethe central end remains unchanged after years; and this degeneration is not owing solely to the inactivity of the nerve, for itstill takes place when the nerve is regularly stimulated, andtakes place much less quickly in frogs and cold-blooded animalsIt is customary now to describe as reflex the modifications of sensation, aswell as those of nutrition, secretion, and motion, which occur in a distant partby reason of the irritation of some afferent nerve; but it is a question deservingconsideration whether the old word sympathy is not more appropriate to designatethe modifications of sensation, and whether the word " reflex " should not be appliedspecially 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, mightnot improperly be described as synergy.III.] TERTIARY NERVOUS CENTRES, ETC. 93than in warm-blooded animals. The researches of Waller-whichhave been confirmed by Longet, Schiff, and others -are mostimportant in regard to this subject. It is certainly a fair conclusiou from them that the nerve fibres have their nutrition subjected in some measure to the nerve centres; these would indeedappear to play in relation to them the part of nutritive centres.After apoplexy in or about the corpus striatum, Turck professesto have found granular cells in the course of the fibres as theypass downwards, so that such cells were met with in the spinalcord on the opposite side to the seat of disease. It is known,too, that the removal of the brain in the lower animals increasesthe ease with which reflex movements take place; and there aremany cases on record in which the reflex action has been increasedin man when disease or injury has interrupted the continuity ofthe spinal centres with the brain. May we not, then, concludefrom such facts that a positive influence is exercised by the brainupon the nutrition, of the ganglionic cells of the cord and thenerve fibres which proceed from the cerebro- spinal axis, as wellas by the spinal centres on the nerve fibres which proceed directlyfrom them? In fact, may we not justly conclude that such aninfluence is exerted by every nerve centre on the centre which issubordinate to it, and on the nerves which proceed from it? Theinference would be agreeable to what we know of the directinfluence of the functional action of the brain upon that of thecord; the reflex acts in health being for the most part notablysubordinate to the control of the will. As a guiding influencepasses from above downwards when the cerebro- spinal system isministering to the functions of animal life; so it is not improbable that the brain, in the accomplishment of its function as anorgan of organic life, exerts some power which is favourable tothe nutrition of the parts which lie below it, and which are theinstruments through which it acts. This influence being withdrawn, an exaggeration of the excitability of the cord occurs,such as a wound causing tetanus may produce, or such as wasproduced by Brown- Séquard in guinea-pigs, when, having injuredtheir spinal cord two or three weeks before, he was able toexcite epileptiform convulsions at will, by pinching the skin ofthe face. It is true that some have thought to explain in anotherway the increase in the reflex movements which follows the94 THE SPINAL CORD, OR [CHAP.severance of communication between the brain and cord; theyhave attributed it to the augmented energy of the spinal centres,and to the concentration of the stimulus, now that a path for thedispersion of its force is cut off. Such theory is not innocent ofthe vulgar error of regarding as increased energy that which istruly a diminution or deterioration of the higher vital energy ofthe part. Has it ever yet happened to any one to discover thatthe co-ordinate reflex acts were made more energetic or effectiveby cutting off the influence of the brain? One most necessaryfunction of the brain is to exert an inhibitory power over thenerve centres that lie below it, just as man exercises a beneficialcontrol over his fellow animals of a lower order of dignity; andthe increased irregular activity of the lower centres surelybetokens a degeneration it is like the turbulent, aimless actionof a democracy without a head.Such, then, are the disturbing causes which may affect theactivity of the spinal cord, both as a conducting path and as anindependent centre of the generation of nerve- power. Whenwe reflect upon the great proportion of the daily actions of lifethat are effected by its unconscious agency, we cannot but perceive 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 convulsiveaction when a certain degree of instability of nerve element has,from one cause or another, been produced in the spinal cells. Itwould be as absurd to preach control to the spasms of chorea, orrestraint to the convulsions of epilepsy, as to preach moderationto the east wind, or gentleness to the hurricane. That which insuch case has its foundation in a definite physical cause musthave its cure in the production of a definite physical change.So certain and intimate is the sympathy between the individual nerve-cells in that well-organized commonwealth which thenervous system represents, that a local disturbance is soon felt.more or less distinctly throughout the whole state. When anyserious degeneration of the ganglionic cells of the cord exists,there is not only an indisposition or inability to carry out assubordinate agents the commands which come from above; butthere is a complaint sent upwards-a moan of discontent or painreaches the supreme authority. That is the meaning of theIII. ] TERTIARY NERVOUS CENTRES, ETC. 95feelings of weariness, heaviness, achings of the limbs, and utterlassitude which accompany disorder of the spinal centres; andthe convulsive spasms, the local contractions or paralysis ofmuscles, are the first signs of a coming rebellion. If the warnings do not receive timely attention, a riot may easily becomea rebellion; for when organic processes, which normally go onwithout consciousness, force themselves into consciousness, it isthe certain mark of a vital degeneration. If the appeal is madein vain, then further degeneration ensues. Not only is thereirregular revolutionary action of a subordinate, but there is protanto a weakening of the supreme authority; it is less able tocontrol what is more difficult of control. When due subordination of parts exists, and the individual cell conforms to the lawsof the system, then the authority of the head is strengthened.A foolish despot, forgetting in the pride of his power that thestrength and worth of a government flow from and rest uponthe well-being of the governed, may fancy that he can safelydisregard the cry of the suffering and the oppressed; but when hecloses his ears to complaints, he closes his eyes to consequences,and finally wakes up to find his power slipped from him, andhimself entered upon the way of destruction. So is it with thenervous system: the cells are the individuals, and, as in thestate, so here, there are individuals of higher dignity and oflower dignity; but the well-being and power of the higher individuals are entirely dependent upon the well-being and contentment of the humbler workers in the spinal cord, which do sogreat a part of the daily work of life. The form of governmentis that of a constitutional monarchy, in which every interest isduly represented through adequate channels, and in which, consequently, there is a proper subordination of parts.I have lingered thus long upon the spinal cord, because mostof what has been said with regard to its functions may, withthe necessary change of terms, be applied to the other nervouscentres. A distinct conception of the nature and mode ofdevelopment of the functions of the spinal centres is the best, isindeed the only adequate, preparation for an entrance upon thestudy of cerebral action; it is an indispensable prerequisiteto the right understanding of the higher displays of nervousfunction, and alone fixes the sure basis whereon to build a true96 THE SPINAL CORD, OR [CHAP.mental science. * In this way we apply the laws generalizedfrom the more simple cases to disentangle the phenomena of themore complex cases. Any system not so founded follows notthe order of development in nature, and must be unstable andinsecure Nature herself protests against it with energetic eloquence when she makes, as she unquestionably sometimes does,morbid action of the cells of the cerebral hemispheres vicariousof the morbid action of the spinal cells.1NOTES.¹ (p. 72).- Pflüger compares the movements of a decapitated animalwith those of a sleeping man, deeming the movements in both to beconscious. He tickled the right nostril of a sleeping boy, and the ladrubbed it with his right hand: when Pflüger tickled the left nostril thelad rubbed it with his left hand. If he held the sleeper's right handwithout waking him, and tickled his right nostril, the boy first madeattempts 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.66For a fuller discussion of the assumed consciousness of the spinalcord I must refer to my review of Mr. Bain on the " Senses and theIntellect," in the Journal of Mental Science for January 1865, pp.558, 559. I will only now add a quotation from Spinoza, as translatedby M. Saisset. "Personne, en effet, n'a déterminé encore ce dont lecorps est capable; en d'autres termes personne n'a encore appris del'expérience ce que le corps peut faire et ce qu'il ne peut pas faire, parles seules lois de la nature corporelle et sans recevoir de l'âme aucunedétermination. " "This is not astonishing," he adds, as no one hassufficiently studied the functions of the body," and instances themarvellous acts of animals and somnambulists-" toutes choses quimontrent assez que le corps humain, par les seules lois de la nature,est capable d'une foule d'opérations qui sont pour l'âme jointe à cecorps un objet d'étonnement. . . . . J'ajoute enfin que le mécanismedu corps humain est fait avec un art qui surpasse infiniment l'industriehumaine. " The associating link of many movements-as, for example,of those of the heart, of the eye, of breathing-plainly exists in theIn the "Archiv. für Physiolog. Heilkunde, " 1843, there is an excellent paperby Prof. Griesinger, " Ueber psychische Reflexactionen, mit einem Blick auf dasWesen der psychischen Krankheiten; " and another in the same Journal for1854, " Neue Beiträge zur Physiologie und Pathologie des Gehirns. "III.] TERTIARY NERVOUS CENTRES, ETC. 97conformation of the nervous centres; the wisdom or design isexhibited in the primary arrangement, whereby the reactions of theorganism necessarily following do, as a rule, minister to the furtherance of its well - being."2 (p. 75).—“ And therefore it was a good answer," says Bacon, “ thatwas made by one who when they showed him hanging in a templea picture of those who had paid their vows as having escaped shipwreck, and would have him say whether he did not now acknowledgethe power of the gods, ' Ay,' asks he again, but where are theypainted that were drowned after their vows?'" Speaking of finalcauses, upon which the human understanding falls back, he says thatthey "have clearly relation to the nature of man rather than to thenature of the universe; and from this source have strangely defiledphilosophy. "-Nov. Org. Aphorism xlviii.3 (p. 76). " After the actions which are most perfectly voluntaryhave been rendered so by one set of associations, they may, by another,be made to depend upon the most diminutive sensations, ideas, andmotions, 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 actioninto 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, andwithout any effort of the mind, are rather to be ascribed to the bodythan the mind, i.e. are to be referred to the head of automatic action.I shall call them automatic motions of the secondary kind to distinguish them from those which are originally automatic, and from thevoluntary ones; and shall now give a few instances of this doubletransmutation of motions, viz. of automatic into voluntary, and ofvoluntary into automatic. " He instances the manner in which childrenlearn, and especially the way we learn to speak, to play on the harpsichord, &c. "The doctrine of vibrations explains all the originalautomatic motions; that of association, the voluntary and secondarilyautomatic ones."-HARTLEY'S Theory of the Human Mind, edited byPriestley, pp. 32, 39.4 (p. 82). "Impressionum sensoriarum in motorias reflexio, quæ insensorio communi fit, non peragitur juxta solas leges physicas, ubiangulus reflexionis æqualis est angulo incidentiæ, et ubi, quanta fitactio, tanta etiam sequitur reactio; sed leges peculiares, a naturâ inpulpam medullarem sensorii quasi scriptas, sequitur ista reflexio quasex solis effectibus tantum noscere, neutiquam vero assequi nostroH98 THE SPINAL CORD [CHAP. III . , ETC.ingenio valemus. Generalis tamen lex, quâ commune sensorium impressiones sensorias in motorias reflectit, est nostri conservatio: ita utimpressiones externas corpore nostro noscituras sequantur certæ impressiones motoriæ, motus producturæ eo collimantes, ut monumentuma corpore nostro arceatur, amoveaturque; et vice versâ impressionesexternas seu sensorias, nobis profuturas, sequantur impressiones internæseu motoriæ, motus producturæ eo tendentes, ut gratus ille status ultroconservetur. " -PROCHASKA, op. cit. p. 88.CHAPTER IV.SECONDARY NERVOUS CENTRES, OR SENSORY GANGLIA;SENSORIUM COMMUNE.THETheHE different collections of grey matter which exist in themedulla oblongata, and at the base of the brain, the continuations of the grey matter of the spinal cord , consist chieflyof the nervous centres of the higher senses, with correspondingcentres of motional reaction. Continuing the grey substance ashigh as the floor of the lateral ventricles, they include the opticthalami, the corpora striata, the corpora quadrigemina, and thedifferent sensory centres that are placed in the medulla oblongata, the tuber annulare, and the cerebral peduncles.olfactory bulbs, which lie at the base of the anterior cerebrallobes, must also be included in the sensorium commune. Anyone of the senses may be destroyed by injury to its sensoryganglion as surely as by actual destruction of its organ; blindness is produced by injury to the corpora quadrigemina, smellis abolished by destruction of the olfactory bulbs. These ganglionic centres are thus intermediate between the higher hemispherical ganglia above and the spinal centres below them; tothose they are subordinate, to these they are superordinate. Inmany of the lower animals, as already pointed out, the brainconsists of nothing more than the sensory ganglia, with centresof motional reaction.It is not the place here to enter into a discussion of thedifferent opinions which have been entertained regarding theexact centres of the different senses; much of what is said onthese difficult questions is still conjectural. It was maintainedby Dr. Todd, who has been supported in his views by Dr. Carpenter, that the seat of common sensation is located in theH 2100 SECONDARY NERVOUS CENTRES, OR [ CHAP.thalami optici, because it is in these bodies that the anteriorcolumns of the spinal cord seem to terminate; and that thecorpora striata, to which the posterior columns of the cord pass,are the corresponding motor centres. Vulpian, however, hasbrought forward strong arguments in favour of assigning theseat of common sensation to the tuber annulare. After theremoval of the corpora striata, the tubercula quadrigemina, andthe cerebellum-the tuber annulare and the medulla oblongatabeing the only parts of the encephalon left -he found that dogsand rabbits evinced, by violent agitation and decided cries of suffering, the pain felt when severely pinched or otherwise irritated.Moreover, injuries of the thalami optici, pathological or experimental, do not weaken sensibility, but do often produce motorparalysis. He concludes that we are yet in entire ignorance ofthe special functions both of the thalami optici and the corporastriata. Notwithstanding this opinion, those who have examinedthe arguments on this subject will probably conclude thatVulpian's theory concerning the tuber annulare has blinded himto the import of the evidence in favour of the thalami optici andthe corpora striata as sensory and motor centres respectively.It may well be that they are not the entire centres, and thatthere are other centres of sensibility and motion in the tuberannulare and cerebral peduncles; but that they do minister tothose functions it is hardly possible to doubt. Meanwhile allthat concerns us here, in dealing with the cerebral functions.from a psychological point of view, is to have some generalterm to embrace and designate all the centres of sensation;and for this purpose we shall employ the term sensorium commune, using it to denote the common centres of sensation, andnot, as Vulpian and some others have misused it, to designatethe centres of common sensation. In a similar sense we shallsubsequently use the terms motorium commune and intellectoriumcommune.The ganglionic centres of the sensorium commune are formedof numerous nerve-cells, which, like those of the spinal cord,are in connexion with afferent and efferent nerves; the afferentnerves in this case coming mostly fromthe organs of the specialsenses. The impressions which the afferent nerves bring are,therefore, special in kind, as also are the grey nuclei to whichIV.] SENSORY GANGLIA, ETC. 101they are brought; a progressive differentiation of structureand function is manifest; and we might describe the sensorium commune physiologically as a spinal cord, the afferentnerves of which are the nerves of the special senses, or ratherof the various kinds of sensibility. For although we usuallydistinguish only between the special senses and general sensibility, yet there are really different kinds of the latter, eachprobably having its special nucleus: the tactile sense, the senseof temperature, the muscular sense, and the peculiar sensibilityof the glans penis, differ not in degree only, but in kind. Anexact knowledge of the anatomical relations of the different greynuclei is still wanting, notwithstanding the patient investigationsof Schroeder van der Kolk. All that we are certain of is , thatthe fibres of the nerves are connected with the cells, as may bemost easily seen in the case of the auditory nerve and ganglion;that manifold connexions exist between different nuclei; andthat fibres may sometimes be traced from the nucleus of asensory nerve to a motor nerve upon which it is known to exerta reflex action. The trigeminus, or fifth nerve, for example,passes from above downwards through the medulla, and in itsdownward course forms reflex connexions with all the motornerves of the medulla as it approaches the level of their nuclei;in this way the facial, the glossopharyngeal, the vagus, thespinal accessory, and the hypoglossal receive communicationsfrom it. The ganglionic cells of different nuclei also differ inform and size; and Schroeder van der Kolk holds that, as ageneral rule, at every spot where fibres are given off for theperformance of any special function, there fresh groups of ganglionic cells giving origin to them appear. We justly conclude,then, that, as we should à priori expect, specially constitutedganglionic cells minister to special functions; that the centralcells are, as it were, the workshops in which, on the occasionof a suitable stimulus, the peculiar current necessary for theperformance of the specific action is excited. A message is sentup to them by the appointed channels, and they reply by sendingthrough the regular motor channels the particular energies whichit is their function to supply. Charged with their proper forceduring the assimilating process of nutrition, it exists in them asstatical power, or latent energy; and the condition of unstable102 SECONDARY NERVOUS CENTRES, OR [CHAP.vital equilibrium is upset, the force being then discharged, asthe Leyden jar is, when a certain stimulus meets with a sufficient tension.The natural course of a stimulus, all the force of which is notreflected upon an efferent nerve in the spinal centres, is upwardsto the sensorium commune, where it becomes the occasion of anew order of phenomena; the law of extension of reflex actionexcited by a spinal nerve observably being, as Pflüger has shown,from below upwards to the medulla. Having arrived at theganglionic cells of the sensorium commune, the stimulus may beat once reflected through the motor nuclei on a motor nerve, forwhich there is provision in a direct physical path, and involuntary 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 sensorycentres are unquestionably centres of independent reaction, andin association with their proper motor nuclei give rise to a classof reflex movements of their own. When a man lies with thelower half of his body paralysed in consequence of injury ordisease of his spinal cord, the tickling of the soles of his feet willsometimes produce reflex movements of which he is unconscious.When a man lies with no paralysis of his limbs, but with aperfectly sound spinal cord, the sudden application of a hot ironto his foot or leg will give rise to a movement quite as involuntary as that which takes place in the paralysed limb, but, in thiscase, in answer to a painful sensation; the reaction takes placein the sensory ganglia, and the movement is sensori-motor. Hadthe hot iron been applied to the paralysed limbs, no movementwould have followed, because the path of the stimulus was cutoff as completely as the current of the electric stimulus is interrupted when the telegraphic wires are cut across.Take awaythat part of the brain of an animal which lies above the sensoryganglia, and it is still capable of sensori-motor movement, like asthe animal which possesses no cerebral hemispheres is becausethe ganglionic cell is a centre of independent reaction—a stationon the line which may either send on the message or send off ananswer. * (1) 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 muscularIV.] SENSORY GANGLIA, ETC. 103centres in the rat immediately above the medulla oblongata, andpinch its foot severely: it will utter a short sharp cry of pain,which is reflex or sensori- motor. Now destroy the medullaoblongata, and again pinch the foot: there will be reflex movements, but no cry. The rat, by reason perhaps of having beenhunted 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 thalamibe removed, it remains quiet; but if a sharp noise be made, suchas a cat makes sometimes, the animal makes a bound away, andrepeats the jump each time that the noise is made. *Examples of sensori-motor movements are to be found inthe involuntary closure of the eyelids when the conjunctiva istouched, or when a strong light falls upon the eye; in the distortion ofthe face on account of a sour taste; in the quick withdrawal of the hand when it is touched by something hot; in thecry which excessive pain calls forth; in the motions of suckingwhich take place when the nipple is put between the infant'slips; in coughing and sneezing; and in yawning on seeing someone else yawn. Illustrations of acquired movements of this classare seen in the adaptation of the walk to the music of a militaryband, in dancing, in the articulation of words on seeing theirappropriate signs, and in many other of the common actions oflife of which we are not conscious at the time, but of the necessity of which, were there no power of automatically performingthem, we should soon become actively conscious. The instinctiveactions of animals fall under the category of consensual acts:without the intervention of any conception, the sensation at onceexcites the appropriate movement, and the animal is as skilfulon its first trial as it is after a life experience. It is true thatthe instinctive life is extremely limited in man, but sensorimotor action plays a large part in such manifestations of it asaction, " p. 258. After instancing, as examples, sneezing, coughing, the con- traction of the pupils, and the movements of the eyelids, he says: "We seemauthorized, therefore, by the fullest evidence, to assume that sensation is themental cause, whatever the physical links, of a great proportion of the muscular contractions of our frame; and that among those so produced are foundsome of the most constant, the most remarkable, and the most important of thatgreat class of corporeal phenomena. " -Analysis ofthe Human Mind, p. 265.

• Vulpian, op. cit. p. 548.

104 SECONDARY NERVOUS CENTRES, OR [CHAP.are witnessed; in the taking of food the movements of mastication and deglutition, like the earlier ones of sucking, are inanswer to sensations, as also are some of the co- ordinated movements necessary to the gratification of the instinct of procreation. The adjustment of the human eye to distances, whichtakes place with such marvellous quickness and accuracy, iseffected, according to the best authorities, by a change in theconvexity of the lens or the cornea, and an alteration in thedirection of the axes of the eyes. It is not a voluntary, noteven a conscious act, but a consensual act in respondence to avisual sensation, and it is well suited to convey a notion ofwhat an instinctive act in an animal is. *It was said, when treating of the spinal cord, that its facultieswere, for the most part, not innate but acquired by education;and the same thing may be said of the sensory centres. Sensation is not, as the common use of the word might seem to imply,a certain inborn faculty of constant quantity, but in reality ageneral term embracing a multitude of particular phenomenathat exhibit every degree of variation both in quantity andquality. The sensation of each sense is a gradually organizedresult or faculty that is matured through experience; the visualsensation of the adult is a very different matter from that of thechild whose eyes have recently opened upon the world; Mr.Nunneley's patient, whose sight was restored by operation, heldhis hands before his face to prevent objects touching his eyes;the wine-taster's cultivated sense is nowise comparable with thatof a man who knows nothing of wine; the tactile sensation ofthe blind man differs toto cælo from that of the man who hasalways had the full use of his eyes. The complete and definitesensation is slowly built up in the proper nervous centres fromthe residua or traces which previous sensations of a like kindhave left behind them; and the sensation of the cultivatedsense thus sums up, as it were, a thousand experiences, as oneword often contains the accumulated acquisitions of generaFor the best summary and discussion of the theories of vision, see Theoriedes Sehens und raümlichen Vorstellens vom physikalischen, physiologischen undpsychologischen Standpunkte aus betrachtet. Halle, 1861. By C. S. Cornelius. Alsoby the same author, Zur Theorie des Sehens mit Rücksicht auf die neuestenArbeiten in diesem Gebiete, 1864.Iv. ] SENSORY GANGLIA, ETC. 105tions. Simple as a sensation appears, it is in reality infinitelycompound. (2) We do not see, hear, or otherwise perceive bysense the exact impression made on the organ, but the effectexcited by the impression in the nerve centre; in other words,we perceive the interpretation of the impression which ourprevious experience has made familiar to us. Vision, BishopBerkeley aptly says, is a language speaking to the eye, whichwe are not conscious to have learned because we have beenlearning it ever since we were born. All that is innate in thedifferent ganglionic centres is a specific power of reaction tocertain impressions made upon organs specially adapted to receive them; but as the waste following activity is restored bynutrition, and a trace or residuum is thus embodied in the constitution of the nervous centre, becoming more complete anddistinct with each succeeding repetition of the impression, itcomes to pass that an acquired nature is ultimately grafted byeducation on the original nature of the cell. In the commonmetaphysical conception of sensation as a certain constantfaculty, what happens is this: the abstraction from the particular is converted into an objective entity which thenceforthleads captive the understanding.Whether, as some hold, our perception of the form and distance of external objects be due to our muscular experience, orwhether, as others maintain, our visual sensation by itself maygive the notion of extension and distance, it is certain that ourordinary estimates of distance are very gradually acquired. Butit is not so in many animals: the young swallow can seize itssmall prey with as accurate a skill as the old one can after a lifeexperience; and there is a fish that spurts a drop of water at thelittle insect moving above the surface, and fails not to bring itdown. The intuition of distance is obviously in such casescomplete and distinct from the first. It is, however, conformableto the law of development from the general to the special in theIn regard to this question, an experiment by Volkmann, quoted by Fick, isinteresting and instructive. When the finger, or any limited portion of skin onone side of the body, is frequently experimented upon with the compasses, inorder to test the degree of sensibility, and its tactile sensibility thereby increased,as it notablyis, above the level of that of neighbouring parts, the symmetrical partof the skin on the opposite side of the body will be found to be almost as acute,-anexperimental proof of the same kind as that which the stereoscope furnishes.106 [CHAP.SECONDARY NERVOUS CENTRES, ORcrganic world, that what is innate in some of the lower animalsshould be acquired by man: the absence of such limitation inhis original nature marks his higher freedom. Still it is mostinteresting to observe how much even he is indebted to originalendowment in this very matter of estimating distance. Forwhat is the immediate cause that determines the muscularadjustment of the eye to distance? The act is consensual, or,using the vaguer term, instinctive, in respondence to a visualsensation or picture-an act of which there is no direct consciousness, and over which the will has no direct control.Though the process is confused and uncertain at first, unlikein that regard the process in the lower animals, yet it is notlong before the proper muscular adaptations are acquired anddefinite muscular intuitions organized. Plainly, then, verymuch is due to the pre-arranged constitution of the nervouscentres even in man. And while we assert that sensation isnot an inborn faculty of constant value in man, it behovesus not to forget the fact that there are implanted in the constitution of his nervous centres the capabilities of certaindefinite associated movements answering to certain sensations.The idea to be formed and fixed in the mind from a consideration of the phenomena of the development of sensation, andnecessary to its proper interpretation, as indeed to the interpretation of every manifestation of life, is the idea of organization.The mind is not like a sheet of white paper which receives justwhat is written upon it, nor like a mirror which simply reflectsmore or less faithfully every object, but by it is connoted aplastic power ministering to a complex process of organization,in which what is suitable to development is assimilated, whatis unsuitable is rejected. By the appropriation of the like inimpressions made upon the senses we acquire a sensation, ofwhich we might speak, as we do when speaking of idea, asgeneral or abstract; it henceforth exists, latent or potential, asa faculty of the sensory centres, and on the occasion of theappropriate impression renders the sensation clear and definite—in other words, gives the interpretation. It is exactly like whathappens in the spinal centres, and exactly like what happens, aswe shall hereafter see, in the ideational centres. Coincidentlywith the assimilation of the like in impressions, there is neces-IV. ] SENSORY GANGLIA, ETC. 107sarily a rejection of the unlike, which, being then appropriatedby other cells, becomes the foundation, or lays the basis, of thefaculty of another sensation, just as nutrient material which isnot taken up by one kind of tissue element is assimilated byanother kind. In the education of the senses, then, there takesplace a differentiation of cells; in other words, a discernment, aswell as an improvement of the faculty of each kind of sensationby the blending of similar residua. There is an analysis separating the unlike, a synthesis blending the like; and by thetwo processes of differentiation and integration are our sensations gradually formed and developed. The process illustratesthe increasing speciality of individual adaptation to externalnature; and the length of childhood in man is in relation tothe formation of his complex sensations.The organization of our sensations is not, however, limitedsimply to the formation of the particular sensation; by it iseffected also the association or catenation of sensations. Inanimals there can be no doubt that one sensation frequently callsanother into activity, in accordance with the order establishedamong them, without the intervention of idea; they are muchmore dependent on sensation than man is, and therefore the association of sensations in the causation of movements is moremarked. Hence it is that blinding of one eye produces vertiginous movements in pigeons, as Flourens and Longet haveshown, and that section of the semicircular canals of the earalso produces various disturbances of movements. The trouble,inconvenience, and occasional vertiginous feelings produced fora time in man when he suddenly loses his hearing in one ear,probably spring from the interruption to the complex association of sensations habitual to him in the daily movements oflife. He only learns how much he depends on such associationswhen disorder or loss of them occurs. It is certainly difficultin him to eliminate the influence of the higher cerebral centres,yet in those functions in which consensual action has mostpart—in the taking of food, for example, where succeeding sensations bring into successive action different complex muscularmovements and again in the sexual act-there is abundantevidence of an association of sensations.Thus much concerning sensation, viewed on its passive or108 SECONDARY NERVOUS CENTRES, OR [CHAP.receptive side. Let us say something more of the active, reacting, or distributive side-of the movements which take placein answer to sensations. These reactions may, like the reflexmovements of the spinal cord, be irregular, as when a wry faceis produced by a sour taste, or a general start of the body followsa 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 orsecondarily automatic, as is mostly the case in man.The instinctive acts of animals are, for the most part, innatesensori-motor actions. They have for aim the preservation ofthe individual and the propagation of the species; and are comparable to such movements in man as the closure of the eyelidwhen the conjunctiva is touched or the eye threatened, thewithdrawal of the hand when suddenly burnt, the sneezing bywhich an offending body is ejected from the air-passages, or someof the movements in sexual intercourse. The faculty of executingthem exists in the pre-arranged constitution of the nervouscentres, and is entirely independent of will or experience; sothat, if we chose to assume a consciousness in the individualcells ministering to them, we should say that they possessed anotion of the end to be effected. Now the cells probably possesssuch notion exactly in the same manner as the elements of achemical compound possess a notion of the end which they aregoing 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 violently a reflex action, in the cessation of which lay the onlyhope of life. When the cerebral hemispheres are experimentallyremoved in animals, as was done by Flourens and Schiff, thesensori-motor acts abide: the animal appears as if in a sleep ordream, and takes no notice; yet if a pigeon so treated be throwninto 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 applyexpressions 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 itlisteth, and we say of water that it will not mingle with oil, that it will force itsway, &c. terms expressive of a choice, compliance, and resolution similar to those exercised by man. "-TUCKER'S Light of Nature, vol. ii . p. 545.

Iv.] SENSORY GANGLIA, ETC. 109contracts to light, and in a very bright light the eyes are shut;it will dress its feathers if they are ruffled , and will sometimesfollow by a movement of the head the movement of a candlehither and thither: certain impressions are plainly received, butthey are not further fashioned into ideas, because the nervouscentres of ideas have been removed; and, as has been aptlyobserved, the animal would die of hunger before a plateful offood, although it would swallow the food if put far enough intoits mouth. The clenching of the teeth in man during severepain is sensori-motor, and only a less degree of the same kind ofreflex action which in lockjaw becomes actual spasm. Schroedervan der Kolk mentions a lady who had her breast amputatedunder chloroform, and who, though she felt no pain, was perfectly conscious on awakening that she had heard herself shriek;and he has witnessed violent shrieking in apoplexy, where therewas no trace of consciousness. Any one who has walked througha parrot house, and heard the fearful noise which these screaming creatures make, must surely have felt an involuntary inclination to shriek also.It must be borne in mind that the sensori-motor reaction maybe excited not only by the stimulus from without, but also by, soto speak, sensation from within the body-by the organic stimuli.Flourens has observed birds deprived of their hemispheres standon one leg, and after a time, owing probably to a sensation offatigue, change to the other leg; shake their heads, and putthem under the wings for sleep; ruffle their feathers, and sometimes plume them with their beaks. Intelligence and will canhave no part in such movements; they are sensori-motor, andsome of them obviously take place in answer to sensationsarising within the body. It is not because we have no directconsciousness of the operation of the stimuli that they do nottherefore influence the mental life. In animals, the actionsrespondent to them constitute the principal manifestations oftheir psychical life; and in man, when the influence of thehigher nervous centres is weakened by disease, or when anorganic stimulus has an abnormal activity, as happens often ininsanity, we sometimes see the instinct for food or the sexualinstinct manifested with an utter shamelessness. In such casesthere is great truth in an observation made by Jacobi, that the110 SECONDARY NERVOUS CENTRES, OR [CHAP.actions of the insane have an instinct-like character, as theirphysiognomies take on an animal-like look. The great revolution effected in the mental nature of man at the time whenthe organs of reproduction come into functional activity, affordsa striking illustration of a physiological effect which in lessdegree is common to all the organic stimuli. And no account ofthe sensori- motor actions can be complete which fails to give dueappreciation to the influence of a stimulus arising within theorganism as an exciting cause of certain associated or aimworking-movements.Of more importance than the innate sensori-motor acts inhuman development are those which are acquired, and whichare often called the secondary automatic acts. When any onemoves about in a house or a room with the objects in which heis quite familiar, he is scarce more conscious of the greater partof his movements or of the objects around than he is of themovements of his breathing or of his particular steps in walking;notwithstanding which he does not run against the chairs norstumble at the stairs, but fairly adapts his movements to thepositions of objects. But if some new piece of furniture beplaced in a part of the room where there was nothing before, thechances are that he does stumble against it, until, by familiarityor habit, the sensation of its presence has been associated witha corresponding movement. It will sometimes happen that,when the mind has been deeply occupied, a person has walkedfrom one place to another through busy streets and yet beenunable, on reflecting afterwards, to say positively which wayhe took, though he has undoubtedly had sensory perceptionsof the objects which he has avoided in his walk. In dancing,in playing some musical instrument, in writing, in that graceand ease of movement acquired by social cultivation, we haveother excellent examples of acquired consensual acts. A morestriking instance, perhaps, than any of these is the associationwhich is established by education between particular sounds, orparticular visual sensations, and the adapted complex movementsfor the articulation of the appropriate words. Children plainlyexhibit a great tendency to imitate a particular sound, whenthere is certainly not yet any idea of what the sound means;and, as every one knows, it is sufficiently easy to read aloudIv. ] SENSORY GANGLIA, ETC. 111without the slightest attention to the meaning of what is read,the consciousness being otherwise engaged. A story is told ofa child which could speak both in English and German, butwhich always replied to a question in the language in which itwas addressed, and could not reply to an English question inGerman, or to a German question in English. Without doubtthe child connected definite ideas with the words used; but thefact that it could not put the same ideas into one language orthe other, as required, showed the dominion exercised by thesound over the articulating movements-the mechanical connexion established between sensation and movement. Language,difficult as it is of acquisition, ultimately gets all the ease of areflex act, and so many waste floods of fruitless words are pouredforth without fatigue by some who, like Peter proposing to buildthe three tabernacles, know not what they say. Consciousness isnot a necessary accompaniment; talking may be conscious, semiconscious, or entirely unconscious. Secondary automatic acts ofa like kind are also observably acquired by animals, although inthem the consensual acts are mostly innate; particular habitsor tricks being observably taught to them or acquired by them.How many of the common actions of man's everyday life fallunder the category of consensual acts, few people sufficientlyconsider.It is of the utmost importance to a true conception of thenature of mental action that the full meaning and real bearingof the foregoing facts should be distinctly realized. From aphysiological point of view they are readily enough admitted;but the moment sensation is viewed as a mental faculty, anentirely new order of ideas commonly supervenes, and it appearsto be thought monstrous to suppose that the full sensation isnot innate, but gradually matured through years of experience.Then, again, it is almost impossible to make those who take themetaphysical view of mental action, realize the organic connexionwhich is established between the stimulus, or the sensation, andcertain movements, whereby these finally become mechanical orautomatic: when any end is accomplished, they fail not instantlyto assign intelligence, and to assume design. It is not necessaryto repeat here what was said of design, when treating of thespinal cord: the act, with whatever of design it contains, is the112 SECONDARY NERVOUS CENTRES, OR [CHAP.necessary result of a certain constitution, innate or acquired, ofthe nervous centres. In the humbler animals the life-aims aremerely organic; the sensory ganglia suffice, therefore, as nervousapparatus; and the facultiesof them, being primordial, arecomparatively few, fixed, and simple. In man, however, whoserelations are so much more numerous and special, whose life-aimsreach far beyond the mere organic, there is not only a furthercomplication of the nervous system as an original fact, but thereis an acquired adaptation throughout life of the sensory gangliato the complex external relations, so that their functional manifestations are more numerous, special, and complex. But in thelatter case, as in the former, the action is ultimately automatic,and then as effectually accomplished without consciousness aswith it. Until the psychologists ground their conceptions onthese simple truths, they must continue to struggle fruitlessly inthe maze of undefined words.Observation has been so much vitiated, and the understandingso enslaved, by the influence of time-honoured metaphysicalconceptions of mental phenomena and by the use of metaphysical language, that it is one of the hardest things in theworld to observe mental acts faithfully and accurately, and tointerpret them naturally. There would seem to be a positiveinability in certain minds to conceive mental action of any kindtaking place with different degrees of consciousness or with noconsciousness at all; and this constitutes the great difficulty inthe endeavour to set forth in their natural order the phenomenaof sensation and sensori-motor action, and to appraise their realnature. Now it admits of no question whatever that sensationsand their respondent movements, which excite consciousnesswhen first experienced, gradually become completely organizedin the appropriate nerve centres, and then take place withoutconsciousness. We cannot, therefore, strictly speaking, use theword memory as applicable to such cases, because of the absenceof consciousness; the memory which exists is an unconsciousmemory. Furthermore, the term perception is very apt to causeconfusion in its application to the senses. Where there issensation, it is said, there is perception; and where there isperception, there is idea or intelligence: how then can youjustly discriminate between the sensorial functions and theIv.] SENSORY GANGLIA, ETC. 113ideational functions? The fallacy here lies in the vague useof the word " perception "-in the confounding of all kinds ofperception under the one general notion. There are in realitydifferent kinds of perception-sensorial perception and ideationalor intellectual perception; the former a kind of instinctive act,the latter an intellectual act. Though, like all other species innature, these run into one another, they still present markeddifferences, and must be distinguished in a true science of mind.A conception of the kind of perception which animals withoutcerebral hemispheres have, or of that which the somnambulisthas, the functions of whose cerebral hemispheres are in abeyance,will materially assist us in the apprehension of the phenomenaof sensorial perception in man and in the right interpretationof them. What degree of consciousness accompanies this perception is not easily determined; the common notion of consciousness, which is applied in all cases, is taken entirely fromreflective consciousness, or self- consciousness, the seat of whichundoubtedly is in the highest ganglionic centres-the nervecentres of intelligence; but a reflection upon the degree of consciousness which any one has of the different steps of his toilet,or of the objects in a room among which he moves when hismind is fully occupied, and of the entire unconsciousness withwhich a sensation of light causes contraction of the iris, or thedistance of an object looked at causes an accommodation of theeye, will convey an idea of the small part which consciousnessplays in the ordinary perception of the senses, and in the motorreactions thereto.If those who are disposed to take the metaphysical view ofmental action, insist on seeing an act of intelligence in everykind of perception, then it will be necessary to give anothernameto that sensory perception of impressions which takes placewhere there are no cerebral hemispheres, or where these havebeen removed, which takes place in fact without the animalperceiving that it perceives. Even so philosophical a writer asMüller thought the sensory centres to be endowed with somedegree of voluntary power, because of the remarkable actions towhich they minister; thus unwarrantably introducing into hisobservation, and applying to his interpretation, of the functionsof the secondary nerve centres, conceptions derived from hisI114 SECONDARY NERVOUS CENTRES, OR [CHAP.knowledge of the higher or primary nerve centres. This was toreverse the natural order of investigation, and to apply thecomplex and obscure to the interpretation, or rather the misinterpretation, of the more simple, instead of ascending inductivelythrough the simple to the complex. Those who maintain everykind of perception to be an act of intelligence are guilty of thesame error as that which Müller fell into; and they will assuredlycontinue to stumble into confusion and error until they modifyin some degree, or get entirely rid of, the metaphysical notionsof consciousness.The reaction of the motor ganglia in the sensorium commune,whether designed or undesigned, co-ordinate or irregular, maybe excited not only by impressions conveyed to them by afferentnerves, and by the so-called organic stimuli, but also by astimulus descending from above. An idea or an impulse of thewill, coming from the higher nervous centres, may act upon theganglionic secondary centres, and call forth those movementswhich are commonly reflex to impressions from without. Insuch case it is tolerably certain that the idea or volitional impulse does not act directly on the motor nerve-fibres, but that itacts 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 organicequilibrium, and, as it were, releasing or setting free the movement together with whatsoever of design there is in it; the sameoperations are performed, and through the same means, as whenthe impression conveyed by the afferent nerve from withoutexcites the movement. Thus the will is entirely dependent forits outward realization upon that mechanism of automatic actionwhich is gradually organized in the subordinate centres; itcannot, as we shall hereafter see, at once instigate successfullya new movement, nor can it execute any movement withouta guiding sensation of some kind: the cultivation of the senses,and the special adaptations of their reactions, which are graduallyorganized, are necessary antecedents, essential prerequisites,to the due formation and operation of will. The sensoriumcommune represents, in fact, various independent nervouscentres, and never does act merely as a conductor transmittingunmodified the stimulus, whether this ascend from without, orIV.] SENSORY GANGLIA, ETC. 115descend from the cerebral hemispheres. Bear this clearly inmind, and the memory of it will help to get rid of some difficulties, when we come to deal with the will.It is not needful to say anything here of the seeming disproportionate amount of force given out in the movement which isrespondent to a moderate stimulus to the sensory ganglia; inasmuch as what was said in this regard of the spinal centres isstrictly applicable to the secondary nervous centres. A specialinvestigation would only serve here, as elsewhere, to adduceneedless evidence in support of the principle of the conservationof force.And now let us briefly indicate the general causes of disorderof the functions of the sensory ganglia: they are mainly suchas have been already pointed out as causes of disturbance of thefunctions 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 faultof nature is commonly owing to the existence of some nervousdisease in the hereditary antecedents; but it may of course bedue to any other of the many recondite causes of degenerationof nerve element. Hallucinations of vision are by no meansunfrequent amongst some children at an early age, especiallyamong such as suffer from chorea. And in those rare cases inwhich insanity occurs in children almost from the time of theirnativity, it is chiefly exhibited in violent and irregular sensorimotor movements; herein resembling essentially the insanitythat sometimes ensues in animals. The unnatural laughter,the shrieking, the biting, and the tearing of the insane infantassuredly testify to a degenerate state of the motor and sensorycells in the sensorium commune: one might even venture to saythat there was a true sensorial madness. It is most interestingto add that the disorder may alternate with, or be replaced by,general convulsions, the madness ceasing when the convulsionssupervene, and supervening when the convulsions cease; thereis a transference of the disturbance from one system of nervouscentres to another.Again, there may be every degree of deficient sensibility downto actual insensibility of the ganglionic cells of the sensoryganglia. It is obvious that people differ naturally in the acute1 2116 SECONDARY NERVOUS CENTRES, OR [CHAP.ness of their senses; and in idiots the senses notably partake ofthe general stupidity. In them the hearing is frequently defective; smell is often imperfect, the olfactory bulbs being insufficiently developed; taste absent or extremely vitiated, so thatthey will eat unconcerned the filthiest or the most pungentmatters; and the sensibility of the skin is sometimes extensivelyabsent, or it is generally dull, so that they suffer very little painfrom injuries. The idiots of the lowest class have usuallyno other affection but that of hunger, which they exhibit byunrest, grunting, or the like; but even some of these miserable creatures have at times attacks of fury, without evidentreason, in which they scratch, strike and bite, as the insaneinfant does.Dulness of sensibility, when not nearly reaching the stage ofidiotic degeneration, is of course unfavourable to intellectualacquisition; but, on the other hand, a very acute and delicatesensibility is attended with evils and dangers of its own. Inthe former case, although there is a hindrance to assimilation,yet that which is appropriated is commonly retained with greatpersistency; in the latter case, there is certainly quick reaction,but no lasting appropriation, and, if the sensibility is intensifiedbeyond a certain point, there may even be a lapse into thatdegenerate state in which, not the special sensation, but pain isfelt, and irregular and convulsive reaction takes place. It is ofno small importance that these natural differences in the constitution of the ganglionic cells should be plainly recognised, forthey unquestionably are at the root of certain differences inindividual character and intellect.2. An excessive use of the senses, without due intervals of rest,produces exhaustion, or actual degeneration of them; here, aselsewhere, the force expended must be restored, if the energy ofthe matter is to be maintained. A too powerful impressionmade upon any sense may also diminish, or actually destroy, itspower of reaction; immediate paralysis of sight, of hearing, orof smell has followed a sudden and powerful impression upon theparticular sense; and if the paralysis is not complete, the sensibility of the sense for weaker impressions may still be lowered forsome time. Moreover, the sensation itself may persist for a whileafter the cause of it has disappeared, as when an image of thev. ] SENSORY GANGLIA, ETC. 117sun remains after we have ceased to look at it, or the roar of thecannon abides in the ears after the firing has ceased. Such persistence of action in the ganglionic cell will serve to convey anotion of the condition of things when there is hallucinationotherwise caused.3. The state of the blood has the most direct effect upon thefunctions of the sensory ganglia. Too much blood, as is wellknown, gives rise to subjective sensations, such as flashes of lightbefore the eyes, and roaring in the ears; but it is not so generallyknown that, when the abnormal action reaches a certain intensity,movements responsive to, or sympathetic with, the hallucinations may take place. Nevertheless, they may as the sensoryganglia have an independent action in health, so also may theyact independently in disease; and as in health there is co-ordinateor designed sensori-motor action, so in disease there may beconvulsive sensori- motor action evincing more or less co- ordination or design. Of violent, but more or less co-ordinate, actionwe have, I think, a good example in the raving and dangerous.fury which often follows a succession of severe epileptic fits, andwhich I take leave to describe as in great part a true sensorialinsanity. 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 whosoever happens to present himself, appears as a devil, or otherwisehorribly transformed; the ears are filled with a terrible roaringnoise, or resound with a voice imperatively commanding him tosave himself; the smell is perhaps one of sulphurous stifling;and the desperate and violent actions are, like the furious actsof the mad elephant, the convulsive reactions to such fearfulhallucinations. The individual in such state is a machine set indestructive motion, and he perpetrates the extremest violenceor the most desperate murder without consciousness at thetime, and without memory of it afterwards. When we come tothe general pathology of insanity, we shall have more to sayupon this matter.A deficiency of healthy blood is a cause of disorder of thesensory centres. A great loss of blood powerfully affects thesenses; the anæmia of chlorotic and hysterical women is theprobable cause of the many anomalous sensations and motor118 SECONDARY NERVOUS CENTRES, OR [CHAP.disturbances, which disappear as the condition of the blood improves; and a manifest poverty of blood often accompanies thechorea of children with its hallucinations.A perverted condition of the blood, whether from somethingbred in the body or introduced from without, is known to be apowerful cause of sensory disorder. Evidence of such injuriousinfluence we have in the hallucinations which sometimes followfor a time certain acute diseases, as well as in the delirium whichoccurs in the course of them; in the effects which alcohol produces upon the senses; in the actions of poisons, such as belladonna and aconite, which markedly affect the senses; andespecially in the operation of haschisch, a poison which appearsto concentrate its action upon the sensorium commune. * Inhydrophobia the presence of a virus in the blood notably givesrise to most violent nervous disturbance; the sight or sound ofa fluid, a movement in the room, or a current of air, being sufficient to excite terrible convulsions.4. An irritation operating by reflex action is undoubtedly theoccasional cause of sensorial disturbance. Pressure upon orwound of a sensitive nerve has sometimes produced extensiveparalysis of sensibility; a bad tooth may notably give rise toamaurosis; vertigo, hallucinations, and illusions are now andthen plainly the result of an irritation proceeding from a centripetal nerve, not perhaps felt in any other way than as it istestified by effects which disappear with the removal of the irritation. An interesting example of severe disturbance of thenervous centres from a slight eccentric irritation, is related byDr. Brown- Séquard, to whom it was communicated by Mr.C. De Morgan. A lad, aged fourteen, as he was getting up inthe morning, was heard by his father to be making a great noisein his bedroom. On the latter rushing into the room, he foundhis son in his shirt, violently agitated, talking incoherently, andbreaking to pieces the furniture. His father caught hold of himand put him back into bed, where at once the boy became composed, but did not seem at all conscious of what he had done.On getting out of bed he had felt something odd, he said, butRegarding the effects of haschisch, I may refer, in addition to Moreau's wellknown experiments, to De Luca in the Journal de Pharmacie, 1862, tome xlii.p. 396.IV.] SENSORY GANGLIA, ETC. 119he was quite well. A surgeon, who was sent for, found himreading quietly, with clear tongue and cheerful countenance, andwishful to get up. He had never had epilepsy, but had enjoyedgood health hitherto. He was told to get up; but on puttinghis feet on the floor, and standing up, his countenance instantlychanged, the jaw became violently convulsed, and he was aboutto rush forward, when he was seized, and pushed back on to thebed. At once he became calm again, said he had felt odd, butwas surprised when asked what was the matter with him. Hehad been fishing on the previous day, and having got his lineentangled, had waded into the river to disengage it, but was notaware that he had hurt his feet in any way, -that he had evenscratched them. " But on holding up the right great toe withmy finger and thumb, to examine the sole of the foot, the legwas drawn up, and the muscles of the jaw were suddenly convulsed, and on letting go the toe these effects instantly ceased ."There was no redness, no swelling, but on the bulb of the toe asmall elevation, as if a bit of gravel, less than the head of a pin,had been pressed beneath the cuticle. On compressing thisagainst the nail cautiously, a slight convulsion ensued; therewas no pricking when pressed, but he said something made himfeel very odd. The slightly raised part was clipped away; nogravel was found, but the strange sensation was gone, and neverreturned. *The general bodily feeling which results from the sum of thedifferent organic processes is not attended with any definiteconsciousness, or idea, of the causes that give rise to it; theorganic stimuli are, in fact, organically felt, but do not in thenatural state of health excite, as a stimulus to one of the specialsenses does, a particular state of consciousness; and when the

• Lectures on the Physiology and Pathology of the Central Nervous System, by

Dr. Brown- Séquard, 1860. A case singularly like the one above related is quotedby Burrows" (Commentaries on Insanity, p. 215) from Hufeland. A boy betweenthirteen and fourteen years of age suddenly began to talk in a very wild andincoherent way, and at length became ungovernable. This state was assuaged bysoporifics. But the paroxysm was observed to recur whenever he was placed onhis feet. On examination, a reddish spot was noticed on one foot, which, whenpressed, always occasioned a fresh paroxysm. Upon an incision being made, aminute piece of glass was discovered, and extracted. During the operation thepatient was furious, but every symptom of violence vanished when the offendingcause was removed.120 [CHAP. SECONDARY NERVOUS CENTRES, ORorganic stimuli do force themselves into consciousness, ashappens in disease, then it is in pain that their action is felt.In respect of our organic feeling we are, in reality, not unlikethose humble animals that have a general sensibility withoutany organs for special discrimination and comparison. Havingno idea of the particular cause of any modification in thisgeneral feeling, we are plainly most favourably placed for thegeneration of illusions with regard to the cause. Consequentlyit is not surprising to find that the insane frequently haveextravagant hallucinations and illusions respecting the cause ofan abnormal sensation, which is actually due to a morbid stateof some internal organ; they think to interpret it as its unusualcharacter seems to demand, and in accordance with theirexperience 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 theirinsides.5. Whether any beneficial influence is exerted upon thenutrition of the nervous centres of the sensorium commune bythe centres that lie above it, must remain uncertain, though it isextremely probable. No trustworthy conclusions can be drawnfrom experiments in which the cerebral hemispheres have beenremoved, for the mischief done is far too great to warrant anyinference. It is certain that an area of morbid activity in thecerebral hemispheres may act injuriously upon the sensorycentres, and give rise to secondary derangement of theirfunctions; but the result is then most likely due to reflex orsympathetic action, the morbid centre acting as a morbid centreof irritation in another internal organ notably does.In concluding this account of the sensory nervous centres, wehave only to add that a review of their relations and functionsdoes certainly establish a close analogy with the relations andfunctions of the spinal centres. In both cases there are nervouscentres which have the power of independent reaction, thoughthey are usually subordinated to the control of higher centres;in both cases the faculties are for the most part organized inrelation to outward circ*mstances through the plastic power ofthe nervous centres; and, in both cases, the independent powerof action of the centres may, by reason of disease, be exhibitedIv.] SENSORY GANGLIA, ETC. 121in explosive demonstration. The convulsive paroxysm whichseizes on the cells of the sensorium commune, and drives thefurious epileptic on to desperate violence, is as little within hiscontrol as is the convulsion of his limbs that is owing to diseaseof the spinal cord.NOTES.66 1(p.102). It ought not to be forgotten that Dr. Darwin distinguishedvoluntary from sensori-motor movements. Many common actions oflife are produced in a similar manner (i.e. by sensation). If a flysettle on my forehead, whilst I am intent on my present occupation, Idislodge it with my finger without exciting my attention or breakingthe train of my ideas. "-Zoonomia, vol. i. p. 40. " Other muscularmotions, that are most frequently connected with our sensations, asthose of the sphincter of the bladder and anus, and the musculierectores penis, were originally excited into motion by irritation, foryoung children make water, and have other evacuations, withoutattention to these circ*mstances-' et primis etiam ab incunabulistenduntur sæpius puerorum penes, amore nondum expergefacto. ' Sothe nipples of young women are liable to become turgid by irritation,long before they are in a situation to be excited by the pleasure ofgiving milk to the lips of the child. "-Ibid. , p. 38. "There is acriterion by which we may distinguish our voluntary acts or thoughtsfrom those that are excited by our sensations. The former are alwaysemployed about the means to acquire pleasurable objects, or to avoidpainful ones; while the latter are employed about the possession ofthose that are already in our power. " And he goes on to say that theideas and actions of brutes, like those of children, are almost perpetually produced by their present pleasure or their present pains;they seldom busy themselves about the means of procuring futurebliss or avoiding future misery. -Ibid. , vol. i . p. 184.2 (p. 105) . " ALCIPHRON:-If vision be only a language speakingto the eyes, it may be asked, when did men learn this language? Toacquire the knowledge of so many signs as go to the making up alanguage, is a work of some difficulty. But will any one say he hathspent time, or been at pains, to learn this language?"EUPHRANOR -No wonder we cannot assign a time beyond ourremotest memory. If we have been all practising this language eversince our first entrance into the world-if the author of nature constantly speaks to the eyes of all mankind, even in their earliest infancy,122 SECONDARY NERVOUS CENTRES, ETC. [ CHAP. IV.company,whenever their eyes are open in the light, whether alone or init doth not seem to be at all strange that men should not be aware thatthey had ever learned a language begun so early, and practised so constantly as this of vision. And if we also consider that it is the samethroughout the whole world, and not like other languages, differing indifferent places, it will not seem unaccountable that man should mistakethe connexion between the proper objects of sight and the things signified by them to be founded in necessary relation, or likeness, or thatthey should even take them for the same things. Hence it seemseasy to conceive why men, who do not think, should confound in thislanguage of vision the signs with the things signified, otherwise thanthey are wont to do in the various particular languages formed bythe several nations of men. " -BISHOP BERKELEY'S Minute Philosopher,vol. i. p. 393.CHAPTER V.HEMISPHERICAL GANGLIA; CORTICAL CELLS OF THE CEREBRALHEMISPHERES; IDEATIONAL NERVOUS CENTRES; * PRIMARYNERVOUS CENTRES; INTELLECTORIUM COMMUNE.THAT the nerve-cells which exist in countless numbers in thegrey cortical layers of the hemispheres are the nervouscentres of ideas, is fully admitted by all those who have moststudied the physiology of the brain, and are best entitled tospeak on the matter. The cerebral hemispheres represent, inreality, two large ganglia that lie above the sensory centres, andare superadded in man and the higher animals for the furtherfashioning of impressions, or of sensory perceptions, into ideasor conceptions. This important step in the evolution of thehuman mind consists in the abstraction of the essential from theparticular and its re-embodiment in idea; it is strictly an idealization of the sensory impressions, and represents, so to speak, anepigenetic development of nature: what the true artist does inhis art nature does continually in the development of the humanmind. Looking not at the individual man and his work as theend, but looking at him as a small and subordinate part of thevast and harmonious whole, as a means to a far-off end, it is sufficiently evident that the history of mankind is the history ofthe latest and highest organic development-that in the evolutionof the human mind nature is undergoing its consummate development through man. And the law manifest in this highestdisplay 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 ' Sensation, ' we might also say ' Ideation; ' it would be a very useful word; and thereis no objection to it, except the pedantic habit of decrying a new term. "-JAMESMILL, Analysis of the Human Mind, p. 42.124 HEMISPHERICAL GANGLIA, OR [CHAP.specialization and increasing complexity which has been traceable through the long chain of organic beings. So exquisitelydelicate, however, are the organic processes of mental development which take place in the minute cells of the cortical layers,that they are certainly, so far as our present means of investigation reach, quite impenetrable to the senses; the mysteries oftheir secret operations cannot be unravelled; they are like nebulæwhich no telescope can yet resolve.The cerebral hemispheres are not alone the nerve centres ofideas, but they are also the centres of emotion and volition.In animals that are deprived of their hemispheres, all trace ofspontaneity or will in their movements disappears; this effectbeing, as might be expected, much more evident in experimentson the higher than on the lower Vertebrata. In Fishes, as forexample in the carp, scarcely any difference is observed in itsswimming after its hemispheres have been removed; but if itsmovements be watched more carefully, and compared with thoseof a carp which has not been mutilated, a certain change will berecognised. According to Vulpian, it moves forward in a straightline, never turning to one side or the other except when it meetswith an obstacle, and not stopping until it is completely fatigued;it seems impelled to move by some necessity, a necessity occasioned probably by the stimulus of the water on its body.The more marked effects produced in the higher Vertebrata bythe removal of the hemispheres have already been described.The anatomists believe that they have now demonstrated thatthe nerve-fibres which ascend from the spinal cord through themedulla oblongata do not pass directly to the surface of thehemispheres, but end in the ganglionic cells of the corporastriata and optic thalami; new fibres starting from these cells,and radiating to the cortical cells, to establish the communicationbetween the primary and secondary nervous centres. * There is,then, a sufficient anatomical reason for an inference previouslymade on other grounds, which is, that an idea, or an impulse ofVulpian, however, believes that some fibres from the cerebral peduncles passdirectly to the cerebral hemispheres of the corresponding side, either through thecorpus striatum or beneath it; founding his opinion on some cases in which hehas seen lesion of the hemispheres, not affecting the corpus striatum, followed bya descending atrophy of nerve fibres analogous to that which follows lesion of thecorpus striatum.v.] IDEATIONAL NERVOUS CENTRES. 125the will, cannot act directly upon the motor nerve-fibres of thebody, but can only act through the medium of the proper subordinate centres. There is an explanation also of the fact thatirritation of the white substance of the brain does not occasioneither movements or signs of pain. It is extremely probable,again, that different convolutions of the brain do discharge different functions in our mental life; but the precise mapping outof the cerebral surface, and the classification of the mentalfaculties, which the phrenologists have rashly made, will notbear scientific examination. That the broad, high, and prominentforehead indicates great intellectual power was believed in Greece,and is commonly accepted as true now; the examination of thebrains of animals and idiots, and the comparison of the brain ofthe lowest savage with the brain of the civilized European, certainly tend to strengthen the belief. Narrow and pointed hemispheres assuredly do mark an approach to the character of themonkey's brain. There is some reason to believe also, that theupper part of the brain and the posterior lobes have more to dowith feeling than with the understanding. Huschke has foundthese parts to be proportionably more developed in women thanin men; and Schroeder van der Kolk thought that his pathological researches had afforded him the most convincing proofsthat the anterior lobes of the brain were the seat of the higherintellectual faculties, while the upper and posterior lobesministered rather to the emotional life. Recently some observations have been made with the view of establishing a theory,that a portion of the anterior lobe, the third frontal convolutionof the left hemisphere, was the seat of language; but the observations reported are unsatisfactory, directly contradictory observations are overlooked or ignored, and it is contrary to the firstprinciples of psychology to suppose that language, complex andorganic as it is in its intellectual character as the sign or symbolof 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 anycertain and definite knowledge of the functions of the differentparts of the cerebral convolutions. The anatomists cannot evenagree on any convolution as peculiar to man; all that they cansurely say is, that his convolutions are more complex and lesssymmetrical than those of the monkey. "If man was made in126 HEMISPHERICAL GANGLIA, OR [ CHAP.the image of God, he was also made in the image of anape."The cortical cells of the hemispheres, like the ganglionic cellsof the sensory centres and of the spinal cord, may certainly actas nervous centres of independent reaction . Without any volition, or even in direct defiance of volitional effort, an ideawhich has become active may pass outwards, and produce movement, or some other effect upon the body. The suddenly excitedidea of the ludicrous, for example, causes involuntary laughter;the idea of an insult, a quick movement of retaliation; the ideaof a beautiful woman, a glow of amatorial passion; the idea of agreat impending danger, or of a sudden terrible affliction, seriousor even fatal disturbance of the organic life; the idea of anobject, sometimes an actual hallucination. Most of the earlieractions of children are prompted by ideas and feelings which areexcited by suggestions from without, and which immediatelyreact outwards. In the phenomena of electro-biology or hypnotism, the mind of the patient is possessed with the ideaswhich the operator suggests, so that his body becomes an automatic machine, set in motion by them. Every one's experiencewill recall to him occasions on which an idea excited in hismind could not be dismissed therefrom by the will, and perhapswould not let him rest until he had realized it in action, eventhough such realization appeared to his judgment inadvisable.Those who have attended carefully to the course of their ownthoughts, and reflected upon their actions, will readily acknowledge that an idea sometimes arises and produces a movementwithout there having been any active consciousness of it, theeffect being that which first arouses consciousness, if it bearoused at all. How many of the daily actions of life, thusaccomplished, are we never conscious of unless we set ourselvesdeliberately to reflect. It is most certain that there may be areaction outwards of an ideational nerve- cell, independently ofvolition, and even without consciousness.As it is with the faculties of the spinal and the sensorycentres, so is it with the faculties of the ideational centres:they are not innate, but are developed by education. Thenotion of innate idea, in the exact meaning of the word, as conHallam, Introduction to History of Europe.•v.] IDEATIONAL NERVOUS CENTRES. 127natural or contemporary with birth, is not less untenable andabsurd than an innate pregnancy. (1) But if by innate is onlymeant that, by the necessity of his nature, a well- constitutedindividual placed in certain circ*mstances will acquire certainideas, then all the phenomena of a man's life, bodily or mental,are just as innate or natural. It is necessary here to distinguishbetween what is predetermined by the nature of things, and whatis preformed. The formation of an idea is an organic evolutionin the appropriate nervous centres, a development which isgradually completed in consequence of successive experiences ofa like kind. The impressions of the different properties orqualities of an object received through the different senses, arecombined in the compound idea of it which is gradually maturedin the mind; there is a consilience of sensory perceptions inthe production of the idea; and henceforth we can make assertions concerning the object when it is not present to sense. Thecells of the cerebral ganglia do, in reality, idealize the sensoryperceptions grasping that which is essential in them, and suppressing or rejecting the unessential, they mould them by theirplastic faculty into the organic unity of an idea, in accordancewith fundamental laws. Every idea is thus an intuition, andimplicitly comprises far more than it explicitly displays. It isnot the idea of any particular object or event, but the idea ofevery object and event of a particular kind. Herein the processof ideation only follows the law of organic development asmanifest everywhere, and as previously illustrated in the development of nerve element itself. Whosoever, biassed by themetaphysical conception of mind, finds it difficult to realizethis process of the organic growth of idea, let him reflect uponthe manner of organic growth which confessedly takes place inthe language in which our ideas get embodiment. Languagewas not innate in mankind; it has undergone a slow development through the ages, in conformity with the developmentof thought; and by using the study of language as an instrument of the analysis of ideas, we may make use of the scienceof what is seen to indicate the nature of processes that atpresent are unseen.Those who are metaphysically minded have done with idea asthey have done with sensation: they have converted a complex128 HEMISPHERICAL GANGLIA, OR [CHAP.notion or general term summing up a great number of variedphenomena into an actual entity, and thenceforth allowed it totyrannize over the thoughts. It is a great and mischievous errorto suppose that an idea of the same object or event has alwaysa uniform quantitative and qualitative value; and the way inwhich it is the custom to speak of certain abstract ideas, as ifthey were constant entities admitting of no variation, nor of theshadow of a change, is a remarkable example of that self- deception by which man fondly fools himself " with many wordsmaking 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 nameis given to an idea in two persons, it has the same value in each.Certain ideas will always have a different value in persons ata different stage of cultivation; and when the well-meaningtraveller, or the ardent missionary thinks to find in the miserable savage the idea of a god, he should take heed that he is noterroneously interpreting the savage mind by the text of his own.The ideas of virtue and vice, for which the Australian savageconfessedly has no words in his language, cannot be implantedor organized in his mind, until, by cultivation continued throughgenerations, he has been humanized and civilized. (²)To acquire those so-called fundamental ideas, universal intuitions, or categories of the understanding, of which some metaphysicians make so much, as constant elements, though theydiffer greatly in value in different people, there is no other needbut, using Hobbes' words, "to be born a man, and live with theuse of his five senses. " (3) Because all men have a common nature,and because the nature by which all men are surrounded is thesame, therefore are developed certain ideas which have a universalapplication, but they are nowise independent of experience; onthe contrary, the universality of their character is owing to thevery fact that in every experience they are implicitly suggestedor involved, so that they finally become fixed as endowmentsin the acquired nature or organization of the nervous centres;conscious acquisition becoming here, as elsewhere, unconsciousfaculty, by virtue of an organic process. But their absolutetruth, as expressions of certain fundamental relations betweenman and nature, is only guaranteed by the assumption of anv.]IDEATIONAL NERVOUS CENTRES. 129unchanging persistence of these relations; a new sense conferredupon him would entirely change the aspect of things, and rendernecessary a new order of fundamental ideas. * (*)Having said thus much concerning the manner in which ourideas are acquired, I proceed to indicate the different ways inwhich the reaction of an idea, when active, may be displayed:having considered idea as statical, it now remains to consider itin actual energy.(a) The reflex action or reaction of an ideational nerve- cellmay be downwards upon the motor centres, and may thus giverise to what has been called ideomotor movement.t () The energymay be exerted either upon the involuntary or upon the voluntary muscles; and in the latter case, it takes place either withconsciousness or without consciousness. The idea that the bowelswill act may notably sometimes so affect their involuntaryperistaltic movements as to produce evacuation of them; theidea that vomiting must take place, when a qualmish feelingexists, will certainly hasten vomiting; the idea of a nervousman that he cannot effect sexual intercourse assuredly mayrender him incapable of it; and there is a very remarkableinstance told in the Philosophical Transactions of a man whocould for a time stop the motions of his heart. These are"We can conceive ourselves as endowed with smelling and not enjoying anyother 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; thesmell at one time of the rose, at another of the violet, at another of carrion,and so on. Ourlife would be a train of smells. "-J . MILL, Analysis of the HumanMind."To prove that Ideas, as well as Sensations, are the cause of muscularactions, it is necessary to make choice of cases in which the idea is in no dangerof being confounded with that state of mind called the Will. And hardly anycase will answer this condition, except some of those which are held to beinvoluntary, for the Idea itself never can be very clearly distinguished from theWill. "-J. MILL, 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 simpleinduction, that muscular actions follow ideas, as invariable antecedent and consequent, in other words, as cause and effect; that, whenever we have obtained acommand over the ideas, we have also obtained a command over the motions;and that we cannot perform associate contractions of several muscles, till we haveestablished, by repetition, the ready association of the ideas. "-Ibid. p. 274."There is an instance told in the Philosophical Transactions of a man whocould for a time stop the motions of his heart when he pleased; and Mr. D. hasK130 HEMISPHERICAL GANGLIA, OR [CHAPexamples of the influence of idea upon the involuntary muscles,and they are conformable to what has been previously said ofthe subordination of the organic nerve centres to the cerebrospinal system. Some people even are able, through a vivid ideaof shuddering, or of something creeping over their skin, to produce a cutis anserina, or goose's skin: the immediate effect ofthe idea in this case, however, is probably to excite the apprcpriate sensation which thereupon gives rise to the sequentphenomena. Examples of the action of idea upon our voluntarymuscles are witnessed in every hour of our waking life. Veryfew, in fact, of the familiar acts of a day call the will intoaction when not sensori-motor they are mostly prompted byideas. But the point on which I would lay stress here is, thatsuch ideomotor movements may take place, not only withoutany intervention of the will, but also without consciousness;they are automatically accomplished, like the actions of the sleepwalker, in obedience to an idea or a series of ideas, of which thereis no active consciousness. It may seem paradoxical to assert,not merely that ideas may exist in the mind without any consciousness of them-which every one admits in their dormant,latent, or statical condition they may-but that an idea, or atrain of associated ideas, may be quickened into action, andinstigate movements, without themselves being attended to.But it is unquestionably so: a great part of the chain of ourwaking thoughts, and of the series of our daily actions, actuallynever is attended to: at first consciously acquired, these havenow become automatic. Persons who have a habit of talking tothemselves are generally unaware that they are talking, andyet they are performing both associated ideas and associatedmovements.It is surprising how uncomfortable any one may be made bythe obscure notion of something which he ought to have saidor done on some occasion, but did not say or do, and which hecannot for the life of him now remember. There is a dim feeling of some impulse unsatisfied, an effort, as it were, of the lostidea to get into consciousness; this activity is not sufficient tooften told me he could so far increase the peristaltic motion of his bowels byvoluntary efforts as to produce an evacuation by a stool at any time in half-anhour. "-Zoonomia, vol . i. p. 39.v.]IDEATIONAL NERVOUS CENTRES. 131excite consciousness, but sufficient to react upon the unconsciousmental life, and to produce a feeling of discomfort or vagueunrest, which is relieved directly the idea bursts into consciousness. Then, again, when an active idea has once taken firmpossession of consciousness, how hard a matter it is to dismissit! Some weak-minded persons cannot do so until they haveexpended its force in suitable action: let a hysterical womanget a vivid idea of some action that she must do the ideabecomes a fate which she must sooner or later obey, not otherwise than as in electro-biology or hypnotism the patient isgoverned by the idea which the operator suggests. Let a quicktempered man conceive a great insult suddenly done to him: ina moment, without any intervention of the will, the idea reactsupon the muscles of his body, and produces more or less generaltension of them. Let a man engaged in a fight get the idea thathe will be beaten his muscular energy is weakened, and he isalready half conquered.(b) The reflex action of an ideational nerve- cell may operatedownwards not only upon the motor nuclei, but also uponthe sensory ganglia. As the idea is excited into activity bythe impression on the senses, so it may in turn react downwards upon the sensory centres, giving rise even under certaincirc*mstances to illusions and hallucinations. The idea of anauseous taste may excite the sensation to such a degree as toproduce vomiting; the sight of a person about to run a sharpinstrument over glass will set the teeth on edge; the images ofdreams are sometimes, as Spinoza has remarked, really visiblefor a while after the eyes are open. The celebrated Baron vonSwieten, says Dr. Darwin, who illustrates this kind of ideationalaction by many instances, " was present when the putrid carcaseof a dead dog exploded with prodigious stench; and, some yearsafterwards, accidentally riding along the same road, he wasthrown into the same sickness and vomiting by the idea of thestench, as he had before experienced from the perception of it. "The action of idea upon our sensory ganglia is a regular partof our mental life; for the co-operation of sensory activity isnothing less than necessary to clear conception and representation. In order to form a distinct and definite conception of whatis not present to sense, we are compelled to form some sort ofK 2132 HEMISPHERICAL GANGLIA, OR [CHAP.image of it in the mind; the sense of sight, which anatomicallyis in most extensive connexion with the cerebral ganglia, affording us the greatest assistance in this regard. Men differ muchin the power which they have of thus rendering an idea sensible.Goethe could call up an image at will, and make it undergovarious transformations, as it were, before his eyes; Shelleyappears to have been, on one occasion at least, the victim ofpositive hallucinations generated by his ideas. But the mostremarkable instance of a habit of seeing his own ideas as actualimages was afforded by the engraver, William Blake. " Youhave only to work up imagination to the state of vision, and thething is done," was his own account of the genesis of his visions. *To render definite the creations of the imagination, and to givefit expressions to them, they must be accompanied by somesensorial representation. The great writers whose vivid descriptions of scenery or events hold our attention and stir our feelings,have this power in high degree; they create for themselves aworld of sense by the influence of idea, and then strive to presentvividly to us what they have thus represented to their own minds.Natural endowments being equal, those writers who have thegreatest number of residua stored up in consequence of muchand varied experience, are best qualified to call up vivid images,and best qualified to call up such as are truly representative ofnature; whilst those who are wanting in experience, or who66" Dr. Ferriar mentions of himself that, when at the age of fourteen, if hehad been viewing any interesting object in the course of the day, as a romanticruin, a fine seat, or a review of troops, as soon as evening came the whole scenewas brought before him with a brilliancy equal to what it possessed in daylight,and remained visible for some minutes. "-ABERCROMBIE, On the IntellectualPowers. Sir I. Newton could recall an ocular spectrum of the sun when he wentinto the dark and directed his mind intensely, as when a man looks earnestlyto see a thing which is difficult to be seen. " From these recollected images ofobjects of sense, which the reason duly distinguishes from the realities around,we meet with examples marking a gradual transition to those spectral images orillusions which cannot be distinguished from realities, which, in fact, compel belief and excite emotions and actions in accordance with their character. Abercrombie mentions a patient who had the power of creating the illusion by aneffort of will, but had no power of removing it. A step farther, and there isneither the power of calling up an illusion at will -for it rises in spite of the willnor of distinguishing it from realities, nor of dismissing it at will. It is excitedby some morbid cause, confounds itself with realities, compels belief, and domi- nates the conduct.v. ] IDEATIONAL NERVOUS CENTRES. 133have not sufficiently cultivated observation, are apt to becomevisionary, vague, and unreal. Even in matters of scientificresearch, the scientific imagination by which hypotheses aresuccessively framed until a fit one is obtained, its verificationcompleted, and a discovery thus made, is based upon a previouscareful training of the senses in scientific observation, and worksby means of sensory representations. Natural endowments notbeing equal, however, we then perceive the wide difference whichthere is between one who has an adequate idea and one who hasnot. The latter, in describing scenery or events, will give a tediouspicture characterised by minute industry and overwrought detail,in which there is no due subordination of parts, no organic unityof idea—in which truly soul is wanting-and from which, therefore, no one can carry away a true idea of the whole: unpregnantof his subject, he has been going about to give a photographiccopy or a minute delineation of what cannot be photographed;he has laboured to realize the appearance until at last onlysomething unreal remains. The former, on the other hand, produces, by virtue of the plastic power of idea, a picture in whichthe unessential is suppressed, the essential thoroughly graspedand moulded into an organic unity, in which due subordinationand co- ordination of parts prevail, and from which, therefore, atrue idea of the whole may be educed; truly comprehending orgrasping his subject, he has in fact idealized the sensory perceptions, producing the illusion of a higher reality, and hasdisplayed a real development of nature. This sort of differencebetween men is not less evident in scientific working. One manrecords, with a praiseworthy but tedious industry, the unconnected impressions made upon his senses, and never gets furtherthan that: fondly thinking that he sees with his eye, and notthrough it, he would, were he set to describe the sun for thefirst time, describe it as a bright disc about the size of a big" For facts," Lord Shaftesbury observes in his Characteristics, " unablyrelated, though with the greatest sincerity and good faith, may prove the worstsort 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 neitherknow how to lye, nor tell truth, discovers a taste which methinks no one shouldbe apt to envy. The greatest critic says of the greatest of poets, when he extolshim the highest, that above all others he understood how to lye: Aedidáσxe dèμάλιστα Όμηρος καὶ τοὺς ἄλλους πσευδῆ λεγεῖν ὡς δεῖ. ”134 HEMISPHERICAL GANGLIA, OR [CHAP.cheese, and rest content for the future with this sensory representation of it. The other and truer man of science succeedsin combining, by means of the organizing power of idea, thescattered impressions made upon the senses, is able by comparison to complement or correct the impression made on aparticular sense, and to form to himself a true image of the sun,not as a mere disc of fire, but as an immense central bodymoving through space, with its attendant planetary system.Only those who are destitute of idea would dream of rejectingentirely the aid of idea in scientific inquiries.These observations will not be a useless digression if theyserve to teach how essential to the completeness of conceptionis the functional action of the sensory ganglia, how much ourintellectual development depends, not only upon the cultivationof careful habits of observation, but also upon the co-operationof the sensory centres in the subsequent intellectual action. Theexcitation and cultivation of the sensorial cells are necessaryantecedents, in the order of mental development, to the activityof the ideational cell; and the ideational cell in turn effects itscomplete function in the formation of a distinct conception byreacting downwards upon the sensory centres. This secondaryintervention 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 furiouslyat the burrow, it is plain that the sense of smell has excitedeither directly the visual image of the rabbit, or rather, as thedreaming of the dog would seem to indicate, the idea of therabbit, which idea thereupon calls up the appropriate image.It is worthy of remark in this relation, how singularly effectivein man the sense of smell is in recalling vividly the ideas andimages of forgotten scenes and places. The reaction of ideas uponthe senses is again very notable in dreams; and in insanity,when the nerve centres are disordered and their relations disturbed, actual hallucinations of a sense, such as cannot becorrected by the evidence of unaffected senses, or by reflection,are sometimes due to the influence of morbid ideas. This disordered action is, after all, only an exaggeration of a processwhich is natural in our mental life. The idea cannot receiveits stimulus directly from the external world, nor can it reactv.] IDEATIONAL NERVOUS CENTRES. 135directly upon the external world; both in its origin and in itsexpression are the senses concerned.(c) Athird important, though little recognised, way in whichidea may operate, is upon the functions of nutrition and secretion. Whether the idea act, as is probable, directly upon theorganic elements of the part through its nerves, or indirectlyby an effect upon the vaso-motor system, it is certain thatthe influence of an idea may increase or lessen a secretion,and may modify nutrition. The idea of food will cause a flowof saliva; a sympathetic idea, a flow of tears; the idea of itchingin a particular spot will give rise to an itching there; and theidea that a structural defect will certainly be removed by a particular act does sometimes so affect the organic action of thepart as to produce a cure. The most successful physician is everone who inspires his patient with the greatest confidence in thevirtue of his remedies. Bacon rightly, therefore, would have usinquire into the best means to " fortify and exalt the imagination. " "And here," he says, " comes in crookedly and dangerously a palliation and defence of a great part of ceremonialmagic. For it may be speciously pretended that ceremonies,characters, charms, gesticulations, amulets, and the like, do notderive their power from any tacit or sacramental contract withevil spirits, but serve only to strengthen and exalt the imagination of him who uses them." *(d) There is yet another path which the energy of an ideamay take. As, in reflex action of the spinal cord, the residualforce which was over and above what passed directly outwardsin the reaction travelled upwards to the sensorium commune andexcited sensation; and as in sensori-motor action the residualforce which was over and above what passed outwards in thereaction travelled up to the cortical cells, and gave rise to idea;so in ideational action the force which does not pass, or theresidual force which may be over and above what does pass,immediately outwards in the reaction, abides in action in thecortical centres, and passes therein from cell to cell. There isno superimposed collection of cells of a higher kind to which itmight 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 [CHAP.nerve- cells in the cortical layers, having most numerous, varied,and intricate connexions, whereby excitation may be communicated from one to another. This communication is what doestake place, when one idea calls up another by some association,itself partly or wholly disappearing in the act. It is probablethat one idea can only call another into activity through its ownpartial or entire disappearance from consciousness, as one wavedisappears in the production of another; but it is, perhaps,doubtful whether this, which is Müller's simile, expresses thecondition of things so well as that of Hobbes, who looked uponone idea as obscured by the more active one, " in such manneras the light of the suu obscureth the light of the stars; whichstars do no less exercise their virtue, by which they are visible,in the day than in the night." * (6) There is, as would appear,not only a transference, but a transformation of force from cellto cell within the hemispherical ganglia; and the energy of theparticular cell, or the idea for the moment active, is attendedwith consciousness . We are now come, then, to another sphereof mental activity, namely, activity within consciousness, orreflection.It behoves us here to settle clearly in our minds the relationof consciousness to ideational function, or at any rate to be onour guard against considering-consciousness as co-extensive withDr. Brown (Physiology of the Mind, p. 223) held, however, that the slightestattention to the successive states of mind would show, " that a conception, aftergiving rise to some new conception, does not always cease to be itself a part of ourcontinued consciousness. " He thought that it often remained so as to co-existwith the conception which itself had induced, and might afterwards suggest otherconceptions, or other feelings, with which it might then co- exist in a still morecomplex group. "We compare, we choose, in our internal plans, becausedifferent objects are together present to our conceptions. " Sir W. Hamiltonlimited to six the number of objects which might exist in consciousness at thesame time; and Mr. J. S. Mill, in his Examination of Sir W. Hamilton'sPhilosophy, allows a " great multitude of states, more or less conscious, whichoften co-exist in the mind!" On this question Sir H. Holland has some excellentremarks in his " Chapters on Mental Physiology; " and for a fuller notice of itthan would be proper here, I may refer to a review, in the Journal of MentalScience for January 1866, of Mr. J. S. Mill's criticism of Sir W. Hamilton. Itwould appear that ideas are in this regard like movements: several of them may be in simultaneous action, though not equally present to consciousness. Experienceproves again that a more acute pain will frequently obscure or suspend a lesssevere 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. 137such function. When the whole energy of an idea that is excitedpasses immediately outwards in ideomotor action, then there isscarce any, or there may be no, consciousness of it; in order thatthere may be consciousness of the idea, it is necessary not onlythat its excitation reach a certain intensity, but that the wholeforce of it do not pass immediately outwards in the reaction.The persistence for a time of a certain degree of intensity ofenergy in the ideational cell would certainly appear to be thecondition of consciousness. Accordingly when the process ofreflection is going on, quietly and rapidly, through the regularassociation of ideas, there is no consciousness of the steps; inthe train of thought one idea calls another into activity withoutbeing itself attended to, so that the result may appear as ifsudden and accidental, and it may be very difficult, or quiteimpossible, to retrace the steps, or take up the successive links,by which it was evolved. In the course of a day how manythoughts or ideas do thus suddenly start into consciousness , or,as we may say, suddenly strike us! The excitation of oneideational cell would seem to be communicated immediately toanother, and the energy thus to run through a series by a continuous transformation, with no residual persistence at any ofthe intermediate stages.A conception of the way in which a group or series of movements are observably associated, and the faculty of them isfirmly organised in the nervous centres, so that they are henceforth automatically performed, will be found most serviceablein 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, theyare 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. Thequestion of the time necessary for the performance, so to speak,of an idea is really a most important one, which has not hithertoreceived sufficient attention. It is sometimes not less than thetime required for the performance of a muscular motion; for, asDr. Darwin observed, a musician can press the keys of a harpsi-138 HEMISPHERICAL GANGLIA, OR [CHAP.chord with his fingers in the order of a tune which he has beenaccustomed to play, in as little a time as he can run over thosenotes in his mind. Nay, an idea may even require more timethan a movement: how many times in a day do we cover oureyes with our eyelids without ever perceiving that we are inthe dark? In this case, as Dr. Darwin has also observed, themuscular motion of the eyelid is performed quicker than theidea of light can be changed for that of darkness: the twinklingof an eye being quicker than thought. (7) The interference ofconsciousness is often an actual hindrance to the association ofideas, as it notably is to the performance of movements thathave attained the complete ease of an automatic execution.It happens that we try hard to recall something to mind, andare unable by the utmost effort of volition, and the strongestdirection of consciousness, to do so we thereupon give up theattempt, and direct our attention to something else; and, aftera while, the result for which we strove in vain, flashes intoconsciousness: the automatic action of the brain has worked itout. That is exactly what we might expect to happen: for ifconsciousness implies a persistence of the tension of a nervecell's energy, then in proportion to the degree of persistenttension must be the retardation of, or hindrance to, the processof association of ideas, which is effected by a transference ofenergy from one to another of the catenated cells. An activeconsciousness is always detrimental to the best and most successful thought the thinker who is actively attentive to thesuccession of his ideas is thinking to little purpose; what thegenuine thinker observes is that he is conscious of the words.which he is uttering or writing, while the thought, unconsciouslyelaborated by the organic action of the brain, flows from unpenetrated depths into consciousness. Reflection is then, in reality,the reflex action of the cells in their relations in the cerebralganglia it is the reaction of one cell to a stimulus from aneighbouring cell, and the sequent transference of its energy toanother cell-the reflection of it. Attention is the arrest of thetransformation of energy for a moment-the maintenance of aparticular tension. Bear in mind what was said of the varyingvalue of an idea and of the manner of its gradual organizationin the nervous centres, and the applicability of the term delibera-v.] IDEATIONAL NERVOUS CENTRES. 139tion to a process of thought, as a weighing or balancing of onereason against another, will be evident. Or if we prefer theterm ratiocination, we may say, with Hobbes, that by it is meantcomputation. " Now to compute is either to collect the sum ofmany things that are added together, or to know what remainswhen one thing is taken from another. Ratiocination, therefore,is the same with addition and subtraction." Subtract the energyof an opposing idea from a more powerful one, and the energyleft represents the resultant force of impulse after deliberation;add the energy of a like idea to another, and the sum representsthe force of the resolution. After severe reflection or deliberation the decision or resolution may be held to signify that wehave resolved, to the best of our ability, the complex equationset us.Though reflection is a process of mental activity that takesplace within consciousness, yet consciousness itself, when fairlyexamined, will show how limited is the power of the mind overthe train of its ideas. The formation of an idea is an organicprocess that takes place by imperceptible degrees beyond therange 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 likemanner the catenation of a group or series of ideas is an organicprocess of which consciousness has no knowledge, and overwhich volition has no control; once the train is firmly linkedtogether by this organized coherence, the excitation of one mustneeds bring on the excitation of the others, one after another, asit traverses its appointed orbit, rising above the mental horizoninto consciousness, and in due order again sinking below it.The power of the mind over the succession of its states isplainly at best but a limited faculty; herein correspondingwith that limited control which an individual has over thephenomena of his bodily life, where conscious and unconscious, voluntary and involuntary, acts are so intimately intermixed. To make states of consciousness synonymous withstates of mind, as some have heedlessly done, is scarcely lessunwarrantable than it would be to assert all bodily acts to beconscious acts.There yet remains something more to be said concerning the140 HEMISPHERICAL GANGLIA, OR [ CHAP.association of ideas. The anatomical connexions of a nerve-cellin the cerebral ganglia do, of a necessity, limit the direction andextent of its action upon other cells; it cannot act on othercells indifferently; for it may be deemed tolerably certain thatas the conduction in nerve- fibres demonstrably does not passfrom one to another except by continuity of tissue, so theactivity of one cell cannot be communicated to another exceptalong an anastomosing process. Besides, or within, this necessary limitation, which exists in the anatomical constitutionof the nervous centres, there is a further determination ofthe manner of association by the individual life experience,just as is the case with movements. "Not every thought toevery thought succeeds indifferently; " but, as all ideas havebeen acquired by means of experience, and we have " no imagination whereof we have not formerly had sense in whole orin parts," so the connexions which ideas have with oneanother in the brain must answer in some manner the orderof experience; and even an individual's habit of association ofideas will witness to the influence of his particular educationand surroundings. Social life would simply be rendered impossible if we could not depend upon the uniformity of the lawsof nature in man as well as out of him; if one idea followedanother casually, it would be all one as if one event in natureoccurred without connexion with another. That one idea doesseemingly follow another casually, or at any rate without recognisable coherence, justifies us, we are in the habit of thinking,in shutting a man up in a lunatic asylum; and one of the firstsigns of insanity confessedly is an unaccountable change in, ordisruption of, the particular uniformity of an individual character. 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 veryaptly says, " discovers the impossibility of his escape as wellwhen he considers the obstinacy of the gaoler as the walls andbars with which he is surrounded; and, in all attempts for hisfreedom, chooses rather to work upon the stone and iron of theone than upon the inflexible nature of the other." Althoughideas are thus as definitely associated in the mind by physical necessity as are cause and effect in external nature; yet,v.] IDEATIONAL NERVOUS CENTRES. 141because sometimes one idea has succeeded another in our experience, and sometimes another, it is not certain always in soobscure and complex a labyrinth what idea shall in a givencase ensue; only this is certain, that it shall be an idea thathas been associated with it at one time or another. Necessity is, in truth, confessed in every deliberation and in everyact of our life.Because each one has a certain specific nature as a humanbeing, and because the external nature in relation with whicheach one exists is the same, therefore are inevitably formed certain general associations which cannot without great difficulty,or anywise, be dissociated, just as different movements are solinked together in all men that they cannot be dissociated.Such are what have been described as the general laws of association of ideas-those of cause and effect, of contiguity in timeand space, of resemblance, of contrast; in all which ways, it istrue, one idea may follow another, though also in many otherways. We are enabled, however, by virtue of the general laws ofassociation in which all men agree, to predict the general courseof human conduct, and to establish laws for the regulation of thesocial state. Within these general principles, however, there arenumerous subordinate differences; the special character of anindividual's association of ideas being determined partly by hisoriginal nature, and partly by his special education and lifeexperience.That natural differences in the mental susceptibilities of different persons do influence the character of their association ofideas, is shown, as Dr. Priestley long since pointed out, * by thegreater ease with which some men associate those co-existencesof sensory perceptions which combine to constitute the idea ofan object, while others associate more readily those successivesensory impressions which go to form the idea of an erent.These different tendencies and dispositions are really at thefoundation 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 andpainful properties of things-in fact, a mind good at description ,and fond of natural history; in the latter case, there is a mindIn his Introduction to Hartley.142 HEMISPHERICAL GANGLIA, OR [ CHAP.observant of the order of occurrence of phenomena, prone to theinvestigation of the genesis of things, or the connexion of causeand effect-in fact, a philosophic intellect, affecting science andabstract truth, to which an event that can be nowise explainedor displayed as an evolution of antecedent causes, is a painfultribulation. Such mind is at the opposite end of the scale tothat of the " poor idiot born," who, by reason of his imperfectconstitution, has but few ideas, and cannot duly associate thosefew, just as he is capable of but few imperfectly associatedmovements. Forget not, however, that between the idiot atthe bottom of the scale of human life, and the philosopherat its summit, there are to be met with beings representingevery grade of the transition.Special adaptations to particular circ*mstances of life alsoconcur to lay the foundation of individual habits of thoughtand conduct. The successful tact or skill of one man in circ*mstances in which the awkwardness or failure of another isstriking, is the consequence of a rapid association of ideaswhich has, from repeated special experience, become so familiar,so much a habit, as to appear like an intuition. In such casethe group, or series of ideas, is so closely united, so firmlyorganised, as to behave almost as one idea; while the excitation,though sufficient for the desired end, does not take place to suchdegree as to produce consciousness. * Even the instantaneousand acute judgment of a much experienced and well-trainedmind, which is sometimes so rapid as to look like an instinct orintuition, is founded upon a previous careful training in observation and reflection; it depends in reality on an excellentassociation of ideas that has been organized in correspondence" Not only do simple ideas, by strong association, run together, and formcomplex ideas; but a complex idea, when the simple ideas which compose it havebecome so consolidated that it always appears as one, is capable of entering intocombinations with other ideas, both simple and complex. Thus two complexideas 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 oftwo complex ideas into one, Dr. Hartley has called a duplex idea. Two also ofthese duplex ideas, or doubly compounded ideas, may unite into one; and these,again, into other compounds without end. " . . . . " How many complex orduplex ideas are all united in the idea of furniture? How many more in the ideaof merchandise? How many more in the idea called Every Thing? "-J. MILL,op. cit. p. 82.v.] IDEATIONAL NERVOUS CENTRES. 143with, or adaptation to, the series of co- existences and successions in external nature; and thus it comes to pass that eventhe judgment of an individual in his particular relations of lifebecomes almost automatic. When it is said, again, that a man'scharacter is completely formed, we express thereby the fact thathe has acquired certain definite combinations and associationsof ideas which, firmly organized, henceforth avail him in thedifferent circ*mstances of life. It is evident, then, that if wehad a complete knowledge of the inner nature of an individual,if we could penetrate that most exquisitely organised fabric ofthought which by reason of his particular education and lifeexperience has been grafted on the original capabilities, itwould be possible to foretell with certainty his mode of thoughtand conduct under any given circ*mstances. Is not this a prediction which, as it is, those who know a man best can oftenmake, with close approximation to truth? But inasmuch asno two minds are exactly alike originally, and as no two personshave precisely similar experiences, the speciality of human conditions being infinite in variety, we cannot obtain the exact andcomplete elements for a correct and definite judgment of theoperation of a given cause upon any individual. None the less.true is it that every cause does operate definitely by as sterna necessity as any which exists in physical nature.Once more, then, is it rendered evident how necessary toa complete psychology of the individual is the considerationof the circ*mstances in which he has lived, and in relation towhich he has developed, as well as the observation of his habitsof thought, feeling, and action. From what has been said ofideas and their associations, it is obvious that in the samelanguage, when used by different people, there must often beconsiderable difference in regard to the fulness and exactnessof the ideas conveyed by it . (3) In translation from one languageto another it plainly appears that ideas, which have a generalresemblance, have yet certain special differences according tothe depth of thought, the religion, the manners and customsof the different nations; it is as hard a matter to conveyadequately in the French language the meaning of Germanphilosophy as it is to express adequately, by the correspondingGerman words, the exact meaning of the French names for144 HEMISPHERICAL GANGLIA, OR [CHAP.different shades of elegant vice or elegant cookery. And whosoever enters upon the study of psychology with the assumptionthat an idea deemed or called the same has always the sameconstant value in different people of the same nation, will be ledinto the vainest errors by so false a metaphysical conception.Do not men owe most of their errors and disputes to the factthat they cannot come to a right understanding of words?How should they, indeed, when by the same word is frequentlysignified an idea at very different stages of its evolution?It remains only to add here, that the successive formation ofideas in mental development and the progressive complexity oftheir association and of their interaction in the supreme centresof the brain, illustrate, as do the development of the spinalcentres and the development of the sensory centres, an increasing organic specialization in the relations of man to externalnature; that Von Baer's law of progress from the generaland simple to the special and complex here, as elsewhere inorganic development, has sway.Thus far, then, we have exhibited the path of distribution forthe energy of an idea when it does not pass outwards in a directreaction to the stimulus from without: it travels from cell tocell within the cortical layers of the hemispheres, and thus givesrise to reflection. But at the end of all this wandering or of thevarious transformations, as the final result of reflection, theremay still be a reaction downwards, and consequent outwardactivity of the individual. When that takes place it is volitional action: the will, abstractly speaking, is the resultant ofthe complex interaction of the supreme ganglionic cerebralcells. We ascend gradually to this highest manifestation offorce by tracing upwards the fundamental reaction of nerve- cellthrough reflex action, sensori-motor action, and ideo-motoraction in our knowledge of the more simple phenomena wehave a guide with which to enter on the study of those whichare more complex and obscure. As, however, there is usuallypresent in the action of will some desire of a good to beobtained, or of an evil to be shunned, it will be proper, beforeconsidering the nature of volition, to deal with the emotions.To them, therefore, shall the next chapter be devoted.v.] IDEATIONAL NERVOUS CENTRES. 145NOTES.¹ (p. 127).- " For what is meant by innate? If innate be equivalentto natural, then all the perceptions and ideas of the mind must beallowed to be innate or natural, in whatever sense we take the latterwords, whether in opposition to what is uncommon, artificial, or miraculous. If by innate he meant contemporary to our birth, the disputeseems to be frivolous; nor is it worth while to inquire at what timethinking begins, whether before, at, or after our birth. Again, theword idea seems to be commonly taken in a very loose sense by Lockeand others as standing for any of our perceptions, our sensations andpassions, as well as our thoughts. Now, in this sense, I should desireto know what can be meant by asserting that self-love, or resentmentof injuries, or the passion between the sexes, is not innate? "-HUME,Essay concerning the Human Understanding.2 (p. 128). " I cannot but think that the two main articles ofbelief which have been set down to the credit of the Indian-namely,the Great Spirit or Creator, and the Happy Hunting-grounds in a futureworld, —are the results of missionary teaching, the work of the FathersHennepin, 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 isdoubtful whether these savages ever grasped the idea of a human soul. ""I do not believe that an Indian of the plains ever became aChristian. He must first be humanized, then civilized, and, lastly,Christianized; and, as has been said before, I doubt his surviving theoperation. "-The City of the Saints, by R. F. Burton, p. 133.3 (p. 128). "There is no other act of man's mind that I canremember, naturally planted in him, so as to need no other thing inthe exercise of it, but to be born a man and live with the use ofhis five senses. Those other faculties of which I shall speak by andby, and which seem proper to man only, are acquired and increasedby study and industry, and of most men learned by instruction anddiscipline; and proceed all from the invention of word and speech. "-HOBBES, Leviathan, ch. iii.4 (p. 129). "The first consideration I have upon the subject ofthe senses is that I make a doubt whether or no man be furnishedwith all natural senses. I see several animals who live an entire andL146 HEMISPHERICAL GANGLIA, OR [CHAP.perfect life, some without sight, others without hearing; who knowswhether to us also, one, two, three, or many other senses may not bewanting? For if any one be wanting, our examination cannot discover the defect." " Tis the privilege of the senses to be the utmostlimit of our discovery; there is nothing beyond them that can assist usin exploration, not so much as one sense in the discovery of another."..."There is no sense that has not a mighty dominion, and that doesnot by its power introduce an infinite number of knowledges. If wewere defective in the intelligence of sounds, of harmony and of thevoice, it would cause an unimaginable confusion in all the rest of ourscience; for, besides what belongs to the proper effect of every sense,how many arguments, consequences, and conclusions, do we draw toother things, by comparing one sense with another? Let an understanding man imagine human nature originally produced without thesense of seeing, and consider what ignorance and trouble such a defectwould bring upon him, what a darkness and blindness in the soul; hewill then see by that of how great importance to the knowledge oftruth, the privation of such another sense, or of two or three, shouldwe be so deprived, would be. We have formed a truth by the concurrence of our five senses; but, perhaps, we should have the consentand contribution of eight or ten to make a certain discovery of it in itsessence. "-MONTAIGNE'S Essays.5 (p. 129). It would appear that one hemisphere of the brain canonly act, whether by means of idea or volitionally, on the limbs of theopposite side, that it cannot act upon the limbs of the same side of thebody. Philipeaux and Vulpian injured or removed portions of theleft hemisphere in dogs. All of them are said to have exhibited aslight degree of paralysis of the right side, and moved in a circlewhen forced to move. The hemiplegia was slight, though evident, forthe animals supported themselves on the enfeebled limbs. But wasthere a true hemiplegia? Was not the paralysis spurious, and duereally to the loss of intelligence and volition in the damaged hemisphere, so that the animal only had sensori-motor power left on thatside? Accordingly, as the left side continued to act freely under theinstigation of the will proceeding from the right hemisphere, while theleft depended on sensori-motor action only, or on synergy with theright, the animal was made to move in a circle.6 (p. 136). "The decay of sense in men waking is not the decayof the motion made in sense, but an obscuring of it, in such manner asthe light of the sun obscureth the light of the stars; which stars do noless exercise their virtues, by which they are visible, in the day than inv.] IDEATIONAL NERVOUS CENTRES. 147the night. But because among many strokes which our eyes, ears,and other organs receive from external bodies, the predominant only issensible; therefore, the light of the sun being predominant, we arenot affected with the action of the stars. "-Leviathan, ch. vi.7 (p. 138). "The time taken up in performing an idea is likewisemuch the same as that taken up in performing a muscular motion. Amusician can press the keys of an harpsichord with his fingers in theorder of a tune he has been accustomed to play in as little time as hecan run over these notes in his mind. So we many times in an hourcover our eyeballs, without perceiving that we are in the dark; hencethe perception or idea of light is not changed for that of darkness inso small a time as the twinkling of an eye, so that, in this case, themuscular motion of the eyelid is performed quicker than the perceptionof light can be changed for that of darkness. " -Zoonomia, vol. i. p. 24.8 (p. 143). "It will easily appear from the observations here madeupon words, and the associations which adhere to them, that the languages of different ages and nations must bear a general resemblance toeach other, and yet have considerable particular differences; whence anyone may be translated into any other, so as to convey the same ideasin general, and yet not with perfect precision and exactness. Theymust resemble one another because the phenomena of nature, whichthey are all intended to express, and the uses and exigencies of humanlife, to which they minister, have a general resemblance. But then,as the bodily make and genius of each people, the air, soil, andclimate, commerce, arts, science, religion, &c. , make considerabledifferences in different ages and nations, it is natural to expect that thelanguages should have proportionable differences in respect of eachother. "-HARTLEY'S Theory of the Human Mind, by Dr. Priestley."Wherefore, as men owe all their true ratiocination to the rightunderstanding of speech, so also they owe their errors to the misunderstanding of the same; and as all the ornaments of philosophy proceedonly from man, so from man also is derived the ugly absurdity of falseopinions. For speech has something in it like to a spider's web (as itwas said of old of Solon's laws), for by contexture of words tenderand delicate wits are ensnared and stopped; but strong wits breakeasily through them. "-HOBBES, vol. i. p. 36.L2MANCHAPTER VI.THE EMOTIONS.AN is patient and agent; he suffers certain passions, anddoes certain actions. Passion is actual suffering, anddepresses; action is the cure for suffering, and elevates. Acalm deliberation involves an equilibrium between suffering anddoing; 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 anemotion or a passion. The definite form of the idea in thematerial substratum is obscured or partially lost in the agitationor commotion of the nerve elements. Strictly speaking, all conscious psychical states are, at first, feelings; but, after having beenexperienced several times, they are adequately and definitelyorganized, and become almost automatic or indifferent underordinary circ*mstances. So long as the ideas or mental states arenot adequately organized in correspondence with the individual'sexternal relations, more or less feeling will attend their excitation: they will, in fact, be more or less emotional. When theequilibrium between the subjective and objective is duly established, there is no passion, and there is but little emotion. (¹)It has been sufficiently evident, up to the present point, thatthe condition of the nervous centres is of the greatest consequence in respect of the formation of the so- called mentalfaculties, and of the manifestation of their functions; it willnow be seen that this condition is of still more manifest importance in regard to the phenomena of the emotions. Everyone's experience teaches him that an idea which is at one timeindifferent, being accompanied by no feeling of pleasure orCHAP. VI. ] THE EMOTIONS. 149discomfort, may, at another time, be attended by some feeling ofdiscomfort, or become positively painful. And it requires no veryattentive observation of men to discover that different personsare very differently affected by one and the same object, andoften pass very different judgments upon it in consequence. Somuch is this the case that we are in the constant habit of distinguishing men by the difference of their emotional disposition,or of the temper of their minds, and of speaking accordingly ofone man as timid; of another as courageous; of one as irritable,quick-tempered; of another as even-tempered, placid. One ofthe earliest symptoms of an oncoming insanity, and one that isalmost universally present as the expression of a commencingdeterioration, howsoever caused, of the nervous centres, is anemotional disturbance, upon which follows more or less perversion of judgment. It is feeling, or the affective life, thatreveals the deep essential nature of the man; for it expresses thetone of his nerve element, which again is the result of itsactual constitution or composition, inherited and acquired.The first occurring observation is, that an idea which is favourable to the impulses or strivings of the individual, to self-expansion, is accompanied by a feeling of more or less pleasure;and that an idea which betokens individual restriction, which isopposed to the expansion of self, is attended with a feeling ofmore or less discomfort or pain. As the organic germ does,under circ*mstances favourable to its inherent developmentalimpulse, incorporate matter from without, exhibiting its gratification by its growth, and, under unfavourable conditions, doesnot assimilate, but manifests its suffering or passion by itsdecay; so likewise the ganglionic nerve-cell of the hemispheres attests by a pleasant emotion the furtherance of itsdevelopment, and declares by a painful feeling of discomfort therestriction or injury which it suffers from an unfavourablestimulus. Even in the earliest sensation, therefore, the existence of pain or pleasure is a sort of obscure judgment on itsadvantage or disadvantage to the personality or self-a judgmentin which, as Herbart has observed, the subject cannot yet beseparated from the predicate that expresses praise or blame. *"Ein Urtheil, in dem nur das Vorgestellte sich noch nicht von demPradicate, das Beifall oder Tadel ausdrückt, sondern lässt. "-HERBART.150 THE EMOTIONS. [CHAP.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 scornfullyto be looked at, that one has neither the power nor wish to havedone otherwise. For every man is desirous of what is good forhim, and shuns what is evil, but chiefly the chiefest of naturalevils, which is death; and this he doth by a certain impulsionof nature, no less than that whereby a stone moves downwards." (2)Children and savages best exhibit in a naked simplicity thedifferent 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 inmoderation 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 desireto shun the stimulus, like as one altogether noxious is shunned;the desire becoming the motive or spring of action. The impulsein such case is described as desire, because there is consciousnessof it; but it is without doubt the equivalent in a higher kind oftissue of that effort which the lowest animal organism exhibits,without consciousness, in getting away from an injurious stimulus. In both instances there is, in truth, the display of theso-called self- conservative impulse which is immanent in allliving matter-an impulse or instinct, which, whatever deeperfacts of intimate composition may be connoted by it, is theessential condition of the continued existence of organic element.Such reaction of organic element is as natural and necessary asthe reaction of any chemical compound, because as much the consequence of the properties of matter thus organically combined.When the stimulus to a hemispherical nerve-cell is not insufficient force to satisfy the demands of the latter, -when, infact, it is inadequate, then there is the manifestation of anaffinity 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 nodifference, indeed, as Spinoza observes, between appetite anddesire, except in so far as the latter implies consciousness;desire is self- conscious appetite. (3) Because we have an appetiteor desire for something, therefore we judge it to be good: itcertainly is not because a thing is judged to be good that wevi. ] THE EMOTIONS. 151have an appetite or desire for it. Here, again, there is anexact correspondence with that attraction, impulse, or strivingof organic element towards a favourable stimulus manifestedthroughout nature, and the necessary correlate of which is arepulsion of what is unfavourable. Because the affinity isexhibited 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, bymeans of a self- conservative impulse or instinct, for the stimulusfavourable to its growth. But the attraction is no less a physicalnecessity than the attraction of an acid for an alkali, of theneedle to the pole, or of positive for negative electricity; ifthere were no stimulus, there would be no reaction on the partof the organic element; if the stimulus were in injurious excess,or otherwise unfavourable, there must be disturbance of thestatical equilibrium, and a reaction of repulsion; and when thestimulus is favourable but deficient, the reaction is evinced inan attraction or affinity for an additional amount, like as a nonneutralized acid will take up more alkali, or as unsatisfiedappetite craves more nutriment. Now, it is most importantthat we do not allow the presence of consciousness to mislead usas to what is the fundamental condition of things in the ganglionic cells of the brain. Here, as elsewhere, healthy organicelement manifests its fundamental properties, pursuing the good,eschewing the ill; and consciousness is something superadded,but which nowise abolishes them. The striving after a pleasingimpression, or the effort to avoid a painful one, is at bottom aphysical consequence of the nature of the ganglionic cell in itsrelation to a certain stimulus; and the reaction or desire becomesthe motive of a general action on the part of the individual forthe purpose of satisfying a want, or of shunning an ill. Thecare of himself no man in good health has the power of neglecting. To cease to strive is to begin to die, physically, morally,and intellectually.It is obvious then, not only how desires become the motivesof action, but how they are gradually evolved into their completeform out of the unconscious organic appetites. In the desire ofthe adult there is necessarily some sort of conception of what isdesired, though it is at times a not very definite one; but in152 THE EMOTIONS. [CHAP.the child, as in the idiot, we frequently witness a vague restlessness evincing an undefined want of, or desire for, something ofwhich itself is unconscious, but which, when obtained, presentlyproduces quiet and satisfaction: the organic life speaks out withan as yet inarticulate utterance. Most striking is that exampleof the evolution of organic life into consciousness which isobserved at the time of puberty, when new organs come intoaction; then vague and ill-understood desires give rise toobscure impulses that have no defined aim, and produce a restlessness which, when misapplied, is often mischievous: theamorous appetite thus first declares its existence. But to provehow little it is indebted to the consciousness which is a naturalsubsequent development, it is only necessary to reflect that evenin man the desire sometimes attains to a knowledge of its aim,and to a sort of satisfaction, in dreams before it does so in reallife. This simple reflection might of itself suffice to teach psychologists how far more fundamental than any conscious mentalstate is the unconscious mental or cerebral life. Given an illconstituted or imperfectly developed brain at the time when thesexual 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 adesire that immediately issues in uncontrollable efforts for itsgratification. Given, on the other hand, a well constituted andnaturally developed brain, the sexual desire undergoes a complexdevelopment in consciousness: from its basis are evolved allthose delicate, exalted, and beautiful feelings of love that constitute the store of the poet, and play so great a part in humanhappiness and in human sorrow. What, however, is true ofthese particular desires is true of all our desires: it may befitly said, with Bacon, " that the mind in its own nature wouldbe temperate and staid, if the affections, as winds, did not put itin tumult and perturbation; " or, with Nova is, that " life is afeverish activity excited by passion. "When the circ*mstances are exactly adapted to the capacityof the organic element, then are they most favourable to thedevelopment of the latter; and a steady growth of it fails not totestify to the complete harmony of the relations. Or, adoptingthe language proper in such case to the highest relations of man,VI.] THE EMOTIONS. 153there is an equilibrium between the subjective and the objective,and no passion: there is neither a painful feeling with consequentdesire to avoid a suffering, nor is there a feeling of insufficientsatisfaction with consequent desire to increase or continue anenjoyment; but a steady assimilation, promoting the evolution ofidea, goes favourably on: intellectual development is then mostfavoured. As there is no outward striving or craving in suchcase, the energy of the response to the stimulus is expended inthe growth of the idea and in the reaction of it upon other ideas,-in other words, in intellectual development. Conception anddesire, therefore, stand in a sort of opposition to one another,although in every mental act they co-exist in greater or lessrelative degree; in every conception there is, or has once been,as previously said, some feeling; and again, in every distinctdesire there is a conception of something desired. But the opposition between them is in reality a matter of the degree of formation of the idea or conception; for, whatever its nature, thereis always more or less feeling with it when first experienced,which, however, disappears in proportion as it becomes definitelyorganized; and even though some little feeling or desire remainsconnected with the idea, it may often remain in consciousness,or only modify reflection, not being of sufficient degree to passinto outward manifestation. May we not then justly affirm, aswe clearly perceive, that the intellectual life does not supply themotive, 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 bringsits own accomplishment. The desire is the expression of theindividual's character, the manifestation of the essential affinitiesof his nature; accordingly he strives with all his might to attainunto the aim which he sets before him, and probably succeedseither in a direct or a circuitous way. Thus it is that aspirationsare often prophecies, the harbingers of what a man shall be in acondition to perform. Men of great reasoning powers, on theother hand, are notoriously not unfrequently incapacitated therebyfrom energetic action; they balance reasons so nicely that no oneof 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, being154 THE EMOTIONS. [CHAP.exhibited rather in the hindrance of passion-prompted action,and in the guidance of our impulses, than in the instigationof conduct; its office in the individual as in the race is,as Comte observed, not to impart the habitual impulsion, butdeliberative. (4)As there are two factors which go to the production of anemotion-namely, the organic element and the external stimulus-it is plain that the character of the emotional result will notbe determined only by the nature of the stimulus, but willdepend greatly also upon the condition of the organic element.The equilibrium between the individual and his surroundingsmay, in fact, be disturbed by a subjective modification, or aninternal commotion, as well as by an unwonted impression fromwithout. When some bodily derangement has affected the condition of the cells of the cerebral ganglia, either directly or bya sympathetic action, then an idea arising is accompanied withcertain emotional qualities, though it is an idea which, in health,is commonly indifferent; just as when a morbid state of an organof sense, or of its sensory ganglion, renders painful an impressionwhich in health would be indifferent or even agreeable. Everyone's experience teaches how much his tone of mind varies according to his bodily states. The drunken man, at a certainstage of his degradation, gets absurdly emotional; and thegeneral paralytic, whose supreme nervous centres are visiblydegenerate, is characterised by great emotional excitability, aswell as by intellectual feebleness. The general feeling of wellbeing which results from a healthy condition of all the organs ofthe body, which is indeed the expression of a favourably proceeding organic life, is known as the cœnæsthesis, and is sometimes described as an emotion: but it is not truly an emotion;it is the body's sensation or feeling of its well-being, and marksa condition of things, therefore, in which activity of any kindwill be pleasurable-in which an idea that arises will bepleasantly emotional, not otherwise than as bodily movementis then pleasurable. On the other hand, the general feeling ofdiscomfort which follows upon a visceral disturbance, or someother cause, is a condition in which activity of any kind will berather painful than otherwise; there is a restricted or hinderedpersonality, and an idea arising is apt to be gloomily emotional.VI. ]THE EMOTIONS. 155It plainly amounts to the same thing, whether an excessivestimulus acts upon nerve element when in a stable andhealthy state, and produces suffering; or whether a naturalstimulus acts upon it when in an enfeebled or unstable condition, and similarly gives rise to suffering: in both cases,there is, physically speaking, a disturbance of the equilibriumof the nervous element, or a resolution of it into lower butmore stable compounds; or, psychologically speaking, there is,in both cases, an idea excited which is attended with painfulemotional qualities—an idea unfavourable to individual expansion. The pain which is occasioned is the cry of organic element for deliverance. The greater the disturbance of nerveelement, however produced, the more unstable is its state; andan instability of it, signifying, as it does, a susceptibility to rapidmolecular or chemical retrograde metamorphosis, furnishes themost 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 exhaustingfor the same reason, in fact, that repeated electrical dischargesby the gymnotus or torpedo produce exhaustion; it is easy toperceive, also, that whatever cause, moral or physical, works anexhausting or depressing effect upon an individual, inclines himto become emotional.The original nature of nerve element is, however, as nothingin the determination of the special character of the higheremotions, compared with its acquired nature as this has beenslowly organized by education and in relation to the circ*mstances of life. Much discussion has taken place as to whetheran emotion is merely a feeling of pleasure or pain accompanyinga particular idea; whether, for example, benevolence is nothingmore than the pleasant feeling that accompanies the idea ofaccomplishing the good of another, malice the feeling that attendsthe idea of injuring another, and so on. But there is somedanger here of being confused or misled by words; it certainlymust be allowed that there is something in the emotion morespecial than the general feeling either of pleasure or pain: suchfeeling is present, no doubt, but it does not determine the specialcharacter of the emotion; it is something superadded, whichdetermines only the agreeableness or disagreeableness of the156 THE EMOTIONS. [CHAP.emotion. It is, in reality, the specific character of the ideawhich determines the specific character of the emotion; andaccordingly emotions are as many and various as ideas. (5) Andit has been before shown that the character of the idea is determined by the nature of the impression from without, and by thenature, as it has been modified by a life experience, of thereacting nervous centre: this now containing an organizationof ideas as its acquired nature, or as the expression of its duedevelopment. How difficult it is to explain matters from apsychological point of view, is easy to perceive; while weare considering the relation of emotion to idea, they are bothconcomitant effects of a deeper lying cause. As there aresubjective sensations , so also are there subjective emotionalstates. It depends upon the nature of the fundamental elements, the internal reacting centre and the external impression,whether in a given case we shall have a definite idea with littleor no emotional quality, or whether we shall have the emotionalquality so marked that the idea is almost lost in it. The hemispherical cells are confessedly not sensitive to pain; but theyhave a sensibility of their own to ideas, and the sensibilitywhich thus declares the manner of their affection is what wecall emotional. And as there may be a hyperæsthesia or ananæsthesia of sense, so also there may be a hyperesthesia or ananæsthesia of ideas. Certainly there do not appear to be satisfactory grounds either in psychology or physiology for supposingthe nervous centres of emotion to be distinct from those of idea.AndAs we justly speak of the tone of the spinal cord, by thevariations of which its functions are so much affected, so wemay fairly also speak of a mental or psychical tone, the tone ofthe supreme nervous centres, the variations of which so greatlyaffect the character of the mental states that supervene.as it appeared when treating of the spinal cord that, apart fromits original nature and accidental causes of disturbance, thetone of it was determined by the totality of impressions madeupon it, and of motor reactions thereto, which had been organizedin its constitution as faculties; so with regard to the supremecentres of our mental life, from the residua of past thoughts,feelings, and actions, which have been organized as mentalfaculties, there results a certain psychical tone in each indi-vi. ]THE EMOTIONS. 157vidual. This is the basis of the individual's conception of theego-the affections of which, therefore, best reveal his realnature-a conception which, so far from being, as is often said,fixed and unchanging, undergoes gradual change with thechange of the individual's relations as life proceeds. Whosoever candidly reflects upon the striking modification, or ratherevolution, of the ego, which happens at the time of pubertyboth in men and women, will surely not find it hard to conceive how the self may imperceptibly but surely change throughlife. The education and experience to which any one is subjected likewise modify, if less suddenly, not less certainly, thetone of his character. By constantly blaming certain actionsand praising certain others in their children, parents are able soto form their character that, apart from any reflection, theseshall ever in after life be attended with a certain pleasure;those, on the other hand, with a certain pain. Experienceproves that the customs and religions of different nations differmost widely; what one nation views as crime another praises asvirtue; what one nation glorifies in as a legitimate pleasure,another reprobates as a shameful vice: there is scarcely a singlecrime or vice that has not been exalted into a religious observance by one nation or other at one period or other of the world'shistory. The prayer of the Thug was a homicide, his sacrifice acorpse. How much, then, is the moral feeling or conscience dependent upon the due educational development of the mind! (6)The manner in which music affects some people, producing alively feeling of immediate pleasure, calming mental agitationand exalting the mental tone, and thereby indirectly muchaffecting mental activity, affords an excellent example of amarked effect upon the psychical tone by physical agency;it might be adduced, if it were necessary, to attest the corporeal nature of the process. Such sentiments as the love ofwife and the love of children, various as they are in kind anddegree in different persons, are not definite emotions so muchas the general tone of feeling resulting from certain relations inlife; they represent a mental state in which ideas in harmonywith the tone of mind will be attended with a pleasant emotion,and discordant ideas with a painful emotion, just as harmony inmusic produces pleasure and discord produces pain. So also of158 THE EMOTIONS [CHAP. .the gentle feeling of social propriety, which is easily recognisedin one who has it, and the absence of which cannot be concealed, is indeed made more evident by the pretence of it;there is not a definite emotion, but a disposition or tone ofmind with which certain thoughts, feelings, and actions harmonize so as to occasion pleasure. The refreshing and invigorating influence of some writers does not depend so muchon the actual sense of the words as upon the tone of mindproduced by them. Again, the higher æsthetic feelings arewithout question the result of a good cultivation, consciousdevelopment having imperceptibly become a sort of instinctiveendowment, a refinement to which vulgarity of any kind will berepugnant; they are the bloom of a high culture, and, like thecœnæthesis, represent a general tone of mind which cannot bedescribed as definite emotion, but in which certain ideas thatarise will have pleasant emotional qualities. Reflect, again, onthe powerful effects which the aspects of nature produce uponphilosophic minds of the highest order. The vague mysteriousfeelings which such minds have, as instinctive expressions oftheir fellowship with nature, thrills of that harmonious sympathywith events whereby they are transported with an indefinitefeeling of joy in view of certain of her glories, or oppressed bya dim presentiment of evil under different relations—these arevague psychical feelings that in reality connote the highest intellectual acquisition; they are the consummate inflorescence ofthe highest psychical development, the supreme harmonies ofthe most exalted psychical tone. (7)It is most necessary clearly to realize how much, not the cerebral centres only, but the whole system of bodily nerves, areconcerned in the phenomena of the emotional life . The beatingsof the heart, the movements of respiration, the expressions ofthecountenance, the pallor of fear, or the flush of anger, and theeffects upon all the secretions and upon nutrition-all these evincewith certainty that the organic life participates essentially in themanifestation of emotion. Before definite paths of association ofideas, and groups of ideas, have been organised through cultureand experience, every emotion tends to react directly outwards,either upon the organs of the organic life or upon the instrumentsof the animal life. In children and savages simple emotions areVI.] THE EMOTIONS. 159observably easily excited, and as readily manifested in outwarddisplay; it is only when a strong character has been fashionedthat the power exists to retain the emotional energy within thesphere of the intellectual life; and even in the strongest characterit sometimes happens that an emotion, too powerful or too suddenly excited, will escape control. It has now been sufficientlydemonstrated, by observation and experiment, that the cerebrospinal system does exercise an influence over the ganglia immediately concerned in the phenomena of the organic life; and itis quite in accordance with physiological observation, therefore,to admit that the commotion in the nerve element of the supremecentres, which an emotion implies, will affect the nervous centresof the organic life, and through them the organic movements, orthe more intimate processes of nutrition. * In fact, the experiments of Pflüger, Bernard, and others, on the influence of thecerebro- spinal system over the small arteries; and those ofLister, on the movement of the pigment granules in the stellatecells of the frog's skin,-may be said to have experimentallydemonstrated what has long been popularly observed of themanner of action of the emotions. A joyous, hopeful, enthusiastic feeling has an enlivening influence on the bodily life:when moderate, producing a quiet, equable effect; but whenlively giving rise to more evident results, as brilliancy of theeyes, an accelerated pulse, increased warmth, and an inclinationto laugh or sing. Though a moderate stimulation of the cerebrospinal system appears to favour or increase the action of theorganic centres, yet it admits of no question that an excessiveirritation of the higher centres produces an inhibitory effect upontheir functions; wherein, again, we may perceive a sufficientreason of the disease in an organ which is sometimes the resultof a prolonged depressing passion, especially of depression inits highest degree-hopelessness.† 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 Pflüger calls inhibitorynerve phenomena (Proceedings of the Royal Society, No. xxxii. p. 367) " that oneand the same afferent nerve may, according to its operating mildly or energetically, either exalt or depress the functions of the nervous centres on which itacts. It is, I believe, upon this that all inhibitory influence depends. "160 THE EMOTIONS. [CHAP.organ is ever the sufferer, because here, as elsewhere, to be weakis to be miserable, the effect of a passion is generally experiencedin his affected organ by one who is the subject of any localidiosyncrasy; it more easily sympathises with the centric commotion. Passion, in its essential nature, really betokens thesympathy of the whole nervous system; and a great dispositionto passion means a great disposition to such sympathy. It istrue that, in consequence of a certain elective affinity and of cultivation, the effects of an emotion are usually limited to a certaingroup of muscles, or to some other definite activity; but theless the culture, the more general are the visible effects ofemotion or passion in the idiot an explosion of passion issometimes an explosion of convulsions.But there is another important consideration with regard toour emotions. When we fix the countenance in the expression,or the body in the attitude, which any passion naturally occasions, it is most certain that we acquire in some degree thatpassion. In fact, as we complete our intellectual activity bythe participation of the sensory centres, thereby rendering ourabstract ideas definite through a sensory representation of them,so in our emotional life any particular passion is rendered strongerand more distinct by the existence of those bodily states whichit naturally produces, and which in turn, when otherwise produced, tend to engender it. There can be little doubt that eachpassion which is special in kind has its special bodily expression; this being truly an essential part of it. Mr. Braid found,by experiment on patients whom he had put in a state of hypnotism, that by inducing attitudes of body natural to certainpassions he could excite those passions. We perceive, then,how close is the sympathy or connexion between the bodilysystem and the emotional or affective life, which supplies thehabitual impulsion to action; while the intellectual life which,as deliberative or regulative, controls and directs the activity ofthe individual, has the closest relations with the senses. Fromwant of attention to the essential intervention of the whole of thebodily in the mental life -a-neglect springing from the unjustifiable contempt of the body inherited from the theologists - thephysical expressions of our mental states have not been properlystudied. As the Indian savage surely tracks the footsteps of hisVI.]THE EMOTIONS.161enemy where the uneducated European eye can see no trace; oras the American hunter, by careful attention to the appearancesof the trees, guides himself safely through pathless forests inwhich the greatest philosopher would lose his way and perish;so it is probable that any competent observer who devotedhimself to study scientifically, with patient care and sedulousattention, the manners of a large number of persons, the differentexpressions of their features and of their actions, might discovera certain clue to their character, and often be able to read offwith ease their feelings and desires. It was the recognition ofthe intimate connexion and mutual reaction between the passions and the bodily life that moved Bichat to locate them.as the ancients did, and in common language is now sometimesdone, in the organs of the organic life . But although there wasin this view the just acknowledgment of a truth, it was onlyof part of a truth; for, in the first place, not the organs of theorganic life only, but those also of the animal life, are concerned in the expression and production of passion; and, in thesecond place the feeling of the passion unquestionably takesplace in the brain. It is the display of its organic sympathies. Consequently it is found that, as the effect of adepressing passion is felt by the victim of a local idiosyncrasy in his weak organ, so inversely the effect of a weakor diseased organ, is felt in the brain by an irritability ordisposition to passion, a disturbance of the psychical tone.The phenomena of insanity furnish the best illustrations ofthis sympathetic interaction.The study of disordered emotions will naturally find a placeafterwards, when we come to treat of the pathology of mind.Suffice it here to say that disordered emotion may act upon theanimal life, the organic life, and the intellectual life. It maygrave itself in the lineaments of the countenance, or declareitself in the habit of the body; it may initiate or aggravateorganic disease, producing, according to its duration, a transientor lasting derangement, and it may temporarily obscure, or permanently vitiate, the intelligence. When the emotions aredisordered, as they are particularly in some forms of insanity,and generally at the commencement of insanity, pleasure is feltfrom objects and events which should naturally excite pain, orM162 THE EMOTIONS [CHAP. .pain from causes which should naturally occasion pleasure ina healthy mind: scenes of disorder, excess, and violence, aregrateful to the perverted feelings; order and moderation irritating and repugnant.It may be thought, perhaps, that it would not be amiss ifsomething were now said of the difference between passion andemotion, inasmuch as the terms have hitherto been used almostindifferently. This, however, is scarcely necessary in dealingonly with their general nature, which is fundamentally the same;every so-called emotion, when carried to a certain pitch, becomesa veritable passion. If it were thought well to distinguish themin a special analysis of the particular emotions, as it doubtlesswould be, the ground of distinction would be in the egoistic oraltruistic character of them-names by which Comte distinguishesrespectively those feelings which have entire reference to selfand 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 threeprimitive passions, on the basis of which all others are foundedjoy, sorrow, and desire. (a) Desire, he says, is the very nature.or essence of the individual, whence it is that the joy or sorrowof each individual differs from that of another as the nature oressence of one differs from that of another. (b) Joy is the passagefrom a less degree of perfection to a greater degree of perfection, and accompanies, therefore, all actions that are called good.(c) Sorrow is the passage from a greater degree of perfection toa less degree of perfection, and accompanies all acts that arecalled evil. It will easily be understood, from what has beenalready said, how much the particular character of a passionwill depend upon the education; how, according to the differenceof his education and circ*mstances, one man may repent bitterlyof an act of which another boasts exultantly.Here, again, it is rendered evident how impossible it is todeal satisfactorily with the emotions by considering them onlyas accomplished facts, and grouping them according to theircharacters as we observe them in the adult of ordinary cultivation. We are driven by the psychological method to studyemotion under hopeless disadvantage; for we are constrained toexamine the complexity of an advanced development instead ofVI.]THE EMOTIONS. 163following up, as is the true method, the genesis of emotion orthe plan of its development. In the classification of the animalkingdom, the study of its plan of development is now acknowledged to be the only valid method of determining the true relations between one animal and another: in like manner the interpretation of the phenomena of mind cannot be rightly groundedexcept on an analysis of their development. Whosoever aspiresto give an adequate account of the emotions should devote himself, then, to a careful investigation of their simplest manifestations in the higher members of the animal kingdom; to thestudy of the different grades of their evolution in the savageand the civilized person, in the child and the adult, the womanand the man, the idiot and him who is in his right mind; tothe patient delineation of their special bodily expressions; andshould patiently unfold that progressive specialization and increasing complexity which prevail here as in every other department of organic development. Like as ideas are blended, orcoalesce, and connected in groups and series so that, by complexdevelopment, a character is forined, so are the feelings belongingto the ideas and the desires accompanying them blended andgrouped in a corresponding complexity, and inclinations or disinclinations of every variety and complexity are thus formed asa part of the character. Again, the desire naturally attachingto a certain aim is often transferred after a time to the meansby which that aim is attained, so that there ensue in this waymanifold secondary formations: the end of wealth is to giveenjoyment and comfort; but how often does a passion for themeans oversway the end! By looking to a desirable end, anact 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 slighteffects have insensibly culminated . *Nemo repente fuit turpissimus is really the expression of the physical natureof the growth of character." CustomConstrains e'en stubborn Nature to obey;Whom dispossessing oft, he doth essayTo govern in her right; and with a paceSo soft and gentle does he win his way, [ThatM 2164 THE EMOTIONS [CHAP. .As it is in the individual, so it is through generations. Theinternal organic adaptations which take place in correspondencewith differences in the external conditions of existence, aresometimes observedly propagated through generations, and thatwhich was a conscious acquisition in the parent becomes moreor less an innate endowment of the offspring. It seems toadmit of little doubt that this law works in the improvementof the human brain in the course of generations: as those whomigrate from their native land to other and different climesdo in course of time endow their progeny with an inherentadaptability to the new conditions, so that they do not perish,but flourish in them; or as the young fox or young dog inheritsas an instinct the cunning which its ancestors have slowly acquired by experience; so the records which are available provethat the brain of man has undergone considerable development in the course of generations. Between the inborn moralnature of the well-constituted civilized person and the brutalnature of the lowest savage, all question of education and cultivation put aside, the difference as a physical fact is not lessthan that which often exists between one species of animaland another. The exalted ideas of justice, virtue, mercy—which are acquired in the course of a true civilization, andwhich the lowest savage has not-do, without doubt, add something to the nervous endowment of succeeding generations; notonly is there in their constitution the potentiality of such ideas,which there is not in the lowest savage, but there is generatedan instinctive quality of mind, an excellent tone of feeling,which rebels against injustice of any kind; there is formed thepotentiality of a so-called moral sense. Thus it is that the individual rightly developing in his generation is, by virtue of thelaws of hereditary action, ordaining or determining what shallbe pre-ordained or pre-determined in the original nature of theindividual of a future age. But are we then to lose sight ofthe physical aspect of this development? Certainly not: themoral feeling betokens an improved quality, or higher kind ofThat she unawares is caught in his embrace,And tho' deflowered and thralled nought feels her foul disgrace. "Stanza ofGilbert West, quoted by Coleridge in hisBiographia Literaria.VI.] THE EMOTIONS. 165nerve element, which ensues in the course of a due development, and which may easily again be disturbed by a slightphysical disturbance of the nervous element. In the exaltationof mankind through generations, in the progress of humanization,so to speak, this height of excellence is reached in the deterioration or degeneration of mankind, as exhibited in the downward course of insanity proceeding through generations, one ofthe earliest evil symptoms is, as we shall hereafter see, the lossof this virtue -the destruction of the moral or altruistic feeling.Insane persons are entirely wrapped up in self, though the selffeeling may take many guises.The intimate and essential relation of emotions to the ideas,which they equal in number and variety, is sufficient to provethat the law of progress from the general and simple to thespecial and complex prevails in their development. If suchrelation were not a necessary one, it would still be possiblefrom a consideration of the emotions themselves to display thatmanner of evolution. And the recognition of this increasingspecialization and complexity in the function compels us toassume a corresponding development in the delicate organization of the nervous structure, although by reason of theimperfection of our means of investigation we are not yet ableto trace a process of such delicacy in these inmost recesses towhich our senses have not gained entrance.NOTES.1 (p. 148). "Notre âme fait certaines actions et souffre certainespassions; savoir: en tant qu'elle a des idées adéquates, elle fait certaines actions; et en tant qu'elle a des idées inadéquates, elle souffrecertaines passions. "-SPINOZA, Des Passions, Prop. i.2 (p. 150) .-"Among so many dangers, therefore, as the natural lustsof men do daily threaten each other withal, to have a care of one's selfis so far from being a matter scornfully to be looked upon, that onehas neither the power nor wish to have done otherwise. For everyman is desirous of what is good for him, and shuns what is evil, butchiefly the chiefest of natural evils, which is death; and this he dothby a certain impulsion of nature, no less than that whereby a stonemoves downwards. " -HOBBES, vol . ii. p. 8,166 THE EMOTIONS. [CHAP3 (p. 150).-" Le désir, c'est l'appétit, avec conscience de lui-même.Il résulte de tout cela que ce qui fonde l'effort, le vouloir, l'appétit, ledésir, ce n'est pas qu'on ait jugé qu'une chose est bonne: mais, aucontraire, on juge qu'une chose est bonne par cela même qu'on ytend par l'effort, le vouloir, l'appétit, le désir. " -SPINOZA, Des Passions,Schol. to Prop. ix.-4 (p. 154). But we must frankly admit, on consideration, that thepolitical rule of intelligence is hostile to human progression. Mind musttend more and more to the supreme direction of affairs; but it cannever attain it, owing to the imperfection of our organism, in whichthe intellectual life is the feeblest part; and thus it appears that thereal office of mind is deliberative; that is, to moderate the materialpreponderance, and not to impart its habitual impulsion. "-COMTE,Positive Philosophy, vol. ii. p. 240.5 (p. 156) . "For it is not his disputations about pleasure and painthat can satisfy this inquiry; no more than he who should generallyhandle the nature of light can be said to handle the nature of particular colours; for pleasure and pain are to the particular affectionsas light is to particular colours. " -BACON, De Augment. Scient."Autant il y a d'espèce d'objets qui nous affectent, autant il fautreconnaître d'espèces de joie, de tristesse, et de désir; et en généralde toutes les passions qui sont composées de celles- là, comme la fluctuation, par exemple, ou qui en dérivent, comme l'amour, la haine,l'espérance, la crainte," &c. -SPINOZA, Des Passions.On6 (p. 157) .—" Mais il faut en outre remarquer ici qu'il n'est nullementsurprenant que la tristesse accompagne tous les actes qu'on a continuéd'appeler mauvais, et la joie tous ceux qu'on nomme bons.conçoit en effet par ce qui précède que tout cela dépend surtout del'éducation. Les parents, en blâmant certaines actions, et réprimandant souvent leurs enfants pour les avoir commises, et au contraireen louant et en conseillant d'autres actions, ont si bien fait que latristesse accompagne toujours celles-là et la joie toujours celles- ci.L'expérience confirme cette explication. La coutume et la religion nesont pas les mêmes pour tous les hommes: ce qui est sacré pour lesuns est profane pour les autres, et les choses honnêtes chez un peuplesont honteuses chez un autre peuple. Chacun se repent donc ou seglorifie d'une action suivant l'éducation qu'il a reçue. " -SPINOZA, DesPassions, p. 159.7 (p. 158). Many illustrations might be adduced from Shakspeare'splays of the wonderful harmony between the highest human feelingsand the aspects of nature; someof these I have pointed out in anVI.] THE EMOTIONS. 167essay on "Hamlet " in the Westminster Review of January 1865. Thebest known passage is that in the " Merchant of Venice: "-"Sit, Jessica. Look how the floor of heavenIs thick inlaid with patines of bright gold.There's not the smallest orb which thou behold'stBut 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 decayDoth grossly close it in, we cannot hear it. ”Again, Milton in his Arcades:"But else in deep of night, when drowsinessHath locked up mortal sense, then listen ITo 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 drawAfter the heavenly tune, which none can hearOf human mould with gross unpurged ear."Sir T. Browne, in his Religio Medici, says: " It is my temper, andI like it the better, to affect all harmony and sure there is music evenin the beauty and the silent note which Cupid strikes, far sweeter thanthe sound of an instrument: for there is music wherever there isharmony, order, or proportion; and thus far we may maintain themusic ofthe spheres; for these well- ordered motions, and regular paces,though they give no sound to the ear, yet to the understanding theystrike a note most full of harmony. . It is a hieroglyphical andshadowed lesson of the whole world, and creatures of God; such amelody to the ear, as the whole world, well understood, would affordthe understanding." Passages of like import might be quoted fromGoethe, Jean Paul, Humboldt, Emerson, Carlyle, and many other menof genius.....CHAPTER VII.VOLITION." Les hommes se trompent en ce point qu'ils pensent être libres. Or, en quoiconsiste une telle opinion? En cela seulement, qu'ils ont conscience de leursactions et ignorent les causes qui les déterminent . L'idée que les hommes sefont de leur liberté vient donc de ce qu'ils ne connaissent point la cause de leursactions, car dire qu'elles dépendent de la volonté, ce sont là des mots auxquels onn'attache aucune idée. Quelle est en effet la nature de la volonté, et commentmeut- elle le corps, c'est ce que tout le monde ignore, et ceux qui élèvent d'autresprétentions et parlent des siéges de l'âme et de ses demeures prêtent à rire oufont pitié. "-SPINOZA." En tout ce que je puis dire à ceux qui croient qu'ils peuvent parler, se taire, enun mot, agir en vertu d'une libre décision de l'âme, c'est qu'ils révent les yeuxouverts. "-Ibid.ITT is strange to see how some, who confidently base theirargument for the existence of a God on the ground thateverything in nature must have a cause, are content, in theirzeal for free-will, to speak of the will as if it were self- determined and had no cause. As thus vulgarly used, the term Willhas no definite meaning, and certainly is not applicable to anyconcrete reality in nature, where, in the matter of will, as inevery other matter, we perceive effect witnessing to cause, andvarying according as the cause varies.Previous considerations must have sufficiently proved thenecessity of modifying the notion commonly entertained of thewill as a single, undecomposable faculty of constant and uniformpower; for they have shown that under the category of voluntary.acts, as commonly made, are included very different kinds ofactions, proceeding from different nervous centres. A considerable proportion of the daily actions of life is confessedly due tothe automatic faculty of the spinal cord; the sensory centres areclearly the independent causes of other actions; while many ofthe remaining actions that would by most people be deemedCHAP. VII. ] VOLITION. 169volitional, are really respondent to an idea or emotion. Thisjust discrimination is, notwithstanding, entirely neglected bythose who take the metaphysical view of will; by them, asusual, an abstraction from the particular is converted into anentity, and thenceforth allowed to tyrannize in the mostdespotic manner over the understanding. The metaphysicalessence thus created has no other relation to a particular or concrete act of will, than, using Spinoza's illustration, stoneness to aparticular stone, inan to Peter or Paul.It is obviously, then, of importance, in the first place, to getrid of the notion of an ideal or abstract will unaffected byphysical conditions, as existing apart from a particular concreteact of will, which varies according to physical conditions. Whena definite act of will is the result of a certain reflection, it represents physically an available or a liberated force, consequent onthe communication of activity from one cell or group of cells toother cells or groups of cells within the cortical layers of thehemispheres. Any modification, therefore, of the condition ofthese centres may, and notably does, impede reflection, andaffect the resultant power of will -a power which, in reality, isseen to differ both in quantity and quality in different persons,and in the same person, according to the varying conditions ofthe nervous substratum. On the other hand, speaking psychologically, the definite will is the final issue of the process of reflection or deliberation which a man's life-culture has rendered himcapable 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 ideasof virtue do not enter, nor can any one will a bestial act of vice,whose appetites or desires have not been vitiated, and whosemind is not familiar with lewd ideas. The will appears, then,to be nothing but the desire, or aversion, sufficiently strong toproduce an action after reflection or deliberation-an action.that, as Hartley observes, is not automatic primarily orsecondarily. * (¹) Since, then, it is generated by the precedingAppetite, therefore, and aversion are simply so called as long as they follownot deliberation. But if deliberation have gone before, then the last act of it, ifit be appetite, is called will; if aversion, unwillingness. "-HOBBES." In a series of valuable articles On the Nature of Volition, in the Psycholo170 VOLITION. [CHAP.association, it must needs differ greatly in quality and quantity,according to the extent and character of the association, as thishas been established by cultivation, or is temporarily modifiedby bodily conditions. Every one can easily perceive this to betrue of the will of an idiot or a child, which is palpably a verydifferent matter from that of a well-cultivated adult; and hemust be very much blinded by metaphysical conceptions, whofails to recognise the infinite variations in the power of willwhich any given individual exhibits at different times or indifferent relations. When one of the higher senses is wantingin any one, he necessarily wants also the ideas, feelings, desires,and will, which arise out of the perceptions of this sense. Theblind man cannot know the variety and beauty of colouring innature, nor can he will in regard to those external relationswhich are revealed only through the sense of sight. Because,however, he knows not what he lacks, he does not consider hiswill inferior in quality, less complete, or less free. Were anadditional sense conferred upon any one, it would doubtlesssoon teach him how much might yet be added to the will, howlittle his boasted freedom is, and might, perhaps, make himwonder much that he should ever have thought himself free.When is it that man is most persuaded that he speaks or actswith full freedom of will? When he is drunk, or mad, or isdreaming. It may be a reflection, then, worth dwelling upon,that man thinks himself most free when he is most a slave; butat any moment, in whatever mood he be, he would affirm thathe is free. A person when under the influence of drink judgesvery differently from what he does in his sober senses, but ishe in his own estimation less free at the time? Passion notoriously perverts the judgment, warping it this way or that;but will any appeal to the man who is in a passion elicitgical Journal for 1863, Mr. Lockhart Clarke enters into an able analysis of the different forms of volition, and shows that in each case the process consists inthe co-operation of two of the psychical elements which together constitute ourpersonal integrity; namely the intellectual or regulative element, and theæsthetic or dynamic element, the latter being either a sensation, an appetite, or emotion. What are called " motives " to the " will " consist of our varioussensations, appetites, and emotions, when subjected to the judgment of theunderstanding in deliberation . The " will, " therefore, as a peculiar power, comesinto existence only at the time of acting, by the combination and co- operation of its constituent elements.VII.]VOLITION. 171from him a confession that he is not acting with perfectliberty? Place the very same arguments before a man when heis elated by some joyous, or depressed by some grievous event;when he is in the full flow of vigorous health, or when he isprostrate on the bed of sickness, or of death, and how differentwould be his judgment upon them: but whatever others maythink of him, he will hold for certain the conclusion of themoment, just as a man in his sleep is fully persuaded of thereality of his dreams. While the looker-on can often predicthow a madman will act under certain circ*mstances, with asmuch certainty as he can predict an event conformable to aknown law of nature, -who thinks himself so free as does themadman? Whence comes this false opinion? It arises plainlyfrom this that consciousness reveals the particular state ofmind of the moment, but does not reveal the long series of causeson which it depends. It is a deliberate fooling of one's self tosay that actions depend upon the will, and then not to ask uponwhat the will depends! It is as though, says Leibnitz, the needleshould take pleasure in moving towards the pole, not perceivingthe insensible motions of the magnetic matter on which itdepends. As in nature we pass from event to cause, and fromthis cause again to an antecedent one, and so on till we aredriven to a great first cause, so, in the sincere observation of themind, we see that it is determined to will this or that by a causeor motive, which again is determined by another, this again byanother, and so on till we have gone through the whole series ofdesires, aversions, hopes, and fears-the sum of which is deliberation that have preceded the last appetite or aversion, whichwe call an act of will. Those who fondly think they act withfree will, says Spinoza, dream with their eyes open.Now, if the final reaction after deliberation, which we callwill, is, like other modes of reaction of nerve element previouslydescribed, a resultant of a certain molecular change in a definitelyconstituted nervous centre, then all the design exhibited in anygiven act of will must, like the design displayed in the functionof the spinal cells, or the cells of the sensory centres, be a physical result of a particular and intimate constitution or organization of nervous matter. In other words, the act of will whichis the final expression of a process of reflection must needs172 VOLITION. [CHAP.contain a conception of the end desired-such a conception ashas been determined by the nature of the reflection; the coneeption of the result, or the design, in the act of will constituting,in fact, the essential character of the particular volition. Inorder that desire may become action for its gratification, a consciousness of the result of the action is necessary-that is, aconception of the aim of it. The desire, therefore, gives the specialimpulse which is directed or regulated by reflection, and the particular act of will is not the determining agent, but is the resultdetermined bythe impulse acting in conformity with the conception of the aim to be attained. The design, then, which a lookeron discovers in any act of will -and, be it remembered, there isno actual volition apart from the particular volition-will dependupon the nature of the individual whom he is observing, as thatnature has been inherited, and subsequently developed by theexperience of life. The idiocy of any one, or his congenitalinability to adapt himself to external relations by correspondencesof internal cerebral reaction, is a physical fact: there is no designin many of the idiot's conscious acts, because such quality orproperty has not been built up by cultivation as a faculty of thesupreme nervous centres, a congenital defect of constitutionhaving made such organization impossible; in other words, theidiot is, by defect of nature, incapacitated from acquiring reflection, and cannot, therefore, have in his mind the conception of aresult to be attained, cannot display conscious design. But thedesign manifest in any voluntary act of the best cultivated mindis likewise physical necessity: in consequence of reacting cerebraladaptations to the varieties of external impressions, reflectionhas, as already set forth, been organized as a development of thesupreme nervous centres, or, in other words, as a faculty of themind; and according to the extent and kind of the reflectionwill be the completeness of the conception of the end to beattained, or the degree of design discoverable in any act of will.The particular volition and whatever it contains, whether offolly or design, is a product of the organized residua of allformer like volitions, excited into activity by the appropriatestimulus. For volitions, like sensations and ideas, leave behindthem their residua which are organized in the nerve centres,and thus render future volitions of a like kind more easy.VII.]VOLITION. 173In this sense only are we warranted in speaking of abstractvolition.It has been necessary to lay stress upon this vague and troublesome question of design, because mistaken notions with regardto it appear to have been at the bottom of much error in philosophy. The design manifest in a mental act has been supposedto 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 undecomposable entity, in which was no variability nor the shadow of aturning, is greatly indebted for its origin to that error. Themischievous doctrine of final causes which Bacon, Comte, Spinoza,Descartes, and others scarcely less great, all agree to have doneso much harm in philosophy, has sprung from erroneous viewsof the nature of design. Supposing that the argument fromdesign as to the existence of will as a metaphysical entity werepressed to its logical consequences, what must be the result?Nothing less than this, that the animal, with its marvellousinstinct of instant adaptation to the most complex and unfamiliarconditions, is possessed of a higher immaterial principle than thehelpless child or the erring adult. We know right well, however,that the instinct of the animal is sometimes positively traceableto the acquired power of former generations; that it has beenobservably built up in the constitution of the nervous centres ,and transmitted to succeeding generations as an innate endowment. It is exactly the same with the design that is formedwithin the term of an individual life, and which ever testifies tothe previous cultivation of the individual; the more cultivatedthe mind and the more varied the experience, the better developed is the will and the stronger its co- ordinating power overthe thoughts, feelings, and actions, not otherwise, in truth, thanas the co-ordinate reflex action of the spinal cord is developedby experience and culture. Design, therefore, when its natureis fairly analysed, so far from tending to make the will a fixedmetaphysical entity, goes really to prove that the will is an insensibly organized result, of varying value, quantitative andqualitative.Having now adduced sufficient reasons to prove that the willis not a self-generating, self- sufficing force of constant quantity,174 [ CHAP.VOLITION.but, on the contrary, a force varying in quantity and quality,and, like every other natural force, determined by antecedentcauses, we may proceed to consider what power it actually hasin our mental and bodily life. It is manifestly ordained thatthe will, as the highest mode of energy of nerve element, shouldcontrol the inferior modes of energy by operating downwardsupon their subordinate centres: the anatomical disposition ofthe nervous system is in conformity with what psychologicalobservation teaches. But the undoubted fact, that the will of aman can and does control inferior functions has led to a veryextravagant and ill- founded notion as to its autocratic power;and it must be allowed that not a little windy nonsense hasbeen written concerning its authority. Assuredly it is no irresponsible despot in any mind, but is ever most obedient whereit has most power; it conquers by obeying. Let us, then, consider what the power of the will is ( 1) over the movements, and(2) over mental operations, the two departments in which itsrule is felt.1. (a) The will has no power whatever over certain movements that are essential to the continuance of life. Not only dosuch motions as those of the heart and the intestines go onwithout any co-operation of the will and in spite of any intervention on its part, but movements that are only microscopicallyvisible, such as to contractions of the small arteries, which areof so great importance in nutrition, are not under its directinfluence. Nature has been far too prudent to rely upon suchan uncertain and comparatively late appearing force for themovements essential to the continuance of life, or to admit itscapricious interference: let a man try to asphyxiate himself byvoluntarily restraining the respiratory movements, and he willlearn a lesson as to the impotency of will which he might usefully remember when studying mental phenomena. We saynothing here of those insensible molecular movements of thephysiological elements which, like thermal oscillations, are yetimpenetrable to sense, but which are undoubtedly at the foundation of all visible vital actions.(b) The will has no power to effect movements that are confessedly voluntary, until they have been very carefully acquiredby practice. Every one knows that the theory of a particularVII.] 175 VOLITION.skill of movement is a very different matter from the practice ofit, and that the complete capacity of accomplishing the act isgained, not simply by desiring and willing it, but by patientexercise and cultivation; the faculty of the movement is thusgradually organized in the proper nervous centre. Aspecial andcomplex act, never hitherto attempted, will be as little likely tobe carried out, in obedience to the commands of the so- called"autocrat ofthe mind," as a determination to fly. *(c) When the will does dictate a movement, it is the eventwhich is determined; it sets free, so to speak, the movementwhich has been organized in the motor nerve centre; there is nodirect volitional control over the means by which the result iseffected; so that it may even happen, and does sometimeshappen, that in a man struck with a palsy of his limbs, all unaware of its impotency, the will commands a result which nevertakes place. Questionless, in face of such an experience, somewould still not shrink from affirming that consciousness neverdeceives. When the will dictates a certain event, its power ispropagated, first through certain nerves, and then through themto certain muscles, in a manner of which we have no consciousness whatever all we do know is, that if we wish to select acertain muscle, and put it singly in action, we have not thepower to do so, and that, if certain movements have beenhabitually 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 ofthe will.2. The extent of voluntary power over the mental operationsis not nearly so great as is commonly assumed; much the samething happening here as in its influence over movements. Itwill not be difficult to understand how this should be so, if wereflect that the immediate action of the will, even when dictatingmovements, is not upon muscles, but upon the motor grey nuclei,or the nervous centres of movement; that in both cases, there66 "We know how slowly the child acquires the power of so balancing hisbody as to hold it erect. " . . . . We observe how slowly the child learns toperform, with the requisite precision, the contractions on which the operation ofwalking depends." "There is another very familiar instance, that oflearning to write. "-J. MILL, Analysis of the Human Mind, pp. 271–273.176 FOLITION [CHAP. .fore, the immediate operation is alike upon ganglionic cells,which are, in one case, the associated centres of ideas, in theother the associated centres of movements. (2)(a) As the formation of our ideas gradually takes placethrough experience, and as the association between ideas is alsoeffected in accordance with experience, both processes beingbased in the organic life and beyond the domain of consciousness,it is plain that the will does not determine either the material ofthought or the laws of the interworking of ideas: it must acceptas accomplished facts, as organized results, the ideas and themanner of their association. As with movements, so here, thewill has no control over the means by which it works; it cannotdissociate firmly established connexions, nor can it determine anew train of ideas without the first link of it being in thethoughts; and when the first link, however originated, is, so tospeak, grasped, the train of ideas initiated is not irregular andalterable at will, but definite, in stern accordance with an orderand system previously established by cultivation. * It is truethat as it is with the power of will over movements, so it iswith its power over mental states-it is a power which maybe greatly enlarged and increased by exercise and cultivation.While some persons seem quite incapable of regulating theassociation of their ideas, and can hold to no subject consecutively, others are distinguished by the mastery which they haveover the subject and course of their thoughts, by their powers ofdismissing what is frivolous or irrelevant, and of adhering singlyand steadily to the matter on which the mind is employed. Thewill, however, always presupposes definite and fixed series ofideas formed in the mind, series in which, without individualco-operation, one idea must definitely and of necessity followanother as one wave necessarily produces another as itself disappears. There is an order or a necessity in the mental organization of a sane person, then, reflecting the order or necessity in"Deliberation and investigation are like the hunting of a hound; he movesand sniffs about by his own activity, but the scent he finds is not laid, nor thetrail he follows drawn by himself. The mind only begins a train of thinking, orkeeps it in one particular track, but the thoughts introduce one another successively . . . . which shows they have a motion of their own independent ofthe mind, and which they do not derive from its action, nor will lay aside uponits command. "-TUCKER'S Light of Nature, vol. i. p. 14.VII.]VOLITION. 177the co-existence and succession of events in external nature;and the will can as little control the fundamental laws of theone as it can those of the other. Certainly it is not absolutelypowerless in the mind, any more than it is absolutely powerlessin nature; by recognition of the laws which govern mental development we can so arrange the conditions of their operationsas 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 development in the one case as in the other it conquers only by obeying.True liberty, as Milton expresses it, --' Always with right reason dwellsTwinn'd, and from her hath no dividual being. ”(b) Thus we come to a second consideration in regard to thepower of the will: it is that those who so unduly exalt itunwarrantably derive their arguments entirely from the selfconsciousness of a well-cultivated mind, and altogether neglectthe instances of its simplest manifestations. It is merely justiceto insist upon a reference to the earlier stages of developmentof cultivated mind, or to mind in its least cultivated state, asoffering the simplest and most favourable instances for theformation of a sound induction. Will any one be so bold as tomaintain that there exists in the young child or in the idiotvolitional control over the thoughts? Is any one so ignorant ofthe genesis of mind as to uphold the existence of true volitionin the earliest stages of mental development? The child notablylives in the present, and its actions are direct reactions to thefeelings and ideas that are excited in its mind.(c) But as the will cannot originate an idea or a train ofthought in the mind, so likewise it is unable sometimes todismiss one when desirous of doing so. A painful idea will, asevery one's experience must have taught him, return again andagain into consciousness notwithstanding every effort of the willto get rid of it, just as a movement may take place in spite ofthe will. The command which a man has over his thoughts isvery different at different times, and one person may be able todismiss a troublesome reflection when another cannot for thelife of him do so. We can give no exact reasons for thesevariations; the causes of them lie deeper than consciousness canN178 VOLITION. [CHAP.reach or will control. So far, then, from the will being autocratic,it is at the mercy of unknown conditions, which may seriouslyaffect at any moment its power or energy. Moreover, when anunwelcome idea is dismissed from the mind, it is not done by asimple despotic order of the will; but by fixing attention onsome other idea which arises-by maintaining the tension of it,the latter is made consciousness; and inasmuch as two ideascannot exist in consciousness at the same time, or at any ratecannot co-exist in equal intensity, that implies the dismissal of theformer idea into the background and the initiation of a new current of reflection —a current which, however, is not uncommonlyinterrupted by the irruption of the old idea, which refuses tobecome latent or dormant. Volitional control exercised over thethoughts manifestly presupposes the existence of many ideas inthe mind, and the possibility of some of these latent ones arisingto influence those that may be active. Denken machtfrei. Whatpower 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 psychologywhen he demonstrated that there were no innate ideas in themind, but that all its ideas were formed by observation andreflection. The necessary consequence of his demonstrationplainly is, what the foregoing considerations have shown, thatthere is no inborn will in the human mind. It would be a verydifficult matter to fix that period in the child's mental developmentwhen volition might be acknowledged to have distinctly manifested itself. Whence and when the first volition comes, wouldindeed be perplexing questions if the will were admitted to be aspecial faculty of the mind, distinct from other faculties, of constant quality, and never falling below a certain level of energy.Why is it that we are powerless to fix the time of the firstvolition? Because the will is not one and constant, but infinitelyvariable in quantity and quality, having many nervous centres,and not having any existence apart from the concrete act. Thereare in reality as many centres of volitional reaction in the brainas there are centres of idea; and to assume one constant will isa part of that metaphysical system of making abstractions intoentities by which also is made one understanding, one reason, andthe mind is mischievously parcelled out into faculties that haveVII.] VOLITION. 179no existence in nature. It is utterly at variance both with psychological analysis of the nature of will, and with physiologicalobservation of the constitution of the supreme nervous centres,to assume a single nervous centre from which will proceeds; ifwe must make a definite statement on so obscure a matter, it isthat 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 theidea is not instantly so expended, but persists in the mind for amoment, so as to produce a clearer consciousness of it beforepassing outwards, and especially if there is some feeling or desireattending it, then, when it does pass outwards, we commonlydescribe the effect as volitional. As consciousness may, however,exist in every degree of intensity, it is plain that we cannot definitely fix a stage at which ideational reaction may be supposed tobecome volitional, nor determine the nature of the change whichthen ensues. "The will and the intelligence are one and thesame 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 itsnervous centre; when the idea occurs again, there will be atendency to a similar reaction. Suppose, however, that theaction causes pain to the child, and thereupon a second idea isformed in its mind, the energy of which is opposed to that ofthe first. When the first idea appears again, it will, instead ofpassing outwards at once, excite into activity the second idea,which is inhibitory or preventive. That is the simplest caseof volition the child has voluntarily refrained from doingsomething, or voluntarily done something else; and the impulsethat has prompted the choice is not any abstract power, butsprings from that fundamental property of organic element bywhich what is agreeable is sought, what is painful is shunned.Bear in mind, when weighing volition, that there is oftenmore power demanded for preventing or inhibiting action thanfor producing it. As ideas multiply in the mind, and groups orseries of ideas are associated, of course the process becomesmore and more complicated; the residua of volitions, like theresidua of sensations or ideas, remain in the mind and renderfuture volitions of a like kind more easy and more definite;N 2180 VOLITION. [ CHAP.abstract or general volitions, as it were, are formed as the representatives of certain trains or groups of ideas, or as the expression of their due co-ordinate activity; and by their persistencein the mind, when not in consciousness, and their interactionthere, the character of our thought, feeling, and action ismodified in a way which we cannot comprehend. Every onemust have felt that an act, which was at first disagreeable anddemanded a painful effort of will, may become, in fact invariablydoes become, after several repetitions, much less disagreeable oreven an easy habit. Not only, however, does that particularact lose its painful qualities, but all acts of a like kind aremade 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 weare aided by the traces of past volitions, it is plain enough thatwe are so aided; conscious acquisition becomes unconsciouspower; and by an organic assimilation of some kind, even thewill becomes automatic in certain relations.Three conclusions are then to be distinctly established fromthe foregoing considerations: first, that the will is not an innateand constant faculty, but a gradual and varying organization;secondly, that wherever an afferent nerve passes to a cell orseries of cells in the cortical layers of the hemispheres, and anefferent nerve issues fromthe cell or series of cells, there is thepossible or actual centre of a particular volition; and thirdly,that volition or will, used in its general or abstract sense, doesnot denote any actual entity, but simply expresses the due coordinate activity of the supreme centres of mental force, nototherwise than as the co-ordinate activity of the spinal cord ormedulla oblongata might be said to represent its will-thefaculty in both cases being commonly an acquired one in man.When the animal acts in answer to some stimulus with directand definite purpose, or, as we are in the habit of saying, instinctively, it does so by virtue of an endowment of its nervecentres which is original in it; but in the formation of humanvolition we observe this power of intelligent action in gradualprocess of acquirement-we witness an illustration of design inthe making; and if we only go far enough back through generations, the acquisition by the animals may sometimes be traced.VII.] FOLITION. 181It would belie observation less to place an ideal entity behind.the innate instinctive impulse of the animal than behind thegradually fashioned will of man.To the fullest action of will in an individual two conditionsare obviously necessary: first, an unimpeded association ofideas whereby one conception may readily call up another, andcomplete deliberation ensue; and secondly, a strong personalityor character to give the decision between conflicting ideas anddesires. We shall say something of the second condition first.The strong or well-formed character which a well-fashionedwill implies, is the result of a good training applied to a wellconstituted original nature; and the character is not directlydetermined by the will, but in any particular act directly determines the will. The way in which the will does operate uponthe character, or affect the ego, is indirectly by determining thecirc*mstances which subsequently gradually modify it; we mayplace ourselves voluntarily in certain conditions of life, but allthe energy of the strongest will cannot then prevent somedegree of modification of character by them-cannot prevent anequilibration taking place. In any future act of will thealtered character, or acquired nature, is expressed; and whilewe, perhaps, all unaware of any change, strenuously upholdour constancy, a looker-on clearly perceives the difference.What we by a mental abstraction call the ego, is in reality acombination in which are contained the residua of all formerfeelings, thoughts, volitions, -a combination which is continuallychanging and becoming more and more complex. That itCommon language, Tucker observes, implies two wills or more, opposing,impeding, restraining, and mastering one another; when an inordinate passioninterferes with the prosecution of some design, we still regard it as a voluntaryresult, because sensible of the instigation. " But if we listen to the commondiscourses of mankind, we shall find them speaking of several wills, severalagents, in the same person, resisting, counteracting, overpowering, and controlling 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, subduingour passions, or being enslaved by them, of acting unwillingly or against thewill, and the like. All which takes rise from a metonyme of the cause for theeffect; for our actions being constantly determined either by the decisions of ourjudgment, or solicitations of our desires, we mistake them for the will itself; noris it a little confirmation of the will being actuated by motives, to find them sointimately connected therewith, that a common eye cannot distinguish themapart. "-Light of Nature, i. 547.182 VOLITION [ CHAP. .differs at different times of life, and in consequence of differentexternal relations, those who would most zealously uphold itsso-called identity do unconsciously admit when they acknowledge that, by religious influence or otherwise, any one maybe made " quite another man," may be " converted," or be"regenerate." The will of Saul of Tarsus was not the willof Paul the apostle to the Gentiles. When the ego is transformed in correspondence with changed external circ*mstances,the changes are so gradual as to be imperceptible at the time;but a rapid transformation of the ego may sometimes be effectedby a great event, internal or external,-as, for example, when,with the development of puberty, new ideas and impulsespenetrate the old circle of thought, and become constituentparts of it, producing no little subjective disturbance untilthe assimilation is completed and an equilibrium established.When a great and sudden revolution in the ego is producedby an external cause, it is most dangerous to the mentalstability of the individual, and very apt to become pathological:nothing is more dangerous to the equilibrium of a characterthan for any one to be placed in entirely changed external circ*mstances without his inner life having been gradually adaptedthereto; and madness, when its origin is fairly examined, alwaysmeans discord between the individual and his circ*mstances. Hewho has unexpectedly received a sudden, great exaltation in life,and is not made mad by his good fortune, cannot realize his newposition for some time, but gradually grows to it; he who, fromsome subjective cause, believes that he has received a greatexaltation in life, while external circ*mstances are not correspondent, is mad-the transformation of his ego being pathological. *

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Dr. Channing, in a sermon On the Evil of Sin, speaking of the absurdity ofthe notion that in changing worlds we shall change our character, says:—“ Inthe first place it contradicts all our experience of the nature and laws of themind. There is nothing more striking in the mind than the connexion of itssuccessive states. Our present knowledge, thoughts, feelings, characters, are theresult of former impressions, passions, and pursuits. We are this moment whatthe past has made us, and to suppose that at death the influences of our wholepast course are to cease on our minds, and that a character is to spring up altogether at war with what has preceded it, is to suppose the most important law orprinciple of the mind to be violated, is to destroy all analogy between the presentand future, and to substitute for experience the wildest dreams of fancy. Intruth, such a sudden revolution in the character as is here supposed is to destroyVII.]VOLITION.183The history of a man is the true revelation of his character;what he has done indicates what he has willed; what he haswilled marks what he has thought and felt, or the character ofhis deliberations; what he has thought and felt, has been theresult of his nature then existing as the developmental productof a certain original construction and a definite life experience.Objectively considered, the identity of the ego is neither morenor less than the identity of the full-grown oak with the firstslight shoot from the acorn: subjectively considered, the strongand sure conception which every one has of the ego, is notsurprising, inasmuch as it is the most frequently active idea,being concerned with more or less consciousness in every eventof his life, being that to which every action has fundamentalreference. The fashioning of the will is the fashioning of thecharacter; and this can only be done indirectly by fashioningthe circ*mstances which determine the manner of its formation.But, however formed, it is the character which determines whatthe judgment shall decide to be most eligible, the inclinationprompt as most desirable, and the will effect. If it were possible for any one to enter thoroughly into the inmost characterof another person, and to become exactly acquainted with themoving springs of his conduct in his particular relations of life,it would be possible not only to predict his line of action onevery 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 ofthe will an unimpeded association of ideas, so that the duematerials for the formation of a sound judgment may be available. But the ease, completeness, and character of such association depend, as already shown, on the condition of thenervous element, very slight disorders of which accordinglyquickly declare themselves in a deterioration of the will. Asthe secondary automatic faculties of the spinal centres soonsuffer from any disorder of nerve element, and reveal theirsuffering in the loss of co-ordinate power over the movements,so in the loss of co-ordinating power over the ideas and feelings,a man's identity. The individual thus transformed can hardly seem to himselfor to others the same being. It is equivalent to the creation of a new soul. ”184 VOLITION [CHAP..in their irregular and independent reactions, is revealed thedeterioration of the will. And as, when the disorder of thespinal centres is still greater, all co-ordination is lost and convulsions ensue; so in the supreme ganglionic cells of the hemispheres, when the disturbance is great, there is no co-ordinationof the thoughts and feelings, convulsive reactions of the cellstake place, and the individual is a raving lunatic, or a dangerous one dominated by a few persistent morbid ideas. Volition is, as it were, resolved into the inferior constituents out ofwhich it is in the due course of things compounded, as a rayof white light may be decomposed into several coloured rays;and in place of the definite, calm, co-ordinate activity of wellformed will, there is the aimless, irregular, explosive displayof inferior activity. It is obvious, however, that even in thesound mind the quantity and quality of the volition dependupon the fulness of the reflection , and that any hindrance tothe due association of ideas will pro tanto affect the will: ifthe particular volition were to be resolved by a retrogrademetamorphosis into its component elements, there would be anexplication or unfolding of all the ideas and desires which hadgone to form it; and going still further back in the analysis,there would be a revelation even of those particular relationsin life which have helped to determine the individual's definiteorganization of ideas, the character of his ego.It will be proper, before finishing with the consideration ofthe will, to say something of the relations of the emotions to it.Independently reacting, as an emotional idea tends to do, it sofar weakens the will; duly controlled and co-ordinated in reflection, as is the case after a just mental cultivation, it strengthensthe will. Before many ideas have been acquired, and theirmultitudinous associations fixed, as in the young child; orwhere the state of the development of the brain precludes intellectual development, as in the idiot and in the animal, -theemotions excited immediately expend their energy in outwardmanifestation; and when in the cultivated adult there exists,from some cause, an unstable condition of nerve element, orwhen 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 avii.] VOLITION. 185husband to have slain a man whom he had surprised in the actof adultery with his wife. But whosoever takes careful note ofhis own mental states may call to mind occasions on whichan emotion suddenly excited strongly prompted a particularaction, which he nevertheless withstood for an instant, andmight, if necessary, have restrained altogether; but perceiving,with quick intuition, that he might do well to manifest theemotion, he afterwards allowed the action to take place. Thelooker on, perhaps, sees only an impulse and rashness; and yetthe rashness was in some sort deliberate-an indiscretion whichserved the end when wiser plots might have failed. Emotionwas the real motive force, but an emotion acting under thedirection of reason, and, therefore, in accordance with prudentinsight into the external relations. The individual might havedone the same action in obedience to a calm resolution of thewill, and better so, perhaps, if he had been operating uponinanimate objects; but in dealing with men it may sometimesbe that a prudent exhibition of feeling much aids the success ofthe ends designed . Only let a man beware that, however heimpose 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 inall minds, and sure to do so in weak minds; but, duly subordinated and co- ordinated in reflection, it adds force to resolution.Restrained passion, acting under the calm control of reason, isverily a most potent force; it gives a white heat, as it were, tothe expression of thought, an intensity to the will.An emotional person certainly often produces great effects inthe world, and especially such effects as are destructive of someexisting system or belief; it is, indeed, commonly their greatself- feeling that gives to the reformers their abandonment,energy, and consequent success. But an evil often outweighingthese advantages is that there is no guarantee that they areright; for, necessarily one-sided, they see but a part of a truth.It is certain that a great principle has often suffered seriouslyfrom the hasty, violent, and ill- considered action of its sincereand earnest advocates: adverse events or circ*mstances, whichthey in their passion could not recognise, but which, as rationalbeings, it behoved them to have recognised, have swept them186 VOLITION [CHAP..away, and the truth which they have been upholding has beenfor a while the victim of their indiscretion. As in the mentalphenomena of the individual the power of reflection is oftenbest exhibited in the prevention of action prompted by feelingin an inhibitory function, so amongst men in the social statethe power of a good understanding is sometimes best shown bynot pressing an immature reform. But it is a very hard matterfor a reformer who feels strongly to perceive that what is theoretically desirable and right may also practically be undesirableand wrong under existing social conditions; he is apt to treatadverse circ*mstances as ifthey were accidents or anomaliesin nature, having no right of existence, and thus more or lesswilfully shuts his eyes to the force of events on which heproposes to operate, and which will, in any case, operate uponhis principle. He hurls a favourite principle, which may be avery 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 oppressedand seemingly extinguished by the opposition which it meetswith, then he is disheartened and complains, or is angry andrails: he is like the boy sending his paper boat on the lakethe waters of which are lashed by a storm. However, it is notnature which is wrong, if there be any wrong, but himself-thereformer. The fact that he did not succeed proves that he didnot deserve to succeed; he has not rightly estimated the character and weighed the force of circ*mstances which have beentoo strong for his truth, and by a simple law of nature have, fora time at least, quenched its light. A great advance can never besuperimposed upon a people miraculously; in order to be permanent it must be a natural evolution from pre-existing events-must grow out of them; and that which most effectuallydemolishes an old error is not a passionate attack upon it by theintensely feeling reformer, but a new and better creation , whichquietly undermines it so that it falls without trouble. Creation isa far higher order of work than destruction; it is the quiet, selfcontained activity of definite productive aim-in other words,of will in its highest development-as opposed to the explosiveand dissipated play of an inferior and mostly destructive emotional force. But as the calm intellectual contemplation ofvii. ] VOLITION. 187events, viewing all the relations of them, is attended with nogreat spur to any particular activity, but marks an equilibrationbetween the individual and his environment, it is easy to understand how excellent a thing to put the will in motion in a particular case is some feeling or desire of good to be attained orof ill to be shunned, in order to establish an equilibration. Thenthe will, enlightened by an adequate reflection upon all the cooperating conditions, is able to act with a calm, steady, intelligent and most potent energy.The difference, in quality and immediate energy, betweenthe will which is urged by strong desire and the will whichproceeds from a calm and full reflection, is strikingly evidentin the character of the work done by two kinds of reformers.Surveying the men who have exercised great effects on theprogress of mankind in this capacity, they appear broadlydivisible into two classes: the men of wide intellectual grasp,vast knowledge, and serene energy, and the men of limitedvision, intense feeling, and impetuous energy-the extensive ormany-sided, and the intensive or one-sided men. The former,taking a comprehensive survey of events, seeing in them thesimple operations of natural law, recognising the character andthe import of existing relations, and the true value of the present question, often exaggerated by its immediate urgency, havetheir feelings subordinated to their reason, and do not abandonthemselves to an unrestrained impetuosity. They may do greatwork, but they do it, not like lightning, rapidly and tumultuously,but like light, slowly, quietly, and silently; their work is constructive, not destructive; they are reformers of opinion ratherthan of practice; and the fertilizing influence of their thoughtis felt through many generations. The latter, on the other hand,are possessed with a conviction so tremulous with intense selffeeling that it seems the one important thing in the world, andthey are more or less blind to everything else; they put all theirenergy into explosive action, which, like lightning, is destructive;they are iconoclasts who beat down furiously the idols that areworshipped in order to set up another in their places; they arereformers of practice rather than of thought; and though theyeffect a great immediate practical result, they have little or nofertilizing influence upon the intellectual development of the188 VOLITION [CHAP..future. The earnest desire which inspires their energy springsfrom a basis of strong self- feeling.Without doubt the will is the highest force in Nature, thelast consummate blossom of all her marvellous efforts. Thenatural product of the highest and completest reflection , itrepresents the exquisitely and subtly adapted reaction of manto the best insight into the relations in which he moves. Hencethe vast power of the human will witnessed in the lives of thoseeminent men of practical genius who have exhibited its highestevolution. They were in harmony with the current of eventsamong which they lived; co- ordinating in themselves the forcesthat were at work around them, they accomplished what theworld had at heart in that age. Thus the force which they displayed was a force not their own; the power of the universe wasbehind them, and they became the organs of its manifestation.If we reflect upon the way in which the social and intellectualforces of an age are thus co-ordinated in the work of genius,and again upon the manner in which the actions of the differentnerve centres of the body are subordinated and co- ordinated inthe manifestation of will, -how there are, as it were, a gatheringtogether and a concentration of different forces into one definitemode of action, a unifying of their energies, —we may be able toform a conception, by help of what we can thus observe, of themode of that exaltation or transpeciation of force and matterthroughout nature which we cannot follow through its inmostprocesses.By the power of a well-fashioned will man reacts withintelligent success upon the external world, brings himself into acomplete harmony with its surroundings, assimilates and incorporates nature, and thus carries forward its organic evolution.The highest action of the will is therefore truly creative, forin it is initiated a new development of nature; it adumbratesthe possibilities of mankind, as a rudimentary organ in a lowerspecies of animal obscurely foretells the higher species in whichit will have full development. If we ask whence comes theimpulse that displays itself in this upward nisus, we can onlyanswer lamely that it comes from the same unfathomable sourceTranspeciation is a word used by Sir Thomas Browne which might be found useful at the present day.VII.] VOLITION. 189as the impulse that inspires or moves organic growth throughoutnature.NOTES.1 (p. 169). "Sixthly, the will appears to be nothing but a desire oraversion sufficiently strong to produce an action that is not automaticprimarily or secondarily. At least it appears to me that the substitution of these words for the word will may be justified by the commonuse of language. The will is, therefore, that desire or aversion whichis strongest for the present time. Since, therefore, all love and hatred,all desire and aversion, are factitious and generated by association, i.e.mechanically, it follows that the will is mechanical also . " -HARTLEY'STheory of the Human Mind, p. 205."Appetite, therefore, and aversion , are simply so called as long asthey 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 notwilling greater in man than in other living creatures. For wherethere 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 freefrom necessity is not to be found either in the will of men or ofbeasts. But if by liberty we understand the faculty or power, not ofwilling, but of doing what they will, then certainly that liberty is tobe allowed to both, and both may equally have it, whensoever it is tobe had. " -Hobbes, vol . i . p. 409 ."The whole sum of desires, aversions, hopes, and fears, continuedtill the thing be either done or thought impossible, is that we callDeliberation." -Leviathan, vii.2 (p. 176) .—I extract the following remarks of Hume:-1. " But do we pretend to be acquainted with the nature of thehuman soul, and the nature of the idea, or the aptitude of one to produce the other? . . . . We only feel the event, namely, the existenceof an idea, consequent to a command of the will. But the manner inwhich 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 itscommand over the body; and these limits are not known by reason.Will any one pretend to assign the ultimate reason of theseboundaries, or show why the power is deficient in one case, not inanother?"190 VOLITION. [CHAP. VII.3. " Self-command is very different at different times. . . . . Can wegive any reason for these variations, except experience? Is there nothere, either in a spiritual or material substance, or both, some secretmechanism or structure of parts, upon which the effect depends, andwhich, being entirely unknown to us, renders the power or energy ofthe will equally unknown and incomprehensible? "4. "The motion of our body follows upon the command of ourwill. Of this we are every moment conscious. But the means bywhich this is effected, the energy by which the will performs soextraordinary an operation; of this we are so far from being immediately conscious, that it must for ever escape our most diligentinquiry."After explaining that volition does not act directly on a limb itself,but through certain muscles and nerves, through which the motion issuccessively propagated, he asks-"Can there be a more certain proofthat the power by which this whole operation is performed, so farfrom being directly and fully known by an inward sentiment or consciousness, is to the last degree mysterious and unintelligible. Herethe mind wills a certain event; immediately another event unknownto ourselves, and totally different from the intended, is produced.This event produces another equally unknown; till , at last, through along succession, the desired event is produced."-Inquiry concerningthe Human Understanding.CHAPTER VIII.MOTOR NERVOUS CENTRES OR MOTORIUM COMMUNE, ANDACTUATION OR EFFECTION.THUS HUS far we have been engaged in considering the formationof the so-called mental faculties by the organization ofresidua, as this takes place in the production of simple or presentative ideas out of sensory impressions, that is, in apprehension; in the production of representative ideas or conceptions byabstraction from the simple ideas, —that is, in comprehension;and in the production of volition as the result of the complexinterworking of desires and conceptions. But it is not man'sfunction in life merely to think; his inner life he must expressor utter in action of some kind. Consequently there are otherresidua besides those already dealt with, which enter as constituents into his mental life-the residua, namely, that are leftbehind by movements or actions. The movements that areinstigated or actuated by a particular nerve centre do, like theidea, leave behind them their residua, which, after severalrepetitions, become so completely organized into the nature ofthe nerve centre that the movements may henceforth be autoInatic. There is then, intervening between the volitional impulseand 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 movements. If recourse be had to physiology, it is found that,conformably with what psychological analysis teaches, there arenumerous special motorial nervous centres, or nuclei of ganglioniccells, cerebral and spinal, from which motor nerves proceed ,and by the experimental irritation of which movements may192 MOTOR NERVOUS CENTRES, [CHAP.be artificially excited . The term which we have taken leave touse for the purpose of designating psychologically the commoncentres of movement is the motorium commune.This region of motor residua, or, if we may venture so tocall it, this motorium commune, is related to conception on thereactive side of human life, as sensation is on the receptive side.As the residua of sensorial activity, as already seen, ministerand are necessary to a definite representative conception, sothe residua of motorial activity in their turn enter into conception, and are indispensable to its realization in action. It maynot be amiss, then, to take notice here, again, how the highestmental 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 qualityof it; and the motorial activity of the body is essential to itsdue effectuation. How mischievously unjust, then, is theabsolute barrier set up between mind and body! How misleading the parcelling out of the mind into separate facultiesthat answer to nothing in nature!What name may most properly be given to this neglected butimportant motorial region of our mental life? The motor residuathat mingle in our conceptions have been called , in Germany,motor intuitions (Bewegungs- anschauungen); but this description,though admirably expressing their intervention in conception, isperhaps too psychological to convey an adequate idea of theirphysiological importance as the immediate agents or faculties ofall movements. The motor intuition, furthermore, intervenesnot alone between conception and respondent action , but alsobetween sensation and the motor reaction thereto, and even between the stimulus and the resultant reflex action; so that theterm intuition is not altogether suitable, and may perhaps produce confusion. More appropriately might this region of motorresidua be described generically as the department of actuation;a department containing the powers or faculties through whichthe nervous centres, excited into activity, act upon the muscularsystem, and, by thus uttering or expressing their energies, restorethe equilibrium. It contains the means by which will, idea, orsensation actuates definite movements, or prevents their occurrence. To describe it as the locomotive faculty would bring usVIII. ] OR MOTORIUM COMMUNE. 193to the inconsistency of calling locomotive that the aim of whichis often inhibitory or preventive of motion, and would scarcelyinclude the organic reflex movements.However it be named, there can be no doubt that such aregion of mental activity exists, and that in it are contained,predetermined and co-ordinated , the faculties of different groupsand series of movements. It is easy to perceive, then, why thewill can only determine the result-cannot determine the actionof a particular muscle, or the combined actions of certainmuscles which have not acted together before. All it cando is to will the event, and thereupon the proper nerve- fibresand muscles are put in action through the medium of the motorintuition. If the result wished is a new, unfamiliar one, noresidua thereof from previous experiences existing in the motorcentres, 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 repeatedtrials, the desired skill is firmly acquired, and the movement ishenceforth automatic, the motor intuition having been graduallyorganized in the proper nervous centres: the result stored upstrictly corresponds with that which in other nervous centres wedescribe as abstract idea. Here again we are taught that thedesign manifest in any act of will is due to organic processessimilar to those which build up the design in the nervecentres of sensori-motor action and of reflex action; it is onlybecause of its being attended with consciousness that we describethe energy of one of these definitely organized residua in thehighest centre as a conception or notion of the result-speakingpsychologically rather than physiologically. But even here consciousness disappears when the organization is complete.In the animals the motor intuitions, like their other faculties,are mostly innate. There are no distinct, clear conceptionsaccompanying their instinctive actions; but obscure sensationsand feelings excite the motor intuitions, which then determinethe 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 aremostly acquired; in this regard corresponding with the formation of his other mental faculties. Our ideas of distance, size,194 MOTOR NERVOUS CENTRES, [CHAP.and solidity furnish striking examples of the manner in whichwe are indebted to our muscular intuitions, and of the differencein respect of them between us and the animals. The youngswallow's intuition of distance appears to be as perfect when itbegins to fly as it is after a life-experience; but it is not so withthe young child, which cannot for some time tell how far off orhow near an object is. In the first instance, the child's bodymoves with the eyes, when these are fixed upon a light that ismoved about. After a few weeks the moving light is followedby a motion of the head only; next the eye-ball itself isturned also; and ultimately objects are followed with the eyewithout any motion of the head. As this is going on, there isacquired gradually a recognition of the distance of an object,and the convergence of the axes of the eyes is seen to changeregularly and quickly with the distance of the object. Now itis well known that the accommodation of the eyes to distancetakes place through a convergence of their axes and an accommodation of their lenses, two actions which are from the firstvery firmly associated; so much so that a congenital defect inthe lens is now recognised to be the frequent cause of squintingin children. But these accommodating movements are notdetermined by any act of will, nor are they within consciousness; they are consensual movements in respondence to thevisual sensation, and strictly comparable with the instinctivemovements of the animals. It is not the visual sensation directlywhich gives us the idea or intuition of distance, but the motorintuition of the accommodating movement which, though uncertain and confused at first in man, soon gets precision anddistinctness. In this example we have a type of that whichhappens, with greater or less rapidity, in the case of every movement in the body. The infant at first kicks out its leg-whetherfrom a so-called spontaneous outburst of energy, or by reason ofsome organic or external stimulus, matters not-and bringing itin contact with some external object, gets thereby a sensation,in respondence to which, as in the consensual accommodation ofthe eyes, adaptations of movements take place, and muscularintuitions 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 muscularVIII.]OR MOTORIUM COMMUNE.195intuitions, are henceforth essential constituents of our mentallife, whether we are distinctly conscious of them or not. Consider, if further illustration be needed, the gradual acquisition ofthe complex movements of speech, and the intimate connexionwhich they have with the formation of our conceptions. Aweak-minded person, or a person of low cultivation, often cannotcontent himself with the mental representation of a word, orclearly comprehend a question put to him, without bringing theactual movement to his assistance; he must utter the word orrepeat the question aloud, in order to get his conception distinctly; the essential importance of the articulating movementsto conception is furthermore attested by the frequent deficiencyof them in idiots. It is most necessary, however, to guard againstthe strong disposition which there is to look upon certainmovements, those of the eye and the tongue, as having a specialconnexion with the mental life which other movements of thebody have not; they have a specially intimate connexion, butnot a special kind of connexion. Unwarrantably separating byan absolute barrier the mind from the body, and then locating itin a particular corner of the latter, as is commonly done, we areprone to forget that in mental action the whole bodily life iscomprehended-that every muscular intuition, therefore, has itsdue place and influence in our mental life.Another consideration which it is necessary to bear well inmind is, that there is no fundamental difference in organicnature between those motor intuitions that are original, or primarily automatic, and those which are acquired in the naturalorder of development, or are secondarily automatic. Betweenthe stimulus and the definite reflex action, whether innate oracquired, between the sensation and its assemblage or successionof muscular movements, the definite motor intuitions interveneas necessarily as between the conscious conception and theanswering movement; though in the latter case only have we theconsciousness of effort or motive energy. That the former maytake place without consciousness, proves that the motor residuahave been definitely and adequately organized in the proper motorcentres; so that so far from design implying consciousness, asmetaphysical psychologists have thought, consciousness altogethervanishes when the design is firmly fixed in the nature of the0 2196 MOTOR NERVOUS CENTRES, [CHAP.nervous element. Consider only the manifold co-existent andsuccessive movements of the many muscles of the tongue, thepalate, the pharynx, and the jaws, in mastication and deglutition-complex movements which the will could never effect, of whichwe have little or no consciousness, and before which humaningenuity is mute-and it will be abundantly evident how muchwe depend in our active life upon the region of motor intuitions.But it should not be overlooked, it should indeed be prominentlyheld in remembrance, that these external motor manifestationsonly represent what is contained internally in the appropriatenervous centres; that what is outwardly displayed exists in theinnermost; that every motor intuition is, consciously or unconsciously, an essential part of the mental life.The foregoing observations are greatly strengthened by certainmorbid phenomena, in which a variation of the circ*mstancesfurnishes an excellent test of the principles enunciated. Inthat condition which Mr. Braid called " hypnotism," it has beenpointed out already that if the face or limbs of the patients areplaced in an attitude which is the normal expression of a certainemotion, thereupon that emotion is actually excited; the motorintuition immediately awakening the appropriate conception.This is in accordance with what we frequently observe in watching the genesis of mind in young children, where it is plainthat an attitude or gesture, unconsciously or involuntarily produced, sometimes awakens in the mind the correlative idea oremotion, and where, on the other hand, every thought is immediately translated into some movement. *The condition of disease known as aphasia, which has beenso much studied during the last few years, is especially interestingin its bearing on the doctrine of motor intuitions. A personloses the power of expressing his thoughts by articulate language;and although in the majority of cases in which this happensthere is hemiplegia of one side, generally of the right, theremay be no paralysis at all. Moreover, in those cases in whichthere is hemiplegia there is not any paralysis of the muscles ofVulpian (op. cit. p. 290) formularizes the general physiological law, thatevery excitation of a nerve, at any point in its length, is transmitted immediatelyand simultaneously both in a centripetal and centrifugal direction.VIII. ] OR MOTORIUM COMMUNE. 197articulation; the loss of speech is not due to any defect in theactual instruments of utterance, nor is the loss of power ofintelligent expression by speech owing in all cases, or entirely inany case, to the loss of intelligence, though it is certainly truethat there is in many cases of hemiplegia some degree of mentalfailure some degree of enfeebled intelligence and of emotionalexcitability. Intelligence, however, often fails or is lost withoutloss of the power of speech; and there are said to be met withoccasional instances of the latter defect without any appreciableloss of intelligence-instances in which the patient is able tocommunicate his thoughts by gesture-language, or by writing.It is important to bear in mind, in regard to this question, thatlanguage consists essentially in the establishment of a definiterelation between the idea and the sign by which it is outwardlymanifested; that it may be verbal, vocal, graphic, or mimic;and that the general faculty of language includes all thesemodes of expressing the thoughts. The persistence of theseother modes of expression, where the faculty of speech is lost,proves that, notwithstanding the intelligence is most probablydecidedly weakened in all cases of aphasia, it is certainly notweakened to such an extent that the loss of speech can be dueto the abolition of ideas. When, however, an aphasic personcannot succeed in learning some language of signs so as to beable to make himself understood, it can hardly admit of doubtthat he has either no ideas to express, or at any rate not sufficient intelligence to learn a language which it is not difficult forany 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 residuaof speech, whereby the necessary motor intuitions fail, and thepatient cannot for the life of him bring to mind the words whichhe wants to use, and perhaps uses, wittingly or unwittingly,wrong words? The essential connexion and interaction betweenthe sign and the thought signified, between the centres of themotor residua of speech and the centres of ideation, is cut off,either by some interruption of the function of their internuntiantfibres or by injury to the functions of the motor centres themselves; whence it is easily conceivable that a loss of power ofthe ideas to play upon their appropriate signs will be occasioned198 MOTOR NERVOUS CENTRES [CHAP.,—an inability to utter by speech the thoughts, a loss of memoryof the appropriate words. The failure is not strictly mental, noris it strictly motor, but lies in that intermediate region betweenmind and movement which is essential to the due performanceof both motor and mental functions; without which, indeed,thought cannot attain to expression-cannot attain to knowledge of itself-movement cannot accomplish definite purpose."Herein lies the necessity of utterance, the representation ofthought," says Heyse. Thought is not even present to thethinker, till he has set it forth , out of himself. Man, as anindividual endowed with sense and mind, first attains tothought, 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 ofhimself, his thinking ' I.' He comes first to himself in utteringhimself."Having regard, then, to the important, indeed the essential, partwhich the motor intuitions play in the mental life, it is impossibleto conceive the loss of them taking place without secondary injuryto the ideational functions-to the intelligence; these may notbe primarily affected by the disease, but they cannot fail to suffersecondarily. Even though the patient may not be himself awareof any mental failure, and may feel convinced that it is only thewords to express his ideas that he lacks, yet it is not unlikelythat his condition resembles somewhat that of a person in adream, who fancies that he is thinking most logically, anddiscoursing most eloquently,, when his thoughts are confusedand his words incoherent. The history of cases of aphasiaprove that this is certainly so sometimes. It is easy to comprehend the disputes which arise among onlookers who endeavourto test the intelligence in these cases: when the regular channelby which intelligence expresses itself is closed, it must obviouslybe 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: ademented person whose mental faculties were almost abolished,might answer sensibly when he was asked what he would do ifthe room were on fire; and many patients in lunatic asylumswhose intelligence is in a very shattered state, are able to playVIII.]OR 199 MOTORIUM COMMUNE.cards and draughts skilfully. It is certainly quite possible foran aphasic patient to make intelligent responses to simple questions and obvious suggestions when he has lost all power ofsustained and definite thought. And, apart from all theoreticalconsiderations, the evidence which exists at present is in favourof the opinion that the intelligence is decidedly weakened inaphasia.There is one observation more to make before passing fromthis subject. Some writers are in the habit of affirming that itis in names we think, and that they are the indispensableinstruments of thought. " I therefore declare my conviction ,"says Max Müller, " whether right or wrong, as explicitly aspossible, that thought in one sense of the word, i.e. in reasoning,is impossible without language." This sounds too absolute astatement 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 withoutbeing able to speak; the instances of aphasic patients who canexpress their ideas in writing point in the same direction; butneither these instances, nor the case of Laura Bridgman, can beused to prove that it is possible to think without any means ofphysical expression. Onthe contrary, the evidence is all the otherway. Laura Bridgman's fingers worked, making the initial movements for letters of the finger- alphabet, not only during herwakingthoughts, but in her dreams. If we substitute for "names""the motor intuitions," or take care to comprise in language allthe modes of expressing thoughts, whether verbal, vocal, writingor gesture-language, then it is unquestionable that thought isimpossible without language. In man the tongue has beenalmost exclusively appropriated for the expression of thought,but there is no absolute reason why his fingers, hands, and armsmight not be used, like the antennæ of ants, to express all theresults of mental action. The reasons why the tongue has beenspecially selected for this purpose are obvious: first, because ofits connexion with the vocal organs, whereby its movements, inconjunction with those of the lips, modify in a great variety ofways the different sounds, and thus make audible language,which is plainly on the whole more useful to man than visiblelanguage; secondly, because of the great variety and complexity200 MOTOR NERVOUS CENTRES, [CHAP.of movements of which the numerous muscles of the tongue arecapable in so small a space; and, thirdly, because the movementsof the hands are required for other purposes, while it is difficultto perceive what other purpose the wonderful variety of thetongue's movements could have served, when it was not engagedin the taking and mastication of food.The influence of the motor department of mental action, theregion of actuation, might receive further illustration from thephenomena of insanity and of certain convulsive diseases. Itscarcely admits of question that some of the delusions of theinsane have their origin in what may justly be called muscularhallucinations: a disorder of the nervous centres of the muscularintuitions generates in consciousness a false conception, or delusion, as to the condition of the muscles, so that an individuallying in his bed believes himself to be flying through the air,or imagines his legs, arms, or head, to be separated from hisbody, just as he has hallucinations of sense when the sensorialcentres are disordered. * In dreams we may sometimes observe the same kind of thing, as when from hindered respiratorymovements a person suddenly wakes up with the idea that he isfalling over a precipice. Illusory movements, or illusory positions, are the characteristic traits of vertigo; other subjectivesensations, such as noises in the ears, flashes before the eyes,and painful sensations in the head, accompanying them. Indreams, and also in drunkenness, there is no power of correctingthese subjective muscular experiences; and the brain or mind,rendering them conscious, converts them into false conceptionsof space. Such muscular illusions, or hallucinations, can ofcourse only ensue when the reaction of the disordered motorintuition is into consciousness; if, as may happen, and commonlydoes happen, the reaction takes place outwards, there areirregular or convulsive movements, but no delusion is generated.In fact, when the motorium commune is disordered, its morbid" I had some years since, " Dr. Whytt writes, " a patient affected with anerysipelas 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 imaginationbegan to be greatly disturbed. He thought himself carried swiftly through theair to distant regions; and sometimes imagined his head, arms, and legs, to beseparated 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. 201function may be displayed in irregular or convulsive muscularaction, and, if the deterioration proceed far enough, in paralysis;or it may react upon the mental life, and give rise to disorder ofintelligence.The phenomena of convulsions, properly examined, will serveto illustrate the existence and to exhibit the independent natureof the motor intuitions. Every kind of movement which may benormally excited by the will may occur as a convulsive act,when, of course, there is no question of the exercise of will, andwhen there is often an entire absence of consciousness. As theindividual in sound health must give intense attention in orderto isolate a certain muscular movement, which usually takesplace as a part of a complex series, and then cannot alwayssucceed, it is not surprising that there should often be more orless co-ordination of movements in spasmodic or convulsivemuscular action, the design in the centres of motor intuition notbeing entirely abolished. In cases of cerebral hæmorrhage, itsometimes happens that the articulating movements of singlesounds, or of a certain series of sounds, syllables, or words, areproduced without any mental act, or even against the will ofthe patient. Romberg relates a remarkable case of what he callsrotatory spasin in a girl ten years of age, and another case ofco-ordinated spasm in combination with chorea, which occurredin a boy aged six, who was occasionally attacked with an irresistible desire to climb in spite of every impediment; in theintervals he was affected with chorea. Consciousness is notalways entirely abolished; and then patients are able to give anaccount of the impulse which instigates the movements, andwhich they are unable successfully to resist. It is well knownthat the idea of convulsions, whether excited by present perception or by memory, may express itself in convulsive movements-movements which, nevertheless, often display a considerableamount of co-ordination. It is evident enough how, in a healthyperson, swallowing, coughing, and yawning are excited by theobservation of these acts in another; and as instances of similarly produced morbid actions, Romberg adduces those dancingepidemics of the Middle Ages, in which co-ordinate spasmodicmovements were notoriously excited in delicate women to anextent and for a period such as the strongest man could not202 MOTOR NERVOUS CENTRES, [CHAP.have endured in health. It behoves us to keep in mind that asso many of our co-ordinate actions are automatically done inhealth, so there may be considerable co- ordinate automaticaction in disease.There yet remain further important considerations. Let aman have the will to command or effect a certain movement,and a notion of the result desired, without any paralysis ofmotor power, and he may still be impotent to perform the movement. And why? Because there may be a paralysis of sensibility in the muscles, by reason of which he has no means ofknowing what is the condition of the muscles of the part, theinstruments which he has to use-cannot tell whether they areacting or not; he lacks that information which the muscularsense should rightly afford him. In order that the will mayactuate a movement, there are necessary, then, not only a conception of the end desired and a motor intuition of the muscularmovements subserving that end, but also a sense of the action ofthe muscles. Any psychological arguments as to the value ofthis guiding muscular feeling are rendered needless by pathological experience, which plainly proves that, when the muscularsense is paralysed, the movements cannot be performed exceptsome other sense come to the rescue. The sense of sight usuallydoes this a woman whom Sir Charles Bell saw, who had lostthe muscular sense in her arm, could nevertheless hold her childwhen she kept her eyes upon it; but the moment she turnedher eyes away she dropped the child. I have seen a similarinstance recently of a woman, epileptic in consequence ofsyphilis, who had lost the muscular sense in her left arm, andwho did not know, except she looked at the limb, whether shehad got hold of anything with her hand or not; if she graspeda 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 oftactile sensation. In such morbid states the difference betweentactile sensation and the muscular sense is well marked. “ Ollivier details a case in which the patient had lost the cutaneoussense of touch throughout the side in consequence of concussion; at the same time he was able to form a correct estimateof the weight of bodies with his right hand. The physicianobserved by Marcet, who was affected with anaesthesia cutaneaVIII.] OR MOTORIUM COMMUNE. 203of the right side, was perfectly able to feel his patient's pulsewith the fingers of the right hand and to determine its frequencyand force, but in order to determine the temperature of the skinhe was obliged to call in the aid of his left hand. " Anæsthesiaof the muscle, without loss of tactile power, does, according toRomberg, 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, orthey are in the dark, is extreme; if told to shut their eyes whilein the erect posture, they begin to oscillate until they fall down,unless supported. The skin remains sensitive except during thelast stage of the disease.Romberg, duch*enne, and others have, moreover, describedsimilar morbid conditions in anæmic and hysterical women,which can hardly be called paralysis, as they are manifest onlyin the night or when the eyes are shut: the patients can performmovements, but these do not answer accurately to the will;they are deceived as to the amount of force necessary to be putforth, and sometimes cannot undertake the movement of a limbwithout the help of sight. In these cases there is the desire toeffect a certain action, there is the motor intuition of the movement necessary to the end desired, but there is wanting theguiding sensation of the muscular sense; and accordingly theaction cannot be done unless the sense of sight takes upon itthe 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 psychologicalor from a physiological basis. The relation appears to be notunlike that which the sensation of a special sense has to thecorresponding idea: as the sensation of the special sense isnecessary 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 ofco-ordination of the muscles, and the morbid appearances are those ofdegenerationof the posterior columns of the spinal cord-the motor repository or centres ofco-ordination of the movements of the limbs. Hence the disease is now moreproperly called Progressive Locomotor Ataxy. Loss of muscular feeling is asymptom that may occur in different diseases; if another sense takes its place,movements are still effected; so that the power of movement, the repository ofmotor residua, is not affected.204 MOTOR NERVOUS CENTRES, [CHAP.necessary to its existence or function, so the muscular feelingwould seem to be an essential prerequisite to the formation.of the motor intuition, but, once formed, not necessary to itslatent existence, or indeed to its active function , provided onlyanother sense furnish the guiding information. Like other senses,the muscular sense is receptive; it ministers to the building upof the fundamental ideas of solidity, size, figure, and distance,through the impressions which it receives from without andconveys inwards, and the subsequent internal adaptations whichtake place; and in the outward intelligent reaction of theindividual upon external nature, by virtue of these ideas, itfurnishes the guiding feeling by which he is enabled to directthe action and to regulate the amount of force applied in anygiven case. How admirably graduated is the application of forceby the skilful hand in delicate handicraft operations! Howclumsy and incapable is the beginner in such crafts until, by frequent practice, the requisite motor intuitions have been acquired!Consider how awkward any one is at so simple a matter aswinding up a watch even for the first time; and how quick,easy, and certain the operation afterwards becomes. Observations made upon persons born blind prove that there is nothingessential to the highest intellectual processes that may not beacquired in the absence of sight, mainly through the muscularfeeling in combination with touch.Because the muscular feelings gradually build up the motorintuitions in accordance with the order, synchronous or succesive, of our experience, it is not difficult to deceive them bya new experience modifying or reversing that order. It is wellknown that, if the middle finger be crossed over the fore-finger,and a pea or a like round body be put between them, whilethe eyes are turned away, there will be the sensations of twobodies; the impression on that side of the fore-finger which ishabitually associated in action with the thumb excites independently its residua, and that side of the middle finger which is accustomed to act with the third finger excites also its residua; andthe consequence is a feeling of two bodies which it requires theevidence of another sense to correct. So closely and definitely,however, are our different senses associated in their functions, thatthey may, instead of aiding and correcting one another, as is theirvill.] OR MOTORIUM COMMUNE. 205proper function, sometimes actually help to deceive one another.When the metal potassium was first shown to an eminentphilosopher, he exclaimed, on taking it into his hand, “ Bless me,how heavy it is! " and yet potassium is so light as to float onwater. The metallic appearance had suggested a certain resistance, or the putting forth of so much muscular energy asprevious experience of substances having a similar look hadproved necessary;, and for a moment the suggestion of thevisual sense overswayed the actual experience of the muscularsense the latter was deceived as the man is who concludesthat a certain co- existence or succession in nature must alwaysexist because he has observed it in a great many instances; oras, at the disinterment of a body suspected to have beenmurdered, one of the spectators who fainted on account of thebad smell was deceived; for, when the coffin was opened, it wasfound to be empty.The perfect function of the muscular sense is not only ofessential importance to the expression of our active life, but, likethe function of any one of the special senses, it has its due partin our mental life. In the general paralysis of the insane thereare two prominent characteristics: the first is the general paralysis in greater or less degree of the muscles of the body; andthe second is the extraordinary delusions of grandeur. It is aquestion well worth consideration, whether these characteristicsymptoms do not stand in some degree of causal connexion toone another. A tailor who is suffering from general paralysiswill readily promise to make a magnificent waistcoat, and, if thematerials are supplied to him, will at once set to work. It isnot improbable that, deceived by his quiet assurance, and knowing that to sew is his business, one may believe that he can makethe waistcoat. But, in a little while, it will be found that hisstitches are most unequal in size, and are placed in the mostdisorderly way; and it is made clear that, whatever he himselfmay think, he certainly cannot sew. He has a sufficient desireto accomplish the result, an adequate general notion of the enddesired, a full belief in his ability to effect it; but he failsbecause his muscular feeling is very deficient, and because hecannot regulate the action of the necessary muscles. That isnot all, however: as the sleeper, whose external senses are so206 [CHAP. MOTOR NERVOUS CENTRES,closed as to shut out the controlling influence of external objects,often does in his dreams the most wonderful things, and findslittle or no hindrance to an almost miraculous activity, intellectual or bodily; so the general paralytic, whose defectivemuscular feeling cuts him off from the due appreciation ofexternal relations, has engendered in his mind the most extravagant notions as to his personal power; he dreams with his eyesopen. * As we owe to the muscular sense the development ofour fundamental ideas of resistance, form, size, and space, itwill easily be understood that, when this sense is deficientthroughout the body, as in the general paralytic, there cannot be that intelligent accord between the inner life andthe outward relations which, when in a perfect state, it maintains. Here, again, we perceive how impossible it is to separatethe mental from the bodily life; how plainly, when we scan thedeeper relations of things in their genesis, there are displayedthe closest connexion and continuity of parts and functions.To the action of the will, as already pointed out, a conceptionof the result is essential, whether the volitional exertion be forthe purpose of causing a movement, of preventing or checking amovement, or of dismissing a painful idea from the mind. When.a sensation excites a co- ordinate movement in so- called sensorimotor action, we do not say there is a conception of the result,because of the absence of consciousness; but at the same timewe must admit that there is a motor intuition of the result,-inother words, that there is a definitely organized residuum in theproper motor nervous centre which, as it were, implicitly contains the movement. Now it is important to bear in mind that,when the will excites that co- ordinate movement which a sensation alone may do, as not unfrequently happens, it cannotoperate directly on the motor nerves, but must necessarilyoperate through the medium of the same motor intuition asthat through which the sensation acts in other words, theAt the present time I have under my care a general paralytic who, occasionally much excited, then believes that he is fighting great battles, and winninggreat victories with his fists; he believes, too, that he wins immense sums ofmoney as wagers on his prowess. The disorder of his motorium commune entersinto his thoughts and engenders corresponding delusions. He is confined to hisbed or couch by reason of having lost one leg, or he would be a violent anddangerous lunatic.VIII.]OR MOTORIUM COMMUNE. 207movement in both cases proceeds directly from the motor nervous centre in which the movement is latent. If we couldexcite these centres artificially, not over-exciting and injuringthem, as in our gross experiments we necessarily do, then weshould not fail to set free the definite movements. Speakingpsychologically, the conception of the result becomes in theexecution of voluntary movements the motor intuition, and themotor intuition excited into activity expresses itself in thedesigned movement. Thus, then, it appears that, as in the actionof nature upon man, the stimulus which is not reflected inthe spinal cord passes upwards and excites sensation, and thestimulus which is not reflected in sensori -motor action passesupwards and becomes idea, and the stimulus which is notreflected in ideomotor action passes from cell to cell in thehemispheres and excites reflection; so in the reaction of manupon nature, the force of the will passes downwards through thesubordinate centres in an opposite direction: the will involvesa conception of the result or a definite ideational action; theconception of the result demands for its further transformation 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 functionof the muscular feeling, and the integrity of the motor nervesand muscles. There is an orderly subordination of the differentnervous centres, a chain of means such as is revealed in everydepartment of nature. Viewing the different sciences, we perceive that chemistry is dependent on physics, while physicsare independent of chemistry; physiology is dependent on chemistry, while chemistry is independent of physiology; socialscience is dependent on physiology, while physiology is independent of social science and so the just analysis of our mental lifeproves that sensori-motor action is dependent on reflex action,while reflex action is independent of sensori-motor action; ideomotor action dependent on sensori- motor action, while sensorimotor action is independent of ideomotor action; the willdependent on ideomotor action, while ideomotor action is independent of the will. These different epochs in the order ofdevelopment of the nervous system are represented by differentclasses of the lower animals and it is interesting to note that,208 MOTOR NERVOUS CENTRES [CHAP. VIII. .as in man there is a subordination of parts, and the will, as thehighest energy, controls the inferior modes of nervous energy,so in the animal kingdom there is a subordination of kinds, andthe mind of man, as the highest development, controls and usesthe 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 regionof mental activity in which dwell the motor residua, and whichmay properly be named the region of actuation . We have onlyto add that men differ much naturally as to the perfection ofthis as of other mental faculties. There are some who, withgreat intellectual power, never can attain to the ability of successfully expressing themselves: and there are others, on theother hand, who can pour forth endless talk with the most facilefluency. The art of expression in speech, or in writing, or evenin eloquence of action, is one which, if there is not an innatefaculty for it, can never be acquired in its highest perfection:unseen fetters hinder the full utterance, and lame execution fallsfar short of ambitious conception: with the distinct conceptionof what they would say, and the best will to say it, there issomething wanting in the region of actuation, whereby they areprevented from doing justice to their thoughts, and are compelled , like Moses, to delegate that function to others. " Thereis Aaron he shall be thy speaker, and thou shalt be to himinstead of God." (Exodus iv. 16. ) *And a greater than Moses or Aaron was so gifted with the faculty ofexcellent expression, that it was justly said of Him that " Never man spake asthis man speaks. "CHAPTER IX.MEMORY AND IMAGINATION."You tell me it consists of images or pictures of things. Where is thisextensive canvas hung up? or where are the numerous receptacles in which theseare 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 eyeseems to have given rise to this illusive oratory. It was forgot that this representation belongs rather to the laws of light than to those of life; and may withequal elegance be seen in the camera obscura as in the eye; and that the picturevanishes for ever when the object is withdrawn. "-DR. DARWIN, Zoonomia.THOUGH Memory has not hitherto been specially treated ofas a faculty of the mind, its true nature has been none theless discussed largely, though incidentally, in the foregoing pages.It may be desirable, however, to bring together into one bodythe fundamental facts concerning it. There is memory in everynerve- 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 organicelement remembers for the rest of life certain modificationswhich it has suffered; the manner in which the scar on a child'sfinger grows as the body grows evinces, as Mr. Paget has pointedout, that the organic element of the part does not forget theimpression that has been made upon it; and all that has so farbeen said respecting the different nervous centres of the bodycannot fail to demonstrate the existence of memory in the nervecells which lie scattered in the heart and in the intestinal walls,in those that are collected together in the spinal cord, in the cellsof the sensory and the motor ganglia, and in the ideational cellsof the cortical layers of the cerebral hemispheres. The residuaby which our faculties, as already shown, are built up, are theP210 MEMORY AND IMAGINATION. [CHAP.organic conditions of memory. These organized residua of thecerebral centres, which, when excited into activity by some external impression, enable us to perceive distinctly, or apprehendthe object, appear, when excited by some internal cause, asmemory or recollection. When an organic registration has beencompletely effected, and the function of it has become automatic,we do not usually speak of the process as one of memory, becauseit is entirely unconscious. Thus, for example, when a beginneris learning his notes on the pianoforte, he has deliberately to callto mind each note; but when, by frequent practice, he hasacquired complete skill in playing on that instrument, there isno conscious memory, but his movements are automatic, and sorapid as to surpass the rapidity of succession of conscious ideas.As with such movements, so it is with many ideas, which are socompletely organized that they are automatically and quicklyperformed in our mental life without conscious memory. (¹)The organic registration of the results of impressions upon ournervous centres, by which the mental faculties are built up, andby which memory is rendered possible, is the fundamental process of the mental life. There can be no memory of that whereofwe have not had experience in whole or in parts; and nothingof which we have had experience can be absolutely forgotten.But it is most mischievous to regard mental phenomena as merepictures of nature, and the mind as a vast canvas, on whichthey are cunningly painted. Such representation, as Darwinwell observes, belongs rather to the laws oflight than to those oflife; the real process is one of organization, and is rightly conceivable only by the aid of ideas derived from the observation oforganic development, -namely, the fundamental ideas of Assimilation and Differentiation.There is in mental development, then, the organic registrationof the simple ideas of the different senses; there is the assimilation of the like in ideas which take places in the production ororganic evolution of general ideas; there is the special organization, or differentiation, or discrimination, of unlike ideas; andthere is the organic combination of the ideas derived from thedifferent senses into one complex idea, with the further manifoldcombinations of complex ideas into what Hartley called duplexideas. In fact, no limit is assignable to the complexity ofIx. ] MEMORY AND IMAGINATION. 211combinations which may go to the formation of an idea. Take,for example, the idea of the universe. But how comes itto pass that a new creation of the mind, to which nothing innature answers, is effected? By a similar organic process tothat by which like residua are blended, and general or abstractideas formed. There are no actual existences answering to ourmost abstract ideas, which are, therefore, so far new creations ofthe 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 extraction of the essential out of the particular, a sublimation of theconcrete; and, by the creation of a new world in which theseessential ideas supersede the concrete ideas, the power of themind is most largely extended. Although there is no concreteobject in nature answering to these abstract ideas, yet they arenone the less, when rightly formed, valid and real subjectiveexistences that express the essential relations of things, as theflower which crowns development expresses the essential natureof the plant. Thus it is that we rise from the particular idea ofa man to the general idea of man, and then again to the abstractidea of virtue; so that for the future we can make use of theabstract idea in all our reasoning, without being compelled tomake continual reference to the concrete. * Herein, be it remembered again, we have a process corresponding with that whichministers to the production of our motor intuitions; the acquiredfaculty of certain co-ordinate movements by means of whichcomplicated acts are automatically performed, and we are ableto do, almost in the twinkling of an eye, what would cost hours.of labour if we were compelled on each occasion to go deliberately through the process of special adaptation, is the equivalent,on the motor side, of the general idea by which so much timeand labour are saved in reasoning: in both cases there is aninternal development in accordance with fundamental laws, andthe organized result is, as every new phase of development is,a new creation. Creation is not by fits and starts, but it is continuous in nature.But it should not be forgotten, as it is so apt to be, that the meaning of thegeneral or abstract is to be sought in the concrete, not the interpretation of theconcrete in the general or abstract.P 2212 MEMORY AND IMAGINATION. [ CHAP.These considerations are of importance in respect of the natureof Imagination, which must ever be incomprehensible on themischievous assumption of ideas as pictures or images of thingspainted on the mind. Though imagination is certainly dependent on memory, is it not, it may be asked, more than reproductive,--is it not, in fact, productive? Productive, we reply, as toform, but certainly only reproductive as to material. When anyone affirms that he can imagine something-as, for example,some animal of which he has not had experience, what he doesis to combine into one form certain selected characters of different animals of which he has had experience; creating inthis way, as nature is continually doing, new forms out of oldmaterial. When the artist embodies in ideal form the result ofhis faithful observation, he has, by virtue of that mental processthrough which general ideas are formed, abstracted the essentialfrom the concrete, and then by the shaping power of imaginationgiven to it a new embodiment. In every great work of art thereis thus an involution of the universal in the concrete: it ispregnant in its meaning, yielding a wide range to the actionof another's imagination when he contemplates it. So it isthat high art does not express anything essentially evanescent:it confers on the moment the stedfastness of eternity, representing the " snows of nature frozen into a motionless immortality." The man of science, who unlocks the secrets ofNature by means of observation, experiment, and reflection, thussystematically training his mind in conformity with Nature byexact interrogation and faithful interpretation of her works, hasrecourse, when he proceeds to react upon nature, to a scientificimagination thus carefully cultivated, and is enabled to constructwonderful works of art that are truly an advance upon, or adevelopment of, nature-new creations. What else then, fundamentally, is the true imagination but the nisus of nature'sorganic development displaying itself in man's highest function?What is human art but nature developed through man? Thereis going on a recreation of nature by human means, but naturemakes the means. * The productive or creative power of Imagi-"Yet nature is made better by no mean,But nature makes that mean; so, over that art,Which, you say, adds to nature, is an art1x. ]MEMORY AND IMAGINATION. 213nation, which seems at first sight to be irreconcilable withknowledge gained entirely through experience, is then at bottomanother, though the highest, manifestation of that force whichimpels organic development throughout nature; and the imagination of any one either creates truly, or brings forth abortionsand monstrosities, according as the mind is well stored withsound knowledge and has true concepts, or as it is inadequatelyfurnished with knowledge and has erroneous concepts-according, in fact, as the individual is or is not in harmony with nature.As imagination thus exhibits an evolution of the mental organization, so the well-grounded imagination of the philosopher orthe 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 theideal, the general, that we reproduce; and when we believe thatwe are remembering, we are often misremembering, being influenced by the feelings of the moment, and unable to reproducethe feelings of the past. The faculty by which we recall a sceneof the past, and represent it vividly to the mind, is at bottomthe same faculty as that by which we represent to the imagination a scene which we have not witnessed. “ For φαντάζεσθεand meminisse, fancy and memory, differ only in this, thatmemory supposes the time past, which fancy doth not." Memory, indeed, has been called the grave of the past, imagination the womb of the future; but the grave of the past ever isthe womb of the future. How much of our perception even isactually imagination! The past perception unavoidably minglesin the present act, prevents us often from discriminating minutedifferences which exist, and thus causes us to perceive wronglyThat nature makes.This is an artWhich does 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 theworld. The mind that is parallel with the laws of nature will be in the currentof events, and strong with their strength. One man is made of the same stuff ofwhich events are made; is in sympathy with the course of things; can predictthem. "214 [CHAP.MEMORY AND IMAGINATION.or observe incorrectly. What shall be admitted as a fact inscientific observation, depends entirely upon the observer's previous knowledge and training. So strong is the disposition toassimilate a present observation with a past perception, to blendtogether the like in two ideas, that we are apt to overlook thosespecial differences which demand a discrimination or organicdifferentiation; there is, indeed, almost as great a danger ofhasty generalization in perception as there is in reasoning. If anew 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 propermental training prevents such neglect, the fact is deliberately.appropriated or registered as a special fact, although small satisfaction is felt in the martyrdom of thus registering it, isolatedas it appears; after a while, however, other observations clusterabout it, some blending with it, others connecting it withideas to which it seemed entirely unrelated, until this pariah ofthe mind is found perhaps to fill up a gap in knowledge, andorganically to unite distant ideas. It is a most necessary habitto acquire in the true cultivation of the mind, that of observingaccurately, of carefully noting minute differences, and of scrupulously registering them, so as to effect an exact internalcorrespondence with external specialities.As we perceive more accurately, so shall we remember morecorrectly, judge more soundly, and imagine more truly. Thehabit of hasty and inexact observation, the unwarranted blendingof residua that are not truly like, is necessarily the foundationof a habit of remembering wrongly; and the habit of remembering wrongly is of necessity the cause of an incorrect judgmentand erroneous imagination: exact internal correspondence toexternal relations being the basis of an imagination true tonature, ―in other words, of a true organic mental development.For these reasons, " the whole powers of the soul may," asHartley observes, " be referred to the memory, when taken ina large sense. Hence, though some persons may have strongmemories with weak judgments, yet no man can have a strongjudgment with a weak original power of retaining and remembering." Infinite mischief and confusion have been caused bythe habit of speaking of ideas as if they were the mechanicalIX.] MEMORY AND IMAGINATION. 215stamps of impressions on the memory, instead of as, what theytruly are, organic evolutions in respondence to definite stimuli;our mental life is not a copy but an idealization of nature, inaccordance with fundamental laws.As organic growth and development take place in obedienceto 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 developmental advance upon it. This esemplastic faculty, as Coleridge,following Schelling, named it, is perhaps indicated by the German word for imagination, namely, Einbildung, or the one- makingfaculty.* Its highest working in our great poets and philosophers really affords us an example of creation going steadily onas a natural process; and creative or productive activity isassuredly the expression of the highest mental action: whosoeverhas such capacity has more or less genius; whosoever has it notwill do nothing great, though he work never so hard. What anamount has been unwisely written by the sedulous followers ofa so-called inductive philosophy in disparagement of imaginationand in favour of simple observation! " Men should consider,"says Bacon, " the story of the woman in Æsop, who expectedthat with a double measure of barley her hen would lay twoeggs a day; whereas the hen grew fat and laid none."It wereas wise in a man to load his stomach with stones instead offood as to load his mind with facts which he cannot digest andassimilate. It is in the great capacity which it has of assimilating material from every quarter, and of developing in proportion, that the superiority of genius consists; and it is in theexcellence of its imagination, whether poetical, artistic, philosophic, or scientific, that its superior energy is exhibited.Because the least things and the greatest in Nature are indissolubly bound together as equally essential parts of the mysterious but harmonious whole, therefore the intuition into one

• More correctly, perhaps, Ein for en (in), and Bildung (formation, -internal

image, i.e. imagination.216 MEMORY AND IMAGINATION. [CHAP.pure circle of her works by the high and subtile intellect of thegenius contains implicitly much more than can be explicitlydisplayed in it. Hence it comes to pass at times that, in theinvestigation of a new order of events by such an intellect, thelaw of them will, as by a flash of intuition, explicitly declareitself in the mind after comparatively few observations: theimagination successfully anticipates the slow results of patientand systematic research, flooding the darkness with the light ofa true interpretation, and thus illuminating the obscure relationsand intricate connexions. Therein a well-endowed and wellcultivated mind manifests its unconscious harmony with nature.The brightest flashes of genius come unconsciously and withouteffort: growth is not a voluntary act, although the gathering offood is.Certainly the intuition of truth can never be the rule amongstmen, inasmuch as the genius capable of intuition, so far frombeing common, is a most rare exception amongst them. Andthe result, however brilliantly acquired, can never be safelyaccepted as lasting, until it has been further subjected to thetests of observation, experiment, and logical reasoning,—until ithas undergone verification. The man of genius who has revealeda great truth may probably, on some other occasion, promulgatean equally great error. Happily his errors are indirectly mostuseful; for the experiments and observations provoked anddirected by them, and prosecuted for the purpose of displayingtheir instability, often lead to valuable discoveries. Mischief isundoubtedly wrought by the rash promulgation of ill-groundedtheories on the part of those who have neither superior originalcapacity, 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 anadequate knowledge of the subject can always recognise in theunwarranted theory the exact amount of knowledge which itsauthors have had, and the character of the defect in their reasoning. Those, again, who take a philosophical view of things, audlook upon the progress of human knowledge as a developmentthat is going on continuously through the ages, will find it conformable to their experience of every other form of vital growththat there should be, coincidently with advance, a retrogradeIx.] MEMORY AND IMAGINATION. 217

metamorphosis, degeneration or corruption of that which is notfitted for assimilation, and which is ultimately rejected: as thebody dies daily as the condition of its life, so false theories andcorrupt doctrines are conditions of the progress of knowledge. *That there is a deep distrust of hasty generalization is a manifestation of the self- conservative instinct; it prevents the humanmind from being led astray by vain and windy doctrines, andthus promotes a true development. It is not, however, inthe individual, where so much active change takes place in soshort a time, that the regular corruption and decay of false doctrines will be clearly perceived, but in the historical developmentof the race, where the gradual evolution of the mind may bebetter traced.Thus much concerning memory and imagination, which, whenproperly examined, reveal, better perhaps than the analysis ofany other of the so- called mental faculties, the complex organization which mind really is. It remains only to add here, thatthe manifold disorders to which memory is liable illustrate inthe most complete manner its organic nature. Its disorders arenumberless in degree and variety; for there is not only everydegree of dulness, but there is met with every variety of partialloss, as of syllables in a particular word, of certain words, places,So various and numerous are its possible defects, thatit has not yet been possible to reduce them to any system,although it is probable that a careful classification of themmight be very useful. All that we can at present concludefrom them is, first, that memory is an organized product; and,secondly, that it is an organization extending widely through thecortical layers of the cerebral hemispheres. It is interesting toobserve that differences exist in different persons in the characterof the organic function which ministers to memory: one man,names.

• I may make the following quotation from an article by me, on " Recent

Metaphysics, " in the Journal of Mental Science, January 1866: —“ As in thegrowth and development of the body there is a correlative degeneration or retrograde metamorphosis of organic element going on--a daily death in strict relationwith 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 ofthe false in strict relation with the growth of the true; thus healthy energythrows off effete matter, which, in the very act of becoming effete, gives up forcethat 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 noway remarkable for reasoning power, or is even singularlydeficient therein-the registration of the concrete impressionstaking place with the greatest ease, but the further digestion ofthe residua not being accomplished; another, on the other hand,has no memory for particular isolated facts, -they must havesome relation to ideas already appropriated, or must fall undersome principle, if he is to recollect them; the digestion ofresidua is well effected, so that there exists a great power ofgeneralization. The latter is the memory of intellect; theformer is not unfrequently the memory of idiots.Some flaw in the memory, some breach in its exquisite organization, is ever one of the first indications of a disorder or degeneration of nerve element. But its slight, early affections arevery apt to be overlooked, forasinuch as they do not reveal themselves in a conscious inability to remember something, but in anunconscious 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 highestefforts of organic assimilation, are here the first to attest by theirsufferings any interference with the integrity of nerve element,just as disorders of the finest associated movements of the spinalcord are the first to declare the commencing degeneration of itscentres. Long before there is any palpable loss of memory ininsanity, even before an individual is recognised to be becominginsane, there is a derangement of his highest reasoning and ofhis moral qualities; his character is more or less altered, and,as it is said, " he is not himself." If the degeneration of nerveelement proceeds, we witness successively every stage of declension in the disorder of the complex organization of the memory;namely, manifest perversion of the higher social feelings, thengreater or less destruction of the organic connexions of ideas,whence follows incoherence of thought, and, finally, general forgetfulness, declining into complete abolition of memory.It is not difficult to understand how it is that the old mansometimes has a tenacious memory of the past, and can reasontolerably correctly with regard to it, when he cannot duly appropriate and rightly estimate the present. The brain, like everyother organ of the body, suffers a diminution of power of activityIx. ] MEMORY AND IMAGINATION. 219with the advance of age; it reacts to impressions with less andless vigour and vivacity, and there is less and less capacity toassimilate the influence of them, so that there are a dulness ofperception 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 lessvivacity than formerly. It is easy, again, to perceive how it isthat children, like animals, live almost entirely in the present;they have no store of ideas organized in the mind which mightbe called into activity to influence the present idea, and they reactdirectly to the impressions made upon them. The best possibleevidence of the gradual process of mental organization is indeedafforded by the mental phenomena of young children; for theresidua of impressions not being completely organized, theirmemory is fallacious, and, a firm organic association betweenideas not being established, their discourse is incoherent. Theold man and the child both fail in judgment: the former, becausehe has forgotten more or less of the past, and has lost thestandard by which to measure the present perception, or becausehe cannot take in accurately the present perception, and measuresit entirely by the past; the latter, because it has not yet anypast. Bythe necessity of the case almost, an old man becomesconservative and the laudator temporis acti; for the evolution ofevents goes on when his nature has ceased to assimilate anddevelop; he has accordingly no sympathy with them, but, retreating within the shell of a calcified past, obstinately brands asrevolutionary what is truly evolutionary. How different with theyouth! The curtain of life rises, and he is fascinated with theshow; his nature expands trustfully, and though he may often.mistake fleeting illusions for lasting truths, and come to no littlesorrow thereby, yet he assimilates, grows, and develops.Lastly, it will not be amiss to bear in mind, in regard to theorganic nature of memory, that we cannot remember pain. It iscertainly possible to remember that we have suffered a particularpain; but vividly to recall the pain as we can a definite ideais not possible. And why? Because the idea is an organizedproduct which abides, while the disorganization or disturbanceof nerve element which pain implies, passes away with therestoration of the integrity of the nerve centre. For the same220 MEMORY AND IMAGINATION. [CHAPreason, we cannot easily or adequately recall a very powerfulemotion in which the idea or the form has been almost entirelylost in the commotion-where, in fact, the storm among theintimate elements has been so great as to be destructive of form:Shakspeare's words, " formless ruin of oblivion," admirablyexpressing the state of things. When we do strive to bring tomind a particular sensation or emotion, it is by vivid representation of its cause, and consequent secondary excitation of it: weremember the idea, and the idea generates the emotion or thesensation. But the sensation of pain is a very different matterfrom the sensation of one of the senses; it is the outery ofsuffering nerve element, and cannot be generated by any idea;it is not the result of organization, but the token of disorganization. How, then, should it be accurately remembered?NOTES.1 (p. 210). " The truth that memory comes into existence when theconnexions among psychical states cease to be perfectly automatic is incomplete harmony with the obverse truth, illustrated in all our experience, that as fast as the connexions of psychical states which we formin memory become, by constant repetition, automatic, they cease to bepart of memory. We do not speak of ourselves as remembering thoserelations which become organically, or almost organically, registered;we remember those relations only of which the registration is not yetabsolute. No one remembers that the object at which he is lookinghas an opposite side; or that a certain modification of the visualimpression implies a certain distance; or that the thing which he seesmoving about is a living animal. It would be a misuse of languagewere we to ask another whether he remembers that the sun shines,that fire burns, that iron is hard, and that ice is cold . . . . . . . Andsimilarly, though, when a child, the reader's knowledge of the meaningof successive words was at first a memory of the meanings he hadheard given to them; yet now their several meanings are present tohim without any such mental process as that which we call remembrance. "-HERBERT SPENCER, Principles of Psychology, p. 551.2 (p. 213) .-Jean Paul Richter, in one of his Letters, says: "Thedream is an involuntary art of poetry and it shows that the poetworks more with the bodily brain than another man. How is it that

Ix.] MEMORY AND IMAGINATION. 221no one has wondered that in the detached scenes of dreaming, he putsin the mouth of the actors the most appropriate language, the words mostexactly characteristic of their nature; or rather that they prompt him,not he them? The true poet even is in writing only the listener, notthe language-teacher of his characters. . . . . Victor's observation thatthe opponent of his dreams often put before him more difficultobjections than a real bodily one, may be made of the dramatist, whocan in no manner be the spokesman of his company without acertain inspiration, though he is at the same time easily the writer oftheir parts. That dream- forms surprise us with answers with whichwe ourselves have inspired them is natural; even when awake everyidea springs forth suddenly like a spark of fire, though we attribute itto our attention; but in dreams we lack the consciousness of attention,and we must thus ascribe the idea to the figure before us, to whichalso we ascribe the attention." Again:-" Das Mächtigste in Dichter,welches seinen Werken die gute und die böse Seele einbläset, istgerade das Unbewusste. "-Aesthetik.Carlyle, whose writings exhibit in a marked degree the influence ofJean Paul and Goethe, says of Shakspeare:-" Shakspeare is whatI call an unconscious intellect; there is more virtue in it than he ishimself aware of. His dramas are products of Nature, deep as Natureherself. 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, whateverhe with utmost conscious exertion and forethought shall accomplish,grow up withal unconsciously from the unknown deep in him, as theoak- tree grows from the earth's bosom, as the mountains and watersshape themselves. "Dr. Brown (Philosophy of the Mind, p. 200), when enumeratingwhat he calls the Secondary Laws of Suggestion, lays much stress onconstitutional differences in individuals-the differences of Genius,Temper, or Disposition. The tendencies in some minds are wholly tosuggestions of proximity; in other minds there is a powerful tendencyto suggestions of analogy. It is in this latter tendency to the newand copious suggestions of analogy that the distinction of geniusappears to consist; a mind in which it exists is necessarily inventive;"for all to which we give the name of invention, having a relation tosomething old, but a relation to that which was never before suspectedor practically applied, is the suggestion of analogy." There would benothing new if objects were to suggest only, according to proximity,the very objects that had co- existed with them; but there is aperpetual novelty of combination, when the images that arise after222 MEMORY AND IMAGINATION. [CHAP. IX .each other, by that shadowy species of resemblance which we areconsidering, are such as never existed before together or in immediatesuccession. Hence the rich figurative language of poetry-theexpressions of resemblances that have arisen silently and spontaneouslyin the mind; hence the discoveries and inventions of science, &c .He goes on, too, to point out that this novelty of combination inimagination cannot depend upon the will. It is absurd, he says, tosuppose that we can will directly any conception, since, if we knowwhat we will, conception must be already a part of consciousness."Hence, in proportion as the memory is enriched and providedwith materials, in the same proportion the rational mind, if backed bya happy genius, will be able skilfully, felicitously, and approximately,and agreeably to the truth, to distribute its analysis into series, toadjust and conclude them, of many analytic conclusions again to formnew analyses, and in the end to evolve its ultimate analyses. "-SWEDENBORG'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 anunderstanding of equal grasp. For the faculty of reducing the contents of memory to order is a fresh intellectual requisite. An edificeis not built simply by the accumulation of implements, bricks, tiles,and the materials. These and skill must be tasked to put all thingstogether in their places. "PART II.THE PATHOLOGY OF MIND.CHAPTER I. ON THE CAUSES OF INSANITY.999999"929II. ON THE INSANITY OF EARLY LIFE.III. ON THE VARIETIES OF INSANITY.IV. ON THE PATHOLOGY OF INSANITY.V. ON THE DIAGNOSIS OF INSANITY.VI. ON THE PROGNOSIS OF INSANITY.VII. ON THE TREATMENT OF INSANITY.

CHAPTER I.ON THE CAUSES OF INSANITY.THEHE causes of insanity, as usually enumerated by authors, areso general and vague as to render it a very difficult matterto settle in the mind what they really are. But it is hardly lessdifficult, when brought face to face with an actual case of insanity, and when there is every opportunity of investigation,to determine with certainty what have been the causes of thedisease. It is a question, however, asked over and over again ofthe physician by the members of an insane person's family, whoappear sometimes more anxious to know what can have causedthe disease than to know what will cure it. The uncertaintysprings from the fact that, in the great majority of cases, there isa concurrence of conditions, not one single effective cause, Allthe conditions which conspire to the production of an effect arealike causes, alike agents; and, therefore, all the conditions,whether they are in the individual or in the circ*mstances inwhich he is placed, which in a given case co-operate in the production of disease, must alike be regarded as causes.When weare told that a man has become deranged from anxiety or grief,we have learned very little if we rest content with that statement. How does it happen that another man, subjected to anexactly similar cause of grief, does not go mad? It is certainthat the entire causes cannot be the same where the effectsare so different; and what we want to have laid bare is theconspiracy of conditions, internal and external, by which amental shock, inoperative in one case, has had such seriousconsequences in another. A complete biographical account ofthe individual, not neglecting the consideration of his hereditary૨226 ON THE CAUSES OF INSANITY. [CHAP.antecedents, would alone suffice to set forth distinctly the causation of his insanity. If all the circ*mstances, internal andexternal, were duly scanned and weighed, it would be found thatthere is no accident in madness; the disease, whatever form itmight take, by whatsoever complex concurrence of conditions, orby how many successive links of causation, it might be generated, would be traceable as the inevitable consequence of certainantecedents, as plainly as the explosion of gunpowder may betraced to its causes, whether the train of events of which it isthe issue be long or short. The germs of insanity are sometimeslatent in the foundations of the character, and the final outbreakis the explosion of a long train of antecedent preparations.When the causation of insanity may thus extend over a lifetime, it is easy to perceive how little is taught by specifying asingle moral cause, such as grief, vanity, ambition, which mayafter all be, and often is, one of the earliest symptoms of thedisease. Do we not, in sober truth, learn more of its real causation from a tragedy like " Lear " than from all that has yet beenwritten thereupon in the guise of science? An artist likeShakspeare-penetrating with subtile insight the character of theindividual, and the relations between him and his circ*mstances,discerning the order which there is amidst so much apparentdisorder, and revealing the necessary mode of the evolutionof the events of life-furnishes, in the work of his creative.art, more valuable information than can be obtained from thevague and general statements with which science, in its presentdefective state, is constrained to content itself. Because of thesedifficulties, I believe that I shall help to accomplish my taskof conveying distinct notions of the causation of insanity bybringing forward in an appendix, as illustrations, the notes ofsome cases, the histories of which I have thoroughly investigated. Before doing this, however, it is necessary to makesome 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 physicaland moral, though it is not possible thus to discriminate themwith exactness. Where hereditary taint exists, for example, andis the cause of some defect or peculiarity of character whichultimately issues in insanity, one person might describe the1.] ON THE CAUSES OF INSANITY. 227cause as moral while another would describe it as physical.Certainly, where there existed manifest defective developmentof the brain in consequence of inherited mischief, as in somecases of idiocy, every one would agree as to its physical nature;but where there was no observable morbid condition in thebrain, and the evil only declared itself in a vice of disposition inthe individual, most people would consider it of a moral nature,though really as certainly due to physical conditions as idiocyconfessedly is. In reality, every moral cause operates throughthe physical changes which it produces; and in the greatmajority of cases in which the cause has been pronounced moralthere has been something in the physical constitution by the cooperation of which the result has been brought about. Life inall its forms, physical or mental, morbid or healthy, is a relation;its phenomena result from the reciprocal action of an individualorganism and external forces: health, as the consequence andevidence of a successful adaptation to the conditions of existence, implies the preservation, well-being, and development ofthe organism, while disease marks a failure in organic adaptationto external conditions, and leads, therefore, to disorder, decay,and death. Now it is obvious that the harmonious relationbetween the organism and the external world, which is the condition of health, may be disturbed either by a cause in theorganism, or by a cause in the external circ*mstances, or by acause, or rather a concurrence of causes, arising partly from oneand partly from the other. When it is said that mental anxiety,produced by adverse circ*mstances, has made any one mad,there is implied commonly some infirmity of nerve elementinherited or acquired, which has co-operated: were the nervoussystem in a state of perfect soundness, and in possession of thatreserve power which it then has of adapting itself, within certainlimits, to the varying external conditions, it is probable that themost unfavourable circ*mstances would not be sufficient to disturb permanently the relation, and to initiate mental disease.But when unfavourable action from without conspires with aninfirmity of nature within, then the conditions of disorder areestablished, and a discord, or madman, is produced.From what has been said, it would seem that it cannot conduce to exact knowledge to maintain the violent distinction.Q 2228 ON THE CAUSES OF INSANITY. [ CHAP.between physical and moral causes of insanity. This will appearmore plainly if we call to mind the conclusions established inthe First Part of this book. There it was distinctly shown thatthoughts, feelings, and actions leave behind them certain residuawhich become organized in the nervous centres, thenceforthmodifying the manner of their development so as to constitutean acquired nature; consequently, the moral manifestationsthroughout life inevitably determine physical organization; anda slowly operating moral cause of insanity is all the while producing physical changes in the occult recesses of the supremenervous centres of the mental life. In fact, the brain which isexercised so habitually in a given manner as to acquire duringhealth a strong peculiarity or bias of action is sometimes moreliable to disorder in effect of this; and, when the disorder is produced by an independent cause, this bias or habit may aggravateits effects. When insanity occurs as the consummate exaggeration of a particular vice of character, as it sometimes does, themorbid mental manifestations mark a definite habit of morbidnutrition in the supreme nervous centres, —a gradually effectedmodification of the mental organization. On the other hand, thebrain which is habitually exercised in the best possible wayacquires a strong and healthy habit of thought and volitionwhich counteracts the effects of a morbid cause.I shall deal first with the consideration of those general conditions which are thought to predispose in any way to insanity,and which may be summed up as its remote or predisposingcauses. Of so vast a subject it is plainly impossible to treathere in any but the most summary way; to attempt to traverse thewide field over which the predisposing causes of human degeneracy extend would be to enter upon a survey of human history.Predisposing Causes. -There are general causes, such as thestate of civilization in a country, the form of its government andits religion, the occupation, habits, and condition of its inhabitants, which are not without influence in determining the proportion of mental diseases amongst them. Reliable statisticaldata respecting the prevalence of insanity in different countriesare not yet to be had; even the question whether it hasincreased with the progress of civilization has not been positively settled. Travellers are certainly agreed that it is a rare1.] ON THE CAUSES OF INSANITY. 229disease amongst barbarous people, while, in the different civilized nations of the world, there is, so far as can be ascertained,an average of about one insane person in five hundred inhabitants. Theoretical considerations would lead to the expectationof an increased liability to mental disorder with an increase inthe complexity of the mental organization: as there are a greaterliability to disease, and the possibility of many more diseases, ina complex organism like the human body, where there are manykinds of tissues and an orderly subordination of parts, than in asimple organism with less differentiation of tissue and less complexity of structure; so in the complex mental organization,with its manifold, special, and complex relations with the external, which a state of civilization implies, there is plainly thefavourable occasion of many derangements. The feverish activityof life, the eager interests, the numerous passions, and the greatstrain of mental work incident to the multiplied industries andeager competition of an active civilization, can scarcely fail, onemay suppose, to augment the liability to mental disease. Onthe other hand, it may be presumed that mental sufferings willbe as rare in an infant state of society as they are in the infancyof the individual. That degenerate nervous function in youngchildren is displayed, not in mental disorder, but in convulsions;that animals very seldom suffer from insanity; that insanity isofcomparatively rare occurrence among savages; all these arecirc*mstances that arise from one and the same fact-a want ofdevelopment of the mental organization. There seems, therefore, good reason to believe that, with the progress of mentaldevelopment through the ages, there is, as is the case with otherforms of organic development, a correlative degeneration goingon, and that an increase of insanity is a penalty which an increaseof our present civilization necessarily pays.So far as facts are available for the determination of thisquestion, they confirm the foregoing theoretical considerations.The sort of insanity most common amongst savages is imbecility, or idiocy, for the same reason that idiocy is the mostcommon form of insanity in children: where the mind is notdeveloped, varied degeneration of it cannot take place, thoughit may obviously remain morbidly arrested. It is plainly impossible, for example, that the most typical moral insanity230 ON THE CAUSES OF INSANITY. [CHAP.should occur where no moral development has taken place;before the native Australian savage -who has not in hislanguage any words for vice or justice, nor in his mind anysuch ideas as these words convey to an intelligent Europeancould become morally insane, he must first be humanized andthen civilized; development must precede retrograde metamorphosis, mental organization precede mental disorganization.Another fact which deserves serious consideration is, that therehas undoubtedly been a very large increase of late years in thenumber of the insane who have come under care and observation. The reports of the Lunacy Commissioners show that, onthe 1st of January, 1849, there were 14,560 patients in thehospitals, asylums, and licensed houses of England and Wales;that six years afterwards, on the 1st of January, 1855, there were20,493 insane; that ten years afterwards, on the 1st of January,1865, there were 29,425 insane under certificates; and that onthe 1st of January, 1866, the number had risen to 30,869. Nowit is certain that only a small proportion of this large increase isto be attributed to an increase of insanity in the population; itis undoubtedly mainly owing ( 1 ) to the large number of cases,formerly unreported, which more stringent legislation hasbrought under observation; ( 2) to the larger number of insane,especially of paupers, who are now sent to asylums; and (3) tothe prolongation of life in those who have been brought underproper care. In fact, it might be said roughly, that the greaterpart of this large increase in the insane population of Englandand Wales is due to the facts that nowadays more people arethought and declared mad than would formerly have beenthought 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, thanformerly. But, when all due allowance has been made for thesecauses, it must be admitted that a steady increase of about1,000 a year in the insane population of England and Walesfor the last seventeen years, does seem to point to an actualincrease in the production of insanity, and even to an increasemore than proportionate to an increasing sane population.If we admit such an increase of insanity with our presentcivilization, we shall be at no loss to indicate causes for it.1.] ON THE CAUSES OF INSANITY. 231Some would no doubt easily find in over-population the prolificparent of this as of numerous other ills to mankind. In thefierce and active struggle for existence which there necessarilyis where the claimants are many and the supplies are limited ,and where the competition therefore is severe, the weakest mustsuffer, and some of them, breaking down into madness, fall bythe wayside. As it is the distinctly manifested aim of mentaldevelopment to bring man into more intimate, special, andcomplex relations with the rest of nature by means of patientinvestigations of physical laws, and a corresponding internaladaptation to external relations, it is no marvel, it appearsindeed inevitable, that those who, either from inherited weakness or some other debilitating causes, have been rendered unequal to the struggle of life, should be ruthlessly crushed out asabortive beings in nature. They are the waste thrown up bythe silent but strong current of progress; they are the weakcrushed out by the strong in the mortal struggle for development; they are examples of decaying reason thrown off byvigorous 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 thishard law, we may see it in the appropriation by man, thestronger sex, of all the means of subsistence by labour, to thealmost entire exclusion of women, the feebler sex. Because,however, women are necessary to the gratification of man'spassions, indispensable to the comfort of his life, they are notcrushed out of existence, they are only kept in a state of subjection and dependence. The woman who can find no openingfor her honourable energies in the present social system, is yetwillingly permitted to gain a precarious livelihood by sellingthe charms of her person to gratify the lusts of her lord andmaster. Under the institution of marriage she has the positionof a subordinate, herself debarred from the noble aims andactivities of life, but ministering, in a silent manner, to thecomfort and greatness of him who appropriates the labour andenjoys the rewards. Practically, then, woman has no honourable outlook but marriage in our present social system: if thataim is missed, all else is missed. Through generations hercharacter has been formed with that chief aim; it has been232 ON THE CAUSES OF INSANITY [CHAP. .made feeble by long habit of dependence; by the circ*mstancesof her position the sexual life has been undesignedly developedat the expense of the intellectual. Now, therefore, when theluxuries thought necessary in social life are so many and costlythat marriage is much avoided by men, there is a cruel stresslaid upon many a gentle nature. In this disappointment oftheir life- aim, and the long train of consequences, physical andmoral, which it unconsciously draws after it, there is, I believe,a fertile source of insanity among women. It is not only thatwomen of the better classes, not married, have no aim in life towork for, no opening for the employment of their energies inoutward action, and are driven to a morbid self-brooding, or toan excessive religious devotion or a religious enthusiasm whichis too often the unwitting cloak of an exaggerated and unhealthy self-feeling; but, through the character produced bythe position which they have so long held in the social system,their organic life is little able to withstand the consequences ofan unsatisfied sexual instinct. Disturbances of all sorts ensue,and social customs debar them from the means of relief whichmen have both in active employment and in illicit sexual indulgence. Masturbation is undoubtedly sometimes provoked, andaggravates the evil for which it was sought as a relief. Let itnot be supposed, however, that all these things take place consciously in the woman's thoughts, feelings, and actions: thesexual passion is one of the strongest passions in nature, andas soon as it comes into activity, it declares its influence onevery pulse of the organic life, revolutionizing the entire nature,conscious and unconscious; when, therefore, the means of itsgratification entirely fail, and when there is no vicarious outletfor its energy, the whole system feels the ill effects, and exhibitsthem in restlessness and irritability, in a morbid self- feelingtaking a variety of forms, and sometimes in an act of self- abusewhich, on the first occasion, may be a sort of instinctive frenzy,of the aim of which there is only the vaguest and most dimnotion.Another way in which over-population leads to deteriorationof the health of a community is by the overcrowding and theinsanitary condition of dwelling-houses which it occasions intowns. Not fevers only, but scrofula, perhaps phthisis, and1.] ON THE CAUSES OF INSANITY. 233certainly general deterioration of nutrition, are thus generatedand transmitted as evil heritages to future generations: theacquired ill of the parent becomes the inborn infirmity of theoffspring. It is not that the child necessarily inherits the particular disease of the parent, for diseases unquestionably undergotransformation through generations; but it does often inherita constitution in which there is a certain inherent aptitude tosome kind of morbid degeneration, or a constitution destitute ofthat reserve power necessary to meet the trying occasions oflife. Lugol found insanity to be by no means rare amongstthe parents of the scrofulous and tuberculous; and in onechapter of his work on Scrofula treats of hereditary scrofulafrom paralytic, epileptic, and insane parents. Schroeder vander Kolk was also of opinion that a hereditary predisposition tophthisis might develop into or predispose to insanity; and, onthe other hand, that insanity predisposed to phthisis. It iscertain that there are very intimate relations between phthisisand insanity: one- fourth of the deaths in asylums are causedby phthisis; and Dr. Clouston, who found that there is hereditary predisposition in 7 per cent. more of the cases of insanitywith tubercle than of the insane generally, has described acertain form of insanity as phthisical insanity. Watching thedecay of a family, it is often seen that phthisis and insanity areof frequent occurrence amongst its members; and when extinction of it occurs, when the last of the family dies, he notseldom dies insane or phthisical or both. When we reflect thata disease is not a specific morbid entity that, like some evilspirit, has taken mischievous possession of the body, or of aparticular part of it, but a condition of more or less degeneration from healthy life in an organism whose different parts constitute one harmonious whole, it will be sufficiently evident thata disease of one part of the organism will not only affect thewhole sympathetically at the time, but may lead to a moregeneral infirmity in the next generation-to an organic infirmitywhich shall be determined in its special morbid manifestationsaccording to the external conditions of life.Perhaps one, and certainly not the least, of the ill effectswhich spring from some of the conditions of our present civilization, is seen in the general dread and disdain of poverty, in234 ON THE CAUSES OF INSANITY. [CHAP.the eager passion to become rich. The practical gospel of theage, testified everywhere by faith and works, is that of moneygetting; men are estimated mainly by the amount of theirwealth, take social rank accordingly, and consequently bend alltheir energies to acquire that which gains them esteem andinfluence. The result is that in the higher departments of tradeand commerce speculations of all sorts are eagerly entered on,and that many people are kept in a continued state of excitement and anxiety by the fluctuations of the money market. Inthe lower branches of trade there is the same eager desire forpetty gains; and the continued absorption of the mind in thesesmall acquisitions generates a littleness of mind and meannessof spirit, where it does not lead to actual dishonesty, whichare nowhere displayed in a more pitiable form than by certainpetty tradesmen. The occupation which a man is entirely engaged in does not fail to modify his character, and the reactionupon the individual's nature of a life which is being spent withthe sole aim of becoming rich, is most baneful. It is not thatthe fluctuations of excitement unhinge the merchant's mind andlead to maniacal outbreaks, although that does sometimeshappen; it is not that failure in the paroxysm of some crisisprostrates his energies and makes him melancholic, althoughthat also is occasionally witnessed; but it is that the exclusiveness of his life-aim and occupation too often saps the moralor altruistic element in his nature, makes him become egoistic,formal, and unsympathetic, and in his person deteriorates thenature of humanity. What is the consequence? If one conviction has been fixed in my mind more distinctly than anotherby observation of instances, it is that it is extremely unlikelysuch a man will beget healthy children; on the contrary, it isextremely likely that the deterioration of nature which he hasacquired will be transmitted as an evil heritage to his children.In several instances in which the father has toiled upwards frompoverty to vast wealth, with the aim and hope of founding afamily, I have witnessed the results in a degeneracy, mental andphysical, of his offspring, which has sometimes gone as far asextinction of the family in the third or fourth generation. Whenthe evil is not so extreme as madness or ruinous vice, the savourof a mother's influence having been present, it may still beL:] ON THE CAUSES OF INSANITY. 235manifest in an instinctive cunning and duplicity, and anextreme selfishness of nature-a nature not having the capacityof a true moral conception or altruistic feeling. Whateveropinion other more experienced observers may hold, I cannotbut think, after what I have seen, that the extreme passion forgetting rich, absorbing the whole energies of a life, does predispose to mental degeneration in the offspring-either to moraldefect, or to moral and intellectual deficiency, or to outbreaks ofpositive insanity under the conditions of life.Without going on to enumerate other causes which arise outof our present civilization, and appear to favour the increase ofinsanity, it will be sufficient to say that any condition that isinjurious to mental or bodily health, though it does not produceinsanity directly, may so far predispose to it in the next generation; determining in the present what shall be predeterminedin the future. But while giving due weight to this consideration,it is necessary to bear in mind that an increase in the numberof insane persons in a country does not necessarily mean thedegeneracy of the people: the capability of development is thecapability of degeneration, and where the general progress isgoing on actively the retrograde action in the elements must begoing on also the particular is sacrificed to the general, "theindividual withers, and the race is more and more. " If this beso, may we not then say that an increase of insanity is after alla testimony of development, that a great apparent evil is but aphase in the working out of good? may we not, indeed, ask withthe prophet, " Shall there be evil in a city, and the Lord hathnot done it? " *Sex.-Esquirol and Haslam thought insanity to be of morefrequent occurrence among women than men, but authors arenow generally agreed that the converse is true. Esquirol omittedin his calculations, as Dr. Thurnam has pointed out, to take intoaccount the preponderance of females in the population, andmoreover drew his conclusions from a comparison of existingcases, instead of from cases occurring in the two sexes.† FemaleAmos iii. 6. Again, Isa. xlv. 7: " I form the light, and create darkness: Imake 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 wasaware; "but he does not appear to have known that, from twenty to fifty years236 ON THE CAUSES OF INSANITY [ CHAP..patients accumulate in asylums more than males; for the proportion of relapses is greater in them, and the probability ofdeath is less general paralysis, which is particularly fatal, beingalmost confined to men. Dr. Thurnam affirms men to be moreliable to mental disorder than women; and Dr. Jarvis came tothe same conclusion from an examination of the statistics ofdifferent countries. Recently it has been said that the femalesex is more liable to suffer from hereditary insanity. If my experience were large enough to be of any value, it would give thepreponderance to the women: of 106 persons whom I admittedinto a lunatic hospital, there were 50 men and 56 women. Thisresult agrees closely with the statistics of the number of peopleconfined in asylums in England and Wales: on the 1st ofJanuary, 1855, there were in the hospitals, asylums, and licensedhouses 10,885 females and 9,608 males, and on the 1st of January,1866, 15,437 females and 13,988 males-the numbers giving apreponderance of from about five to six per cent. to women. Onwhichever side, male or female, the uncertain difference lies, itis probably inconsiderable. There is hardly sufficient ground tomaintain positively that there is by simple reason of sex anyinborn liability to insanity. The female sex is certainly theweaker, and on this account will be more likely to suffer from theadverse circ*mstances of life, especially in a complex social statewhere it is precluded so much from active work, suffers from abad system of education, has so few resources, and is enfeebledby dependence; it has moreover conditions which in some regardfavour disturbance in the revolutions effected in the system atpuberty, during pregnancy, by the puerperal state, and at theclimacteric period. These conditions, in concurrence with thecirc*mstances of female life, may possibly become the cause ofmore frequent insanity amongst women; and one is the moreapt to think so when one calls to mind that causes whichundoubtedly act more frequently amongst men-intemperanceand other excess, for example -do not avail to notably increaseof 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 twentyto thirty years of age than it is subsequently; it being 12 per cent. from twentyto 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 cases amongst women. "-THURNAM, Statistics of Insanity, p. 146.1.] ON THE CAUSES OF INSANITY. 237the proportion of insanity amongst them. On the whole Ishould be disposed to hold that, while the number of men andof women who become insane appears to differ but little, as thecauses 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 onehas, the acquired nature which he owes to the circ*mstances ofhis education and training is most important in determining thecharacter. I mean, not the education which is called learningalone, but that education of the nature of the individual, thatdevelopment of the character, which the circ*mstances of hislife have determined. There are in every nature its particulartendencies or impulses of development which may be fostered orchecked by the conditions of life; and which, therefore, accordingto their good or evil nature, and the external influences whichthey meet with, may minister to the future weal or woe of theindividual-may lead to a stability of character which preventsthe mental equilibrium ever being seriously disturbed, or to suchan instability of character that the smallest adversity may destroyit for ever. How often one is condemned to see, with pain andsorrow, an injudicious education sorely aggravate an inherentmischief! The parent not only transmits a taint or vice ofnature to the child, but fosters its evil growth by the influenceof a bad example, and by a foolish training at the time whenthe young mind is very susceptible, and when the direction givento its development is sometimes decisive for life. Where thereis no innate taint, evil may still be wrought by enforcing anunnatural precocity, wherein is often planted the germ of futuredisease. Parents who labour to make their children prodigiesof learning or talent often prepare for them an early death oran imbecile manhood-" In pueritiâ senex, in senectute puer. "Parental harshness and neglect-repressing the child's feelings,stifling its need of love, and driving it to a morbid selfbrooding, or to take refuge in a world of vague fancies-is notless pernicious than a foolish indulgence through which it neverlearns the necessary lessons of renunciation and self-control.The aim of a good education should be to develop the powerand habit of what the events of life will not fail to rudelyenforce-renunciation and self- control, and to lead to the con-238 ON THE CAUSES OF INSANITY [CHAP. .tinued transference of thoughts and feelings into external actionsof a beneficial kind. By the habitual encouragement of selffeeling, and by an egoistic development in all the relations oflife, a character may, by imperceptible degrees, be so framedthat insanity is the natural and consummate evolution of it,while every step taken in such deterioration will so far predispose to insanity under adverse circ*mstances of life. It is bythe influence of a good education and a sound training that wemay expect, not only to neutralize a predisposition to insanity inthe individual, but to counteract that tendency to an increaseof mental disease in the community, which is attributable tosome of the concomitant evils of civilization. The external advantages of civilization should naturally lead to a better internalculture, so that in its higher stages a remedy may be furnishedfor some of the evils which it produces in its earlier stages.It is hardly necessary to point out how ill adapted the presentsystem of female education is to store the mind with usefulknowledge, and to train up a strong character. It is peculiarlyfitted for the frivolous purposes of female life; but that it is sois its greatest condemnation. "Those who have seriously contemplated," Feuchtersleben remarks, " the female education ofour times (undoubtedly the partie honteuse of the moderns) willfind it, in this etiological respect, much more influential thanthat of the other sex. It combines everything that can heightensensibility, weaken spontaneity, give a preponderance to thesexual sphere, and sanction the feelings and impulses that relateto it." As the education of women is widened, deepened, andimproved, other and better resources will be discovered andearnestly used, and the reaction of a higher mode of life onfemale education and female nature cannot fail to be mostbeneficial.Religion. I have said that the practical religion of the day,the real guiding gospel of life, is money-getting the professedreligion is Christianity. Now, without asserting that riches arenot to be gotten by honest industry, it may be maintained thatthe eager passion to get rich-honestly it may be, but if not,still to get rich-is often inconsistent with the spirit of thegospel professed. The too frequent consequence is, that lifebecomes a systematic inconsistency, or an organized hypocrisy.1 ] ON THE CAUSES OF INSANITY. 239With a profession of faith that angels might adopt, there is toooften a rule of practice which devils need not disdain. I do notspeak here of those whose religion is a mere social observance,which it beseems a man of respectability willing to stand wellwith his neighbours to conform to. Such persons will, in all probability, belong to the Church of England, which is eminentlythe 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 desiresto avoid anything that is extreme, and insists only on the maintenance of the social proprieties; it is the established religion,and, in close alliance with the governing classes, it aims at thepreservation of the established state of things. But it may bequestioned whether the Church of England really reaches thepoor and struggling, those who truly need a gospel of life . Thoseof them who have any religion at all belong, for the most part,to two religious bodies into which the two extreme parties inthe English Church insensibly merge-to Roman Catholicismand Methodism. When, therefore, we have to consider a religionreally influencing life, when we have to weigh its effect on character as predisposing or not to insanity, we have practically todeal with Roman Catholicism, actual or abortive, or with Dissentin some of its forms. I do not hesitate to express a convictionthat the excitement of religious feelings, and the moroseness ofthe religious life, favoured by some of the Dissenters, arehabitually injurious to the character, and sometimes a directcause of insanity. Young women who fail to get married areapt to betake themselves fervently to religious exercises, andthus to find an outlet for repressed feeling in an extreme devotional life; having of necessity much self- feeling, they naturallyfly to a system which expressly sanctions and encourages a habitof attention to the feelings and thoughts-a self- brooding-andwhich attracts to them the sympathy and interest of others.This is not, nor can it come to, good: as the man whose everyorgan is in perfect health scarcely knows that he has a body,and only is made conscious that he has organs when somethingmorbid is going on, so a healthy mind, in the full exercise of itsfunctions, is not conscious that it has feelings, and is onlyawakened to self- consciousness by something morbid in the2240 ONTHE CAUSES OF INSANITY. [ CHAP.processes of its activity. To fly for refuge to the contemplationof one's own feelings and thoughts is in direct frustration ofthe purposes of one's being as an element in nature, and in thedirect way of predisposing to insanity. It is only in actionsthat we truly live, and by our actions that we can truly knowourselves. How mischievous, then, any encouragement of amorbid self-feeling, religious or otherwise, is likely to be, it iseasy to perceive. Among the cases of mental disease that havecome under my care, there are some in which the cause of theoutbreak has been satisfactorily traceable to religious influenceinjudiciously exerted. Not amongst Dissenters only, but amongstthose members of the High Church party in the Church ofEngland who are so much addicted to playing at Roman Catholicism, the most baneful effect is sometimes produced on womenthrough the ignorant influence and misapplied zeal of priests,who mistake for deep religious feeling what is really at times amorbid 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 religioussects, which every now and then appear in a community anddisgust it by the offensive way in which they commingle religionand love, are really inspired by an uncontrolled and disorderedsexual instinct. They are compounds of systematic knaveryand of vain folly verging on madness: on the one hand, thecunning of a hypocritical rogue (who may, perhaps, have sogrown to the habit of his knavery as to deceive himself as wellas others) using the weaknesses of weak women to minister tohis vanity or his lust under a religious guise; on the otherhand, an exaggerated self-feeling, rooted often in sexual passion,which is fostered under a spiritual cloak, and drives its victimon to madness or to sin. The holy kiss of love owes all itswarmth to the sexual impulse which inspires it, consciously orunconsciously, and the mystical religious union of the sexesleads directly to a less spiritual union.The Roman Catholic religion cannot, I believe, be justlycharged with any such positive influence for evil on those whohave been born and bred up within its pale. On them its effectis rather to arrest mental development by imposing the divineauthority of the Church, and thus keeping the mind in leading-1. ] ON THE CAUSES OF INSANITY. 241strings. The unquestioning faith demanded and accorded as thehabit of life is not calculated to predispose to insanity. But theinfluence of Roman Catholicism, as represented by some of theover- zealous perverts from the English Church, is in the highestdegree mischievous: it is a hotbed, fostering the weaknesses ofweak women, the morbid tendencies of those who are half insane,and, too often, the evil impulses of the vicious. It becomes thecongenial refuge of those who are so afflicted with restlesspassions, ill-regulated feelings, and selfish impulses, that theyare unable to conform long to their social duties and relations,and are ever eager for change, excitement, and attention, atwhatever cost. Without doubt a hot religious perversion, andthe earnest display of a feverish religious zeal, are, in someinstances, really a phase in the manifestations of a morbiddisposition, not unlikely to pass at some time into actual mentalderangement.The question of religion generally, apart from any particularform of religion, as an agency influencing in a powerful mannerfor good or evil the minds of men, and therefore predisposing ornot to mental degeneracy, I must leave untouched, not only because of the difficulty and the delicacy of the subject, but becauseof the impossibility of doing justice to a matter of such transcendent importance in a brief and incidental manner. It wouldbe necessary to attempt soberly and faithfully to estimate theinfluence of religious belief, not upon any particular mind norat any particular time, but upon the common mind of mankind,upon its development through time. Three great questionswould naturally present themselves for discussion:-First, whatinfluence 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 enervatethe intellect? Secondly, what has been the practical effectworked on the hearts of men by the fear of punishment andthe hope of reward after death; whether their feelings anddesires have been beneficially affected, and how far affected, bypossibilities which always seem so far off; or whether, as someargue, their feelings have thereby been deadened and their intelligence blinded to the certain laws by which their sins, or errors,or crimes, are always avenged in this world on themselves or onR242 ON THE CAUSES OF INSANITY. [CHAP.others? Thirdly, what has been the practical effect producedon the character and conduct of the many by the belief thatthrough prayer they might obviate the effects of their own wantof foresight, or want of self-renunciation, and rely upon supernatural aid where the will failed? It would be necessary also,in considering the vast influence which the moral code inculcated by all religions has exerted upon the conduct of mankind,to weigh the actual effect upon character of the profession ofmoral maxims and precepts which have sometimes been tooexalted 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, itis necessary to bear in mind that a person's particular creed isto some extent the result of his character and mode of development. The egoist whose vanity and self-love have not otheroutlets of display will manifest his disposition in his religiousviews and practice. The victim of a morbid self- feeling, or anextreme self-conceit, will find in a certain religious zeal the convenient gratification of an egoistic passion, of the real natureof which he himself is ignorant. Those who make it theirbusiness to get rich by over-reaching and deceiving others, invariably end by over-reaching and deceiving themselves in thesincere assumption of religious observances entirely inconsistentwith the tenor of their daily lives. When such persons becomeinsane, we cannot truly say that religion has been the cause ofthe disease, although it can admit of no question that themental degeneration, which has been the natural issue of themode of development of the character, has found circ*mstancesvery favourable to its increase in the religious views and practices adopted.Condition of Life. -The statistics hitherto collected withreference to this point are of little or no value. Whether aparticular 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, orwhether they are addicted to intemperance and riotous living.On the whole, however, those who work with the head are moreliable to mental disease than those who work with the hand,and they are less likely to recover when once attacked: theE1.]ONTHECAUSESOFINSANITY.243more complex mental organization of the former, and thegreater activity of function, will render it conceivable howthis may be. The aristocratic or privileged classes of everycountry have in their privileges the elements of corruptionand decay; and degeneracy of one sort or another is sure,sooner or later, to become rife in them. There is grave reasonto suspect that insanity is of disproportionate frequency amongstthe aristocracy of this country. Other things being equal, it iscertain that insanity is more frequent amongst the unmarriedthan amongst the married.Age and Period of Life.-Insanity is rare before puberty,although it is certain that every form of it, except generalparalysis, may occur even so early in life. Idiocy is the mostcommon form of mental defect in the early years of life; andeven the cases of mania met with occasionally in childrenpartake much of the character of idiocy, and might not improperly be described as examples of excited idiocy. Themental organization has not been completely accomplished, andthe symptoms of its degeneration are therefore somewhatuniform in character. Between the ages of sixteen and twentyfive, insanity is far more frequent; but it is the most frequentof all during the period of full mental and bodily development-from twenty-five to forty-five-when the mental functions aremost active, and when there is the widest exposure to its causes.The internal revolution which takes place in women at theclimacteric period leads to many outbreaks of a melancholicinsanity in them between forty and fifty. In the male thereappears to be a climacteric period between fifty and sixty, wheninsanity sometimes supervenes. In old people symptoms ofmental derangement sometimes precede for a time softening ofthe brain and dementia; an old man may be found to be keeping a mistress in secret, or to be making foolish proposals ofmarriage, when sensual impulses only mock extinct sexualfunctions.Hereditary Predisposition. -The more exact and scrupulousthe researches made, the more distinctly is displayed the influence of hereditary taint in the production of insanity. It isunfortunately impossible to get exact or accurate informationon this subject. So strong is the foolish feeling of disgraceR 2244 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 denymost earnestly the existence of any hereditary taint, when allthe time the indications of it are most positive; yes, when itsexistence is well known, and they must know that it is wellknown. To elicit an acknowledgment of the truth in some ofthese cases would be as difficult a task as to elicit from auerring woman a confession of her single frailty. Not even itsprevalence in royal families has sufficed to make insanity afashionable disease. The main value, indeed, of the manydoubtful statistics collected in reference to the question of thefrequency of hereditary taint is to prove that, with the increaseof opportunities of obtaining exact information, the greater is theproportion of cases of insanity in which its presence is detectable. The proportion is put by some authors-as Moreau-ashigh as nine-tenths, by others as low as one-tenth; the mostcareful researches agreeing to fix it as not lower than one- fourth,if not so high as one-half. Of fifty insane persons, taken without any selection, the family histories of whom I was able totrace with considerable precision, there was strongly markedhereditary predisposition -that is, there was the positiveevidence of an inherited predisposition to insanity-in fourteencases; while in ten more there was sufficient evidence of aninborn defect of nerve element, not due to actual insanity inany of the immediate ancestors, but to an infirmity acquired bythem in consequence of degenerative influences at work. Twoimportant considerations in regard to this question should havefull weight given them: first, that the native infirmity or taintmay be of very different degrees of intensity, so as, on the onehand, to conspire only with certain more or less powerful exciting causes, or, on the other hand, to give rise to insanity evenamidst the most favourable external circ*mstances; secondly,that not insanity only in the parents, but any form of nervousdisease in them-epilepsy, hysteria, and even neuralgia-maypredispose to insanity in the offspring, as, conversely, insanityin the parent may predispose to other kinds of nervous diseasein the offspring. Whatever, then, may be the exact number ofcases in which hereditary predisposition is positively ascertained,it may, I think, be broadly asserted that, in the great majority1.] ON THE CAUSES OF INSANITY. 245of cases, whether there has been observable madness or not infather or mother, or some remoter relative , there has been someconstitutional instability or infirmity of nervous element in theindividual whereby he has been unable to rally against adversity, and has broken down in insanity. Infinitely various asthe constitutional idiosyncrasies of men notably are, it is easyto perceive how impossible it is that statistics should ever giveexact information concerning the causation of insanity; here, asin so many instances of their application, their value is thatthey settle distinctly the existence of a certain tendency, so tospeak, which, once fixed, affords a good starting-point for furtherand more rigorous researches: they indicate the direction offuture investigation.Careful inquiries into the sundry and manifold causes ofnervous degeneration could not fail to attract attention to themetamorphoses which diseases undergo in hereditary transmission, as a matter demanding exact study. We certainly distinguish in our nomenclature the different nervous diseases, but,as we actually meet with them in practice, the disorders of thedifferent nervous centres may occasionally blend, or combine, orreplace one another in a remarkable manner, so as to give riseto varieties of disease intermediate between those which arecommonly regarded as typical. Now this circ*mstance, manifest enough in individual life, is much more plainly displayedwhen we trace the history and progress of nervous diseasethrough generations. If, instead of limiting attention to theindividual, we scan the organic evolution and decay of a family-processes which, as in the organism, are sometimes going onsimultaneously-then it is made sufficiently evident how closeare the fundamental relations of nervous diseases, how artificialthe divisions between them sometimes appear. Epilepsy in theparent may become insanity in the offspring, or insanity in theparent epilepsy in the child; and chorea or convulsions in thechild may be the consequence of great nervous excitability,natural or accidental, in the mother. In families in which thereis a strong predisposition to insanity, it is not uncommon to findone member afflicted with one form of nervous disease, andanother with another; one suffers perhaps from epilepsy orchorea, another from neuralgia or hysteria, a third may commit246 ON THE CAUSES OF INSANITY. [CHAP.suicide, and a fourth become maniacal or melancholic. Generalparalysis is a disease which is usually the result of continuedexcesses of one sort or another; but it may unquestionablyoccur without any marked excesses, and when it does so therewill mostly be discoverable a hereditary taint in the individual.More than this: an innate taint or infirmity of nerve elementmay modify in a striking manner the mode of manifestation ofother diseases; where it exists, gout flying about the body mayproduce obscure nervous symptoms, so as greatly to puzzle theinexperienced practitioner; and the syphilitic poison is similarlyapt to seize upon the weak part, and to give rise to severenervous symptoms. On the other hand, it can admit of noquestion that a parental disease which does not specially affectthe nervous system, may, notwithstanding, be at the foundationof a delicate nervous constitution in the offspring: phthisis,scrofula, syphilis, probably also gout and diabetes, sometimes actthus banefully. An interesting circ*mstance in connexion withdiabetes, which affords a certain argument in favour of itsnervous origin, is that it has been observed to occur in familiesin which there existed a predisposition to nervous or mentaldiseases. Again, it is a disease which appears to be sometimescaused in man by mental anxiety, while it may be producedartificially in animals by irritation of the floor of the fourthventricle and of other adjacent parts of the nervous system.The interesting researches of Morel into the formation ofdegenerate or morbid varieties of the human race have served tofurnish a philosophical view of the chain of events by whichcauses that give rise to individual degeneracy continue theirmorbid action through generations, and finally issue in theextinction of the family. When some of the evil influences

• " I saw very recently a boy, æt 14, who was afflicted with extremely

severe tic, throwing his head sideways with an excessively abrupt gyratorymotion, and uttering a short sharp cry. I had seen him before during thesummer of 1860, and he then used to utter fierce cries every moment, withouthis mind seeming to be in the least impaired . His eldest brother had for severalyears suffered from facial spasm, characterised by grimaces during which all themuscles of his face were violently convulsed . His father has been affected with locomotor ataxy for the last twenty years. His paternal grandfather committedsuicide in a fit of monomania, and several of his relatives on his mother's sidehave been insane. "-TROUSSEAU, Clinical Lectures.1. ] ON THE CAUSES OF INSANITY. 247which notably give rise to disease-whether the poisoned atmosphere of a marshy district, or the unknown endemic causes ofcretinism, or the overcrowding and starvation of our large towns,or persistent intemperance of any kind, or frequent intermarriages in families, or any other of the sources of humandegeneracy-have engendered a morbid variety, the evil will,unless counteracted by better influences brought to bear, increasethrough generations, until the degeneration has gone so far thatthe continuance of the species is impossible. Indeed, insanityof 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 mentally unsound persons for a generation or two, and as is sometimes demonstrated by the disastrous consequences of frequentintermarriages in foolish families. Morel relates the history ofone family, which may be adduced as a typical example of thecourse of degeneration proceeding unchecked, and which may besummed up thus:-First generation. - Immorality. Alcoholic excess. Brutaldegradation.Second generation. - Hereditary drunkenness. Maniacal attacks. General paralysis.Third generation. Sobriety. Hypochondria. Lypemania.Systematic mania. Homicidal tendencies.Fourth generation. -Feeble intelligence. Stupidity. Firstattack of mania at sixteen. Transition to complete idiocy, andprobable extinction of the family.In this degeneration going on through generations we have aretrograde movement which is the opposite of that progressivespecialization, and increasing complexity of relation with theexternal, which have already been described as characteristic ofadvancing development. In place of sound and proper elements,which may take their due place and perform their function harmoniously in the social organism, there are produced morbidvarieties fit only for excretion. For, in truth, we may not improperly compare the social fabric to the bodily organism in thisregard as in bodily disease there is a retrograde metamorphosisof formative action, and morbid elements are produced, so in theappearance of insanity in individuals we have examples of the248 ON THE CAUSES OF INSANITY. [CHAP.formation of morbid varieties in the social organism, and theevidence of a degeneration of the human kind. And as in thebody morbid elements cannot minister to healthy action, but, ifnot got rid of, give rise to disorder, and even death; so in thesocial fabric morbid varieties are themselves on the way ofdeath, and if not sequestrated in the social system, or extrudedfrom it, inevitably engender disorder incompatible with itsstability. But, however much man may degenerate from hishigh estate, he never really reverts to the exact type of theanimal, though he may sink lower than it: the so-called theroiddegeneration, spoken of by some writers, signifies no more thana resemblance to the animals. As it is among plants, wheredegeneration 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 thewrecks.Baillarger has confirmed what Esquirol had observed, thatinsanity descends more often from the mother than the father,and from the mother to the daughters more often than to thesons. From a Report presented to the French Government byM. Béhic, it appears that of 1,000 admissions of each sex intoFrench asylums, 264 males and 266 females had suffered fromhereditary predisposition to insanity; of the 264 males 128inherited the disease from their father, 110 from the mother,and 26 from both parents; of the 266 females, 100 inheritedfrom the father, 130 from the mother, and 36 from both parents.Children born before the outbreak of an attack are less likely tosuffer than those born after an outbreak.Thus much concerning the remote or predisposing causes ofinsanity; it remains nowto set forth the direct or proximatecauses of defect or derangement of the supreme centres of intelligence. In doing this it will be most convenient, and in theend most philosophical, to describe them under similar divisionsto those under which have already been grouped the causes ofdisorder of the sensori-motor and spinal centres -in other words,to treat of the causation of insanity from a pathological pointof view.1.] ON THE CAUSES OF INSANITY. 249THE PROXIMATE CAUSES OF DISORDER OF THE IDEATIONAL NERVOUS CENTRES, THE SUPREME GANGLIONIC CELLS OF THECEREBRAL HEMISPHERES, THE INTELLECTORIUM COMMUNE.1. Original Differences in the Constitution of the Supreme Nervous Centres. —It is most certain that there exist great naturaldifferences between different people in respect of the development of their cerebral convolutions. In the lower races of menthese are visibly less complex and more symmetrical than inthe higher races; the anatomical differences corresponding withdifferences in intellectual capacity. Place a Bushman, with hisinferior type of brain, in the complex circ*mstances of civilizedlife; and though he may represent a high grade of developmentof his lower type, he is to all intents and purposes, as Gratioletallows, an idiot, and must, unless otherwise cared for, inevitablyperish in the severe competition for existence. And if a person,from some arrest of the natural development, is born amongstcivilized people with a brain of no higher order than the naturalbrain of the Bushman, it is plain that he will be more or less ofan idiot; a higher type of brain, arrested by morbid causes ata low grade of development, is brought to the level of a lowertype of brain which has arrived at its full development. As VonBaer long ago pointed out, the actual position of a particularanimal in the scale of life is determined, not by the type alone,nor by the grade of development alone, but by the product ofthe type and the grade of development.The principal varieties of defective brain met with may bebriefly indicated here as falling under one of the followingdivisions:-• (a) There are idiots of the microcephalic type, in whom anarrest of cerebral development has taken place, and a palpablydefective brain is met with in consequence. Malacarne was atthe pains carefully to count the lamina of the cerebellum inidiots and in men of intelligence, and he found them to be lessnumerous in the former than in the latter. Now, these laminæare less numerous in the chimpanzee and the orang than in man,and still less numerous in other monkeys; so far, therefore, thereis 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 beena complete arrest of development at the fifth month of foetal life:there were no posterior lobes, the cerebellum being only halfcovered by the cerebral hemispheres. Gratiolet found in thebrain of a microcephalic idiot, aged seven, the under surface ofthe anterior lobes much hollowed, with great convexity of theorbital arches, as is the rule in the monkey. * Mr. Marshall hascarefully examined, and described in an elaborate paper, thebrains of two idiots of European descent: the convolutions werefewer in number than in the apes, individually less complex,broader, and smoother-" In this respect," he observes, "theidiots ' 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 condition of the cerebra in the idiots is neither the result of atrophy,nor of a mere arrest of growth, but consists essentially in animperfect evolution of the cerebral hemispheres or their parts,dependent on an arrest of development, he points out the stronggrounds there are for inferring that, after the cessation of evolutional changes, the cerebra experience an increase of size generally, or a mere growth of their several parts. Consequently thecerebra are much larger than foetal cerebra in which the convolutional development is at a similar stage; whilst the individualconvolutions themselves, though the same in number, are necessarily broader and deeper. Not only is the brain-weight inmicrocephalous idiocy very low absolutely, as the instructivetables of Dr. Thurnam show, but the relative amount of brainto body is " extraordinarily" diminished. Thus in the two idiotsdescribed by Mr. Marshall, the proportion of brain to body wasonly as 1 to 140 in the female, and as 1 to 67 in the male, thenormal proportions being as 1 to 33 and as 1 to 14 respectively.It is not necessary that I quote more authorities to prove thatsmall-headed idiots have small brains, and sometimes even fewerand more simple convolutions than the chimpanzee and theorang; that man, thus made a morbid kind by an arrest ofdevelopment, is brought to a lower level than that of his nearest

• Anatomie comparée du Système Nerveux.

+ Philosophical Transactions, loc. cit.1.] ON THE CAUSES OF INSANITY. 251related fellow animal. * A strict examination of the stories ofwild men, as of Peter the Wild Boy, and the young savage ofAveyron, has proved that these were really cases of defectiveorganization-pathological specimens.†(b) In idiots or imbeciles of the Cretin type, where the morbidcondition is endemic, the defect seems to depend on certainmorbid changes which primarily affect the skull rather than thebrain. Injurious influences, affecting the general processes ofthe bodily nutrition, prevent the normal growth of the bones,and lead to a premature ossification of the sutures, and a consequent narrowing of the skull at th part where this happens.Secondary wide interference with the development of other partsof the skull and compensating enlargements in other directionsfollow the primary evil, and give rise to cranial deformities ofvarious kinds. Of necessity the natural growth of the brain ishindered by those morbid changes; and it is no wonder thatthe deformed head of the Cretin is accompanied with a torpidapathetic character and with great mental deficiency. As theevil changes are commonly not manifest until a year or moreafter birth, an objection might well be made to the descriptionof them as original defects; but whatever the nature of theunknown morbid influence which is the cause of cretinism ,whether malarious or not, it can admit of no question that itacts upon the mother perniciously, and predetermines the cretinism of the child.(e) It is obvious that an arrest of the development of thebrain occurring soon after birth may give rise to idiocy just ascertainly as an arrest occurring some time before birth. Andalthough an objection might here again be made to the description of such a defect as original, yet if we reflect that theimportant development of the brain as the supreme organ of theconscious 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 mentalweakness or idiocy during life . Dr. Julius Sander has collected ten cases, whichappear to be all the cases hitherto recorded of this defect, and described them in Griesinger's Archiv. für Psychiatrie und Nervenkrankheiten, b. i. 1868.+ Observations on the deranged Manifestations of the Mind.heim, M.D. Also, Lectures on Man. By W. Lawrence, F. R.S.By J. S. Spurz-252 ON THE CAUSES OF INSANITY. [CHAP.take place after birth, we may admit a defect rendering suchdevelopment impossible, to be, though not congenital, practicallyoriginal. There are many idiots in whom the brain and bodyappear to be well formed, while the mental development remainsat the lowest stage. Accidental affections of the brain arrestingits development after birth, while the rest of the body goesthrough its normal growth, have occurred in some of these cases;epilepsy is not uncommonly such a cause of idiocy; but it isimpossible in some cases to assign any definite cause of thearrest. Other idiotic creatures have the development of thebody as well as mind arrested: the extremest cases of this kindare those in which there has been a complete cessation of growthat an early period of childhood, without any observable deformity.Dancel has recorded the case of a girl, aged twenty-four, who haddeveloped normally up to the age of three and a half years, afterwhich no further growth took place until she reached eighteenand a half years, her bodily and mental condition being that ofa child of three and a half years old. At twenty-one she increased a little more in size, and then remained unchanged forthe rest of life. Baillarger exhibited, in May 1857, to the FrenchAcademy of Medicine, a young woman aged twenty- seven, whoonly had the intelligence and inclinations of a child four yearsold, and who was about three feet high. I have seen a somewhat similar instance in an idiot boy. These extreme andsingular cases are well calculated to excite surprise and curiosity;they are, however, only the manifest consequences of a deficiencyin developmental power which is not unfrequently met with inless marked degree, and which is actually witnessed in everysort of degree. In any large idiot asylum there are to be found.some who, without any particular deformity, without any observable disease of brain or defective development of it, aregenerally sluggish both in bodily and mental development; theirsize is small; their sexual development takes place late in life,or perhaps does not take place at all; they often exhibit somepeculiarity of countenance, perhaps a squint; in mental capacitythey are in advance of the true idiots, for they can learn a little,are capable of remembering, and, perhaps, imitate cleverly someof them constitute the " show-cases " of the idiot asylum whenthey are in it; and when they are not, they may become difficult.1.] ON THE CAUSES OF INSANITY. 253cases for medico- legal inquiry, in which the decision come to,whatever it be, may be challenged not without reason. All theconcern that we have with them here is to draw from them thecertain conclusion that there may, by reason of unknown conditions affecting nutrition, be every degree of imperfect development of mind and body down to actual incapacity to developat all.The causes of the defective cerebral development which is thephysical condition of idiocy are often traceable to parents.Frequent intermarriage in families may undoubtedly lead to a degeneration which manifests itself in individuals by deaf mutism,albinonism, and idiocy. * Parental intemperance and excess, according to Dr. Howe, hold high places as causes of convulsions,idiocy, and imbecility in children; out of 300 idiots in the Stateof Massachusetts, whose histories were carefully investigated, asmany as 145 were the offspring of intemperate parents. Here,as elsewhere in nature, like produces like; and the parent whomakes himself a temporary lunatic or idiot by his degrading vice,propagates his kind in procreation, and entails on his childrenthe curse of the most hopeless fate. Again, the natural term ofinsanity proceeding unchecked through generations is, as Morelhas shown, sterile idiocy. When men wilfully frustrate thenoble purposes of their being, and selfishly ignore the laws ofhereditary transmission, nature takes the matter out of theirhands, and puts a stop to the propagation of degeneracy.During fœtal life great fright or other mental agitation affecting the mother, or irregularities and excesses on her part, andduring parturition injury to its head, may occasion a congenitalmental defect in the child. But many of the causes of idiocyoperate after birth up to the third or fourth year. They areepilepsy, the acute exanthemata, perhaps syphilis, and certainlystarvation, dirt, and overcrowding.When there are no such signs of degeneracy as to warrantthe mention of idiocy even in its mildest form, there is stillabundant room for physical causes of psychical defect, withoutour being able to recognise them. The exceeding sensibility of

• On Consanguineous Marriages. By Arthur Mitchell, M.D. -Edinburgh 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 isalmost instantaneously felt at any distance, is the sure testimonyof delicate, active, but occult movements of its molecules which,like thermal oscillations or undulations of light, or the intimatemolecular conditions of colour, belong to that inner life of naturethat is still impenetrable to our most delicate means of investigation, still inaccessible to our most subtile inquiries. Who cansay what is the nature of those hidden molecular activities whichare the direct causes of our different tastes and smells? Couldwe but ascertain what these intimate operations essentially are,we might perhaps attain to some knowledge of the intimateconstitution of bodies; indeed it seems not improbable that inthe scientific cultivation and development of the senses of tasteand smell, as the eye, the ear, and the touch have been cultivatedand developed, we may ultimately gain some means of insightinto the inner recesses of nature.A second reason why there may be numerous and seriousdefects of nervous structure without its being possible to recognise them, is based upon the infinitely complex and exquisitelydelicate structure of the cortical layers of the hemispheres. Itwould certainly be most unwarrantable to assume that thephysical paths of nervous function in the supreme centres maynot be actually obliterated without our being any the wiser, whenit was only yesterday, so to speak, that men succeeded, afterinfinite patient research, in demonstrating a direct communicationbetween the different nerve-cells, and between nerve fibres andcells. The obliteration of such a physical communication in thesupreme centres would simply render impossible a certain association of ideas, or the transference of the activity of the idea toa nerve-fibre-the function and the expression of mind.Thirdly, it must be admitted that, all question of defect ofphysical structure put aside, the extremest derangement offunction might be due to chemical changes in nerve element-changes which, in the present state of knowledge, are stillless discoverable in so complex a compound than physicalchanges. Examine the cells of a man's brain at the end of a dayof great mental activity, and at the beginning of a day after agood night's rest; what difference would be detectable? Nonewhatever; yet the actual difference is between a decomposition.1.]ON THE CAUSES OF INSANITY. 255and a recomposition of nerve element-between a capacity andan incapacity of function.It is beyond question, then, that there may be modifications ofthe polar molecules of nerve element, changes in its chemicalcomposition, and defects in the physical constitution of nervouscentres, entirely undetectable by us, all of which do neverthelessgravely affect function, and are thus most surely testified .To affirm, then, that all men are born equal, as is sometimesheedlessly done, is to make about as palpably untrue a proposition as it is possible to make in so many words. There is asgreat a variety of minds as there observably is of faces or ofvoices as no two faces and no two voices are exactly alike, soare no two minds exact counterparts of one another. Men differgreatly both in original capacity and in quality of brain. Insome there is the potentiality of great and varied development,whilst in others there is the innate incapacity of any development; and between the two extremes every gradation exists.There are important differences also in the quality of the brainin different people: in some the mental reaction to impressionsis sluggish and incomplete, and, without being idiots, they areslow at perception and stupid; in others, the reaction, thoughnot quick, is very complete, and they retain ideas very firmly,although they are slow at acquiring them; in some, again, thereaction is rapid and lively, but evanescent, so that, thoughquick at perception, they retain ideas with difficulty; while inothers, that just equilibrium between the internal and externalexists by which the reaction is exactly adequate to the impression, and the consequent assimilation is most complete. Thesenatural differences in the taking up of impressions plainly holdgood also of the further processes of digestion and combinationof idea, which in the progress of mental development followupon the concrete perception. It is easy surely to perceive thatwe have, as original facts of nature, every kind of variation inthe quality of mind and in the degree of reasoning capacity.So long as we are unable to discover any explanation of thecausation of a fact which yet seems to stand out very distinctly,it is wonderful how difficult it is to accept it heartily, how easyindeed it becomes to overlook it habitually; but as soon as wehave attained to a knowledge of its cause and relations, then the256 ON THE CAUSES OF INSANITY [CHAP..recognition of it becomes a part of our habit of thought and perception: it has entered into our mental organization. Becauseit has been the fashion to look upon an individual as if hewere the product of an independent creative act, and a selfsufficient being-because men commonly look not beyond asingle link in the chain of causation-therefore it has beenimpossible hitherto to uproot the erroneous notion, explicitlydeclared or implicitly held, that each one is endowed by naturewith a certain fixed mental potentiality of uniform character.But now that observation reveals more and more clearly everyday how much the capacity and character, bodily and mental, ofthe individual is dependent upon his ancestral antecedents, it isimpossible to deny that a man may suffer irremediable ill throughthe misfortune of a bad descent. Each one is a link in the chainof organic beings, a physical consequent of physical antecedents;the idiot is not an accident, nor the irreclaimable criminal anunaccountable casualty; the laws of causality have sway hereas elsewhere in nature. It cannot, therefore, but be of theutmost importance, when tracing the causation of insanity, toweigh closely the elements of the individual character.Viewed on its physical side, as it rightly should be viewed, apredisposition to insanity means nothing less than an actualdefect or vice of some kind in the constitution or composition ofthe nerve element of which the mental phenomena are functionalmanifestations; there is an instability of organic compositionwhich is the direct result of certain unfavourable physical antecedents. The retrograde metamorphosis of mind, manifest in thedifferent kinds of insanity, and proceeding as far as actual extinction in extreme examples of dementia, is the further physicalconsequence of the hidden defect of constitution or compositionof nerve element. It is easy enough, no doubt, to point on theone hand, to the nervous substance of the infertile idiot's brain,and on the other hand, to that of the philosopher's, and to maintain that the kind of organic element of which they are constituted is the same, as it certainly appears to be; but so longas we have no exact knowledge of the constitution of nerveelement, such an assertion is an unwarrantable assumption;and, while the functional effects are so vastly different in thetwo cases, there are the most valid reasons for contradicting it.1. ] ON THE CAUSES OF INSANITY. 257The conclusion, then, at which we have arrived is, that whenan individual is, by reason of a bad descent, born with a predisposition to insanity, he has a native constitution of nerveelement which, whatever name may be given to it, is unstableor defective, rendering him unequal to bear the severe stress ofadverse events. In other words, the man has the insane temperament; 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 surprising him, instigates eccentric or extravagant actions; whilean extraordinary and trying emergency may upset his stabilityentirely. If it were thought desirable to give a name to thistemperament or diathesis, as in algebra we employ a letter torepresent an unknown quantity, it might properly be describedas the Diathesis spasmodica or the Neurosis spasmodica; suchnames expressing very well an essential character of the temperament, that is, the tendency to independent and spasmodicaction on the part of the different nervous centres. There is , infact, some inherent instability of nervous element, wherebythe mutual reaction of the nerve- cells in the higher walks ofnervous function does not take place properly, and due consentor co- ordination of function is replaced by irregular and purposeless independent reaction outwards: there is , as it were, a loss ofthe power of self- control in the individual nerve- cell, an inabilityof calm self- contained activity, subordinate or co-ordinate, andits energy is dissipated in an explosive display, which, likethe impulsive action of the passionate man, surely denotes anirritable weakness. Here, as elsewhere, co - ordination of functionsignifies power, innate or acquired, and marks exaltation oforganic development. Assuredly the worst of all tyrannies isthe tyranny of a bad organization, the best of all inheritancesthe inheritance of a good descent.Is it not very plain, then, how impossible it is to do full justiceto any individual, sane or insane, by considering him as anisolated fact? Beneath his conscious activity and reflectionthere lies the unconscious inborn nature which all unawaresmingles continually in the events of life-the spontaneitywhence spring the sources of desire and the impulses of action;for the conscious and the unconscious, like warp and woof,S258 ON THE CAUSES OF INSANITY. [CHAP.together constitute the texture of life. No one, be he ever socunning in dissimulation or crafty in reticence, can conceal ormisrepresent himself; in spite of art his real nature reveals.itself in every movement of the part which he plays, in everypulsation of his life. The inborn nature constitutes the foundation upon which all the acquisitions of development must rest,the substratum in which all conscious mental phenomena arefundamentally rooted. When it is radically defective, no amountof systematic labour will avail to counterbalance entirely thedefect: it were as hopeless to attempt to rear the massive structure of a royal palace upon foundations dug only for a cottage asto impose the superstructure of a large, vigorous, and completeculture upon the rotten foundations which an inherited taint ofnerve element implies: something will always be wanting, somecrack in the building will discover the instability of the foundations, even when the whole structure does not fall " in ruinhurled." Any mental philosophy which takes no notice of thefoundations of the character, but ignores the important individualdifferences of nature, does not truly reflect the facts, and cannotfail to be a provisional and transitory system. It is guilty, infact, of the same error as that into which an introspectivepsychology falls , when, isolating the particular state of mind, andneglecting 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'sorganic evolution, it transforms him into an abstract and impossible entity, and often judges his actions with a most unjustjudgment.2. Quantity and Quality of the Blood.- The grey centres ofthe brain, and especially the cortical layers of the hemispheres,are well known to be richly supplied with blood-vessels, evenwhen comparison is made with the notably abundant supply ofthe spinal centres. The ideational cells demand for the dueexercise of their functions a rapid renewal of arterial blood, andthere is obviously an active interchange of some kind continually going on between the blood and the nervous elements.The quantity and quality of the blood, therefore, circulatingthrough the supreme centres, must affect their functions in animportant manner, especially as they are the most sensitive1.] ON THE CAUSES OF INSANITY. 259elements of the body in this regard. When the most skilfulchemist is unable to detect anything unusual in the atmosphereof a room in which are many people, a delicate woman may geta headache and actually faint away. Send through the brain ofany one blood charged with carbonic acid, and destiny could notdoom him not to die; whilst a mixture of air and carbonic acidin certain proportions, inspired like chloroform, will, like it, actas an anæsthetic, paralysing consciousness.When there is a rapid flow of healthy blood through thesupreme cerebral centres, a quick interchange goes on betweenthe nerve-cells and the blood, and the excitation and interaction of ideas proceed with great vivacity. The effect of activethought is to produce such a determination of blood, which inturn is the necessary condition of the continuance of the activefunction. But when a natural determination of blood degenerates into a greater or less stasis or congestion, as it may easilydo when intellectual activity is too much prolonged, or whencongestion is otherwise produced, then there is an inability tothink; confusion of thought, emotional depression and irritability, swimming in the head, disturbance of sight and of hearing,testify to a morbid condition of things. It is striking how completely a slight congestion of the brain may incapacitate any onefor mental activity, and how entirely the strong man is prostratedthereby an afflicting stagnation of ideas accompanies the stagnation of blood; and he, heretofore so strong and confident, realizesin vivid affright on how slight a thread hangs the whole fabricof his intellect. If the morbid state should, instead of remainingpassive, or passing away altogether, become active, as it doeswhen actual inflammation occurs, then the functional activity ofthe cerebral cells becomes most irregular and degenerate; theco-ordination of function maintained in health is lost, as that ofthe spinal cord is under like circ*mstances, and a wild and incoherent delirium witnesses to the independent and, if we mightso speak, convulsive action of the different cells: the deliriousideas are the expression of a condition of things in the supremecentres which is the counterpart of that which in the spinalcentres utters itself in spasmodic movements or convulsions.With the destruction of that co-ordination of function whichvolition implies the will is necessarily abolished; and suchs 2260 ON THE CAUSES OF INSANITY. [CHAP.purposeless or dangerous acts as the delirious being executes are.dictated by the morbid ideas that automatically arise. Somewith inconsiderate haste speak of this degenerate activity in itsearlier stages as increased mental activity, as they also speak ofactive inflammation as increased vital action; not otherwisethan 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,though signifying nothing, were the safe index of a high mentalactivity. Dr. Mason Cox pointed out long ago that in certain ofthe insane the pulse in the radial and carotid arteries sometimesdiffered, being soft and weak in the former when full and hardin the latter. Of no small interest, in relation to the influenceof the supply of blood to the brain, are the vigour and renewalof action sometimes imparted by an attack of fever to a brainenfeebled by chronic insanity; patients in an advanced state ofinsanity even becoming quite rational for a time during fever,and relapsing after its subsidence; or a demented patient, whousually exhibits no spark of intelligence, then quickening intoa certain mental activity. *Since the time of Hippocrates it has been known that whenthere is too little blood in the brain symptoms are exhibitedsimilar to those which are produced by a congestion of blood:pains and swimming in the head, confusion and incapacity ofthought, affections of the senses and of movement, occur inExamples of such revival of cerebral functions during fever have been relatedby 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 mindmay be rather suppressed than destroyed. Ayoung woman, who was employedas a domestic servant by the father of the relater when he was a boy, becameinsane, and at length sunk into a state of perfect idiocy (dementia) . In this condition 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 surprised to observe, as the fever advanced, a development of the mental powers.During that period of the fever when others are delirious, this patient wasentirely rational. She recognised, in the face of her medical attendant, the sonof her old master whom she had known so many years before; and she relatedmany circ*mstances respecting the family, and others which had happened toherself in her earlier days. But, alas! it was only the gleam of reason; as thefever abated, clouds again enveloped the mind; she sauk into her former deplorable state, and remained in it until her death, which happened a few yearsafterwards. "-Description of the Retreat near York, p. 137. By Samuel Tuke 1813.1.] .ON THE CAUSES OF INSANITY. 261consequence of anæmia of the brain as certainly as they do inconsequence of congestion. In both cases the due nutrition ofthe nerve-cell, which is the agent of cerebral function, is greatlyhindered; and much of the ill effect is similar though the causeappears to be so different. In reality, however, the causes arenot so different when we proceed to analyse the conditionscomprised under the terms anæmia and congestion. In thatcontinued relation between the organic element and the bloodby which the due reparative material is brought and wastematter carried away, it amounts to much the same thing whether,through stasis of the blood, the refuse is not carried off andreparative material brought to the spot where it is wanted,or whether the like result ensues by reason of a defective bloodand deficient circulation: it is little matter to the inhabitantswhether the street is almost blocked, or whether its entrance isalmost closed, so long as free circulation is prevented. If thecarotid arteries of a dog be tied, and pressure be then made onits vertebral arteries, as was done by Sir A. Cooper, the functionsof the brain are entirely suspended-the animal falls into a deepcoma, its respiration ceases in a few moments, and it appears tobe dead; but, if the pressure be removed from the vertebralarteries, the manifestations of life reappear, and the animal regainsrapidly the integrity of its cerebral functions. Brown- Séquardhas made this experiment: he severed the head of a dog fromits body, and, at the expiration of about eight or ten minutes,when all traces of excitability had disappeared in the medullaoblongata and the rest of the encephalon, he made, by meansof a suitable apparatus, repeated injections of defibrinated andoxygenated blood into the carotid and vertebral arteries. At theend of two or three minutes, after some irregular movements, hefound the manifestations of life reappear; there were visible,in the muscles of the eyes and of the face, movements whichappeared to indicate that the cerebral functions were re-established in the head separated from the body.Temporary irregularities in the supply of blood to the supremenervous centres may, and often do, pass away without leavingany ill consequences behind them; but when they recur frequently, and become more lasting, their disappearance is byno means the disappearance of the entire evil the effect has262 ON THE CAUSES OF INSANITY. [ CHAP.become a cause that continues in action after the original causehas been removed; and permanent mental disorder may be thusestablished. Once the habit of morbid action is fixed in a part,it continues as naturally as, under better auspices, the normalphysiological action. It is ever, therefore, of the first importanceto give timely heed to the earliest warning which morbid actiongives; but it is of especial importance to do so in the case oforganic element so exceedingly susceptible and so exquisitelydelicate as is nerve element.A perverted condition of the blood quickly exercises a markedeffect upon the function of the supreme cerebral cells. Theinfluence of alcohol upon the mental function furnishes the simplest instance in illustration of the action of a foreign matterintroduced into the blood from without: here, where each phaseof an artificially- produced insanity is successively passed throughin a brief space of time, we have the abstract and brief chronicleof the history of insanity. The first effect of alcohol is to produce an agreeable excitement, a lively flow of ideas, and a generalactivity of mind-a condition not unlike that which sometimesprecedes an attack of mania; then there follows, as in insanity,the automatic excitation of ideas which start up and follow oneanother without order, so that more or less incoherence of thoughtand speech is exhibited, while at the same time passion is easilyexcited, which takes different forms, according to the individualtemperament; after this stage has lasted for a time, in somelonger, in others shorter, it passes into one of depression andmaudlin melancholy, as convulsion passes into paralysis; thelast scene of all being one of dementia and stupor. The differentstages of mental disorder are compressed into a short period oftime because the action of the poison is quick and transitory;we have only to spread the poisonous action over years, as theregular drunkard does, and we may get a chronic and enduringinsanity in which the scenes above described are more slowlyacted. The chronic insanity so produced has been called theinsanity of alcoholization; its most constant symptoms are hallucinations of hearing, and sometimes of touch, leading to thebelief in persecution by spies, mesmeric action, magnetic influence, and like evil agencies; the memory is usually muchenfeebled, the intellect dull, and the higher sentiments are1.] ON THE CAUSES OF INSANITY. 263blunted. Or, if death cuts short the career of the individual ,and puts a stop to the full development of the tragedy in hislife, we may still not be disappointed of seeing it played out inthe lives of his descendants; for the drunkenness of the parentsometimes observably becomes the insanity of the offspring,which thereupon, if not interfered with, goes through the courseof degeneracy already described. It is worth while to take notehere how differently alcohol affects different people, accordingto their temperaments, ever bringing forward the unconsciousreal nature of the man: of one it makes a furious maniac forthe time being; another it makes maudlin and melancholic;and a third under its influence is stupid and heavy from thebeginning. So it is with insanity otherwise caused: the particular constitution or temperament, rather than the excitingcause of the disease, determines the form which the madnesstakes. An exact differential pathology would involve the knowledge of what constitutes individual temperament.Many other poisons besides alcohol, as opium, belladonna,Indian hemp, stimulate and ultimately derange the function ofthe supreme cerebral cells. It is deserving of remark that the different nervous centres of the body manifest elective affinities forparticular poisons: while the spinal centres have a special affinityfor strychnine, the cerebral centres seem to be unaffected by it;belladonna, on the other hand, seems rather to depress spinalactivity, but produces a great effect upon the centres of consciousness, giving rise, at an early period of its action, to deliriumcharacterised by extreme delusions; and Indian hemp concentrates its action mainly on the sensory centres, exciting remarkable hallucinations. That medicinal substances do display theseelective affinities is a proof, at any rate, that there are importantthough delicate differences in the constitution or composition ofthe different nervous centres, notwithstanding that we are unableto detect the nature of them. It may be also that there is shadowedout in these different effects of poisons on the nervous system ameans which may ultimately be of use in the investigation ofthe constitution of the latter. Though the rapid recovery fromthe effects of these poisons proves that the combination whichthey form with nerve element is temporary, it must be borne inmind with regard to them, as with regard to alcohol, that the264 ON THE CAUSES OF INSANITY. [СПАР.nervous system, when repeatedly exposed to their poisonousinfluence, 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 continuedabuse-they are efficient to initiate a degeneracy which thenproceeds of itself.But the condition of the blood may be perverted by reason ofsomething bred in it , or by reason of the retention in it of somesubstance which should rightly be excreted from it. Withoutany change whatsoever having taken place in his external relations, the presence of bile in his blood may drive any one toregard his surroundings and his future in the gloomiest lightimaginable; he may know that a few hours ago things lookedquite differently, and may believe that in a few hours more theywill again have a different aspect, yet for the time being he isthe victim of a humour which he cannot withstand. Philosophyis of no avail to him; for philosophy cannot remove that condition of nervous element which the impure blood has engendered,and which is the occasion of his gloomy feelings and painfulconceptions. Carry this morbid state of nervous element to afurther stage of degeneration, there ensues the genuine melancholia of insanity. In like manner the presence of some urinaryproduct in the blood of a gouty patient gives rise to an irritabilitywhich no amount of mental control can remove, though it maysucceed sometimes in repressing its manifestations. The mentaltone being, as already set forth, the expression of a physicalcondition of nervous element, is beyond conscious determinationjust as the delirium and convulsions of the patient dying fromuræmic poisoning are beyond control. All writers on gout areagreed that a suppressed gout may produce severe mental disorder, and that the sudden disappearance of a gouty swelling issometimes followed by an outbreak of insanity. Lord Chatham,who was so great a martyr to that disease, had an attack of distressing melancholy lasting for nearly two years, from which heonly recovered after an attack of the usual gouty paroxysm. Ihave recently seen two cases of severe melancholia in elderlypersons of the gouty diathesis, in which the best results followedthe treatment suitable to gout; and in one old lady, who wasdeeply melancholic, rheumatism seemed finally to take the place1.] ON THE CAUSES OF INSANITY. 265of the mental unsoundness. It can admit of no question thatevery degree of mental disorder, from the mildest feeling ofmelancholic depression to the extremest fury of delirium, maybe due to the non-evacuation from the blood of the wastematters of the tissues; but as we know very little at presentof the nature of those waste products of the retrograde metamorphosis, and of the different transformations which theyundergo before they are eliminated, we must rest content withthe general statement, and set ourselves in practice to prosecuterigorous inquiries into the particular instances. The irregularities of menstruation, which are so common in insanity, are ofgreat importance in regard to this question: the return of themenses at their due season not unfrequently heralds recovery;and, on the other hand. severe exacerbations of epilepsy andinsanity sometimes coincide with the menstrual period. In onecase of a demented epileptic under my care, the fits always cameon at the time of menstruation, and continued in severe formduring the progress of that function; but there were commonlyno fits in the intervals: on the other hand, many cases are onrecord, 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 aliving, developingfluid, that, "burnished with a living splendour," it circulatesthrough the body, supplying the material for the nutrition ofthe various tissues, receiving again their waste matter andcarrying it to those parts where it may either be appropriatedand removed by nutrition or eliminated by secretion, —it is plainthat multitudinous changes are continually taking place in itsconstitution and composition; that its existence is a continuedmetastasis. There is the widest possibility, therefore, of abnormal changes in some of the manifold processes of its complexlife and function, such as may generate products injurious orfatal to the nutrition of the different tissues. The blood itselfmay not reach its proper growth and development by reason ofsome defect in the function of the glands that minister to itsformation, or, carrying the cause still further back, by reason ofwretched conditions of life; there is in consequence a defectivenutrition generally, as in scrofulous persons, and the nervous266 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 anæmia, we have an observable defect in the blood and palpablenervous suffering in consequence; headaches, giddiness, lowspirits, and susceptibility to emotional excitement reveal themorbid effects. Poverty of blood, it can admit of no doubt,plays the same weighty part in the production of insanity as itdoes in the production of other nervous diseases, such as hysteria,chorea, neuralgia, and even epilepsy. The exhaustion producedby lactation is a well- recognised cause of mental derangement;and a great loss of blood during childbirth has sometimes beenthe cause of an outbreak of insanity. But while we can thusdetect an evil so manifest as a great loss of blood or a deficiencyof iron in the blood, there are good reasons to think that othergraver defects in its constitution or development, of which wecan give no account, do exist and give rise to secondary nervousdegeneration. It is in this way probably that ill conditions ofexistence, as overcrowding, bad air, insufficient food, intemperance, lead to defects of nervous development, or to actualarrest thereof, and thus produce mental as well as physicaldeterioration 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 mostbaneful manner upon the supreme nervous centres. That theseorganic poisons do act in a definite manner on the organicelements, and give rise to definite morbid actions, is proved bythe symptoms of such diseases as syphilis and small-pox. Now,tho general laws observable in the actions of morbid poisonsappear for the most part similar to those which govern theaction of medicinal substances; and as the Woorara poisoncompletely paralyses the nerves and does not affect the muscles,or as strychnia poisons the spinal centres, and leaves the cerebral centres unaffected, so it may be presumed that a particularorganic virus may have a predominant affinity for a particularnervous centre, and work its mischievous work there. It iscertain that in some states of the constitution an organic virusis generated in the blood, or elsewhere in the organism, whichalmost 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 asa poisonous dose of prussic acid. With what marvellous destructive force certain morbid materials bred in the blood, orpassing into it, may act, is shown, as Mr. Paget has pointedout, in certain cases of so-called putrid infection in which thepatient dies after an injury or a surgical operation before therehas been time to feel the after- consequences, or in some casesof malignant typhus where the virus is directly fatal to nerveelement before the fever has had time to develop itself. It iseasily conceivable that a virus which, when concentrated, produces fatal results, may, when acting with less intensity, giverise to nervous derangement which stops short of death. Thesyphilitic virus usually affects the nervous system more or lessseverely at one period or other of its action; but in someinstances it appears to select the nervous system specially forits pernicious influence, or to concentrate its action upon it, soas to produce a hopeless insanity. There are cases on recordagain, in which mental derangement has appeared as the intermittent symptoms of ague; instead of the usual symptoms thepatient has had an intermittent insanity in regular tertian orquartan attacks, and has been cured by the treatment for intermittent fever. * Sydenham observed and describes a species ofmania supervening on an epidemic of intermittent fever; contrary to all other kinds of madness, he says, it would not yield toplentiful venesection and purging; slight evacuations producingthe relapse of a convalescent, and violent ones inevitably rendering the patients idiotic and incurable. Griesinger directs specialA young man in an agueish district suffered from five brief attacks of mentalderangement, one occurring every other day. The attacks began with an indescribable 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 patientrecovered 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 headwas 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. [CHAP.attention to cases in which mental disorder has occurred in thecourse of acute rheumatism, the swelling of the joints meanwhile subsiding; and Arnold has known cases of people subjectto frequent fits of gout who have had none while suffering froman attack of insanity. The viruses of acute fevers, as typhusand typhoid, may notably act in the most positive manner onthe supreme nervous cells, giving rise to an active delirium orsometimes to a more or less enduring insanity; and, where theydo not act directly at the height of the fever, they may stillpredispose to an outbreak of insanity during the decline of theacute disease. Not only may a morbid poison thus attack thenervous system, or a part of it, but it should be borne in mindthat a particular virus will most likely produce its special effects,not otherwise than as tea and coffee commonly produce wakefulness while opium produces sleep.The earliest and mildest mental effect by which a pervertedstate of blood declares itself is not in the production of positivedelusion or of incoherence of thought, but in a modification ofthe mental tone. Feelings of discomfort or depression, of irritability or uneasiness, testify to some modification of the staticalcondition of nervous element; and a great disposition to emotional subjectivity is the psychical manifestation of this state.It may exist in different degrees of intensity, from the slightirritability or gloom which attends upon a sluggish liver, or thegreater irritability which the urea in the blood of the goutysubject produces, to that profound depression which we describeas melancholia, or that active degeneration of function which wedesignate mania. Though there may be no active delusion, theemotional perversion existing by itself, yet the ideas which ariseunder such circ*mstances do not fail to experience the influenceof the morbid feeling, but are strongly tinctured by it; they areobscure, or painful, or, at any rate, not faithfully representativeof external circ*mstances. The morbid character of the depression lies, not in the depression itself, which would be natural ornormal so long as there was an adequate external cause of it,but in its existence without any external cause, in the discordbetween the individual and his circ*mstances. But as there isan irresistible disposition in the mind to represent its feelings asqualities of the external object, as in all our mental life we con-1.] ON THE CAUSES OF INSANITY. 269tinually make this projection outwards of our subjective states,it commonly happens after a while that the victim of an internally caused emotional perversion seeks for an objectivecause of it, and, thinking to find one, gets a delusion: beingin discord with the external, he establishes an equilibrium between himself and it by creation of a surrounding in harmonywith his inner life. The form which the delusion takes may bea natural crystallization or condensation, so to speak, of the particular morbid emotion which prevails, or it may be suggested,as it often is, by some prominent external event. What wehave to bear in mind with regard to the organic nature of thedelusion is, that a series of ideational cells have now enteredupon the habit of a definite morbid action; that the generalcommotion of nerve element, which the emotional disturbanceimplied, has now centred in a particular form of diseased action,not otherwise than as general inflammatory disturbance of somepart of the organism issues in a definite morbid growth there.For although a temporary emotional disturbance produced bybad blood may completely pass away with the purification ofthe blood, yet the prolonged continuance or frequent recurrenceof such morbid influence will inevitably end in the ideationalnerve- cell, as elsewhere, in chronic morbid action, which, onceestablished, is not easily got rid of. Thus, then, it appears thatthe first effect of the chronic action of impure blood is to produce a general disturbance of the psychical tone or indefinitemorbid emotion; and the further effect of its continued actionis to engender a chronic delusion of some kind—a systematization of the morbid action. But a third effect of its more acuteaction, as witnessed in the effects of acute fevers and of certainpoisons, is to produce more or less active delirium and generalincoherence of thought: the poison is distributed generallythrough the supreme centres by the circulation, and, actingdirectly upon the different cells, excites ideas rapidly and without order or coherence: the delirium is not systematic, andthere is good hope of its passing away. The approaches of thissort of delirium in fever illustrate many of the phenomena ofinsanity. First, there are wandering images or thoughts, knownto be unreal, and often described by the patient, who recognisestheir character, as nonsense; then there follows vague rambling270 ON THE CAUSES OF INSANITY [ CHAP. .talk, from which he may be aroused by talking to him, thoughhe falls back into it as soon as he has answered; afterwards thestate of complete delirium comes on, when the mind is entirelypossessed by unreal images and false thoughts uncontrolled byimpressions from without. A general incoherence equally unsystematized, but which never can pass away save with lifeitself, is the natural issue of long-continued chronic morbidaction in the supreme centres: it is the chronic dementia following continued insanity, and marking mental disorganization.I mention it here in order to render pathologically intelligiblethe very different prognosis in acute dementia from that inchronic dementia.It is before all things necessary to keep stedfastly in viewthat the relation between the supreme nervous centres and theblood is fundamentally of the same kind as that between otherparts of the body and their blood supply, and that the disordered mental phenomena are the functional indications ofmorbid organic action. Firmly grasping this just conception,as we may do by calling to mind the mode of nutritive actionin other parts of the body, we get rid of the notion of a delusion as some abstract, ideal, and incomprehensible entity,and recognise it as the definite expression of a certain form ofmorbid action in certain of the supreme centres, neither morenor less wonderful than the persistence of a definite morbidaction in any other organ. If there is defective or disorderednutrition of the brain, and some striking event or some powerfulshock produces a great impression on the mind, constraining itinto a particular form of activity-in other words, engrossingits whole energy in a particular gloomy reflection-what more inaccordance with analogy than that this should take on a chronicmorbid action, and issue in the production of a delusion? Anygreat passion in the sound mind notably calls up kindred ideas,which thereupon tend to keep it up; and it is plain that themorbid exaggeration of this natural process must lead to theproduction of delusion.3. Sympathy or Reflex Irritation. -Like every other nervouscentre, or like any other part of the organism, the supremecells of the ideational centres may be deranged by reason ofa morbid cause of irritation in some other part of the body.1.]ON THE CAUSES OF INSANITY. 271Why such morbid effect should be produced at one time andnot at another, or in one person and not in another, it is impossible to say, just as it is impossible to explain how it isthat a wound in the hand or elsewhere at one time gives riseto tetanus and at another time to no such desperate consequence, or why epilepsy should be caused by an eccentric irritation in one case and not in another. "Afever, delirium, andviolent convulsions, " says Dr. Whytt, " have been produced by apin sticking in the coats of the stomach; and worms affectingeither this part or the intestines occasion a surprising varietyof symptoms.' These effects were of old attributed to asympathy or consent of parts, -terms which were, thoughequally void of any real explanation, quite as expressive asthe modern reflex irritation." *Amongst many other instances which might be quoted inillustration of this manner of pathological action, a case recordedby Baron Larrey is a striking example. A soldier, who hadbeen shot in the abdomen, had a fistulous opening on theright side, which passed inwards and towards the left. When asound was introduced into this opening and made to touch thedeeper parts, immediately singular attacks supervened: firstthere was a feeling of coldness and oppressive pain, then a convulsive contraction of the abdomen and spasm of the limbs;after which the man fell into a sort of somnambulism, andtalked incoherently, this stage ending after about thirty minutesin a melancholy depression which from the time of the woundhad been habitual. Larrey attributed the hypochondria andother nervous symptoms to the injury which the cæliac axishad suffered from the ball. The direct effect of the sympathetic system upon the brain, which this case so strikinglyillustrates, Schroeder van der Kolk once verified in his ownexperience. After great mental exertion and an unaccustomedconstipation of a few days, he was attacked with a fever, forwhich his physician, deeming it nervous, would not sanctionany 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- Physiologischer 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 peoplearound him, although quite conscious that they were only phantasms. These continued for three days and increased, until hegot a thorough evacuation of a quantity of hardened fæces fromhis bowels, when all the morbid phenomena vanished in amoment. A man who came under my observation, havingsuffered for more than a year with profound melancholia, andwho had become greatly emaciated, passing at intervals piecesof tape-worm, recovered almost immediately after the expulsionof the whole of the worm by means of a dose of the oil of malefern. * Many like cases are on record in medical books; but itis not necessary to multiply instances in order to prove thatmorbid action in some part or organ of the body may be thecause of secondary functional and organic disorder of thesupreme nervous centres. It may be well to add, however,that affections of the uterus and its appendages afford notableexamples of a powerful sympathetic action upon the brain, andnot unfrequently play an important part in the production ofinsanity, especially of melancholia. M. Azam investigated thehistories 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 ofthe neck of the uterus in five cases; there was anteversion ofthe uterus, with congestion of its neck and ulceration of theinferior lip, in one case; in three cases there were fungous andfibrous growths of the uterus; and in one case there was painfulengorgement of it with leucorrhoea. Schroeder van der Kolkrelates the case of a woman profoundly melancholic , who suffered at the same time from prolapsus uteri, and in whom themelancholia used to disappear directly the uterus was restoredto its proper place; Flemming relates two similar cases in whichGriesinger has seen deep melancholia arise in an hysterical woman afteraccidental wound of the eye by a splinter. Herzog relates an instance of insanityafter the operation for strabismus. Jördens tells of a boy who was attackedwith 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, “ Ihave known sudden mania originate from the irritation of cutting the dentessapientiæ." ... " Violent nausea also from sea- sickness, continued for a fewhours, has produced mania in three instances within my knowledge. "1.] ON THE CAUSES OF INSANITY. 273the melancholia was cured by the use of a pessary, in one ofthem regularly returning whenever the pessary was removed;and I have in one instance seen severe melancholia of twoyears' duration disappear after the cure of a prolapsus uteri.Instances are on record in which a woman has regularly becomeinsane during each pregnancy; and, on the other hand, Guislainand Griesinger mention a case respectively in which insanitydisappeared during pregnancy, the patient at that time onlybeing rational. * These are striking examples of a mode of reflexaction which is a continual function of the organic life both inhealth and in disease. Perhaps the best opportunity of studyingthe early stages in the genesis of melancholia is afforded by themental depression that commonly accompanies certain uterinediseases. On the other hand, there is equally striking evidenceof this intimate sympathy of parts in the fact that morbidstates of organs favouring a certain mental disposition mayunquestionably be in turn caused by the latter when it isprimary and of long standing.Perhaps the most instructive example of the intimate organicsympathy of parts is afforded by the great mental revolutionwhich accompanies the development of the sexual system atpuberty-when there occurs, as Goethe aptly expresses it, “ anawakening of sensual impulses which clothe themselves inmental forms, of mental necessities which clothe themselves insensual images. " The great moral commotion produced at thisperiod is the cause of an unstable equilibrium of mind, which,if hereditary predisposition exist, may, without further auxiliarycause, issue in insanity. In any case it constitutes a frame ofmind favourable to the action of other causes of mental derangement. Dr. Skae is of opinion that a natural group orfamily might be formed of the cases of insanity occurring atthe period of pubescence, and dependent apparently upon thechanges 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 shecompelled 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 anurgent desire to eat the flesh of her husband, that she killed him and pickled theflesh, that it might serve for several banquets. (Prochaska on the NerrousSystem, Syd. Soc. translation. )T274 ON THE CAUSES OF INSANITY. [CHAP.development of puberty. He believes that the insanity thenoccurring presents certain characteristic features, most commonly manifesting itself in the form of mania, sometimesaccompanied by epileptic fits.It is uncertain whether the puerperal state acts as the occasional cause of a maniacal outbreak by this kind of sympatheticaction, or whether it acts in some other way; but there can beno doubt of the fact that a woman is sometimes attacked withmental alienation during delivery, and that her child may fall avictim to her frenzy. This form of puerperal insanity is differentfrom the insanity of pregnancy; different again in regard ofcausation from that which occurs a few days after delivery, andwhich is then probably due to blood-poisoning; and moredifferent still from that mental disorder occurring some weeks ormonths after, and due seemingly to the exhaustion produced bylactation, together with depressing moral influences . Under thename of Puerperal Insanity have sometimes been confoundedthe Insanity of Pregnancy, Puerperal Insanity, and Insanity ofLactation. Of 155 cases of so- called Puerperal Insanity admitted into the Edinburgh Asylum, 28 or 18:06 per cent. werecases of the Insanity of Pregnancy; 73 or 47 09 per cent. werecases of Puerperal Insanity proper; 54 or 348 per cent. werecases of Insanity of Lactation. Now these varieties, differentlycaused, 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 thecourse of insanity. Most women are susceptible, irritable, andcapricious at that period, any cause of vexation then affectingthem much more seriously than usual; some exhibit a disturbance of character which almost amounts to disease; and, inthe insane, exacerbations of the disease frequently occur at themenstrual periods. In a few rare cases, a sudden suppression ofthe menses has been followed by an outbreak of acute madness;but more frequently the suppression has occurred some timebefore the insanity, and acted as one link in the chain ofcauses. 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. 275may in some cases be an effect of the mental derangement.When menstruation ceases entirely at the change of life, a revolution takes place in the system, favouring the production ofinsanity in those predisposed to it, and sometimes sufficing toproduce it. Most women suffer some change of moral characterby the revolution which the whole economy of the constitutionundergoes at the change of life. The age of pleasing is past,but not always the desire; and it is now that jealousy, extremereligious sentiments, and a propensity to stimulants are aptto appear.The earliest and mildest effect of sympathetic morbid actionwill be, as it is with the effect of vitiated blood , to producea modification of the tone of nerve element, which is functionallymanifest in disordered emotion. But the continued operation ofthe morbid cause will be apt to lead to a systematized disorderin the supreme cerebral centres: in other words, to the production of a delusion or of a definite derangement of thought, whichthen is not always without discoverable relation to the primarymorbid cause. When, for example, a woman with morbid irritation of the sexual organs has salacious delusions, or with uterineor ovarian disease believes herself with child by the Holy Ghostor other supernatural means, the secondary derangement of thecerebral centres testifies to the special effect of the particulardiseased organ; and when the disordered action forces itself intoconsciousness, the interpretation given of it in the delusion witnesses to the nature of the primary morbid cause. Dr. Skae hasproposed to make a special group of the cases of insanity associated with ovarian and uterine disease; one of the most commonsymptoms presented by them being sexual hallucination. Thereis the most perfect harmony, the most intimate connexion orsympathy, between the different organs of the body as the expression of its organic life—a unity of the organism beneath consciousness; and the brain is quite aware that the body has aliver or a stomach, and feels the effects of disorder in any one ofthe organs, without declaring it directly in consciousness. Thisunconscious, but not unimportant, cerebral activity, which isthe expression of the organic sympathies of the brain, cannotfail, when rightly appreciated, to teach the lesson, already muchinsisted on, that every organic motion, visible or invisible,T 2276 ONTHE CAUSES OF INSANITY. [CHAP.sensible or insensible, ministrant to the noblest purposes or tothe humblest aims, does not pass away issueless, but has its dueeffect upon the whole, and thrills throughout the most complexrecesses of the mental life. *Though the morbid sympathetic action of a diseased organupon 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 consciousness, just as physiologically the idea does when its energyreaches a certain tension; declaring itself in the sensationalcentres by pain or some more special anomalous feeling, and inthe cognitional centres by emotional perversion or actual delusion. It often happens that no information is given until theprimary and secondary mischief are far advanced, and it is thenonly given indirectly; for while there is entire unconsciousnessof the primary disease in the distant organ, and an entire unconsciousness of the secondary morbid action in the brain, theeffect may nevertheless be positively attested by melancholia,delusion, or some other form of mental disorder. Esquirol graphically tells the story of a woman who thought she had in herbelly the whole tribe of apostles, prophets, and martyrs, andwho, when her pains were more than usual, railed at them fortheir greater activity. After death, her intestines were foundglued together by a chronic peritonitis. I have recently seen apatient suffering from chronic insanity, who fancies that he hasgot a man in his inside, and who, when his bowels get muchconstipated, as they are apt to do, makes the most desperateattempts, by vomiting and otherwise, to get rid of him. After apurgative, however, he is quite comfortable for a time, and hisdelusion subsides into the background. In the insanity attendedwith phthisis there are often delusions of suspicion which appearto 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. "-GEORGE HERBERT." There is, " says John Hunter, " a connexion of the living principle in the powersof one part with those of another, which might be called a species of intelligence. "1.] ON THE CAUSES OF INSANITY. 277the advance of the tubercle: one such patient under my carefancied that he was maliciously played upon by secret fire, interpreting in this way the actual increase of bodily temperaturewhich occurs during the progress of phthisis; he also imaginedthat a filthy disease had been produced in his mouth, the delusion probably having its origin in the perversion of smell ortaste resulting from the disease. Not only is the remote pathological effect of a diseased organ thus evinced by the occurrenceof some form of insanity, but, as already pointed out, a specialeffect of the particular morbid organ may be revealed in thecharacter of the delusion engendered . It is by virtue of thissympathetic action that dreams sometimes have a truly propheticcharacter in regard of certain bodily affections, the early and obscure indications of which have not been sufficiently marked toawaken any attention during the mental activity of the day, orat any rate to do more than produce a vague and formless feeling of discomfort; nevertheless they declare themselves in themental action of dreaming, when other impressions are shut out.When the disease ultimately declares itself distinctly in ourwaking consciousness, then the prophetic dream, the forewarning,is recalled to mind with wonder. The return of a certain moodof mind before an outbreak of recurrent insanity or of epilepticfits, such as has been displayed before former attacks, and enablesan experienced person to predict with certainty what is coming,and the recurrence of particular morbid ideas, feelings, and desires during the insane outbreak, may be, and probably oftenare, owing to a periodical revival of the morbid irritation in thedistant organ. There is abundant reason to believe that the brainretains a memory of the impressions received from the organiclife, even when the impressions are morbid. In those womenwhose mental dispositions are much affected sympathetically atthe menstrual periods, the same sort of feelings, susceptibilities ,caprices, and fancies recur. In this physiological and pathological action may lie also the explanation of the fact beforestated, that the thoughts and feelings of dreams, not rememberedin the waking state, may still appear in and influence the courseof subsequent dreams. After all, however, the most strikingexamples of this kind of action in its physiological form are metwith in the marvellous creations of dreams originating in states278 ON THE CAUSES OF INSANITY. [CHAP.of the sexual organs *-" tensio phalli visâ muliere nudâ etiamin insomnio"-these illustrating admirably the close sympathywhich prevails; while numerous examples of this kind of actionin its pathological form are furnished by the salacious delusionsof certain of the insane in whom there is derangement of thesexual system. In every large asylum are to be met with womenwho believe themselves to be visited every night by their lovers,or violently ravished in their sleep; and in some of these, as inSt. Catherine de Sienne and St. Theresa, a religious ecstasy isunited with their salacious delusions. Indeed, a religious fanaticism carried to a morbid degree is not seldom accompanied by acorresponding morbid lasciviousness; while religious feeling of aless extreme kind in some women, especially certain unmarriedand 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, thereexist the closest relations; in truth, they run insensibly intoone another. Thus the digestive organs have the closest sympathy with the sense of taste, as we observe in the bad tasteaccompanying indigestion, and especially perhaps in the avoidance of poisonous matters by animals; the respiratory organsand the sense of smell are in like manner intimately associated;and the sense of touch has close relations with the cœnæsthesis.In insanity we find these physiological relations become sometimes the occasions of delusions: derangement of the digestiveorgans, perverting the taste, gives rise to the delusion that thefood is poisoned; disease in the respiratory organs is sometimesthe cause of disagreeable subjective smells, which are thereuponattributed to an objective cause, such as the presence of a deadbody in the room; and more or less loss or perversion of sensibility in the skin, which is not uncommon amongst the insane,is frequently the occasion of extravagant delusions. A womanwhose case Esquirol relates, had complete anæsthesia of the surface of the skin: she believed that the devil had carried off herbody. A soldier who was severely wounded at the battle ofAusterlitz considered himself dead from that time: if he were"And as love and beauty stir up heat in other organs, so heat in the sameorgans, from whatever it proceeds, often causeth desire and the image of an unresisting beauty. "-HOBBES.1.] ON THE CAUSES OF INSANITY. 279asked how he was, he invariably replied, that " Lambert nolonger lives; a cannon-ball carried him away at Austerlitz.What you see here is not Lambert, but a badly imitatedmachine, " which he failed not to speak of as it. The sensibility of his skin was lost. A striking instance of delusion inconnexion with defective sensibility occurred in an amiable andamusing patient who was under my care suffering from generalparalysis. As the disease approached its end, the end of life, hehad severe epileptiform convulsions, which latterly affected theleft side only, and finally resulted in paralysis of that side.But, though the power of movement and feeling were entirelygone, there were frequent spasmodic twitchings of the musclesand convulsive contractions so strong as to raise the arm andleg of the paralysed side from the bed. The poor man had themost singular delusions respecting these movements: he thoughtthat 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 washabitual to him, he thus soliloquized aloud:-" What a powerthat damned fellow has over me! " Then after a severe convulsion, -" He has got me round the neck, and you dare not touchhim, not one of you. Oh! but it is a burning shame to let apoor fellow be murdered in this way in a public institution.It's that boy does this to me." Told that he was mistaken, hereplied, —" You may as well call me a liar at once he has gotme round the neck and he has me tight. Oh! it is a damnedshame to treat me in this way-the quietest man in the house."Then after a while,-" It's a strange power these lunatics haveover one. That boy is playing the devil with me: he stinksworse than a polecat: he'll take my life, sure enough." And soon continually, until the stupor of death overpowered him.Laudably anxious to give due weight to the perversions ofsensibility which are met with in insanity, Griesinger has madefive groups of mental disorder connected with different anomaliesof sensibility, and more frequently than not actually dependentupon them. The first of these is the præcordial form, wherethere are morbid sensation, sense of pressure, or pain about theepigastrium, from which follow fear and mental anguish, withcorresponding ideas and habits of thought. The second is the280 ON THE CAUSES OF INSANITY. [CHAP.vertiginous form, in which some anomaly of muscular sensibilityexists. In the third, which he calls the parasthetical form,there are anomalous sensations in different parts of the body,attributed by the patients commonly to external machinations.The fourth is the anasthetic form, in which absence of sensibilityis often the cause of self- mutilation. Lastly, there is the hallucinatory form, which obviously needs no further explanation here.It is undoubtedly of great importance to bestow scrupulousattention upon all the disorders of sensibility, as well as those ofnutrition and movement, which occur in the different sorts ofinsanity; to do so is an essential part of the physician's duty instudying the natural history of the disease; but it is quite impossible to make perversions of sensibility alone the basis of asystem of classification. Such a classification could not fail tohave an extremely artificial character, and an entirely theoreticalfoundation. All that it seems important to say here is, thatthese pathological phenomena confirm in a striking manner theobservations made in the First Part of this work concerning thecomprehension in the mental life of the whole bodily life.The centre of morbid irritation which is so apt at times togive rise to secondary disorder by reflex or sympathetic actionneed not be in some distant organ; it may be in the brainitself. A tumour, abscess, or local softening in the brain, maynowise interfere with the mental operations at one time, whileat another time it produces the gravest disorder of them; andit is not uncommon in abscess of the brain for the symptoms ofmental derangement, when there are any, to disappear entirelyfor a time, and then to return suddenly in all their gravity.When the motor, sensory, and ideational centres are not directlyimplicated in the disease, they may continue their functions inspite of it, and it does accordingly happen that they sometimesdo so even when there is the most serious mischief going onin the brain; but they may at any moment be affected by asympathetic or reflex action, and a secondary abolition or derangement of function may thus supervene without warning.Instances now and then occur in which a sudden loss of consciousness, or a sudden incoherence, or sudden mania, or evensudden death, takes place where no premonitory symptoms haveindicated grave local disease of the brain.1.] ON THE CAUSES OF INSANITY. 281Furthermore, it would appear that a limited disorder of theideational cells, such as is functionally manifest in the fixed.delusions of the so-called monomaniac, will not usually remainwithout some effect upon the other elements in the supremecentres. So delicately sympathetic and sensitive as nerveelement is, it is hard to conceive it possible that a centre ofmorbid action should fail to affect, by direct or by reflex action,neighbouring parts not immediately involved in the disease. Asa matter of observation it is certain that a greater or less disturbance of the tone of the whole mind does commonly accompany the limited delusions of a partial insanity; in fact, thecondition of things is that which has already been described asthe first stage of the affection of mind by other causes of itsderangement, namely, a modification of the mental tone. Thisbaneful effect of a limited local disorder is in strict accordancewith the analogy of what we observe elsewhere. Hereafter weshall have occasion to describe instances of the sudden andentire transference of active disorder of one nervous centre toanother; for, as Dr. Darwin long ago observed, " in some convulsive diseases a delirium or insanity supervenes and the convulsions cease; and, conversely, the convulsions shall superveneand the delirium cease.'It is necessary here, as in the spinal, sensory, and motorcentres, to distinguish between the degrees of secondary pathological disturbance to which a morbid cause may give rise. Thesudden way in which extreme mental symptoms appear, and theequally sudden way in which they sometimes disappear, as inabscess of the brain, prove that extreme derangement may bewhat is called functional; for it is impossible to suppose thatserious organic change has existed in such cases. Although,therefore, the functional disorder necessarily implies a molecularchange of some kind in the nervous element, the change may beassumed to be one affecting the polar molecules, such as theexperiments of Du Bois Reymond and others have proved mayIn what is called metastasis of disease the primary disease disappears, whereasin sympathy it remains in action . Old writers treat also of the conversion ofdiseases a very imperfectly cultivated department which is just beginning toattract attention again. Heberden suggests that madness, like gout, absorbsother distempers, and turns them perfectly to its own nature.282 ON THE CAUSES OF INSANITY. [CHAP.rapidly appear and rapidly disappear. The induction of recognisable temporary changes in the physical constitution andfunction by experiments certainly warrants the belief in similarmodifications by causes which are not artificially produced, butwhich are just as abnormal as if they were artificial. Thisprobable modification of the polar relations of nervous element,which disappears with the removal of the cause, will not fail, iftoo great or too prolonged, to degenerate into actual nutritivechange and structural disease, just as an emotion which observably often alters a secretion temporarily may, when long enduring, lead to actual nutritive change in the organ. The longera functional derangement is allowed to continue, the moredanger is there of structural disease; and this serious changeonce definitely established, the removal of the primary morbidcause will not suffice to remove an effect which has now becomean independently acting cause.4. Excessive Functional Activity. -As the manifestation offunction is the waste of matter, it is obvious that, if the dueintervals of periodical rest be not allowed for the restorationof the statical equilibrium of nerve element, degeneration of itmust take place as surely as if it were directly injured by amorbid poison or a mechanical or chemical irritant. It is sleepwhich thus knits up the ravelled structure of nerve element;for, during sleep, organic assimilation is restoring as staticalforce the power which has been expended in functional energy.The strongest mind, if continually overworked, will inevitablybreak down; one of the first symptoms that foreshadows thecoming mischief being sleeplessness. That which should healthe breach is rendered impossible by the extent of the breach.Like Hamlet, according to Polonius's fruitful imagination, theindividual falls into a sadness, thence into a watch, thence intoa lightness, and, by this declension, into the madness wherein hefinally raves. To provoke repose in him is the first condition ofrestoration; the power of it often closing the " eye of anguish,"and curing the " great breach in the abused nature " of nervouselement.It is, however, when intellectual activity is accompanied withgreat emotional agitation that it is most enervating-when themind is the theatre of great passions that its energy is soonest1.] ON THE CAUSES OF INSANITY. 283exhausted. What has already been said as to the instability ofnerve element which a great emotional susceptibility implies,will enable us to understand how this destructive effect is workedout. When an exceedingly painful event produces great sorrow,or a critical and uncertain event great anxiety, the mind isundergoing a passion or suffering; there is not an equilibriumbetween the internal life and the external circ*mstances; anduntil the mind is able duly to react, the passion must continue,-in other words, the wear and tear of nervous element must goon. Painful emotion is in reality psychical pain; and painhere, as elsewhere, is the outcry of suffering organic elementa prayer for deliverance and rest. The same objects or eventsdo notably produce very different impressions upon the mind.according to the condition of it at the time—according as something pleasant or something unpleasant has just happened . Ifthere exist a temporary depression of the psychical tone byreason of some misfortune that has happened, then an event,which under better auspices would have been indifferent, willexcite painful emotion, and, calling up congenial ideas of agloomy kind, continue and add to the mental suffering, just asreflex action increased by a morbid cause will in turn sometimesaggravate the original disorder. If there be a lasting depressionof the psychical tone by reason of some morbid cause, then everyevent is apt to aggravate the suffering, and one particularly unfavourable event, or a series of painful events, may lead to thedegeneration of insanity. After a piece of good news, or aftera man has just drunk a glass of sound wine, the psychical toneis such that there is a direct and adequate reaction to an unfavourable impression, and the individual will not suffer. Hereinthe supreme centres of thought do not differ from the inferiornervous centres; when the spinal centres are exhausted, excitability is increased, and an impression which under betterauspices would have produced no effect gives rise to degenerateactivity that displays itself in spasmodic movements—an explosion not unlike that which in the higher centre is manifestas emotion, or as an ebullition of passion. Excess is, however,a relative term; and a stress of function which would benothing more than normal to a powerful well- ordered mind, andconducive to its health, might be fatal to the stability of a feeble284 ON THE CAUSES OF INSANITY. [CHAP.and ill-regulated mind in which feeling habitually overswayedreason, or even to that of a strong mind temporarily prostrate.Thus it is that in examining into the causationof insanity inany case it is not sufficient to investigate only the series ofinfluences to which the individual has been subjected, but itis necessary also to ascertain what capacity at the time he hadof bearing them.It is evident from the foregoing reflections that, from a pathological point of view, the so-called moral causes of insanity mayproperly fall under the head of excessive stimulation or excessivefunctional action: the mind is subject to a stress beyond thatwhich it is able to bear. Of necessity the depressing passions arethe most efficient causes of exhaustion and consequent disease:grief, religious anxiety, disappointed affection or ambition, thewounds of an exaggerated self-love, and, above all perhaps, thepainful feeling of being unequal to responsibilities, or other likeconditions of mental agitation and suffering, are most apt toreach a violence of action by which the equilibrium is lost.Great intellectual activity, when unaccompanied by emotion, doesnot often lead to insanity; it is when the feelings are anxiouslyengaged that the mind is most moved and its stability mostendangered on the stage of mind as on the stage of the worldthe 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 intodefinite relations with regard to it, and made it, as it were, apart of the inner life, a sudden and entire change, shatteringlong cherished hopes, is not unlikely to produce insanity; forwhat is more fraught with danger to the stability of the strongestmind than a sudden great change in external circ*mstances,without the inner life having been gradually adapted thereto?Thence it comes that a great exaltation of fortune, as well as agreat affliction , rarely fails to affect for a time the strongest head,and sometimes quite overturns a weak one; the strong mindsucceeding after a time in establishing an equilibrium betweenitself and its new surroundings, which the feeble mind cannotdo. When depressing passion does not act directly as the causeof a sudden outbreak of insanity, it may still act mischievouslyby its long-continued evil influence on the organic life, and thus1.] ON THE CAUSES OF INSANITY. 285finally produce mental derangement. It is not often that menbecome insane, though they sometimes die, from excess of joy;and when one of the expansive passions, as ambition, religiousexaltation, overweening vanity in any of its Protean forms, leadsto mental derangement, it does not, like a painful passion, actdirectly as the cause of an outbreak, nor indirectly by producingorganic disorder and subsequent insanity; but it produces itseffects by degrees as an exaggerated development of a certainpeculiarity or vice of character.A fatal drain upon the vitality of the higher nervous centresmay in certain cases be produced by the excessive exercise ofa physical function-by an excessive sexual indulgence, or bycontinued self-abuse. Nothing is more certain than that eitherof these causes will produce an enervation of nerve elementwhich, if the exhausting vice be continued, passes by a furtherdeclension into degeneration and actual destruction thereof. Theflying pains and heaviness in the limbs, and the startings of themuscles, which follow an occasional sexual excess, are signs ofinstability of nerve element in the spinal centres, which, if thecause is in frequent operation, may end in inflammation andsoftening of the cord, and consequent paralysis. Nor do thesupreme centres always escape: the habit of self-abuse notablygives rise to a particular and disagreeable form of insanity, characterised by intense self-feeling and conceit, extreme perversionof feeling, and corresponding derangement of thought, in theearlier stages; and, later, by failure of intelligence, nocturnalhallucinations, and suicidal or homicidal propensities. Themental symptoms of general paralysis—a disease notably produced sometimes by sexual excess -betray a degenerate condition of nerve element in the higher centres, which is thecounterpart of that which in the lower centres is the cause ofthe loss of co-ordination of movement and of more or less spasmor paralysis. The great emotional excitability, the irritable feebleness, of the general paralytic, no less than the extravaganceof his ideas, marks a degeneration of the ideational cells of thesupreme centres; there is accordingly an inability to co- ordinateand perform his ideas successfully, just as there is an inabilityto perform movements successfully, because the spinal centresare similarly affected. It is not usual, however, for sexual286 ON THE CAUSES OF INSANITY. [ CHAP.excesses to produce insanity unless it be general paralysis; theyrather tend to produce epilepsy or some kind of paralysis. Selfabuse is a cause of insanity which would appear to be morefrequent and effective in men than in women. Apart from allquestion whether the vice be so common among women, theybear self-abuse, as they do sexual excesses, better than men.On the other hand, privation of sexual function is more injuriousto women than on men.5. Injuries and Diseases of the Brain and Nervous System notnecessarily, but occasionally, producing Insanity. -Injuries of thehead, when not followed by any immediate ill consequences,may still lead to insanity through the degenerative changeswhich they ultimately induce in the cortical layers of the hemispheres. Insolation notably acts perniciously on the supremecerebral centres, either by causing, as some imagine, acute hyperæmia and œdema, or, as is more probable, over- stimulation andconsequent exhaustion of nerve element. Abscesses and tumoursof the brain, cysticerci and effusions of blood, do not directly orcommonly produce mental derangement; when they do, it isprobably by a reflex or sympathetic action. Professor Gerhardtmentions one case in which mental disorder was the first symptomof an embolism, the paralytic phenomena following later; and ina case, related by Dr. L. Meyer, chronic tubercular meningitisgave rise to mental disorder. It has been already said that thereare instances on record in which insanity, like tetanus, has beencaused by peripheric injury of nerve, obscure as the manner ofoperation 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 disorderfollowing injury of the brain. Out of 500 insane, he traced mental disorder toinjury of the brain in 49 ( 42 men and 7 women) . In 21 cases there had beencomplete unconsciousness after the accident; in 16, some insensibility and confusion of ideas; in 12, simple dull headache. In 19 cases the mental disordercame on in the course of a year after the injury, but not till much later in manyothers, and in 4 cases after more than ten years. In most of the cases thepatients were disposed to congestion of the brain, excitement and great emotionaldisturbance, from the time of the injury, on taking a moderate quantity ofspirituous liquor; frequently there was singing in the ears, or difficulty of hearing,or hallucination; and very commonly the disposition was changed, and thepatient was prone to outbursts of anger or excesses. The prognosis was very unfavourable; the issue in 7 cases was dementia with paralysis, while 10 went on to death.1.] ON THE CAUSES OF INSANITY. 287made the observation that mental derangement sometimes occursas the transference of disorder from the spinal centres.Hysteria in some instances undoubtedly produces or passesinto insanity. An acute attack of maniacal excitement, with greatrestlessness, perverseness of conduct, loud and rapid conversation-sometimes blasphemous or obscene, laughing, singing, or rhyming, may follow the ordinary hysterical convulsions, or may occurinstead of these. Or the ordinary hysterical symptoms maypass by degrees into a chronic insanity; the patient losing moreand more self- control, becoming more fanciful about her health,and more indifferent to what is going on around her; the bodybecomes anæmic and emaciated, and there are usually irregularities of menstruation. An erotic element is sometimes evinced inthe 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 beplaced chorea and epilepsy, although what may be their exactseats in the nervous system is yet uncertain. Chorea in theadult is not unapt to terminate in insanity. It is necessary tobear in mind that there are different sorts of insanity connectedwith epilepsy. When the fits have recurred frequently, and thedisease has continued for a long time, it undoubtedly producesloss of memory, failure of mental power, and ultimately complete dementia. Again, a succession of severe fits may be followed by a condition of acute dementia which lasts for a shorttime, or by an acute, violent, and most dangerous mania whichusually passes away in a few days. Not only may acute maniathus follow epilepsy, but an attack of acute transitory mania—a true mania transitoria-may take the place of the epilepticparoxysm, representing a masked epilepsy. Lastly, in some casesa profound moral disturbance, an irritability, moroseness and perversion of character, lasting for months, with periodical exacerbations in which vicious or criminal acts may be perpetrated,precede the appearance of the regular epileptic fits, which thenthrow 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 occasionaleffect of tertiary syphilis, may lead to destructive consequencesby extension of morbid action to important parts beneath. There288 ON THE CAUSES OF INSANITY. [CHAP.are, however, other ways in which syphilis is now known to leadto mental disorder: a syphilitic node formed on the internalsurface of the skull may occasion secondary mental disease ofa grave kind; and, again, syphilis may give rise to inflammation of the membranes of the brain, followed sometimes by a lowdiffuse exudation in or between the membranes, or by a moreor less defined tumour (syphiloma); the result being a hopelessdementia, with gradually increasing paralysis. The syphiliticexudation sometimes, though rarely, takes place in the substanceof the brain itself; its starting-point then being the nuclei ofthe connective tissue which exists throughout the brain, and thedestruction of the nervous cells being secondary. But of this,more hereafter.CONCLUDING REMARKS.An important but obscure question, of which little thought isever taken now, is not so much what is the cause of the insanityas what is the cause of the particular form which the insanitytakes. The inborn temperament of the individual has certainlygreat influence in determining the kind of mental disorder, thesame external cause giving rise to different forms of diseaseaccording to the constitutional idiosyncrasy: the melancholictemperament will, it may be presumed, predispose to melancholicinsanity, the sanguine temperament to a more expansive derangement. On the other hand, injury of the head will tend toproduce intellectual disorder rather than emotional depression,while abdominal disease will favour the production of emotionaldepression; for the organic conditions of the integrity of theintellectual faculties are, as Müller has observed, mainly in thebrain itself, but " the elements which maintain the emotions orstrivings of self, in all parts of the organism." Furthermore, itis plain that the degree of development which the mind hasreached must determine in no slight measure the features of itsdisorder; the more cultivated the mind the more various andcomplex must be the symptoms of its derangement; while it isnot possible that the undeveloped mind of the child immediatelyafter birth should exhibit ideational disorder of any kind. Consider what an infinitely complex development the cultivatedmind has been shown to be, and what a long series of processes1.] ON THE CAUSES OF INSANITY. 289and what a variety of interworkings of so-called faculties evenits simpler conceptions involve; it will then be easily understood how great and varied may be the confusion and disorderof its morbid action . The different forms of insanity representdifferent phases of mental degeneration; and in the disorganization, degeneration , or retrograde metamorphosis of the mentalorganization-call the retrograde change what we will-- therewill be exhibited the wreck of culture. The morbid mentalphenomena of an insane Australian savage will of necessity bedifferent from the morbid mental phenomena of an insaneEuropean, just as the ruins of a palace must be vaster and morevaried than the ruins of a log hut. For the same reason theinsanity of early life always has more or less of the character ofimbecility or idiocy about it: as is the height so is the depth, asis the development so is the degeneration. The developmentof the sexual system at puberty, and the great revolution whichis thereby effected in the mental life, must needs often give acolour to the phenomena of insanity occurring after puberty.During the energy of mental function in active manhood maniais the form of degeneration which appears most frequently tooccur, while as age advances and energy declines melancholiabecomes more common. Future researches will probably discover the definite causes of the special features of many of thedifferent forms of insanity in the bodily disorders which causethem, or which are constantly associated with them. Then,instead of a vague psychological classification of insanity, wemay hope to attain to an exact medical history of the differentforms 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 characterand development, therefore no two cases of mental degeneration are exactly alike. The brain is different in the matter ofits development from other organs of the body; for while thedevelopment and function of other organs are nearly alike indifferent individuals, and the diseases of them accordingly havea general resemblance, the real development of the brain as theorgan of mental life only takes place after birth, and, presentingevery variety of individual function in health, presents alsoevery variety of morbid function: consequently, two cases ofU290 ON THE CAUSES OF INSANITY. [CHAP.insanity may resemble one another in the general features ofexaltation or depression, or in the character of the delusion, butwill still have their special features. Insanity is not any fixedmorbid entity; every instance of it is an example of individualdegeneration, and represents individual mental life under otherconditions than those which we agree to regard as normal ortypical. No more useful work could be undertaken in psychologythan an exact study of individual minds, sound and unsound.Still, although different cases will present their special details,there is a wonderful sameness about insanity, a great lack ofinvention; delusions repeat themselves in all lunatic asylums,and any one who has studied well the patients in one largeasylum knows the general features of the madness of all agesand of all countries, under all conditions and among all classesof men. Productive, in the sense of creative, activity is thehighest function of the highest and healthiest mind.Weigh carefully the manner of its causation, and it will appearthat mental derangement must be a matter of degree. Theremay be every variety (a) of deficient original capacity, (b) ofdeficient development of the mental organization after birth, and(c) of degree of degeneration. Between the lowest depths ofmadness, therefore, and the highest reach of mental soundness,there will be infinite varieties shading insensibly one intoanother-a very gentle gradient; so that no man will be able tosay positively where sanity ends and insanity begins, or todetermine with certainty in every case whether a particularperson is insane or not. The question of an individual's responsibility must then plainly be a most difficult one: there areinsane persons who are certainly responsible for what they do,and, on the other hand, there are sane people who under certaincirc*mstances are as plainly not responsible for their actions.A madman is notably capable of great self- control when hisinterest specially demands it; in the majority of cases he knowsfull well the difference between right and wrong; but, knowingthe right, he is instigated by the impulses of his morbid natureto do the wrong, and is not held in check by those motiveswhich suffice to restrain the sane portion of the community.Again, the investigation made into the causation of mentaldisease exhibits the necessity of taking wider views of its origin1.] ON THE CAUSES OF INSANITY. 291and import than is commonly done. Insanity marks a failurein organic adaptation to external nature: it is the result andevidence of a discord between the man and his surroundings: hecannot bend circ*mstances to himself nor accommodate himselfto circ*mstances. The lunatic has not learnt, nor can he learn,how much more noble, more conformable to Nature's laws, it isto merge his small individual discord in her harmonious unison,than to spoil the latter by it. Now, whosoever, either frominherited weakness of nature or from adverse circ*mstances, isunequal to the predetermined impulse or nisus of evolutionwhich is immanent in mankind, as in every other form of organiclife, must fall by the wayside and be left stranded. For as inthe stupendous progression of the human race whole nationsdrop away like dead branches from the living tree, so amongstnations individuals decay and perish in crowds as the deadleaves fall from the living branches. Nature indeed countsindividual life very cheaply: in the development of vegetableand animal life she sacrifices numberless seeds and germs, offifty bringing but one to bear, and in the organic evolution ofmankind she sacrifices with like lavish profusion countlessthousands 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 historyconveys they are instructive instances well fitted to teach thecauses of failure, and thus to indicate the method of a successfuladaptation to external nature. When he is thus brought intoharmony with nature, the development of the individual becomesthe consummate evolution of nature.APPENDIX.In order to illustrate more fully this chapter on the causation ofinsanity, I append here the short notes of fifty cases, all of which wereunder my care, and in which I laboured to satisfy myself of the conspiring 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,U 2292 ON [CHAP.THE CAUSES OF INSANITY.and he was wasting away with phthisis. Mental state, that of dementedmelancholia, with manifold delusions of suspicion. He was the lastof his family two brothers having died very much as he died. Hisgrandfather began life as a common porter, ultimately became partnerin a great manufacturing business, and, having amassed enormouswealth , made a great display in London on the strength of it. Hishigh hopes of founding a family on the wealth which it was the soleaim of his life to acquire have thus issued.2. There was direct hereditary predisposition, and the temperamentwas notably excitable through life. There was no evidence of excessesof any kind, but there had been many business anxieties. The mentaldisease was general paralysis.3. An amiable gentleman, on the death of his wife, formed aconnexion with a woman of loose character. Continual sexual excesses, with free indulgence in wine and other stimulants, ended ingeneral paralysis.4. A conceited co*ckney, the son of a successful London tailor andmoney-lender, strongly imbued with the tradesman's spirit, and with.offensive dissenting zeal. Hopelessly addicted to masturbation, andsuffering from the disagreeable form of mental derangement followingsuch cause.5. Two ladies of middle age, unmarried, and cousins. They bothsuffered from extreme moral insanity, both revealing in their conductthe tyranny of a bad organization. There was insanity in the fan.ily,in one case the father being actually insane; and in both cases theparents 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 coarsestexcesses, though of good social position and of independent means;justifying in every respect her conduct, though it more than oncebrought her to the gaol. Family history not ascertainable, but evidentlynot good organization in her. No aim nor occupation in life, butextreme egoistic development in all regards.7. A publican, æt. 31 , had done little for some time but stupifyhimself with brandy in his own bar- parlour. The consequence wasfurious mania and extreme incoherence: acute mania from continuedintoxication, not delirium tremens. -Recovery.8. A woman, æt. 47 , of dark bilious temperament, who had enduredmuch from her husband's unkindness and domestic anxieties , underwent "the change of life, " and became extremely melancholic.-Recovery.1. ] ON THE CAUSES OF INSANITY. 2939. Hereditary predisposition marked . First attack, æt. 38, whenunmarried. Second attack, æt. 58, she having a few years beforemarried an old gentleman in need of a nurse. She was given totaking stimulants, fancied herself ill, and must always be having thedoctor; in fact, hypochondriacal melancholia gradually grew intopositive insanity. - Recovery.10. A married lady, æt. 31, without children, and having great selffeeling. She went on one occasion to a Methodist meeting, was muchexcited by a violent sermon, and immediately went mad , fancying hersoul to be lost, and making attempts at suicide.-- Recovery.11. A young lady, æt. 25, who had some anxieties at home, suffereda disappointment of her affections. Black depression running intoacute dementia. -Recovery.12. A married woman, æt. 44, of dark bilious temperament, hadnever had any children. At the " change of life " profound melancholia came on.13. A gentleman, aged 60, of fine sensitive temperament, whosemother was said to have been flighty and peculiar, had himself beennoted for slight peculiarities. He became profoundly melancholic,thinking himself ruined, and intensely suicidal. Refusal of food.Everything taken, however, was vomited, and diagnosis of organicabdominal disease, probably malignant, was made. -Death from exhaustion.14. A bookseller, æt. 41 , temperate, of considerable intellectualcapacity, but of inordinate conceit; advocated a general division ofproperty and other extreme notions. He ultimately got the notionthat there was a conspiracy against him on the part of the Government, and tried to strangle his wife as a party to it . After two yearshe died of phthisis, with many of the symptoms of general paralysis.The bodily disease seemed to have conspired with a natural vice ofcharacter, and thus to have made the mental derangement one of itsearliest symptoms.15. A married man, æt. 50,of anxious temperament. Profoundmelancholia; refusal of food. Second attack. Apart from the predisposition established by a former attack, the cause seemed to begreat self- feeling, assuming a religious garb. Very fervent always indevotion, but intense egoistic feeling; entire reference of everything toself, and natural inability to form altruistic conceptions. -Recovery.16. A single lady, æt. 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. [ CHAP.scratched her face, &c. Quasi- hysterical maniacal exacerbations.Irregularity of menstruation, and suspected self- abuse -Recovery.17. A lady, æt. 45, but looking very much older, having had ananxious life. Hereditary predisposition; change of life; melancholicdepression, passing into destructive dementia. Convulsions, paralysis,death. Here softening of the brain was preceded for some weeks bymental symptoms.18. Hereditary predisposition.paralysis.Great intemperance. General19. Habitual alcoholic excesses; pecuniary difficulties; mania.After some years hemiplegia of right side, muscular power beingpartially regained after a time. The patient lived for years thus.Paralysis of long duration was the usual family disease and causeof death.20. Suicidal insanity in a married lady. Strong hereditary predisposition to insanity. Exhaustion produced by lactation , and mentaldepression, occasioned by the long absences of her husband from home.-Recovery.21. Third or fourth attack of acute moaning melancholia in awoman, aged 40. Intense self- conceit and selfishness natural to her.Gastric derangement, and obstinately constipated bowels. Wheneverbodily derangement reaches a certain pitch, or adversity occurs, itseems to upset the equilibrium of an ill-balanced mind, predisposed todisorder by former attacks. -Recovery.22. Gambling, betting, drinking, and sexual intemperance. Generalparalysis.23. A bad organization plainly-not due to insanity in family, butto the absence of moral element. A life of great excitement, andof much speculation in Australia. Alcoholic and sexual excesses (?) .General paralysis.24. A widow, æt. 58, the daughter of one who had begun life as alabourer at a coal wharf, but who made a great deal of money. Hewas without education, so that his daughter, brought up as a richperson, but without social cultivation, did not get opportunely married:as it is expressed in the North, " she was too high for the stirrup, andnot high enough for the saddle. " When 50 years old, she married anold gentleman, whose former manner of life had made a nurse needfulto him. He died, and left her the income of a large property for herlife. She now got suspicious of his relatives, to whom the propertywas to revert on her death; was harassed with her money, which shedid not know what to do with, but fancied others had designs on;1.]ON THE CAUSES OF INSANITY. 295and finally went from bad to worse until, believing all the world wasconspiring against her, she got a revolver, and threatened to shoot herfancied enemies.25. The daughter of a common labourer, who had become very richin the colliery business, æt. 32, single. Her father being dead shewas very wealthy; she was without any real education, and very vulgar,and spent the greater part of her time in drinking gin and readingsensational novels. Great hereditary predisposition, not to insanityonly, but to suicidal insanity. Suicidal melancholia, with an incoherence approaching dementia.26. A gentleman, aged 34. Steady, quiet drinking, on all possible occasions. The " ne'er-do-weel " of the family, having tumbledabout the world in Mexican wars and South American mines, and inother places, as such persons do. Feebleness of mind and loss ofmemory. An uncle had been very much the same sort ofhad died in an asylum.person, and27. A married woman, aged 49, gaunt, and seemingly of bilioustemperament. 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 catamenialperiod. Brother maniacal, and sister without the moral element inher disposition.29. The young lady before mentioned as No. 11 was removed by apenurious father from medical care before recovery was thoroughlyestablished, and in opposition to advice. The return to homeanxieties brought on an attack of acute mania, with gabbling ofendless incoherent rhymes.-Permanent recovery this time.30. A warehouseman, aged 35, a Primitive Methodist, grievouslyaddicted 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 -selfrenunciation not being a word that enters into their vocabulary. Thisman, for example, though well aware that vomiting followed eating,and sufficiently afflicted thereby, could not be induced to regulate hisdiet voluntarily, but ate gluttonously, unless prevented.31. A married woman, æt. 32, of stout habit of body, andhabitually locked secretions. The sudden death of a son broughton severe moaning melancholia.296 ON THE CAUSES OF INSANITY. [ CHAP.32. A single lady, aged 57, who had been insane for thirty years.There was the strongest hereditary taint.33. Ayoung 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 injudicious education. A tradesman's daughter, æt. 24, brought up in idleness. Domestic troubles and anxieties after marriage. Mania.-Recovery.35. A woman, æt. 30, Wesleyan, single. Suicidal melancholiawith the delusion that her soul is lost. Menstrual irregularity.Extreme devotional excitement, with evidently active sexual feelings.-Recovery.36. A young woman, æt. 25, single, Wesleyan. Mania. Cause,same probably as in the last case. —Recovery.37. A respectable, temperate, and industrious tradesman, æt. 40,Wesleyan, a teetotaller, and much superior to a vulgar wife. Secondattack. His father committed suicide; his brother is very flighty.General paralysis.38. A sober, hardworking, respectable bookseller, not given toexcesses of any kind, so far as was ascertainable. Slight hereditarypredisposition. General paralysis.In both these last cases there was general paralysis in men who hadnever been intemperate. In both, however, there were large familiesof children, and the struggle of life had plainly been very anxious and severe.39. A woman, æt. 32. Acute mania came on two months afterchildbirth.40. A lady, æt. 34, single, without other occupation or interestthan religious exercises. Suicidal melancholia, with the delusion thatshe had sold herself to the devil. Amenorrhoea. -Recovery.41. A married woman, æt. 40. Sudden outbreak of mania, aftergoing to a revival meeting. Amenorrhoea. -Recovery.42. A married man with a family, æt. 52, a Dissenter, holdingan office of authority in his church, and most exact in his religiousduties. Secretly, he kept a mistress, however, and lived a rather dissipated life. Outbreak of acute mania, with a threatening of generalparalysis . Recovery; for a time at any rate.43. Acute mental annihilation in a young man about a year and ahalf after marriage. One or two intervals of a few hours of mentalrestoration. -Death in epileptiform convulsions. Softening of the1.]ON THE CAUSES OF INSANITY. 297brain in extreme degree, but limited in extent.indulgence.Excessive sexual44. A married woman, æt. 44, who has had several children, andwho has become insane after each confinement. Maniacal incoherenceand 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 yearsold, and became melancholic a short time after the birth of his firstchild. Recovery.46. Complete loss of memory, and of all energy of character, andfailure of intelligence, in a man, æt. 36, single, from continualintemperance in drinking and smoking. Has previously had twoattacks of delirium tremens.47. An extremely good - looking young widow, who had been asinger at some public singing- rooms, and the mistress of the proprietorof them. Sexual excesses. General paralysis.48. Attack of acute violent mania in a young surgeon, æt. 27.Afterwards three days' heavy stertorous sleep; then seeming recoveryfor twenty-four hours; but on the next day recurrence of mania, followed soon by severe epileptic fits. - Recovery.49. Extreme moral perversion, with the most extravagant conceitof self, and unruly conduct in a young man, a clerk. Alternations ofdeep depression and suicidal tendency. Cause, self- abuse.50. A single lady, aged 41, who, on her return from school whenfifteen years old, was queer, listless, and has always since been ratherpeculiar. Hereditary predisposition. Acute melancholia, with thedelusion that she is lost because she has refused an offer of marriageby a clergyman, such offer never having been thought of by him.IFCHAPTER II.INSANITY OF EARLY LIFE.F the account previously given of the gradual evolution of theso-called mental faculties be correct, the insanity met within children must of necessity be of the simplest kind; where nomental faculty has been organized no disorder of mind can wellbe manifest. The kind of mental derangement displayed inearly life will in reality serve as a searching test of the value ofthe principles already enunciated, and, if found to be in strictaccordance with them, will not fail to afford them strong support. While it is commonly thought sufficient to dismiss allsuch instances as singular anomalies in nature, inexplicable, andbelonging to the regions of disorder-as though to call a thingunnatural were to remove it from the domain of natural lawany glimpse of law or order discernible in such confusion willbe so far a gain.The first movements of the child are reflex to impressionsmade upon it; but so quickly does sensorial perception withmotor reaction thereto follow upon these early movements, thatwe are not able to fix a distinct line between the reflex andsensori-motor actions. The aimless thrusting out of the infant'slimb brings it in contact with some external object, whereuponit is probable that a sensation is excited. But it would appearthat the particular muscular exertion must be the condition ofa muscular feeling of the act; so that the muscular sense ofthe movement and the sensation of the external object becomeassociated, 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 formationaccomplished. If we call to mind how, when discussing actua-CHAP. 11.] INSANITY OF EARLY LIFE. 299tion, it was shown, in the case of the eye for example, that asensation was the direct cause of a certain accommodating movement, and that the movement thereupon gave us the intuition ofdistance, we may perceive how the organic association of a sensation from without with a respondent or associated muscularact, does by degrees impart definite intuitions of external objectsto the young mind. Suppose now that an infant becomes insaneimmediately after birth, what sort of insanity must it exhibit?The extent of mental disorder possible is clearly limited by theextent of existence of mental faculty: which, as we have seen,is almost nothing. In this regard the observed facts agreewith theory; when a child is, by reason of a bad descent or ofbaneful influences during uterine life, born with such an extremedegree of instability of nerve element that, on the first play ofexternal circ*mstances, its nervous centres react in convulsiveform, it mostly dies in convulsions. The diseased action is adiseased action of the nervous centres of reflex action-thosewhich alone have at this time power of functional action; theconvulsions 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 convulsiveaction of the higher nervous centres.It has been shown, however, that it is impossible, by reasonof the close connexion of sensorial action with reflex action inthe infant-the actual continuity of development which thenexists to fix a distinct period during which its functions areentirely reflex. It happens consequently that in the earliestmorbid phenomena of nervous centres there is commonly theevidence of some sensori-motor disturbance. An impressionon the sense of sight, for example, is not quietly assimilatedso as to persist as an organized residuum in the proper nervouscentre, but inmediately excites a reaction outwards of the unstable cells of the associate motor centres; irregular and violentactions prompted by sensations attest the disorder of the sensorial and corresponding motor centres, as convulsions testify tothe disorder of the centres of reflex action. The phenomena ofa true sensorial insanity are intermixed with the morbid manifestations of the lower nervous centres; to every impressionmade upon the infant there is irregular and violent reaction ,300 [CHAP.INSANITY OF EARLY LIFE.sensori-motor and reflex. Instances of such morbid action sosoon after birth are certainly rare; nevertheless they do sometimes occur, and have been recorded. Crichton quotes fromGreding a well-known case of a child which, as he says, wasraving mad as soon as it was born. " A woman, about fortyyears old, of a full and plethoric habit of body, who constantlylaughed and did the strangest things, but who, independently ofthese circ*mstances, enjoyed the very best health, was, on the20th January, 1763, brought to bed, without any assistance, of amale child who was raving mad. When he was brought to ourworkhouse, which was on the 24th, he possessed so much strengthin his legs and arms that four women could at times with diffculty restrain him. These paroxysms either ended in an uncontrollable fit of laughter, for which no evident reason could beobserved, or else he tore in anger everything near him, -clothes,linen, bed furniture, and even thread, when he could get hold ofit. We durst not allow him to be alone, otherwise he wouldget on the benches and tables, and even attempt to climb up thewalls. Afterwards, however, when he began to have teeth hedied. " It is certainly remarkable that a child so young shouldhave been able to do so much; and those who advocate innatemental faculties might well ask how it is possible under anyother supposition to account for such an extraordinary exhibitionof more or less co- ordinate power by so young a creature. Twoconsiderations should be borne in mind with regard to this case:first, that the mother of the child was herself peculiar, so thather infant inherited an unstable condition of nerve element, andconsequently a disposition to irregular and premature reaction onthe occasion of an external stimulus; and secondly, that theredoes, as previously set forth, exist in the constitution of thenervous 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 immediatelyco-ordinating their muscles for a definite end, and the humaninfant is not destitute of the germ of a like power over voluntarymuscles, while it has complete the power of certain co- ordinateautomatic acts; it is conceivable, therefore, that, without will,and even without consciousness, there may be displayed by it, inanswer to sensations, actions which, like those of this insane11.] INSANITY OF EARLY LIFE. 301infant, have more or less semblance of design in them. * Byreason of the morbid condition of nerve element we have aconvulsive manifestation of the innate co-ordinate facultyinregular, violent, and destructive movements, and the prematureand extravagant exhibition of acts which would be natural ina more restrained form at a later stage of normal development,such, for example, as " uncontrollable fits of laughter withoutany evident reason. "+As the earliest stages of the infant's mental development correspond in a general way with the permanent condition of mindof those animals all the actions of which are reflex and sensorimotor, it is no wonder that the phenomena of infantile insanityshould be comparable with those of animal insanity. In bothcases the morbid phenomena are mainly referable to disorder ofthe sensorial and associate motor nervous centres; so that wemight almost describe the insanity as sensorial. The elephant,usually a gentle enough creature, is subject at certain seasons toattacks of furious madness, in which it rushes about in the mostdangerous way, roaring loudly, and destroying everything withinits reach; and other animals are now and then affected withsimilar paroxysms of what might almost be called an epileptic"That they do this by instinct, something implanted in the frame, themechanism 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 offighting peculiar to their species; and children strike with their arms as naturallyas horses kick, dogs bite, and bulls push with their horns. " -MANDEVILLE'SFable of the Bees, vol. ii. p. 352.11+ " The youngest person whom I have seen labouring under mania, " says SirA. Morison, " was a little girl of six years old , under my care in BethlehemHospital. I have, however, frequently met with violent and unmanageable idiotsof 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 theReports of the Scotch Lunacy Commissioners, mention is made of a girl aged sixyears, 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 onwhen she was a year old; she was incoherent, and subject to paroxysms of violentpassion; at all times very intractable; slept little, and ate largely. Dr. Spurzheim ( Observations on Derangement of Mind) views all such cases as partial idiotsfrom birth. The cerebral organization at so early an age is, he adds, so delicatethat it does not bear severe morbid affections without losing its fitness for mentaldevelopment, and endangering life. Indeed , it might fairly be said of the cases ofinsanity 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 inthe insane infant, and it is able to do a great deal more mischief;but there is really no difference in the fundamental nature ofthe madness; the maddened acts are the reactions of morbidmotor 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 phenomenaof mind strictly confirm in this regard the principles which areestablished by an inductive study of the plan of developmentof mind.The moment we have recognised the existence of sensorialinsanity, we become sensible of the value of the distinction.Not only does it furnish an adequate interpretation of the violentphenomena of the insanity of the animal and of the infant, butit alone suffices to explain that desperate fury which sometimesfollows a succession of epileptic attacks. When the furiousepileptic maniac strikes and injures whatsoever and whomsoeverhe meets, and, like some destructive tempest, storms through award with convulsed energy, he has no notion, no consciousness,of what he is doing; to all intents and purposes he is an organicmachine, set in the most destructive motion; friend or foe alikeperish before him; all his energy is absorbed in the convulsiveexplosion. And yet he does not rage quite aimlessly, but makesmore or less definite attacks upon objects: he sees what is beforehim and destroys it; there is some method in his madness; hisconvulsive fury is more or less co- ordinate. These desperatedeeds are respondent to morbid sensations; there often existterrible hallucinations, such as blood- red flames before the eyes,loud roaring noises or imperative voices in the ears, sulphuroussmells in the nostrils; any real object which does present itselfbefore the eyes is seen with the strangest and most unrealcharacters; lifeless objects seem to threaten his life, and thepitying face of a friend becomes the menacing face of a devil;his movements therefore do not answer to the realities aroundhim, but to the unreal surroundings which his disease hascreated. 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 terribledestruction. He thought at these times that he was fighting for his life against a lion.11.] INSANITY OF EARLY LIFE. 303the higher nervous centres being in abeyance; and after thefrantic paroxysm is over there is complete forgetfulness of it asthere is forgetfulness of sensorial action in health. There arenecessarily points of difference between this epileptic fury andinfantile insanity, arising out of the residua, sensory and motor,that have been acquired and organized through experience inthe nerve centres of the adult: the residua in the sensory gangliaof the adult render possible those special hallucinations whichthe 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 asare original, must needs fall short of.No one who has observed himself attentively when suddenlyawaking out of sleep but must have noticed that he has had attimes hallucinations both visual and auditory. He has heard avoice, which no one else could hear, distinctly say something,and on reflection only is convinced that the words were subjective; or he has waked up in the night and seen around him theobjects of his dream, and been positively unable for a time todiscriminate between the real and the unreal,-has perhaps laiddown and gone to sleep again without successfully doing so.When the integrity of nerve element has been damaged, whetherby reason of continued intemperance or from some other cause,these half-waking hallucinations acquire a vivid reality, andleave behind them a painful feeling in the mind. If we couldimagine this temporary condition to last some time, and ouractions to be in accordance with our hallucinations, then weshould get a conception of what is the real state of things insensorial insanity.After a child has lived a few years, the residua of its sensations have been so far organized in their proper nervous centresthat on the recurrence of a sensation it has a definite character:in other words, the child has acquired the power of definitesensory perception. Suppose now that some morbid cause, suchas a deranged condition of the blood, excites to activity theseslumbering or quiescent residua, there will then be a subjectivesensation or hallucination, which may remain as such, or lead toan answering motor reaction. In dealing with sensorial insanity304 INSANITY OF EARLY LIFE. [CHAP.it is necessary then to bear in mind, as was done when treatingof the physiology of sensation, both the receptive and the reactiveside. A violent and convulsive reaction may mask all otherfeatures of the disease, and give it an epileptiform character; orthe active sensory residua may persist in consciousness as hallucinations, giving rise, if they give rise to any answering movements, to such as are rather of a choreic character.A variety of insanity in children, then, which we may nextconsider, is that form of sensorial insanity in which hallucinations occur, and in which the motor reactions are not epileptiform but choreic. There is some reason to think that temporaryor fugitive hallucinations are not uncommon in infancy, andthat the child stretching out its hand and appearing to grasp atsome imaginary object is deceived by a subjective sensation.The excitation of the latent residua of sensation takes placefrom some internal cause, and bodily states thus give rise totemporary hallucinations in children, without there being anypositive disease. Experimental proof of this manner of origin isnot wanting: Dr. Thore describes the case of an infant, agedfourteen months and a half, which had accidentally been poisonedby the seeds of the Datura stramonium; hallucinations of sightoccurred, as shown by the motions of the child, which seemedto be constantly seeking for some imaginary objects in front ofit, stretching out its hands and clinging to the sides of thecradle in order to reach them better. * The most remarkableexamples of such condition of hallucination is afforded, however, by that form of nightmare which some children suffer somuch from: they begin shrieking out in the greatest terrorwithout being awake, though their eyes are wide open; theytremble with fright, and do not recognise their parents or otherswho attempt to calm them; and it is some time before theparoxysm passes, and they can be pacified. They are for thetime possessed with a vivid hallucination, which terrifies thembeyond measure, and which does not readily subside; in themorning, however, they know nothing of their fright, but haveforgotten it as the somnambulist forgets his midnight walk, oras sensation is commonly forgotten. Strictly speaking, however,Annales Médico- Psychologique, 1849.11.] INSANITY OF EARLY LIFE. 305it is not proper to say that they have forgotten their mentalstate, because the activity was all the while sensorial; and, asthere was no conscious perception, as the child did not perceivethat it perceived, there could be no conscious memory. Theundoubted and not uncommon existence of this state of vividhallucination in children, when the matter has certainly passedbeyond ordinary dreaming, will serve to prove how possible itis that children may have, when awake, positive hallucinations.Some who have written upon this subject have thought such athing entirely impossible or exceptional, having been misled bythe ill -grounded assumption that a hallucination must havesome necessary connexion with a delusion. Certainly it mustbe, and it is, rare to meet with positive delusion in young children, inasmuch as at that time idea has not been fashioned inthe mind; but the moment a child has acquired a definite sensation, 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 inchildren of a variety of sensorial insanity, which is characterisedby hallucinations, most frequently of vision, and sometimes byanswering irregular movements. Fits of involuntary laughterare often notable in such cases: the laugh, or rather smile, ofthe infant is an involuntary sensori- motor movement before ithas any notion of the meaning of the smile, or any consciousnessthat it is smiling; consequently we meet with the irregular andconvulsive manifestation of this function as one of the expressions of a morbid state of things. Dr. Whytt relates the instanceof a boy, aged 10, who, in consequence of a fall, had violentparoxysmal headaches for many days. After a time thereoccurred " fits of involuntary laughter, between which he complained of a strange smell and of pins pricking his nose; hetalked incoherently, stared in an odd manner," and immediatelyafterwards fell into convulsions. He recovered on this occasion,but two years afterwards was similarly attacked: he had severeheadache, saw objects double, and suffered from a severe pain inthe left side of his belly, confined to a spot not larger than ashilling; " sometimes it shifted, and then he was seized withfatiguing fits of involuntary laughter. " Ultimately he recovered partially, but never completely. * It is always desirable,Op. cit. p. 144.X306 INSANITY OF EARLY LIFE. [CHAP.in cases of hallucination in children, to make a close examination of the state of the general sensibility; for perversions ordefects of it will frequently be found both where there arecorresponding perversions of a choreic character on the motorside and where there is no evidence of motor disorder. Becausethis form of sensorial insanity is often found associated withmore or less evidence of chorea, and because, as compared withthe previously illustrated epileptiform variety, it has relationsnot unlike those which chorea has to epilepsy, it may be described as the choreic variety of sensorial insanity.Perhaps no more fitting opportunity than the present willpresent itself for reference to the singular state of somnambulism,the phenomena of which illustrate in a striking manner thatindependent action of the sensorial and corresponding motorcentres which plays so important a part in the early mentallife of the child, and so large a part in the daily life of theadult. An individual appears to be fast asleep, and yet executescomplicated acts of some kind which he could hardly do, andcertainly could not do better, if he were awake; his highestnervous centres are in partial abeyance, and yet his movementsare as skilful as if they were under the cognizance and controlof these supreme centres. But the man's senses are not entirelyasleep, and the organized motor reactions to impressions on thesesenses are not asleep: he is a sensori-motor being, and very muchin the position of one of those lower animals that are destituteof cerebral hemispheres, and which notwithstanding are exceedingly active in their movements; or very much in the positionof a child before the higher centres of idea have come into action.Recently there has come under my observation a striking instanceof somnambulism in a young woman suffering from consumption,who has on many occasions risen from her bed in the night, gonethrough a sustained series of rather difficult acts, and returnedto bed without ever knowing what she had been doing; in themorning after such feats, however, she feels general aching inthe limbs, exhaustion, and prostration, such as from her description of her suffering would appear to be very like that whichfollows an epileptic fit in the night. One example of what shedid in her sleep may be adduced here: she was engaged inquilting a petticoat for a lady, and after a good day's work went11. ] INSANITY OF EARLY LIFE, 307to bed at night, intending in the morning to get up early andfinish it; but, when the morning came, she was so weary andprostrate that she felt quite unable to rise; she called hermother, therefore, and told her to say, should the lady send forher petticoat, that she was so ill that she had not been able tofinish it. The mother, wishing to see how much still remainedto be done, fetched the petticoat, when it was found to befinished the poor girl had been up in the night, and, seen of noone, had completed her task. Soon the long day's task of lifewill be over with her, and she will sleep well where no troublesmore can reach her, and no dreams of work or sorrow disturbher slumbers.If it were possible to induce artificially a temporary disorderin the sensory and corresponding motor centres of the somnambulist, such as would give rise to hallucinations and answeringmotor 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 beendescribed as the choreic variety of sensorial insanity, or in thecondition of the man who, after a succession of epileptic fits, isattacked with furious sensorial insanity. Suppose, however,that after a moderate disorder had been artificially excited in thesomnambulist's sensorial centres, such as might engender hallucinations, his higher centres of cognition were to awake toactivity, what would be the result? Either he would be imposed upon by the false. sensations, and his thought thus share inthe disorder of his sense; or his reflection would discover thesubjective nature of the hallucination, and he would then bevery much in the position of the well-known Nicolai, of Berlin,and of others, who, like that bookseller, have suffered from hallucinations of the nature of which they were quite conscious.Every one who has observed himself with attention must havebeen conscious of occasions when a suddenly occurring hallucination has caused him to make a quick respondent movement,which, recognising the hallucination, he has discovered to be unnecessary. But it is different with a very young child, which, ifit is affected with hallucination, must believe in it; it cannot.correct sense by reflection, because the higher nervous centreshave not yet entered on their full function. Hallucinationsx 2308 INSANITY OF EARLY LIFE [CHAP. .may, therefore, exist temporarily in children without indicatingany serious disturbance; the organic residua of sensation beingquickened into activity by an internal cause, before any distinctperception of the cause of the sensation has been formed.Thus far, then, it is certain that hallucination may occurin a child before it has acquired a definite idea. With eachsucceeding presentation of an object to the child, however, theimpressions made on the different senses become more andmore combined, so that an idea of the object is at last organizedin the higher ideational centres; there is a consilience of thesensory impressions into an idea, which henceforth makes itpossible for the child to think of the object when it is not presentbefore the senses, or to have a definite and adequate perceptionof it when it is. As development proceeds, one idea afteranother is thus added to the mind until many simple ideas havebeen organized in it; but for a long time these ideas remainmore or less isolated and imperfectly developed; there are nodefinite associations between them, and the child's discourse isconsequently incoherent; there is not moreover a complete organization of residua, and its memory is consequently fallacious.Children, like brutes, live in the present; their happiness ormisery being dependent upon impressions made upon the senses:their actions are direct reactions to impressions; the idea oremotion excited does not remain in consciousness and call upother ideas and emotions, but it is directly uttered in outwardaction. Such a condition of development, which is natural tothe child before the fabric of its mental organization has beenbuilt up, and to the animal in which the state of the nervoussystem renders further development impossible, would, were itmet with in an European adult, represent idiocy, or an arrest ofmental development from morbid causes.So soon as a definite idea has been organized in the child'smind a delusion is possible. But as ideas are at first comparatively few in number, and as they are very imperfectlyassociated, a derangement of the function of their centres mustbe characterized by a very incoherent delirium. Divers morbidideas will then spring up without coherence; and the morbidphenomena, wanting system, will correspond, not so much withthose which in the adult we describe as mania, as with those11.] INSANITY OF EARLY LIFE. 309described as delirium. In the mania of the adult there is commonly a systematized derangement, some coherence between themorbid ideas, some method in the madness; whereas in thedelirium from fever or other cause, ideas spontaneously arise inconsciousness in the most incoherent way: in the young child theideas are equally incoherent by reason of the absence of anorganic association between the residua. Let us proceed then totest these principles by an examination of such facts as areavailable.As a morbid idea in the child's mind has, by the nature ofthe case, but a small range of action upon other ideas, it willtend to utter itself by its other paths of expression; namely, bya downward action upon the sensory ganglia or upon the movements. When it acts downwards upon the sensory ganglia itgives rise to a hallucination; and in such cases, as may easily beimagined, it will not always be possible to determine whetherthe hallucination is really secondary or primary-whether it isengendered indirectly through the agency of the morbid idea ordirectly by the excitation of the sensory residua by some organiccause. When a child of only a few years old sees figures ofsome kind on the wall, which have no real existence, but disappear with apparently as little reason as they came there, thehallucination is most likely owing to some organic cause affecting directly the sensory ganglia. But when a child of eight ornine years old, whose head has been wickedly filled with foolish.and dangerous notions concerning the devil and hell, suddenlysees the frightful face of a devil appear and threaten to eat himup, and shrieks in terrified agony, then the hallucination is undoubtedly secondary to the wilfully implanted delusion. In afew moments the phantasm disappears, and the child regains itscomposure. This sort of idea-produced hallucination doubtlessoccurs frequently enough in those nightmares of children alreadymentioned.This secondary generation of hallucinations again is strikinglyillustrated by the occurrence of phantasms before the eyes ofcertain precocious children; these appear to be visible representations of the thoughts that are passing through their minds:what they think, that they actually see. Accordingly a sortof drama is evolved before their eyes, and they live for the310 INSANITY OF EARLY LIFE. [CHAP.time in a scene which is purely visionary as though it werequite real. "What nonsense are you talking, child? " themother perhaps exclaims; and thereupon the pageant vanishes.In delicate and highly nervous children, affected with mesenteric tubercle—and, perhaps, also with meningeal tubercleit sometimes happens that great anxiety is caused to themother by the strange way in which, during the night, whenouter objects are shut out by the darkness, they will talk asif they were surrounded by real events, or, as the motherperhaps puts it, as if they were light-headed. They are dreaming while they are awake; though the outer world is shutout, the morbid deposit within acts as an irritating stimulusto the ganglionic nervous centres, and thus gives rise to anautomatic activity of them. Such hallucinations may undoubtedly be fugitive events in the history of any child endowed with a highly nervous temperament, as in WilliamBlake, the engraver, and may not denote any positive disease;but if the habit grows upon the child by indulgence, and thephantasms are regularly marshalled into a definite drama,—as,for example, was the case with Hartley Coleridge, then acondition of things is initiated which will in all likelihoodultimately issue in the degeneration of some form of insanity. *For it is not the natural course of mental development thatideas, so soon as they are fashioned in the mind, should operatedirectly downwards upon the sensory ganglia, and thus create avisionary world; but, on the contrary, it is necessary in theprogress of mental development that ideas should be completelyorganized within the centres of consciousness, and act upon oneanother there; that thus, by the integration of the like in perceptions and the differentiation of the unlike, accurate conceptions of nature should be formed and duly combined in themental fabric; and that the reaction upon external nature shouldbe a definite, aim-working, volitional one. Men like HartleyColeridge 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; itwas a vision of a tree filled with angels. Mrs. Blake, however, used to sayYou 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. '"" -GILCHRIST'SLife of Blake.11.] INSANITY OF EARLY LIFE. 311their supreme nervous centres is prematurely expended in theconstruction of toy- works of the fancy; the state of thingscorresponding in some sort with that which obtains in thespinal centres when, by reason of an instability of nerveelement, direct reactions take place to impressions, so thatdefinite assimilation and acquired co-ordination are renderedimpossible. In both cases an arrest of development, commonlythe forerunner of more active disease, is indicated; in both casesthere is the incapacity for a true education. The precociousimagination of childhood should always be restrained as anactual danger, not fostered as a wonderful evidence of talent;the child being solicited to regular intercourse with the realitiesof nature, so that by continued internal adaptation to externalimpressions there may be laid up in the mind stores of material,and that, by an orderly training, this may be moulded into trueforms, according to which a rightly- developed imagination mayhereafter work in true and sober harmony with nature.The difference between fancy and imagination, as Coleridgehas very aptly remarked, corresponds with the difference between delirium and mania. The fancy brings together imageswhich have no natural connexion, but are yoked together bymeans of some accidental coincidence; while the imaginationcombines images seemingly unlike by their essential relations,and gives unity to variety. Now the precocious imagination ofa child, which sometimes delights foolish parents, cannot possibly be anything more than lying fancy; and this, for exactlythe same reason that the insanity of children must be a delirium ,and cannot be a mania-the incomplete formation of ideas andthe absence of definitely organized associations between them.Those who like to speak of faculties of the mind may certainly maintain that fancy and imagination are fundamentallythe same faculty; if so, they should bear in mind that fancyindicates the faculty working wildly and often mischievously,without adequate material and without due training, and thatimagination represents the working of the faculty when dulysupplied with proper material and justly developed by a propertraining. In like manner, those who consider closely and without prepossession the fundamental meaning of the characterwhich the delirium of children has, will not fail to recognise in312 INSANITY OF EARLY LIFE. [CHAP.it the strongest evidence of the gradual organization of ourmental faculty; the fancy of the sane, and the delirium of theinsane, child both testify to the same condition of thingsthat which the habitual incoherence of a child's discourse alsoevidences.In order to exhibit clearly the manner of action of morbididea in children, and to educe therefrom a physiological lesson,its operation has been somewhat artificially separated from othermorbid phenomena which usually accompany it. In youngchildren it is practically rare to meet with disorder confined tothe supreme nervous centres; the other centres are almostcertain to participate more or less markedly in the morbidaction. In chorea, for example, besides the disordered movements which are its common characteristic, there are oftenhallucinations marking disorder of the sensorial centres, andmotiveless weeping or laughing, or acts of mischief and violence,marking disorder of some of the higher motor centres; there arefurthermore in some cases mental excitement and incoherence,which may pass into maniacal delirium, and end fatally, or intochronic delirium , and end in recovery. The different centressympathize with one another; and, according as they ministerto ideation, sensation, or movement, express their disorder indelirium, hallucination, or spasmodic movements.Let us now proceed, then, to arrange in groups the differentforms of insanity that are actually met with in children.1. Monomania, or Partial Ideational Insanity. -When amorbid idea or delusion reacts downwards, but not upon thesensory ganglia in the way described, its action is upon themovements, and it is realized in some particular act. Is thiskind of monomania ever met with in children? Certainly itis; and, as might be predicted from a consideration of thechild's mental development, chronic ideational insanity willcommonly be of this partial kind. It admits of no questionthat the desperate sort of monomania which is manifest in apowerful impulse to some act of violence-the kind of diseasein which the morbid idea attains to such a nisus for outward reaction as to become an irresistible impulse-is met with occasionally in children . Examples of children thus possessed withan uncontrollable impulse are given by Esquirol: in one case, a11.] INSANITY OF EARLY LIFE. 313child, of only five or six years old, made repeated attempts tokill its stepmother, who had always treated it kindly; in anothercase, a child was afflicted with a never-resting impulse to stealwithout having need for, or making any use of, what it hadstolen; another child was ever striving with a perverse diligenceto set fire to whatever it could; and another displayed a persistent longing desire for self- destruction—a genuine suicidalmonomania. These are indisputable instances of what havebeen designated homicidal monomania, kleptomania, pyromania,and suicidal monomania; they commonly indicate more or lessintellectual and moral imbecility springing from a strong hereditary predisposition to insanity; the fountain of the child'sbeing having been poisoned at its source. Let the psychologistexplain them how he will, they are in strict conformity withphysiological observation; and their occurrence at so early aperiod of life, where some morbid taint, inherited or acquired, canusually be traced, is a strong argument in favour of the principles already laid down. Children, again, have thought themselves possessed by the devil, who moved them to perpetratethe strangest acts; and at the time of the Crusades, when theWestern world was infected with a fanatical enthusiasm fordelivering 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 theLord," many of them perishing miserably on the way, others ofthem being sold as slaves, and none of them reaching theirgoal.2. Chorcic Delirium, or Choreic Ideational Insanity. -There is achoreic delirium sometimes met with in children, which appearsto be the exact counterpart of the choreic spasms that occur.What is sufficiently striking, even to an ordinary observer ofthis delirium, is its marked incoherence, and its manifestlyautomatic character. It seems as if the cells or groups of cellsof the primary centres had been dislocated from their connexions, and as if each cell, or group of cells, were acting on itsown account, giving rise thereby to a sort of mechanically repeated and extremely incoherent delirium. A boy of abouteleven years of age, who came under my care, was, after a slightand not distinctly described sickness, suddenly attacked with314 INSANITY OF EARLY LIFE. CHAP.this form of delirium; he moved about restlessly, throwing hisarms about and repeating over and over again such expressionsas-"The good Lord Jesus, " " They put Him on the cross,"“ They nailed His hands," &c.: it was impossible to fix his attention for a moment; for he turned away, wandered aimlesslyabout, pointing to one hand and then to the other, and babblinghis incoherent utterances. So far as could be made out, therewas considerable insensibility of the skin over certain parts ofthe body. In two days, after appropriate treatment, the deliriumpassed off, and the boy was quite himself again. I have latelyseen an interesting case of insanity in a girl, æt . fourteen, who islively, pretty, and intelligent. She suddenly jumps up in aparoxysm of excitement, exclaiming, " Mother, I'm dying! " andbegins praying frantically in a mechanical manner. Theparoxysm lasts for three or four hours, and leaves her pale, cold,exhausted, and trembling like a leaf. A brother died after beingsimilarly afflicted. The mother suffered for months at one timefrom speechless melancholia, and nearly all her family have diedfrom phthisis. She has had fourteen miscarriages and threechildren, this girl being the only one left; when carrying hershe had a terrible fright from seeing one child accidentally killed,and the child was born affected with constant choreic movements, which continued until six months after birth. Beforethe paroxysms of mental excitement came on, she had beensubject to periodical attacks of depression with much weeping;and all her life she has suffered more or less from pain in thehead, especially in the left temple.Dr. Bucknill relates the case of a boy, aged twelve, who wasadmitted into the Devon Asylum, and who had been affected allhis life to some extent with chorea. A few days before admission he had attempted to hang himself, and there was the markmade by the rope upon his neck. On admission, he was acutelymaniacal, attempted to dash his head against the walls, and,when put in the padded room, lay on the floor, crying—“ Oh, dokill me! Dash my brains out! Oh, do let me die! " He kickedand bit the attendants, and tried in every way to kill himself:his head was hot, his pulse quick, he refused food, and did notsleep. He completely recovered under proper treatment after afew days.11.] INSANITY OF EARLY LIFE. 315These cases will suffice as illustrations of choreic mania: itis only necessary to bear in mind that-as with choreic movements, so with choreic insanity-examples of every degree ofconvulsive violence and incoherence are met with. Hallucinations of the special senses and perversions of general sensibilityfrequently also accompany the delirium .3. Cataleptoid Insanity. -Another form which insanity maytake in childhood is that of a more or less complete ecstasy;and this may be appropriately described as the cataleptoidvariety. It generally occurs in young children: the littlepatient lies perhaps for hours or days seemingly in a sort ofmystical contemplation, with limbs more or less rigid, or fixedin strange postures; sometimes there is insensibility to impressions, while in other instances vague answers are given, or thereis actual incoherent raving; there may be sudden bursting outinto wild shrieks. These attacks are of variable duration, andare repeated at varying intervals: they would seem to represent a sort of spasm of certain nervous centres, so that for thetime being the body becomes an automatic instrument of theiractivity, while all voluntary power is in abeyance. While, onthe one hand, there are intermediate conditions between thisform of disease and chorea, its attacks, on the other hand, sometimes alternate with true epileptic seizures, and at other timespass gradually into them. In a girl who came under Dr. West'streatment at the age of ten years and ten months, there hadbeen first an attack of general convulsions without any obviouscause, when she was eight years old. Afterwards she was subject to occasional attacks of great excitement of behaviour, andfor six months there was a sort of cataleptic state in which shestood immoveable for one or two minutes, staring wildly orfixedly, and murmuring unconnected words that had referenceto any object which she might happen to see. About elevenmonths from the commencement of these attacks their characterchanged; they became truly epileptic, the child's conduct in theintervals between the seizures, though sometimes quite reasonable, having mostly something insane about it. * The example

• Ueber Epilepsie, Blödsinn und Irrsein der Kinder, von Charles West,

M. D. -Journal für Kinderkrankheiten, vol. xxiii. 1854. See also a paper byM. Delasiauve in Annales Médico- Psychologique, vol. vii. 1855 .316 INSANITY OF EARLY LIFE [CHAP..may serve to illustrate how closely related are disorders of thedifferent nervous centres in children, as well as to show thehybrid nature of the diseases presented, and the artificialcharacter of the divisions usually made between them.4. Epileptic Insanity. -Not only are the different forms ofepilepsy met with in children, but the different forms of insanity that occur in connexion with epilepsy are also exhibitedin early life. The petit mal sometimes lasts for many monthsin children, and then passes into regular attacks of convulsiveepilepsy; the usual effect of which is to produce loss of memoryand more or less dementia. In the case of a young girl, agedeight years, of good physical conformation, who came under mycare, there seemed to have been produced by epilepsy an arrestof mental development at the sensorial stage: she was a mostmischievous little machine, never resting, but seizing, or attempting to seize, whatever she saw; nowise content with what shecaught hold of, but throwing it down directly she had got it,and struggling for something else; not amenable to correctionor instruction, and demanding the whole energies of one personto look after her. She was an automatic machine incited bysensory impressions to mischievous and destructive acts.As in adults, so in children, an attack of violent mania, or afuror transitorius, may precede, or take the place of, an attack ofepilepsy, representing in reality a masked epilepsy. Childrenof three or four years old are sometimes seized with suddenattacks of violent shrieking, desperate stubbornness, or furiousrage, when they bite, tear, and destroy whatever they can; theseseizures come on periodically, and may either pass in the courseof a few months into regular epilepsy, or may be found to alternate with epileptic attacks; they are a sort of vicarious epilepsy.Morel has met with two cases in which children fell into convulsions and lost the use of speech in consequence of a greatfear; afterwards a maniacal fury, with tearing, destroying, andcontinual turbulence, occurred: in one case, the child beingten years and a half old, epilepsy followed; in the other child,aged five years, it did not. * One of the boys in a school wasTraité des Maladies Mentales, 1860, p. 102. He relates another case ofa girl , æt. 11 , who had furious maniacal attacks, during which she attemptedto kill her mother, and injure her sisters, and who finally recovered.11.] INSANITY OF EARLY LIFE. 317attacked in the night, without evident cause, with a suddenfuror transitorius: he rushed wildly up and down the dormitory,speaking loudly but inarticulately, so that another of the pupilsgot 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 attackfollowed; and in the morning he knew nothing whatever ofwhat had happened, but felt weary and exhausted. *Again, in children as in adults, regular attacks of maniacalexcitement may follow epilepsy. Many such instances are onrecord; but I shall content myself here with a singular exampleof insanity, more cataleptoid perhaps than epileptic, followingconvulsions, which is quoted by Griesinger from Kerner: -Margaret B., æt. 11 , of a passionate disposition, but a pious,Christian child, was, without any previous illness, seized onJanuary 19th with convulsive attacks, which continued, withfew and short interruptions, for two days. So long as the convulsions lasted the child was unconscious, twisted her eyes,made grimaces and strange movements with her arms: fromthe 21st January a deep bass voice proceeding from her keptrepeating the words, " They are praying for thee." When thegirl came to herself, she was wearied and exhausted, but knewnothing of what had happened, only said that she had dreamed.On the evening of the 22nd January another voice, quitedifferent from the bass one, spoke incessantly while the crisis.lasted for half an hour, an hour, or several hours; and wasonly now and then interrupted by the former bass voice regularly repeating the recitative. The second voice manifestlyrepresented a different personality from that of the girl, distinguishing itself in the most exact manner, and speaking ofher in the third person. In its utterances there was not theslightest confusion nor incoherence observable, but all questionswere answered by it coherently. What, however, gave a distinctive 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, æt. 13, who was subject to periodicalattacks of fury, followed by epileptic convulsions, and who often had the furiousmaniacal excitement without the convulsions, illustrating the transition of maniatransitoria into epilepsy.318 [ CHAP. INSANITY OF EARLY LIFE.immoral tone of them-the pride, arrogance, scorn and hatredof truth, God, Christ, that were declared. " I am the Son ofGod, the Saviour of the world: me ye shall worship," the formervoice frequently repeated . Scorn of all that is sacred, blasphemyagainst God and Christ, violent dislike of everything good, andextreme rage at the sight of any one praying, or even of handsfolded as in prayer, expressed by the second voice-all thesemight well betray the work of a strange spirit possessing her,even if the pious voice had not declared it to be the voice ofa devil. So soon as this demon spoke, the countenance of thegirl changed in the most striking manner, and assumed a trulydemoniacal appearance. She ultimately quite recovered, a voicecrying out " Get thee out of this girl, thou unclean spirit. "5. Mania. Although the delirium of childhood commonlyoccurs in connexion with some form of convulsive disease, yetit is possible for it to occur from other recognised causes ofmania; in children these usually are blowson the head, intestinal worms, and onanism . It is certainly surprising howgreatly tolerant of injury the young brain is; children willrecover without any bad symptoms from an injury which wouldinevitably prove fatal to the adult: in one severe case of fractureof the skull in a child, which came under my observation, thebones loosely grated as in a bag under the scalp, whilst thechild's head was held, and yet it recovered without any severesymptoms. Under the name of Monopathie furieuse Guislaindescribes maniacal attacks in a young girl æt. 7, which weredue to caries of the nose following a blow. Other like cases arerecorded by Haslam, Spurzheim, Frank, Burrows, Perfect, andFriedreich. The most striking example of mental derangementin children which Morel ever met with was in a little girl æt. 11 ,who, after the sudden disappearance of a disease of the skin,exhibited choreic symptoms, and soon afterwards those of truemaniacal fury. She tried to kill her mother, and had nearlydrowned one of her sisters by throwing her into a pond in herparoxysms she displayed a strength almost incredible, and itis 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. 319destructive tendencies of the little being. She recovered after afever, when all medical treatment had failed. Certain acutediseases, as for example typhus, may of course give rise todelirium in the child just as in the adult.6. Melancholia. This form of depression is met with inchildren both with and without definite delusion or morbidimpulse. Without doubt children differ naturally in livelinessof disposition; but it sometimes happens that depression arrivesat such a pass even in very young children as to constitute agenuine melancholia. In such case the child whines and wailson all occasions; whatever impression is made upon it seems tobe followed by a painful feeling. The mother brings it formedical advice; for, as she complains, it thrives not, it rests noteither by night or day, it is continually crying, and nothingcalms it; there is no living with it, and she is almost worn outwith anxiety. Such symptoms mark a constitutional defect ofnerve element, whereby an emotional or sensational reaction of apainful kind follows all impressions; the nervous or psychicaltone is radically infected with some vice of constitution, so thatevery impression is painful; and, according to my experience,the cause of the defect in a great many instances is inheritedsyphilis. At any rate remarkably beneficial results often in suchcases follow the treatment for hereditary syphilis. No doubt,however, other causes besides syphilis may give rise to a likemorbid condition of nerve element.With the deep melancholic depression there may be associated, in older children, a distinct delusion of some kind. Aboy who from his fifth year had been rather peculiar in hisbehaviour, standing still occasionally without apparent reason inthe street and not moving again without considerable pressure,was, when aged twelve, afflicted with positive melancholia anddelusions of suspicion. He was extremely depressed, and hismanner indicated the greatest fear: he was prone to weepconstantly, and was in great dread of his fellow- scholars and ofhis teacher, all of whom, he thought, suspected him of anythingwrong that happened to be done-if a theft were committed, hewas sure that he was suspected to be the thief. He was restlessat night, and often sighed and uttered unconnected words in hissleep. In five weeks he was said to have recovered, but there320 INSANITY OF EARLY LIFE. [CHAP.still remained eccentricities of conduct: if he kicked a stone, hemust return to kick it twice more; if he spat once, he mustspit twice more; if he had written a word incorrectly, he mustrepeat the correction. Of these peculiarities he was quite conscious, and struggled against them, but without avail; after greatrestlessness and mental disquietude he was ultimately obligedto give way to them. * In other like cases, morbid notions withregard to religion may be the exponents of the emotional disturbance of psychical tone.Perhaps the most striking form in which the melancholiaof children manifests itself is by suicide. So strange andunnatural a thing does it seem that a child of eight or nineyears of age should, world- weary, destroy its own life, that oneis apt to consider the fact inexplicable. Such act of suicideis certainly done sometimes under a sudden impulse from thedread of punishment or after the infliction of punishment, or itis perhaps deliberately resolved upon in a state of sadness anddepression consequent upon continued ill-treatment by a brutal.schoolmaster or parent.+ Falret mentions the case of a boy ofeleven years of age, who was driven by the ill treatment of histeacher into such a state of melancholia that he determined tostarve himself, and made repeated attempts at suicide by drowning. This premature disgust of life will most often be found tobe the result of some ancestral taint, by reason of which thechild's nervous constitution is inherently defective, and disposedto perverted feeling and irregular reaction. The question ofhereditary taint is in reality the important question in anexamination of the insanity of early life.7. Affective Insanity, or Moral Insanity. —In the majority ofinstances the affective insanity of early life might justly bedescribed as hereditary; but there are some cases in whichthe morbid condition of nerve element which manifests itselfin extreme moral perversion is not inherited but observablyacquired by reason of vicious habits of self-abuse. It is notcorrect, therefore, to describe all cases of so- called moral insanityin children as examples of hereditary insanity. I prefer using

• Irrsein bei Kinder, von Dr. Beckham.

Étude sur le Suicide chez les Enfants, par Durand Fardel.-AnnalesMédico-Psychologique, 1855.n.] INSANITY OF EARLY LIFE. 321the word affective to the word moral, because the latter term isvery vague, and implying, as it does, a consciousness, is ofteninappropriate, and always objectionable; the affective life, orfeeling, on the other hand, mirrors the real nature of the individual. The term affective insanity will, therefore, appropriatelyexpress the fundamental vice of nerve element in such case.The examples of affective insanity in early life fall naturallyinto two divisions: (a) the first includes all those instancesin which there is a strange perversion of some fundamentalinstinct, or a more strange appearance of some quite morbidimpulse; and (b) the second division comprises all those casesof systematic moral perversion in which there often seems tothe onlooker to be wilful wickedness. The former might bedescribed as the instinctive variety of affective insanity; thelatter as moral insanity proper.(a) Instinctive Insanity.-What are the inborn instincts ofmankind? The instinct of self-conservation, which is truly thelaw of the existence of living matter as such, and the instinctfor propagation which provides for the continuous existenceof life, and is, therefore, in some sort a secondary manifestation of the self-conservative instinct. Nowthe instinct of selfconservation is manifested not only by individual organicelement, humble or exalted, but it is manifest in all thephenomena of vitality, conscious or unconscious: it is, asalready seen, at the foundation of all the passions, which arefundamentally determined according as impressions producegratification of self or are painful to self. Children are ofnecessity extremely selfish; for it is the instinct of their beingto appropriate from without, to the end that development maytake place a baby is the only king, as has been said, becauseeverybody must accommodate himself to it, while it accommodates itself to nobody. Associated, however, as necessarilycorrelate with the instinct of appropriation whereby what isgrateful to self is assimilated, is plainly a destructive or repulsive instinct or impulse whereby what is not grateful to self isrejected, got rid of, or destroyed. The infant rejects the mother'sbreast if from some cause, internal or external, the milk is notgrateful to it; by crying and struggling it strives to get rid ofa painful impression which may happen to be affecting it, as theY322 INSANITY OF EARLY LIFE [CHAP. .Gregarina shoots away from a stimulus, or as a snail retracts itsprotruded horns when they are suddenly touched; and when itis a little older, it destroys or attempts to destroy what is notpleasing to it. To talk about the purity and innocence of achild's mind is a part of that poetical idealism and willinghypocrisy by which man ignores realities and delights to walkin a vain show. The purity and innocence of the child's mind,in so far as they exist, testify to the absence of mind; theimpulses which actually move it are the selfish impulses ofpassion. "A boy," says Plato, " is the most vicious of all wildbeasts; " or again, as it has been put, " a boy is better unbornthan untaught. " By nature sinful above everything, and desperately wicked, man acquires a knowledge of good through evil;his passions are refined and developed through wider considerations of interest and foresight; the history of mental development begins with the lowest passions, which circulate as anunder-current in every life, and frequently come to the surfacein a very turbulent way in many lives. Evil is good in themaking as vice is virtue in the making. " I cannot praise,"continues Milton, after saying that we know good by evil, "afugitive and cloistered virtue, unexercised and unbreathed, thatnever sallies out and sees her adversary, but slinks out of therace where that immortal garland is to be run for, not withoutdust 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 whichis a youngling in the contemplation of evil, and knows not theutmost that Vice promises to her followers, and rejects it, is buta blank virtue, not a pure; her whiteness is but an excremental,adventitious whiteness. "When insanity is met with in the young child, we observewhat we do in the adult under the same circ*mstances—passion in all its naked deformity and in all its exaggeratedexhibition. The instincts, appetites, or passions, call themas we may, manifest themselves in unblushing, extreme, andperverted action; the veil of any control which discipline mayhave fashioned is rent; the child is as the animal, and revealsits animal nature with as little shamefacedness as the monkeyindulges its passions in the face of all the world. As in the11.]INSANITY OF EARLY LIFE. 323child of three or four years old there is as a rule only theinstinct of gratifying itself, involved in which is the effort toreject or destroy what is not agreeable, its disease, if it becomeinsane, will be exhibited in a perverse and unceasing appropriation of whatever it sees, and in destructive attacks uponwhatever it can destroy. Refuse it what it grasps at, and itwill scream, bite, and kick with a frantic energy: give it theobject which it is striving, for, and it will smash it if it can: itis a destructive little machine which, being out of order, layshold of what is suitable and what is unsuitable, and subjectsboth alike to its desperate action. Haslam reports a case ofthis kind in a girl, aged three and a quarter years, who hadbecome mad at two and a half years of age, after inoculation forsmall-pox. Her mother's brother was, however, an idiot, thoughher parents were sane and undiseased. This creature struggledto get hold of everything which she saw, and cried, bit, andkicked if she was disappointed. Her appetite was voracious, andshe would devour any sort of food without discrimination; shewould rake out the fire with her fingers, and seemed to forgetthat she had been burnt; she passed her urine and fæces anywhere. She could not be taught anything, and never improved.The most striking manifestation of the destructive impulsewhich sometimes reaches such an extreme degree in the madnessof childhood is afforded by the instance of homicidal impulse."A girl, aged five years, conceived a violent dislike to her stepmother, who had always treated her kindly, and to her littlebrother, both of whom she repeatedly attempted to kill. "†Here there was a sort of conscious design apparent in the act;but it is obvious that the further back in mental developmentwe go, the less of conscious design will there be in the morbidmanifestation of the inborn impulse. Moreover, in the case ofhomicidal impulse in a young child, the consciousness of theend or aim of the act must at best be of a very vague andimperfect kind: it is driven, by an impulse of which it can giveno account, to a destructive act, the real nature of which itdoes not appreciate; a natural instinct being exaggerated andperverted by disorder of the nerve-centre. The character ofObservations on Madness.+ Esquirol, Traité des Maladies Mentales.Y 2324 [CHAP.INSANITY OF EARLY LIFE.the morbid manifestation is often determined by accidents ofexternal circ*mstances; the child is driven by an automaticimpulse to kill its stepmother as it would strive to kill a canarybird or to destroy crockery ware, the impulse being as muchits master as the convulsion of its limb is in chorea. Manycases, again, are on record of older children who have displayeda hideous and uncontrollable propensity to acts of cruelty anddestruction, practised on such creatures as were not too powerfulto be their victims.Because of the variety of forms which the morbid manifestations of perverted instinct may take, it sometimes happensthat a young child very much resembles a monkey in its conduct,as it does in its wizened and old-fashioned face. It may display a wonderful talent for mimicry, a precocious skill in lyingwith all the ease of an instinct, and a positive faculty for thievingwhich is quite natural to it. Of the best thieves as of the bestpoets it may in truth be said that they are born, not made.Though we are apt to look on such precocious viciousness assingular and inexplicable, a little reflection will show that underconditions of disease it is just as natural in the child as it is inthe monkey under conditions of normal development.Thus much concerning those phenomena of insanity in children that spring from the perversion of the self- conservativeimpulse. Let me now say a few words concerning the perversion of the instinct of propagation. It is necessary first to guardagainst a possible objection that this instinct is not manifest tillpuberty, by the distinct assertion that there are frequent manifestations of its existence throughout early life, both in animalsand in children, without there being any consciousness of theaim or design of the blind impulse. Whosoever avers otherwise must have paid very little attention to the gambols ofyoung animals, and must be strangely or hypocritically obliviousof the events of his own early life. It is at puberty that theinstinct makes its appearance in the consciousness of man, andthereupon generates knowledge of its aim, and craves meansof gratification; in like manner as, in the course of developmentthrough the ages, the blind procreative instinct which is immanent in animal nature finally undergoes a marvellous evolutionwithin human consciousness.11.] INSANITY OF EARLY LIFE. 325As we have exhibitions of this blind impulse in the healthychild, it is quite natural to look for exaggerated and pervertedinanifestations of it in the insane child. These we do not fail tomeet with while the enthusiastic idealist is greatly shocked bydisgusting exhibitions of unnatural precocity in children of threeor four years of age, and exclaims against them as if they wereunaccountable and monstrous, they are not without interest tothe scientific observer, who sees in them valuable instances onwhich to base his generalizations concerning man, not as an idealbut as a real being. In the Philosophical Transactions for 1745is the account of a boy, aged only two years and eleven months,who displayed a remarkable sexual precocity. Esquirol quotesthe case of a girl, aged three years, who was constantly puttingherself into the most indecent attitudes, and used to practise themost lascivious movements against any piece of furniture. Atfirst the parents thought nothing particular of it, but finding thepractice continued, and of unmistakeable significance, they triedevery means in their power to prevent it, but without avail. Inchurch or anywhere at the sight of an agreeable object therewas the same abandoment, ending in a general spasm. Thechild confessed to a positive pleasure from the acts, continuedthem as she grew up, and, though ultimately married, was aregular nymphomaniac. The greatest salacity was always manifested from the beginning to the end of spring. Other similarexamples of this sort of instinctive insanity might easily beadduced. The afflicted child has no true consciousness of theimport of its precocious acts; certain attitudes and movementsare the natural gesture-language of certain internal states; andit is little more than an organic machine automatically impelledby disordered nerve-centres.(b) Moral Insanity.-This variety of affective insanity mightbe illustrated by numerous examples of all degrees of severity,ranging from what might, not without reason, be described asviciousness to those extremer manifestations which pass farbeyond the bounds of what any one would call wickedness. Inthe spring of 1827, Dr. Prichard was asked to see the daughterof a farmer, in some members of whose family insanity existed.She was a little girl, aged seven, and was described as having

• See also Morel's " Études Cliniques sur les Maladies Mentales. " 1852.

326 INSANITY OF EARLY LIFE. [ CHAP.2been quick at apprehension, lively, affectionate, and intelligent.A great change, however, took place in her conduct: she becamerude, vulgar, abrupt, and perfectly unmanageable; doing nowork, running about the fields, and, if rebuked, very abusive andextremely passionate. Her appetite was perverted so that shepreferred raw vegetables to her proper food; and she wouldsleep on the cold and wet ground rather than upon her bed.Her parents had no control over her, and she was persistentlycruel to her sisters, pinching them when she could do so withoutbeing observed. She had a complete knowledge of persons andthings, and recollected all that she had learned. Her eyesglistened brilliantly; the conjunctiva was reddened; her headwas hot, her extremities were cold, and her bowels disordered;there was a disagreable odour of the body. Dr. Prichard tookher into his own house, as she was getting worse at home."At this time she had taken to eat her own fæces, and to drinkher urine, and she would swear like a fishwoman and destroyeverything within her reach; yet she was fully conscious ofeverything she did, and generally appeared to know well thatshe had done wrong." After doing something wrong she wouldexclaim, " Well, Mrs. H., I have done it. I know you will beangry; but I can't help it, and I could not let it alone untilI had." Among her pleasures was that of dirtying herself asfrequently as she had clean clothes; indeed, " she would rarelypass her excrements into the proper place, but reserved themfor the carpet of the sitting- room, or for her own clean clothes. ""At other times she was so far conscious of her situation as tocry bitterly, and express her fears that she would become likeher aunt, who was a maniac. In addition to all these indications she had stolen everything which she thought would becared for, and either hid or destroyed it; and swore in languagewhich it is difficult to imagine that such a child could everhave heard." There was no fixed idea which influenced herconduct; she acted " from the impulse of her feelings, and thesewere unnatural, and perverted by disease." After two monthsshe recovered. *Haslam relates the following case of a young gentleman, agedOn the Different Forms of Insanity in relation to Jurisprudence. By J. C.Prichard, M. D. 1842 .11.] INSANITY OF EARLY LIFE. 327ten, in whose ancestors no insanity was admitted. When onlytwo years old, he was so mischievous and uncontrollable that hewas sent from home; and until he was nine years old he continued " the creature of volition and the terror of the family,"and was indulged in every way: he tore his clothes, broke whatever he could break, and often would not take his food. Severediscipline was tried, but in vain; and the boy was ultimatelysent to a lunatic asylum. There was deficient sensibility of theskin. He had a very retentive memory with regard to matterswhich he had witnessed, but was attracted only by fits andstarts, so that he would not learn: he was " the hopeless pupilof many masters," breaking windows, crockery, and anything elsewhich he could break. Whenever the cat came near him heplucked out its whiskers with wonderful skill and rapidity, saying, “ I must have her beard off," and then commonly threw theanimal on to the fire or through the window. He was quiteinsensible to kindness, and never played with other boys. " Ofhis own disorder he was sometimes sensible: he would oftenexpress a wish to die, for he said very truly, ' God had not madehim like other children; ' and when provoked he would threatento destroy himself." No improvement took place. A case insome regards similar is quoted by Moreau from Renaudin, underwhose care it was -A boy, whose intelligence and behaviourwere usually of an ordinary character, was subject every now andthen to a positive mania of acts, without any mental incoherence. *When these attacks came on him he was quite incorrigible, andin consequence of them he had been expelled from differentschools. After several unsuccessful trials at discipline, he wasat 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 circ*mstance was that there was a complete insensibility of the skin at the time of the attacks of irresistibleviolence, and that, in his docile and affectionate intervals, thesensibility of the skin was natural. The acts of violence wereof so extreme a character that, says the reporter, " we were ableto 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 insuch young children than when it is met with in the adult.The extreme acts of precocious wickedness seem so inconsistentwith the immaturity of childhood that they are readily accountedunnatural, and are attributed to disease. However, to call themthe result of disease is not to explain them, nor to cancel theneed of an explanation; and to designate them unnatural is notto remove them from the domain of natural law. Whosoeverscrupulously traces these acts as the necessary consequences ofcertain coefficient causes implied in the vitiated constitution ofthe nerve element of the child, and thus banishes, as he mustdo, the notion of witting and wilful vice, will be prepared torecognise the possibility of like physical conditions in the adultbeing the agents in producing like morbid effects. Instead ofdismissing a thing from the mind after labelling it as unnaturalor morbid, without being at the pains to attach any definitemeaning to such words, it is most necessary to strive to getprecise ideas as to its nature and causation, so that in the eventof a similar effect being at some time observed, there may belight thrown upon the hidden causes and true relations, in placeof vague or unfounded assumption agreeable only to ignorant.prejudice.There are children of a defective mental capacity not reachingthe degree of idiocy, or even of positive imbecility, whom it isvery difficult to knowwhat to do with sometimes. They are dull,heavy, stupid, appear careless, indifferent, and as if they will nottry to learn anything, and display low or vicious tastes; whensent to a respectable school, they are commonly after some timesent home again as impracticable. Their inability to learn looksvery much like stupidity and obstinacy, when it is really theresult of disease, and marks a certain measure of imbecility. Itis sometimes the misfortune of boys of this sort to be sent, afterfailing at the usual schools, to some one who advertises forunruly pupils, and who represents himself as possessed of somespecific for managing and training them. A few years since aboy of this kind was said to have been flogged to death by hismaster, who was put upon his trial for manslaughter, was foundguilty, and received a severe sentence. Without doubt the poor11.] INSANITY OF EARLY LIFE. 329boy was harshly and cruelly used, but there are medical reasonsfor thinking that the case was not quite so bad as it was represented in the public papers. Dr. Wilks has expressed anopinion to this effect, grounding it on the fact that in some ofthese cases of half imbecility there is an abnormal quantity ofserum in the ventricles of the brain, and that death may sometimes take place suddenly in consequence of the increase of thefluid beyond a certain amount. In the case referred to an unusual quantity of serum was found in the ventricles of the brainafter death; and the medical man called for the prosecutiongave it as his opinion that this was the result of the treatmentto which the boy had been subjected, and the probable cause ofdeath. In reality, the condition of things may have been thecause of the youth's stupidity, and so his death have been occasioned by a punishment which would not have seriously injureda healthy child. Although this would not be a justification ofthe punishment, it would still absolve the schoolmaster fromsome portion of his culpability. When we reflect on the possible state of things in the brain, it will be obvious that no good,but much mischief, will be done by harsh measures: kindnessand encouragement, good diet and regular habits, proper bodilyexercise and the regular control of some judicious person, willbe the best means to employ. Above all things, it is necessaryto forego attempts to make such defectively organized beingsattain to a degree of mental development which they are bynature incapable of; they should be put to some humble occupation for which they are fitted.There is another class of boys who cause great trouble andanxiety to their parents and to all who have to do with them.Afflicted with a positive moral imbecility, they are inherentlyvicious; they are instinctive liars and thieves, stealing anddeceiving with a cunning and a skill which could never beacquired; they display no trace of affection for their parents, or offeeling for others; the only care which they evince is to contrivethe means of indulging their passions and vicious propensities.Intellectually, they are certainly defective also, for they usuallyread no better when they are sixteen years old than a healthychild of six years of age would do; and yet they are very acute indeception and in gratifying the desires of their vicious natures.330 INSANITY OF EARLY LIFE. [CHAP.Passionate, selfish, cruel, and sometimes violent, they are intolerable at home; and if they are sent to school, they are sure tobe expelled. When they belong to the lower classes, they findtheir way to prison many times; indeed, they contribute theirquota to the criminal population of the country when theybelong to the better classes, there is nothing for it but to seekout some firm and judicious person who, for suitable remuneration, will take care of them, keep them out of mischief, and,while checking their vicious propensities, will try to discoverand foster any better tendencies which they may have in them.The resemblance of these beings in moral character to the lowestsavages, and even to monkeys, is not without interest.What is of the utmost importance to be borne in mind inregard to all cases of affective insanity, and especially of thatvariety which we have described as moral insanity, is the question of hereditary taint. As the nature of man has been slowlydeveloped into that which it now is by a progressive fashioningthrough generations, so by a retrograde descent may it pass backwards to a lower stage: the degeneration which the individualwho becomes insane without having had any predisposition toinsanity represents, may observably become the inherent defector taint of the nervous element of his progeny, so that theacquired or, as it were, accidental irregularity of the parentdetermines a natural predisposition to irregular, perverse, anddiscordant acts in the offspring. The progress of organic development through the ages is a progressive internal specialization inrelation to external nature; the human organism, as the highestorganic development, has the most special and complex relationswith the external; and the highest mental development, as thesupreme development of the human organism, represents thecompletest expression of the most special and complex harmonybetween man and nature. Now this harmony will plainly bedestroyed, and a discord produced instead, by that inherentdefect of nerve element which an hereditary taint implies; forit implies, as we have seen, a predisposition to discordant action.Accordingly, there is witnessed in the infant, long before anyresponsibility attaches to its acts, either a congenital inabilityto respond to external impressions, whereby idiocy of greateror less degree is the consequence, or a degenerate state of nerve11.] INSANITY OF EARLY LIFE. 331element, whereby the natural assimilation of impressions andthe fitting reaction to them are seriously interfered with. Inthe latter case there is a positive defect in the composition orconstitution of nervous element; its degeneration means theloss of its kind and the existence of an inferior kind; accordingly its fundamental self- conservative impulse, as living matterof specific quality, is abolished. The strange perversions of thechild's appetites and instinctive strivings plainly reveal this;for, instead of displaying an aversion from what is injuriousand rejecting it, the young creature positively seizes with eagerappetite what is most baneful. In all the degrees and kinds ofhealthy life we witness in operation the attraction of what issuitable to growth and development and the repulsion of what isunsuitable in the lowest forms of life we describe them simplyas attraction and repulsion, or assimilation and rejection; as werise higher in the scale of life the attraction becomes appetiteand the repulsion becomes aversion; higher still the attractionis desire or love, the repulsion is dislike or hate, although if thereis any character of uncertainty about the event, hope and fearare used to express the opposite strivings; and the last andhighest development of these fundamental impulses is willingnessand unwillingness. But in the child born with a strong predisposition to insanity there is a want of this pre-established harmony between the individual constitution and external nature:the morbid creature devours with eager appetite the greatesttrash, and rakes out the fire with its fingers; it desires passionately and frantically struggles for what is detrimental to it, andrejects or destroys what is suitable and should, were it rightlyconstituted, be agreeable; it loves nothing but destructive andvicious acts, which are the expressions of an advanced degradation, and hates that which would further its development, andis necessary to its existence as a social being. By reason ofits physical constitution it is a fundamental discord in nature;and all its perverse reactions are the utterances of a graduallyproceeding course of deterioration whereby it ultimately goes todestruction: it cannot assimilate nature, and nature will therefore,sooner or later, assimilate it. Meanwhile, as a diseased elementin the social organism, it must be isolated or removed for thegood of the organism.332 INSANITY OF EARLY LIFE. [CHAPAs the mad acts of the insane infant or child mark a degenerate state of nerve element, so the degenerate creatureitself represents a degenerate variety or morbid kind of humanbeing. However low a human being may fall or be brought,he never reverts to the type of any animal; the fallen majestyof mankind being manifest even in the worst wrecks. Certainly there may sometimes be a general resemblance to oneof the lower animals, but the resemblance is never anythingmore than a general and superficial one; all the special differences in mental manifestations are still more or less apparent,just as all the special differences in anatomical structure stillremain. The idiot, with hairy back, may go on his knees and" bah " like a sheep, as did one of which Pinel tells; but as hedoes not get the wool and conformation of the sheep, so hedoes not get its psychical characters: he is not adaptedfor the relations of the sheep, and, if placed in them, wouldsurely perish, and he does exhibit unconscious traces of adaptation to his relations as a human being which the best developedanimal never would. So also with regard to man's next of kin,the monkeys: no possible arrest of development, no degradationof human nature through generations, will bring him to thespecial type of the monkey: a degenerate kind of human beingmay be produced, but it is a morbid kind, wanting the instinctsof the lower animals, and the unconscious upward aspirations oftheir nature, as well as the reason of man and his consciousaspirations. It is a very rare thing, for example, to meet amongidiots with that instinctive discrimination of poisonous matterswhich beasts have; on the other hand, it is very common tomeet among them with that perverted craving for improper orinjurious food, which is in reality the unconscious display ofnature's effort to extinguish a morbid variety, and which, butfor charitable interference and fostering care, would soon accomplish its aim.Man exists in an intimate correlation with nature at itspresent stage of development-is, as it were, the outgrowth atthis stage of its evolution, and therefore flourishes well underthe existing conditions: the monkey, on the other hand, is notin harmony with the complexity of surrounding nature, and israpidly becoming extinct, the stronger species surely superseding11.]INSANITY OF EARLY LIFE. 333it. If it were desired to bring man to the monkey level, it wouldbe necessary that the latest mighty changes in nature should beundone, and that condition of things restored which prevailedages before man appeared, and of which the monkey was thenatural outgrowth. While, then, the monkey type, and everyother pure animal type, represent stages in the upward development of nature, the theroid degenerations of mankind are pathological specimens, which, not being serviceable for development,are cast off by the stream of progress, and are on their way todestruction for re-issue by nature under better form. Let themnot pass by in their decay, however, without their uses, that we,profiting by the experiments which their failures afford, mayform for ourselves true generalizations suited to the successfulconduct of life, and therein to the promotion of nature's development. By such examples, nature teaches how best to promotethe progress of humanization.Do not the foregoing considerations render it sufficientlyintelligible how it is that we sometimes witness such a precocityof seeming vice in the insane infant or child? Innate in itshuman constitution is the potentiality of a certain development, the latent power of an actual evolution which no monkeyever has; in it is contained as by involution, or implicitlycomprehended, the influence of all mankind that has gonebefore. When, therefore, such a being is insane, there is notonly an individual creature, but there is human nature, in perverse action, in retrograde metamorphosis: there are actualizedin a morbid display certain potentialities of humanity, andaccordingly there are presented exhibitions of degenerate humanaction, which, so far as regards the individual infant, seem tomark prematurity of vice. Humanity is contained in the individual; and in these strange morbid displays we have anexample of humanity undergoing retrograde resolution. Whatever act of vice, folly, crime, or madness one man has perpetrated,there is in every man the potentiality of perpetrating; if it werenot so, why repeat the decalogue? In the sense of anything innature being self- determined and self-sufficing, there is no individuality as in one word are summed up ages of human cultivation, so in one mortal are summed up generations of humanexistence. Both in his knowledge and in his nature each one is334 INSANITY OF EARLY LIFE. [CHAP. II .the inheritor of the acquisitions of the past-the heir of all theages. Take the word which represents the subtile and, as it were,petrified thought of a high mental culture, and trace back withanalytical industry its genesis, -resolve it into its elementary production,-what a succession of human experiences is unfolded!What a gradual process of growth, rising in speciality and complexity up to that organic evolution which the word now marks,is displayed! Take, in like manner, the individual being, andtrace back through the long records of ages the antecedent stepsof his genesis, or observe rather the resolution of his essentialhuman nature as it is exhibited in the degenerate acts of theinsane child-in this experiment thus obtruded on the attentionby nature—and there will then be no cause for surprise at phenomena which the young creature could never have individuallyacquired, and which, so far as its conscious life is concerned,appear strangely precocious and inexplicable. There is therapid undoing of what has been slowly done through the ages,the irregular morbid manifestation of faculties which have beentediously acquired, the formless ruin of carefully fashioned form.It will not be amiss to add that the phenomena of the insanityof early life, examined with scrupulous fidelity, confirm in thefullest and most exact manner the general physiological andpathological principles which throughout this work it has beenthe aim to establish, enforce, and illustrate.THERECHAPTER III.VARIETIES OF INSANITY.THERE are certain mild forms of Insanity, or rather certaineccentricities of thought, feeling, and conduct, which scarcelyreach the degree of positive insanity, yet not unfrequently causegreat difficulty when the question of legal or moral responsibilityis concerned. Many people who cannot be called insane,notably have what may be called the insane temperament, -inother 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. Thiscondition, in the causation of which hereditary taint is commonlydetectable, may be described as the Diathesis spasmodica, or theNeurosis spasmodica.1. The Insane Temperament, or Neurosis spasmodica.—It ischaracterised by singularities or eccentricities of thought, feeling, and action. It cannot truly be said of any one so constituted that he is mad, but he is certainly strange, or " queer," or,as it is said, " not quite right." What he does he must oftendo in a different way from all the rest of the world. If hethinks about anything, he is apt to think about it under strangeand novel relations, which would not have occurred to an ordinary person; his feeling of an event is unlike that which otherpeople have of it. He is sometimes impressionable to subtile andusually unrecognised influences; and now and then he doeswhimsical and apparently quite purposeless acts. There is inthe constitution an innate tendency to act independently as anelement in the social system, and there is a personal gratificationin the indulgence of such disposition, which to lookers-on seemsto mark great self-feeling and vanity. Such an one, therefore, is336 VARIETIES OF INSANITY. [CHAP.deemed, by the automatic beings who perform their duties in thesocial system with equable regularity, as odd, queer, strange, ornot quite right. He is certainly not unlikely to break downsome time or other into actual insanity.This peculiarity of temperament, which undoubtedly predisposes to insanity, does nevertheless in some instances bordervery closely upon genius; it is the condition of the talent or witwhich is allied to madness, only divided from it by thin partitions. The novel mode of looking at things may be an actualadvance upon the accepted system of thought; the individualmay be in a minority of one, not because he sees less than, ornot so well as, all the world, but because he happens to seedeeper, or to be favoured with a flash of intuitive insight. Hemay differ from all the world, not because he is wrong, and allthe world is right, but because he is right, and all the worldis wrong. Of necessity every new truth is at first in a minority of one; it is a rebellion against the existing system ofbelief; accordingly the existing system, ever thinking itself afinality, strives with all the weight of its established organization to crush it out. But by the nature of things that musthappen, whether the novelty be a truth or an error. Afterall, it is only through the appearance of rebels in the socialsystem that progress is effected; and precisely because individuality is a reproach, and sneered at as an eccentricity, is it wellfor the world, as Mr. J. S. Mill has pointed out, that individuality or eccentricity should exist. * It may be advisable to setthis matter forth at greater length, to the end that we may, ifpossible, get a just conception of the real relation of certainsorts of talent to insanity.The genius is always recognised to be in the van of his age;in that wherein he is in advance, he necessarily differs from hisage, and is often enough therefore pronounced mistaken, unpractical or mad: in that wherein he agrees with his age, he is necessarily not original; and so appears the truth of an observation ofGoethe, that genius is in connexion with its century only by itsdefects-that in which there is not genius. Certainly the originality of a man of true genius will grow out of the existingsystem, may be traced as a genetic evolution of it; he is thereEssay on Liberty.III.]VARIETIES OF INSANITY. 337fore in radical connexion with his century; but the moreadvanced his development, the more he will outshoot anddiffer from his age. Accordingly, many a man of genius—whohas appeared before his time, or, in other words, before thesocial organism has reached that stage of evolution represented by him-has been forgotten, having most likely beenthought more or less mad in his lifetime; and the person whousually gets most reputation, and whose name is made to markan epoch in development, is he who systematizes and definitelysets forth-that is, brings into illuminated consciousness-themethod which mankind has for some time been instinctively orunconsciously pursuing. A Bacon and a Comte, being in realitynot much in advance of their centuries, but having eyes todiscern the tendencies of development, and a capacity of coordinating knowledge, are those who get the most honour.But even these men are not honoured so much by their own ageas by a posterity which has developed up to their level. Wenever know how high the mountain is until we get some distancefrom it.An inherent disposition of nervous constitution, rendering aman dissatisfied with the existing state of things, and impellinghim to novel strivings, is really an essential condition of originality to suffer greatly and to react with corresponding force,is a means of dragging the world forward at the cost of individualcomfort. Consider, however, what an amount of innate powera man must have in order to do that, without himself sinkingunder the huge weight of opposition! Many earnest and intense reformers, whose vital energies have been absorbed in thepromulgation of a truth, which was perhaps an important one,have notoriously broken down in face of the crushing force ofthe organized opposition. They have been so abandoned to theiridea, so carried away by it, so blind to the force of the circ*mstances with which they have had to contend, so one- sided andfanatical, as to be almost as inconsiderate of the manifold relations of their surroundings as actual madmen are; accordinglythey 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 toZ· 338 [CHAP. VARIETIES OF INSANITY.succeed. Whatever the will, there was not in their nature thecapacity to establish an equilibrium between themselves andexternal conditions. They could not mould circ*mstances agreeably to their wishes; they could not accommodate themselvesto circ*mstances; they were inevitably, therefore, the victims.cases.It is undoubtedly true, that where hereditary taint exists in afamily, one member may sometimes exhibit considerable genius,while another is insane or epileptic; but the fact proves no morethan that in both there has been a great natural sensibility ofnervous constitution which, under different outward circ*mstances, or internal conditions, has issued differently in the twoNow we may properly look at the functional manifestations of unstable nerve element from two different aspects-first,as regards the reception of impressions; and, secondly, as regards the reaction outwards. In the first case, for example, wemay have one who is equal to the ordinary events of a calm life,but who, possessing no reserve power, is unequal to the strain ofa calm self- renunciation, and breaks down under the stress ofadverse events. And yet his extreme nervous susceptibility mayrender him capable of slighter shades and more subtile delicaciesof feeling and thought than a more vigorously constituted beingis. The defect, then, is in some respects an advantage, althougha rather perilous one, for it may approach the edge of madness:such men as Edgar Allan Poe and De Quincey illustrate thisgreat subtlety of sensibility amounting almost to disease, and sofar give some colour to the extravagant assertion of a Frenchauthor (Moreau de Tours), that a morbid state of nerve elementis the condition of genius. It should not be lost sight of,however, that any one so constituted is nowise an example.of the highest genius; for he lacks, by reason of his greatsensibility, the power of calm, steady, and complete mentalassimilation, and must fall short of the highest intellectualdevelopment. Feeling events with a too great acuteness, he isincapacitated from the calm discrimination of the unlike inthem, and the steady assimilation of the like, by which theintegration of the highest mental faculties is accomplished, -bywhich, in fact, the truly creative imagination of the greatest poetandthe powerful and almost intuitive ratiocination of the greatestphilosopher are fashioned. His insight may be marvellously111.] VARIETIES OF INSANITY.339subtile 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 denoteda morbid condition of nerve element, yet no one, after a moment'scalm reflection, would venture to speak of the genius of such asShakspeare, Goethe, and Humboldt, as arising out of a morbidcondition. * The impulse which instigates these men to theirsuperior striving, is not so much one of dissatisfaction as one ofnon-satisfaction-a craving, in fact, for appropriation; the internal potentialities display their endeavour towards realizationthrough the concurrence of suitable external impressions by afeeling of want, a craving, or an unsatisfied instinct-not otherwise than as the lower organic elements manifest their sense ofhunger, or as the sexual instinct reveals its want at puberty.The difference between the desires which are the motives toaction of the highly- endowed, well- balanced nature of the genius,and the desires which instigate the eccentric and violent acts ofthe incipient madman, is indeed very much like the difference between the natural feeling of hunger in the healthy organism, andthe perverted appetite for garbage and dirt which the hystericalperson occasionally displays. In the former case the aspirationis sound, and directed towards perfecting a harmony between theindividual and nature; in the latter, it is unsound, and tends tothe production of an irreconcilable discord. The good organization hardly needs a long training; it will make the means of itsown best training by the operation of its excellent affinities; andit will thus, directly or circuitously, attain to its complete development. The bad organization, on the other hand, can only besaved 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- endowednerve element of the genius and the morbid nerve element ofthe hereditary madman will be apparent when we look to the"So far from the position holding true, that great wit (or genius, in ourmodern 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 forthe mind to conceive of a mad Shakspeare. The greatness of wit, by which thepoetic talent is here chiefly to be understood, manifests itself in the admirablebalance of all the faculties. Madness is the disproportionate straining or excessof any one of them. "-Sanity of True Genius, by Charles Lamb.z 2340 VARIETIES OF INSANITY. [CHAP.cactive, instead of the receptive, side. The difference is notunlike that which there is between a quiet aim-working volitional act and a spasmodic movement. The acts of the geniusmaybe novel, transcending the routine of the established systemof thought and conduct; but, however original and startlingthey may appear to those who are, as it were, automatic elements.in the social organization, they contain, consciously or unconsciously, well-formed design: there are in them an intuitiverecognition of and an intelligent respondence to outward relations; in other words, they are aim-working for the satisfaction.of an inherent impulse, which operates none the less wiselybecause there may not be a distinct consciousness of its natureand aim. Inspiration is the exact opposite in this regard ofhabit or custom-that " tyrant custom" which so completelyenslaves the whole manner of thought and action of the majorityof men in the inspiration of a great thought or deed there isthe sudden starting forth into consciousness of a new combination of elements unconsciously present in the mind; these havingbeen steadily fashioned and matured through previous experience.On the other hand, the acts of the person who has the evil heritage of an insane temperament are purposeless , irregular, and aimat the satisfaction of no beneficial desire; they tend to increasethat discord between himself and nature of which the purposeless acts are themselves evidences, and they must ultimately endin his destruction.I have thus lingered upon the relations which a form of talentbears to insanity, in order to exhibit, if possible, the position ofeach in the social organization. In both cases there may be anuncommon deviation from the usual course of things; but inone case there is the full recognition of the existing organizationas the basis of a higher development, a fusing of the pastthrough a new mould into the future; in the other, there is acapricious rebellion, as the initiation of a hopeless discord.man of deep insight and comprehensive view may penetratebeneath the masks of things, and see into the real nature of manyof the delusions set up by common consent to be worshipped,but he stills finds a real truth and meaning beneath the fleetingphenomena, and he accepts with equanimity the present, not asthe end, but as means to an end, perceiving in it the prophecyAIII.] VARIETIES OF INSANITY. 341of a completer future: he can subordinate his self- hood to thesystem, works quietly and sincerely in his sphere, and is movedby no passion springing from offended self-feeling to set theworld violently right. The man of great self- feeling, on theother hand, may with penetrating insight recognise the incompleteness, inadequacy, or vanity of many existing phenomena,but he is too apt to find the whole ridiculous, not havingsufficient perception to discern the degree of truth which lies inall these apparent shams; he deems himself thoroughly emancipated when he is actually the unconscious slave of an extravagant self-feeling, by reason of which he is made angry with thecomedy of life, or passionately earnest to set the world rightwith a onesided vehemence: there is the reaction of a great selflove which incapacitates its possessor, or rather its victim, fromsubordinating his personality to the laws of the existing organization. Has not Goethe, as usual, admirably put this truth inthe words, " The man of understanding finds almost everythingridiculous; the man of reason hardly anything "?Where the heritage of the insane temperament exists , it willof course depend much on the internal bodily conditions and theexternal circ*mstances of life whether the mischief shall remainlatent or issue in positive insanity. Under favourable circ*mstances it may declare itself only in harmless eccentricities andsingular caprices; but if the individual is placed under conditions of great excitement, or subjected to a severe mental strain,the inherent propensity is apt to display itself in some impulsiveact of violence. The great internal disturbance produced inyoung girls at the time of puberty is well known to be anoccasional cause of strange morbid feelings and extraordinaryacts; and this is especially the case where the insane temperament exists. In such case also irregularities of menstruation,always apt enough to disturb the mental equilibrium, may giverise to an outbreak of mania, or to extreme moral perversionmore afflicting to the patient's friends than mania, because seemingly wilful. The stress of a great disappointment, or any otherof the recognised causes of mental disease, will meet with apowerful co-operating cause in the constitutional predisposition.On this matter, however, enough has already been said whentreating of the causation of insanity.342 VARIETIES OF INSANITY. [CHAP.It remains only to add here-what should never be lost sightof-that a morbid hereditary taint frequently impresses itsstamp on the individual's character and conformation in a muchmore decided manner than by eccentricities of conduct whichare compatible with considerable talent. There is often anervous and excitable manner, a peculiar or awkward gait, restless behaviour, or impulsive and whimsical conduct; oddities ofdress and demeanour, capricious likes and dislikes, a lack ofpower of sustained thought, and abrupt transitions in conversation are also frequently witnessed. " This fatal heritage,"Esquirol wrote, " is painted upon the physiognomy, on theexternal form, on the ideas, the passions, the habits, the inclinations of those who are the victims of it." In more extremecases the physiognomy has not the regularity and harmony ofbeauty; there is, perhaps, an irregular conformation of thehead; a vicious implantation of the ears, or a deformity ofone or both of them, is not uncommon; convulsions may occurin early life, or there are tics and spasmodic movements inafter life; the walk is uncertain, vacillating in extreme cases,and there is sometimes a disproportion between the limbs.Arrest of development of the sexual organs is not very uncommon; slight diseases readily take on a fatal character, so littleis the power of vital resistance; and the mean duration of life.among those strongly marked by this fatal heritage is less thanthe average. There are corresponding peculiarities of disposition: Morel, of Rouen, to whom we are most indebted for thescientific investigation of this subject, describes these victimsas purely instinctive beings; they display instinctively certainremarkable talents, as for music, drawing, calculation, or exhibita prodigious memory for details; but they are incapable ofsustained thought and work-they cannot bring anything to asteady perfection, " do not know that they know, do not thinkthat they think; " and under any great strain they are almostcertain to break down into desperate insanity, or to explode inan act of extravagant violence. It is strange what a remarkablemusical talent may co- exist with the extremest imbecility. I havelately seen a little girl, æt. five, imbecile by birth by reason ofhereditary degeneracy, who cannot speak a word, who screamsfrightfully, and who is so mischievous and destructive that she111. ] VARIETIES OF INSANITY. 343cannot be left alone for a minute; yet she can hum correctlymany tunes-her mother counts as many as twenty. As theresult of his elaborate researches, Morel comes to the conclusionthat " in the inferior varieties of degenerate beings a like physicaltype is to be observed amongst all the individuals that composethese varieties, and a certain conformity in their intellectual andmoral tendencies. They betray their origin by the manifestationof the same character, the same manners, the same temperament,the same instincts. These analogies establish amongst degenerate individuals under the same causes the bond of a pathological relationship. " Forget not that between the extreme formsof this degeneracy and those slight eccentricities compatible withhigh talent there are to be met with cases marking every shadeof the long gradation .Closely allied to the insane temperament is that which existsin those hysterical women, mostly under thirty years of age, whoare the favourite subjects of mesmeric experiments or of religious imposture, and who commonly exhibit some peculiarityof nervous constitution, such as catalepsy, paralysis, somnambulism, or spasmodic affections. They have no well -formed willof their own, and they become the easy victims of ideas forciblypresented 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 feeling or idea and to spasmodic movements. A further consequence of this bad organization is manifested in some of thesecases by a strangely perverted or defective moral nature.Certain women exhibit a desire for imposture which approachesa moral insanity: they will undergo extraordinary sufferingsand privations, in order to substantiate some outrageous fraudwhich they are practising; openly refuse all food for weeks, inorder to produce the belief that they live without food; drinkwhat urine they clandestinely pass, in order to have it thoughtthat they never make water; and burn or blister their arms andbodies with some corrosive fluid, in order to fabricate a peculiarskin-disease. The religious ecstatics of the Middle Ages weredoubtless of this class; and the miraculous stigmata which theyexhibited not less fictitious. When the vagaries of hysteriaaffect the mind rather than the body, as they are apt to do344 VARIETIES OF INSANITY. [CHAP.where the insane temperament exists, they occasion the mostextraordinary symptoms.Thus much concerning those peculiarities of temperamentwhich do not reach the degree of positive insanity, althoughthey strongly predispose to it. I shall now go on to treat of thedifferent varieties of actual mental disease from a symptomatological point of view. On a general survey of the symptomsof these varieties it is at once apparent that they fall into twowell-marked groups: one of these embracing all those cases inwhich the mode offeeling or the affective life is chiefly or solelyperverted-in which the whole habit or manner of feeling, themode of affection of the individual by events, is entirely changed;the other, those cases in which ideational or intellectual derangement predominates. More closely scanning the character andcourse of the symptoms, it will be seen that the affective disorderis the fundamental fact; that in the great majority of cases itprecedes intellectual disorder; that it co-exists with the latterduring its course; and that it frequently persists for a time afterthis has disappeared. Esquirol rightly then declared " moralalienation to be the proper characteristic of mental derangement. " " There are madmen," he says, " in whom it is difficult tofind any trace of hallucination, but there are none in whom thepassions and moral affections are not perverted and destroyed.I have in this particular met with no exception." To insist uponthe 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 varietiesof the two great primary divisions of melancholia and manianamely, a melancholia simplex, or melancholia without delusion,and a mania sine delirio. These are truly very importantvarieties; because it is in them, especially in the mania sinedelirio, that dangerous impulses to homicide, or suicide, or otherdestructive acts, are apt to arise.2. Affective Insanity. -Insanity of Feeling and Action . -Thefeelings mirror the real nature of the individual; it is from theirdepths that the impulses of action spring; the function of theintellect being to guide and control. Consequently when thereis perversion of the affective life, there will be morbid feelingIII . ]VARIETIES OF INSANITY. 345and morbid action; the patient's whole manner of feeling, themode of his affection by events, is unnatural, and the springs ofhis action are disordered; and the intellect is unable to check orcontrol the morbid manifestations, just as, when there is diseaseof the spinal cord, there may be convulsive movement, ofwhich there is consciousness, but which the will cannot restrain.In dealing with this kind of derangement, it will be most convenient, as in the investigation of the insanity of early life, todistinguish two varieties -impulsive or instinctive insanity, andmoral insanity proper.(a) Impulsive Insanity. -Fixing their attention too muchupon the impulsive act of violence, to the neglect of the fundamental perversion of the feelings which really exists, manywriters have unwittingly helped to increase the confusion anduncertainty which prevail with regard to these obscure varietiesof mental disorder. Already it has been pointed out, atsufficient length, that the first symptom of an oncoming insanitycommonly is an affection of the psychical tone, -in other words,a perversion of the whole manner of feeling; and what we havehere to fix in the mind is that the mode of affection of theindividual by events is entirely changed: this is the fundamental fact, from which flow as secondary facts the insaneimpulses, whether erotic, homicidal, or suicidal. The effect ofthe abnormal condition of nerve element is to alter the mode offeeling of impressions: in place of that which is for the individual good being agreeable, and exciting a correspondent desireto acquire it, and that which is injurious being painful, andexciting an answering desire to eschew it, the evil impressionmay be felt and cherished as a good, and the good impressionfelt and eschewed as an evil. There are not only pervertedappetites, therefore, but there are perverted feelings and desires,rendering the individual a complete discord in the social organization. The morbid appetites and feelings of the hystericalwoman and the singular longings of pregnancy are mild examplesof a perversion of the manner of feeling and desire, which mayreach the outrageous form of morbid appetite exhibited bythe pregnant woman who killed her husband and pickled hisbody in order to eat it. The sexual appetite may exhibit strangeand painful perversions, which again of necessity involve the346 VARIETIES OF INSANITY [ CHAP. .destruction of all those finer feelings of affection and proprietyin the social system that are based upon it; for it is impossiblethat natural and healthy love should co-exist with morbid lust.The morbid perversion of feeling may be general, so that allsorts and conditions of abnormal feelings and desires are exhibited, 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 thosein which there is a persistent morbid desire to be hanged, andthe victim ofthe diseased feeling is actually impelled to a homicidal act to satisfy his unnatural craving; or, again, such insanityas that of the father or mother who kills a child with the sincerepurpose of sending it to heaven. The act of violence, whateverform it may take, is but the symptom of a deep morbid perversion of the nature of the individual; a diseased state whichmay at any moment be excited into a convulsive activity, eitherby a powerful impression from without producing some greatmoral shock, or by some cause of bodily disturbance such asintemperance, sexual exhaustion, masturbation, or menstrualdisturbance. There are women, sober and temperate enough atother times, who are afflicted with an uncontrollable propensityfor stimulants at the menstrual period; and every large asylumfurnishes examples of exacerbation of insanity or epilepsy coincident with that function. In fact, where there is a conditionof unstable equilibrium of nerve element, any cause, internalor external, exciting a certain commotion, will upset its stability,just as occurs in the case of the spinal cord under similar circ*mstances. By his acts, as well as by his speech, does man utterhimself; gesture- language is as natural a mode of expression asspeech; and it is in insanity of action that this most dangerousform of affective insanity is expressed-most dangerous, indeed,because so expressed.Amongst numerous examples that might be quoted of thisform of insanity, in order to illustrate different uncontrollableimpulses-suicidal, homicidal, erotic, or of other kind-it shallsuffice here to adduce three cases, all of which came under myobservation and treatment. The first is an instance of irresistiblesuicidal impulse:-A married lady, aged thirty-one, who had only one child a few111.] VARIETIES OF INSANITY. 347months old, was for months afflicted with a strong and persistent suicidal impulse, without any delusion or any disorderof the intellect. After some weeks of zealous attention andanxious care from her relatives, who were all most unwillingto send her from among them, it was found absolutely necessaryto send her to an asylum; so frequent were her suicidal attempts,so cunningly devised, and so determined. On admission she wasvery wretched because of her frightful impulse, and often weptbitterly, deploring the great grief and trouble which she causedto her friends. She was quite rational, even in her great horrorand reprobation of the morbid propensity; and all the faultthat could possibly be found with her intellect was, that it wasenlisted in the service of the morbid impulse. She had ascomplete a knowledge of the character of her insane acts asany indifferent bystander could have, but she was completelypowerless to resist them. Nevertheless, her attempts at suicidewere unceasing. At times she would seem quite cheerful, so asto throw her attendants off their guard, and then would makewith quick and sudden energy a pre-contrived attempt. On oneoccasion she secretly tore her night-dress into strips while inbed, though an attendant was close by, and was detected in theattempt to strangle herself with them. For some time sheendeavoured to starve herself by refusing all food, and it wasnecessary to feed her with the stomach-pump. The anxietywhich she caused was almost intolerable, but no one couldgrieve more over her miserable state than she did herself.Sometimes she would become cheerful and seem quite wellfor a day or two, but would then relapse into as bad a stateas 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 onehad seen the last of her attempts at self- destruction. Watchfulness was somewhat relaxed, when one night she suddenlyslipped out of a door which had been carelessly left unlocked,climbed a high garden-wall with surprising agility, and ran offto a reservoir of water, into which she threw herself headlong.She was got out before life was quite extinct; and after thisall but successful attempt she never made another, but graduallyregained her cheerfulness and her love of life. Her family348 [ CHAP.VARIETIES OF INSANITY.was saturated with insanity. In face of such an exampleof uncontrollable impulse, what a cruel mockery it is tomeasure the lunatic's responsibility by his knowledge of rightand wrong!Cases belonging to the same class as the foregoing, but inwhich the impulse was homicidal, have been recorded by manydifferent observers. The following example occurred in mypractice: An old lady, aged seventy-two, who had severalmembers of her family insane, was afflicted with recurringparoxysms of convulsive excitement, in which she always madedesperate attempts to strangle her daughter, who was very kindand attentive to her, and of whom she was very fond. Usuallyshe 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, shriekingout that she must do it, make a rush upon her daughter thatshe might strangle her. During the paroxysm she was sostrong, and writhed so actively, that one person could not holdher; but after a few minutes of struggling she sank down quiteexhausted, and, panting for breath, would exclaim, " There,there! I told you; you would not believe how bad I was." Noone could detect any delusion in her mind; the paroxysm had allthe appearance of a mental convulsion; and had she unhappilysucceeded in her frantic attempts, it would certainly have beenimpossible to say honestly that she did not know that it waswrong to strangle her daughter. In fact, it was because of herhorrible propensity to so wrong an act that she was so wretched.It is a sufficiently striking commentary on the present state ofthe English law to add that, had this patient succeeded intaking her daughter's life, sentence of execution must have beenpassed, and might have been carried into effect, notwithstandingshe was so entirely insane and irresponsible.In the Report of the Morningside Asylum for 1850, Dr. Skaerelates a somewhat similar case of a female who was tormentedwith " a simple abstract desire to kill, or rather (for it took aspecific form) to strangle," without any disorder of the intellectual powers, and who " deplored, in piteous terms, the horriblepropensity under which she laboured. " The existence of thiskind of disease is placed beyond doubt by the concurrent testi-111. ]VARIETIES OF INSANITY.349mony of all those whose practical knowledge of insanity givesweight to their opinions and authority to their words; the denialof it on theoretical grounds derived from the deliverances of asane self- consciousness is most unwarrantable. In some of thosewho are afflicted with this most distressing form of mentaldisease, the only fault that can be found with the intellect is,that it is enlisted in the service of the morbid propensity-thatit is governed by it, instead of governing it.The next case may serve to illustrate a multitude of insaneacts, without corresponding intellectual disorder: there was notthe impulse to any particular insane act, but there were variousperverted feelings and many impulses to different strange andfoolish acts. A young lady, aged twenty-nine, of good appearance and manners, and well connected, was, after long patienttrial at home, sent to an asylum. From the age of twenty-twothere had been a tendency to lowness of spirits without apparentcause. Lately she had become worse, and was now described aswilful, impulsive, passionate, and as having lost all affection forher parents, though formerly most affectionate and amiable. Herhabit of body was sluggish, the circulation being languid andthe extremities often cold and livid; menstruation was veryirregular. She complained of feeling strange, quite unlike herself,and ill, and would buy all kinds of queer compounds at thechemist's, and take them; sometimes she wrapped a wet sheetround her body, and then put her clothes on over it . She entertained a very high opinion of her talents, and was exceedinglyvain, seeming to think herself a peculiar person, and angrilycomplaining that she was treated most shamefully if her inclinations were anywise thwarted. And her inclinations were peculiar,and suddenly manifested: she would all of a sudden scale a highgarden wall and run off into the fields, or sit down by the roadside when walking out, and refuse to move for a long time, orstand still in the middle of the road, or jump up in the middle ofthe service and walk out of church. She was continually writingletters to her parents, relatives, and people whom she did notknow, complaining of her confinement, sometimes angrily, atother 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. [CHAP.The letters often contained very clever and vigorous remarks,but the sentences were rarely connected, each one being, as itwere, an independent shot; as the thought came automaticallyinto the mind, so it was automatically expressed. Now and thenshe would refuse to take any food for a day or two, and at othertimes would eat far more than was good for her. She alwaysexhibited extreme religious feeling, was fond of distributing tractsas she went along the road, and would sometimes read to theunfortunate patients who were more severely afflicted; notwithstanding which benevolence, however, she would, if she had notthe exact seat at church which she might happen to desire, burstinto tears and sob with passion, or rise up in the midst of theservice and walk quietly out; at other times she would not moveafter the service was over, notwithstanding all the entreaties andreproaches of those who attended upon her. Adjured beforehandto behave properly, she would promise to try to do so; remonstrated with at the time of her extravagances, or after she hadindulged in them, the reply usually was that her motives werenot understood; although when in a better mood she confessedthat she was a great trouble, acknowledged the attention whichshe received, and said that she was prompted by Satan; sometimes she wished heartily that some one would give her a goodbeating so as to rouse her from her apathy. If any reason wasgiven for her impulsive deeds at the time, it usually was that " itwas revealed to her " that she was to do so; and it is remarkablethat, though usually overcome with languor, and looking as ifscarcely able to move, she would, when the impulse seized her,scale a high brick wall with a cat-like agility, though she seemedto have no definite notion what she was going to do when shehad got over, and had run for a certain distance. In all herconduct she exhibited an odd combination of reason of thoughtand of dementia of action; a stranger conversing with her wouldhardly have discovered that her mind was at all affected; butany one living with her for a time could not fail to perceive howexceedingly insane she really was. In truth, it would not beinappropriate to describe the case as one of Dementia sinedelirio; with good natural endowments and general correctnessof thought there was an insanity of feeling and of action evincing fundamental derangement of her mental nature. Although111.]VARIETIES OF INSANITY.351hereditary taint was denied, yet it ultimately turned out thattwo other near relatives were in confinement, and incurablyinsane-a fact which might have been predicted with someconfidence from the character of her disease. The idea whicharose in the mind as the motive impulse of her singular deedscame not by any regular process of conscious association; itappeared as the result of cerebral activity in the recesses ofthe unconscious mental life; the unconscious nature, as sooften happens in every one's life, surprised and overpoweredthe conscious life. The idea thus starting automatically intosudden activity appeared to her verily as a revelation fromheaven or an impulse from Satan; and the action which itdictated was scarcely more within control than the sudden spasmof chorea, or the convulsion of epilepsy.The foregoing cases may be accepted as typical examples ofdifferent forms of impulsive insanity. In each of them there wasa strong hereditary taint, as indeed there commonly is in thisconvulsive form of mental disease; but other causes may giverise to a similar morbid state without any hereditary taint beingpositively detectable. Irregularities of menstruation sometimesproduce severe disorder of nerve element, giving rise in one person to hysterical convulsions or hysterical mania, in another toepilepsy, and in another to violent suicidal or homicidal impulse.A woman who was in the deepest despair because she wasafflicted with the idea that she must murder her children, andfrequently ran actively up and down stairs so as to endeavourto drive away the idea by producing exhaustion , perfectlyrecovered on the return of the menses, which had stopped. "Wehave, amongst others, " says Dagonet, " observed a patient whowas seized at each menstrual period with violent impulses.Under the influence of this disposition she had killed her threechildren a short time before her arrival at Stephansfeld." * Thedegeneration of nerve element induced by habits of self- abuse, orby great sexual excesses, sometimes manifests itself in the dangerous form of impulsive insanity. Lallemand relates severalstriking cases in which patients suffering from spermatorrhoeawere afflicted with painful homicidal and suicidal impulses.The most desperate examples of homicidal impulses are

• Traité Élémentaire et Pratique des Maladies Mentales, par H. Dagonet, 1862.

352 VARIETIES OF INSANITY [CHAP. .undoubtedly met with in connexion with epilepsy. Sometimesan attack of mania notably precedes an epileptic fit or a seriesof epileptic fits; but it is not so clearly understood that the mentalderangement so occurring may have the form of profound moraldisturbance with homicidal propensity, but without manifestintellectual derangement. A shoemaker was subject to severeepileptic fits, and was often furious for a while immediately afterthem; but in the intervals he was sensible, amiable, and industrious. One day, when in the gloomy and morose frame ofmind that often foretells an attack of epileptic fits-a condition which corresponds with what is described as mania sinedelirio-he met the superintendent of the asylum, to whom hewas much attached, and suddenly stabbed him to the heart. Hehad not had a fit for three weeks, but in the night following hishomicidal deed he had a severe fit, and for some time the attackscontinued to be frequent and severe. In such cases, as indeedin the above case, there are often sudden and vivid temporaryhallucinations. Again, the mental disorder which sometimestakes the place of an epileptic attack, being in fact a maskedepilepsy, may appear as simple impulsive insanity. A peasant,aged twenty-seven, had suffered from epilepsy since he waseight years old; but when he was twenty-five the character ofhis disease changed, and instead of epileptic attacks he wasseized with an irresistible impulse to commit murder. He feltthe 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 itonly a child." Before the attack he complained of great weariness; he could not sleep, felt much depressed, and had slightconvulsive movements of his limbs.*The connexion of homicidal insanity with epilepsy is a subject of extreme importance from a medico-legal point of view,and one which has only lately received the attention which itdeserves; it will not be amiss, therefore, to give additional examples, and to give them in the words of those who have related them. The first case is one mentioned by Dr. Burrows." A very sober, quiet, and industrious man, æt. thirty, subject

• De la Folie considérée dans ses Rapports avec les Questions Médico-judiciaires,

par C. C. H. Marc.III.]VARIETIES OF INSANITY. 353to occasional fits of epilepsy, who had lately been much inclinedto religious devotion, was sitting calmly reading his Bible, whena female neighbour came in to ask for a little milk. He lookedwildly at her, instantly seized a knife, and attacked her andthen his wife and daughter. His aim appeared to be to decapitate them, as he commenced with each by cutting on the napeof the neck." He was secured, remained maniacal for threedays, and then recovered, " but never had the least recollectionof the acts he had committed. Nine years have since elapsedwithout a recurrence of the epilepsy, or disturbance of hismental faculties."*Griesinger relates the following example of the explosion ofthe epileptic aura, not in the usual epileptic seizure, but interrible violence:-"A man who was a brandy drinker lay in a room with hisfive children, who were that morning asleep. It came into hismind that he must then destroy the children; but how couldit be most conveniently done? He said, ' It rose into my headlike foam; it went through the chamber like a shot, or like astrong gust of wind; a strong odour of marjoram filled thechamber and took away my senses; my thoughts vanished, sothat I sank down.' He soon rose again, however, seized an axe,and hacked right and left among the children, three of whomfell victims to his violence. If nothing else had been knownthan the deed and these details furnished by himself, theepileptic might almost with certainty be recognised; but themedical investigation revealed actual and well- defined epilepticattack."+Dr. Skae describes the instructive case which follows:-" One of the patients admitted afforded a highly instructiveand interesting example of homicidal and suicidal impulseswithout any intellectual derangement or delusions. His case isclassed among those of epileptic mania; for although he neversuffered from an epileptic fit properly so called, he labouredunder symptoms which closely approached to those of an epileptic seizure of the milder form known as the petit mal. Hedescribed a feeling like the aura epileptica, beginning at his toes

• Commentaries on Insanity, p. 156.

Introductory Lecture-Journal ofMental Science, 1866.A A354 VARIETIES OF INSANITY [ CHAP..and rising gradually upwards to his chest, producing a sense offaintness and constriction, and then going up to his head, andgiving rise to a momentary loss of consciousness. This aurawas accompanied by an involuntary jerking-first of the legs,then of the arms. It was at the times when he suffered fromthese attacks that he felt impelled to commit some act ofviolence to others or to himself. On one occasion he attemptedto commit suicide by throwing himself into the water; morefrequently the impulse was to attack others, and was at onetime accompanied by such impetuous violence that it requiredthe strength of several men to restrain him. He deplored hismalady, of which he spoke with great intelligence, giving allthe details of his past history and feelings. His attacks, whichhad been frequent and severe at about the age of sixteen years,had for a long time almost disappeared, but had lately recurredat intervals, until it was found necessary to send him to theasylum. Sleeplessness and constipation almost invariably preceded his seizures. The state of the patient was greatly improved by the use of bromide of potassium and other remedies,and, with the exception of one or two very transient and slightattacks, he has kept well for some months. "*Professor Trousseau cites several instances out of an endlessnumber of cases that he has seen, in which the vertigo of epilepsy was followed by transitory fury during which violence wasdone without any recollection afterwards of what had happened.Indeed, he asserts that " sudden and irresistible impulses are ofusual occurrence after an attack of petit mal, and pretty frequentafter a regular convulsive fit. "†Because the general perversion of the whole manner of feelingwhich exists in all these cases has commonly been so completelyoverlooked, attention being fixed exclusively on the morbidact, a great resistance has been excited in the public mind tothe admission of what seemed to be the dangerous theory ofinstinctive insanity. The word " instinctive," again, is not wellchosen; it naturally seems absurd to imply that there is in manan instinct to commit homicide or suicide. Moreover, it is quiteevident in some cases of impulsive insanity that there is presentReport of the Edinburgh Asylum, 1866.+ Lectures on Clinical Medicine. By A. Trousseau.111.] VARIETIES OF INSANITY. 355in the mind of the sufferer the idea that he must kill some one;the idea arises involuntarily in a mind whose affective nature isprofoundly deranged, and becomes convulsive; he is consciousof the horrible nature of it, struggles to escape from it, and ismiserable with the fear that it may at any moment prove toostrong for his will, and hurry him into a deed which he dreads,yet cannot help dwelling upon. So desperate sometimes is thefear of yielding to the morbid impulse, so intense the horror ofdoing so, and so extreme the mental suffering, that a mother,afflicted with the impulse to kill her child, has killed herself toprevent a worse consummation. It happens, sometimes, thatthe patient succeeds in controlling the morbid idea for a time,calls up other ideas to counteract it, warns his probable victimto get out of the way, or begs earnestly to be himself put undersome restraint; but at last, perhaps from a further deteriorationof nervous element through bodily disturbance, the morbid ideaacquires a fatal predominance; the tension of it becomes excessive; it is no longer an idea the relations of which the mind.can contemplate, but a violent impulse into which the mind isabsorbed, and which irresistibly utters itself in action. Asshowing how artificial are the divisions commonly made betweendifferent kinds of insanity, and as illustrating at the same timethe state of the affective life in impulsive insanity, it may notbe amiss to remark here, that while we should describe the profoundly depressed patient struggling with his morbid idea assuffering from melancholia, we usually designate his diseaseimpulsive insanity when he is hurried into action by the intensity of the morbid idea. The fact that a person so afflictedcan, and sometimes does, resist the diseased idea or impulse,causes many to think, and some to argue, that it might alwaysbe successfully resisted. In reality, however, it is a simplequestion of the degree of morbid degeneration of nerve element,whether the idea shall remain in consciousness and be undersubjection, or become uncontrollable and realize its energy inaction. By an act of the will a person may prevent involuntarymovement of his limbs when the soles of his feet are tickled,but the strongest will could not prevent spasmodic movementsof the limbs when the excitability of the spinal cord is increasedby strychnia or disease. It is impossible, however, that trueAA 2356 VARIETIES OF INSANITY. [ CHAP.conceptions of mental disease can be acquired until men ceaseto regard its phenomena entirely from a psychological point ofview, and consent to study them by aid of the established principles of physiology and pathology. The despair of any onewriting upon mental diseases at present is, that he cannotconvey just and adequate ideas of them by any care or labourof expression so long as men will judge them by the revelationsof sane self- consciousness. Such practice is not one whit lessabsurd than it would be to form conclusions with regard to convulsions on the basis of the recognised power of the will overvoluntary movements.Once more let it be distinctly affirmed, that the disorderedcondition of nerve element, of which the morbid impulse to aviolent deed is so marked a symptom, is not less certainlyevidenced by a general perversion of feeling or of the affectivelife. It is the violence and suddenness of the outward reaction.in impulsive insanity which mask the less patent symptoms ofaffective derangement.(b) Moral Insanity. -Here the moral perversion is veryevident and cannot be overlooked, while the outward acts of theindividual are less convulsive in their manifestations, and answermore exactly to the morbid feelings and desires, than is the casein impulsive insanity. Hence it is so difficult to induce thepublic to entertain the idea that moral insanity is anythingmore than wilful and witting vice. Much as the assumption ofit as a disease has been reprobated, there can be no doubt thatall the eminent men who have studied insanity, and whoseauthority we habitually accept, are entirely agreed as to theexistence of a form of mental disorder in which, without anyhallucination, illusion, or delusion, the symptoms are exhibitedin a perverted state of those mental faculties usually called theactive and moral powers, or included under feeling and volition-the feelings, affections, propensities, temper, habits, and conduct. As, however, feeling is more fundamental than cognition,the intellectual activity cannot be entirely unaffected, thoughthere may certainly not be any positive delusion: the wholemanner of thinking and reasoning is tainted by the morbidself-feeling through which it is secondarily affected. Thepatient may judge correctly of the relations of external objectsIII.]VARIETIES OF INSANITY. 357and events, and may reason very acutely with regard to them;but no sooner is self deeply concerned, his real nature touchedto the quick, than he displays in his reasoning the vicious influence of his morbid feelings and an answering perversion ofconduct he cannot truly realize his relations, and his wholemanner of thought, feeling, and conduct in regard to himself ismore or less false. The social fabric is held together by morallaws; but we have here a being who, by reason of his inabilityto recognise them, is outlawed from the social domain. In agreat many cases, where this disordered condition of mind ismet with, it will be found to precede an outbreak of unquestioned insanity—indeed, we might almost say that in more orless marked form it precedes nearly every attack of insanity;while in other cases it will be found to be a condition persistingfor a time after all the intellectual derangement of an attack ofmadness has disappeared. The disappearance of hallucinationor delusion only becomes a sure sign of convalescence whenthe patients return at the same time to their natural healthyfeelings.When moral insanity is thought to exist by itself, and to constitute the disease, as it certainly may do, it would be quiteunjustifiable to assume that a particular vicious act or crime, ora series of vicious acts, proved its existence; in the previoushistory of the patient there will be evidence of a sufficient causeof disease having been followed by an entire change of manner,of feeling, and acting; the vicious act or crime will be logicallytraceable through a chain of symptoms to disease as cause, asthe acts of the sane man are traced to or deduced from hisdesires and motives. " There is often," says Dr. Prichard, whofirst called attention to this form of mental derangement, " astrong hereditary tendency to insanity; the individual has previously suffered from an attack of madness of a decided character; there has been some great moral shock, as a loss offortune; or there has been some severe physical shock, as anattack of paralysis or epilepsy, or some febrile or inflammatorydisorder, which has produced a perceptible change in the habitual state of the constitution. In all these cases there has beenan alteration in the temper and habits. "*⚫ ATreatise on Insanity and other Disorders of the Mind. By J. C. Prichard, M.D.358 VARIETIES OF INSANITY [[CHAP..When compelled to give an opinion touching a particular caseof suspected moral insanity, it is of importance to bear in mindthat the individual is a social element, and to have regard therefore to his social relations. That which would scarcely beoffensive or unnatural in a person belonging to the lowest strataof society-and certainly nowise inconsistent with his relationsthere-would be most offensive and unnatural in one holdinga good position in society, and entirely inconsistent with hisrelations in it: words which, used in the latter case, wouldbetoken grave mental disorder, may be familiar terms of addressamongst the lowest classes. Between individuals, as elementsin the social organism, there is in this regard a difference notunlike that which there is between the different kinds of organicelements in the bodily organism; it is important, therefore, tohave in remembrance the individual's social relations whendealing with moral insanity, as we regard the very differentrelations of an epithelial cell and a nerve- cell when dealing withstructures so far apart in the scale of life. As it is chiefly inthe degeneration of the social sentiments that the symptoms ofmoral insanity declare themselves, it is plain that the mosttypical forms of the disease can only be met with in those whohave had some social cultivation.The following cases, which came under my observation andtreatment, may stand here as examples of a mental perversionwhich it would seem impossible to describe as other than moralinsanity:-Miss A. B. , aged thirty-eight, was the only child of indulgentparents who were in high social position and wealthy. Herfather was harmlessly insane, nearly imbecile, and it was necessary, after every means of controlling her at home had beentried in vain, to send her to an asylum. She was completelygiven over to drinking spirits when she could get them, andwould bribe the servants or any one else she could bribe to buyspirits for her; nor was she capable of any self- restraint in otherregards, making no scruple to indulge whatever passion shefound means of indulging. When excited she was extremelyviolent in conduct, and on more than one occasion threatenedher father's life with a pistol. When she could not get spirits,she was abusive, mischievous, quarrelsome, full of complaintsIII. ] VARIETIES OF INSANITY. 359of the injustice done to her, and truly intolerable. In theasylum she was the cause of endless disturbances; continuallymaking complaints against the attendants, ingeniously perverting and exaggerating real facts so as to make of themmonstrous iniquities, doing the most mischievous things forthe sole purpose of giving trouble and annoyance to theservants, and delighted with her success; sometimes she wouldrefuse to take her food, and at the same time would bribe theattendant to secrete it for her so that she might take it without any one else knowing. Removed from the asylum, partlyin consequence of her manifold complaints, she was tried athome unsuccessfully, then sent back to the asylum, where shewent on just as before, removed again after a time, sent toa different asylum, taken away from that, and sent again toanother; indeed, her wanderings were many, and she was thehopeless patient of every doctor who had the misfortune tohave anything to do with her.Miss C. D., æt. forty-five, was a cousin of the above patient,and also of good social position. Her appearance was anythingbut attractive; she was withered, sallow, blear-eyed, with aneminently unsteady and untrustworthy eye. So improper andimmoral was her conduct, that she was obliged to live apart fromher family in lodgings; for she seemed incapable, in certainregards, of any control over her propensities. Whenever she wasable, she left her lodgings to spend days together at a brothelwith a common fellow, whom she supplied with money, frequentlypawning her clothes for that purpose. When at home, shegenerally lay in bed for most of the day. No appeal was of anyavail to induce her to alter her mode of life. She was proneto burn little articles, impulsively throwing them into the fire,saying that she could not help it, and then cutting and prickingher own flesh by way of penance. Now and then she would allof a sudden pirouette on one leg, and throw her arms about;and, with like sudden impulsiveness, would not unfrequentlybreak a pane of glass. When reasoned or remonstrated withabout her foolish tricks, she professed to feel them to be veryabsurd, expressed great regret, and talked with exceeding plausibility 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. [ CHAP.It was of no use whatever speaking earnestly with her, for sheadmitted 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 moresensible of the other patients amongst whom she was, used toget very angry with her, because they thought that she couldbehave better if she would. " One can bear with Missbecause, poor girl, she does not know what she does, and cannothelp it; but Miss knows quite well what she is about, andI am quite sure she can help it if she likes," was the style ofcomplaint made against her. And there could be no doubt thatshe did know perfectly well what she was about, but her unconscious vicious nature, ever prompting, surprised and overpowered conscious reflection, which was only occasional.Miss æt. forty, was respectably connected, and washerself possessed of sufficient property to enable her to liveindependently. She had a sister confined in an asylum. Fora long time she had been utterly given over to intemperance,and lost to all sense of propriety; she was abandoned to sexualindulgence, and cared not with whom, and more than once hadbeen sent to prison for her irregularities. Her natural feelingsand affections were entirely perverted, and she wrote angrily andabusively to her brother, who had at last been compelled totake steps to have her taken care of, telling him that she wasunder the protection of an officer, and that she would let himknow that she was a gentleman's prostitute. Of truth sheseemed quite unable to form a conception, while lies, mischief,and vice were congenial to her nature. When prevented fromindulging her vicious propensities, she would lie all day on thesofa, asserting that she was too ill to do anything, even to takea walk, and insisting that she ought to have every sort ofdelicacy. In her moods of excitement, she would sometimestalk of people plotting against her, and of herself being guidedby the ruling planets; but there was no positive intellectualdisorder detectable, though there was a painful state of extremeand hopeless moral alienation.It is quite certain that these three women, so lost to all senseof the obligations and responsibilities of their position, couldnot restrain their immoral extravagances and perverse acts for111.] VARIETIES OF INSANITY. 361any length of time; punishment had no effect, except in so faras it was a restraint for the time being. All of them knewquite well the difference between right and wrong, but no motivecould be excited in their minds to induce them to pursue theright and eschew the wrong; their conduct revealed the tyrannyof an unhappy organization; its natural affinities were for evil;the world's wrong was their right. The ruling planets, by whichone of them in her angry moods professed to be guided, werenot, therefore, an absolute fiction, for therein was expressed thefate made for her by a vicious organization. For a like reasonsuch 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 illtreated by their relatives when they are interfered with. Theyare examples illustrating the retrograde metamorphosis of mind.The moral feeling has been slowly acquired in the course ofhuman cultivation through generations as the highest effort ofmental evolution; and in the course of family degeneration, wefind its loss mark a stage in the downward course. The victimsof such vice or defect of nature cannot be fitted for social intercourse. Friends may remonstrate, entreat, and blame, andpunishment may be allowed to take its course, but in the endboth friends and all who know them recognise the hopelessnessof improvement, and acknowledge that they must be sent to anasylum. This, or a control equal to that enforced in such anestablishment, is the only treatment applicable to them; forthey are so viciously constituted that they could not be differentunless by being born again.It is where hereditary taint exists that we meet with the moststriking examples of this kind of insanity, and those which oftencause such great difficulties in medico-legal investigations. Thereis the strongest aversion on the part of the public to admit thatan extreme hereditary taint may be a not less certain cause ofdefect or disease of mind than an actual injury of the head;and yet it is the fact. The hereditary predisposition to insanitysignifies some unknown defect of nervous element declaringitself in a disposition to irregularities in the social relations;the acquired infirmity of the parent has become the naturalinfirmity of the offspring, as the acquired habit of the parent362 [CHAP.VARIETIES OF INSANITY.animal observably becomes sometimes the instinct of the offspring. Hence comes the impulsive or instinctive character ofthe phenomena of hereditary insanity, the actions being frequently sudden, unaccountable, and seemingly quite motiveless.Appeal calmly to his consciousness, the individual may reasonwith great intelligence, and seem nowise deranged; leave himto his own devices, or place him under conditions of excitement,his unconscious life appears to get the mastery, and drives himto immoral, extravagant, and dangerous acts. He perpetratessome singular act of eccentricity because all the world willcensure it, or even commits a murder for the sole purpose ofbeing hanged. It is worse than useless for a sound mind toattempt to fathom the mad motives which spring up in a madman's mind; it is most unjust to measure his actions by astandard based upon the results of an examination of sane selfconsciousness: to do so is simply to attempt to make coherenceand incoherence, order and disorder, equivalent. Only longexperience and careful study of actual cases of mental diseasewill suffice to give any sort of adequate notion of what amadman really is.When there is no hereditary taint detectable in a case ofso-called moral insanity, it is necessary to traverse the wholephysical and mental life of the patient, by a careful research intohis previous history, and scrupulous examination of his presentstate. It will be of great moment to ascertain whether therehas been any previous attack of insanity; for it sometimeshappens that after one or two attacks of melancholia withsuicidal tendency, from which recovery has taken place, thepatient has an attack of genuine moral insanity, which mayfinally pass into intellectual disorder and dementia. The extremest example of moral insanity which I have seen was in anold man aged sixty-nine, who had been in one asylum or anotherfor the last fifteen years of his life. He had great intellectualpower, could compose well, write tolerable poetry with muchfluency, and was an excellent keeper of accounts. There wasno delusion of any kind, and yet he was the most hopeless andtrying of mortals to deal with. Morally he was utterly depraved; he would steal and hide whatever he could, and severaltimes made his escape from the asylum with marvellousIII.] VARIETIES OF INSANITY. 363ingenuity. He then pawned what he had stolen, begged, andlied with such plausibility that he deceived many people, untilhe finally got into the hands of the police, or was discovered, ina most wretched state, in the company of the lowest mortals inthe lowest part of the town. In the earlier part of his insanecareer, which began when he was forty- eight years old, he wasseveral times in prison for stealing. In the asylum he was amost troublesome patient. He could make excellent suggestions, and write out admirable rules for its management, andwas very acute in detecting any negligence or abuse on the partof the attendants, when they displeased him; but he was alwayson the watch himself to evade the regulations of the house, and,when detected, he was most abusive, foul, and blasphemous inhis language. He was something of an artist, and delighted todraw abominable pictures of naked men and women, and toexhibit them to those patients who were addicted to self- abuse.He could not be trusted with female patients, for he wouldattempt to take indecent liberties with the most demented creature. In short, he had no moral sense whatever, while all thefault that could be found with his very acute intellect was, thatit 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 hadbeen tried many times, and tried unsuccessfully. And therewas another reason why prison-discipline could not rightly bepermitted to supersede asylum treatment. At long intervals,sometimes of two years, this patient became profoundly melancholic for two or three months, refused to take food, and was asplainly insane as any patient in the asylum. It was in anattack of this sort also that his disease first commenced.In other cases of moral alienation there will be found to havebeen more or less congenital moral defect or moral imbecility;maniacal exacerbations of positive moral insanity occurringperhaps at puberty, perhaps at the menstrual periods, perhapsafter severe disappointment. Again, moral insanity may occurafter acute fevers, after injury to the head, after some form ofbrain disease; in some instances it is the first stage of mentaldegeneration consequent on self-abuse; now and then it occursin consequence of a severe moral shock as the forerunner of364 VARIETIES OF INSANITY. [ CHAP.more marked insanity; and it not unfrequently precedes generalparalysis. But the disease with which it is most commonlyfound in conjunction is epilepsy: a so- called masked epilepsysometimes appears in attacks of positive moral insanity ofvariable duration and of periodical recurrence, the attacks.perhaps coming on regularly for months before the characteristic convulsions make their appearance; or extreme moralperversion may immediately precede epilepsy; or again, theepileptic convulsions may cease, and attacks of moral insanity,with more or less maniacal excitement, take their place. Therecan be no question in the minds of those who have studiedmental diseases that certain unaccountable criminals belong tothe class of epileptics. *Thus much concerning this second variety of affective insanity-Moral Insanity Proper. Whatever name it may ultimatelybe thought best to give it, there can be no doubt of the necessityof recognising in practice the existence of such a form of disease.If, indeed, the evidence drawn from its own nature and causation were insufficient, the fact that it is often the immediateforerunner of the severest mental disease might suffice to teachits true pathological interpretation. When, therefore, a personin good social position, possessed of the feelings that belong to acertain social state, and hitherto without reproach in all therelations of life, does, after a cause known by experience to becapable of producing every kind of insanity, suddenly undergo agreat change of character, loose all good feelings, and from beingtruthful, temperate, and considerate, become a shameless liar,shamelessly vicious, and brutally wicked, then it will certainlybe not an act of charity, but an act of justice, to suspect theeffects of disease. At any rate it behoves us not to be misled inour judgment by the manifest existence in such a patient of afull knowledge of the nature of his acts-of a consciousness, infact, of right and wrong; but to remember that disease mayweaken or abolish the power of volition, without affecting consciousness. Fortified by this just principle, we shall be farbetter prepared for a right interpretation of the facts of aMorel, D'une Forme de Délire suite d'une Surexcitation nerveuse se rattachant à une Variété non encore décrit d'Épilepsie: 1860. J. Falret, De ' ÉtatMentale d'Epileptiques.III.] VARIETIES OF INSANITY. 365particular case than when biassed or blinded by the oppositemost false principle.3. Ideational Insanity.-Under this general name may beincluded those different varieties of insanity usually described asMania or Melancholia: the unsoundness affects ideation, and isexhibited in delusions and intellectual alienation. Cases ofideational insanity are easily recognised to be of two principalkinds, according to the character of the accompanying feeling:in one kind there is great oppression of the self- feeling withcorresponding gloomy morbid idea; in the other there is excitement or exaltation of the self- feeling, with corresponding livelyexpression of it in the character of the thoughts or in the conductof the patient. The former cases belong to Melancholia; thelatter to Mania, acute or chronic. Again, on looking at casesof ideational insanity, it is easily seen that there is general intellectual derangement in some, while in others the alienationseems to be confined to a small number of fixed ideas; so thatwe might make a division of ideational insanity into (a) generaland (b) partial. If we did so, then partial ideational insanitywould really correspond with what Esquirol called Monomania,though not with what is now usually called so; for under thatname was included by him not only partial mania accompaniedby an exciting or gay passion, but also partial intellectual insanity accompanied by a sad and oppressive passion; the latterhe sub-distinguished as Lypemania, but it is now commonlyknown as Melancholia. Whether this is wisely done may admitof considerable doubt: there are met with in practice as manyvarieties of emotional perversion as there are varieties of morbidideas, different patients exhibiting every degree and kind ofpassion, from the rapture of the exalted monomaniac to the deepgloom of the profound melancholic; accordingly it is not alwayspossible, under the present nomenclature, to determine satisfactorily whether a particular case belongs to monomania or tomelancholia. Certain cases of melancholia do in point of factfurnish the best examples of monomania. Another reasonagainst the present classification is that there are cases of acutemelancholia in which the excitement and the derangement ofideas and conduct are so great that they run insensibly intoacute mania, and might just as properly be called so they are366 VARIETIES OF INSANITY. [CHAP.examples of acute ideational insanity, but whether they areclassified as maniacal or melancholic is very much a matter ofcaprice or accident.A third objection to an adherence to the present artificialclassification 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 properlyrecognised and exactly studied because they did not fall underthe time-honoured divisions; and the real manner of commencement of intellectual insanity in a disturbance of the affectivelife has frequently been overlooked. It is true that Guislainand Griesinger have pointed out that a melancholic stage of depression almost invariably precedes an outbreak of mania; therecan be no doubt that the sequence is traceable in very manycases; but it cannot be admitted, as some would have it, inevery case. What has been overlooked even by those who havenot overlooked the preliminary affective derangement is, thatthere is not only (a) a melancholic perversion of the affective lifepreceding intellectual derangement, but that there is also (b) amaniacal perversion of the affective life, so to speak, —an affective insanity which is of an excited or expansive kind, in whichthe individual's self-feeling is greatly exaggerated or morbidlyexalted. It is a maniacal disorder of the feelings, sentiments,and acts, without delirium, and it is expressed chiefly as thecorresponding affective melancholia is, not in delusion but in theconduct of the patient. Though frequently following a briefstage of melancholic depression, this condition is sometimesprimary. It is displayed in a great change of moral character:the parsimonious person becomes extravagant, the modest manpresumptuous and exacting, the affectionate parent thoughtlessand indifferent; there is great liveliness of manner, or a restlessactivity as of one half-intoxicated; an overweening self- esteemis very evident; and an extravagant expenditure of money, anexcessive sexual indulgence, or other intemperance, is common.The tone of the mental nature is profoundly deranged; thefoundations of the mental being are shattered; and the patientis often practically less fitted for his relations in life than at asubsequent stage of the disease, when matters have gone furtherand the morbid action is systematized in definite delusions. In111.] VARIETIES OF INSANITY. 367some cases there may be less exaltation manifest, while the perversion of the affective life is more marked, -in other words,the moral alienation more extreme; this condition being perhapsbest witnessed in that profound moral derangement which sometimes precedes a series of epileptic fits, or takes the place of anepileptic fit. The premonitory symptoms presented by insaneepileptic patients, before a fit or a succession of fits, may be ofa melancholic or of a maniacal nature, corresponding in thisregard 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 atother times is pleased with any notice or attention, will thenperhaps get into a violent and dangerous fury if spoken to;others suffer from slowness of ideas, failure of memory, physical and moral prostration; while others again are unusuallyanimated, loquacious, active, display exaggerated notions oftheir physical and moral well-being, and become at timeseven maniacal. It is worthy of note too, in relation to thevivdi hallucinations which sometimes arise in mania sinedelirio and become the causes of desperate acts of violence,that similar vivid hallucinations foretell in some cases theepileptic attack.So soon as we have recognised the existence of a deep perversion of the feelings, sentiments, and acts, having a brisk maniacalrather than a gloomy melancholic character, and preceding insome cases the outbreak of intellectual derangement, we fail notto perceive how closely it is allied to, or rather how fundamentally identical it is with, those stages of insane degenerationalready described as varieties of affective insanity. In fact, theMania sine delirio of Pinel, the Monomanie raisonnante ou sansdélire of Esquirol, the Monomanie affective of the same author,and the Moral Insanity of Prichard, —all are varying phases ofthis affective disorder, which, continued, usually ends in positiveintellectual disorder or dementia. Though an earlier stage ofmental degeneration than intellectual insanity, it is really, froma social point of view, a more dangerous form of mental disease;for its natural tendency is to express itself, not in words, asideational insanity does, but in actions. It is a condition inwhich dangerous hallucinations and dangerous impulses are368 VARIETIES OF INSANITY [CHAP. .both apt to arise suddenly and to hurry the patient into somedesperate act. Once more then let it be repeated, that manis not only a consciously active being, but also an unconsciously active being; and that, although the unconsciousmental function is, in the state of perfect bodily health, subordinated to the directing power of the will, yet, when diseasehas disturbed the harmony of parts, the unconscious activitydisplays its effects independently of the will or even of consciousness.For the foregoing reasons, I hold that it would conduce togreater precision of knowledge, and would be followed by somevaluable practical results, if the present artificial classification,which is not really in conformity with nature, and which assumes a fictitious exactness, were considerably modified. If abroad division were made of insanity into two classes, namely,insanity without positive delusion and insanity with delusionin other words, into affective insanity and ideational insanity;and if the subdivisions of these into varieties were subsequentlymade-would not the classification, general as it may appear,and provisional as it should certainly be deemed, be for thepresent preferable to one which, by postulating an exactnessthat does not exist, is a positive hindrance to an advance inknowledge? It will be necessary to clear the ground of oldincumbrances before attempting to lay the foundation of a betterstructure; and it will be desirable to encumber it as little aspossible until the materials for a new and natural classificationhave been collected. One desirable result of great practicalconsequence-medico-legally-could not fail to follow the modification of the received classification; that is, the adequaterecognition of those serious forms of mental degeneration inwhich there are no delusions. I have ventured, accordingly, ina former publication, to put forward the following arrangement;and I use it here, not as a complete and positive scientific classification, which can only be a devout imagination for some yearsto come, but as a convenient scheme for treating of the symptomatology 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. 369I. AFFECTIVE OR PATHETICINSANITY.II. IDEATIONAL INSANITY.1. MANIACAL PERVERSION OF THE 1. GENERAL.AFFECTIVE LIFE. MANIA SINEDELIRIO.2. MELANCHOLIC DEPRESSION WITHOUT DELUSION. SIMPLE MELANCHOLIA.3. MORAL ALIENATION PROPER. Approaching this, but not reachingthe degree of positive insanity, is the INSANE TEMPERAMENT.a. Mania.b. Melancholia. }Acute and Chronic.2. PARTIAL.a. Monomania.b. Melancholia.3. DEMENTIA, primary and secondary.4. GENERAL PARALYSIS.5. IDIOCY, including IMBECILITY.The cases of so- called impulsive insanity, which for practicalpurposes has just been illustrated separately, will really fallunder one or other of the above-mentioned varieties of affectiveinsanity in all of them dangerous impulses are apt to arise,and to express themselves in convulsive action; and where adesperate impulse displays itself without any apparent affectivedisorder, it is only that the outward violence masks the internalderangement.Whatever classification be adopted in the present state of ourknowledge of so obscure a subject, it must be provisional. What,meanwhile, it is most important to bear in mind is, that thedifferent forms of insanity are not actual pathological entities,but different degrees or kinds of the degeneration of the mentalorganization,-in other words, of deviation from healthy mentallife; they are consequently sometimes found intermixed, replacingone another, or succeeding one another, in the same person.There is in the human mind a sufficiently strong propensity notonly to make divisions in knowledge where there are none innature, and then to impose the divisions upon nature, makingthe reality thus conformable to the idea, but to go further, andto convert the generalizations made from observation into positive entities, permitting for the future these artificial creationsto tyrannize over the understanding. A typical example ofmadness might be described as one in which the disorder, commencing in emotional disturbance and eccentricities of actionin derangement of the affective life--passes thence into melancholia or mania, and finally, by a further declension, into dementia. This is the natural course, also, of mental degeneration whenproceeding unchecked through generations. Although then we B B370 VARIETIES OF INSANITY. [CHAP.may have the different stages passed through within the briefspace of a single life, this is not a sufficient reason why theyshould not be distinguished and separately treated of; for notonly may a person suffer from one kind of mental derangementwithout ever falling victim to another, but the different varietiesrun their particular course, call for their special prognosis, andrequire their special treatment.(a) Partial Ideational Insanity. This division will correspond with that originally described as monomania by Esquirol ,and will include not only delusion accompanied by an exaltedpassion, but also delusion accompanied by a sad and oppressivepassion -monomania proper and ordinary melancholia. In theformer an exalted self- feeling gets embodied in a fixed delusion,or in a group of delusions, which fails not to testify an overweening self- esteem; it is clothed in a corresponding delusion of poweror grandeur, and the personality of the patient, who may fancyhimself king, prophet, or divine, is transformed accordingly inthe latter, the feeling of oppression of self becomes condensedinto a painful delusion of being overpowered by some externalagency, demonic or human, or of salvation lost through individual sins. In both cases we have a partial ideational insanityin the one case with overweening esteem of self, in the other withoppression of self-with fixed delusion or delusions upon onesubject or a few subjects, apart from which the patient reasonstolerably correctly. Pathologically, there is a systematizationof the morbid action in the supreme cerebral centres -the establishment of a definite type of morbid nutrition in them.A morbid idea, or a delusion, engendered in the mind and persisting there, may be compared with a morbid growth in someorgan of the body, or with a chronic morbid action, which cannotbe brought under the correcting influence of the surroundinghealthy tissues, and restored to a sound type. Similarly, themorbid idea does not, as in health, call up other ideas whichmay supersede it, its energy being transferred, and itself becoming latent or statical under the unconscious assimilating influence of the cerebral centres, so that the present is brought intoaccord with the past, or with that mental organization which byan abstraction we call the ego; but the morbid idea is not assimilable, cannot be brought under the domain of the laws of the111.] VARIETIES OF INSANITY. 371surrounding healthy structures and made of the same kind withthe sound elements of the mental organization, is in entire contradiction with the past, and remains unaffected by reflection,because it cannot really enter into any reflection. Like acancer, or any other strange morbid growth, it continuesits own morbid life, and the whole conscious life may at anymoment be brought under its dominating influence: it representsa partial automatic morbid action, like a spasm beyond the control of volition, though, like a spasm, not always beyond theknowledge of consciousness. A young man, for example, whohad previously had a few epileptic fits, became extremelymelancholic, being possessed by the morbid idea that he wasto be murdered in his father's house; he made frequent attemptsto escape from it, and the precautions taken to prevent his escapeonly served to strengthen his delusion. * Reasoning with him wasofno use, for the notion was not explicable on any reasonable principles if a looker- on could truly enter into the steps of the obscure and tangled mental processes by which such a delusion wasgenerated, he would be as mad as the patient; and if the patientcould appreciate the force of the reasoning by which the lookeron proves the notion to be madness, why then he would not bemad at all. It is the patient's disease that he cannot: when theconstitution of his nerve element is such that an absurd delusionof that kind can persist and not be corrected by the stored-upresults of past mental acquisitions-whether such as might beconsciously recalled , or such as existed as statical faculties interworking in unconscious assimilating action-then it is the suretestimony of fundamental damage to the mechanism of mentalaction; the consequences of which are a disorder and incoherence of action inconsistent with, and therefore unintelligible to,the experience of the sound mind. The very fact that such anotion is not self-annihilating is evidence of a fundamental disorder, which, if it should not actually prepare us to look for, atany rate should make us receive without surprise, any furtherirrational exhibition by the patient. Hence also it is that if weadmit the false premisses of the madman's delusion, he cannotfollow 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 2372 VARIETIES OF INSANITY. CHAP.not logically mad; the sound and the unsound parts of his beingare mixed up in his conduct; his whole manner of action is moreor less inconsistent and incoherent, and betrays the disease ofwhich the delusion is a symptom. In vain do men pretend thatthe 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 manhas a serious disease of some vital organ, but the exquisitelydelicate and complex mechanism of mental action is radicallyderanged the morbid idea could not else have been engenderedand persist. The mind is not unsound upon one point, butan unsound mind expresses itself in a particular morbidaction. Moreover, when the delusion is once produced, thereis no power of drawing a sanitary cordon round it, and thus, byputting it in quarantine as it were, preserving all other mentalprocesses from infection: on the contrary, the morbid centrereacts injuriously on the neighbouring centres, and there is noguarantee that at any moment the most desperate consequencesmay not ensue. That was precisely what did happen in the casewhich we have taken for illustration: the young man, whosefather was a butcher, becoming calmer after a time, and beingthought trustworthy, was permitted at his own request to bepresent at the slaughter of an ox; but when all was finished, hedid 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 approachedthe door of his house, he suddenly drew out a butcher's knifewhich 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 livedsome distance off, and said that he had run away from home, asthey wished to kill him there. In this case the homicidal acthad a discoverable relation to the delusion, although a veryinsane one; but in some cases of monomaniacal delusion thereis no relation whatever discoverable between the delusion andthe act of violence, while in others the patient may subsequentlymake known a most absurd and incoherent connexion which themost sagacious looker- on would never have suspected, and cannotunderstand.III.] VARIETIES OF INSANITY. 373The signification of a persistent delusion in the mind, inregard to those intimate organic processes on which rests theintegrity of mental action, is threefold: first, the fact of thedelusion betokens a fundamental disorder in the organic processes of the mental organization as the condition of its existence, the extent of such disorder being nowise necessarilylimited to its production; secondly, the existence of a morbidarea in the midst of numerous most sensitive nervous centres,which are connected in the most delicate, intimate, and complexmanner, will tend to produce by sympathy, infection , or induction, or reflex action, call it as we may, some derangement inthem; and, thirdly, the automatic activity of the morbid centre,reaching a certain intensity, may become an uncontrollable impulse, and, irresistibly uttering itself, hurry the patient into aninsane action instigated by it. In other words, psychologicallyspeaking, the existence of a delusion indicates fundamental disorder of mental action-radical insanity; secondly, the delusionreacts injuriously upon other mental phenomena, interferingsecondarily with correct ratiocination, or due co-ordination offunction, and predisposing to convulsive mental phenomena;and, thirdly, while it cannot be subordinated to reflection, theindividual may at any moment be subordinated to it, and actunder its instigation. The mind, then, which suffers frompositive ideational insanity, however seemingly partial, is, beingunsound, not to be relied upon, nor to be held responsible; diseaseis going on in it, and it does not depend upon the individual'swishes or will what course it shall take or what height it shallreach, any more than the health of a man bodily sick dependsupon the desire which he may have to rise, take up his bedand walk.Certainly, in some cases of so-called monomania or partialideational insanity, there does appear to be but little evidence ofinsanity apart from the particular morbid ideas; but such casesare generally met with in an asylum, where the patient is removed from those particular relations in which the moralperversion might be expected to display itself, and where thequiet regularity of life and the absence of all exciting impressionsfavour the latency of the affective insanity. Allow those patientswho are so calm and serviceable in the asylum to return to active374 VARIETIES OF INSANITY. [CHAP.life, and to be subjected to the strain of trying circ*mstances, orthe stress of adverse events, and they soon suffer from attacks ofgeneral excitement, if they do not perpetrate acts of dangerousviolence; even in the asylum they have now and then theirbad times, in which they are morose, uncertain, and excitable.Nothing is more surprising to the inexperienced person thanthe extreme passionate excitement and utter irrationality, whenthey do break out, of these monomaniacs, whom he has hithertoregarded as quite sensible apart from their delusion, and asharmlessly interesting perhaps by reason of it . They will mostlytolerate with great composure the annoyances of their fellowpatients, because they look down upon them with pity as mad;but once let them be offended and excited, it is rendered veryplain how unstable and dangerous is their state of mind.It is necessary to guard against the mistake of supposing thedelusion to be the cause of the passion, whether painful or gay,that may accompany partial ideational insanity. In cases ofsimple melancholia there may be no delusion: the patient'sfeeling of external objects and events may be perverted so thathe 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 interestin his affairs; he is profoundly miserable and shuns society,perhaps lying in bed all day. All this while he may be quiteconscious of his unnatural state, and may strive to conceal itfrom his friends. Suddenly, it may be, an idea springs up inhis 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 formas a concrete idea-in other words, bas become condensed intoa definite delusion, this now being the expression of it. Thedelusion is not the cause of the feeling of misery, but is engendered of it, —is precipitated, as it were, in a mind saturated withthe feeling of inexpressible woe; and it takes different formsaccording 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 isto the extreme mental anguish, the patient assigning the mostridiculously inadequate cause for his gloom: one man under my111.] VARIETIES OF INSANITY. 375care, whose suffering was very great, said that it was because hehad drunk a glass of beer which he ought not to have done, andanother man was, as he thought, lost for ever because he hadmuttered a curse when he ought to have uttered a prayer. Withhim who believes that he is doomed to infinite and eternalmisery, it is not the delusion but the affective disorder that isthe fundamental fact; there cannot be in the finite mind anadequate or definite idea of the infinite or the eternal; and theinsane delusion of eternal damnation is but the vague and futileattempt to express an unutterable real suffering. In all thesecases of melancholia the deep sense of individual restrictionwhich exists, the wretched feeling of the oppression of self, is interpreted as due to some external agency; and as the existenceof any passion notably intensifies an idea that is congruous withit, the delusion ultimately attains great vividness. So withregard to other passions, whether excited by some external eventor some internal commotion; when vehement and long continued, they are apt to end in some positive delusion . The vainperson who cherishes an ambitious passion may after a time beso entirely possessed by it that he is unable to see things as theyreally are, and his overweening self-esteem terminates perhapsin the delusion that he is emperor, king, or even divine. Theessential nature of the delusion will depend upon the specialnature of the passion in which the individual's self-feelingis engaged, but the particular form which it assumes will dependgreatly upon the education and upon the circ*mstances of life inwhich he has been placed. Thus the vain and ambitious personwho has had a religious training will assume a character inaccordance with his sentiments, and will deem himself a prophetfavoured of heaven, or even Jesus Christ; the politician will bea prime minister, or some great political character; the man ofscience will have solved the problem of perpetual motion, or willbe the victim of complicated and ingenious persecution by meansof electricity. When witchcraft was generally believed in, theinsane frequently fancied themselves to be tormented by witches;but since the police have been established, they often believe thepolice to be in pursuit of them. At the time when Napoleonwas setting up and pulling down kings, many people were admitted into French asylums who believed themselves to be kings376 VARIETIES OF INSANITY [CHAP. .and emperors; and Esquirol thought that he could have writtenthe history of the French Revolution from the character of theinsanity which accompanied its different phases. The insanityof any time will be a more or less broken reflection of thecharacter of the events that happen in it.When a vague morbid feeling of a painful nature gets definitely embodied in a fixed delusion, the patient is often lessdifficult to deal with, perhaps less miserable, than when theaffective derangement predominates and is occasionally manifested in morbid ideas, or is manifested in transient and changingdelusions. One of the most difficult and distressing cases tohave to do with in practice is that of a wife possessed withmorbid feelings of jealousy of her husband; a passion which,increasing to an insane degree, breaks out under excitementinto the most absurd and unfounded accusations and violentbehaviour, ending finally-it may be at the change of life—infixed ideational insanity. The monstrous imaginings, the foulaccusations, the obscene language and violent conduct, sometimes displayed in such cases before there is any fixed intellectual derangement, are truly most surprising. These paroxysmsof maddened jealousy are sometimes brought on by an excessive,and perhaps secret, indulgence in stimulants, and they are notunlikely to occur at the menstrual periods.The following briefly reported cases may serve as illustrationsof partial ideational insanity, and of the foregoing observations:-C. K., æt. thirty- six, married, had always been of an extremelyreligious character and of exemplary behaviour. After he hadbeen married for about a year, his present illness began withgeneral depression of feeling and with the involuntary appearancein his mind of blasphemous ideas in spite of all his efforts toavoid them; he was greatly afflicted by this state of things, hisgloom increased, and at last he concluded that "he had done it,"-namely, committed the unpardonable sin. Here we perceive,first, a morbid affection of nerve element revealed in the emotional depression, then an automatic and spasmodic activity ofcertain ideational cells manifest in the involuntary and irrepressible ideas that arose, and finally the concentration or systematization of the morbid action into a definite delusion. The patient111.] VARIETIES OF INSANITY. 377was further very hypochondriacal, and fearful that he should diesoon; but, although his heart's action was very feeble, and hispulse remarkably slow, there was no evidence of organic disease;and it appeared that the feebleness of cardiac action was due tothe depressing effects of the morbid idea upon the organic functions, all which shared more or less in the prostration. Hisreasoning powers were, however, nowise affected apart from hisdelusions; he was fully alive to all business relations, and wouldconverse intelligently and even cheerfully on indifferent matters.But the moment his attention was no longer diverted from hisown suffering and otherwise engaged, the morbid idea returnedin all its force, entirely occupied consciousness, his countenancebecame overcast, and he-just now so cheerful-presented thecharacteristic dejected appearance of profound melancholy. Helived, as it were, two separate lives-as a sound, reasonablebeing, and as a morbid automatic being; he was quite aware ofhis affliction, and could reason about it as a man might reasonabout a peculiarity of his character or a particular conformationof his body, though he could not be persuaded of its true nature;but, so soon as the train of mental activity excited by externalevents was past, the morbid idea became consciousness. Hewas made so miserable by it that he more than once attemptedsuicide. Herein we have an example of what is sometimes calledthe correct reasoning of the monomaniac from false premisses;believing that he has committed the unpardonable sin, and thathis soul is for ever lost, he does that which may soonest precipitate the result which he so much dreads. An uncle had beensimilarly afflicted, and had died insane.Intelligently as this patient could talk, and rational as he appeared, apart from his delusion, it would not be correct to pronounce him perfectly sensible under such limitation. There wasno sufficient reason in his intellectual disorder why he should nothave continued his business, but he could not do so; he could nottake interest in that, in his family, or in anything else but himself; every impression was more or less painful to him, his wholemanner of feeling being perverted, and he sought therefore toavoid society and to be alone. At times, too, his anguish increased to a veritable acute paroxysm, and then he looked veryhelpless and insane. Nowthe case which follows, very similar to378 VARIETIES OF INSANITY. CHAP.the foregoing in general symptoms, illustrates, by an importantadditional symptom, a dangerous feature in some of these cases.J. B., æt. fifty- one, married, had made a small fortune by hisown energies, and had brought up a family respectably. He wasa stout, hard-faced, big-browed man, of surly appearance andmelancholic temperament. Of the Wesleyan persuasion, he hadalways been very attentive to his religious duties; indeed, religious devotion was said to be the cause of his illness, whichcertainly began with doubts as to his religious state. He becamegloomy, morose, and depressed, and took to his bed five weeksprevious to his being sent to an asylum. He would not get up,however much entreated: why should he? He was dying, andthere was no salvation for him, for his soul was lost. He sleptfairly and ate well, though he professed at times that he couldnot eat. In the asylum he was listless, gloomy, and exceedinglyaverse from exertion of any kind, always maintaining that he wasdying. " It's of no use, I tell you, doctor, asking me how I am:you know I'm dying." Apart from the delusions as to his souland his body, he was intellectually rational, although his affectivelife was much perverted. After a month's residence, there wassome improvement in his state; he walked outside the groundsregularly after having been on the first occasion forced to go; hewas more cheerful too, and would talk a little. It was thoughtthat he was going on very favourably. One night, however, without any warning, he suddenly started out of his bed, rushed at awindow, through which it would have been thought impossiblethat a man of his size, or indeed of any usual size, could havegot, struggled through it, and fell from a height of twenty feet,fortunately on his feet, so that he was only grievously shaken.He was, however, in a state of fearful excitement, fancying thatthe world had come to an end, writhing, and crying frantically," Let me go, let me go! " Like sudden desperate paroxysmsseized him periodically for the next three weeks; after whichhe began to improve. He became talkative, cheerful, and interested in his family, though maintaining for a time, for the sakeof consistency seemingly, that he was no better, and only employing himself when he thought that no one was observing him. Inthree months more he was discharged quite recovered.In these cases, when the melancholic anguish has reached a111. ] VARIETIES OF INSANITY. 379certain intensity, it appears to be a matter of accident whetherthe convulsive explosion is expressed in some act of violencedirected against the patient's own life or against the life ofanother, although it may be expected that, if the delusion is oneof persecution by others, the violence will be displayed againstthe supposed enemies.The following case further illustrates the acute attacks ofparoxysmal anguish that supervene in the course of chronicmelancholia or ideational insanity with depressed passion:-33.66Miss F. , æt. forty-one, appeared to be as strong- minded andgood-natured a lady as could be met with. Her manner wasabrupt and decidedly energetic, and she is described as havingalways been a little queer. The melancholy for which she wasfinally sent to an asylum was said to have come on seven monthsbefore, in consequence of a supposed offer of marriage which shethought she had refused—in reality, none such was ever made.She now believed that she was lost for ever in consequence ofthis refusal; she wrung her hands in her extreme distress, and,with a face tense with anguish, exclaimed that "she had doneit; that she was so near Zion's gate. " But her mental statevaried much, and varied suddenly. One day she would be inthe greatest mental agony, rolling on the floor, writhing andtwisting herself into the strangest forms, as though in her anguish' she would tie her body into knots: on another day her delusionseemed to have retired into the background, and she was calm,natural, conversed most sensibly, and employed herself industriously. No one who saw her only in those calmer periodscould conceive how unspeakably insane she was in her acuteparoxysms. In her calmer moods, when not engaged in anyoccupation or conversation, and when apparently unnoticed, shemight be observed to wring her hands, and to repeat in an undertone, " Good God! " When her attention was called, on theseoccasions, to what she was saying and doing, she was often quiteunconscious of it. And that might teach us that the morbidmanifestations were of an automatic or reflex character, and thatit is possible for such morbid phenomena, under certain bodilyconditions, to attain a convulsive character, without consciousness of them at the time, and without memory of them afterwards. The psychologist would be a bold , as he certainly would380 VARIETIES OF INSANITY [CHAP.,be an ignorant and mistaken man, who should assert that thefrenzy might have been controlled because there was usually apersistence of reason. It were as just to assert that the reflexconvulsive action of a spinal cord poisoned by strychnia mustbe controllable, because the ordinary reflex acts of a healthycord are so.It is noteworthy, in some of these cases, how sudden and complete may be the change from the deepest anguish and despairto a state of perfect calm and sanity. Thus one of my patients,who suffered from acute melancholy, who usually wandered aboutmoaning grievously, or sat weeping profusely, and who had madeseveral attempts against her own life, awoke one morning seemingly quite well, rational, cheerful, and wonderfully pleased ather recovery, remaining so for the rest of that day. Next morning, however, she had entirely relapsed, and it was some monthsbefore she finally recovered. Again, Griesinger mentions the caseof a woman with melancholia and delusions as to loss of propertyand persecution, who for the space of a quarter of an hour wasquite herself, and then relapsed. Such cases are of interest inregard to the pathology of the disease, as they would seem toprove that there is no serious organic disease so far-that thecondition of nerve element is a polar modification which maysoon pass away, not unlike, perhaps, the electrotonic state thatmay be artificially produced in nerve.Miss S. , at. twenty-two, was rather a good-looking younglady, though with an irregularly formed head, and a deformityof one ear, and with a strangely wandering and occasionallyvacant look. Her family is saturated with insanity, and thepresent is said to be her third attack. She is surcharged withgrief, moaning continually, and weeping so abundantly as tosurprise one how she can raise so many tears. She exclaimsthat she is utterly estranged from God, and sobs as though herlittle heart must break. Notwithstanding this extreme exhibitionof mental suffering, one could not, on carefully observing her,but conclude that she was not really so miserable as she looked,that her distressing actions were in great part automatic. Andthere was truth in the instinctive suspicion; for in the midst ofthe most violent sobbing, she would sometimes, on the occasionof a ludicrous or sarcastic observation, look up quite calmly,111. ] VARIETIES OF INSANITY. 381speak quietly, and even smile for a moment, and thereuponrelapse instantly into her extreme grief. She was quite conscious of her state, and threw all the blame of it upon her friends,who, she said, ought to have subjected her to proper restraintand discipline, instead of indulging her in every way, as they haddone. Previously to being sent from home she had been verywilful and impulsive, sometimes starting out of the house, andsaying that she must kill herself. After being in the asylum fora few days she became calm and composed, spoke quite rationally,and professed herself very well contented with her position, andwith the course which her friends had taken on her behalf. Andyet, while wearing this cheerful and contented manner, she wassecretly posting letters to her friends full of the bitterest complaints, moanings, and reproaches, sentence after sentence inthem beginning, " Oh God! " Reminded of her inconsistency,she sank into the deepest self-accusation and abasem*nt, said shewas utterly wretched on account of her deceitfulness and wickedness, which she could not help, and that she was lost for everAnd, indeed, she could not help it. She was sincerely cheerfulin her new relations when engaged in conversation, or in someoccupation, but when she sat down to write home the old feelings returned, and the old automatic morbid activity broke out.Ultimately she recovered, the morbid tension gradually subsiding,and finally disappearing in the entirely changed relations. Thisexample enables us to understand, in some sort, how it is thatmurderers in an asylum sometimes appear to be unconscious ofwhat they have done, and, if they are conscious of their crime,never think they are to blame; for the automatic activity of theirmorbid nature has surprised them, and when they reflect uponthe act of violence, if they do so, it is as upon an act done bysome one else.The foregoing cases will suffice to illustrate partial ideationalinsanity, although they all fall under that division of it usuallycalled melancholia. In conversing with patients so afflicted, itis impossible to avoid being surprised at the strange discord orincoherence which their mental character exhibits: they areoften, as it were, double beings-a rational and an insane being:the two beings cannot be brought into intercommunication andbeneficial reaction upon one another, for the persistence of the382 VARIETIES OF INSANITY. [CHAP.delusion implies the cutting off of such interaction; as consciousmanifestations they are independent, isolated. One day thesound being is in predominant or exclusive action; anotherday, the unsound being; on different occasions one might say-"Now I am talking with the rational being; now with themorbid being." Herein we have the explanation of the doubtwhich such patients sometimes have of themselves; they arenot confident at times, and appear only to half believe intheir delusion, because they are not then under its entireinfluence: their rational nature is in predominant action, andthey act in their relations as if their delusion really was adelusion. It would be a mistake, however, to put any relianceon such seeming hesitation: let the delusion be excited intoactivity, all doubts vanish, and the sound being is brought intodangerous bondage to the unsound being.In a complete account of partial ideational insanity, whetheraccompanied by a gloomy or a gay passion, the effects of thedelusion should be considered -as was done when consideringidea physiologically-first, upon sensation; secondly, upon theprocesses of nutrition and secretion; and, thirdly, upon the movements or general conduct of the patient. As the delusion issometimes the final effect of a morbid organic stimulus resulting from bodily disease, so it in turn, however caused, reactsinjuriously on the bodily nutrition and on sensibility. Thelatter is commonly much affected in melancholia. There maybe general or partial diminution or perversion of the sensibilityof the skin, or a local complete loss thereof; and complaints ofprecordial anguish and of strange epigastric or abdominal sensations testify to the perversion of organic sensibility. A burningor heavy pain on the top of the head, or running down the spine,appears to cause much suffering in some cases. These complaints, causeless as they may seem, are not always withoutsignificance. Illusions and hallucinations of the special sensesare frequent one patient, believing himself lost, sees the devilin his room, another smells a corpse in his room, a third tastespoison in his food, a fourth hears voices which revile and accusehim, or which suggest impious thoughts and instigate violentdeeds-it may be to imitate Abraham and sacrifice his child.The hallucinations of hearing which occur are evidently some-111.]VARIETIES OF INSANITY.383times owing to the fact that the patient perceives as voices themorbid thoughts that arise automatically in his mind. Sir H.Holland mentions the case of a gentleman who believed in andacted upon the reality of illusive sounds and conversations, andwas necessarily treated as deranged, but who after a while recovered so far as to recognise and treat them as delusions.When he was asked how he had come to regard them in thissensible light, he said that it was partly by his never discoveringany person in the places where the voices had come, but chieflyby finding himself able, on trial, to suggest the words whichwere thus seemingly uttered by some one external to himself.The ideas excited by some morbid cause, not coming into actionthrough the regular train of association, and being strange andnovel to the individual, appear as if they belonged to and weresuggested by some person external to himself. Hence somepatients complain bitterly that their thoughts are perceived,taken up, and replied to by other persons before they are conceived by themselves; their lives are made wretched and intolerable to them by this mysterious system of espionage andpersecution. A similar thing happens in dreams: the repliesand arguments of the person with whom the dreamer speaks arereally his own replies and arguments, though he fails to recognisethem; but the unusual suggestion and irregular association of hisideas, giving them a strange and independent character, makesthem appear to belong to some one else; there is no co-ordination of them, and the will is therefore in abeyance. Now thehabitual co-ordination of the thoughts, feelings, and desires isthe basis of the individual character-of personal identity;accordingly when it is lost, a person loses the consciousness ofhis identity. The special interest of the case mentioned by SirH. Holland lies in its illustration of the gradual recovery of thepower of co- ordination evinced by the patient's trial to suggest tohimself the words which were seemingly uttered by another, andthus to bring back the riotous elements of the mind under thedomain of regular law.The general depression of tone in melancholia is felt throughout the processes of nutrition, although not usually in observableproportion to the great apparent suffering. So vast indeed doesthis seem in some cases that the wonder is that organic life can384 VARIETIES OF INSANITY [CHAP. .go quietly on. However, digestion mostly fails, and in a fewcases an obstinate sickness occurs after food; constipation oftenbecomes troublesome; the skin loses its freshness, and gets sallowdry, and harsh; the temperature of the body is lowered, and theextremities are cold; the pulse is feeble, sometimes very slow,and even intermittent; the respiration is slow, moaning, andinterrupted by frequent and long-drawn sighs; the urine is insome cases abundant in quantity and very pale in colour; themenstruation is generally irregular or suppressed. Everythingindicates the depressing influence of the gloomy morbid idea onthe organic life. There is usually a great want of sleep, althoughpatients are apt to assert that they have not slept when theyreally have, so little has been the feeling of refreshment therefrom. They are often tormented by vivid and painful dreams,their delusions pursuing them in their restless and unrefreshingslumbers. Refusal of food, which is common and sometimes verypersistent, may be due to other causes besides the want ofappetite and general sluggishness of nutrition: it may be inconsequence of a fear of poison in the food, or of a delusionthat the intestines are sealed up, or in order to die by starvation,or in fancied obedience to a voice from heaven. It is of nolittle practical importance to realize how much the refusal offood, and the delusions which instigate it, are sometimes aggravated in melancholia when the tongue is coated and the digestion out of order. A lady who was under my care refused foodentirely for a week at the beginning of her illness, under thebelief that her throat was completely closed up; and the refusalwas only overcome gradually by persistence on the part of herattendants. Afterwards, during her illness, whenever the digestion was disordered, the old delusion became active, and therefusal of food returned in the old way: that cured, thesedisappeared.There is the same depressing influence exerted upon thevoluntary movements; these, like the ideas, are sluggish generally, and the conduct of the patient accords with the characterof his mental state. In an extreme form of melancholia knownas melancholia with stupor, M. attonita, where the mind isentirely possessed with some terrible delusion , the patient sitsor stands like a statue, and must be moved from place to place;III.] VARIETIES OF INSANITY. 385the muscles are generally lax, or some of them are fixed in acataleptic rigidity; the patient, as if in a trance or as one onlypartially awake, scarcely seems to see or hear; consciousness oftime, place, and persons is lost; and the bodily wants andnecessities are alike unheeded. Between this condition at one.end of the scale, and those cases at the other end in which thereis an acute utterance of the internal agony in gesture-language,though this is usually of a somewhat uniform or even monotonouscharacter, there are of course cases representing every sort ofintermediate stage. But where there is the most activity ofmovement in melancholia it is confined to the expression of themental suffering, or to the common attempt to escape from itby suicide: there is an extreme aversion for the most part toexercise, employment, and activity of a beneficial kind.In monomania proper, where the delusion is attended with anexalted feeling, its effects upon sensibility, nutrition, and movement are different. There appears to be no real diminution ofgeneral sensibility, though the sensations are not always attendedto, on account of the excited mental state; but hallucinationsof the special senses, especially of hearing, are by no meansuncommon, and they appear both as occasional consequences andoccasional causes of the delusion, which in any case they failnot to strengthen. There is not usually any notable interferencewith the processes of nutrition. The behaviour of the patientoften expresses with sufficient distinctness the character of hisdelusion: one may reveal his exalted notions in his gait, manner,and address, while another is not satisfied with the capabilitiesof ordinary language to express the magnificence of his ideas,but invents new and mysterious signs which, unintelligible toevery one else, have wonderful meaning for him. Athird makesperhaps sweeping plans and projects, enters upon vast undertakings, and sometimes goes through an immense amount ofpatient and systematic work in perfecting some impossiblescientific invention.The courses which melancholia and monomania run respectively are different. In melancholia remissions are common,but complete intermissions rare. It is striking in some caseshow suddenly a great change may take place: Griesinger, asalready said, quotes one case in which there was a perfectly lucidC C386 VARIETIES OF INSANITY. [CHAP.interval for the space of a quarter of an hour; and I have morethan once seen a melancholic go to bed cheerful and seeminglyquite well, and yet awake in the morning as bad as ever. Itis never safe to trust to these sudden conversions from gloom tocheerfulness. When recovery does really take place, as it doesin half or even more than half of the cases of melancholia, itis usually gradual, and takes place within from four to twelvemonths from the commencement of the disease. After twelvemonths a favourable result, though less probable, is still nothopeless, for there are instances on record in which recovery hastaken place after the disease has lasted years. Of the cases thatdo not recover, about half decline into mental weakness or complete dementia, the rest remaining chronic or ending in death.Though death may take place in consequence of refusal of foodand exhaustion, it is often due to intercurrent disease, phthisical,cardiac, or abdominal, and most often to phthisis . It was inmelancholics who had died after long refusal of food thatGuislain met with the most frequent instances of gangrene ofthe lung. I have met with it in one such case.The course of monomania, once established, is very seldomtowards recovery. The reasons of this are not far to seek inthe first place, monomania is often secondary to mania or melancholia, and represents therefore a further degree of mentaldegeneration than these diseases; and in the second place, whenit is primary, the fixed delusion is commonly the exaggerationof some fundamental vice of character, and has been slowlydeveloped. Whether primary or secondary, the fixed delusionmarks the establishment of a definite type of morbid action ofa chronic nature, such as is not easily got rid of in any organ ofthe body, much less in an organ so delicate as the brain. Nevertheless recovery does sometimes take place under the prolongedinfluence of systematic moral discipline, or after some greatshock to, or change in, the system-whether emotional, or produced by some intercurrent disease, or occurring at the climactericperiod. As a general rule it may be said that recovery does nottake place when a fixed delusion has lasted for more than half ayear. When it does not, the disease remains chronic, or passesinto dementia: the morethe exaggerated self- feeling which underlies and inspires the delusion wanes, and the more this, losingm.]VARIETIES OF INSANITY. 387its inspiration, becomes a mere form of words, the nearer thecase gets to incoherent dementia.The reason why the prognosis is so much more favourablein partial ideational insanity with depression than in partialideational insanity with exaltation, though sufficiently set forthalready, might be roughly stated thus: that in the former thesystem is painfully sensible of its infirmity, depressed thereby,and feels the need of amendment, while in the latter it isabundantly satisfied with its condition, gay, and not sensible ofanything to amend.(b) General Ideational Insanity. -This division will includeall those cases of intellectual alienation which are commonlydescribed under mania, as well as many cases of general intellectual disorder in which, notwithstanding the excitement, theevidence of much mental suffering leads to their being placedunder melancholia. In fact, it is not possible in practice todraw the line of distinction between acute mania and acutemelancholia, which often blend, follow one another, or run into.one another, in a way that defies exact division; for althoughwe may properly say that there is in acute mania an excitementor exaltation of the self-feeling, the expression of which takesplace chiefly in the actions of the patient, who sings, dances,declaims, runs about, pulls off his clothes, and in all ways actsmost extravagantly, yet there may be equal excitement andrestlessness of action in a patient who believes himself bewitched 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 mostcases, before the actual outbreak, there is, as already set forth,a premonition of it-a precursory stage of depression, of shorteror longer duration, sometimes so brief as to escape notice; uponwhich follow increased excitability, sleeplessness, restlessness,extravagance of behaviour, rapid flow of ideas imperfectly orstrangely associated or entirely incoherent, and hallucinations.and delusions of various kinds. A similar brief period of unaccountable depression sometimes precedes the outbreak of a fever:it is the projected shadow of the coming calamity. The condition of excitement may last for some time as an acute disease,and then pass away, and recovery take place; or it may degeneCC 2388 VARIETIES OF INSANITY [CHAP..rate into a chronic state, in which there is a persistent incoherenceof ideas, and permanent delusions and hallucinations exist. Thelast stage of declension or degeneration is that of dementia, inwhich not only the organized coherence of ideas in the supremecentres is destroyed by disease, but most of the very centres ofideas themselves are disorganized and rendered incapable evenof morbid function in the extremest cases of dementia there isnot the capability even of a delusion, so disorganized by themorbid degeneration is " that noblest garment of organization inwhich the soul is clad. "Instead of entering into a general description of the symptomsof acute mania and melancholia, I shall give an example ofeach of these forms of ideational insanity, interposing suchcommentaries as may appear necessary to elucidate the character of each, and to convey just ideas of its nature, symptoms,and course.W. P. was a merchant, of great originality of thought andenergy of character, who became insane, after making a considerable fortune entirely by his own abilities. His mother haddied insane. After slight depression, and certain transactions inbusiness, which rather astonished his friends as being opposedto his usual manner of doing things, he broke out into eccentricities and extravagances of behaviour, with which was associated an unaccustomed liveliness; in fact, he acted very muchas if he were intoxicated , turning certain pictures with theirfaces to the wall, putting chairs in queer positions, walkingabout the garden bareheaded and singing: altogether heappeared joyous, and was eccentrically industrious. If spokenwith, he was lively, witty, original, and satirical, laughing witha laugh of peculiar harsh and metallic ring, which he could nothave imitated when in health: still he could control himselffor a time, and speak with a marvellous assumption of calmnessif he pleased. There was so far no positive insanity of thought,though there was great insanity of action: his condition mightbe said to represent an acute form of that stage of disease whichhas already been described as the mildest form of hereditaryinsanity. Degeneration proceeding, however, he became in aday or two much worse: he raved incoherently in conversation,was violent in action, and not amenable to control; his lan-III.] VARIETIES OF INSANITY. 389guage was obscene and disgusting, his behaviour not less so;and he represented very completely the condition of a furiousmaniac, whose habits were of the filthiest kind: he masturbat*d with frenzied energy, and eagerly licked up the secretion,swallowed his urine, and painted himself with his fæces, chantinga wild chant the while, or talking in rapid incoherence. In allthis extremity of fury, however, there were plainly evinced onhis part a certain consciousness of his extravagances and a capability of modifying his actions in certain regards, which couldnot fail to give his conduct the semblance of wilful defiance andwitting offence to the feelings and opinions of those who had todo with him. As the energy of this stage somewhat subsided,various delusions-as that he was made the victim of medicalexperiments by night and by day, but especially by nightwere exhibited the strange disease-produced feelings, nowiseconforming to the order of his previous experience, and avague feeling of being the automatic agent of morbid acts nothis own, were interpreted as the results of external maliciousagencies, as they were plainly not within the domain of hisconscious life and voluntary control. This condition of thingslasted for more than a week, after which, as the maniacal furyand delusions disappeared, there ensued a state of the profoundest moral disturbance. He was possessed with a greathatred to all those who were especially his friends; was sullen,morose, and gloomy; represented , in the unfairest way, everything which had been done to control him-and he had anexcellent memory of what had been done-as a violent cruelty;misrepresented any kindness or act of attention from his relatives; refused his food or took it most capriciously; and,although all positive delusions seemed to have vanished, yet heappeared to look upon others as responsible for all his sufferingsand extravagances. One might reason with him, but even if heacknowledged the justice of the arguments, which he sometimesdid, it was a hypocritical affectation; for to another he wouldimmediately afterwards set forth his unparalleled grievances inthe most perverse and untrue manner-more untrue because heso completely twisted and perverted some little truth. Whenwell, he had always displayed a scrupulous regard for truth.There was no intellectual incoherence, but marvellous ingenuity:390 VARIETIES OF INSANITY [CHAP. .he could assume such an appearance of calmness and logicalmoderation in his complaints, accusations, and statements aswould deceive the very elect. And he actually succeeded inimposing upon an influential friend, who, himself a most honourable man, was so much influenced by the calmness and coherenceof his stories, and by the plausible way in which he accountedfor all his peculiarities, as consequences of the position in whichhe was placed, or slurred them over, that he represented in thestrongest possible manner to his immediate relatives the injusticeof keeping him longer under any sort of restraint. Accordingly,in this condition of imperfect convalescence, of unquestionableextreme moral or affective insanity, and in opposition to medicalremonstrances, the patient was freed from all restraint: all thepeople in his neighbourhood thinking that he had been mostunjustly confined. The consequence was, that in the courseof a few weeks he had so managed, or rather mismanaged, hisproperty-selling stock at great loss, and giving away largesums of money under the most singular pretences-as to affordan excellent harvest to the lawyers, and greatly to impoverishhis children. It was found absolutely necessary to place him.under restraint again, where he will remain doubtless for therest of his life. For although he was apparently quite rationalfor three or four weeks at a time, yet the attacks of mania constantly recurred, gradually becoming more prolonged and theintervals of sanity less, until the disease acquired the characterof dementia.In this case we may observe that the first stage of the degeneration was a short period of unquiet and unaccountable depression, which Guislain believed to occur in the great majorityof instances, and which not unfrequently precedes an ordinaryfever or other grave disease; it is, as it were, the gloom thatforeshadows a great calamity, the painful forefeeling of thecoming storm. Afterwards there quickly followed a stage of socalled exaltation, in which the patient seemed to be in anexuberantly happy state, as though transported with some joyfultidings, and perpetrated various extravagances of speech andaction as though from an overflow of life. Some have nothesitated to describe this condition as one of increased mentalactivity; even Schroeder van der Kolk has fallen into what we111.] VARIETIES OF INSANITY. 391cannot but consider this great error. The real state of thepatient 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 thananything else; he is entirely incapacitated for the calm reception and discrimination of impressions, the subsequent quietreflection , and final intelligent act of volition-the complete coordination of mental action, which is implied in the highestmental activity; his words and actions are like the idiot's tale,"full of sound and fury, but signifying nothing." The conditionof nerve element, which is the basis of this excitability, is areaction after the preceding depression, and it marks the commencement of a degeneration which, if not checked, will go onto the further stage of positive maniacal degeneration of mentalaction, like as the reaction of other kinds of organic elementthat have been chemically or mechanically injured passes intoinflammation and purulent degeneration: it is a state of instability of composition corresponding to that which is the condition of the mildest forms of hereditary insanity, where, asalready pointed out, such striking exhibitions of particulartalents sometimes occur.Striking in this case was, what is often observable in othercases, the metallic ring of the strangely altered voice. Thismaniacal change in the tone of voice, which is apt to grate soharshly on the sensibilities of those unaccustomed to hear it,testifies not less surely than the deranged thought, pervertedsensibility, and furious conduct to the profound and general disturbance of the nervous system. When a man is a lunatic,"says Dr. Bucknill, " he is a lunatic to his finger ends: " he isalienated from himself both bodily and mentally. I cannothelp making the remark here, that in almost every disease, butespecially in insanity, there are a great many unobtrusivesymptoms in which nature speaks that are almost entirely overlooked, attention being so much fixed on a few prominent symptoms. In insanity, for example, there is not only the changedtone of the voice, but there are peculiarities in the expressionof the countenance, in the look of the eye, in the posture of thebody: these constitute the physiognomy of the disease, anddeserve the most exact study. I think it not impossible in392 VARIETIES OF INSANITY [ CHAP. .many cases to determine from such signs not only whether thepatient is suicidal, but in what degree he is suicidal—whetherat any rate there is a desperate impulse that, like an evil fate,governs the patient and waits and watches for opportunities, orwhether a fluctuating impulse is excited to activity by opportunities. Again, there are great diversities in the character ofwhat we confound under the general name of pain, as well as inthe character of those manifold modifications of sensibility whichfall short of pain, all which have their specific meanings had webut the knowledge to interpret them. Two circ*mstances, noteworthy in many cases of insanity, were marked in the caseunder consideration: these were, the peculiar indescribable odourof the patient-the bouquet de malades of lunatic wards-andthe intensely offensive character of the intestinal excretions.Manifestly there is some unknown chemical change produced inthe excretory functions by the profound nervous disturbance,not otherwise than as secretions are observably altered in composition by passion; and the result attests, as other effects justmentioned do, the essential interaction of the mental life in thewhole bodily life, and the impossibility of separating, save inthought, mental and bodily phenomena. It behoves us therefore to carry with us to the investigation of any case of insanitya deep sense of the importance of scrupulously studying everysign of physical disturbance, motor, sensory, or nutritive, as wellas the prominent mental symptoms.The third stage of degeneration exhibited by the patient wasthat of acute maniacal fury; of which it is not necessary to saymore than to point attention to the evidence of the persistenceof a certain amount of self- consciousness, and the occasionalmanifestation of a certain power of self-control for a moment.This is the more necessary because of the foolish criterion ofresponsibility sanctioned by English law, or rather by Englishlawyers. Certainly this patient, at all but his very worstmoments, and perhaps even then, was conscious of what he wasdoing at the time, as he had an exact and complete memory ofit afterwards, and was quite aware that it was disgusting andoffensive to those around him; he had even some power of selfcontrol at times, as he would not do before me what he woulddo before attendants; so that if the legal criterion of responsi-111.] VARIETIES OF INSANITY. 393bility had been strictly applied to his actions, this man, sufferingthe extremity of maniacal disease, would not have escapedpunishment. As the maniacal fury subsided and delusionsappeared, the disease becoming more chronic, we might say thata fourth chronic stage was passed through-a stage characterisedby the persistence of ideational disorder; that is, not only ofmorbid ideas, but of the morbid association of ideas, after excitement of conduct had ceased. From this the patient soonpassed into the fifth, well-marked stage of affective insanity, acondition which usually lasts for some time after ideational disturbance has disappeared. The result of his premature removal,while so suffering, affords an excellent illustration of the truthof the observation of Esquirol, that the disappearance of hallucination or delusion is only a certain sign of convalescence whenthe patients return to their natural and original affections. Atthe earlier period of the disease there succeeded to this stage aninterval of apparently perfect sanity before the supervention ofa new attack, but as time went on this interval became lessevident, and at last was omitted altogether; so that, instead ofa recurrent mania, there was a continued mania established,with regular stages of exacerbation and decline, and a steadydeclension towards the last stage of all, that of dementia, tookplace.Now if we choose to suppose, as we might not unfairly do,each of the stages of disease gone through by this patient toexist in some individual, and to constitute his permanent state-if we conceive in fact the progress of degeneration throughgenerations instead of through the individual life -then we mayform a tolerably correct idea of the varying forms of generalideational insanity that are met with. In one person the furyof action may be most marked; in another, the delirium ofthought, chronic or acute; and in a third there is a predominanceof the affective disorder. If we eliminate the element time inconsidering the course of mental disease, and do not suffer ourthoughts to be constrained by it , we may certainly be enabled toget more correct views of the relations which the different formsbear to one another; the events of generations and of theindividual life are brought together within the same compassof 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 benoticed or might be entirely passed over on account of itsrapidity and briefness in the individual, will be distinctlyevolved in the progress extending through generations; and aphase of disease which might have an exaggerated importance.or an independent character assigned to it in the generation willreceive its right interpretation by a consideration of the courseof the disease in the individual. Had this principle been at alltimes clearly apprehended, it may be justly questioned whetherany one would have been found to doubt or misinterpret thoseobscurer forms of mental disease that have been the cause of somuch unprofitable contention and angry feeling.A form of most acute mania, which runs a rapid course, deserves particular attention, both on account of the rapidity ofits course, the gravity of the prognosis, and the special treatment demanded. It is really an acute maniacal delirium ratherthan a systematized mania, the délire aiguë of French authors,and is characterised by great excitement, entire incoherence,apparent unconsciousness of what is going on around, and extreme restlessness; the course of the disease being swift eitherto recovery or to death. The following example will serve toillustrate it -A cook in a gentleman's family, whose age wasnot known, though plainly between forty and fifty, was rathersuddenly attacked with acute mania. Nothing was known ofher previous history, but she had been considered by her fellowservants to be a little peculiar, and she had suffered from achronic erysipelatous inflammation of one leg, which had disappeared a short time before her attack of insanity. She hadbeen ill seven days when admitted into the hospital, and duringthe whole of that time had been noisy, violent, and utterlyincoherent; and she had taken no food for several days. Onadmission her state was one of the extremest maniacal excitement: she was noisily incoherent, stripped off her clothes, rolledon the floor, was unconscious of the calls of nature, and seemingly unconscious also of what was said or done to her; shewas continually spitting frothy and sticky saliva, and the lookof her countenance was horrible and heartrending. She couldnot be got to take food, and it was with the greatest difficultythat beef- tea, eggs, and brandy were administered to her at111.] VARIETIES OF INSANITY. 395frequent intervals. Morphia made her sick, and did not makeher sleep. This went on night and day for a week, when shewas reported to have become quiet; but it was the quiet ofcomplete exhaustion. Her pulse was so feeble and rapid that itcould not be counted, though up to the moment of the collapseshe had been as excited, as noisy, as restless as ever, and shestill rolled on the floor, tossing her arms about and pulling ather clothes. Next day the heart beat feebly 160 times in aminute, so far as could be made out where no exact examinationwas possible, and with a certain undulatory action which raisedthe suspicion of pericarditis; but there was no increase ofcardiac dulness. The skin was hot and dry; there was extremejactitation; and she drank fluids eagerly, as she had never donebefore. I thought there was some abdominal tenderness onpressure, but could not be sure of it. Next day she was clearlysinking fast, and muttered words which so far as could be madeout were a request for holy water: she was a Roman Catholic.Pressure on the abdomen now produced evident shrinking. Onthe following day she died. On examination of the body afterdeath, the pericardium, when opened, was found not to containa drop of fluid; its surface was dry, rough, and markedly injected, and its substance seemingly thickened generally, andcertainly so in parts by oblong patches of lymph of old standing. There were similar layers of lymph on the heart, the substance of which was pale and flabby, and its cavities were fullof blood, mostly uncoagulated. The intestines were almostuniversally of a rosy red hue, which on closer inspection wasseen to be due to injected vessels. The arachnoid was slightlyclouded, like glass gently breathed upon, and streaked with adelicate milky opacity along the lines of the vessels, while itwas bulged at the sulci by a clear serous fluid beneath. Theventricles were filled with a similar fluid, which existed also inconsiderable quantity at the base of the brain. On slicing thebrain numerous red spots were visible, and when the surface ofthe cerebellum was exposed, it was seen to be strongly injectedin beautiful arborescent fashion. Had the examination beencarried further into the minute structure by a competent microscopist, I doubt not that the ideational cells of the corticallayers would have been found to be clouded and troubled like as396 VARIETIES OF INSANITY. [CHAP.the arachnoid was. The visible morbid appearances at any ratewere instructive and interesting, and afforded some compensation for the painful feeling of utter helplessness which one hadhad in face of the disease during life. An obvious speculationas to the cause of the disease could not fail to present itself:that an erysipelas disappearing from the surface of the bodyhad selected for attack the arachnoid and other serous membranes. Though the issue was fatal in this case, it is not so inall cases of acute maniacal delirium; it is, however, a diseasewhich should unquestionably be regarded seriously, both onaccount of its occasional intractableness, and on account of thesuddenness with which fatal exhaustion may supervene.Puerperal mania does not present any special symptoms,although the general features have usually something characteristic. The skin is often pale and cold, the pulse quick andsmall; the features are pinched, and the patient stares wildly asif there were hallucinations or illusions of vision; there areextreme and noisy incoherence and sleeplessness; restlessnessand obscenity are not unfrequently marked features. It rarelyoccurs at a later period than one month after confinement, andusually before sixteen days have elapsed, the first confinementbeing the most dangerous. The prospect of recovery is veryfavourable. When it occurs after sixteen days from the confinement, it is, Dr. J. B. Tuke observes, more likely to take amelancholic 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 fromall 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 presenta certain family likeness. There is often an erotic characterdisplayed in the conduct or conversation of the patient, who isby no means indisposed to refer to the troubles of her sexual oruterine organs. Dr. Clouston has described a phthisical maniawhich might be called a mixture of subacute mania and dementia, being sometimes like the one and sometimes like theother. As the disease advances, the symptoms of dementia predominate, but the mental faculties are seldom entirely obscured;there are fitful flashes of intelligence, and in these patients moreIII. ]VARIETIES OF INSANITY. 397often than in any other cases, there is increased manifestation ofintelligence immediately before death. If there be any singletendency which characterises these cases, it is their suspicious.disposition; indeed, the records of the Edinburgh asylum showthat nearly all the cases of monomania of suspicion werephthisical. It appears, however, that the peculiar type ofmental derangement which Dr. Clouston calls phthisical maniais after all only met with in about one-fourth of the cases inwhich tubercle is found, and that he is compelled to limit theterm to those cases which died within five or six years afterbecoming insane, and in which the development of the phthisisand the insanity were about contemporaneous. Moreover, thealleged characteristics of the group, as thus limited, must beadmitted to be vague and indefinite.I now proceed to relate the history of a case which wouldusually be described as a typical example of acute melancholia,because of the fixed mental suffering that accompanied the incoherence and excitement. It was of a very extreme kind, andillustrates what an amount of consciousness may co- exist withthe most desperate insanity. A young woman, æt. twenty-four,whose parents were Dissenters in a respectable position, had beenreligiously brought up; she had been much engaged in Sundayschool work, and had written several little tracts of more or lessmerit. When first seen by me she was said to have beenill for two months, but there was some probability that she hadsuffered for a longer period. She was miserably restless and unhappy, and wandered about moaning and exclaiming, " My poorfather! My poor father! " She also spoke incoherently of thehouse being burnt down, and of every one in it being lost; andshe made several attempts at suicide. After a little while shebecame still worse: she was much excited during the day, rushing wildly at any door the moment it was opened, grasping atthe clothes of anyone who might enter, and clinging to them withoffensive tenacity; and at night she slept not, tore to pieces bedclothes, nightdress, and whatever else she could tear, and plasteredherself and her chamber with her excrement. Day by day, sheseemed to get, if possible, worse and worse, gabbling automatically some such sentence as " Let me see my poor father;let me kiss my poor father," and making the most frantic rushes398 VARIETIES OF INSANITY. [CHAP.at any door that was opened, no matter where it led to. Nightwas not the time for sleep, but for the awakening of a more disgusting frenzy. Withal it was clear that, notwithstanding herterrible and distressing excitement, she knew what she was doing,and could control herself in some measure for a time; she didnot like, for example, to be put in seclusion, and the threat oremployment of that means of treatment had a calming effectupon her. On the whole, there was certainly an appearance ofwilfulness in the worst acts of this poor woman, whom anordinary observer would have pronounced the maddest personthat he could imagine: she was perfectly conscious whether shewas doing what she should do or should not do; and if asufficiently powerful motive was excited, she could sometimesrestrain the automatic utterance of her convulsive frenzy. Hadthe supremely absurd question whether she knew the differencebetween right and wrong been put to a medical witness in hercase, the reply, so far as rational answer could be made toirrational question, must needs have been that she did. Inmany like instances of hereditary insanity nothing is more clearthan the persistence of consciousness with the most extreme insanity of action. In this case, the so-called asylum ear, whichis ever of evil augury, appeared first on one side and then onthe other, and the end was the natural end of such cases, -namely, dementia: the fury had raged out, and the calm ofmental extinction followed: by making a desert of the mindthere was made peace. As in the natural order of events convulsion is the forerunner of paralysis, so maniacal fury is thenatural forerunner of dementia in the regular course of mentaldegeneration.In this case there is notable a feature which is observed alsoin most other cases of acute melancholia, and which, indeed,constitutes a point of difference between it and acute mania;The " Insane ear "-Hæmatoma auris, or Othæmatoma-is produced by aneffusion 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 thecystic stage, absorption finally taking place, and the ear becoming dry and shrivelled.When it appears, the prognosis is very unfavourable. Some have attributed itto a traumatic cause, but its gradual manner of coming on, its symptoms, andduration, are widely different from those of a contusion. Dr. Stiff, who has investigated its nature most carefully, believes that there is no foundation for supposingit to be produced by injury.-" Hæmatoma auris, " Brit. and For. Review, 1858.111. ] VARIETIES OF INSANITY. 399it is the monotonous and apparently automatic character of theexpression of the disease, whether in the delirious ideas or infrenzied actions. We know not why it should be so, but so itis, that the most excited melancholics exhibit far less variety intheir delusions and conduct than the acute maniac. The moreactivity of movement there is, however, in melancholia, as theexpression of the mental suffering, the more acute the utterance of the agony in gesture-language-in the wringing of thehands and the writhing of the body-the nearer does the caseapproach mania.In the insanity of pregnancy the symptoms are as a rule of amelancholic type; and in no other form of the disease is thesuicidal tendency stronger. There is not uncommonly a considerable amount of moral perversion, so that the patient acts ina way which she would be heartily ashamed of if she were well.The insanity of lactation also most often has the melancholicform, with determined suicidal attempts. In both forms theoutlook is favourable.It is striking how complete in most cases of general ideationalinsanity is the memory of the past during the attack, and of allthat has happened during the attack after it has passed off; butin other instances, especially those of acute maniacal delirium,the patient forgets altogether the events of his madness, likeas a dream is forgotten, though he may remember them againduring a subsequent outbreak. Immediately before a secondattack it sometimes happens that thoughts and feelings displayedon the occasion of a first attack, but latent since, will reappear,so that even attendants are able to recognise the evil presageand to predict the outbreak, Here, again, we perceive a resemblance to what happens sometimes in epilepsy. The auraforerunning an epileptic attack may be mental, consisting in therecollection of a fact, or the reproduction of an idea, which ona former occasion preceded or accompanied the fit. " Manypersons," Dr. Jules Falret observes, " who have become epilepticafter strong moral emotions or intense terror, see again inmind, or before their eyes, on each succeeding seizure, thepainful circ*mstances or the dreadful scene which produced theircomplaint."• De l'État mental d'Épileptiques.400 [CHAP.VARIETIES OF INSANITY.Hallucinations of the different senses are common enoughin acute mania and melancholia, and illusions still more so;but both are usually of a fleeting and fluctuating character.Patients hear voices address them, see persons that have noreal existence, or mistake for others those whom they really dosee, taste poison in their food, smell strange odours, or feelunaccountable shocks, which they attribute to electricity orwitchcraft. Some have thought that the long endurance of thegreat expenditure of energy in acute insanity may be owing toa perversion of the muscular sense, by reason of which the truestate of the muscles is not declared in consciousness. There canbe no doubt that the centres of motor residua are very muchdisordered, just as the centres of ideas are: a patient lying in hisbed fancies, therefore, that he is moving, or that his limbs areflying through the air; he has motor illusions and hallucinations,and the muscular sense is so perverted that it cannot makeknown the real state of the muscles, and help to correct by itsperception the deluded motor intuition. Even where there isno actual illusion of movements in acute insanity, the rapidity,confusion, and incoherence of them attest not less certainly thederangement of the motor centres; the movements are not willed,nor do ideas of them consciously precede their accomplishment,but the motor intuitions, excited into activity by disease, instigatethem the moment they rise; not resting there, moreover, thesecarry their morbid activity into the intellectual life, and aid andabet the morbid work going on in the ideational centres.Considering the great and continued agitation, mental andbodily, and the loss of sleep, in acute insanity, the bodilyfunctions are very little affected. In the early stage, whenthere is perhaps some febrile disturbance, the pulse may be alittle quicker, but it is afterwards scarcely accelerated. Thetemperature of the body is slightly, if at all, increased in ordinary cases; but in cases of a typhoid type, where there aresleeplessness, restlessness, gradual wasting, and where the tendency is to death from exhaustion, it may be raised from 3 to5 degrees above the natural standard. In the insanity occurring after acute disease, Dr. Weber found only a slight increase

• Report on the Devon County Asylum for 1865.

III.] VARIETIES OF INSANITY. 401

of temperature, although this had been considerably raisedduring the previous acute disease, and immediately rose againon the occasion of a relapse. When the temperature risesnotably in a case of insanity, we may then justly suspect anattack of some other disease, or a tendency to fatal exhaustion;in either case the prognosis is made serious. The skin maybe dry and harsh, but it is often moist, and of offensiveodour. Dr. Sutherland thought he had discovered an excess ofphosphates in the urine were this true, it might be supposed to testify, like the slight increase of temperature, to anabnormal disintegration of tissue; but the researches of Dr.Addison have not confirmed the statement. Constipation iscommon, but in some cases there is an obstinate relaxationof the bowels; not unfrequently, however, these act quiteregularly.What explanation can be offered of the fact that maniacs dofor so long a time continue an unceasing activity, without any,or with very little, sleep? Some have thought that there wasan actual excess in the production of nerve power by theexhaustion of which, under ordinary circ*mstances, sleep isproduced. But if there were an excess of production, it musttake place at the cost of something, there must be an excess ofconsumption of nerve element: expenditure of power must bebalanced by a corresponding supply in the maniac as in thesane person, or as in the steam-engine. Is this supply in themaniac supposed to take place from the blood without sleep?If so, where is the necessity of sleep in order that a similarrestoration may take place in health? The proffered explanation, when analysed, becomes no explanation at all, but anassumption of the impossible. The question to be consideredis the kind of power displayed by the maniac: it is surely notan excess of power, but the more demonstrative display of aninferior power, many equivalents of which only balance oneequivalent of the higher power of a rightly controlled and coordinated mental and bodily activity. Convulsion is not• On the Delirium during the Decline of Acute Diseases, by Hermann Weber,M.D. -Med. - Chir. Transactions, 1865.+ On the Urine of the Insane. -Brit. and For. Review, 1865.D D402VARIETIESOF INSANITY.[CHAP.strength; nor is a maniac strong-minded because twenty men.cannot reason with him, nor strong-willed because the strongestman cannot hold him. If we bear these considerations in mind,and at the same time reflect on the mental prostration whichfollows an attack of acute mania and the permanent mentalfeebleness which is produced by many such attacks, we shallsee our way to something like an adequate explanation of themaniac's ceaseless and sleepless activity.Acute insanity is not often regularly progressive in its course;remissions usually take place, and sometimes there are completeintermissions, or so-called lucid intervals. When the attacksoccur at regular or irregular intervals, as they are apt to doin the sympathetic mania connected with amenorrhoea, theyconstitute a periodic or recurrent insanity; and when a melancholic and maniacal excitement alternates with some approach toregularity, we get what some French writers have called foliecirculaire, or folie à double forme. Since the time of Esquirolthere has been in France an ambition to discover a new varietyof insanity, and to coin a new name for it; but the verbal distinctions 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 transitoriuslasting for a few hours or days, and accompanied sometimes byvivid hallucinations and destructive tendencies, has been attestedby so many trustworthy observers, that it is impossible todoubt its occasional occurrence; the outbreak is comparable,indeed, with an attack of epilepsy, in connexion with which itoften occurs, and, well considered, is no more wonderful norinexplicable. * Recovery, when it does take place, usuallyNumerous instances of such transitory fury are on record, and might bequoted. The following is an example: -" A sober and industrious shoemakergot up early one morning as usual to go to his work; soon after his wife wasstruck with his wild look and incoherent talk. He seized a knife, and rushed athis wife, who escaped. The neighbours had great difficulty in seizing and disarming him, for he defended himself with the knife. His face was flushed, hispulse full and frequent, and his body covered with perspiration. In the afternoonhe became calm, and slept heavily. When he awoke in the evening he was quitehimself, and remembered nothing of what had passed ." -CAZAUVIEH, De la Monomanie Homicide, 1836. See also Virchow's Archiv, vol. viii. p. 192; UeberMania Transitoria, by Dr. Ludwig Meyer and cases in Marc's work, De laFolie considérée dans ses Rapports avec les Questions Médico-judiciaires.11.]VARIETIES OF INSANITY.403occurs within the year, and sooner and oftener in the melancholic than the maniacal form; it is rare after two years havepassed; indeed, the longer the disease lasts, the worse is theprognosis, which is always unfavourable in the recurrent form,and where there is an alternation of melancholic and maniacalexcitement. When recovery does not take place, the diseasepasses 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 thatacute 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 afterdeath, especially, according to Guislain, in those who have longrefused food. When maniacal exhaustion proves fatal, it sometimes does so suddenly and unexpectedly, leaving in the mindan anxious feeling of doubt whether a more energetic treatmentmight not have prevented death , or, if energetic treatment hasbeen employed, whether that has not had something to do withhastening the fatal issue.After the acute symptoms of an outbreak of insanity havesubsided without recovery taking place, the chronic diseaseexhibits the most varied features, according to the nature of theoriginal cause, and the extent and degree of mental degeneration.When the disease has been produced by a moral cause, there isusually considerable intellectual power apart from the delusions, or even manifested in the display of them; the case maythen properly fall under partial ideational insanity. When thedisease has been produced by a physical cause, or has followeda severe attack of acute insanity, there is often a great loss ofmental power, together with delusions, some general feebleness,and incoherence; the morbid action has spread through themental organization, and the case might be referred to one ofthe groups of dementia. Between dementia and what is describedas chronic mania, the difference is only one of degree of degeneration, and examples perpetually occur that render the establishment of any definite line of division impossible. On the onehand, then, chronic insanity runs insensibly into monomaniaor melancholia; on the other, into dementia. The principleswhich guide the prognosis in these forms of mental disease willDD 2404 VARIETIES OF INSANITY. [ CHAP.apply to it. To give an account of chronic insanity would besimply to describe, in tedious and useless detail, the physicaland mental characteristics of numerous individual cases. It isimportant only to bear in mind, that an excellent memory andmuch intellectual power may co-exist with numerous extravagantdelusions. A lady under my care, who fancied that not an eventin Europe happened which had not some hidden relation to herand her affairs, who detected a plot against herself in the meetingof a cabinet or in the movements of a court, who heard voicesfrom the ceiling, and who used terrible language in her frequentoutbursts of excitement, had a most exact memory of all heraffairs, and an acute judgment regarding them. It was onlybecause she could not control her conduct, but threatened witha loaded pistol the lives of those whom she thought to be herenemies, that it became necessary to put her under care andcontrol.4. Dementia. It is the natural termination of mental degeneration, whether going on in the individual or through generations; 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, sometimesfollows a serious attempt at strangulation or drowning, or aseries of epileptic fits; and in one case which came under myobservation, there was strong reason to believe that a maskedepilepsy appeared in that guise. A man of epileptic visage, andsaid to have had " fits " occasionally, was suddenly, after whatwas called a slight faintness, but what possibly was an epilepticvertigo, affected with a blank confusion of mind, entire incoherence, and complete inability to recognise anybody or anything to remember the past or to appreciate the present; hewas, in fact, completely demented. So he remained for a fewdays, and then got quite well. Again, the insanity which sometimes occurs after certain acute diseases, as typhus and typhoidfevers, pneumonia, acute rheumatism, may take the form ofacute dementia. Lastly, it appears to be sometimes brought onsuddenly by a great moral shock; and it now and then occursin young men and women as a primary disease of unknowncausation, though connected in some way probably with dis-III.] VARIETIES OF INSANITY. 405turbed sexual function . A pale, delicate, fragile, blue- eyed younglady, æt. twenty-five, came under my care after being ill for aweek. She had not taken food, and was much exhausted. Hervacant wandering eyes were devoid of all intelligent perception,and her countenance was blank and expressionless.There wasa 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 ofresponse, or to fix her attention. She took no food but whatwas forced into her mouth, and was inattentive to the callsof nature. Before three months were over she recovered undersuitable treatment. She had suffered some disappointment ofher affections; menstruation had ceased; and acute dementiafollowed. Another somewhat similar case was that of a younggentleman, æt. nineteen, of pale, delicate appearance, with largeprominent grey eyes. He had for some time been worked ratherhard in an office, and had not quite satisfied his friends with hismode of life out of it, when one day he was suddenly attackedwith a quasi-hysterical attack of incoherence. There was blankconfusion of mind; he neither uttered nor expressed otherwiseanything indicating ideas in his own mind, and he showed nosign of understanding what was said by others. There wereoccasional periods of confused excitement. He took no food butwhat was forced upon him, and he was inattentive to the calls ofnature. Recovery took place within a month.Dr. Skae describes a sexual insanity taking the form of acutedementia, met with both in the male and female sex, but morefrequently in the latter, and connected, he believes, with theeffect produced on the nervous system by sexual intercourse. Ihave known one case in which a gentleman was attacked withacute and furious mania, of a transitory nature, after each act ofsexual intercourse. The transitory mania was no doubt comparable to an epileptic attack, which may occur in a similarway, and may also, as already seen, when masked, appear asfuror transitorius or as acute dementia.These examples will serve to show the character of acutedementia, and to indicate the favourable character of the prognosis. The mental functions are abolished for the time byreason of some severe shock to their nerve centres; the expres-406 VARIETIES OF INSANITY. [CHAP.sionless countenance of the patient, his passive attitude of body,perhaps an occasional aimless and confused excitement, hisinability to understand what is said, or to say anything whichcan be understood, and a loss of sensibility-all mark theabeyance of mental function. If a restoration does not soontake place, as in most cases it does, there is danger lest thedisease pass into chronic and incurable dementia. It is hardlynecessary to say that senile dementia, though primary, doesnot get well.Chronic dementia is the form of dementia which we mostoften meet with, and we meet with every degree of mentaldecay in different cases. It is observed that after a very severeattack of acute insanity the evil effects are many times visiblefor a while in a certain condition of mental weakness withoutactual intellectual disorder. The force of the character seems tohave been sapped, and, though perception appears to be sufficiently acute, there is some want of power of reflection; thefiner feelings, moral and æsthetic especially, are gone; thephysiognomy has lost its highest expression, and the individualgives the impression of a certain childishness of manner. Thisfeebleness may gradually pass off as time goes on and strengthis regained, or it may be more or less apparent for the rest oflife. In the latter case, recurring attacks of positive insanityare apt to come on at uncertain intervals, and to issue finally incomplete dementia. In a lady under my care, who had sufferedfrom an attack of acute insanity when only fifteen years old,the development of the mind seemed to have been completelyarrested; twenty years afterwards she had quite the appearance, manner, and mental character of a girlof fifteen; andthough she had during that period three more acute attacksof derangement, these resembled in character those that occurin early life rather than such as are usually met with inadults. Between this mild form of mental weakness at oneend 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 ofthe gradation.Most of the permanent residents in asylums, those who constitute the greater part of the insane population of the country,III.] VARIETIES OF INSANITY. 407are persons who, after mania, monomania, or melancholia, havesubsided into a state of greater or less feebleness and incoherence of mind. They represent in undistinguishable varietiesthe shattered wrecks of the mental organization. Three maingroups ofthem may perhaps be made. The first will consist ofthose who exhibit a few striking delusions which seem to beautomatically expressed; for the strong self-feeling which underlies or inspires the delusions of partial ideational insanity hasfaded away, and they are no longer full of self-assertion, noreager and earnest about their opinions. They quietly giveutterance to the most extravagant delusions, as if they were themost ordinary truths, and, when under proper care, only getexcited for a time when these are opposed or attacked. Thepaths of mental association are broken up, so that the delusionsare cut off from any active influence upon such mental functionsas are left, and all real interest in the past or the present isabolished. The actions of the patient exhibit a correspondingimbecility. Many of them are incapable of employing themselves in any useful way; a few may be induced to continuetheir 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 kindsare exhibited, as, for example, to stand or crouch in a particular corner, to walk backwards and forwards for a certaindistance on a particular piece of ground, or to ornament fantastically the person with feathers or flowers. The mood ofmind may be surly and depressed, or brisk and exalted, orplacid and cheerful; it appears to be determined in greatmeasure by the previous disposition of the patient. Hallucinations and illusions of the most extreme kind are frequent.Awoman under my care used to think she ate different peoplein her food, and when she saw them alive still could not be persuaded that she had not eaten them; another woman maylovingly nurse as her long dead child a lump of wood decked inrags; a third person, whose singular movements seem unaccountable, is busy spinning sunbeams into threads; a fourth continues violent movements of his arms in order to prevent hisblood from coming to a standstill. The bodily health is usuallygood, the patients frequently improving in this regard as the408 VARIETIES OF INSANITY. [CHAP.active symptoms of mania or melancholia subside into the calmof dementia.In a second group of cases there is a more general incoherenceor craziness, without any particular delusions, but with greaterexternal activity. Although there are no distinct delusionsmanifest, there are evident, in the patient's incoherent babblingsor his senseless parrot-like repetition of certain words, traces ofsuch as existed in the maniacal stage. The morbid degenerationhas advanced so far, that not only are the paths of association inthe mind broken up, but the centres of ideas are themselvesdisorganized. Consequently there is an entire incapacity offashioning into ideas the impressions made upon the senses, aswell as a complete loss of memory; in extreme cases there isthe incapacity even of a distinct and fixed delusion . There issometimes an entire indifference to what is going on around ,and there may be a remarkable insensibility to pain; or thereare occasional violent outbreaks of incoherent passion and fury;or there may be even desperate homicidal violence. J. B. was ademented patient, utterly incoherent, who walked about muttering to himself; no one could make out what he was mutteringabout, for no intelligible answer could ever be got from him,yet every one who had had any experience of him had a livelyand well-grounded dread of him. Without giving the slightestwarning beforehand, he used, from time to time, to rush suddenlyupon some one, and deal him savage blow, or make a furiousattempt to strangle him; so sudden and dangerous were theseattacks that nothing would induce an attendant to sleep in thesame room with him. H. P., again, was a heavy, wild-looking,hopelessly demented woman, who usually laughed vacantly whenspoken to, and seemed not to comprehend anything that wassaid; every now and then, however, she used to begin, withoutany evident reason, to shriek and howl fearfully, and to stampon the ground furiously, her whole body being agitated by aconvulsive paroxysm. This fit of agitation would often issue ina murderous attack made on some one with the rush of anavalanche, while at other times she would fall down, and lieshrieking and kicking for some minutes; after which she would,with mechanical drawl, murmur, " I beg pardon," " I'm verysorry; " not a few homicidal lunatics belong to this group. TheIII. ] VARIETIES OF INSANITY. 409predominant mood is different in different cases: some are gay,happy, and prone to laugh and chatter; others are gloomy, anddisplay the mimicry of sorrow; while others, again, are malicious ,spiteful, and addicted to a purposeless mischief with a monkeylike cunning and persistence. The loss of memory is great:some have lost all remembrance of their former lives, theirfriends, and their own names; whilst others, who perhaps forgetinstantly the last thing said, can reproduce the distant past withconsiderable fidelity. The bodily health is usually good, and thebodily functions are well performed; some of these patientsindeed get fat, and remain so till an outbreak of excitement andagitation, to which they are periodically liable, reduces them.The physiognomy is blank and expressionless, especially whenthe patient is addressed; it is often also prematurely aged.Lastly, there is a group of demented patients in whom themind is almost extinguished: who have to be fed, moved,clothed, and cared for; who evince little or no sensibility; whoseonly utterance is a grunt, a whine, or a cry; and whose onlymovements are to rub their heads or hands. Of the three degreesof dementia they represent the worst-the lowest state to whichit is possible for a human being to sink. Their existence is,indeed, little more than vegetative; and if they are not carriedoff by pneumonia, tubercle, or some other disease, as they oftenare, they die from effusion on the brain, serous or hæmorrhagic,or from atrophy of the brain, or from the effects of accident, towhich, through their apathetic helplessness, they are muchexposed.Though secondary dementia may last for a long time, it isimpossible that recovery should take place. The condition,habits, and conduct of patients suffering from it may often bemuch improved by proper care and control, but their mentaldecay will generally go on increasing unto the end. Whendeath takes place, it is sometimes due to effusion on the brain,or to atrophy of it; or it is produced by accidental disease, astubercle or pneumonia.Now that we have sketched the progress of mind through thegradual processes of its growth and development to the full evclution of its highest faculties, and have traced the steps of itsdegeneration and decay to its lowest degradation in apathetic410 VARIETIES OF INSANITY [CHAP..dementia, we may once more call attention to the analogy betweenmental and spinal function. Bearing in mind that the functionsare mental in one case, and in the other motor, the results ofdegeneration will admit of an unstrained comparison. Whenthe spinal functions suffer, there is first a loss of power ofco-ordinating the movements of the limbs, -in other words, acertain motor incoherence; when the degeneration has gone stillfurther, there is spasmodic or convulsive muscular action, a condition heralded by twitchings and slight spasms at an earlierstage; last of all, when things have got to the worst, comesparalysis . So with regard to the morbid manifestations of diseased mind: there is first a loss of power of co-ordinating the ideasand feelings, a certain incoherence of mind; at a more advancedstage there are convulsive mental phenomena, or fixed morbidideas, comparable to motor spasms or convulsions; and, lastly,there is extinction of mental function in dementia, as there isextinction of motor power in paralysis. If I have so far failed ,however, to display how entirely untenable is the metaphysicalconception of mind when brought face to face with facts, and tomake evident how necessary it is to study the highest mentalphenomena inductively by aid of the light which a knowledgeof the simplest phenomena affords us, no amount of iterationnow will avail to counterbalance a failure, the cause of whichmust lie not so much in the difficulty of the subject, great asthat 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 todescribe separately. In the great majority of cases there aresingularly exalted notions, extravagant delusions of wealth andgrandeur, accompanying a gradually increasing general paralysisof the muscular system. But as cases undoubtedly occur inwhich there are no such exalted delusions, it is impossible to fixupon the character of the delusion as distinctive of the disease;in fact, all forms of hypochondria, melancholia, mania, and incoherence, may be met with in general paralytics. The essentialdifference recognisable at the commencement of general paralysisis a mental weakness; the intellectual powers, and especially thememory, being notably enfeebled, which is not the case at thecommencement of ordinary melancholia and maniacal states.111.]VARIETIES OF INSANITY. 411Accordingly it is necessary to define it as a form of insanitycharacterised by a progressive diminution of mental power, andby a paralysis which gradually increases and invades the wholemuscular system.It has an interest above that attaching to other forms of mentaldisease in the fact that it selects its victims commonly from thebetter classes of society, and selects, again, those who seem to bebuoyant with health, and at the full height of their energy; sofatal is it, too, that it may be truly said of those once attackedby it, that " in the midst of life they are in death ." The mostfrequent cause of it is thought to be intemperance, alcoholic orsexual; but it not unfrequently occurs where there has been noreason to suspect anything of the kind. Then, however, somesort of hereditary taint is likely enough to be present. Two ofthe best marked examples of the disease which I have seenoccurred in teetotallers, who never had been addicted to alcoholicexcess; in both of them, however, there was hereditary taint;both of them had undergone the struggles and anxieties springingfrom a large family and a moderate business; and in both therewas some reason to suspect enervating marital excess. Generalparalysis is emphatically the disease of manhood, for it is hardlyever met with before thirty or after sixty: the fact agrees wellwith the supposition that the sole cause of the disease maysometimes lie in the agitation and anxieties incident to the mostactive period of life. Women seldom suffer from general paralysis: they are not subjected to such severe mental activity asmen are; they do not suffer so easily from sexual excess; andthey are not so much addicted to alcoholic intemperance.It has been a point of dispute amongst some writers, whetherthe mental symptoms precede the paralysis, or whether the latterappears first-whether the insanity is primary, or whether theparalysis is the primary and main affection, the insanitysecondary and accessory. There can be no doubt in the minds.of those who simply observe cases without prejudice, that themental symptoms are witnessed in many cases before there isany trace of paralysis visible; and that in other cases themental disorder appears simultaneously with the motor disorder.Whether instances do not occasionally occur in which theparalytic phenomena appear first, I cannot undertake to say412 VARIETIES OF INSANITY. [CHAP.positively; Leidesdorf has related the history of one case inwhich the earliest symptoms were spinal, the disease actuallybeginning 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 27cases the paralysis was subsequent; and in 8 the precedencecould not be determined. Before asserting in a particular casethat there is no evidence of paralysis, it will be well to observethe patient when emotionally excited, or after a sleepless night;then there may be exhibited a tremulousness about his speechwhich is not at all visible when he is perfectly calm andcollected.The motor symptoms are first evident in the tongue, whichhas to execute so many delicate and complex movements withsuch exact precision, and especially in the articulation of wordsabounding in consonants, where the most complex co-ordination.is necessary; when the patient speaks earnestly, he does notarticulate clearly, and there is a certain pause or indecision inhis utterance, as if there was a difficulty in bringing out theword; in some cases the speech is slower, more deliberate, witha strong accentuation of and a lingering on the syllables, as ifthe patient were speaking with great consideration . When thetongue is put out, which it is with some difficulty, there may bea fibrillar quivering of its muscles, but it is not pulled to oneside. There is a tremulousness also in the muscles of expression when they are put in action, especially in those of thelips, which quiver as in one just about to burst into tears. Thetone of the voice is often altered; it becomes harsher and losesits various shades of expression, though the change may hardlybe recognisable by one who has not known the patient beforehis illness, or hardly perceptible to one who has, unless he isvery attentive. These symptoms are more evident when there isany mental excitement. An inequality in the size of the pupilsis often an early symptom, but it is not a characteristic one; itis sometimes present in other forms of insanity, and it is notalways present in general paralysis. In some cases the pupilsare contracted to a pin's point. A transitory squint is observedoccasionally at the commencement of the disease, and at a laterperiod a slight ptosis of the upper eyelid. As the disease ad-11 ] VARIETIES OF INSANITY. 413vances, the muscles of the limbs and trunk are affected; inwalking, the feet are not quietly raised and firmly planted on theground; the patient easily stumbles at a step, or on unevenground, and, if asked suddenly to turn round when goingstraight forward, he staggers like a drunken man. Neverthelesshe may be energetic in walking, setting about it earnestly, asif it were his business, and pleased with his performance ofit; he does not want muscular power, but the power of usinghis muscles; he is unaware of his deficiencies, and commonlythinks himself wonderfully well and strong. Precise co- ordination of movement, such as is necessary for writing, sewing, andlike acquired automatic acts, is lost. At the outset of thedisease it is sometimes very difficult for one unacquainted withthe patient before his illness to perceive anything peculiar in hiswalk. When no symptoms of paralysis are detected, there maybe something stiff, proud, abrupt about it; the steps shorter andquicker, and the foot being set down more sharply. Like themental symptoms, the motor symptoms may disappear almostentirely for a time. Dr. Westphal describes two groups of casesaccording to the different motor disturbances manifested bythem those belonging to the first group have the peculiar walkof tabes dorsalis; it is uncertain, swaying, the feet being raisedabruptly, thrown forward and brought down forcibly on theground. In such cases he believes that the motor disorder precedes the mental symptoms. In the second group, instead ofthe forcible and jerking raising and throwing forward of the feet,these are raised very little from the ground, so that the walk israther shuffling, and the patients go as if they were on slipperyground; their movements are slow and helpless, and they do notfall when their eyes are shut. In these cases, he believes thatthe motor disorder follows the mental symptoms. As thedisease advances, the articulation becomes less distinct; thewalk more and more tottering; the knees fail; the patient frequently tumbles, and finally is unable to get up at all. Thecontractility of muscles for the electric stimulus is retained. Atlast the primary automatic or reflex movements fail; the pupilsbecome dilated, but unequal in size; the sphincters lose theirpower, 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 anarm or leg occur sometimes, and a grinding of the teeth is notuncommon in the last stages of the disease.Cutaneous sensibility appears to be diminished in the earlystages, and towards the end it is sometimes almost lost. Thereare, however, occasional transitory conditions of extreme hyperæsthesia of parts, so that the patient shrieks out in agony. Themuscular sense is especially affected, so that the sufferer, havinglost all power of executing the more delicate and complex movements, is quite unaware of his impotence, and deems himself notless skilful than when at his best state. The special senses arenot usually affected until near the end, when smell and taste arediminished or lost, and vision fails. One patient under my care,who at times used to fancy himself blind, had vivid hallucinations in the night; on one occasion he had a glorious visionof angels descending from heaven on ladders of gold, and, onanother, an agonizing vision of his own wife in the act ofadultery. A great increase of sexual desire and an exciteddisplay of it are not unfrequent at the beginning of the disease,but there is not corresponding sexual power; and this is soonquite lost.The mental disorder is generally marked by an exaggeratedfeeling of personal power and importance, out of which arisecorresponding delusive ideas. After a transient depression,perhaps, there takes place a marked change of character andhabits: the patient exhibits unwonted perversities of feeling andconduct, such as surprise and grieve his friends; he breaks outinto sexual excesses quite foreign to his usual sober character,or orders numerous valuable articles of all descriptions which hedoes not need and cannot pay for, or steals what strikes hisfancy. Another displays considerable mental excitement; he isbusy with wide-reaching projects and speculations, indifferentto the stern realities, and in all ways eager and ready to accomplish the impossible: like one in a dream, he is not limited byexternal conditions of time and space, from which in truth he iscut off almost as effectually as if he were dreaming with his eyesopen; accordingly he finds no hindrance to a miraculous activity.A third exhibits a lack of his former energy he is painfully111. ] VARIETIES OF INSANITY. 415troubled 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 asto personal power and grandeur: " The miserable sufferer whocan scarcely support his tottering body avers that he has themight and vigour of Hercules; while industriously hoarding uppieces of rag, paper, or glass as articles of value, he will sign acheque for countless millions, or make an easy present of NewYork; maintaining that he can command a king to do hispleasure, in the same breath he begs piteously to be allowed togo to his own humble home; or, with sexual power extinct,boasts exultantly that a princess shall be his wife and princesbe born of his loins. An extreme loss of memory is in strikingcontrast with the semblance of exaltation: the patient forgetsentirely how long he has been in confinement, or denies angrilythat he has a wife, though recognising her gladly when shevisits him." Delusions of a terrific character, with accompanying great emotional depression, are found to prevail steadilythroughout the course of some cases of general paralysis; and aday of great melancholic depression now and then intervenes inthe course of the exalted form. By some writers a class ofpatients has been described who present in physiognomy andhabit of body a mixture of stupidity and of the deepest depression, and exhibit delusions of as definite a character as thedelusions of grandeur: they think themselves bodily transformedin whole or in part; that their body has enlarged immensely;that their eyes cannot see, their ears cannot hear; that theirthroat is sealed up so that food does not enter their body.There is in their symptoms marked evidence of great mentalweakness or dementia. Dr. Clouston has observed that casesof general paralysis commencing with melancholia, and evenexhibiting suicidal tendency and refusal of food, will be chieflyfound among the phthisical. He believes that there is an intimate relationship between the general paralysis with depressionand tuberculosis. A regular decline of intelligence, withoutany marked delusions -in fact, a gradually increasing stupidityfrom the first -is the course of one variety of general paralysisby no means of frequent occurrence. Outbreaks of great exciteArticle " Insanity, " Reynolds's System of Medicine, vol. ii.416 VARIETIES OF INSANITY [CHAP. .ment and violence during the progress of the disease frequentlyoccur: during them the temperature of the head was observedby L. Meyer to be raised, and afterwards the mental decay isfound to be increased. Dr. Westphal, however, has denied anyconnexion between these attacks of excitement and the increaseoftemperature, pointing out that in most of Meyer's cases someother disease co-existed which would itself raise the temperature. " As the disease approaches its end, the end of life, thedementia is extreme, and the face becomes an expressionlessmask, across which now and then flickers the broken ripple of asmile, or it is fixed in a ghastly sardonic grin; but even in thelast stage of mental disorganization, when the capability of adistinct delusion is gone, the muttered words may be about gold,and carriages, and millions of money."General paralysis is a disease of special pathological interestbecause of the co-existence of mental and motor disorder, notas an accidental circ*mstance, but as a constant occurrence.The patient loses the power of performing both ideas and movements, and gradually gets worse and worse until he dies. Thereis a certain analogy between drunkenness and general paralysiswhich Bayle was the first to point out; the embarrassed speech,the vacillating walk, the exalted ideas, and the mixture ofstupidity being common to both conditions. Many times in thecourse of this work I have laid stress on the manner in whichmovements enter into our intellectual life, and on the closeanalogy between ideas and motor intuitions; and now I cannotrefrain from calling particular attention to the phenomena ofgeneral paralysis as confirmatory of the views enunciated. Thatthe nervous centres of ideas are disordered is plain enough, butit is equally plain that something more than these centres isaffected; for we get all kinds of morbid ideas in other forms ofinsanity, without any interference with motor power. Nor arethe muscles themselves at all affected: the patient has not lostmuscular power, but intelligent power over the muscles. Infact, what is further diseased is the region of the motor intuitionsor actuation- the nervous centres in which the motor residuaare organized. In progressive locomotor ataxy the motor centresare diseased, but then it is only the spinal centres, and the mindis quite clear: in general paralysis, however, those motor residuaIII.] VARIETIES OF INSANITY. 417are affected which are in the closest relations with the intellectual life, indeed essential to complete intellectual action-themotor residua of speech, those which words in their intellectualmeanings as symbols or signs of the ideas imply. One of theearliest symptoms of general paralysis is the difficulty noticed ingiving fit outward expression to the ideas, by reason of someaffection of the motor intuitions which are the internal equivalents of the words externally audible. But the mischief doesnot end there not only does the morbid state of the motorcentre lead to a difficulty of expression bythe appropriate movements, but the diseased motor intuition enters into the intellectual life, and, in conjunction with morbid ideas there, givesrise to all sorts of extravagant and outrageous delusions as topersonal power. Now it is well known that, when a delusion isfixed in the mind, the evidence of the senses does not avail tocorrect it- it is a morbid product, not in relation with thesurroundings, but creating its own surroundings in generalparalysis the possibility of correction by the influence of externalcirc*mstances is made more hopeless, is in fact practically cutoff, by the failure of the muscular sense; thereby, indeed, theavenue by which are acquired the notions of the size, form, andposition of objects in space is closed, and the patient is left aneasy prey to the internal disorder. *The course of general paralysis is towards death, though notsteadily so. Under proper treatment a great improvement takesplace in the early stages, and the disease appears sometimes tobe arrested. A few cases of actual recovery have been put onrecord; and, whether the recovery in such cases has been permanent or not, there can be no question that there have been inexceptional cases intermissions of such length that the diseasehas lasted for ten years or more. On the whole, however, itIt may be considered tolerably certain that we could not think without somemeans of physical expression, though thought is possible without speech.Laura Bridgman's fingers moved both during her waking thoughts and herdreams. Children who have learnt to speak, and afterwards become deaf, lose bylittle and little all they have learnt, unless great pains is taken with them.Note, again, how frequently deficiency of speech and movement accompanies theincapacity of thought in idiots. It is not difficult, therefore, to believe thatthe gradual failure of the power of movement in general paralysis may aggravatethe mental disorder and decay.E E418 VARIETIES OF INSANITY [CHAP..must be pronounced irregularly progressive, its duration beingusually from about a few months to three years. In the moreadvanced stages sudden attacks of loss of consciousness withepileptiform convulsions are frequent, after which the paralysisand mental decay are both found to have increased. These epileptiform or apoplectiform attacks consist of slight or deeperlosses of consciousness, with or without convulsions, disappearinggenerally in a short time; sometimes paralysis of one side mayoccur, with convulsions of the same side, or contraction of onearm or leg. It has been observed by Dr. Saunders that thetemperature of the body in general paralysis is generally one ortwo degrees below the average, but that it rises during the accessesof maniacal excitement, falling again as calmness returns.During the so-called congestive attacks, when there is completecoma or epileptiform convulsion, there is generally a considerablerise of temperature: in one case the temperature was for sometime 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 fromthe commencement of the attack. * In the last miserable stageof all, when life flickers before expiration, large sloughing bedsores form, notwithstanding the best care, and diarrhoea or pneumonia hastens the long- expected ending." †In the following chapter it will be seen how well themorbid appearances found in the bodies of those who havedied from general paralysis agree with the symptoms exhibitedduring 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.· 111.] VARIETIES OF INSANITY. 419NOTE ON CLASSIFICATION.The classification of mental diseases now generally adopted in Germany is a modification of that proposed by Esquirol, and is as follows:-I. Die Diepressionzustände.1. Die Hypochondrie.2. Die Melancholie.II. Die Exaltationzustände.1. Die Tobsucht.2. Der Wahnsinn.III. Die psychischen Schwächezu- stände.1. Die Verrücktheit.2. Der Blödsinn.3. Idiotismus und Cretinismus.IV. Der paralytische Blödsinn.Die allgemeine Paralysie der Irren.I. Conditions of Depression.1. Hypochondria.2. Melancholia.II. Conditions of Exaltation.1. Acute Mania.2. Monomania.III. Conditions of Mental Weakness.1. Craziness or Incoherence.2. Dementia or Fatuity.3. Idiocy and Cretinism .IV. Paralytic Dementia.General Paralysis of the Insane.of this classification; but it isThe fact that more than fiftyIt is easy to point out the defectsnot so easy to propound a better one.different systems of classification have been devised, is sufficient proofof the dissatisfaction felt, and of the difficulties encountered inmaking a real improvement. Hitherto no other classification has foundfavour with any one but its ingenious author. The principal andmost evident objection against the received system is, that it is vagueand artificial, because it embraces in the same class forms of diseasesufficiently distinct to warrant separate description, and because thereare many forms of mental disease which, presenting the characters oftwo or more of the different classes, might be placed in one or theother, or cannot be placed satisfactorily in either. It cannot be deniedthat this is a well- grounded objection; that it is so, however, is owingto the imperfect state of our knowledge. The same cause vitiates allother classifications that have been proposed. What is wanted now isan exact observation of the causes, the symptoms, bodily and mental,and the course of all the different forms of mental disease, and anaccumulation of such observations; so that we may arrive at a naturalhistory of the disease, and be able ultimately to arrange the manifoldvarieties in natural groups or families, each according to its kind.Instead, then, of four or five classes having characters so vague andgeneral that a knowledge of them conveys very little definite information, we may perhaps hope to have numerous groups or families, eachhaving certain characteristic features, a knowledge of which will instructEE 2420 VARIETIES OF INSANITY. [CHAP.us as to the causation, course, probable termination, and suitable treatment of a particular case belonging to the family. For what is thequestion which occurs to the practical physician when he sees a case ofinsanity, and is asked to give his opinion concerning it? What hasbeen the cause, and what the natural history, of the disease, up to itspresent stage? Is it hereditary? Is it associated with epilepsy; orcaused by masturbation? Or is it a case of general paralysis? Instinctively putting to himself questions of this kind, and drawingupon the stores of his experience for information respecting the naturalcourse and termination of insanity so caused or so associated, he isable to give something like a definite answer to the anxious inquiriesmade of him concerning the origin, course, duration, and terminationof the disease.Dr. Skae has proposed and sketched out an arrangement in groupsof 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 usea phrase more familiar to the physician's ear, that we should groupthem in accordance with the natural history of each. " Why, he asks,should we attempt to group and classify the varieties of insanity bythe mental symptoms, and not, as we do in other diseases, by thebodily diseases, of which those mental perversions are but the signs?The answer, we fear, is only too obvious: because in a great manycases of insanity there is yet no recognisable bodily disease to becomethe basis of a classification. This being so, a symptomatological classification is the only classification practicable, though we may dislike itever so much; it becomes a natural classification, which, if it be madewith care, will most likely not be abolished entirely, but rather developed, by future discoveries. The groups which Dr. Skae, fullyrecognising the difficulties of the subject, proposes, are twenty-five;and I shall now briefly indicate them.The first natural group is idiocy, including imbecility under all itsvarious forms and degrees. To this class must be referred a largenumber of cases of moral idiocy and imbecility, many of which aremixed up in the present system of classification as monomaniacs ofvarious sorts, e.g. , cases of instinctive cruelty, destructiveness, andtheft. "Many of our most noted kleptomaniacs have had thattendency from childhood, and have been moral imbeciles." He wouldrefer all those cases of insanity, which are but the development andaggravation of a congenital moral perversion, or want of balance, tothe class of congenital moral imbeciles.111.] VARIETIES OF INSANITY. 421The second natural group is that of epileptics. As a disease ofchildhood, epilepsy arrests the development of the brain, and is associated with idiocy and imbecility. Afterwards, it is associated withmaniacal paroxysms, monomania, dementia, or total fatuity.- The third natural family is that of the masturbators. It is characterised by a series of symptoms easily recognised the peculiarimbecility and sly manner of the youthful victim; the suspicion, andfear, and suicidal impulses, and palpitations, and scared look, andfeeble body of the old offenders, passing gradually into dementia orfatuity.The fourth group is formed of the insanity occurring at the periodof pubescence, and apparently dependent upon the changes affecting thecirculation 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 wellmarked natural order.Closely allied to the last group is that of sympathetic mania, connected with amenorrhea, or dysmenorrhoea, commonly assuming arecurrent or a periodic form, frequently with maniacal attacks, and notunfrequently passing into chronic mania or dementia.Sexual mania includes a form of insanity occasionally met with bothin the male and female sex, but more frequently in the latter, developedimmediately after marriage, and connected with the effect produced onthe nervous system by sexual intercourse. It usually presents itselfin the form of acute dementia.The insanity of pregnancy, puerperal mania, and the insanity oflactation form three distinct groups.Climacteric insanity, occurring at the change of life, manifests itselfas a monomania of fear, despondency, remorse, hopelessness, passingoccasionally into dementia.Another group consists of cases of insanity associated with ovarianor uterine disease, and of which one of the most common symptoms issexual hallucination. It is, par excellence, the insanity of old maids.The next natural order is senile insanity, beginning occasionally asmania or melancholia, but more frequently during its whole coursepresenting the features of dementia.Phthisical mania is a form of insanity which Dr. Skae believes topresent characteristic features and a natural history which can be wellmade out. It has been described by Dr. Clouston in the Journal ofMental Science for 1863.The insanity following blows on the head, traumatic mania, and422 VARIETIES OF INSANITY. [CHAP.that following sunstroke, present their distinctive characteristics, andmay be described and defined by their natural history.Syphilitic mania is a distinct form of insanity associated withsyphilis.Delirium tremens, and its allied disease dipsomania, are referred tospecial natural orders.General paralysis of the insane has been more completely studiedthan any other form of insanity, so that there is no need to do morethan mention it here.Metastatic mania includes all those cases following the sudden suppression of an accustomed discharge, or eruption, or erysipelas, &c.The cases which remain and cannot be referred to any of thesegroups Dr. Skae would class under the general term of idiopathicinsanity, divisible into two varieties, sthenic and asthenic: sthenic, combined with distinct symptoms of vascular action, occurring in personsof robust health, and brought on most commonly by causes excitingthe emotions and passions; asthenic, when combined with symptomsof anæmia, emaciation, feeble pulse, &c. , and brought on by suchcauses 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 mentalderangement is the most salient feature-" a disease presenting a certainvariety and kind of mental symptoms, varying in different cases, andat different times in the same case, but still varying within certainlimits only, so as to give to each variety its own special psychologicalcharacter, sufficiently marked and peculiar to make out a distinctphysiognomy for each group. "This method of classification would certainly be of great practicalvalue, could it be thoroughly worked out, as it has already been donein part by some of Dr. Skae's pupils. But it is obviously a classification of which it is much more easy to sketch the outlines than to fillup the details, and which looks better in outline and promise thanprobably it would ever do in actual accomplishment. In fact, it maywell be doubted whether the endeavour to work it out in detail wouldnot disclose its artificial character, and be the worst service any onecould do to it as a method of classification, valuable as such anattempt would be as a contribution to our knowledge of insanity. Theobjections against it which suggest themselves are: first, that thepicture of the characteristic features of each group or family appearsto be overdrawn; that in practice we do not find them so well defined asthey are represented to be; that the physiognomy of the mental de-III. ]VARIETIES OF INSANITY. 423rangement of each of the groups does not really present characteristicfeatures or a special psychological character; that one of these specialcauses, which is made the basis of a natural order, may really producequite different kinds of mental derangement, according to the particular temperament or idiosyncrasy of the individual, or according tosome other circ*mstances of which we know little or nothing. Andthis brings us to the second objection: that under the term idiopathicDr. Skae lets in all the vagueness and all the defects of the oldclassification; for beneath the mysterious word there is no knowledgehidden; there is no definite cause, nor definite course, nor definiteduration, nor definite termination for the manifold varieties of insanityincluded under it; nor are there any characteristic features distinguishing the varieties of idiopathic insanity from some of the formsof insanity included under the other so- called natural groups or families.The practical outcome of the objections would be then: first, theinconstancy of the psychological characters of the different groups, andthe consequent impossibility of distinguishing those of one group fromthose of another; and, secondly, the necessity of treating of idiopathicinsanity 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, certainbodily disease other than brain- disorder; whereas many cases ofinsanity are examples of brain-disorder only, other bodily derangements, if present, being accidental coincidences or consequences.Suppose an emotional shock to produce an attack of idiopathic insanity in a young woman, and after a time a suppression of the mensesto take place will the insanity so caused present such peculiar features as will enable us to distinguish it from sympathetic mania connected with amenorrhoea, or, indeed, from two or three others of theso-called natural groups? There can be no doubt of the distinctivecharacters of some of these groups, and that they ought to receiveseparate description in any treatise on insanity. But that is not thepoint in discussion here: the question now is whether there aregroups numerous enough and sufficiently characteristic to form thebasis of a new system of classification, or whether their proper placeis as varieties of the classes or orders in the old system. Surely aclassification which is applicable only to certain varieties of mentaldisease, and which must, in dealing with a great proportion of cases,have recourse to the system which it discards, stands condemnedfor the present as a system of classification. Whatever may be thecase in the future, it cannot but be admitted that, in the present state424 VARIETIES OF INSANITY. [ CHAP.of knowledge, a treatise on insanity must deal generally with thesymptomatology of the principal forms, and afterwards proceed toenumerate and delineate the special groups -must describe the classfirst, and then descend to the orders and varieties. The class ofmania includes certain well-defined orders, but there are none ofthese orders which have not characters in common with the class, suchas enable us to recognise them as belonging to it, and to distinguishthem, by the general characters of the class, from other forms ofinsanity included under another class. For these reasons, amongstothers, I have thought it best in the foregoing chapter to treatgenerally of the symptomatology of the principal forms of insanity,leaving the practical points connected with the different varieties tobe dealt with in the chapters on Causation, Diagnosis, Prognosis,and Treatment. I have done so, however, not without considerabledoubt and reluctance, because I think it probable that futureresearches, by accumulating observations, will supply a more exactand complete medical history of the different varieties of insanitythan we have now, and therein furnish the materials for a positiveand truly scientific classification in the direction indicated byDr. Skae.M. Morel, of Rouen, has propounded a classification of mentaldiseases according to their apparent causes-an etiological classification. Though it is unquestionably imperfect, leaving a large numberof cases unprovided for in its classes, and ascribing to insanity produced by a particular cause special features which are not easilyrecognised in practice-in fact, like Dr. Skae's classification, makingartificial groups to suit the demands of the system-yet I think itwell to give a brief summary of it here, because of the positivescientific spirit which has evidently instigated it.FIRST GROUP. -Hereditary insanity.1st Class. It includes patients who have a congenital nervous temperament in consequence of hereditary causes, and who easily becomeinsane under influences which, but for the hereditary taint, would notgive rise to insanity.2nd Class. It includes those who, in consequence of hereditarytaint, display their insanity in acts rather than in words-in eccentricities, incoherence, irregularity, and often extreme immorality of conduct.3rd Class. It includes those who exhibit innate insane propensitiesto various forms of crime-to theft, incendiarism, a vagabond life, &c.Their physical degeneration is marked by malformation of the head orIII.] VARIETIES OF INSANITY. 425ears, smallness of stature, sterility, &c. They come between the thirdclass and that which follows.4th Class.—It includes imbeciles and idiots.SECOND GROUP. -Insanity produced by toxic influences.1st Class. It includes those cases in which insanity has been occasioned by the regular use of alcohol, opium, and other narcotics; alsothose cases in which lead, mercury, and phosphorus have producedspecial forms of delirium.2nd Class.-Under this class come the cases produced by the influence of an insufficient or a bad form of nourishment-ergotism, causedby bad rye, and pellagra.3rd Class. It includes cases produced by marshy influences, or bycertain geological conditions-cases of cretinism.THIRD GROUP. - Insanity produced by the transformation of othernervous 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, divisibleinto at least two varieties: first, simple hypochondria, where thepatient is continually occupied with his health, and is scarcely actuallyinsane; secondly, a variety in which the patients think themselvessubject to persecutions, and perhaps commit crimes in order to attractpublic attention.FOURTH GROUP. -Idiopathic insanity.1st Class. It includes cases of the progressive enfeeblement, or theabolition of the intellectual faculties, following chronic diseases of thebrain or of its membranes.2nd Class. It includes general paralysis.FIFTH GROUP. - Sympathetic insanity. It includes all cases inwhich a morbid condition of some other part of the body than thebrain is the cause of the insanity-the cases in which insanity followsfever, or pneumonia, or uterine disease.SIXTH GROUP. -Dementia. Though here departing entirely fromthe principle of his method, Morel thinks that this will not suffer bymaking a separate group of those who have fallen into dementia."Whatever may have been the primitive form of their affection, theyconstitute a large family, all whose members present common characters. "Assuredly this last group opens a very wide trap-door in the floor ofMorel's system of classification, and forces us back upon the old system426 VARIETIES OF INSANITY. [CHAP.in no little disorder. It is not necessary here, however, to enumeratethe obvious objections against an etiological classification generally,and against the one above mentioned in particular. Much of whathas been urged against the method of arrangement proposed by Dr.Skae might be repeated here; and if we compare the two methods, andobserve how facts, which are made leading characteristics in thedivisions of the one, are left without consideration in the other, wecannot help coming to the conclusion that they are both fundamentallydefective, though we may at the same time acknowledge in both theevidence of an excellent scientific spirit. Morel's method is, on thewhole, of a more ambitious character, but of less practical worth, thanthat of Dr. Skae. In the chapter on the causation of insanity will befound various facts and reflections bearing directly on the principles ofboth methods, and weighing against the practicability of their presentadoption.NOTE ON THE TEMPERATURE IN INSANITY.While this sheet was passing through the press, Dr. Clouston haspublished in the Journal of Mental Science for April 1868, someimportant inquiries concerning the temperature of the insane.conclusions are:-" 1. The temperature of the body is higher in the insane than inthe sane.2. The temperature is highest in phthisical mania, gradually fallingin 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 temperature is below health.4. The great characteristic of all the forms of insanity is that thedifference between the morning and evening temperature is much lessthan in health, and this is owing to the rising of the evening temperature, and not to the lowering of the morning temperature ascompared with the healthy standard.5. This rising of the evening temperature, as compared with themorning, is in the exact ratio of the death-rate among the variousforms of insanity, finding its acme in general paralysis.III.] VARIETIES OF INSANITY. 4276. In general paralysis, the average evening temperature is higherin every case than the morning temperature (the observations beingtaken over a sufficient period).7. In phthisical patients the temperature is high, and is especiallyhigh in the acute forms of the disease, but the latent forms cannotbe certainly diagnosed by thermometric observation.8. The evening temperature of every form of insanity (even completedementia) is higher than the evening temperature of health.9. The greatest differences in different individuals labouring underthe same form of insanity are found in general paralysis, epilepsy, andacute mania. In the first named a difference of 8.7° has been found.10. Excitement in a patient is almost always attended by an increased temperature as compared with depression or quiescence. Thisdifference averages 2.2° in periodic mania with long periods, and 1.1°in periodic mania coming at shorter intervals. In general paralysisthere may be a difference of 5.8° in the same individual in differentstages of the disease.11. An epileptic fit depresses the temperature at first, and thentends to raise it a little, but it makes a difference whether the patientsleeps or wakes after the fit.12. The epileptiform fits of general paralysis are always followedby a greatly increased temperature, lasting for several days, and theymay in this way be distinguished from ordinary epileptic fits.13. The average temperature falls as the patients get older, but thefall takes place chiefly in the morning temperature.14. The average frequency of the pulse in the various forms ofinsanity corresponds with the mean temperature, but the rise in theevening temperature has no corresponding rise in the evening pulse. "BEFORECHAPTER IV.THE PATHOLOGY OF INSANITY.EFORE proceeding with the description of those morbidappearances which have been met with in insanity, it willbe well to have regard to certain preliminary considerations of ageneral character. Already the absence of any physical appearances where psychical disorder has existed, has been dwelt uponat some length. A patient dies in a raving madness, and there isno reason disclosed by pathological observation why he shouldhave died. Is it a right inference, then, that nerve element doesnot subserve mental function, or is not affected when functionis affected? Certainly not: at present we know nothing whatever of the intimate constitution of nerve element and of themode of its functional action, and it is beyond doubt that important molecular or chemical changes may take place in thoseinner recesses to which we have not yet gained access. Wherethe subtlety of nature so far exceeds the subtlety of humaninvestigation, to conclude from the non- appearance of change tothe non-existence thereof would be just as if the blind manwere to maintain that there were no colours, or the deaf manto assert that there was no sound. Matter and force are necessary co-existents, and mutually suppose one another in humanthought; and to speak of change in one is of necessity to implychange in the other. We cannot write the order of the variablewinds or of the shifting clouds, but we are none the less certainthat both clouds and winds have an order which they cannotdisobey, and which we shall some time discover; and so likewise we have the fullest confidence that in due time a means willbe discovered of penetrating the yet inscrutable recesses of nervelife, and of making known the physical conditions of its func-CHAP. IV. ] THE PATHOLOGY OF INSANITY. 429tional manifestations. The mechanism of nervous function isnow a region of uncertainties and obscurities; it is the destinedfield, therefore, of future discoveries.There are numerous facts available to prove that the mostserious modifications in the constitution of nerve element maytake place without any knowledge of them otherwise than bythe correlative change of energy. After severe and prolongedmental exertion there inevitably comes exhaustion, which maybe so great that the brain is utterly incapacitated for furtherfunction; a large increase of phosphates in the urine testifies tothe disintegration of nerve; the individual is, so far as power ofactive life is concerned, almost a nonentity; and yet neithermicroscopist, nor morbid anatomist, would succeed in discovering any difference between the nerve substance of that man'sbrain and the nerve substance of the brain of one who, after duerest and nutrition, was prepared for a day of vigorous activity.The sudden shock of a powerful emotion may produce instantaneous death, just as a stroke of lightning may, and perhaps inthe same way; but neither in one case nor in the other maythere be any detectable morbid change. If the electric fish bepersistently irritated so as to be made to give forth shock aftershock, the excessive expenditure of energy leaves it utterlyexhausted, and it can will no more shocks until rest and nutrition have restored its power; the nervous centres have plainlyundergone some modification, though we know not the natureof it. Instead of arterial blood send through the brain bloodheavily charged with carbonic acid, and the victim of the experiment must inevitably die; but who can tell the secretchange that has been produced in the composition of the nerveelement? Without killing a man outright, it is possible, bycausing him to breathe a mixture of one part of air and threeparts of carbonic acid, to render him as insensible to pain as ifhe had inhaled chloroform; but it is the gross result only thatis recognisable by our senses. In this regard, however, the experiments of Lister on the early stages of inflammation are ofsome interest; for he showed that carbonic acid produced adirect sedative effect upon the elements of the tissue, paralysingfor the time their vital energies; the effect being transient, andthe tissue recovering its energy after a considerable time. The430 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. Thedifference may obviously be the difference between life anddeath, and yet there may be no appreciable physical or chemicalchange. As regards the morbid appearances met with in casesof insanity, there can be no question that the instances in whichthey are not found are becoming less frequent as investigationbecomes more searching; and those who are best capable ofjudging, and best qualified by acquirements to give an opinion,are those who are most certain of the invariable existence oforganic change. It is known that when a morbid poison actson the body with its greatest intensity there are fewer traces oforganic alteration of structure found than when the poison hasbeen of a milder character and has acted more slowly; and solikewise organic change of nerve element in insanity, appreciableby the imperfect means of investigation which we now possess,may justly be expected only when the degeneration has beenlong continued.1. Physiological Researches into Nervous Function. The important researches into the physiology of nerve which have beenmade during the last few years, will help to render conceivablethe existence of organic change which, though undetectable, cannot be doubted. It is, indeed, of the first moment that a distinctidea of nervous activity as dependent on physical and chemicalprocesses should be formed. Because nerve is looked upon asministering to mind, the exalted and indefinite conception ofmind has reflected on nerve functions a sort of spirituality and unreality, and has, consciously or unconsciously, caused them to beset apart from the category of like organic processes. The metaphysically minded have not been content to declare the mind toexist independently of all the physical processes which determinethe mode of its manifestations, but they have actually imposed.metaphysical conceptions on nervous function as the instrumentof so exalted a mission. However, the regions of the wonderfulare becoming less and less as science advances its lines; andthere has now been found in the electric stream a means ofpartially penetrating the hitherto unapproachable secret of nervous function. With the perfecting of this means, which mayjustly be expected in the course of time, it cannot be doubtedIv. ]THE PATHOLOGY OF INSANITY. 431that the knowledge of nervous activity will follow as surely asthe knowledge of the heavens followed the invention of thetelescope.In the endeavours made to elucidate the mechanism of nervousaction, it has already been clearly proved that time is as essential an element as it is in the motions of the heavenly bodies.A definite period of time is necessary for the propagation of astimulus from the peripheric ending of a nerve to its centralending in the brain; and when the stimulus has arrived at thebrain, a certain lapse of time, about one-tenth of a second, takesplace before the will is able to transmit the message to thenerves of the muscle so as to produce motion. This time-rateof conduction varies in different persons, and at different periodsin the same person, according to the degree of attention; if theattention be slight, the period is longer and less regular, but ifthe attention be active, then the period is very regular. But,whether the attention be great or little, a certain time mustelapse from the moment of irritation of a sensory nerve to theresultant contraction of muscle; and a message from the greattoe to the brain will take an appreciably longer time than amessage 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 tentimes less in a cold than in a normal nerve; and in a coldblooded animal, like the frog, the rate is only about 80 feetin a second, while in man it is about 180 feet in the second.It was Haller who first proposed to measure this speed ofnervous action, and he made a calculation of it in man, whichwas not very far from the truth; but after him no one seems tohave attempted the task, and Müller even pronounced it impossible, because the time seemed infinitely little and unmeasurable. In experiments on frogs poisoned with opium or nuxvomica, he could not perceive the slightest interval of timebetween the stimulus applied and the resulting muscular contraction. Helmholtz has since shown in the most brilliantmanner that Müller was mistaken, and has, by means of a veryingenious and delicate mechanism, measured the time whichelapsed between the stimulus applied and the reflex contraction:he found, too, that the stimulus required a much longer time432 THE PATHOLOGY OF INSANITY. [CHAP.proportionately to pass through the cells of the spinal cord thanto pass along the motor and sensory nerves concerned. The rateof conduction by nerve is then not only measurable, but it iscomparatively moderate-less even than the rate at which soundtravels. Instead of nervous action being due to the instantaneous passage of some imponderable or psychical principle,conduction by a nerve depends upon some modification of itsmolecular constitution, for the accomplishment of which a certain time is essentially requisite.Although no such researches into the cerebral centres as thosemade into the conditions of conduction by nerve have beenmade, we may not unfairly apply the analogy to psychicalactivity. At any rate, there can be no question that there is aconsiderable variation in the time in which the same mentalfunctions are performed by different individuals, or by the sameindividual at different times. Such variations may depend uponoriginal constitution, or they may be due to transitory conditionsof the psychical centres. " There is," says Locke, " a kind ofrestiveness in almost every one's mind. Sometimes, withoutperceiving the cause, it will boggle and stand still, and onecannot get it a step forward; and at another time it will pressforward, and there is no holding it in." The oppression ofmental suffering is notably attended with great sluggishness ofthought, the train of ideas seeming to stand still, and even perception being imperfect. In some forms of mental disease thisdefective association is well marked, whilst in others a certainsort of association is wonderfully quickened, so that ideas followone another without restraint, or like- sounding words are strungtogether in the most incoherent rhymes. In many cases ofaffection of the brain, as in recovery from apoplectic seizure, aconsiderable time must elapse between a question asked of thepatient and his reply: there is, as it were, a sluggishness of themind, which perceives and reacts more slowly than is natural. *Every one must have noticed the slowness, as well as difficulty, with whichthe tongue is put out, the eyelids raised , or words uttered by patients in a semicomatose state. It seems as if a certain time were needed, either for concentrationor transmission of nervous power, before the intended action can be begun;while so much labour is necessary in pursuing it, that I have repeatedly observedperspiration breaking out from the continued effort to raise a palsied arm, and anexhaustion to follow, such as might ensue in health upon violent muscular exerciseIv.] THE PATHOLOGY OF INSANITY. 433Such facts, proving beyond all question that the rapidity andsuccess of mental processes are dependent upon the physicalcondition of the supreme nervous centres, prove also that timeis an essential element in every mental function. The time- rateof the function is probably the measure of the molecular activitywhich is the condition of it.But there are yet more important physiological discoveries,which may help us towards some conception of the physicalconditions of mental activity. The researches of Matteucci andDu Bois Reymond into the electrical relations of nerve haveshown that there are curren's of electricity engendered in nerve,as in other animal structures, which are constantly circulatingin it. When the nerve is active there is a diminution of itsproper current, and the needle of a galvanometer connected withit then exhibits a negative variation . It has been supposed byMatteucci that there is a rapid succession of electric dischargesfrom nerve and muscle during activity; but, although thatassumption is very doubtful, and altogether ignored by Du BoisReymond, there can be no doubt that the negative variation ofthe needle of the galvanometer marks a decrease in the electromotive force of the nerve, and that this decrease is in some way"intimately related to that molecular change in the interior ofthe nerve, which, when it reaches the muscle, will produce contraction, or when it reaches the brain, will be received as sensation." It is to be borne in mind that every minute particle ofnerve acts according to. the same law as the whole nerve; thecurrent, therefore, which a piece of nerve produces in a circuitof which it forms part, must be considered only as a derivedportion of incomparably more intense currents circulating in theinterior of the nerve around its ultimate particles. There is thuscertain evidence, not only of the electro-motor properties ofnerve, but of a modification of these during functional activity:such modification again testifying to an intimate change at anyrate in the polar molecules of the nerve.But there are yet further considerations. If a constant galof the whole body. How striking the contrast here to that instant and free effortby which action is evolved almost simultaneously to all sense with the externalimpression producing it, thongh various mental and bodily operations actuallyintervene. "-SIR H. HOLLAND, Chapters on Mental Physiology.F F434 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 polesbut an extra- polar portion or tract also is put into what is calledan electrotonic state. Pflüger has, in fact, shown that the nerveimmediately falls into two zones, in one of which, namely, at thenegative pole, the excitability of the nerve is increased; in theother, namely, at the positive pole, the excitability is diminished.The former state he has called Katelectrotonus-the latter, Anelectrotonus. A given tract of nerve is excited, therefore, throughthe production of katelectrotonus and the disappearance ofanelectrotonus, but not through the disappearance of katelectrotonus and the appearance of anelectrotonus. Now, the conduction of a stimulus along the nerve is found to be delayed bythe electrotonic condition of it in the polarized tract; and thisdelay passes to complete stoppage of conduction when the electrotonic condition reaches a certain degree, or oversteps it. Thediminution of conducting power takes place both in the neighbourhood of the negative pole and in the neighbourhood of thepositive pole; so that the nerve-tract near the positive pole ofan electrotonic nerve is distinguished by a decrease of directexcitability, and by retardation of the speed of conduction; thenerve-tract near the negative pole, on the other hand, undergoesan increase of direct excitability, and a retardation of conductingpower. These changes all agree in increasing with the increasingstrength of the stream, with the increase in the time of itsclosure, and with the decrease of the distance of the nervetracts concerned from the poles. Such are the broad results ofPflüger's admirable investigations: what conclusions do theyseem to point to? Considering that the states of excitabilityare of an opposite kind at the positive and negative poles, andconsidering further the sort of change which is notably producedin soft conductors by an electric stream, it is a natural inferencethat the physical and chemical changes of which the retardationof conduction is a result are quite different at the negative fromwhat they are at the positive pole-in a certain regard, opposite:between the poles there being a centre of indifference at whichone kind of change passes into the other. If this be so, then itis not impossible, perhaps not improbable, that the excitingoperation of a galvanic stream through a nerve may lie in thev.]THE PATHOLOGY OF INSANITY. 435chemical effects which the stream calls forth in the soft conductorthrough which it passes: the intrapolar tract of nerve behavingin every regard like polarized moist conductors, the qualities ofwhich are more altered by the stream the nearer the tractsaffected are to the two poles. The molecular process of excitation in the nerve, the passage out of the excitable into theexcited condition, would then be the effect of this electrolysis;and the electric excitation would resolve itself into a definiteform of chemical stimulus, which, like the process of giving offhydrogen during the closure of a stream, appears only at thenegative pole. The analogy of the process of excitation with aproduct of electrolysis is not weakened by the fact that a certaintime is required by a nerve, after it has been in an electrotonicstate, before it recovers its full power of conduction. * Still itwould be unwarrantable, in the present state of knowledge, toassume any such comparison as exact: its use is rather as anillustration from the known, in order to assist us to some kindof conception of the unknown. Chemistry must supply thegroundwork of a physiology of nerve element, and on its progress the physiologist must wait; but for the full exposition ofthe complex phenomena of nerve function there will be neededwider science than chemistry is ever likely to furnish.The results so far obtained prove clearly enough that nervousfunction is not to be embraced in any metaphysical conception,or dismissed as inexplicable, but that it is a matter for positivescientific investigation. The conducting function of nerve isshown to be a measurable process of molecular movement; theproper electrical current of nerve is diminished during itsexcitation, and its intimate molecular constitution modified;and there are grounds for supposing that the electric excitationof nerve results from some definite chemical change. Therelation between chemical force and electric force is probablynowhere more intimate than in the phenomena of nervousaction, could we only unfold their real nature.It has been shown that with nerve as with muscle the chemical reaction becomes acid after activity, owing to the productionseemingly of lactic acid; and the results of the waste of nerveArnold von Bezold, Untersuchungen über die Electrische Erregung der Nerven und Muskeln. 1861 .FF 2436 THE PATHOLOGY OF INSANITY. [CHAP.element during function are found to resemble very much thosewhich are produced by the waste of muscle: they are such asresult from the retrograde metamorphosis of the highly vitaltissue, and seem to fall under two classes, one of which represents the series of fatty acids, the other that of aromatic bodies.These facts are of interest in connexion with what is known ofthe similar electrical relations of nerve and muscle. By meansof the thermo-electrical apparatus Becquerel and Breschet haveshown that a muscle rises one degree in temperature during contraction; the production of heat being due to the oxidationwhich then goes on, as the investigations of Ludwig-provingthat the arterial blood which passes through a muscle in a stateof contraction is almost completely deprived of its oxygen-andthe nature of the waste products of oxidation found in muscleafter contraction, indicate with sufficient clearness . Duringmuscular contraction, then; there is not only motion, but thereis an evolution of heat, together with a modification of the electrical currents of muscle and a certain chemical action; andany comprehensive theory of muscular action must be able toshow how these are related to each other. The observations ofHeidenhain, so far as they go, would certainly indicate that theamount of chemical action was in proportion to the sum totalof latent energy made " actual" during contraction. * I am notaware that like investigations have been made into the chemicalhistory of nerve during the exercise of function; but one mayfairly assume, both from the like electrical properties and fromthe like products of the retrograde metamorphosis, that anabsorption of oxygen and an evolution of heat are part of anundoubted chemical action. Again, then, the appeal is to thechemist to make known the nature of the intimate chemicalchanges.I have adduced the foregoing physiological considerations tothe end that they may furnish the groundwork of a just conception of the pathological phenomena: they are valuable not somuch for what they actually reveal as for what they point to;and they are certainly indispensable to the formation of a consistent theory capable of binding together the many scatteredMechanische Leistung, Wärmeentwickelung und Stoffumsatz bei der Muskelthätigkeit, von Rudolf Heidenhain.IV.] THE PATHOLOGY OF INSANITY. 437facts in nerve pathology at present known, and for directingthe course of future research. At the outset they prove that,so far from its being wonderful that there are no visible morbidappearances in some cases of insanity, the wonder really is thatsuch should have been expected. It has been calculated thata distinct sensation of smell is produced by 3000 gr. of sulphuretted hydrogen, by 0 gr. of bromine, by 1300000 gr.of oil of resin, and by even a still smaller quantity of musk;and yet men familiar with these facts have thought it no inconsistency to look with the naked eye for the physical condition ofdelicate psychical disorder.2. Individuality of Nerve Element. -Not only have the electrical properties of nerve element and the intimate chemicalchanges during its function been hitherto entirely disregardedby those who have written on the pathology of insanity, but itwould be no injustice to assert that nerve element itself, asa living entity, has been almost ignored. The main stress hasalways been laid upon the blood-vessels, as if they were theprimary agents in initiating and keeping up cerebral disorder.But the truth is that the first step in insanity often is, as it isin inflammation, a direct change in the individual elements ofthe tissue, the change in the blood-vessels being entirelysecondary. Take, for illustration, the early steps of inflammation by the interesting observations of Professor Lister ithas been made evident that, in the case of mechanical or chemical injury to some part, the elements of the tissue are directlyinjured; that they are brought to a lower state of life, and theirfunctional activity impaired; as a consequence of the injury theelements are brought nearer to the condition of ordinary nonliving matter and the corpuscles of the blood exhibit a tendencyto stick together in the neighbourhood of the damaged part,just as they do when brought into contact with ordinary matterafter being withdrawn from the body. The dilatation of thevessels is produced indirectly through the nervous system .Observation of the effects of irritants upon the pigment- cellsof the frog's skin confirmed these views: Mr. Lister found thatirritants applied in such a mild form as to cause little or noderangement of the blood did nevertheless produce a certaindegree 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 accompanying, if not preceding, the earliest approaches to inflammatory congestion, " and corresponding with arterial dilatation.Experiments with carbonic acid proved that it had a powerfulsedative effect upon the tissues, paralysing their vital energiesso as to give rise to intense inflammatory congestion, which,however, was transient; even in amputated limbs, in whichthere was of course no circulation, the tissues recovered afterits action, so that, as the restoration of the action of cilia separated from the body might indicate, the " tissues possess, independently of the central organ of the nervous system or of thecirculation, or even of the presence of blood within the vessels,an intrinsic power of recovery from irritation, when it has notbeen carried beyond a certain point." * From which researchesit plainly appears that the earliest condition of inflammation ismore or less complete suspension of functional activity in theelements of the tissue, whatever be the cause; and it is evidentalso that the walls of the blood-vessels are more or less deprivedof their vital endowments when inflammation is established, asthey then allow fibrine to pass readily through, though theyrepel it in health. These experimental results definitely establish the correctness of views long maintained by those philosophical pathologists who gave due weight to such phenomenaas the immediate effects of mechanical and chemical injury of apart, the growth of blood- vessels in the primordial developmentof parts, and the increased action of one kidney and the sequentincreased afflux of blood when the other is destroyed or renderedincompetent. †Bearing well in mind the foregoing observations touching theintrinsic action of the tissues, it will not be difficult to perceivehow damage to the nerve elements of the brain, howevercaused-whether from overwork, or emotional anxiety, or somepoison in the blood, or direct injury-may immediately declareitself in disordered function: the nerve element is brought toa lower state of life, and manifests its deviation from the normalOn the Early Stages of Inflammation, by J. Lister, F.R.S. Philosophical Transactions, vol . xxxi. , 1858.+ General Pathology, by J. Simon, F.R.S.Iv. ] THE PATHOLOGY OF INSANITY. 439state by a disturbance of function. And as in inflammation adetermination of blood and an adhesion of its corpuscles followthe local mischief, so here a disturbance of the circulation inevitably follows, and in its turn becomes the cause of furthermischief. One may perhaps perceive also how it is that, whenthere is an innate feebleness of nerve element in consequenceof hereditary taint, insanity is produced by causes that wouldhave no such baneful effect upon a soundly constituted brain.The knowledge now acquired of the state of the cerebralcirculation during sleep goes to prove the importance of thenerve element as individual. It has for long been thefashion to assert that there was an increased quantity ofblood in the brain during natural sleep, notwithstanding thatBlumenbach had noticed in the trepanned skull of a man thatthe brain sank during sleep, and swelled up with blood when heawakened; but the investigations of Mr. Durham, who removedportions of the skull in different animals, have distinctly shownthat there is considerably less blood in the brain during sleep,its substance then becoming paler and sinking down, while itimmediately swells up and becomes turgid with blood whenthe animal awakes. * If, mindful of the ancient maxim, ubistimulus ibi fluxus, we fix attention on the individual nerveelement as the active cause to which the supply of blood is tosome extent secondary, it will be seen why the quantity of bloodis diminished in the brain during sleep. The actively flowingstream ministers to the functional energy of the cerebral centres;but, as such function implies a waste of organic element, theremust needs be a period of suspension of activity, during whichrenovation may take place. The function of the brain, therefore,as an organ of animal life, is suspended by recurring periods ofsleep the organic life of the brain, however, like organic lifeelsewhere, does not sleep, but by the restoration of the wastedor exhausted element, lays up a store of latent energy to bemade " actual" in future function. The supply of blood answersto these different states, being active when the energy is great,moderate when it is in abeyance. If the thoughts of any one66 Guy's Hospital Reports. Dr. Hammond, in an article on Sleep and Insomnia, " in the New York Medical Journal, vol. i. 1865, confirms Mr. Durham'sexperiments, and gives the observations of previous authors.440 THE PATHOLOGY OF INSANITY. [CHAP.wishing to go to sleep are active, there is a rapid flow of bloodthrough the brain, and he cannot get to sleep; the stimulus ofactivity acts as a cause of the determination of blood, and this inits turn tends to keep up the activity. Some persons under thesecirc*mstances have a certain power of inducing sleep in spite ofthe difficulty by concentrating the attention on some particularmental representation, and steadily checking every tendency torevert to the exciting ideas, the excitation of the nervous centresministering to these subsides, the circulation becomes less active,and the individual passes into sleep, though it is probably notvery sound. Indeed, it were well to bear in mind that thereexists great diversity in regard of the extent and degree ofsleep, one sense being sometimes more deeply involved thananother, or the same sense differently at different times. Allthat we are directly concerned with here, however, is the confirmation which the phenomena of sleep afford of what has beensaid of the primary action of nerve element as individual.If it were desirable to multiply arguments in favour of theforegoing views of the relation of the nerve element to the circulation, one might instance the effects of its direct and rapidexhaustion. By putting any one, for example, on the rack,mentally or bodily, it is possible to produce as great nervousexhaustion in one hour as would be ordinarily produced by aday of vigorous activity; the result whereof notably is irresistible sleep. A man will sleep on the rack in the intervals of theapplication of the torture. Carry the exhaustion still further,the power of recovery in nerve element which, as in all organicelement, is an intrinsic property, is abolished, and the sleep thatoccurs is the sleep from which there is no waking-the sleepthat rounds off the dream of life.When a dog is poisoned with strychnia, it may happen thatthere are no appreciable morbid appearances in the animal'sbody; but if there are any, they are such as congestion of thespinal cord, aneurismal dilatation of the capillaries, and perhapssmall effusions of blood in the grey matter. Now the congestionor effusion of blood in such case is plainly a secondary resultof the intensely morbid activity of the nerve elements uponwhich the strychnia directly acts. Here, in fact, is the abstractand brief chronicle of what happens in many cases of insanity.Iv.] THE PATHOLOGY OF INSANITY. 441Transfer the convulsive action from the spinal nerve-cells to thecortical cells of the hemispheres, the result is an acute and violentmania, in which the furious morbid action of the directly poisonednervous centres initiates an acute determination of blood. Letthe disease be supposed to become chronic, the congestion of theblood- vessels may become chronic also. The common error hasbeen to discover the pathological cause of the insanity in thecongestion, in spite of the observation that it was not the way ofcongestion, otherwise caused, to give rise to insanity. In whatis described as Mania transitoria, it sometimes happens that anindividual falls with great suddenness into a violent fury, inwhich perhaps he evinces dangerous, destructive, and evenhomicidal tendencies: his face is flushed, his head hot, and thereis plainly an active determination of blood to the brain. Aftera short time the attack subsides, and the man is himself again,scarcely conscious of what has happened. There is no good reasonto look upon the rush of blood in such case as the active agentin the production of the fury; but there is the strongest possiblereason to believe it secondary to the violent and degenerateaction of the nerve centres; the attack is, in truth, an epilepsyof the cerebral centres, and the congestion takes place not otherwise than as it takes place in the spinal cord poisoned bystrychnia. To the formation of correct views of the pathologyof insanity it is most necessary that this order of events shouldbe distinctly realized.At the same time it is important not to overlook the fact thatextraneous disturbances in the circulation, quantitative or qualitative, may be the direct cause of disorder of the cerebral centres.Whatever interferes with the regular supply of the proper material to be by them assimilated, and the regular removal of thewaste products of functional action, so far predisposes to disease,and will specially do so where there is any innate disposition tomorbid action or any prostration, otherwise caused, of nerveelement. In his Lumleian Lectures, Dr. Todd much insistedupon what Andral had pointed out-namely, that an anæmiccondition is favourable to the production of delirium and ofcoma. The delirium which sometimes occurs at the end of acutespecific diseases, when the fever is over, and lasts for a few days,has been attributed to acute cerebral anæmia, but it seems442 THE PATHOLOGY OF INSANITY. [CHAP.probable that in this case the great nervous exhaustion is themore important agent; the delirious activity of the nervouscentres being the evidence of an exhaustion which, carrieda little further, becomes coma, or extinction of functionalaction. That congestion or inflammation of the brain mayproduce serious disturbance of its functions is known toevery one; but it is well worth considering how rarely congestion of the brain, originating in causes outside itself, gives riseto delirium or insanity. It is because of a diminution in thefunctional power of the nerve element itself, because this hasbeen brought to a stage nearer to the condition of non-livingmatter, that the adherence of the blood-corpuscles and the stagnation of the blood take place; and under such circ*mstanceswe may understand how little fitted the nervous element is tocontend with the difficulties that are gathered around it. It isweak, 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 weakness always does, with a convulsive or delirious energy, and, ifcirc*mstances continue very unfavourable, its activity is extinguished. May we not, then, perceive how it is that the abstraction of blood by some means from the labouring part may bebeneficial in certain cases? The aim is to put the sufferingpart as nearly as possible in that condition in which it is duringnatural sleep-in a condition of rest; and the recovering powerwhich, as we have seen, exists in the elements of a tissue, willthen be under the most favourable conditions for restoring thenatural state of things."One more consideration shall serve to exemplify the importance of the individual nerve element in the production ofinsanity. To surgeons it is well known that after an injuryerysipelas 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 andirritable, 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 atfirst, saying that he was lost; then became furious, threw himself on his wife orchildren, and several times attempted suicide. Blood- letting and cold to thehead produced immediate calm. -Traité des Maladies Mentales, p. 138.IV.] THE PATHOLOGY OF INSANITY. 443to appear at the seat of the injury. And a true eruptive feverwill do the same. Mr. Paget relates, for example, how he cut aboy for the stone, who became very ill, and seemed in danger ofhis life; but soon a vivid red eruption appeared at and aboutthe wound. This was measles, earliest and most intense at theseat of the injury, just as erysipelas might have been. He hasseen a similar event in a case of injured and inflamed knee withscarlet fever, and Dr. William Budd has recorded a case of smallpox which appeared most intensely over a bruise of the nates.In like manner, the nerve element, when weak by nature, orweakened by accident, is liable to be seized on by a morbidpoison it is the weak part, and therefore the sufferer. Butmore than that: the greatest stress has been laid, throughoutthis work, on the fact that traces or residua of every mental actare left behind by it, modifying henceforth the nature of theelement which subserved the particular function; and indicationswere given that every organic element, and not that of the brain.only, manifested this kind of memory. Hence it comes to passthat any tissue which has been subject to a particular morbidaction 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 trueof the brain, for the residua left behind by previous acts constitute almost the very nature of the elements subserving mentalaction. The weighty bearing, therefore, which previous habitualmental states have in the production of insanity, is revealed inthis law not less surely than the predisposition to a secondattack of insanity which a former attack induces. The event ineach case is an illustration of a law of organic growth andaction to which nervous element is subject in common withother organic elements of the body. Plainly, only by fixingattention on the individual nerve element can the shadow of aconception be formed of the manner of that degeneration whichreveals itself by insanity.3. Reflex Pathological Action or Pathological Sympathy. —Indiscussing the causation of insanity, the general features of thiskind of morbid action have been set forth; and when I come toenumerate the morbid appearances met with in the bodies of theinsane, the statement of the relative frequency of disease ofdifferent organs will find its proper place. Here I take occasion444 THE PATHOLOGY OF INSANITY [CHAP. .only to adduce certain observations with regard to the strikingmanner in which diseased action of one nervous centre is sometimes suddenly transferred to another. This fact, which haslately attracted new attention, was long since noticed and commented on by Dr. Darwin:-" In some convulsive diseases," hewrites, " a delirium or insanity supervenes, and the convulsionscease; and, conversely, the convulsions shall supervene, and thedelirium cease. Of this I have been a witness many times aday in the paroxysms of violent epileptics; which evinces thatone kind of delirium is a convulsion of the organs of sense, andthat our ideas are the motions of these organs." Miss G. , oneof his patients, a fair young lady, with light eyes and hair, wasseized with most violent convulsions of her limbs, with outrageous hiccough, and most vehement efforts to vomit. Afternearly an hour had elapsed this tragedy ceased, and a calm,talkative delirium supervened for about another hour, and theserelieved each other at intervals during the greatest part of threeor four days. " After having carefully considered this disease,"he says, " I thought the convulsions of her ideas less dangerousthan those of her muscles," and thereupon he adopted suchtreatment as resulted in the young lady's recovery. In anothercase, which came under his observation, " these periods of convulsions, first of the muscles and then of the ideas, returnedtwice a day for several weeks." " Mrs. C.," again, " was seizedevery day, about the same hour, with violent pains in the rightside of her bowels, about the situation of the lower edge of theliver, without fever, which increased for an hour or two, till itbecame totally intolerable. After violent screaming she fell intoconvulsions, which terminated sometimes in fainting, with orwithout stertor, as in common epilepsy; at other times a temporary insanity supervened, which continued about half an hour,and the fit ceased." * I quote these observations of Dr. DarwinZoonomia, vol. i. pp. 25, 26. Brodie relates the case of a lady who sufferedfor a year from persistent spasmodic contraction of the sternocleidomastoid;suddenly it ceased, and she fell into a melancholy; this lasted a year; afterwhich she recovered mentally, but the cramp of the muscle returned, and lasted for many years. In another case of his, a neuralgic condition ofthe vertebral column alternated with true insanity. -Lect. on certain LocalNervous Affections.Dr. Burrows mentions similar cases: one " in a very eloquent divine, who wasIv.] THE PATHOLOGY OF INSANITY. 445with great satisfaction, because they have reference to what hasonly lately received due attention, and because they are examplesof enlightened observation, such as lie scattered through hisgreat work. Indeed, a candid inquirer cannot but allow thatthe sagacious views of Dr. Darwin and Dr. Whytt, concerningthe reflex or sympathetic action of the nervous system indisease, would add something of value to the more exact knowledge of the subject which exists at the present day.When treating of the insanity of early life , it was pointedout how commonly the morbid actions of the different nervouscentres were intermixed, or replaced each other; it is, in fact, inearly life that this indistinguishable blending of nervous diseases, which afterwards become distinct, is most evident. Still,marked examples do now and then occur in the adult; and it isnot an uncommon thing for the practical physician, watchingthe phenomena of actual disease of the nervous system, to haveto admit the existence of strangely hybrid forms. The mostinteresting example, perhaps, of the transference of morbidaction, or of the morbid action of one nervous centre beingvicarious of that of another, is presented sometimes in the courseof epilepsy. Instead of the usual attack of the peculiar convulsions, there is a sudden maniacal fury, which has been describedin France as epilepsie larvée-latent or masked epilepsy. Ayoung surgeon, strong and well- made, came under my care in aviolent state of maniacal delirium. He had served during theCrimean war, and on his return had entered into partnership,and become engaged to a relative of his partner. Anxious onthis account, and for pecuniary reasons, he had not been astemperate as he should have been; and he had had two epilepticfits at a considerable interval one from the other. On hisreturn one day from seeing his patients, he complained of a painin his back, and of a feeling of cold, and talked flightily. Nextmorning he appeared well, and was very anxious to know whathe had said on the previous evening; but in the course of theday he became wildly maniacal, extremely incoherent, and veryviolent. So he remained for two days, when he was brought tothe hospital in a strait-waistcoat. After admission he wasalways 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. [CHAP.quiet but confused, and seemed quite unaware of what positionhe was in; in the afternoon he slept for three hours-his sleepdeep, almost stertorous. On awaking he had three very severeepileptic fits in quick succession, after which a long period ofcomatose unconsciousness followed. On the next day he wasquite composed and rational, but very weary; on the day afteranother 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 trueepileptic insanity taking the place of epileptic convulsions.But there are cases, as M. Morel has pointed out, in whichan epileptiform neurosis exists for a long period in an undeveloped or masked form, and gives rise to a variety of madnesswhich is differently described as maniacal fury, or periodicmania, or instinctive mania, homicidal or suicidal, or moralinsanity. In such cases, after some months, or even years,distinct epileptic attacks make their appearance, and supply theinterpretation of the previously obscure insanity.It is a characteristic of the nervous system, a property bywhich its internuncial function is accomplished, that the influence of an impression made at one spot is quickly communicatedto a more distant part. How this takes place we know not;and, therefore, it matters not much whether we ascribe it to asympathy or consent of parts, or to an induction, or an infection,or to a reflex action, or connote it by any other term which, likean algebraic symbol, may serve to express an unknown quantity.It is utterly impossible to account for its operation in diseaseat one time and not at another: " Thus, what reason," asksDr. Whytt, " can be given why sometimes, after cutting off anarm or leg, those muscles which raise the lower jaw should beaffected with a spasm, rather than other muscles? " There isnothing very singular, however, in this ignorance; no one knowshow it is that the irritation extends from the stimulated spot ofa sensitive plant, the Mimosa pudica for example, so that thewhole leaf contracts, and perhaps neighbouring leaves also contract; no one knows how the induction of electricity actuallytakes place, nor how it is that, when a point in a muscle isstimulated, the contraction extends along the fibre, nor how theinterior of a nerve is actually altered when it is put into anIv. ] THE PATHOLOGY OF INSANITY. 447electrotonic condition. It is none the less certain that importantmolecular modifications do take place in those inner recessesof nature which, are impenetrable to our senses, and that theydeclare their insensible motions in sensible results. There issome reason to hope, however, that further researches into theelectrical relations of nerve may throw light upon these phenomena of sympathetic or reflex morbid action. Call to mind fora moment what is the state of a nerve during excitation. Thereis then a molecular change of its interior, and the proper electrical currents are diminished, while chemical action of somekind takes place: this happening in the interior of a gland,must needs modify its invisible molecular processes, and themodification may finally be expressed in a palpable change inthe secretion; in the interior of a muscle the modified molecular activity induced will issue in a manifest contraction; in asensorial centre the modification will declare itself in a sensation; 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 morbidcentre of irritation in some abdominal organ, with which thebrain is in sympathetic organic relation, to give rise to persistentexcitation of the intercommunicating nerve, it is certainly notmore wonderful that disturbance of cerebral activity should beproduced, than that reflex movement should follow the stimulation of a centripetal nerve. But disturbance of the intimateprocesses of the supreme cerebral functions is neither more norless than disorder of the organized basis of thought, the fabricof mind. According to the degree of morbid derangementinduced, therefore, will there be either a disturbance of themental tone and a general painful consciousness, or a positiveperversion of ideas and an incoherence of thought.It is most necessary to bear in mind the different ways inwhich sympathetic or reflex phenomena may be displayed; itwould appear that, wherever there is continuity of nerve- structure, there is the possible agency of such action. It is true thatthe term, reflex action, is commonly used to denote the transference of excitement from a sensory to a motor nerve; butthere is no reason to doubt that the reflexion may sometimes448 THE PATHOLOGY OF INSANITY. [CHAP.take place in the opposite direction-from the motor to thesensory nerve. The severe pain felt along the spine after suddenand violent coughing, or after irregular contraction of the sophagus, the tickling in the throat after long speaking, and theincrease of facial neuralgia by muscular exertion, have beenadduced as examples of that mode of transference. * These areinstances of heterogeneous sympathy, as it has been called; butthe sympathy may be shown also by nerves of the same kind,-that is, it may be hom*ogeneous: pain in the knee often indicates disease in the hip-joint; facial neuralgia is produced bytoothache; or the pain of toothache may be felt in the oppositetooth to that which is carious. When one eye is covered, thepupil of the other dilates, which Henle attributes to the influenceof the darkness diffused transversely from one nervous centreto the other. Ollivier has related the case of a person whoseleft leg and side had been rendered almost entirely insensiblebelow the injury by a wound in the spinal cord of the neck;still, when the skin of this left leg was pinched, the patient hada 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 resultof cutting the internal rectus of the eye; if this muscle be cutthrough on one side, the eye is a little turned out; if bothinternal recti are cut, then both eyes are strongly turned out.Again, the muscles of a paralysed limb in a hemiplegic patientwill sometimes contract during some emotional or even voluntaryact in which symmetrical muscles of the opposite limb takepart. Of diminution or paralysis of movement by sympathetic.action, there are examples in the dilatation of the blood-vesselsin inflammation and in paraplegia from nephritis. Whenmental emotion causes the knees to shake, there is the manifestation of a transference of effect from one nervous centre toanother, as there is also when different impressions on the mindinstantly give the eyes either a dull, a lively, or a fierce look.To these old and familiar examples of reflex action have now tobe added the effects which it is proved to produce upon nutrition and secretion, both by direct action of nerve upon the

• Henle, Handbuch der Rationellen Pathologie, 1846 .

Iv. ]THE PATHOLOGY OF INSANITY. 449elements of the tissue, and indirectly through the bloodvessels.

After these preliminary general considerations, so necessaryto the just appreciation of the morbid appearances that are metwith in insanity, I now proceed to the enumeration of the resultsof pathological observation and to the discussion of their nature.In dealing with them it will be convenient to adopt a threefolddivision 1 , of those gross morbid products such as tumours,abscesses, cysticerci, &c . which, if they do affect the hemispherical cells , commonly do so indirectly; 2, those directresults of morbid action which are microscopically or otherwisediscoverable in the structure of the supreme centres; and 3,those morbid conditions of other organs that have been frequently met with in the bodies of the insane.1. Morbid Products, such as Tumour, Abscess, Cysticercus, &c.-Perhaps one of the most frequent observations which one hasto make in the case of cerebral abscess or tumour, or often insoftening, is the absence of symptoms of mental disturbance.The fact may at first seem striking, because the presence of somuch disease might scarcely be thought compatible with theundisturbed 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 thereduring life anything of the nature of mental imbecility, or anysymptom of the various phases or forms of insanity." Anexamination of the cases furnishes a sufficient reason for thenon-affection of the intelligence in none of the ten was thereany recognised implication of the nervous centres of intelligenceby the morbid action; the mischief was more or less central,and the hemispherical ganglia continued their functions, as theywell might, in spite of it. If there is one thing which pathological observation plainly teaches, it is the slight irritabilityof the adult brain; the gradual growth of the tumour allowsthe brain to accommodate itself to the new conditions; and aclosely adjacent nervous centre may be entirely undisturbed infunction until the morbid action actually encroaches upon it.Not disease in the interior of the brain, but disease of theJournal of Mental Science, July 1864 Cases of Primary Carcinoma of theBrain.G G450 THE PATHOLOGY OF INSANITY. [CHAP.membranes covering it, is most likely to produce disorder ofthe intelligence; because in the latter case the morbid actionis in close proximity to the delicate centres of intelligence, andseriously interferes with their supply of blood. An observation,therefore, which Dr. Ogle makes as the result of an analysis ofhis ten cases is not without interest: it is that in no case wasthere anything like arachnitis in connexion with the variousgrowths. Whatever be the explanation, there can be no doubtof the fact that a large tumour may exist in the brain, or thata considerable amount of the brain substance may soften andundergo purulent degeneration-the pus even becoming incapsuled-without the presence of a single symptom to lead us tosuspect the existence of disease in the brain. It has evenhappened that a patient in hospital, who has complained only ofgeneral debility and utter inability to exertion, has been suspected of feigning and accused of indolence because there wereno marked symptoms of disease, when a sudden and quickdeath has proved at the same time the existence of an abscessof the brain and the injustice done to the sufferer. †Certainly it does sometimes happen that mental disturbanceaccompanies disease in the brain, even though the mischief isquite central. Two things will commonly be observable withregard to the mental symptoms in such cases:-(1 ) that theyare intermittent, so that they may disappear altogether for awhile; and (2) that they have the character either of an incoherent delirium, or of greater or less mental imbecility.(1) The entire disappearance for a time of all symptoms ofmental disorder plainly indicates the absence of any seriousorganic structural change in the nervous centres which directlyminister to the manifestations of mind; for, if such changeexisted, the recovery could not possibly be so sudden and complete. The disturbance of the cortical cells is in realitysecondary it is a reflex functional result of the primary morbidaction that is going on in the neighbourhood; and it may consequently 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 Gehiruabscesse, von Prof. Dr. Lebert, Virchow's Archiv, vol. x. 1856.IV.] THE PATHOLOGY OF INSANITY. 451far more probable explanation of the transitory disorder thanthe assumption of a sudden vascular congestion, of which thereis commonly no sign, and of the absence of which there arecommonly many signs. Why such reflex effect is producedin one case and not in another, or why it is not permanent whenonce produced, we are no more able to say than we are whya like eccentric irritation should in one case give rise to tonicspasm, and in another to clonic spasm, and in a third to nospasm at all. The complete intermission of symptoms does atany rate strongly favour an explanation which recent researchesinto the electric relations of nerve render conceivable.(2) Not less favourable to the interpretation of the mental disorder as a reflex effect is the character of it; for it is manifesteither in (a) great mental feebleness or imbecility, deepeninginto extreme dementia in the last stages; or (b) in delirium.That we do not usually meet with any of the recognised formsof insanity is a fact of some interest and importance; indicating,as it does, the existence of different organic conditions from thosewhich exist in cases of true insanity. A systematized mania ormelancholia represents a certain organized restilt of abnormalcharacter, 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, thoughmorbid action: the incoherent delirium, or mental imbecility,with which we have now to do, indicates, on the other hand, ageneral disturbance of the supreme centres of intelligence, without any systematization of the morbid action; the delicate fabricof thought is strangely shattered by the communicated shock,and the individual elements of the noble organization of mindare suddenly prostrated. Hence, though the delirium may bevery active, it is commonly extremely incoherent, exhibiting anentire absence of co-ordination; it is the automatic expressionof the fluttering action of the ganglionic cells of the hemispheresirritated into action from without. So also with regard to theimbecility, when the mental disturbance has that form it is ageneral weakness without any definite character, wanting thewrecks of systematic delusions which are usually met with inthe dementia following mania or melancholia. The want ofdefinite character, as well as the intermittence, tends to proveGG 2452 THE PATHOLOGY OF INSANITY [CHAP. .that there is no definite morbid action going on within thesupreme centres of consciousness; that the mental disorder is,like the general epileptiform convulsions which occur in localdiseases of the brain, not the direct result of the disease, but asecondary or reflex effect.When the local disease directly implicates the supreme centresof intelligence, there may be extreme mental disorder, althoughit is remarkable how intermittent the symptoms even then sometimes are. The following example may serve for illustration:-Ayoung man, æt. twenty-four, suffered from frequent and severeperiodic pains in the head, weakness of vision, anxiety, extremefeeling of debility and loss of power in the limbs; there wasalso confusion of thought. After a time he was seized with amaniacal attack; had hallucinations of balls of fire falling abouthim; thought himself pursued by monstrous forms; and was veryviolent. After an excitement of three days and nights withoutsleep, he fell into a deep sleep which lasted for twenty- four hours,and from which he awoke quite conscious, with no remembranceof his previous excitement. Again after a time headache cameon, with noise in the ears, and more or less paralysis of thevoluntary muscles; the maniacal excitement recurred, becomingmore continuous, and the paralysis and mental stupor increased.One day he could neither stand nor move his arms; but after atranquil night he could do both quite well, and could returnintelligent answers to questions. In the evening he was againrestless and excited; after which he became comatose, and died.Numerous cysts of cysticercus cellulosus were found in the brain,five of them being fixed to the inner surface of the dura materand the rest dispersed throughout the grey matter. By far thegreater number were found in the grey layers of the hemispheres,being collected here and there into dense groups. In anothercase, in which twelve cysticerci were found after death in thebrain, the symptoms were those of gradually increasing dementiawith paralysis.It is necessary to bear in mind, however, that there may beconsiderable disorder or destruction of a part of the corticallayers of the hemispheres without any mental suffering. It iswell known that a person may lose a part of his brain, and yetnot exhibit any mental disorder; and portions of the hemispheresIV.] THE PATHOLOGY OF INSANITY. 453may be cut away without the patient feeling it, though he isfully conscious. There is, in fact, great reason to think that onehemisphere may sometimes do the work of the whole brain; theonly consequence being an earlier exhaustion by exercise, and, perhaps, a greater irritability. This being so, it is easy to perceivehow direct encroachment by disease on the hemispherical greylayers may in some cases be unattended with any mental disorder.2. Morbid Appearances in the Brain and Membranes. - Thedirect results of morbid action in the brain, discoverable by themicroscope or otherwise, certainly do not admit of very definite description. Some are ready to deny that the post- mortemappearances in the insane throw any light on the nature of thedisease; and the belief affords a comfortable excuse for shirkinglaborious and tedious investigation. Schroeder van der Kolk,however, held a different opinion: " More than thirty years'experience," he says, " has led me to an entirely oppositeopinion, and I do not remember to have performed, during thelast twenty-five years, the dissection of an insane person, whodid not afford a satisfactory explanation of the phenomenaobserved during life. On many occasions, I was able accuratelyto foretell what we should find."*The broad result established by pathological observationundoubtedly is, that the morbid changes most constantly metwith after insanity are such as affect the surface of the brain,and the membranes immediately covering it. Of these changesthere is no need of discussion to prove that those in the layersof the cortical substance are the principal and essential. Theevidence of more or less inflammation of the membranes, andespecially a milky opacity of the arachnoid, is commonly enoughmet with in the bodies of those who have not died insane.Certain observations of Schroeder van der Kolk enable us toperceive how this may happen. In the first place, he hasremarked that adjacent parts of different structure are notreadily attacked by inflammation in equal degree: the intercostal muscles, for example, are almost unaffected when acutecostal pleurisy exists; the muscular wall of the intestine isscarcely affected in peritonitis; and the heart substance remainssound, notwithstanding acute pericarditis and exudation into·On the Minute Structure and Functions of the Medulla Oblongata, p. 231.454 THE PATHOLOGY OF INSANITY. [CHAP.the pericardium. So it is with the pia mater; congestion, inflammation, and effusion may take place in it, while the brainitself is not implicated, and exudation between the arachnoid andpia mater may accordingly be found after death, when there hasbeen no mental derangement during life. In the second place,it is necessary to bear in mind the distribution of vessels in thepia mater: Schroeder van der Kolk found that, while most of thearteries pass down from it into the substance of the brain, andare there distributed, the blood being brought back to themembrane by a corresponding series of veins, there are inaddition direct channels of communication between the arteriesand veins in the pia mater. In that arrangement there isobviously a provision by which temporary disturbance of thecirculation may leave the cortical layers of the brain unaffected,the storm passing over them: but for such provision, one mightwonder that any one escaped serious mental disturbance, considering the frequent changes in the cerebral circulation towhich every one is subject, and the extreme sensibility of nerveelement. As it is, vascular disturbance does not remain entirelywithout effect; though the hemispheres are not themselvessensitive to pain , they manifest their altered state by a feelingof unusual irritability and a proneness to excitement andpassion; and this is a condition of things which, as every one'sexperience teaches him, is not so uncommon, but which mostylsoon passes away with the physical cause of it.There can be no question that the mind suffers when theinflammatory action in the membranes seriously implicates theadjacent cortical layers; for, without claiming acute meningitisin evidence, the morbid appearances sometimes found after acuteinsanity afford sufficient proofs. † In France much attention hasbeen given to the morbid conditions of acute maniacal excitement or maniacal delirium; they are those of acute hyperæmia-namely, great injection of the pia mater with spots of ecchymosis, more or less discoloration and softening of the corticallayers -the discoloration being in red streaks or stains withspots of extravasated blood, and the softening being of a violet

• Die Pathologie und Therapie der psychischen Krankheiten.

The case reported in chap. iii. p. 347, may be referred to for an account of instructive morbid appearances in acute insanity.Iv. ] THE PATHOLOGY OF INSANITY. 455or pink hue-and increase of the puncta vasculosa of the whitesubstance. As patients do not commonly die suddenly in theacute stage of insanity, this pathological condition is not oftenmet with; and it is certainly not invariably met with when theydo die in the acute stage. If we call to mind what has alreadybeen 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 hyperæmia is met with, it is properly to be regarded, notas direct cause of the mental disorder, but, if not as effect of it,certainly as a concomitant effect of a common cause. With dueregard to this relation, it may on the whole be justly said, thatthe risible morbid appearances of acute insanity are those ofacute hyperemia of the brain. There are no recognisabledifferences between the morbid conditions of acute mania andacute melancholia: in the latter form of disease it more frequently happens that anatomical lesions are absent; and whenthey are present, they have been said to mark less hyperæmiathan exists in acute mania, and to be attended with more or lessserous exudation.The cases of chronic insanity in which all anatomical lesionsare wanting are rare: the longer the insanity has lasted , themore evident they usually are. In most instances there is someamount of thickening and opacity of the arachnoid observable;and many of the more advanced cases exhibit some degree ofatrophy of the brain, especially of the convolutions, effusion intothe sub-arachnoid space, discoloration of the cortical substance,and general hardening of the white substance. The pia materis sometimes found to be more or less firmly and generallyadherent to the surface of the brain, so that it cannot then bestripped off without tearing the latter; and a finely granularcondition of the ependyma of the ventricles, with its frequentadherence to the parts beneath, would seem to testify a previousinflammatory condition: the granulations of the arachnoid, carefully described by Meyer, have probably a like interpretation.Of the granulations of the ependyma of the ventricles, whichare certainly not peculiar to general paralysis, as M. Joire, aFrench writer, has asserted that they are, Mr. Lockhart Clarkesays: " They consist of globular aggregations of the ordinaryepithelial cells, which, in a natural or healthy state, are arranged456 THE PATHOLOGY OF INSANITY [CHAP. .side by side, and form a smooth or level surface on the floor ofthe ventricle. The tissue immediately subjacent, and whichconsists of exceedingly fine fibres proceeding from the taperingends of the epithelial cells, and running in various directions,was more abundant than usual; and-as might be expected fromthe hom*ologous relation of this part to that which surrounds thespinal canal-it was interspersed with corpora amylacea, butcertainly not to a corresponding extent. "* Though the adhesionof the pia mater to the surface of the brain is most frequentlymet with in general paralysis, it is now and then witnessed inother forms of chronic insanity, particularly in insanity afterepilepsy or drunkenness.The morbid changes which are found most frequently ingeneral paralysis, although in rare cases they are absent, aregreat œdema of the membranes, adhesion of the pia mater to thesurface of the brain, greyish-red local softening or discolorationof the cortical layers and superficial induration thereof, owingto an increase of the connective tissue and a destruction of theproper nervous elements. † More or less atrophy of the wholebrain, particularly, however, of the convolutions, is common,and is accompanied with greater firmness of its substance,enlargement of the ventricles, and serous effusion.pachymeningitis, effusion of blood into the membranes or thelayers of exudations, as described by Virchow and Rokitansky,and degeneration of the arteries, are not unfrequent. Thedegeneration of the nerve- substance from the increase of connective tissue has been proved by Rokitansky and others toextend sometimes even to the spinal cord. Such morbid changesare certainly more evident in general paralysis than in anyother form of insanity, but they do not occur with uniform constancy, nor are they of uniform character; in some cases themeningitis being most marked, in others the atrophy of thebrain, and in others the induration. Dr. Sankey has made acareful comparison of the morbid appearances met with inBeale's Archives of Medicine, vol . iii .+ Dr. Westphal has recently asserted that this increase of connective tissuehas never yet been satisfactorily demonstrated in the grey and white substance ofthe brain; nevertheless he is very confident with regard to his own observationsof the existence of this process of degeneration in the spinal cord!Iv ]THE PATHOLOGY OF INSANITY. 457fifteen cases of general paralysis with those met with in fifteencases of chronic insanity of other forms. The greatest differencewas in the frequency of effusion beneath the arachnoid, whichwas found eleven times in the fifteen cases of general paralysis,and three times in the other cases. Adhesion of the pia materto the grey matter occurred in eight of the general paralytics,and in only one of the others. The convolutions were abnormally open and wide apart in nine of the cases of generalparalysis, and in three of the other cases; in eight of the former,again, was there a dark discoloration of the grey matter, whichwas met with in only three of the latter; the layers of the greymatter were indistinctly marked in ten cases of general paralysis,and in six of the other cases. * Plainly there are no morbidappearances characteristic of general paralysis, although morbidchanges are more constant in it.The late Schroeder van der Kolk has given a detailed description of several cases of what is commonly considered a very rareaffection, but which he thought by no means so uncommon—namely, a diffuse inflammation of the dura mater, or idiopathicpachymeningitis. It is, he thought, often overlooked, and considered to be rheumatic headache. The symptoms are intolerableheadache, delirium, sometimes calmer delusion, and coma; andafter death the dura mater is found to be extensively inflamed,and more or less adherent to one or both hemispheres; theinflammation has in some cases extended to the brain, which isfound to be softened. According to his experience, this affection,where neither syphilis nor injury could be assumed as cause,was not rare. A remarkable circ*mstance in regard to it is theregular intermissions that occur in its course, the patient havingconsiderable intervals of apparent health.On the authority of so eminent an observer as Schroeder vander Kolk this idiopathic inflammation of the membranes mustbe admitted; but it must also be allowed that the morbidappearances described by him are very like those which havesince been described as almost pathognomonic of syphilis. Adiffuse fibrinous exudation of low form, glueing the membranesto the brain substance beneath, has been held to be a characteristic feature of syphilitic dementia. Instead of being diffusedOn the Pathology of General Paresis. Journal of Mental Science, 1864.458 THE PATHOLOGY OF INSANITY. [CHAP.the exudation is sometimes circ*mscribed, so as to have theform of a tumour; and it may then press into the brain-substance, causing softening immediately around it. Or, again, thegum-like exudation, or syphiloma, as it is called, may take placeas a diffuse infiltration or as a tumour within the substance ofthe brain, the membranes being unaffected. Such is the morbidproduct which recent researches have assigned to syphilis; and,according to Virchow, it consists, at the outset, like the substance of granulations, of an exuberant growth of connectivetissue, its further development taking place in two directions:( 1 ) either the formation of cells predominates, and then theintercellular substance is soft, jelly-like, mucous, or fluid, thewhole mass remaining jelly-like and coherent, or undergoingpurulent degeneration; (2) or the formation of cells is lessprolific, and the intercellular substance increases, so that thefibres preponderate; the cells are spindle-shaped, or have thestellate form of the cells of connective tissue, or the round formof granulation cells . Ultimately yellow patches of fatty degeneration appear in it. There certainly is no character wherebythis albumino-fibroid exudation can be distinguished as a specificproduct, and every pathologist admits the difficulty of distinguishing it from tubercle. The starting-point of its formationhas been shown by Virchow to be the nuclei of the connectivetissue and its equivalents; the proper elements of the organundergoing atrophy as the result of the hypertrophy of the connective tissue. The form of insanity with which this syphilomais associated in its extreme stage is, as might be expected, amiserable paralytic dementia.

Such are the morbid appearances met with in cases of insanity,a general summary of which, after Schroeder van der Kolk, mayhere be added:-When the patient has died at the beginning ofacute insanity, and the pia mater is stripped off, the corticallayer will exhibit unequal coloration; certain convolutions beingrosy, others pale. The differences are often detectable only byvery careful observation; they are the results of great congestionor commencing inflammation, and are found more often in thosewho have died of typhus fever or after acute delirium than inVirchow's Archiv, vol. xv. p. 217. Das Syphilom, oder die constitutionellsyphilitische Neubildung, von E. Wagner. Archiv der Heilkunde, 1863.iv. ]THE PATHOLOGY OF INSANITY. 459insanity, because in it death seldom occurs at an early stage.After a longer duration the disease appears to pass into a chronicinflammation. There is some difficulty in stripping off the piamater, the vessels of which are strongly injected, from the surface of the brain; and portions of grey matter are sometimesbrought away with it. More or less exudation commonly occursbetween the arachnoid and the pia mater, and the former mayform a thick, white, opaque layer, through which the convolutions are scarcely visible. After a still longer duration,when dementia is thoroughly established , there is no longer anyincrease of vascular injection. The vessels are less full thannatural, and the pia mater may even in some cases be strippedoff with more ease than in health, a clear serous fluid flowingaway the while; the grey substance appears pale or anæmic,and somewhat atrophied; and the vessels, especially at the baseof the brain, are beset with atheromatous patches. The degeneration extends into the ventricles, the lining membrane beingthickened, and sometimes covered with fine granulations, andmore or less fluid being effused into them. According toSchroeder van der Kolk, the membrane " covering the corporastriata is most thickened and cannot as a rule be stripped offwithout tearing the commonly softened nerve substance beneath; " this particular change being declared during life byparalytic symptoms, such as trembling of the lips, difficulty ofarticulation, and uncertain walk.The morbid changes in acute insanity, so far as they havebeen discovered, are, then, such as indicate acute hyperemia orinflammation. But whether any changes, and, if any, whatchanges in the nerve- cells themselves accompany the signs ofvascular disturbance, it is not possible to say positively. Certainobservers in Germany have recently spoken of such morbidchanges; they have described the cells as becoming clouded andtheir contents troubled at first, then as having their nuclei increased, and finally as undergoing a rupture of their walls. Thelater changes met with in the brain in chronic insanity seemto resemble those which occur in other organs in consequenceof chronic inflammation and subsequent atrophy and fattydegeneration.Interesting observations have been made upon the absolute460 THE PATHOLOGY OF INSANITY [CHAP. .weight of the brain, and also upon the specific gravity thereofin the insane; but further experiments on these points are yetneeded. Dr. Skae and Dr. Boyd have found the absolute weightof the brain to be slightly increased in the insane, the increasebeing greatest in mania and least in general paralysis. Thelatter observer has discovered that in health the weight of theleft cerebral hemisphere almost invariably exceeds that of theright by about one-eighth of an ounce. * The specific gravity ofthe brain in the insane was found by Dr. Skae and Dr. Sankeyto exhibit an increase as compared with that in the sane; thelowest specific gravity, though still above the average, occurringin dementia, and the highest being met with in epilepsy. Itappears, however, that the mode of death influences the result.Dr. Bucknill, who fixed the average specific gravity of the healthybrain at 1:036, found that in paralysis of chronic character, complicated with insanity, the specific gravity varied from 1· 036 to1046; in paralysis terminating by coma it was 1· 040, and insome acute cases it rose as high as 1· 052; and in paralysis terminating by syncope or asthenia it varied from 1036 to 1039.The increase was ascribable in some cases to a deposit of aninert albuminous matter amongst the proper nervous elements,and to the shrinking of them. This was perhaps a morbid statenot unlike that which has since been more fully investigated byProfessor Albers, and described by him as parenchymatousinfarction of the brain. It is often met with in typhus, andsometimes in cases of insanity, and gives rise to the conditiondescribed as cerebral sclerosis: the brain substance is found tobe more compact and consistent than normal, and on slicing itthe thin layers are tough and unusually elastic. This conditionhas also been met with in imbecile children in whom irregularnutrition of the cranium and the brain has probably ended in asub-inflammatory state. Scrofulous parenchymatous infarctionoccurs sometimes in children and young people of scrofuloushabit, and according to its severity and extent gives rise todifferent degrees of cerebral disorder, which may be arrested, ormay lay the foundation of future insanity. Meckel and othershave recorded instances of induration of the brain in the insane,This is not confirmed by the exact investigations of Dr. Thurnam, Journalof Mental Science, April 1866.Iv.]THE PATHOLOGY OF INSANITY. 461but there was said to be no increase in the weight of the brainsubstance when compared with equal portions of healthy brain,except in a slight degree in one or two examples. A fibrinousor albumino-fibroid exudation amongst the proper nerve elementsis manifestly not an uncommon feature of the degeneration ofextreme insanity, and appears to be strictly comparable with theresult of what is described as chronic inflammation in otherorgans, such as the liver and the spleen . What effect it hasupon the absolute weight and the specific gravity of the brain itmust be the aim of future observations definitely to settle. Therecent researches of Dr. Bastian on the specific gravity of thebrain prove that the specific gravity of different parts of thegrey matter differs considerably in health; so that in the experiments hitherto made on the brain in insanity a most importantconsideration has been overlooked. *A general survey of the foregoing morbid appearances willscarcely fail to leave a conviction of their adequate nature assigns of severe cerebral disorder. Bearing in mind that thevascular disturbance is, in the sequence of events, secondary tothe disordered action of the individual nerve elements, it is,even when only slight, of great significance, and affords sufficientevidence of primary disorder of the delicate nerve element.When it is in a condition of healthy activity, the nerve- cellmaintains certain definite relations with its supply of blood;but when, from some cause, its vital power is lowered and itsfunction disordered, immediately the relations with its surroundings are changed; the blood flowing through the (so tospeak) infected districts feels the effect of the lowered vitality;the vessels dilate, and the blood-corpuscles manifest a tendencyto adhere to one another and to the walls of the vessels; theabnormal vascular injection, not less than the maniacal excitement, testifies indeed to the loss of the natural vital tension andto the manifestation of an inferior activity. Carry the disturbance yet further, or prolong it, and the evidences of vitaldegeneration-in other words, of the resolution of higher intolower forms of life -are still more marked. The increase of theconnective tissue, or the fibrinous exudation, with the atrophy1866.On the Specific Gravity of the Human Brain. -Journal of Mental Science,462 THE PATHOLOGY OF INSANITY. [CHAP.of the proper nerve elements, is as plain evidence of degenerationas is the mental incoherence; and in the difference of dignitybetween the nerve- cell and connective tissue corpuscle thereis a gap as great as that between sound mental activity anddementia.Recent microscopical examinations of the brain after insanityhave added something to our knowledge of its pathology. Themost constant result has been to establish the exuberant production of connective tissue in long standing insanity, and especiallyin general paralysis. It is now known that there is a hom*ogeneous matrix of connective tissue lying between and supporting the nerve elements of the brain, and continuous with theependyma of the ventricles; it appears to be very apt, undercertain circ*mstances, to undergo an undue increase, to the detriment of the proper elements of the part. The researches ofRokitansky and Wedl into the morbid changes in general paralysis made known a more or less diseased state of the capillariesof the cortical substance of the brain. There is a certain tortuosity of the capillaries apparent in almost every case, this beingin some cases only a simple curve or twist, in others amountingto a more complex twisting, and even to little knots of varicosevessels. Dr. Sankey thinks that what Rokitansky and Wedl havedescribed as aneurismal dilatation is really such a varicose knot.Round the capillaries and small arteries and veins there is oftena hyaline deposit of what is supposed to be embryonic connective tissue, beset with oblong nuclei; this afterwards becomingmore and more fibrous, so that the vessel may look like a pieceof connective tissue, in which granules of fat or calcareous matterare occasionally seen. It appears that this growth of connective tissue may have its starting-point, not only from the nucleiof the walls of the blood-vessels, but also from the proper nucleiofthe brain-substance. As a consequence of its exuberant increase,the nerve elements as well as the delicate capillaries are injured or destroyed; " in the grey substance the ganglionic cellsappear inflated, their continuations are undoubtedly torn, andthe nerve-tubes penetrating the grey substance " are destroyed.Rokitansky believes that this is not to be looked upon as animflammatory process, and it certainly is not so in the commonacceptation of the meaning of inflammation. It is important toIv.]THE PATHOLOGY OF INSANITY.463

be aware, however, as Lockhart Clarke and Mr. Robin havepointed out, that in every healthy brain a great number of thecapillaries and small arteries are surrounded by secondarysheaths, precisely similar in all essential particulars to thosewhich have been considered as morbid products in generalparalysis. But Mr. Clarke has observed that the sheaths areoften less delicate in general paralysis; they are thicker, moreconspicuous, and frequently darker than in the healthy brain;and sometimes, especially when the vessels are convoluted, theyappear as fusiform dilatations along their course. Moreover,while in the healthy brain granules of hæmatoisin are commonlyscanty, and frequently absent altogether, they often abound ingeneral paralysis, scattered in some places, collected into groupsin others. In connexion with the hypertrophied tissue arefound amyloid corpuscles, colloid corpuscles, calcareous and fattygranules-all the product of a retrograde metamorphosis goingon. There are, however, two ways in which retrograde productsare formed: first,there is a mal-nutrition, or a retrograde nutritiveprocess, whereby the vitality not being at the height necessaryto the production of the proper elements, there are engenderedfrom the germinal nuclei elements of a lower kind-connectivetissue instead of nerve; and, secondly, there is a retrogrademetamorphosis of the formed elements of the part. The processis essentially one of vital degeneration, whether called inflammation or not; and when we consider the genuine meaning of thepathological changes, they are seen to be in accordance with thesymptoms of mental decay.The results of an elaborate examination ofthe morbid changesin a case in which there was grey degeneration of the brain andspinal cord, by Dr. E. Rindfleisch, may help us to a conceptionof the meaning of the retrograde changes which take place indisease. The patient had died from tabes dorsalis; and in theanterior tracts of the cord, in the fornix, corpus callosum, andcentrum ovale, the continuity of the healthy structure was interrupted by numerous patches exhibiting different degrees ofdegeneration, from a greyish pulp to sclerosity. In the main,Rindfleisch confirms Rokitansky: the process of degenerationOn the Morbid Anatomy of the Nervous Centres in General Paralysis of theInsane. By J. Lockhart Clarke, F. R.S. -Lancet, September 1st, 1866.464 [CHAP. THE PATHOLOGY OF INSANITY.seemed to begin in the vessels, as their walls were enormously thickened by a number of cells and nuclei, and theirdiameter was increased; and this first stage he considers theresult of long enduring hyperemia. The neuroglia, or hyalineconnective tissue, next undergoes change, fibres being formed inthe amorphous basis substance; the nerve fibres then sufferatrophy, lose their medulla, and appear to consist of axiscylinder and sheath, or of axis cylinder only. As they disappear,the connective tissue increases; numerous single nuclei appearin it, as also groups of nuclei, which seem to proceed from thedivision of a single nucleus. Round these groups a certainquantity of finely granular substance collects, so that cell-likebodies are formed, resembling the four-nucleated bodies describedin marrow by Kölliker and Robin. The fibres of the connectivetissue are formed out of the basis substance, Rindfleisch thinks,but are probably developed in organic relation to the nuclei. Ata still further stage, retrogressive metamorphosis sets in molecules of fat appear in the ganglionic cells according to Virchow,and as they increase they form granular bodies, which, however, Rokitansky holds to be produced from the fragments ofthe medulla of the nerve fibres. So also is it, in Rindfleisch'sopinion, with the amyloid corpuscles that are found: thenucleated cells of the connective tissue go through the amyloiddegeneration; and he has watched every stage of the transitionfrom the normal cell to the amyloid corpuscle. When by fattydegeneration the greater number of nerve-cells have been converted into a detritus capable of being absorbed, the fine elasticfibres contract, get closer and closer together, and remain as theconstituent tissue of the cicatrix, which sometimes causes considerable deformity; whole sections of nerve substance havingbeen replaced by a relatively small quantity of an unyielding,compact, dry tissue. There are then three principal stages inthe degenerative process:-(1 ) a change in the vessels, wherebythere must be a great hindrance to regular nutrition; ( 2) atrophyof nerve element, either in consequence of the interference withits nutrition (Rindfleisch), or from the growth of connectivetissue (Rokitansky); and ( 3) the subsequent metamorphosis ofthe connective tissue . ""Histologisches Detail zu der grauen Degeneration von Gehirn u. Rückenmark,Dr. E. Rindfleisch . -Virchow's Archiv, b. vi.Iv. ] THE PATHOLOGY OF INSANITY. 465A very careful microscopical examination of the brains ofthree idiots has been made by Wedl. The changes were such asare usually met with in atrophy of the cortical layers. In thepia mater and the convolutions there was local obliteration ofcapillaries, these sometimes having the appearance of a dirtyyellowish band of connective tissue, which, like other connectivetissue, swelled up and lost its wavy lines in acetic acid. Otherthickenings in the capillaries of the cortical layers he describesas colloid: these were knotty swellings in their course that wereunaffected by acetic acid. Atheromatous degeneration of arteries,veins, and capillaries was more or less marked in all the cases.In one instance the small arteries and veins, and the capillaries,were affected with funnel-like dilatations, owing to a proliferation of nuclei that lay nestled in them; and a transparent basissubstance containing many oval nuclei surrounded the capillariesfor some distance. The ganglionic nerve- cells exhibited somemetamorphosis of their contents in all the three cases; thechange consisting in a condensation of the contents with disappearance of the nuclei-a condition which called to mind thecolloid degeneration of the ganglionic cells of the retina. *It appears, then, that an increase of connective tissue, withatrophy and destruction of nerve element, so far from beingpeculiar to general paralysis, is of common occurrence in cerebraldegeneration of long standing. There can be little doubt thatthe morbid product which is thought to be the result of syphilitic disease is of like nature; and Billroth found a peculiargelatinous degeneration of the cortex of the cerebellum, whichhe met with in one insane person, to consist of soft connectivetissue. This proliferation of connective tissue with destructionof the nerve elements has at any rate been already observed indementia following on continued insanity, in general paralysis, insyphilitic dementia, in tabes dorsalis, and in congenital idiocy.It will be well to enumerate briefly the different kinds ofdegeneration that have been met with in the brain after insanity,to the end that the nature of the retrograde changes may bemore evident:-(a) There is in the most acute form of insanity an acuteHistologische Untersuchungen über Hirntheile dreier Salzburger Idioten,von Dr. C. Wedl: Zeitschrift der K. K. Gesellschaft der Aerzte in Wien, 1863.H H466 THE PATHOLOGY OF INSANITY. [ CHAP.hyperæmia, or an early stage of inflammatory degeneration. Dr.Tigges has recently described an increase of nuclei in the ganglionic cells, and he believes the numerous scattered nuclei,usually thought to belong to connective tissue, to have reallyescaped from ganglionic cells at a later stage of their inflammatory degeneration. *(b) There is that degeneration which consists in the increaseof connective tissue and in the atrophy of the nerve elements.Whether or not called sub- inflammatory, and described as theresult of a chronic hyperæmia, is not of much moment so long aswe keep in mind the true relations of the organic element to thesupply of blood, and also the true degenerative nature of theinflammatory process. It seems indeed to admit of small doubtthat an exudation of a hyaline substance into the parenchyma ofthe brain may take place without any signs of active hyperæmiaor inflammation, and without any of the products of inflammation, the exudation afterwards undergoing more or less fibroustransformation. The vitality of the part is not at the heightnecessary for the due formation and nutrition of the higherspecies of organic element, and organic elements of a lower kindare produced. When the degeneration is greater and moreactive, as it is in advanced inflammation, then elements are produced 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 inthe chronic morbid changes of insanity. Thus much for theconnective tissue degeneration.(c) Fatty degeneration is a retrograde change very frequentlymet with. It may take place either in the smaller vessels ofthe brain, as in atheroma, or in the proper nerve elements, or inthe new morbid products. In what is known as white softeningof the brain, granular bodies are found which are composedprincipally of fat, and which some hold to proceed from thedegeneration of the natural cells of the part, while others maintain that they originate in the morbid products. In the retroZeitschrift für Psychiatrie, b. xx.+ Dr. Meschede, in Virchow's Archiv, 1865, describes the early morbid changesin general paralysis as inflammatory, and the later changes as those of fatty andpigmentary degeneration of the cells.IV. ] THE PATHOLOGY OF INSANITY. 467grade metamorphosis of the hypertrophied connective tissuealready described, fatty degeneration takes place largely.(d) Amyloid degeneration.-It admits of no doubt that thecorpora amylacea, or little starch-like bodies, which are oftenfound in great numbers in the brain, are pathological products.Wedl thinks that they should be ranked with the so- calledcolloid corpuscles, and regarded as indicative of the increasedexudation which may take place without hyperæmia. Rindfleisch, on the other hand, as already stated, believes that hehas traced their production by a gradual transition from thenucleated cells of the connective tissue. Whatever be theirtrue 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 ganglionic cells of the brain in senile atrophy, in dementia, and inadvanced general paralysis. Schroeder van der Kolk found thecells of the medulla spinalis and oblongata to be darker andmore opaque in old age; and in one case of dementia aftermania, where there was partial paralysis of the tongue, theganglionic cells forming the nuclei of the hypoglossal nerveswere in a state of blackish- brown degeneration, so that he atfirst mistook them for little points of blood. On more carefulexamination, however, they were seen to be degenerated ganglionic cells, filled with granular dark brown pigment. Mr.Lockhart Clarke has observed similar structural changes ingeneral paralysis. " These changes, " he says, " consist of anincrease in the number of the contained pigment- granules,which in some instances completely fill the cell . In other instances, the cell loses its sharp contour, and looks like anirregular heap of particles ready to fall asunder. " In regard tothis form of degeneration, certain pigmentary changes that havebeen described in the retina are not without interest. In whatis called-not very philosophically-Retinitis pigmentosa, thereare found scattered over the fundus oculi irregular figures ofdeep black colour, consisting of pigment apparently in thesubstance of the retina. A point of interest with regard tothese cases is, that they often occur in the same family, and areaccompanied by general imperfection of development. Gräfehas observed this degeneration to be often of hereditary occurHH 2468 THE PATHOLOGY OF INSANITY [CHAP. .rence; and Liebreich has pointed out that many subjects of thedefect are, like albinos, the offspring of marriages of consanguinity.More or less imperfection of the mental faculties and arresteddevelopment of the sexual organs usually co-exist; and theconcurrence of mutism and cretinism with Retinitis pigmentosais occasional. Pigmentary degeneration may surely be acceptedas no less certain a mark of retrograde pathological change inthe brain than it is in the retina.(f) Calcareous degeneration.-Granules of earthy matter arecommon enough in connexion with the hypertrophied connectivetissue of long continued and extreme insanity. But cases havealso been described in which calcification of some of the ganglionic cells of the brain has been met with. Erlenmeyer foundthe commissure of the optic nerves hardened by a deposit ofcalcareous matter in the brain of a monomaniac who had diedwith epileptiform convulsions. It had been first depositedabout the small arteries and in the connective tissue; and thecells had afterwards been occupied and made opaque by finegranules of what appeared to be phosphate of lime. Förster, inhis Atlas of Pathological Anatomy, describes calcified cellsfound in the grey substance of the lumbar enlargement of thespinal cord of a boy whose lower extremities were paralysed.Heschl met with what he calls an ossification of cells in thebrain of a patient, aged twenty-six, who had died melancholic:they were in the compact substance surrounding a small hæmorrhagic cavity in the cortical part of the right cerebral hemisphere,Hydrochloric acid dissolved the granular contents, and left thecells with a pale outline in view. * Dr. Wilks believes certainbodies which he found in the brain of a general paralytic, inwhom the small arteries were calcified, to have been ganglioniccells that had undergone calcareous degeneration. Not withoutinterest is it thus to observe, on a microscopical scale, a similardegeneration to that which the whole organism must ultimatelyundergo as the body is formed out of the dust of the earth byan upward transformation of matter and force, so by a retrogrademetamorphosis of matter and correlative resolution of force doesit, 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 Jahrbüch, 1863. + Journal of Mental Science, 1864.Iv. ] THE PATHOLOGY OF INSANITY. 469ferent sorts of degeneration, who reflect on the great gap whichthere is between a calcareous granule and a nerve- cell in theeconomy of nature, or between a connective tissue corpuscle anda nerve-cell in the histological scale, must be constrained toadmit that the difference is not less great than the differencebetween dementia and sound mental action, and can hardlyventure to assert that the morbid appearances throw no lightwhatever on the nature of insanity. Even the slight signs ofhyperæmia in recent insanity are of weighty significance if theirtrue relations are recognised, if they are viewed as results andevidence of that degeneration of individual nerve element ofwhich the mental disorder is also result and evidence, if theyand the insanity are viewed as, what they often are, concomitanteffects of a common cause.3. Morbid Conditions of other Organs. -Amongst the mostfrequent of local diseases met with in the insane, and amongstthe most frequently fatal, are diseases of the respiratory organs.Diseases of the Lungs. -Many insane of low, deteriorated constitution, especially the demented paralytics, succumbto a diffusepneumonia of low type. The usual symptoms, however, arerarely marked, being masked by the madness; there is seldomany cough, expectoration, or pain; no complaint is made; theremay be little or no dyspnoea; and the only ground of diagnosislies in the physical signs. Gangrene of the lung was observedby Guislain almost exclusively amongst the insane who hadrefused nourishment and died of exhaustion , and in as many asnine such cases out of thirteen; but it has been found since histime that the disease is not limited to those who refuse food,although especially frequent amongst them. In the ViennaAsylum there were, out of 602 post-mortem examinations madein three years, fifteen cases of gangrene of the lung. Pain,cough, dyspnoea, and fever are often entirely absent; there isprostration, and the extremities are cold; the complexion isdusky red, or cyanotic; the odour of the sputa and breathbecomes intolerably offensive; extreme weakness is increased bydiarrhoea, and death follows within a period varying from tendays to three weeks.Almost every writer on insanity calls attention to the frequency of phthisis pulmonalis among the insane, although there470 THE PATHOLOGY OF INSANITY. [CHAP.is far from being an agreement as to the proportion of cases inwhich it occurs. A careful comparison of the statistics of severalasylums by Von Hagen showed that on an average about onefourth of the deaths were attributed to phthisis; this proportionreally being about the same as that for the sane populationabove fourteen years of age. Out of 1,082 deaths which occurredin the Royal Edinburgh Asylum from the year 1842 to 1861,phthisis was the assigned cause of death in 315, or in nearlyone-third (Dr. Clouston). In eight of the American asylumsthe 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 carefullymade post-mortem examinations that phthisis was the assignedcause 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 frequentlyassigned cause of death amongst the insane than amongst thesane, but that tubercular deposition is about twice as frequent inthe bodies of the former as in those of the latter.The relations of the phthisical to the mental disease are ofsome interest in a very few cases the outbreak of the insanityseems to benefit the phthisis; in a few more, where the phthisisis chronic, an attack of insanity may be followed by the permanent disappearance of the phthisical symptoms, or attacks ofmania may alternate with exacerbations of the symptoms ofphthisis; but in the great majority of cases, the symptoms ofthe lung disease are merely masked by the insanity, the deposition of tubercle going steadily on.Diseases of the Heart. -Observers, agreed as to the frequencyof their occurrence, differ as to the proportion of cases in whichthey are found: Esquirol found them in one-fifteenth of hismelancholic patients, Webster in one- eighth, Bayle in one- sixth,Calmeil and Thore in nearly one-third. The most reliable observations of late years tend to lessen the exaggerated proportion commonly assumed; out of 602 post-mortem examinationsin the Vienna Asylum, affections of the heart were met with inabout one- eighth of the cases; and in some of these the diseasewas very slight.Iv. ] THE PATHOLOGY OF INSANITY. 471Diseases ofthe Abdominal Organs. -More or less inflammationof the intestinal mucous membrane is not uncommon among theinsane. It is at the bottom of that colliquative diarrhoea whichat last carries off many feeble patients, mostly those sufferingfrom paralytic dementia, but now and then even some who aremaniacal or melancholic. The changed position of the colonespecially noted by Esquirol-the transverse portion of whichlies in the hypogastric region or in the pelvis-is not of anyreal importance or of any special significance.All sorts of disorders of one or more of the abdominal organshave been met with in particular cases, but not in any constantrelation to any particular form of insanity. Rokitansky noticeda considerable increase and induration of the cœliac axis in acase of hypochondriasis with great wasting. Cancer of thestomach, liver, or of some other part, has been discovered incases where there existed during life a delusion with regard tosome animal or man being present in the belly; in one case,described by Esquirol , where delusions of this sort were mostextravagant, there was chronic peritonitis which had gluedtogether the intestines. Diseases of the sexual organs are, asalready pointed out, of some importance in the causation of insanity. In the female, prolapsus of the uterus, fibrous tumourof the uterus, ovarian cyst, &c . may in some few cases impartto the insanity a sexual character, or become the conditions ofpeculiar delusions; but in other cases of like disease there maybe no sort of connexion traceable between the character of theinsanity and the particular disease. Remember only that, byreason of the consensus of parts -the intimate connexion andinteraction between one organ and another as parts of an organicwhole-disorder of any organ must conspire with other predisposing or exciting causes to produce insanity.ITCHAPTER V.THE DIAGNOSIS OF INSANITY.T might seem to be no difficult matter to determine when aman's mind is unsound, and yet the diagnosis is as difficultin some cases as it is easy in others. So imperceptibly doesphysiological function pass into pathological function throughout the organism, that it is impossible to say where one endsand the other begins in the case of any organ: disease is notany mischievous entity that has taken possession of the body,and must be driven out of it as the evil spirit was driven outof the demoniac: it is simply vital action under other conditionsthan those which we agree to call natural or typical. Unsoundness of mind is that degree of deviation from healthy mentallife which it is agreed by the common consent of mankind toregard as morbid. That there should be extreme uncertainty indeciding in particular cases, arises from the fact that variousacts which may be the results of insanity may also be the actsof vicious or criminal persons, in whom there is no reason tosuspect disease. It will not, however, suffice to make it thepositive criterion of insanity, that a man is unable to restrainhis actions; for, in the first place, there are some criminals whoby reason of a bad organization cannot, in face of certain temptations, control their actions; and, in the second place, thereare persons unquestionably insane who are quite capable of controlling their actions, if they have a sufficiently strong motive fordoing so there are some insane persons who are really criminal,on the one hand, and, on the other, there are criminals who arereally insane. The experience of those connected with prisonsproves, that weak-mindedness predominates in the criminalCHAP. V.] THE DIAGNOSIS OF INSANITY. 473population as a class . Mr. Bruce Thomson states that, in theGeneral Prison for Scotland, as many as one in nine, or nearly12 per cent. were positively weak-minded, and that epilepsy isfound to prevail in much larger proportion among prisonersthan in the population at large. Without doubt, there must attimes occur doubtful cases which it is uncertain whether to treatas diseased or to punish as criminal. We are accordingly sometimes placed in a great difficulty, and driven to argue in a viciouscircle. Thus, we infer unsoundness of mind because of thecharacter of the acts; and, on the other hand, it is because wethink there is disease of mind that we pronounce the acts insane. The fact is that every case should be, examined on itsown merits; the previous history of the patient and his presentsymptoms being most carefully studied, and the opinion givenbeing founded on a calm and scrupulous consideration of allcirc*mstances of the case, physical as well as mental. Furnished not merely with psychological theories, but with amedical knowledge of the different varieties of insanity, basedon a large medical experience, we shall be in a position toappreciate the importance of some symptoms, and to interpretthe meaning of others, which would escape the attention ofthose who have not practically studied insanity, and thus atany rate to throw some light on a doubtful case. It is certainlyfar from evident that the popular opinion is correct whichassumes that a rough common sense is best suited to guide thedecision; one cannot indeed but think that special study andexperience of the phenomena of obscure disease must furnishbetter grounds for a just judgment concerning it than entireignorance can. Lord Westbury, speaking as Lord Chancellor, inthe House of Lords, before he fell from the height of placewhich gave a factitious weight to any opinions which he expressed, thought it not unbecoming his high intellectual andofficial position to condemn " the evil habit which had grownup of assuming that insanity was a physical disease, and not asubject of moral inquiry," and to affirm that it was not necessary "that a man should have studied the subject of insanityin order to form a conclusion whether a man was or was not alunatic." It may well be doubted whether a Lord Chancellor• Journal of Mental Science, October 1866.474 THE DIAGNOSIS OF INSANITY [CHAP..ever before gave such complacent and dogmatic utterance to socrroneous, mischievous, and unfortunate an opinion . It wasone which, falling in with and strengthening the current ofpopular prejudice, was received with applause, and did considerable mischief, at the time, but which cannot fail to be remembered with surprise in the future as a striking example of theutter ignorance of the nature of mental disease displayed byone of the greatest legal intellects of his day. But this is notthe place to criticize Lord Westbury, or to combat his opinionsrespecting insanity; we are concerned exclusively with insanityas a physical disease, not with subjects of moral inquiry.Acute mania is not likely to be overlooked, or to be confounded with any other disease. The only doubtful question inregard to it will be in the event of an impostor attempting tosimulate it, or of a drunkard actually simulating it. Certainlyhe must be a clever impostor who can simulate the wild restlesseye, the ceaseless movements, the quick fragmentary associationsof ideas, and the volubility of utterance of acute mania so as todeceive an experienced observer; nor can he, however skilfulan actor, pass days without sleep, and even weeks with only afew hours' sleep, maintaining a continual activity, as the acutemaniac does. The skin in acute mania is dry and harsh, or cooland clammy, but the skin of a pretender who tries to keep upa prolonged muscular agitation will hardly fail to be hot andsweating. Meningitis will be known from mania by its ownpositive symptoms-by the premonitory rigors, when they occur,the cephalalgia, the fever, the contracted pupil, and the intolerance of light; by a muscular activity which is paroxysmal, notcontinuous, and by frequent spasms and convulsions; by theacute severity and incoherent character of the delirium and bythe vivid illusions of the senses; and by the rapid progress ofthe disease either to recovery or to death. Delirium tremenswill be distinguished by its own characteristic symptoms-themuscular tremors, the peculiar fearful illusions and hallucinations, the cold skin, feeble pulse, and the white and tremuloustongue. But there are cases in which positive insanity is produced by drink, and they are sometimes the occasion of greatinjustice being done by our legal tribunals: some persons whohave a strong predisposition to insanity, or who have been oncev.] THE DIAGNOSIS OF INSANITY. 475insane, or who have had a severe injury of the head at sometime, do actually become truly maniacal for a while after analcoholic debauch, or are rendered temporarily maniacal—beingprobably thought drunk-by a very little liquor. Certain it isthat there are persons whom alcoholic intemperance does notmake drunk, but makes mad. In this condition vivid hallucinations are apt to arise, and the sufferer may perpetrate crimenot knowing afterwards what he has done, and certainly at thetime not knowing the nature of the act. On one occasion I wasasked to see in the gaol a respectable builder, who was undergoing imprisonment for a rape on a servant girl under fourteenyears of age, and I was never more convinced of anything in mylife than of the truth of the man's assertion, that he remembered nothing whatever of the crime which he had committed.He had for some time heard voices speaking to him, which hadno existence out of his mind, and he had been continuallydrinking for some days before the crime. There was no attemptat concealment or deception; he spoke with perfect candour;and he still heard voices speaking to him through the ventilatorof his cell. Many such instances have been recorded, and it ishigh time they were recognised by those who preside over theadministration of justice: the common erroneous notion that ifa person becomes furious after intemperance he must be either" mad drunk " or at most have delirium tremens has unquestionably worked much mischief. It admits of no doubt that theeffect of continued intemperance or of a debauch may be agenuine acute mania, marked by active and violent delirium.Chronic mania is the most likely to be feigned, and if feignedwith skill the imposture may deceive many. However, theimpostor generally " o'ersteps the modesty of nature," and overacts his part; he is extreme in the extravagance of what hesays and does, while he falls short of his part in the emotionalexpression of the maniacal countenance. Thinking that alunatic is widely different from a sane person, he exaggeratesand rants, and produces something not like a lunatic. Hepretends perhaps that he cannot remember things, as what dayfollows another, or how many days there are in a week, that hecannot add the simplest figures together, and acts foolishly andanswers stupidly where a real lunatic who was not an idiot476 THE DIAGNOSIS OF INSANITY. [CHAP.would act calmly and answer intelligently. For a person trulyinsane to be as stupid as the pretender represents himself, hemust be completely demented. If a suggestion be made incidentally of some symptom which he ought to exhibit, he mayadopt the hint. The history of the case, and especially of themode of occurrence of the disease and of the circ*mstances ofits development, will most materially aid the diagnosis. Iftherebe no previous history to be had, and if the patient refuse to converse, a long observation may be necessary in order to come to adecision. It is surprising how long an impostor will sometimespersist one man, of whom Dr. Bucknill tells, kept up the practice of insanity for more than two years, and then broke downin his part; and another kept up the appearance of madness solong that it is uncertain to this day whether he was reallyinsane or not. When a man feigns madness so perfectly asto deceive an experienced observer, we may hold, I think, thathe is not far from being the character which he represents;for, unless there be a foundation of real madness beneath thefeigned phenomena, there will be some want of coherence inthem as a whole, and an incongruity with any known form ofmental disease.Hysteria may notably simulate almost every known disease;and when its vagaries are mental rather than bodily, it is noeasy matter to decide at all times whether the patient is hysterical or truly maniacal. The most reliable data to be guidedby will be found in the previous history of the case and thesymptoms which it presents; in the age, sex, and character ofthe patient; and in the presence or absence of the ordinaryhysterical symptoms. A patient who complains of the globushystericus in her throat, and compares the morbid sensation tothe feeling of some animal fixed or growing there, is not insaneon that account, even though she can hardly be persuaded thatthere is not some living thing there; but it must not be forgotten that a genuine mania, acute or chronic, may be occasionedby or associated with hysteria. Not that this often occurs;when hysteria passes into insanity some other cause usually cooperates.It is a difficult matter at times to detect partial ideationalinsanity where the patient is suspicious and tries to hide it. Inv.] THE DIAGNOSIS OF INSANITY. 477the countenance and bearing there may be some sign visiblewhich has its peculiar interpretation, and there are sometimespeculiarities in the dress or actions which, when bottomed, openup a secret mine of madness. Where there is no such guide forthe inquiry, it will be necessary to examine the patient carefullybut 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 seemsto pass hastily over some subject, or entirely to avoid it, he maybe quietly pressed upon it. All this should be done in as quietand polite a manner as possible, without evincing too muchcuriosity, so as to avoid offending his susceptibilities or excitinghis suspicions. Heinroth has said, and it is popularly thought,that the insane will not deny their delusions, though they mayconceal them; that the evidences of their unsoundness willappear when the subjects upon which they are deranged aretouched upon; but this is by no means true of all cases: somewill deny their delusions positively, or even explain them awayas jokes, when they suspect the acknowledgment of them wouldbe injurious. If the patient's self- love is grievously wounded,and he is made extremely angry, he may sometimes, notwithstanding his suspicion, reveal his hidden delusions. Or if he beinduced to write, he may exhibit the plainest evidence ofinsanity, though he has managed to conceal it successfullythrough a long conversation. It is of course necessary to institute careful inquiry into the previous history, in order toascertain whether there is any hereditary taint, and what degreeof it; whether there has been any previous attack of insanity;and whether there has been any observed change of characterand habit, especially after some efficient cause of insanity. Itwill sometimes happen that a patient at the outset suspectsthat he may be thought mad, and is earnest and vehementin accounting for his morbid feelings, and at great pains toconvince others that he is not mad. If a monomaniac believesthat he is watched by spies, followed by enemies, or otherwisepersecuted, he unquestionably is a dangerous lunatic; for at anymoment he may become so impatient of his fancied wrongs asto make a desperate attack on those whom he suspects ofinjuring him. In some cases a sane person may be quite unable478 THE DIAGNOSIS OF INSANITY [CHAP. .to detect any connexion between the act of violence and thedelusion; and yet the connexion exists deep in the unfathomable incoherences of the diseased mind. The pity of it is that,according to English law, where the connexion is not distinctlyevident where the motives of a sound mind cannot be successfully applied to measure the impulses of a diseased mind-theunhappy lunatic must be hanged if his act of violence has beena murder. The monomaniac is not deemed responsible enoughin any case to make a will, however rational it may be on theface of it, but he is deemed responsible enough to do murderand to be hanged, however irrational the deed may be on theface of it.It is usually easy enough to recognise melancholia, as patientsafflicted with it do not care to conceal their unhappiness andtheir delusions. Sometimes, however, a patient having desperate homicidal and suicidal impulses will not only concealbut positively deny their existence, in order to throw thoseabout him off their guard, and to get the means of indulging hismorbid propensities; and instances have happened in whichthis simulation of sanity has been successful, and homicide orsuicide has been the result. Here a lawyer might argue thatthe deliberate concealment of the morbid impulse was ampleproof of a knowledge of its nature, of a consciousness that itwas wrong, and there would be reason in the argument; butwhen he proceeds to the further conclusion that the act istherefore a crime, and the doer of it fully responsible, it is nota logical inference, but a theoretical presumption, unfoundedand unphilosophical. It confounds consciousness of an impulseor act with power of will over it, and ignores the most dangerousand the most lamentable form of insanity. Another melancholic, who cannot entirely conceal his disease, will attributehis depression to the confinement which he is undergoing, andwill assert eagerly that he would be quite well at home. Whena patient has once exhibited homicidal impulse, it is necessaryto observe him carefully for a considerable time before comingto the conclusion that it has left him: when a favourable occasion offers, at an unexpected moment, the horrible propensity,latent for some time and seemingly extinct, may burst forth inviolent action.v.]THE DIAGNOSIS OF INSANITY. 479It may be of importance to distinguish between hypochondriaand melancholia; for a person suffering from the former wouldmost likely be hanged if he committed murder, while the truemelancholic would probably be sent to an asylum. The hypochondriac refers his sufferings to some bodily disorder, for whichthere 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 manydelusions respecting his health or his whole habit of thoughtrespecting 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, andhis feelings are not perverted, apart from questions touching hishealth. The melancholic, on the other hand, attributes hissufferings to some groundless extraneous cause, which eitheroperates 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 medicinecan do him no good; he is often suicidal; his affective life isprofoundly implicated, and he is incapacitated from intellectualactivity notwithstanding there may be no marked intellectualderangement apart from the delusion. Still it is true thathypochondriasis may pass into true melancholia, as well asco-exist with it, and a hypochondriacal depression, especiallywhen associated with some actual bodily disease, may rise tosuch a pitch as to render the sufferer irresponsible for his acts.Aquestion sometimes arises in civil and criminal trials as tothe distinction between eccentricity and insanity, the attemptperhaps being made to prove an eccentric person to be insane,or to prove an insane person to be only eccentric. Nowbetweengenuine eccentricity of character and insanity there is a widedifference; the confounding of them can only proceed from aslavish conformity to that fashion of thought and action throughwhich the original man of any epoch is so apt to be thoughtmad. The truly eccentric man has a strong individuality, whichis expressed in all his doings, and stamps them clearly; he hasbut little vanity, for he is emancipated from vulgar prejudice,and heeds not the world's praise or censure; he knows thatthe world has ever censured great works at their birth, and480[CHAP.THE DIAGNOSIS OF INSANITY.would gladly have uprooted thein during their early growth, andis not therefore greatly moved by its multitudinous outcry; hehas broad and original views and great moral courage; he differsfrom the majority, perhaps, because he has outgrown the habitsand superstitions to which it is in bondage. Such a man hasnothing insane about him, nor is he ever likely to become insane.There is, however, a weak affectation of eccentricity which is notunlikely to end in madness: " with it are infected certain feebleminded beings, often badly bred or badly trained, who are emptyof any true individuality, but inflated with an excessive vanity;who have a small intellect, which they use in the service of theirpassions; who do silly and eccentric things, not unconsciouslyas the spontaneous expression of their nature, but out of amorbid craving to attract notice; who represent a condition ofmental derangement that is the forerunner of insanity; whowhen they are not given up to sexual excesses are often masturbators. "When called upon to give an opinion upon a case in whichvicious or criminal acts are supposed to indicate insanity, it isnecessary to go back carefully through the previous history, andto search for any efficient cause of mental disease, such as greatmoral shock, or physical injury, from which the vicious acts maybe logically traced through changes of character, feelings, andhabits. Has any marked change of character occurred after asufficient cause of insanity or after a former attack of undoubtedinsanity? No one in his senses would assume vice or crime,however extreme, to be positive proof of insanity; to connect itwith disease it must be traced back through a chain of morbidsymptoms, marking the existence of a cause more serious thanevil passion; it is important, therefore, not to confine attentionto the prominent symptom, but to traverse carefully the wholeaffective life, in order to discover the evidences of the perversionof nature detectable in a case of true moral insanity, and toconnect the morbid change with an efficient cause of disease. Itis most necessary also to have careful regard to the social circ*mstances of the person, in order to give their proper weight tothe supposed indications of insanity. When a person in goodsocial position gets into the police- court for stealing some articleof trifling value, a suspicion cannot fail to arise as to his mentalv.] THE DIAGNOSIS OF INSANITY. 481state; and as a matter of fact it will probably be found onexamination that he exhibits other early symptoms of generalparalysis. In another case, an unaccountable perversion offeeling and conduct may be finally explained by the occurrenceof epilepsy. In a third, perhaps a strong hereditary taint, hithertolatent, has been observably brought into mischievous activity byrecognisable mental or bodily causes. Or there has been a notabledegree of imbecility, intellectual and moral, from birth; someacts of instinctive cruelty, destructiveness, theft-of moral perversion in all its forms, being truly the acts of moral imbeciles.When the question of the existence of an irresistible impulse is raised in any case of homicidal or other kind ofviolence, it is above all things necessary to keep in view thepossibility of the person being afflicted with epilepsy, eitherin the form of epileptic vertigo or in its convulsive form.Assuredly the epileptic, who is not insane in the intervalsbetween his fits, must be considered amenable to the laws likeany other person. But if he has committed a murder withoutany discoverable motive, without advantage to himself or to anyone else, without premeditation, openly, and in a way quitedifferent from that in which such a crime is usually committed,then it would be an unjustifiable and cruel thing to take noaccount of his unquestionable disease, and a barbarous act toexecute him as a common criminal. In such a case, saysProfessor Trousseau, " I have the right of affirming before amagistrate that the criminal impulse has been the result, almostto a certainty, of the epileptic shock. I would say almost if Ihad not seen the fit; but if I myself or others had seen a fit oran attack of vertigo immediately precede the criminal act, Iwould then affirm most positively that the culprit had beendriven to the crime by an irresistible impulse. " But even thoughno epileptic fit has preceded the violence, a motiveless andentirely unaccountable crime in a person who has once had, oris subject to, epilepsy should arouse attention to the possibilityof 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 notbe admitted in a case merely because a murder has been donewithout any discoverable motive. The celebrated instance ofI I482 THE DIAGNOSIS OF INSANITY. [CHAP.Henriette Cornier, which is so frequently referred to as a pureexample of homicidal insanity, should certainly act as a warningagainst a too hasty conclusion: it was not until years after shehad murdered her child and had been pronounced insane by thehighest medical authorities in Paris, that it was discovered thatthe deed was done in order to be revenged on her lover who hadmarried another woman; and even now writers on insanity constantly quote her case as an illustration of homicidal insanity,without ever having heardof the motive finally confessed . Ifthere be any suspicion or allegation of homicidal insanity in aparticular case, the most careful inquiry should be made into theprevious history, in order to ascertain whether there has beenany former attack of insanity, whether there is a strong hereditary taint, whether there have been any epileptic fits, whetherthere has been deep melancholic depression, or whether there isevidence of monomaniacal delusion, obviously connected, or not,with the act of violence. It is only in a comparatively few instances that homicidal impulse exists by itself, and constitutesthe disease. Certainly it will be right to view with extremejealousy and suspicion any attempt to obtain the acquittal of amurderer on the ground of insanity, when there is no evidenceprocurable of mental unsoundness before or after the crimewhen, in fact, the crime itself is the only evidence adduced.There is no difficulty about the diagnosis of general paralysisafter it has passed its earliest stage. "It is not always easy ofdiagnosis before the physical signs appear; and yet a man mayat this stage get into trouble -get into the police- court, or getmarried foolishly-entirely by reason of the disease. It isnecessary to weigh carefully the character of the act-whetherit is anywise explicable, or is motiveless and quite unaccountable to mark well the state of the patient's articulation underexcitement or after a sleepless night, and to attend to his happyframe of mind and to the great exaggeration and generalextravagance of his conversation on all matters concerninghimself, even when there is no fixed and positive delusion.General paralytics in the early stage sometimes speak soextravagantly and absurdly regarding things which they haveseen, or events in which they have been concerned, that aninexperienced person might be apt to put down the whole as av.] THE DIAGNOSIS OF INSANITY. 483delusion. It is needful to bear in mind that there may be somefoundation of fact in what they say of themselves-that theydo not at first so much invent as outrageously exaggerate. Itis needful also to remember the alternations of calmness andapparent sanity which occur in the early course of the disease."*If there be no extravagance of thought, and no delusions ofgrandeur, at the outset of general paralysis, and especially if thedisease take that form in which there is a gradually increasingfeebleness of mind, great caution will be necessary before comingto a conclusion. I have known a patient under these circ*mstances to be suspected of indolence and accused of imposture,when he was really in the first stage of this most fataldisease. The character of the articulation should be closelyobserved, and any indication of weakness and confusion of mind,of change of character and of increased irritability, should becarefully noted; if there be a certain hesitation and slowness ofspeech, a loss of memory, and an appreciable confusion of ideas,-if the patient be unable to do successfully some work whichat one time he could do with great ease,--and above all if therebe on his part an entire unconsciousness of these symptoms, andperhaps a denial of them when they are pointed out to him,then it is almost certain that he is the victim of incipientgeneral paralysis.NOTE.In an excellent chapter on the Diagnosis of Insanity in the Manualof Psychological Medicine, Dr. Bucknill makes the following remarkstouching the mode of examining a patient: -" After testing thefundamental faculties, the attention, the memory and recollection,and the judgment, which may be done by ordinary conversation onany subject, it will be well to give up the idea of any metaphysical orphrenological system of mind, and to conduct the further examinationupon 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 bodyand mind, with reference to health, to exercise, diet, and study.Thousands of delusions are entertained by insane people upon thesesubjects. He may then be led to converse respecting his possessions,his means of livelihood, and his hopes of advancement in rank orFrom the Author's article on Insanity in Reynolds's System of Medicine, vol. ii.112484 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 hisnear relatives and friends, and especially respecting his birth andparentage, stress being laid upon his belief whether his parents werehis actual and real parents. This inquiry will tend to open up anydelusions respecting imaginary greatness, and any perverted emotionstowards those who ought to be dear to him. The subjects of religiousopinion may then be introduced. The religious devotions and exercises which he practises may be inquired into, with the reasonableexpectation of finding insane delusions on a subject which touches thedeepest sentiments of the soul. If the patient is an educated man, itwill be right to converse with him upon politics and science. If hecan stand the test of a discriminating inquiry on these and similarsubjects, he certainly cannot be the subject of mania; and if he hasany delusions, he must either retain the power of hiding them, or theymust exist in some obscure corner of the brain, from which they arelittle likely to influence, with any force, the opinions, the feelings, orthe conduct. "WHACHAPTER VI.THE PROGNOSIS OF INSANITY.HAT danger there is to life, and what probability there is ofrecovery, are the two questions of almost equal momentwhich press forward for determination in any case of insanity.In respect of the first question, it may be said that, thoughinsanity certainly does upon the whole reduce the mean durationof life, and much more so in its recent acute forms than in itsmore chronic forms, yet it is not in the majority of cases adisease 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 withinthe first three months. General paralysis passes steadily to afatal ending in the great majority of cases, and usually so withintwo years from its commencement. Now and then an instance ofrecovery has been mentioned, but it has seldom been allowed topass unquestioned: the periods of calmness and lucidity whichintervene in the early part of its course have been too favourably interpreted. Both acute mania and acute melancholia sometimes end fatally in a sudden manner by exhaustion , especiallywhere a persistent refusal of food has accompanied continuedexcitement, agitation, and sleeplessness; the prognosis in suchcases being very much influenced, for better or worse, accordingas food is taken or not. In these cases an advanced age alsoinfluences the prognosis unfavourably: acute excitement withrefusal of food in an old person, especially when the deliriummounts up until all reflection is lost-until the mania becomesthe ego-is almost sure to be fatal. When the temperature of the486 THE PROGNOSIS OF INSANITY. [CHAP.body rises some degrees above the natural standard, it is asymptom of bad omen; for, though it may not indicate an immediate fatal termination, it marks increasing organic mischiefthat 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 inthe 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 somedegrees during the exacerbations, sinking afterwards to itsnatural standard. It would cause no surprise if convulsionsensued during any of these attacks, and death soon followed ,though they may go on being repeated for months before suchan end comes. Any indication of motor paralysis, or any kindof hybrid epileptiform convulsion, or even a recurring subsultusin the muscles of one arm, is of evil omen; but an attack ofgenuine epilepsy, though unfavourable as regards the prospect ofrecovery, is not so as regards life. Where there is nothing inthe disease itself to directly endanger life, the patient may stilldie from exhaustion when a persistent steady refusal of foodhas not been overcome. In melancholic patients afflicted withsuicidal impulse, as many of them are, an unremitting andwatchful care will be necessary to prevent a self- inflicted death.What probability there is of recovery in a particular case willdepend greatly upon the duration of the disease, upon the causeof it, and upon the form which it takes. As a general rule, themore recent the outbreak the better is the chance of recovery;the expectation of which, when proper treatment has beenadopted from within three months from the commencement,is about four to one, while it is hardly as much as one to fourafter the disease has lasted twelve months. Undoubtedly theredo occur instances in which patients recover after being insanefor years, but they are exceptional: when a pathological habit.has been thoroughly established in the mind, it continues almostas naturally as the normal physiological habit. The hope ofrecovery 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 foundthat melancholia is the most curable, acute mania coming nextVI.] THE PROGNOSIS OF INSANITY. 487in order. Recovery often takes place in simple melancholia inthe course of a few weeks or months; and it may sometimestake place when the disease has lasted for years, if the surroundings be entirely changed, and some strong incentive to exertionbe supplied. When the maniacal fury is subsiding, the prospectis good if the patient is sad and depressed, begins to inquireabout his family, friends, and business , and to evince other signsof a return to his former feelings and interests; it is bad if thefeelings remain unmoved and the intellect is calm in its disorder-if, in other words, there is evidence of the organization ofdisorder. Even the disappearance of intellectual derangementis not a certain sign of recovery unless there is a return to theold healthy feelings, and the patient is conscious that he hasbeen insane; if this happy change does not take place, a recurrence of the attack may be looked for. And a periodical recurrence of the attacks is of extremely unfavourable augury; theattacks becoming longer, the intermissions bricfer, and thedecline to dementia being often steadily certain. Still instances do occasionally happen in which recovery takes place inrecurrent mania of long standing. I call to mind one markedexample in a patient who had been confined in an asylum forupwards of three years, and on whom, as he was thoughtincurable, a commission in lunacy had been held; he ultimatelyescaped from the asylum, and got off to America; and aftersome months returned to England, and took steps successfullyfor superseding the judgment of the commission. It was nottill two years after this that he broke down again. He was aman of very active mind and energetic character, and therecould be no doubt that the restraint, monotony, and idleness.of life in an asylum positively favoured the recurrence of themaniacal outbreaks; which, on the other hand, were warded offby the freedom, variety, and bustle of an active life. Such aninstance might well raise a reflection respecting the value of themode of dealing with insanity according to the principles now infashion; but let that pass for the present. A day of depressionand weeping intervening in the course of acute mania is of goodomen; but when attacks of mania and melancholia regularlyalternate, the prognosis is very unfavourable.Chronic mania and monomania, once they are established,483 THE PROGNOSIS OF INSANITY. [CHAP.allow very small hope of recovery. In rare instances it maytake place under the influence of systematic moral discipline, orin consequence of some great shock to the system, which maybe due either to a strong emotional affection or to the effects ofsome intercurrent disease. Where there is a fixed delusion in amelancholic patient that the cause of his misery is in someexternal agency, the prognosis is unfavourable; but it is morefavourable in the melancholic who attributes his suffering toimaginary backslidings of his own. In like manner the homicidal patient who believes himself the victim of persecutionseldom recovers, while the suicidal patient generally doesrecover, particularly after some serious and all but successfulsuicidal attempt. In moral insanity the prognosis is bad; thesymptoms commonly indicating the tyranny of a bad organization. Acute primary dementia is in most cases curable byproper treatment applied in due time. General paralysis isincurable.When insanity has been slowly developed, the prognosis isless favourable than when it has been of sudden origin. Thereason of this will appear when we reflect that it is usually,when slowly developed, produced as an exaggeration of somepeculiarity of character, and marks the establishment of adefinite type of morbid action of a chronic nature; but that,when suddenly caused, it is produced by some severe moral orphysical shock, and may indicate no more than the disturbanceof the mental equilibrium. For a like reason a frequent alternation of symptoms of active disease is more hopeful than a steadypersistence in a particular group of quiet symptoms. Thepopular belief that hereditary insanity is not likely to get wellis not warranted by experience; but the disease is more likelyto recur than when it is not of hereditary origin . In the acutemania sometimes produced by drunkenness the prognosis isgood; it is bad in those cases in which a continued steadyintemperance, associated sometimes with hereditary predisposition, has resulted in mental weakness or dementia. After twoor three attacks of delirium tremens, the mind is sometimeshopelessly weakened, the memory impaired, the moral feelingblunted, and the energy of character lost; all that is left ofmental power is a considerable cunning. When insanity hasvi.]THE PROGNOSIS OF INSANITY. 489been caused by habits of self- abuse or by sexual excesses, theprognosis is unfavourable in all but the earliest stages. If religious excitement purely has been the cause of an outbreak,recovery may be looked for with confidence; but where religiousdisplay is the garb which a pride or vanity of disposition hasassumed, the outlook is very unfavourable. Where disease ofbrain, or injury of the head, or epilepsy, has been the cause ofthe mental derangement, it is practically incurable; but whereit occurs during the decline of some acute disease, it is generallysoon curable. The prognosis is favourable in hysterical insanity;it is even more favourable in puerperal mania and in the insanityof lactation, and this though there may have been previousattacks after confinements. Indeed, when two or three previousattacks of insanity have been recovered from, there is alwaysgood ground of hope of one more recovery, though the final issuewill probably be dementia. We may generally look for a happyissue in the insanity of pregnancy, distressing as the derangementis while it lasts. I have seen no reason to believe that parturitionexercises any specially favourable influence on the disease; inone case, indeed, a lady became much worse after her confinement, finally refusing food entirely, and dying of exhaustion. Adecidedly bad symptom is a fixed hallucination, as is also a complete preservation of bodily health along with a persistence ofthe mental disorder: when there is palpable bodily disorder, asdigestive disturbance, anæmia, menstrual irregularity, there isgood hope that, with the restoration of bodily health, the mindmay be restored also. Climacteric insanity not unfrequentlyterminates in recovery, though it is apt to last some time, but itoccasionally passes into dementia. When insanity is associatedwith ovarian or uterine disease, it is not likely to get well unlessthe ovarian or uterine affection can be cured. The prognosis isfavourable in metastatic insanity. where the derangement hasfollowed the suppression of an eruption or an accustomed discharge. When insanity is associated with phthisis, the prognosisis unfavourable both as regards recovery and as regards life;diseases of the respiratory organs, among which phthisis holds thefirst 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 be490 THE PROGNOSIS OF INSANITY. [CHAP.looked for in pure syphilitic mania of recent origin; but whenthe disease presents any symptoms of dementia or indicationsof paralysis, the outlook is very gloomy.The most favourable age for recovery is youth, the probabilityof it diminishing with the advance of life, and few recoveringafter 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'stables. The recoveries among women exceed those among men,owing probably to the frequency and fatality of general paralysisamong men.The broad conclusion which Dr. Thurnam came to on thebasis of his careful statistics was that, " as regards the recoveriesestablished during any considerable period-say twenty yearsa proportion of much less than 40 per cent. of the admissions isunder ordinary circ*mstances 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 recovery from the first attack cannot, he thinks, be estimated atless than 50 per cent. , or as one in every two cases dischargedrecovered . On the whole, then, he holds that of ten personsattacked five recover, and five die insane sooner or later. Of thefive recoveries not more than two remain well during the restof their lives; the others have subsequent attacks, it may beafter long intervals, during which at least two of them die.The apprehension, then, which the public have of persons whohave once been mad, as if they might at any moment relapseinto their malady, is natural and well founded. The susceptibilities and the impulses of character which issued in the firstattack, remain the same-the personality is not changed; andthere is in addition the acquired aptitude generated by thederanged function-an aptitude prone, under unfavourable circ*mstances, to become a habit.In concluding this chapter I cannot forbear remarking that ininsanity, all question of the intrinsic nature of the disease putaside, the prognosis is often materially influenced by extraneouscirc*mstances the behaviour of those relatives and friends ofthe patient who are most nearly interested in him. It admitsOn the Statistics of Insanity, by J. Thurnam, M. D.VI.] THE PROGNOSIS OF INSANITY. 491of no doubt that in some cases the eager impatience, the restlessanxieties, the meddlesome interference, and the disagreements.of friends thwart the best efforts of the physician. Sincere andsound advice, founded on experience, is not adopted, or, if adopted,not steadily followed; meanwhile that time in which there isthe best hope, and sometimes the only hope, from treatmentpasses; and the period of recovery is delayed, if the progressof it be not permanently arrested. It is not an unwarrantableassertion to make, that some insane persons have owed their lifelong mental affliction to the injudicious conduct of those towhom they were most dear.ITCHAPTER VII.THE TREATMENT OF INSANITY.T may be safely said that in no other disease are the difficultiesof treatment so great as they are in insanity; for they are notonly difficulties appertaining to the nature of an obscure disease,but they are increased and multiplied by the social prejudicesattaching to it; by the frequent concealment and misrepresentation, witting and unwitting, on the part of the friends ofa patient; by the unsatisfactory character and position of theinstitutions especially established for the reception of insanepersons; and, in some measure also, by the tendency of recentlunacy legislation, which has suffered not a little from popularpanic and professional philanthropy. The practical result oflaws eagerly and hastily made under the influence of popularexcitement and clamour has unquestionably been in some respects prejudicial to the true interests of the insane. The landhas been covered with overgrown and overcrowded asylums towhich almost the whole lunatic population of the country hasbeen consigned, while the greatest difficulties have been put inthe way of the early treatment of insanity. No one who hashad experience of the working of the Lunacy Acts in Englandcan feel altogether satisfied with the results. That there hasbeen a steady increase of 1,000 patients a year in the asylumsof England and Wales during the last fifteen years may be goodevidence of the close supervision exercised over them, but it isnot convincing evidence that all has been done which can bedone to secure the best medical treatment of those who arecurable and the greatest comfort of those who are incurable.It would not be difficult to show that the iniquities practisedupon the insane in olden times, the countless unnecessary andCHAP. VII. ] THE TREATMENT OF INSANITY. 493cruel sufferings which they underwent, originated fundamentallyin the shame, horror, and dread of insanity which still infect thepublic mind. Whether these unjust feelings were legacies fromthat ancient superstition which looked on an insane person astormented with an evil spirit, in consequence of some great sincommitted by him or his parents, it is needless to inquire here;suffice it to say that the cruel feelings of suspicion and fearinspired a most cruel practice. To shut the insane up from gaze,and, if possible, from memory, to be rid at any cost of theiroffending presence, that was the one thing to be done, and fitimplements were not wanting to do it. Consequently it happenedthat infinite cruelties grew up and flourished under the influenceof false views and hostile feelings with regard to them; andto be the victim of the most pitiful of diseases became a reason,not for undergoing proper medical treatment, but for enduringthe severest punishments. The memory of this iniquitouspast is thought to justify, and certainly strengthens, the publicjealousy of asylums and of those who superintend them now;they are weighted with an inherited odium; and a stringentlegislation, designed to mitigate the uneasiness of the public conscience on account of the real horror of the insane which isstill felt, and to condone past sins, does not conduce altogetherto their best interests.It is by no means an unnecessary thing to watch carefullyany public action taken in regard to the insane; for it is verycertain that the people have not been in times past, and arenot now, their true friends: the vulgar fear or horror of themhas always prevented that, and the social disgrace thought toattach to insanity still prevents a genuine reform of opinion.How often did Pinel appeal, and appeal in vain, to the authoritiesbefore he was permitted to make the experiment of removingthe chains from a few lunatics, and of treating them with kindness and consideration! Against what an embattled phalanx ofobstructive prejudices, selfish indifference, and interested opposition did the humane system of treatment, the conception andrealization of which were not with the people but in spite ofthem, win its slow way to general adoption in this country! A fewearnest members of the medical profession, inspired by benevolentfeeling, but little aided from without, clung to the drooping494 [CHAP.THE TREATMENT OF INSANITY.standard, and, animated with firm conviction and nerved by asublime determination, bore it onward to triumphant victory.The names of Pinel and Conolly, the great and victorious champions of the humane reform, will ever be remembered withgratitude and honour. But, alas! while men accept and praisethe reforms that have been accomplished, they fail not to opposeand despise those which are to come. What a terrible outcryis now raised by an alarmed and angry public when some poormadman who has committed homicide in a paroxysm of hisfrenzy is permitted to pass the remainder of his unhappy life inconfinement instead of being hanged forthwith! How manyveritable lunatics are year after year executed in obedience toignorant and unrighteous judgments inspired by the popularprejudice! When the superintendent or proprietor of an asylumsends a few of his patients to the seaside, to reside there for ashort time, how frequently does it happen that the whole neighbourhood rises in rebellion, and hastens to protest against theoutrage thought to be practised upon it! And when the protesthas been unsuccessful, with what a singular consideration doesthis public, so eagerly censorious of those who have the difficultcharge of the insane, behave with regard to them: it stares atthem, points at them, perhaps follows them at a distance, asthey take their walks, exactly as if they were so many wildbeasts, and no longer brothers, sisters, fathers, and mothers!To be a lunatic, as public sentiment goes, is to be cut off sociallyfrom humanity. With such feeling prevalent with regard to theinsane, can it be thought possible that the treatment at presentsanctioned by general approbation should be the most just andhumane possible? The feeling is one that cannot be justified,and the system which it inspires cannot be just. That systemis the system of indiscriminate sequestration -of locking up aperson 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 principle, as I shallnow endeavour to show. The principle which guides the presentpractice is that an insane person, by the simple warrant of hisinsanity, should be shut up in an asylum, the exceptions beingmade of particular cases. This I hold to be an erroneous principle. The true principle to guide our practice should be this, —VII.] THE TREATMENT OF INSANITY. 495that no one, sane or insane, should ever be entirely deprived ofhis liberty, unless for his own protection or for the protectionof society. Therefore, instead of acting on the general principleof confining the insane in asylums, and making the particularexceptions, we ought to act upon the general principle of depriving no one of his liberty, and of then making the numerousexceptions which will undoubtedly be necessary in the cases ofinsane persons, as in the cases of criminals. We imprisoncriminals in order to punish them, to reform them if possible,and to protect society from their vices: in dealing with theinsane, who are suffering from disease, there can be no questionof punishment, but we confine them in order to apply propermeans of treatment, and to cure them, if possible; and, secondly,to protect themselves and society from their violence. If anyone says that, on the admission of these principles, the practicalresult as regards the insane would be very much what it is now-for they would actually embrace so many of them that theexceptions would be few-I confidently question the assertion;I venture, indeed, to affirm in opposition to it, that there aremany chronic and incurably insane persons, neither dangerousto themselves nor to others, who are at present confined inasylums, and who might very well be at large. But they arekept in asylums because they have been once put into them;because it is sometimes desirable that their existence should notbe known to the world; because they cost less there than theywould if in private houses; because they are well taken care ofthere; because it is heedlessly taken for granted that it is noinjustice to confine them thus so long as they are mad; and formany other like reasons. But the fundamental reason whichinspires all these other reasons, and without which they wouldwant firm root, is, that the world has grown to the fashion ofthinking that madmen are to be sequestrated in asylums, andcannot now, with every desire to be sincere and unbiassed, conceive the possibility of a different state of things. Even thosedevoted men who laboured so well to effect the abolition ofrestraint within asylums never dreamt of the abolition of therestraint of asylumns.I know well the objections, some fanciful and some weighty,that may be made to the doctrine just propounded. It may be496 THE TREATMENT OF INSANITY. [CHAPsaid that some insane persons go on very well in asylums whowould go on very badly out of them, and that it is not possibleto 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 whomit does not apply, some, however few they may be assumed tobe, of whom it can be said, with as much certainty as it can besaid of any experience in nature, that they are not, and neverwill be, dangerous to themselves or others; secondly, that it isnot true that the difficulty or impossibility is so great and wideas assumed by the objection, for practically there is no moredifficulty to an experienced person in deciding that a patient isnot dangerous to himself or others than in deciding that he isthus dangerous-which is a thing which every physician whohas to do with cases of insanity must constantly do, and which,with a few exceptions, he feels that he can do with perfect confidence; and, thirdly, that the objection might be valid if it wereproposed to leave the insane not in asylums without any sort ofcare and control, which never was proposed, and that its wholeforce, therefore, lies in an assumption which is an unfoundedone. It is a curious commentary upon this objection, that manyof the insane who are really most dangerous to others are notsent to asylums now; they appear to be so slightly affected inmind, exhibiting no incoherence nor frenzy, that the ordinarypractitioner will not certify that they are of unsound mind. Amelancholic mother, who is thought to be simply low- spiritedand is not interfered with, kills her children to save them, asshe supposes, from misery on earth, or to send them to happiness in heaven. Or a man, having the delusion that he isdeceived and dishonoured by his wife, goes steadily about hiswork, 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 advocated will be, that the insane in private houses will not be sowell cared for as they are, nor have any more comfort than theynow 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 actuallydone in asylums.vu.]THE TREATMENT OF INSANITY. 497this objection is urged taints it with suspicion: I never heard itput forward but by those who are interested in the continuanceof the present state of things. Those who make it appear tofail entirely to appreciate the strength of the passion for libertywhich there is in the human breast; and as assuredly there arebut very few persons who would not infinitely prefer a garretor a cellar for lodgings, with bread and water only for food,to being clothed in purple and fine linen and to faring sumptuously every day as prisoners, I can well believe that allthe comforts which the insane person has in his captivity arebut a miserable compensation for his entire loss of liberty, -that they are petty things which weigh not at all against themighty suffering of a life-long imprisonment.I would putit to those who lay stress on the comforts of asylums, whetherthey sufficiently consider the discomforts of them, apart fromthe imprisonment which they are by the nature of the case.Is it not a common thing to hear from an insane person bittercomplaints of the associations which he has in the asylum,and of the scenes of which he is an unwilling witness-sceneswhich cannot fail to occur, notwithstanding the best classification, where all sorts and conditions of madness are congregatedtogether? What, again, can be conceived more afflicting to aman who has any intelligence and sensibility left, than thevulgar tyranny of an ignorant attendant-a tyranny which thebest management cannot altogether prevent in a large asylum?And I might go on to enumerate many more of the unpreventiblemiseries of life in an asylum which, when superintendent ofone, forced themselves painfully upon my attention, and oftenmade me sick at heart. What compensation do a few cheapengravings hung on the walls of the rooms to make them lookcheerful, or the privilege of being present at a theatrical entertainment where officials and their friends enjoy the gratificationof exhibiting their powers before an audience which listensapathetically, afford for the loss of that which any one, howeverlow he may be fallen, prizes beyond all else-for the loss of hisliberty? Those who advocate and defend the present asylumsystem should not overlook the disadvantages; they should notforget that there is one point of view from which they whoorganize, superintend, and act, regard the system, and that thereK K498 THE TREATMENT OF INSANITY. [CHAP.is another point of view from which those who are organized,superintended, and suffer, view it. It is natural and justifiablefor one who has brought into excellent order a large institution,and holds by his controlling mind its different parts in wellbalanced movement, to feel proud of his work, and to contemplate with satisfaction the thorough organization of the whole;but he should surely take much heed lest that very pride ofsuccess and the strong interest which he feels blind him to itsdemerits. This cannot fail to be more or less so, human naturebeing what it is: should not a man most mistrust himself whenhe is most satisfied with himself? Have not the most grindingtyrannies which the world has ever seen been the best organized? It is necessary to pause before accepting this argumentof the comforts of asylums from those who superintend or keepthem; the most sincere person cannot help being unconsciouslybiassed in such case. I am not ignorant, however, of the factthat there are some chronic lunatics who have been in asylumsfor so many years that it would be no kindness now to removethem-who have indeed so grown to the habit of their lives thatit would be cruel to make any change; but I hold that to be noargument for subjecting any one else to the same treatment inorder to bring about the same result: it is not the past conditionbut the future welfare of the insane that is the matter in hand.Human nature is so constituted that it grows to the conditionsof life in which it is placed; but every one would admit it to bea poor argument in favour of unjust confinement in prisons, thata prisoner unjustly confined for years has been very unhappywhen released, and has prayed to be sent back to his cell andto the mice with which he had made friends there. Anotherobjection will be, that if you subject a patient to systematiccontrol outside an asylum, you do actually deprive him of hisliberty quite as much as by putting him into an asylum. Suppose this were granted, it is still open to us to maintain that hewould be happier amongst sane people, and under the circ*mstances of private life, than when surrounded by all degrees andkinds of lunacy, and subjected to the monotonous routine andoppressive regulations of an asylum. But I do not admit thejustice of the objection. Let it be clearly understood that Iam not advocating the placing an insane patient alone in aVII.] THE TREATMENT OF INSANITY. 499cottage with one or two attendants; in such case I readilyadmit that he is subjected to the most odious kind of tyrannyand to a deprivation of liberty in its worst form-that he wouldbe a thousand times better off in a well- conducted asylum, andcertainly could not be worse off in the worst asylum. I amarguing distinctly in favour of placing in private families certain chronic insane persons who are fitted for a more liberaltreatment, where after a time they become truly a part of thefamily, and are considered in all its arrangements, not otherwisethan as a member of it afflicted with some incurable bodilydisease would be. In such case the loss of liberty is by no meansequal to that in an asylum, where the occasional indulgences ofa certain freedom granted only serve to lighten up the presentmisery 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 itshould be; no thought has been given to it by anybody; andthey have suffered from the erroneous views concerning insanitywhich have prevailed in the public mind. But the same thinghappened in asylums at one time. They were abodes of cruelsuffering to the patients; and many people, not wanting in kindfeeling, thought that they must continue so by the nature of thecase. But they are no longer so now; in them more enlightenedviews with regard to insanity arose and spread, and a greatpractical reform has been effected, the completeness and excellence of which have become a positive difficulty in the wayof any further reform in the treatment of the insane. Is there,then, let it be demanded, any insurmountable reason why similarly enlightened views should not be inculcated on those whodesire to receive single patients into their houses, and a similarbeneficial reform should not be effected? That there is not isshown satisfactorily by the reports of the Scotch Deputy Commissioners in Lunacy on the condition of the pauper insane inprivate dwellings in Scotland. * A few years ago these persons

• Eighth Annual Report of the General Board of Commissioners in Lunacy

for Scotland, 1866.See also an exhaustive and conclusive paper " On the Care and Treatment ofthe Insane Poor, " by Dr. Mitchell, Deputy Commissioner in Lunacy for Scotland Journal of Mental Science, January 1868.KK 2500 THE TREATMENT OF INSANITY. [CHAP.were in a wretched state, neglected and ill-treated in manycases, and in no case having the care which their diseasedemanded. Now, however, all this is changed: by the powerful agency of official instruction and inspection, systematicallyexercised, all who have to do with them have been penetratedwith more enlightened views, and the condition of their chargeshas accordingly been immensely improved-indeed, now leaveslittle or nothing to be desired. The former evils sprang not somuch out of deliberate cruelty as out of want of knowledge onthe part of those who had concern or part in them.If other facts were required to strengthen the argument, Imight point to the condition of the numerous Chancery patientsin England who are living in private houses. I have the bestauthority 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 Chanceryvisitors, who have the power of insisting upon his removal elsewhere, if the accommodation and treatment are not satisfactory.Nor would it be correct to attribute the success in these cases tothe large amount paid for the care of Chancery patients; for, inthe first place, though this is great in some cases, it is not so inothers, not being indeed so great as would be demanded for theircare in a good asylum; and, in the second place, the experienceof the Scotch Lunacy Board shows that many pauper patientsare well taken care of in private dwellings at less than one halfwhat the cost would be in a county asylum. The question isplainly not altogether one of expense; the more it is candidlyconsidered, the more evident it becomes that its solution lies inthe promulgation of enlightened views, and in the will to realizethem in practice.No one acquainted with the facts would deny that many ofthe single patients in England who are not Chancery patientsare satisfactorily cared for, and are more comfortable than theywould be in asylums. In the village of Hanwell and its neighbourhood, there are several single patients living with privatefamilies, some Chancery patients, and others not, who are extremely well taken care of in every regard; what insurmountable impediment is there to that which is done successfully inHanwell being done in any other village in England? It wouldVII.] THE TREATMENT OF INSANITY. 501be difficult to assign any such. In order to develop this system,however, it would be necessary to establish more frequent officialinspection; for at present the single patients not under the jurisdiction of the Court of Chancery are only seen, on an average,once a year by the Commissioners in Lunacy; and the officialpolicy has not hitherto been to correct, improve, and developthe system, but rather to discourage and abolish it as a permanent and increasing means of providing for the insane. Whenofficial views and practice have been modified and brought intoconformity with the stream of liberal thought, as we cannotdoubt that they surely will be, and when arrangements havebeen made for a systematic and more frequent visitation of singlepatients, then it cannot be doubted that the number of thesewill rapidly increase, to their infinite comfort, to the pressinglyneeded relief of our overgrown and overcrowded asylums, and tothe general advantage of the community.For the reasons adduced, I cannot but think that future progress in the improvement of the treatment of the insane lies inthe direction of lessening the sequestration and increasing theliberty of them. Many chronic insane, incurable and harmless,will be allowed to spend the remaining days of their sorrowfulpilgrimage in private families, having the comforts of family life,and the priceless blessing of the utmost freedom that is compatible with their proper care. The one great impediment tothis 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 ofignorance, and familiarity banishes the horror bred of ignorance,then will a kindly feeling of sympathy for the insane unite witha just recognition of their own interests, on the part of thosewho receive them into their houses, to secure for them properaccommodation and good treatment; then also will asylums,instead of being vast receptacles for the concealment and safekeeping of lunacy, acquire more and more the character ofhospitals for the insane -they will become infirmaries fordiseased brains rather than the cemeteries of disordered intellect; while those who superintend then , being able to givemore time and attention to the scientific study of insanity, andto the means of its treatment, will no longer be open to the502 THE TREATMENT OF INSANITY. [ CHAP.reproach of forgetting their character as physicians, and degenerating into mere house-stewards, farmers or secretaries. *Thus much respecting the chronic insane who are harmlessand incurable, and for whom the aim to have in view is to securethe most comfortable provision for the rest of their lives. Itnow remains to speak of the means to be adopted for the careand treatment of the insane who are deemed curable. Thistreatment is moral and medical, the two methods being properlycombined in every case. Again, it should be specially directedto the character and circ*mstances of the individual case; it isnecessary to penetrate the individual character, in order to influence it beneficially by moral means, and to investigate carefully the concurrence of conditions that have issued in insanity,in order, as far as possible, to remove them. Not the least of theevils of our present monstrous asylums is the entire impossibilityof anything like individual treatment in them. It would notbe putting the matter fairly to point out the absurdity of twomedical men affecting to really treat seven or eight hundredlunatics in an asylum, because the majority of them assuredly donot require any medical treatment; but it is perfectly fair tocall attention to the uncertain chances of satisfactory treatmentwhich the small curable minority have under such circ*mstances.To the medical officer these are not so many individuals, havingparticular characters and particular bodily dispositions withwhich he is thoroughly acquainted, but they are apt to becomeso many lunatics, whom he has to inspect as he goes his roundof the establishment, as he inspects the baths and the beds; andthe only person perhaps really aware that each of them has anindividual character, is the attendant. Herein lies a reason whyOf this reform my friend Baron Mundy, M. D. has long been the earnest andunwearied advocate, having devoted to it, in a purely philanthropic spirit, manyyears 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 unpractical. Surely a nobleman might have employed himself better than in takingup such a cause at such a cost! Let me add, then, lest it be thought Utopianin him, that Professor Griesinger of the University of Berlin, who by the acknowledgment 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 reputation is higher than that of any other alienist physician in France, have bothgiven their adhesion and support to the principles of the reform advocated byBaron Mundy.vu.] THE TREATMENT OF INSANITY. 503the best possible treatment in some instances undoubtedly is toremove a patient from an asylum to the care of his own friends;he may then recover, as the Positive philosopher, Comte, recovered, and as others have recovered, though there seemed everylikelihood of their becoming permanent lunatics in the asylum.Indeed, I cannot help feeling, from my experience, that one effectof asylums is to make some permanent lunatics: continuallyliving in the atmosphere of the worst lunacy, certain patientsseem to become impregnated with its baneful inspiration, andafter a time sink to the situation. And I can certainly call tomind more than one instance in which I thoroughly believe thatthe removal of a patient from an asylum was the salvation ofhis reason.In dealing with insanity it is before all things necessary thattreatment should begin early, before the habit of a definitemorbid action has been fixed in the mental organization . Thereis reason to think that, if the first obscure threatenings were dulyappreciated, and the proper remedial means at once adopted,many cases of insanity might be arrested at the outset. But themischief is that a case of insanity hardly ever comes under thecare of those specially qualified by their experience to treat it,until the disease has been firmly established, and the hope of recovery, save from gradual and protracted means, is gone in somecases, and all hope gone in others. When the disease is wellestablished, our treatment must not be rashly vigorous andenergetic, with the aim of effecting any sudden revolution, butrather patient and systematic, in the hope of a gradual changefor the better. While in other diseases time is reckoned by hoursand days, it must in insanity be reckoned by weeks and months.Moral Treatment.-" To remove the patient from the midst ofthose circ*mstances under which insanity has been producedmust be the first aim of treatment. There is always extremedifficulty in treating satisfactorily an insane person in his ownhouse amongst his own kindred, where he has been accustomedto exercise authority, or to exact attention, and where he continually finds new occasions for outbreaks of anger or fresh foodfor his delusions. An entire change in the surroundings willIn the St. George's Hospital Reports for 1867, there is an instructive exampleof this kind related by Dr. G. F. Blandford.504 THE TREATMENT OF INSANITY [CHAP. .sometimes of itself lead to his recovery: if the patient is melancholic, he no longer receives the impressions of those whomhaving most loved when well he now most mistrusts, or concerning whom he grieves that his affections are so muchchanged; if he is maniacal, he is not specially irritated by theopposition of those to whose acquiescence he has been accustomed,nor encouraged by their submission to his whims and theirindulgence of his follies." A complete change of associationsgets rid of those thousand occasions of irritating and painfulcontact with his relatives, which it is impossible to avoid whiletheir sympathies are so much excited, and his feelings so muchaffected. Moreover, when recovery takes place, it is well thathis relatives should not themselves have exercised that systematic control which may have been necessary, and which hewill not forget; to him there remains the memory of a humiliation, and he will generally not care to see again those whohave been the immediate agents or witnesses of it. Lastly, theseparation is often a real grief to the patient, and becomes aninducement to other than morbid thoughts. Travelling may berecommended in the early stages to those who can afford it, inorder to secure change of place and scene and a variety of newimpressions; or if the patient is not fit to travel, he should, inmost cases, be removed from his own home to another residence,where he may be placed under the firm and judicious control ofpersons of some cultivation, and where he may have systematicmedical treatment. If a patient suffering from commencingmelancholia can afford to travel accompanied by a sensiblefriend or medical man, or even attendant, it would certainlynot be right to recommend that he should be sent to an asylum;he will probably recover before he gets back home from histravels. Insanity after fever, puerperal insanity and hystericalmania, may usually be treated successfully without the aid ofan asylum. I have never seen any advantage accrue fromsending to asylums at an early period of their disease thosewhose minds suffer in consequence of habits of self-abuse; theyhave no occupation there to occupy their attention; they continue their vicious practice, and invariably sink to the situation. *

• " It is to be feared that many have been condemned to a state of insulation

from all rational and sympathising intercourse, before the necessity occurred forVII.] THE TREATMENT OF INSANITY. 505When they have arrived at a further stage of degradation , however, they are not fit for any other abode. The practice ofplacing insane persons alone in a cottage under the control ofone or two vulgar attendants is certainly to be condemnedexcept as a temporary expedient: those who are permitted totake on them the very responsible charge of controlling thosewho are unable to take care of themselves should assuredlyhave some social stake, and be in a position to lose somethingby evil behaviour. If neither of the above courses can betaken, or if the patient is furiously maniacal, or desperatelysuicidal, or persistently refuses food, it will be necessary to sendhim to a suitable asylum. And in choosing an asylum the mainguiding principle should be, other things being equal, to selectone in which medical treatment is a real feature.No doubt the change by which asylums formerly in thehands of non-professional men, -who kept them, as hotels arekept, simply for profit, -have been placed in the hands of medicalmen, has been a beneficial change; but it has not been withoutcorresponding detriment, nor has it exhausted the possibilitiesof reform . There is not in a medical diploma any miraculoustalismanic power capable of changing human nature, and of preserving it from the frailties incident to its pilgrimage throughlife. And the inevitable tendency of making any one the medical proprietor and manager of a large establishment is to absorbhis attention and energy in the economical management of it, tothe neglect of his function as physician in a hospital for thetreatment of disease: the medical diploma is apt to become amere form, to be obtained, in the least troublesome manner, asan essential prerequisite to getting a licence to keep lunatics,while the scientific study and the scientific treatment of insanityare not thought of at all. It may justly admit of questionwhether the medical profession has gained anything by a changethat has had such a result, while it hardly admits of doubt thatthe public has not gained as much as it might have done. Icannot help thinking that it might be to the advantage of thepublic and the medical profession if there were no such practiceso severe a lot. Diseased members have been amputated from the trunk ofsociety, before they have become so incurable or unsound as absolutely to requireseparation. "-Essays on Hypochondriasis. By J. Reid, M.D. 1823.506 THE TREATMENT OF INSANITY [CHAP..as now finds exclusive favour in England of making medicalmen the proprietors of asylums . Of course it is most necessary to insist on proper medical supervision and proper medicaltreatment, but is there not sufficient reason to believe that thesemight be equally well, if not better, secured by dissociating themedical 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 orderto have a field for practice. It would be a gain also to thepublic; for eminent and accomplished physicians would thenengage in this branch of practice who now avoid it, because itinvolves 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 indispensablein some cases; it may be the only way of adequately exercisingfor him that control which he cannot exercise for himself, or thebest way of so exercising it as to promote early recovery; andto let him distinctly understand that this is legally done will ofitself have a beneficial effect. There should be no secrecy, nodeception about the matter, but all should be done openly andfirmly, in the spirit in which an act of obedience is inculcatedupon a child, and in any case inflexibly insisted upon. Themystery still hanging about the treatment of madness is a relicof the old and barbarous system of the past. It is extremelyobjectionable if it can possibly be avoided, and in the majorityof cases it is entirely unnecessary, to entrap a patient into anasylum; but it is still worse to employ fraud to place him undercertificates, and then to leave him to be removed by attendantswithout ever explaining to him that a change is to be made.The melancholic who finds himself in an asylum has a realgrief to alternate with or perhaps take the place of his fanciedaffliction, and the maniacal patient, feeling his wild spirit ofexultation to be rudely checked by the influence of a systematiccontrol, will often have more sober reflections aroused.The patient having been removed from those influences whichhave conspired to the production of the disease, and now tendto keep it up, and having been made to recognise from withouta control which he cannot exercise from within, it remains to.vII.]THE TREATMENT OF INSANITY. 507strive patiently and persistently by every inducement to arousehim from his self- brooding or self- exaltation, and to engage hisattention in matters external--to make him step out of himself.This is best done by interesting him in some occupation, or in avariety of amusem*nts; and it will be done the more easily nowthat the surroundings have been entirely changed. Steadyemployment will do more than anything else in promotingrecovery; with the insane, as with the sane, action is the bestcure for suffering. The activity of the morbid thoughts andfeelings subsiding in new relations and under new impressions,more healthy feelings may be gradually awakened; and theactivity of healthy thought and feeling will not fail in its turnfurther to favour the decay of morbid feeling. Goethe, in his"Wilhelm Meister," makes some excellent observations concerning the moral means of treating insanity. The means ofcuring insanity, he says, are the same as those by which sanemen are prevented from becoming insane. Their self- activityshould be aroused; they should be accustomed to order; theidea that they have a being and destiny in common with manyothers should be instilled into them; they should be brought tosee that extraordinary talent, the greatest good fortune, and theextremest misfortune are but small deviations from the ordinary.Then madness will not creep into their minds; or if it does, itwill disappear by degrees. " For nothing brings us nearer tomadness than when we distinguish ourselves from others, andnothing so much preserves the common understanding as livingin sympathy with many men." If there is some fixed delusion,it will do no good to enter upon any systematic argumentagainst it; there would be almost as much hope of an argument against the east wind or against a convulsion; but byengaging the mind in other thoughts as much as possible, andthus substituting a healthy energy for the morbid energy, theforce of the delusion will be most likely to abate, and finally todie out. Besides, by denying the reality of what seems so veryreal to the patient, he will lose confidence in your judgment,and conclude that you do not understand his case. For thesame reason, it is a great error to ridicule or to treat lightly hisfancies. But, although it is of no avail to talk against a delusion, it is important to avoid assenting to it: by quiet dissent,508 THE TREATMENT OF INSANITY [CHAP. .or a mild expression of incredulity when it is mentioned, thepatient should be made to understand clearly that he is in aminority of one, and that, though a person in a minority of onemay 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; forthe patient is inevitably excited and made worse by it. Firmness, tempered with sympathy and kindness, will beget confidence in and reliance on those who have the care of him, andwill arouse self- control in him. It may well be questionedwhether the practice of banishing all female nursing from themale department of an asylum, and of leaving the patientsentirely to the care of men, is not prejudicial. An elderlyfemale nurse, of a kind and sensible disposition, could not failto be a great comfort to those of the patients who require gentleand sympathetic attention, and might be expected often to exerta very beneficial influence over them. Assuredly some wouldyield to woman's persuasion more readily and with a less feeling ofhumiliation than to the dictates of an attendant of their own sex.Medical Treatment. -A truly scientific treatment will begrounded upon the removal of those bodily conditions whichappear to have acted as causes of the disease, and to be keepingit up, and upon the general improvement of nutrition. Themorbid sensations in different parts of the body, which are socommonly experienced in insanity, often spring from some realbodily disorder, and tend to sustain the delusion or other derangement of thought. They should obtain the careful attention which they deserve, for bodily disease is not alwaysdetected easily, and is sometimes overlooked, in the insane;the usual symptoms being very much masked, and they, likeanimals, often making no intelligent complaint. It is necessary,therefore, to pay particular attention to the physical signs ofdisease: there may be no cough, no expectoration, when thestethoscope or the thermometer reveals advancing phthisis.General blood- letting is now abandoned in the most acuteand seemingly sthenic insanity, as not merely useless but aspositively pernicious. It is admitted that convulsion of minddoes not mean strength of mind, and is not likely to be curedby draining off the life that is in the blood; violent symptomsVII.] THE TREATMENT OF INSANITY. 509may certainly be reduced for a time by blood- letting, but thedisease is very likely to become chronic, and to pass into dementia. In some cases, in which there appears to be greatdetermination of blood to the brain, a local abstraction of bloodby means of leeches or cupping may be useful; it should notbe done with any view of reducing the general strength, butwith the view of withdrawing blood from the overloaded vessels,and of thus affording the opportunity of rest to the strugglingand suffering nerve element. In such case the aim is to imitatenature, which diminishes the quantity of blood in the brainduring sleep.The continued application of cold to the head by means of adouche pipe, or a shower-bath, or by pouring cold water upon it,while the patient lies in a warm bath, is sometimes successfulin calming excitement and in procuring sleep in acute insanity.of a maniacal type. Professor Albers has published the notesof some cases of excited melancholia, with dirty habits, destructive tendencies, and sleeplessness, in which much good was doneby the prolonged use of a cold bath. The patients were placedfor one hour or two hours, according to circ*mstances, in waterof the temperature of 54° Fahr.; the effect being to lower thetemperature of the body many degrees, to bring down the pulseuntil it was scarcely perceptible, to subdue excitement, and toprocure some hours of sleep when they were afterwards put tobed. Such a means of treatment is obviously attended withsome peril, and should be used only with extreme caution. Thewarm bath alone, taken for about half an hour, has a decidedlysoothing effect; and some have thought its efficacy to be increased by the addition of a few handfuls of coarse mustard,whereby a general redness of the surface of the body is produced. In France the warm bath has been used for eight or tenhours at a time with professedly good results; and Leidesdorfof Vienna has used for three or four hours, and in many caseswith a marked tranquillizing effect, a bath constructed by Professor Hebra, in which patients may be kept night and day at adefinite temperature. It is obviously necessary to avoid anysuch use of the bath where the pulse is very feeble, and wherethere is anything like commencing paralysis; and it can be ofno avail in cases of chronic insanity.510 THE TREATMENT OF INSANITY. [CHAP.The shower-bath or the cold douche may be administeredwith advantage in some cases of melancholia where reactiondoes not fail to take place properly afterwards, and in cases ofchronic insanity, with the purpose of rousing the patient and ofgiving tone to the system; but its use should not be continuedfor more than three minutes, and it should not be with the aimof producing any special effect, but on the general principle ofimproving the bodily health. The advocates of the Turkish bathhave vaunted its beneficial effects in insanity, as in every otherdisease; but no discrimination of the cases in which it is usefulhas hitherto been made. I should be disposed to put more faithin the use of the Russian vapour-bath, which might not improbably be of real service in some cases of mania and melancholia, where the skin is dry and harsh, and its secretiondisordered. Packing in the wet sheet, after the hydropathicfashion, and as recommended by Dr. Robertson of the SussexAsylum, is undoubtedly a useful remedial means in some casesof acute excitement; it has not only a soothing effect of itself,so that the patient will sometimes go to sleep in it, but, bykeeping a restless and excited patient quiet, it enables sedativesto take effect when they would be perfectly useless if no suchmeans were used. On one occasion I was roused hastily to seea girl who had suddenly been attacked with acute hystericalmania, to the great consternation of the whole household, and tothe despair of the medical attendant, who could not get her totake anything, or to remain quiet for a moment. She had tornher night-dress to shreds, was tossing about on her bed ceaselessly, and was quite incoherent. She was immediately packedin the wet sheet, and a cloth dipped in cold water applied to thehead; and when this had been done, she took without anydifficulty a drachm of tincture of henbane, and after a short timeslept. In the morning all excitement had gone, though she wasconfused in mind, and in a few days she was quite recovered.The wet sheet should not be used for more than three hours ata time, and should be changed once during that time. Thus ithas its true character as a means of medical treatment, and isnot abused for purposes of mechanical restraint.Counter-irritants are not much used in insanity. Schroedervan der Kolk, however, thought he had seen beneficial resultsVII. ]THE TREATMENT OF INSANITY. 511follow the application of strong tartar emetic ointment, or of ablister to the shaven scalp; and Dr. Bucknill recommends crotonoil to be rubbed into the scalp in the passage of acute intochronic insanity or into dementia, and in chronic melancholywith delusion. I have seen in one case a wonderful temporaryeffect produced by a blister to the nape of the neck: a younglady who had appeared demented for months, and who had notspoken during that time, woke up out of her usual stupor theday after a blister had been applied , and spoke as rationally asshe ever did in her life; next day, however, she was muchexcited, and inclined to be violent, and after this subsided intoher mute stupor again. The same experiment was repeated onanother occasion with a similar result, save that her excitementand violence were much greater than on the first occasion. Notwithstanding the marvellous effect of the blister in this instance,an effect which might well seem to indicate a valuable therapeutical remedy, I have not been able to satisfy myself of muchpermanent good ever having been done by blisters or setons ininsanity. If they are useful, they are most likely to do good inmelancholia with stupor and in acute dementia.After errors of digestion and secretion have been duly attendedto, the diet of the insane should be good; and it will be desirablein 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 ofthemselves towards curing puerperal insanity and the insanity oflactation. There can be little doubt that an attack of insanitymight sometimes be warded off by a generous diet and a freeuse of wine at a sufficiently early stage. It is, at any rate, atruth worthy of all acceptation, that energetic antiphlogistictreatment in the course of insanity is energetic mischief.Leeches may be applied to the head, and a patient may be kepton low diet, in order to subdue maniacal excitement, withoutany other result than an increase of the excitement with theincrease of exhaustion, and the most active purges may be given,and given in vain, to overcome an obstinate constipation, whenbrandy and beef- tea, reducing exhaustion, will subdue excitement, and a simple enema will produce full action of the bowels.Active purgation, once so much favoured, is now quite eschewed512 THE TREATMENT OF INSANITY. [CHAP.in all forms of insanity. The bowels may often be regulated bydietetic means; and, if a purge is needed, a dose of aloes,rhubarb, confection of senna, or castor- oil, will answer everypurpose; a moderate dose of the latter sometimes succeedingwhere the most drastic purgatives fail. The present bodily stateof the patient, and the history of the causation of his malady,must be weighed in determining whether wine is to be given ornot in the most acute stage; in cases of a sthenic type it may bedesirable to do little more than wait patiently until the fury ofthe storm has passed, and then freely to give support.Coming now to the more purely medicinal treatment ofinsanity, we may speak first of the virtues of opium. Thisdrug is particularly useful in that state of mental hyperæsthesiawhich so often precedes an outbreak of insanity when themental tone is so changed that almost every impression is feltas painful, then opium, freely given, produces beneficial effects.I have seen several cases in which a seemingly imminent attackof severe melancholia has been warded off, and the patient restored to tranquillity and health of mind, by the judicious use ofopium. When the acute symptoms of mania have subsided, anda gloomy and morose mood of mind comes on, which in someinstances heralds recovery, but in other cases a recurrence of theattack, then is a favourable time for the judicious administrationof opium. It is certainly useful, but has undoubtedly beenover-praised, in cases of simple melancholia, when it should begiven in doses of one or even two grains twice a day, and continued steadily for weeks, notwithstanding an apparent want ofsuccess at first. If it produces constipation, each dose may becombined with a grain of aloine, or with two or three grains ofthe extract of aloes, or with a quarter of a grain of podophyllin.Where there is a fixed delusion of some standing, opium is of nouse except as an occasional expedient for procuring sleep. Itmay be given with benefit in the mania caused by intemperance,in the mania or delirium of nervous exhaustion, and in puerperalmania; but it is not of the slightest use in acute idiopathicmania, in melancholia with stupor, or in the attacks of acuteexcitement that occur in the course of chronic mania and generalparalysis.The subcutaneous injection of morphia is a valuable expedientVII.]THE TREATMENT OF INSANITY.513to have recourse to where there is a refusal to take medicine,and frequently operates more certainly, quickly, and effectuallythan opium taken by the mouth. Not more than a quarter of agrain should be injected to begin with, the quantity being subsequently increased, if necessary. It is important, however, tobear clearly in mind that neither opium by the mouth, normorphia hypodermically injected, will avail to quench the furyof acute mania, and that successive injections of morphia, thoughfollowed by brief snatches of fitful sleep, have been followedalso by fatal collapse or coma.In cases of great excitement, maniacal or melancholic, whereit is advisable to give opium, large doses of digitalis sometimesproduce good effects in tranquillizing the patient; it is a drugwhich was much esteemed by some of the old writers on insanity, and which, after having fallen into disuse for some time,has now been restored to favour. The excitement abates, andthe pulse, falling in frequency, may, by repeating the dose, bekept for some time at a standard below the average. In theattacks of excitement which occur in the course of generalparalysis the effects of digitalis are excellent; it had better begiven in doses of half a drachm of the tincture repeated two orthree times a day than in doses of one drachm or two drachms,as some have advocated. Notwithstanding the present fashionof large doses, and the disbelief in the cumulative action ofdigitalis, I hold it to be the duty of a good physician to be exceedingly careful in his administration of so uncertain a drug.I have certainly known an acute maniacal patient to drop downand die in collapse, after taking repeated large doses of digitalis,whether owing to the mania or to the drug must remain uncertain; and I believe that, though a patient who has taken largedoses of digitalis may be safe while he is lying down, he is sometimes in no small danger of fatal collapse if he starts up, or runsabout in an excited manner.Hyoscyamus is much safer than digitalis; it is of no use insmall doses, but, in doses of a drachm or two drachms of thetincture, 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 onlywhere there is some derangement of the stomach, not otherwiseLL514 THE TREATMENT OF INSANITY. [CHAP.than as it does good where there is no insanity. Bromide ofpotassium certainly appears to produce good effects in some casesof insanity, especially when there is evidence of sexual excitement; but in others, apparently similar, it appears to haveno effect whatever. I have tried it in cases of regularlyrecurrent mania, moved to the experiment by the knowledgeof its good effects in epilepsy, with which recurrent maniaalways seems to me to have some close relation or resemblance; and sometimes I have thought it do good andsometimes to be quite useless. Further trial of it, carebeing 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 themind, the administration of bromide of potassium certainly produces good results. Iodide of potassium is the drug indicatedin syphilitic mania. Tartar emetic will often calm for a timethe most furious maniac through the prostration which it produces, but it does no permanent good, if it does not do positivemischief by favouring the passage of the disease into dementia;its employment for such purpose is rather a relic of the oldsystem of quieting a patient by some violent means or othershort of actually killing him. If mercury be ever useful, andnot mischievous, in the treatment of insanity, it is when givenin small doses of the bichloride in cases that are becomingchronic, or where there is a suspicion of syphilis . To administermercury systematically in general paralysis, as has been done,is as untenable in theory as it is undoubtedly pernicious inpractice.When insanity has been caused by a suppression of themenses, it will be desirable to endeavour to restore them bymeans of aloes and iron; I have seen great benefit in some instances from the use of aloes, iron, and strychnia, or of aloes,opium, and strychnia, in pills . But when the suppression of themenses has followed the outbreak of the mental derangement, asit often does, then medicines given for the special purpose offorcing menstruation will do mischief; the best treatment willbe that which alleviates the mental suffering and improves thegeneral health.In all those cases of insanity in which tonics seem to beVII.] 515 THE TREATMENT OF INSANITY.demanded by the state of the bodily health-and they are themajority of cases at one period or other of their course-ironand quinine may be given; and one of the best ways of givingthem is in a mixture containing quinine, the tincture of thesesquichloride of iron, and chloric ether. Cod liver oil and iron.appear to me to be very useful in the early stages of generalparalysis. In some cases it happens that an uncontrollablediarrhoea sets in and carries the patient off, nothing availing tocheck it acetate of lead with opium and enemata of starch andlaudanum are most likely to be useful.When insanity has become chronic, or when fixed delusionsare established, there is small hope of special benefit from drugs.The general health being duly attended to, a systematic moraltreatment will be best adapted to restore health of mind. Wherethere is persistent refusal of food, it must never be allowed tocontinue so as to endanger the bodily health; and if persuasionand perseverance entirely fail, then the stomach-pump must beused to administer food. But if there be digestive disturbance,or if there be obstinate constipation, in conjunction with therefusal of food, the removal of the bodily disorders will sometimes banish the refusal, even though it may be instigated bypositive delusion. Occasionally a woman may be induced totake food by a man when she will not take it from one of herown 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 isplaced near him, without anything being said. In most cases,the steady and persevering trial of a good attendant will overcome the refusal, and render force unnecessary. Those who aresuicidal should be carefully watched at all times, and especiallyso on waking and getting up in the morning, when the thoughtsare gloomy, and the desperate impulse is apt to surprise and overpower them. The monomaniac, who has delusions that he iswatched continually, or otherwise persecuted, must always bedeemed dangerous to others; for at any time he may become soimpatient of his sufferings as to make a fatal attack upon hisfancied persecutor. Those who suffer from moral insanity areoften very troublesome to deal with satisfactorily; but it willbe worth while always to remember that one unequal to theresponsibilities and duties of the social position in which heLL 2516 THE TREATMENT OF INSANITY. [CHAP. VII.was born may not on that account be unequal to the relationsof a much lower social stratum. It is not because a personinsists upon degrading or ruining himself that it is justifiableto deprive him of his liberty by treating him as a lunatic. Verylittle more can be done for those who from childhood havemanifested a moral and intellectual imbecility than to placethem where they will be properly controlled, kindly treated,and well taken care of; they should certainly not be subjectedto the discipline of a stern schoolmaster who expects by severemeasures to implant better feelings and to awaken a brighterintelligence 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.on the intellectualAbscess 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.Albers, Professor, on cold baths in the treatment of insanity, 509.Alcohol, influence of, on the brain, 262,475; in the treatment of insanity,511.Alcoholization, insanity of, 262.Amenorrhoea, treatment of, in in- 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.Arnold, on gout as a cause of insanity,268.Aspirations, 153.Asylums, abuse of, 495, 503; disadvantages of, 497; advantages of,506.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 general paralysis, 416.Beckham, Dr., case of melancholia in aboy, 320.Bell, Sir Charles, on the muscular sense,202.Belladonna, influence of, on brain, 263.Beneke, on mental residua, 39.Berkeley, Bishop, on vision, 105, 121 .Bernard, on the influence of the cerebrospinal system on nutrition, 91.Bezold, Arnold von, on the electrical excitation of nerves, 435.Bichat, on the seat of the passions, 21 ,161.Biography, import of, 8; study of, 29.Blake, William, hallucinations of, 132,310.Blood, vitiation of, 89, 118, 262;irregular supply of, 258, 441 .Blood- letting, in insanity, 442, 506.Bosjesman, cerebral convolutions of, 54.Bouquet 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.Browne, Sir T. , on the harmonies ofnature, 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 ininsanity, 413.520 INDEX.Burrows, a case of homicidal insanity with epilepsy, 352; case of reflex in- sanity, 119; case of mania from seasickness, 272.Burton, R. F., on the mental develop- ment of the Indian savage, 145.C.Cabanis, on the secretion of thought,41.Cannabis Indica, action of, on sensoryganglia, 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; vicariousaction 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, 308; delirium of, 308.Chorea, as a cause of insanity, 287.Civilization, influence of, on increase ofinsanity, 229.Clarke, Lockhart, on the structure ofthe convolutions, 60; on volition,169; on a granular condition ofthe 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.Coeliac-axis, case of injury of, 271.Coenæsthesis, 154.Coleridge, Hartley, 310.Coleridge, S. 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, influence of, on insanity,253.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 cuttingoffsup- 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 ofinsanity, 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 aiguë, 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- deur, 415; mode of dealing with,506.Dementia, acute, 404, 488; chronic,406, 486; sine delirio, 350.Descartes, on consciouness, 26.Design, nature of, 72-74, 80, 171- 173.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. 521Du Bois Reymond, on electrical currents in nerves, 433.Durand-Fardel, on suicide in children,320.Dwellings, the insane in private, 499.E.Ear, the insane, 398.Eccentricity, 336, 479.Ecstatics, religious, 343.Education , influence of, on insanity,237; female, 238.Effection, 191.Ego, conception of, 157, 181; transformation 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; acause of insanity, 287.Esquirol, case of monomania in children,313; case of homicidal impulse in alittle 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.F.Falret, Dr. Jules, on the epileptic aura, 399.Fancy and imagination, 311.Ferriar, Dr., on injuries of the brain,449.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 hemispheres, 108.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.G.Ganglia, sensory, 48, 89; hemisphe- rical , 123.Genius, 35-37; and insanity, 336.Gerhardt, case of embolism causinginsanity, 286.Goethe, 1 , 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 incubation 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 consciousnessby, 24; on obscure perceptions, 38.Hartley, on secondary automatic mo- tions, 83, 97; on duplex 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 insanity 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 heatduring 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; removalof, 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 INDEX.Hobbes, on innate idea, 128 , 145; on language, 147; on the co-existenceof ideas, 147; on the care of self,150, 165; on the will, 169, 189.Holland, Sir H., 64; on co-existenceand sequence ofconscious 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.I.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; fundamental, 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,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; concurrenceofcauses of, 226; physical and moral causes of, 227, 284; predisposing causes of, 228; increase of, 229, 330;proximate causes of, 249; with inter- mittent fever, 267; with rheumatism ,268; with gout, 264, 268; with ute- rine disorder, 272, 448; knowledgeof 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 ormoral, 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, 368; pathology 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- ment of, 503; medical treatment of,508.Insolation, a cause of insanity, 286.Inspiration, 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 achild, 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; importanceof, 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. 523Leidesdorf, on warm baths in the treatment of insanity, 509.Lister, Prof. J., on coagulation of the blood, 46; on inhibitory nerve phenomena, 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,343, 367; case of acute, 388; moral perversion in, 389; condition of intel- lect in, 391; state of consciousnessin, 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; courseof, 403; chronic, 403; diagnosis ofacute, 474; of chronic, 475; prog- nosis of, 487; treatment of, 508- 513 Marshall, John, on the brains of two idiots, 250.Masturbation, 232; a cause of insanity,285, 422.Matter, different kinds of, 68; form of,75.Matteuci, on electrical currents in nerve, 433.Melancholia, 365, 374; in children,319; simplex, 343; cases of, 376- 381; remissions, 380; hallucinationsin, 382, 400; with stupor, 384course 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.Mental action, material conditions of,13; unconscious, 14-20, 32; residua of, 89.Mentalforce, 67, 68; dependence of, 69.Mercury, its use, in general paralysis,514.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 complexideas, 142; on acquired movements,175.Mill, John Stuart, on the psychological 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 development of, 28; degeneration of, 29;history of, 29; organization of, 33,44; method of study of, 34; mate- rial conditions of, 42, 44; essentialidea of, 43; time-rate of activity of,431; metaphysical conception of, 43,67; pathology of, 223.Mitchell, Dr. A., on consanguineousmarriages, 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; prognosisof, 487; treatment of, 515.Monomanie raisonnante, 367.Monopathie furieuse, 318.Montaigne, on the number ofthe senses,146.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, 424on 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, 72; poten- tial or abstract, 76, 114, 191; automatic, 67, 72-79; secondary auto- matic, 76, 97, 110; rhythmical, 81;irradiation of, 85; sensori-motor, 102,103, 108, 121; ideomotor, 126, 129;524 INDEX.voluntary, 175, 179; residua of, 191;illusory, 200; sense of, 202.Müller, 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 conductionby, 429; electrical currents of, 432;anelectrotonus of, 434; katelectrotonus 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;complication 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, 91,0.Opium, use of, in insanity, 512.Organization, the conception of, 106,210; Von Baer's law of, 144, 165.Othæmatoma, 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 brainof an idiot, 250; on the effects ofthe organic virus, 267.Pain, memory of, 219; psychical, 283;diversities of, 392.Paralysis, general, 205, 410; causes of,411; symptoms of, 412-416; tem- perature in, 416, 418; hallucinationsin, 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 onthe primitive, 162.Percept on, sensory, 49, 113; ideational,51, 113; loose use of word, 112.Pflüger, 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.Philosophy, Ionian school of, 2; metaphysical, 235; inductive, 5.Phthisis, as predisposing to insanity,233; in the insane, 470.Pia mater, changes of, in insanity,465.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 in a child, 325; on moral insanity,357.Prochaska, on the action of the sen- sorium commune, 72; general law of reflex action, 98.Productive activity, 20, 186, 188, 212,290.Prolapsus uteri, a cause of melancholia,272.Protozoa, 45; movements of, 46.Psychical pain, 283.Psychical tone, 156, 157; disturbance of, 268, 281.Psychology, empirical, 9; transcenden- tal, 10; uncertainties and contradictions 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.Pupils, state of, in general paralysis,412.INDEX. 525R.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 aboy, 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.Rigor mortis, 89.Robertson, Dr., on packing in the wet sheet, 510.Romberg, on co- ordinate convulsions,201.S.Sankey, Dr., on the specific gravity of the brain, 460; on general paralysis, 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 causinginsanity, 286.Schroeder van der Kolk, 63, 66, 79, 91,101, 271 , 453.Sclerosis, cerebral, 459.Scrofula, as predisposing to insanity,233.Sea-sickness, case of, causing mania,272.Sects, fanatical religious, 240.Self, affections of, 150; case of, 150,165.Self- consciousness, incompetency of, 11- 23.Sensations, seat of common, 99; abstract, 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.Sequestration , excessive employment of, 494.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 insanitywith epilepsy, 353; on sexual in- sanity, 405; on the classification ofinsanity, 420; on the specific gravity of the brain, 460.Sleep, cerebral circulation during, 438;in insanity, 384, 401; on mode ofprocuring, 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 primitivepassions, 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 impulse, 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.Syphiloma, 288, 458; treatment of,514.T.Tabes dorsalis, 203; morbid changes in,462.Tapeworm, a cause of melancholia, 272.Tartar emetic, use of, in insanity,513.Temperament, the insane, 257, 335;influence of, in insanity, 288.526 INDEX.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 achild, 304.Thurnam, 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; onirresistible impulse in epilepsy, 354.Tuberculosis, as predisposing to in- sanity, 233; and general paralysis,415.Tucker, on the misapplication of lan- guage, 108; on the succession ofthoughts, 176; on will, 181.Tuke, Dr. 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 insanity, 272.V.Valentin, on the seat of co- ordinationof 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.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 hemispheres, 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; onthe temperature in insanity, 401.West, Dr. , case of cataleptic insanitypassing into epilepsy, 315.West, Gilbert, on the effect of custom,163.Westbury, Lord, on insanity as a subject of moral inquiry, 473.Westphal, 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 emotionsto, 184, 185; creative, 188.111THE END.LONDON:R. CLAY, SON, AND TAYLOR, PRINTERS,BREAD STREET HILL,

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