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About Google Book Search Google's mission is to organize the world's information and to make it universally accessible and useful. Google Book Search helps readers discover the world's books while helping authors and publishers reach new audiences. You can search through the full text of this book on the web at |http: //books .google .com/I /■./.. ^^, cy>^>M>uW . ^7i l^-J'sji^ MEDICAL JUEISPEUDENCE INSANITY J. H. BALFOUR BEOWNB, Esi,., LONDON: I SAN KKANflsrcl, J. A A. CHURCHILL. ] S. WHITNEY k CO. > • • • • • • • • ,• • •• • • • • • • • •• • • • • • • •• • • • • • • • • • • • •• •• • • • • • • • • •• • • • • •••• •• ••« PKINTED BY J. R. ADLAKl^, BARTHOLOMEW CLOSK. US'/ TO W. A. F. BROWNE, Esq., LATI COMlfflSBIOiriK IN LUNACY rOK 8C0TIJLND, THIS WORK IS AFFECTIONATELY INSCRIBED BT HIS SON. LANE MEDICAL LIBRARY STANFORD UNIVERSITY MEDICAL CENTER STANFORD. CALIF. 9430d '.^^ FRANCr^f^ ^^. <5!/f PEEFACE. The last words of a book are those which meet the reader's eye first. As that is the case, a preface generally says what the book is meant to be, and in how far the writer's intentions have been realised in the work. Most prefaces are apologies. This work on mental defects and diseases in their legal relations is intended as a practical treatise more complete and systematic than the chapters devoted to this subject in medico-legal text-books, or than those monographs on limited portions of it which have from time to time appeared. It is to be hoped that it will prove useful to the lawyer and the medical man, and that it will do some- thing to explain, and therefore to reconcile, the differ- ences which too frequently arise between these, in cases in which civil capacity or criminal responsibility is in question. The work is illustrated by references to recent cases and decisions, as well as to standard authorities, and contains some examples of mental infirmity and asm 4 VIU PREFACE. derangement which have fallen under the author's personal observation. The author has to acknowledge the kindness and assistance which he has received from Dr. Crichton Browne, of the West Riding Asylum. He would also desire to express his thanks to Mr. Frederick J. C. Ross, of the Middle Temple, for the assistance which he has afforded while the work was passing through the press. 6, Ebbbz Coubt, Temple; 6th June, 1871. CONTENTS. CHAPTER I. PAOS LUHACT AND LIMITED BeSPONSIBILITT .1 CHAPTER II. On the Causes of Insanity .23 CHAPTBE m. Of Unsoundness of Mind .38 CHAPTER IV. Amentia and its Legal Relations .46 CHAPTER V. On the Patholoot and Symptoms of Mania 78 CHAPTER VI. On Intellectual Mania .88 CHAPTER VII. On Mobal Mania . .104 CHAPTER Vin. On Pabtial Mobal Mania 119 X CONTENTS. CHAPTER IX. PAGE Thb liEQAL Relations op Mania .176 CHAPTER X. On the LsaAL Relations of Mobal Mania . 195 CHAPTER XI. Dementia and its Legal Relations . 202 CHAPTER Xn. Epilepsy and its Leoal Relations . 218 CHAPTER Xin. Somnambulism and its Legal Relations . 235 CHAPTER XIV. Dbunkennesb and its Legal Relations . 247 CHAPTER XV. On Aphasia and its Legal Relations . .261 CHAPTER XVI. On Acute Delibious Mania .... 265 CHAPTER XVn. On the Legal Relations of Maniacal Delibium . 270 CHAPTER XVIIL Feigned Insanity • . . . . 274 CONTENTS. XI CHAPTER XIX. PAOB Oh Cohcealbd Insanity ..... 288 CHAPTER XX. On Lucid Intebyals ..... 294 CHAPTER XXI. The Admissibility of the Evidence of the Insane . 300 CHAPTER XXn. On the PBoaNOSis of Insanity .... 315 CHAPTER XXIII. On the Examination of Persons Supposed to be of Unsoxtnd Mind ..... 320 TABLE OF CASES. PAOB Alcock V. Alcock . . . , 8 Arnold's case . . . . .200 Att. Gen. v. Parntlier . . 297 Bagster, re . 59 Ball V, Mannin . . . . . 46 Banatyne v. Banatync . . 209 Banks v. Goodfellow 187, 191, 195, 215 Bellingham's case . . . . . 200 Bennett v. Taylor . . . . . 314 Bevan v. M'Donnell 8 Beverley's case . . . . . 8,4^,257 Bird V. Bird . 272 Bittleston v. Clark . 272 Bowler's case . 201 Bridges v. King . . . . . 273 Brogden v. Brown . . 270,272 Brooks t;. Barrett . . . . . 154 Brown t;. Jodrell . . . . 8 Browning t;. Beane 48, 194 Burrows v. Burrows . 154 Butterfield v. Cure . 212 Campbell's case . . . . . 177 Cartwright v. Cartwright . 209,297 Chambers v. Q. Proctor . . 154 Chapman v. Graves . 314 Combe's case . . . . . 211 XIV TABLE OF CASES. PAOB Cook t;. Cholmondely 209 Cook V, Ooude and Bennett ..... 272 Cooke V. Clay worth 257 Creagh V. Blood 209,298 Cimcliffe v. Sefton 314 Currie v. Child 31 4 Dane t;. Kirkwall 8 Davis, re 57 Den t?. Vancleve 217 Dew V. Clark 186, 187 Doe. d. Mather v. Lightfoot 135 Donegal^s, Lord, case ' 210 Douglas' case .177 Dyce Sombre v, Troup 298 Ellis V. Bowman 194 Evans V. Knight 270,271 Fletcher v. Peck 7 Frere v. Peacocke 135 Frost v.Bevan 8 Gellespie v. Gellespie 214 Gibson's case 135 Gore V. Gibson 257 Greenwood v. Greenwood .... 187,211 Groom and Thomas v. Thomas and Thomas . . 298 Hadfield's case 13,290 Hall V. Warren 209 Hardman v. Booth 41 Harford v. Morris 61 Harrison t?. Bowman 216 Harrod v, Harrod 46 Hartford v. Palmer 303 Harwood t?. Baker 217 Holyland, ex parte 290 Humphreys o. Griffiths 48 TABLE OP CASES. XV ■ FAOB Ingram t?. Wyatt 48,64 Johnston v. Brown . 48 Kindleside v. Harrison . . 212 King V. Farley .... . 272 Lemann v. Bonsall . . . . . 270 Levy V, Baker .... . 257 Longman v. Ledger . . . . 9 Lord Donegal's case . . . . . 46 M'Adam v. Walker . . . . . 135, 154 M'Diarmid v. M'Diarmid . 214 M'Naughton's case . . . , . 16 MTherson v. Daniels . . . . . 149 Martin t?. Wotton . 272 Marsh t>. Tyrrell .... . 272 Mather v. Lightfoot . 135 Molton V. Camronx 7 Mordaunt v. Mordaunt . . 31 Morrison v. Laman . 802 Mountain v, Bennet . 210 Nagle t>. Baylor .... . 257 Niell V. Morley .... 8 Nottedge t>. Prince 9 OfiFord^s case . 201 Oulds V. Sansom .... . 48 Parker v. Parker .... . 194 Portsmouth t>. Portsmouth 60, 69 Reg. V. Brayley .... . 310 „ t>. Burgess .... . 154 „ V. Carr . 71 „ V. Crabtree .... . 232 „ V. Crure .... . 255 „ V, Eriswell .... . 314 „ V. Gabbites . . . . . 77 XVI TABLE OP CASES. Reg. !?. Hill . r. PattisoQ t?. Perkins V. Price . V. Reeves r. Rushton r. Ryan . V. Simpson V. Steelib «. Stephens V. Thomas V, Townley V. Wood and Hodson Rex t>. Carroll t?. Cooke V. Dixon V. Parrington V. Grindley t>. Harvery V. Kelly V. Makin V, Moore V. Morley V. Orford V. Philip V. Reynolds V. Ross Tuckett V. Thomas V. Woodfall Ridgeway t?. Darwin Right V. Price Scott's Trs. r. Bannerraan Sentance v. Poole . Shaw t>. Thackray . Sloan V. Maxwell . Smith's case . Smith V. Tibbett . ff >i }> }i » }} }i 9i i) )i >i >9 yy yf j> yy yy ^> yy » PAGE 11, 311, 312 256 305 256 254 302 48 251 302 233 10 16 301 255 149 11 149 255 149 194 255 11 314 18 11 177 135 165, 252 10 64 210 214 257 257 216,217 162 186 TABLE OP CASES, XVU FAOB Snooks V, Watts .... . 209 Sombre^ re . . 68 Stevens t?. Vancleve . . 217 Sullivan «. Sullivan . 48 Tarbuck v. Bisphan 8 Thompson «. Leach . 48 Turner t?. Meyers .... . 194 Van Alst t?. Hunter . 190 Waring v. Waring . 186, 298, 314 Waters v, Hewlett . 272 Watson V. Noble's Trs. . . 214 Watts, re . 209 West V, Sylvester .... . 210 White t>. Driver .... . 298 Winchester's, M. of, case . 211 Windham, re .... . 65 lEDICAL JURISriiUDENCE OF INSANITY. , LUNACY AND LIMITED KESrONSIBIUTY. r Mant men have a pleasant way of taking difficulties to bed with tticm. They sometimes awaken in the morning to find the diffi- culty gone, and in its place, a precipitate of wisdom. Their cir- cumstances have creamed — their course is clear ! Other men allow a difficulty to go to sleep, hoping that lime will remove it. There is a Fabian policy with regard to mental matters. If a man has doubts, and cannot chp their wings, and confine them to the yard of his life, some folks would say of him he is happy ; others would say he is a fool. The latter class is composed of those who, when they come to a question that they cannot answer, dismiss the sub- ject by thinking it ia one of those things that it is not meant that man should understand. A very easy way through life those people find for themselves, for questions are thorns. Such a creed is the panacea for contumely. To look upon humanity as a hne drilled by fate or Deity, and yourself as the pivot man, to stand fast or mark time, and be certain that, notwithstanding the seeming pro- gress of the men at the other end, you will be found as far forward as they in the end, is a pleasant creed. Are not creeds cradles ? and do they not rock us to sleep — sleep with dreams ? But in questions which have to do with the relation of man to man, there is an urgency which will not allow of our placing them on the shelf en, as we do apples. We must get at a sort of trath now. 1 2 MEDICAL JUEISPRUDENCE OF INSANITY. There is a com under the tight leather, and in order to get rid of the pain, even though anon we have to put a patch on, we must cut the shoe. So we must legislate, although anon we may require to amend, and then in a little while to repeal. So that the best laws might really be said to grow, and not to be made. Whatever the growth of humanity shapes, seems, even in its inanimacy, to partake of the attribute of life. No part of the laws of this country has, if we may judge from the outcry of a certain class of the community, been more hard upon the corns of poor humanity than that which regulates the relations of men who are sane to men who are not sane. That some legislative interference was necessary to regulate the numerous relations of those two classes of persons was evident even to our in- competent ancestors. We have certain laws. A man makes a will and dies, and his relations who are not mentioned in the testament, and who would have profited in case of an intestacy, assert that the testator was mad, and therefore unable to make a will. A man with property is profuse in his expenditure, and those who would profit if he was a miser, maintain that he is insane, and therefore unable to manage his afiairs, and request that his hands be tied by the red-tape of the law. An act which in the case of a sane man would be a crime is committed, and the question arises as to whether the individual is sane or insane ; whether, under the law as it at present stands, the person committing the crime is liable to suffer punishment for the act committed by him, or is to be exempted on the ground of unsoundness of mind ? These ques- tions, which are evidently, in individual cases, of paramount im- portance, and which very frequently arise in practice, indicate the necessity of arriving at some thorough answer to the question — What is this insanity which incapacitates a man from making a will, from managing his own affairs, and which, in case he commits a crime, will protect him from the ordinary consequences of such an act ? This question and its answer have caused much difference of opinion. Long before medical men even considered themselves in a position to answer the question, it was necessary that some answer should be recognised in courts of law. The legal relations of the insane were determined long before medical men were pre- pared to look upon insanity as a disease, and while they still ^Cnd LUNACY AND LIMITED KESPONSIBILITT. 3 legardeil it as a " poBsi'ssiou" by devils. When medical men began to *ee that the wliip was not in all cases a cure for mental disease, when those who suffered from mental aberration began to be looked upon more in the light of those who were siek, than in the light of those who were wicked, the profession began to complain of the injustice with wlucli the laws treated persona of unsound mind ; and in the reaction whicb followed the long persecution of the insane, the medical profession has endeavoured, in a sort of making up of the accounts of justice — which tempts a mother to be kind to a surviving child because she killed another by cruelly — to look upon all criminals in the light of the sick ; and has demanded for them the same untiring vigilance and soothing attention, the same solicitude, and the same indulgence, which is looked upon as the right of those who suffer from bodily disease. They seemed to with the Northern Farmer, that — " Tkn't then) as '«m mane; u brenka into 'owea and itsali. Them a» 'm coats to their bucks, aod Isaka tlieir regular nienli So*, but il^a them bb never knnwe where a meaVa to bo 'atl : I^ilte mj' word for it, Sammy, the poor in a loomp U bud :" tnd that the way to put an end to crime was to propagate luxury, and that the way to diminish the criminal class was to suppress poverty. The feelings of the community are at the present time all on the side of the humane treatment of our insane and criminals ; and it is owing to this fact that the important question as to what the law ought to recognise as insanity, and in what cases it should be held to iuca])acitate from the enjoyment of privileges, and in what it should be held to protect from the consequences of certain quasi- criminal acts, has been lost sight of, or at least has received only a breathless and unsatisfactor)' answer. In a class, when it is doubtful to whom a question is pot, and when all the members answer together, the master cannot make out one correct answer. Now, the question stated above has suffered in its answer, because is much doubt as to who has a right to answer it. Medical assert that it is theirs to say what insanity is, and lawyers assert that it is theirs to say what the law calls insanity ; nay, further, legislators have asserted that it is theirs to say what the law ought to call insanity. So, between all the answering, the of the public has been quite full of uoise and hubbub, but 4 MEDirAL JURISPRUDENCE OF INSANITT. it has not received a satiafactory answer to the queslioD. It may even be doubted whether a satisfactory answer has yet been given. The antagonism of the two professions with regard to the pro- perty in the question has militated much against the accuracy and excellence of the answer. When the property in such a question has been in dispute, it is thought incumbent that the answer should be satisfactory when looked at from the point of view, and that it should go far to demonstrate the rightful ownership, of the party answering it ; and it can be easily understood that the existence of such an element in the mind during the taking of the evidence would render worthless the result of the investigation. Lawyers felt called upon to prove that the law had said, and did say, what insanity was and is, and that the Ipgal definition of insanity conid not be improved upon. Medical men, on the other hand, in their answers to the question, attempted to prove the utter incapacity of any class of persons to deal with such questions save one which had been educated to appreciate the bearings of disease ; and, further, that the fact was that the present state of the law was grossly unjust. Human nature has a tendency to monopoly I Again, the medical profession was in times gone by incapacitated by its ignorance of insanity, and in more recent times has been somewhat incajiacitated by the common sentiment of the time from answering the question. The petting of lunatics and criminals waa the game to piny. Showy philanthropy was on the cards. A man who would say with Emerson that the insane and infirm were "fit cases for a gun," w.is looked upon as a brute. The man who gave a weekly dance and a halfpenny bun to the insane patients under his care, who never had recourse to restraint, and induced the Hon mania to he down in the same ward with the lamb imbecile, was looked upon as a true modern hero ! One does not blame a man, or a class of men, for doing what the omnipotent guide, " How-to-get-on," bids them, although one certainly regards a person under the influence of such principles as incapacitated to judge fairly of many questions which might be brought under bis notice. However the fact may be accounted for, it remains a fact that, as yet, no very satisfactory answer has been given to the question stated above. ■ Many people think, with some plausibility, that proverbs are the I I I I LONACY AND LIMITED EESPONSIBILITY. 5 populi : and tliey are certainly a truer vox Dei than ihn thunder which children at the present day are tuught to believe emanatea from the lips of God. Tliat proverbs are agreed-upon wisdom is certain, and that the agreed-upon wisdom of an age often comes near to the truth, is a fact capable of proof. It has become usual to say that medical men find a difficulty in arriving at any uni- formity in their conclusions, and the fact that their opinions differ has become proverbial. In do cases do they differ more than in those which involve a question of sanity or insanity ; and the evidence given in very many cases would lead a casual observer to believe that medical men do not understand the nature of an oalh — for an oath surely, in its highest sense, would keep an individual who understood it, and felt bound by it, from speaking confidently upon a subject of which he had little or no knowledge. But it is not so ; and it is not a matter for wonder to any one that Lord Campbell spoke as he did to the three physicians employed in the Eainbrigge case, and that many other judges have felt it their duty to sjieak of the medical testimony in a similar manner. There is a tendency in all witnesses to become advocates ; and one Snda that they invariably use the possessive pronoun "our" with regard to the side on behalf of which they are summoned. But when they become more than advocates, and seem to forget that ignorance should be a short and not a long tether, they somewliat disgrace themselves and the profession to which they belong. In considering the question as to what the law recognises as insanity, I will, according to custom, in the first instance, quote ird Coke's description of the four kinds of men wlio may be pked upon as aoii compos menl'ia,* 1. An idiot, who from hia nativity by a perpetual infirmity is compot ; S. He that by sickness, grief, or other accident, wholly loaeth his memory and understanding; 3. A lunatic that hath sometimes his understanding and sometimes not, atlquanilo gandct lucidii inlercatlis, and therefore he is called noii compoa mdulia so long as he hath not understanding; ■!■. lie that by his own vicious act for a time depriveth himself of liis memory and understanding, as be that is drunken. No one argues that Lord Coke's classification is without defect. Indeed, each description has faults, and these faults have heea over • Coke's Llttlctou, 247 u. 6 MEDICAL JURISPRUDENCE OF INSANITY. and over again found out. To make the first intelligible^ the word idio6 would require to be defined. To make the second true, a con- struction would require to be put upon it^ which no torturing of the words could make them bear. Commissions of lunacy were originally granted for the purpose of inquiring whether the individual was either an idiot ex nativitate^ or a lunatic^ in the meaning of the term attached to it by Lord Ck)ke. Ultimately, however, the phrase, *' unsound mind," was used in the writ with the view of embracing all those who were considered proper objects of the commission, and who did not fall under either of the terms used in the writ which was originally issued. Lord Hardwicke and Lord Eldon made attempts to give this phrase a de- finite connotation ; and Mr. Amos, at one time Professor of Medical Jurisprudence in the London University, said that '^ the term un- soundness of mind, in the legal sense, seems to involve the idea of a morbid condition of the intellect, or loss of reason, coupled with an incompetency of the person to manage lus own affairs /^ but it has been decided *' that if the jury find merely the incapacity of the party to manage his affairs, and will not infer from that and other circumstances unsoundness of mind, though the party may iive where he is exposed to ruin every instant, yet, upon that finding, the commission cannot go on.'^^ It has been argued that the necessity which the law casts upon the jury of inferring the '* un- soundness of mind,'^ especially when the phrase is not itself clearly understood, or at least defined by some of our ablest lawyers, is inexpedient, and that in many cases the finding of the jury that the individual was incapable of managing his own affairs, should be sufficient for the continuance of the commission. And yet many very cogent reasons can be given why our English courts were dis- inclined to sanction the commission, unless the return asserts men- tal unsoundness. The object of the commission is not to ascertain whether the party is or is not able to manage his own affairs, and is or is not capable of governing himself, but, whether by reason of mental infirmities, amounting to one or another kind or descrip- tion of insanity, he is thus unable to manage his affairs or thus incapable of governing himself. And the principles upon which our law has made an inference of insanity necessary from the cir- cumstances, seem to me to be sound, aud founded upon a more • 19 Vesey. 286. LUNACY AND LIMITED RESPONSIBILITy. 7 thorough principle of justice than has been understood by those whn argne against its expediency. We are now ia & position to consider how far insanity incapaci- tates aa individual to contract. It is necessary to distinguish be- tween execuied and executory/ contracts entered into by or willi a lunatic. A contract executed is one in whicli the object of the contract is performed ;* an executory contract is one in which a party binds himself to do or not to do a particular tiling ;t and it is firmly established with regard to the first class above alluded to, that a lunatic is liable for the price of necessaries, i. e., goods suited to his rank and position, actually ordered and enjoyed by, and bona fide supplied to him. In the case of Molton v. Caniroux,J the right of kin lunatic or his representatives to rescind an executed contract ■flntered into by him, such contract, not being for necessaries, was called in question, d lunatic had purchased certain annuities of a life assurance company, aud had paid the consideration money and a premium in respect thereof. After his death an action was brought for the recovery of the moneys paid by him by his adminis- tratrix, under the following state of facts as found by special ver- dict. At the time the annuities were granted, and payment of the consideration money made, the intestate was a lunatic and of un- sound mind, so as to be incompetent to manage his affairs ; but of this the assurance company had not at that time any knowledge. The purchases of the annuities took, place in the ordinary course of huainesa; they were fair and Lona fide transactions, tlie grantee ap- pearing to the assurance company to be of sound mind, although he was, in fact, a lunatic. Tlie question, therefore, reserved by the special verdict was, whether the mere fact of unsoundness of mind, not apparent at the time of the transaction in question, was sufficient to vacate the act, albeit executed by the grantee by payment of the consideration money, and intended bona fide to be executed by the grantor by payment of the annuity. On deciduig the question on appeal, the Court of Exchequer Chamber made the following remarks :§ — " The old doctrine was that a man could not set up his own lunacy, though such as that he did not know what he was • Fletcher t. ruck ; 1 Powpll Contr, p. 234. t 1 Powell, 235. t 4 Eich. IT, amrmiut; judgm. in a and C, % Eich. 187. 5 1 Exrfi. 19. % xiiiiii r7juZS2^zziyzL :? issasht, TO Kcocd to dmnkcB- mC *^ Clkl SOtllQIl* h pes&ct dis- to prow he vi£ about wfaen bfc Tr«V > pfcedse cr xaiicd ar izagnzegL. This spedalTodki ksnCr litfm az^r focfi stale c/ zdui ; bd ersi if is dki, the modem caMS ftbov that v*acn the ^ate 0/ ndid vis unk&^vn to tbe oihcr tfMOmsir^z putj. ard no adraaiaize vas taken of tlte Iimatk, the defezkoe caxxscC ptrail, fspecaHj vbere the ooctzact is nol meidj execrate^, but executed in the vbcie or in pan, and the parties caxmol be restored akcigetha to their orginal pofition." It is eii- dent, then, that '' vhen a person, apparentlj of sound mind, and not known to be othenrise, enters uuo a contract for the porchase of propertj vfaich is im and b^jma jidi, and vhich is executed and completed, and the property^ the subject-matter of the contract, has been paid for and fullj enjojed, and cannot be restored so as to put the parties in itatu quo^ such contract cannot afterwards be set aside either bj the aU^ed lunatic or those vho represent him."t If an action is brought to recover money paid under a contract upon the ground of the plaintiff's lunacj, and the issue is, whether at the time of the particular transaction the fact of the plaintifi's insanity was known to the defendant, evidence as to the plaintiff's conduct upon various occasions both before and after the date of the par- ticular transaction, with a view to showing that the malady under which the plaintiff laboured, was of such a kind as would make itself apparent to the defendant at the time of the said transaction, will be ailmissible.t Yet a man, by bare execution of an instru- ment under seal, does not make it his deed, if, at the time of the execution, he was so weak-minded as to be incapable of under- standing it when explained to him;§ but a deed executed by a lunatic during a lucid interval is binding upon him, but tbe 01111% • 8ee Ikfverley'f cmc, 4 Rop. 123 b., Co. Litt. 247 b. t Jiidf(in. 2 Kxch. 503. Sec hIho Daue v. Kirkwall, 8 Car. and O. 679 ; Brown V, Jodrirll, 3 Car. and P. 80; Niell v. Morlcy, 9 Yes. 478; Alcock v. Alcock, 3. Mnc!. and (1. 208; Tarbuck v, liisphan, 2 M. and W. 2; Frost v. Sevan, 22 L. J. Ciiaiif!. (;:m. I Dovaii 0. M'Donnell, 10 Excb. l&i. I Hhtlf, Lnimtid, 2nd uditiun, p. 838. LDNAOT AND LIMITED RESPONSIBILITY. 9 ; proving that it was so executed lies upoo the party claiming under the deed. Mere imbecility is not of itself sulVicient to render void B contract, unless an appreciable incapatrjty of understanding and acting with discretion in the ordinary affairs of life results tlicre- from. Such incapacity, it has been said, aifords the true test of what amount of unsoundness of uiiud will avoid a deed at law. While mere weakness of mind will not render void the contracts of the party labouring under this disability, it will be a material circumstance in establishing an inference of uufair practice, fraud, or imposition.* Did we not say that our laws grew and were not made ? and does not even the above akelcli of tUeir progress in one direction bear out the assertion ? Are not clothes best shaped by the nimble dngers of " wear J"' and have not our ancestors been the living models that these our laws have been shaped on? Are we not gainers in comfort by their pains? Who has not considered that it would be the height of luxury to have some one with feet bke our own to wear our new hoots for us? and have not our great ancestors, with feelings very tike our own, woru our new laws for us until there is some comfort in them. Yet our ancestors arc at the wall in these days. We thank them for nothing but the anomalies they left, which we Lave to do away. This is a future- looking age. The greatest difGculty as to a satisfactory defiuition of insanity has arisen in connection with criminai cases. It is laid down in our criminal law books that a wrong intent, or something equivalent thereto, is un essential element in crime, and there is no word, the meaning of which it is more important clearly to understand, than the word " intention" in its relation to the criminal law. " Inten- tion" in this relation is not simply purpose or design. It is clearly distinguishable from motive, which is, as it were, the goal of an action. Yet, while it is distinguishable, it is not always distinguished. The fact that the motive which led to the commission of a certain act is one of the moat prominent points in the proof of the inten- tion, has only too frequently produced some confusion of thought. But it must be remembered that it is the "intention" and not the " motive" which gives in law the character and quality to an act. • Kent Cora., 10th ed., n C m. 46, Seo also Story, ( bttedgc 0. Priutp, 3 Gif. 21 I. ii, p. 609. See per Lord Crsowortli, C, 6 H. L, !C. 234—233; LDUgiuan «. Letlgcr, a Qif. I&7i 10 MEDICAL JTRISPRCDENCE OF IXSASITT. And it is essential to bear in mind the fact, " that the intention to do the act exists for all criminal purposes where it is wilfallj done, although the act itself was merelj the means of obtaining some ulterior object."* For example, if a man removes a piece of pro- perty from another's house without the consent of the owner, with the intent to convert it to his own use, and thereby despoil the owner of it, in that case he is guilty of theft. If, however, he takes it, believing it to be his own, or with the intention of returning it anon, he commits a trespass, but is not guilty of theft. And if he takes it in a case where he is justified by law in so doing, as in distress for rent due by the owner of the article, he is not guilty of theft^ neither does he commit a trespass. In each of these cases the act done is the same, but the intention varies the legal consequences of the act, and it is by the intention that the question whether the individual has subjected himself to civil or criminal consequences, or whether he shall be regarded as altogether innocent, must be decided. In certain cases, however, the statute lawf has declared that such and such acts shall be criminal, and has associated with a proof of the commission of the act certain penalties. In such cases an inquiry as to the intention of the party is not of the same primary importance. In another class of cases the legislature has thought it prudent to declare that there shall be a presumption of criminality associated with the commission of the act, and in that way throws upon the party proved to have committed the act in question the onus of proving that it was done with an innocent intent. In the third class, however, the intention of the individual is of the most material importance, and, in order to secure a convic- tion, the criminal intention must be satisfactorily proved. It was laid down by Lord Mansfield as generally true J that, where an act in itself indifferent, if done with a particular intent, becomes crimi- nal, there the intent must be proved and found by the jury; but where the act is in itself unlawful, the proof of justification or excuse lies on the defendant, and in failure thereof the law implies a criminal intent. A "guilty mind" is, however, as we have seen, essential to the conception of a crime in a very large class of cases ;§ and a * Cr. L. Com., 4fch Rep., p. 15. t See 24 and 25 Vic, c d6, sec. 58. t K. V, Woodfull, 5 Burr. 2667. $ See («af. ^r.) Reg. v. Thomag, 1 S. & C. C. c 313. LUNACY AND LIMITED RESPONSIBILITY. 11 " guilty mind" is aniil to he pre.seiit in every case of intcntionul or voluiitaif wrong where the uiud ia actively in fault, and also in those cases where the miud, although not actively in fault, is yet the cause through ita passivity — it may be by neglecting to exercise sufficient caution — of some hurt or damage. Having considered the meaning of the word "intention" as understood in law, we return to the statement that a wrong intent is an essential element in crime, and the question as to how this intention is to be proved. In our law the jury are justified in inferring the intent from overt acts, becausfl every man, as well in criminal as in civil * procedure, must be taken to have intended that which is the necessary or natural couseqnence of his actj and, said Lord EUenborongfa, Chief Justice,t "When a man is charged with doing an act, of vhich the probable consequences may be highly injurious, the intention is an inference resulting from tlie doing of the act." And Littledale, J., has laid down the prmctple that if a result be the probable consequence of an act, the doer is answerable as if it were bis actual object, "If," he went on to remark, "the experience of mankind must lead any one to expect the result, he will be answer- able for it."! It is quite evident that a man's motives and intentions, which are hidden ttnngEi, can only be inferred from his acts and words. Acts are the language of motives, as words are of thought. It is, of course, impossible to punish mere intention, and it is only when the intention becomes, as it were, the fcctus of the act, in an attempt, that the law can take cognisance of it. The intention is, indeed, a bird's-eye view of the act. You can only judge of it in law when the act is done, as you can only judge of the bird's-eye view when you are above the plane. We are now in a position to consider the capacity to commit crime. The statement of the pro- position, that the criminal law looks mainly to the intention which actuated the accused, has been said§ to "imply the presumption that the individual whom it is sought to bring within the operation of the law has mental capacity, is a free agent, and possesses the power of electing to abstain from what is forbidden rather than suffer the • Per CreMwell. J., 12 C. il. 98 ; par Jervia. C. .1.. Id. 103, ciled Arg. 8 Exch. 22!). t R. V. Dixon. 3 M. and 3. 15 j It. o, Pliilip, 1 Mor. cc 2153, 271 ; Rog. t. Ulll. S C-r. noii P. 27*. See Broom's Com., p. 8CG, nole. t_R. V. Mootr. 3 B. Hnd Ad. 184, 188. ■•Com., p. sea. 1^ nzoirj. rixisiTTiiEyu^ 3? usiJCTT. eu DB L-u iH aeai of nfr^nrntr .'' nul :aif mnmHT mr «f Tiieliwl luadDR: dtsmis u unufaiL viiat iitt Tur, imL ws if vads- BUiudniT or ii»*nrat dacKK. s nic iL & posxaoL tL laiooK indf ; ur Oflnpig'niKTn. nucz^ts ns^ ids iiiffr wpj^ if OlUMft tilt irtfbL ^■■^t'^ TTnrr xie XMlL. JOIC Xbt T*" ■— ■" SSSttT tilUI iLc: QifBiCTi«iU> li s ^Htt sBxut zTTDsmtt ^iK mffiias ikt kv Id eLcaxip: 'vtsy rgmir ommeL imiL "Uif '^'^™t™» jryiuiiffin' of ttKsr mat ; sue lifr ^one jcmcqut s u be imxiiL » laie mHB for vut iioit-ixifijccbL of HT*- nsDktDs viieK 'Uit iiia!na]iil &. soiBiit iiif viL oncpssijfid i& di & ■ - m pTi' ks^ -magmafft k ^ dmd of didiULiniT fuLLTt : ysautXDBt samx jl tsbsul iie axtnei 10 jKCwtH slZSH^ lilt ifiir of ireaen: Fcfisiiir. ^sr £ sior coxEdlf imdtssti^icia — wfst i: msct ib:r:uBt of &ee viil or dioioe — of tLat yower to balance and appivdate mocres vbich is found in tim ordinarr ruiks of m«^Vinosed to be the devil, in accordance with that higher law which encourages resistance — because he knows that assault and battery is contrary to law, be held responsible, it is very difficult to say. The distinction as to a delusion concerning an ex- isting state of facts, and in respect to one or more particular subjects or persons, is, we suspect, worth nothing. To assert that a man can be afflicted with an insane delusion with respect to one or more particular subjects or persons without, at the same time, having erroneous impressions with respect to an existing state of facts, seems to us absurd. And as to the knowledge of the accused that the act was contrary to law, we have only to remark that, in the case where he believes a neighbour ia attempting to deprive him of life, and be kills him — or in the case where he believes his wife ia unfaithful to him, and he kills her paramour, — in both of these cases he is perfectly conscious that he ia acting contrary to law; but the higher law of self-defence, or the protection of his honour, excuses the individual proved to be labouring under a delusion with regard to the facts from the consequences of a breach of the law of the country in which he resides. In many cases that could be put, in which an individual is afflicted with a delusion as to one or more particular persons or subjects, it will be found that, although the individual is conscious that a law forbids the act, yet some more peremptory mandate — it may be the voice of God, or an impulse as esistible as that which makes a nmn draw his band away from a so MEDICAL JUBISPETTDENCE OP INSANITT. » I bummg brand — overcomes the voice of the municipal law, as a thunderclap drowns the still small voice. God may he in the latter, and the devil in the former, but the human ear bears the roar and does not hear the whisper ! Farther, the principle laid down in this answer seema to as to be at variance with the dicta of several very able Judges, above quoted,* ■with reference to the proof of intention. In many cases we saw that intention to commit crime was to be inferred from the acts of the accused, and Lord Ellenborough, Cliief Justice, laid it down as a universal principle "that, wheji a man is charged with doing an act of which the probable consequences may be highly injnrions, the intention is an inference of law resulting from the doing of the act," And we saw that Littledale, J., explained that "the pro- bable conseijuences of an act" were to be judged of by the ordinary "experience of mankind." In any case, then, it occurs to us, in which a delusion respecting one or more particular persons or subjects, or in which mental enfeeblement incapacitated the accused from ap- preciating the experience of mankind, and in that way incapacitated him from anticipating the consequences of his act, the individual should be held incapable of committing any of that class of crimes in which proof of intention is necessary to the conviction. But, upon the other hand, it does not seem dear to us that, in all cases, the same class of persons should be exempted from the legal conse- qaences of their acta when they fall within that class of crimes which the statute law expressly declares to be criminal, and in connexion . with which it has further declared that a certain punishment shall be inflicted. A German jurist,! appreciating the weight of the medical testimony in criminal cases, has maintained that two conditions are required to constitute that freedom of will which is essential to responsibility — viz., a knowledge of good and evil, and the facility of choosing | between them. This definition is perhaps more nearly correct than most that have been given ; but it seems to us, looked at in reference I to the most recent philosophical researches, and also in relation to the duty of the law to protect the sane from bjury, as well as to protect the insane from unnecessary useless punishment, that the beet definition that can be given of legal responsibihly is a knowledge that certain acts are permitted by law, and that certain acts are con- • P«Be 17, etc. t Dr, Mitturmaior. LUNACY AND LIMITED EESPONSIBILITT. 21 trar; to law, and combined with this knowledge the power to appre- ciate and be moved by the ordinary motives which influence the actions of mankind. If a man has no sense of pain, he will not learn to dread the fire by being burned. If it is the same to a man whether be take asa- fcEtida or sugar into his mouth ; if it is the same to him whether bis neighbours praise or disparage him ; if it is the same to him whether he have or have not hberty, — then any of the laws that are at present in force in this and in other civibsed countries are utterly inappli- cable to him, and, as they do not apply to him, he is not responsible to them. But if a man, be he sane or insane, is capable with regard to the act in question of being deterrpd by fear of punishment — if, hke the ordinary criminal, it was a belief in the probability of escaping detection that weighed on the side of committing the act — if it was mainly the ordinary motives which led to the commission of the crime, and if a preponderance of ordinary motives would have deterred, — then the criminal laws of this land are applicable to the accused, and he is responsible to those laws, and has no claim to be exempted from punishment on the ground of mental eafeeblement or derangement of intellect. It is to he remembered that a criminal code has been made with reference to those who are in many respects defective human beings. Certain penalties have been declared as the consequences of certain acts, and it is to be remembered that the law is excellent only where, with its punishments, it emphasises the assertions of nature. Laws are for those who cannot see that their truest good lies in order ; for those who are incapable of appreciating the fact that honesty and virtue and peace are the conditions of the greatest jiossible happiness. The wise man would not steal, whether there were a statute-book or no. The good man has a hundred motives for respecting the life of bis neighbour besides the fear of a shameful death. But while the statute law supplies certain powerful and easily appreciated motives to guide the actions of those who aro so weak as not to see what is for their real advantage — of those who have so Httle aelf-control that, without the fear of immediate punish, ment, they could not respect the property of their neighbours,— it does not, after prescribing one set of punishments for such classes, make, as it were, a second storey of the statute-hook, and prescribe other punishments for those who, even with the motives supplied by m, are unable either to sec what is best for them, or unable to j 22 MEDICAL JTJBISPBUDENCE OP INSANITY. restrain their desires, although conscious that punishment will follow. It confesses that there are certain classes to whom the law can supply no motive sufficiently strong to induce them to conform to certain rules, and it looks upon those persons as insane and as irresponsible ; as punishment of those individuals would fail first in reforming the criminal himself ; second, in deterring others of the same class from committing a similar offence : although it might, as an example, deter others, the law does not punish such persons, but contents itself by protecting the community from the commission of the crime again by the same individual. That the above is a sound principle on which to proceed in all cases to the determination o^ the question of responsibility — ^that it avoids many intricate meta- physical questions, utterly out of place in a court of law, as to the freedom of the will; and that it will tend to fulfil the true and full function of criminal legislation, will, we fed somewhat confident, appear from a thorough examination of the subject, and may even, we hope, be gathered from what has been said in this chapter. CAUSES OP INSANITY. 28 CHAPTER II. ON THE CAUSES OP INSANITY. Those who seek the rainbow are like those who hunt for a caose. And yet it is a great chase. The past is ransacked, and that great digestive system which has supplied the energy for the present^ is found to be like a tunnel with an exit at the other end, and no cause anywhere in it. Cause ! who can get at the cause P The cause of anything in the present is the whole past I But we have to limit our inquiry to the little things which are next in point of succession to the effect-events of our time; and we call them causes^ without raising the metaphysical question. Two things known together, mean knowledge — that is all we know. It is in this light, then, that we must look at the question of the etiology of insanity. Who can say what are the causes of insanity ? One must enter into a synthesis of causes, and confess that the man is half the cause of his own hurt, if he is pierced by an arrow, and that he is half the cause of his own disease, if through any combination of circumstances he becomes insane. Life is like a long string of algebraic figures, with the signs plus ( + ) and minus (— ) before each quantity. They are always varying and being carried over from one side to the other of the equation which is to determine the value of x, which stands for health. Who can work it out, tiU death reduces the value of a? to ? Well, he who would say why a man goes insane, would require a complete and thorough biography of the man, would require to know the influences he fell heir to, the rails which were laid down for him to run on before he was bom, by the material fate of here- ditary transmission. " Every man carries his destiny on his fore- head/' say the Mohammedans ; but not on his forehead only, say we. Every nerve has an iron destiny forged in the past. Man is like a watch wound up by fate, to go for a season ; he is made for 24 MEDICAL JtlEISPBUDENCE OF INSANITY. good or evil, bj the past ; and it is not the present that predeter- mines the fature, but the past that predetermines all time. And what past went before that jiast ? Was it He who was before time F The question is a great one, and not to be answered with s little footmle of common sense. One thing aione seems certain, that any answer to the question, as to what causes insanity,— eave that "through all time, if we read aright, sin was, is, and will be the parent of misery," and misery is the parent — and often tlie child resembles the sire — of insanity, — is almost impossible. But the question narrows itself on account of our inability to answer it. It comes to be a small question, with a little creeping answer, always tentative, always on its hands and knees, always groping in the great darkness. Causes, then, which are thought at the present time to conduce to insanity, have been divided into predisposing and esciting, and into physical and moral. One thing is clear, whether there is nothing but mind, or nothing but matter; and that is, that the one set of these causes, in so far as we are here concerned, may be regarded aa operating through, or by means of, the other. If mind is a manifestation of body, it is quite evident that moral canses are causes only on account of the pliysical changes which they produce. If mind manifests itself through body {which may be the objective idea), and it is with those manifestations that we have to do in this place; and if, as bad glass distorts the images we see through it, by twisting the rays of light, so defective organism, or the lack of power to adapt subjective ideas to the objective idea, may distort the manifestations of mind, — it is with the cause of this distortion that we have here to do. I, Of Reinot'S or Prediapofing Causes. — Civilization, it is said, lias led to an mcrease of insanity. Statistics, in ao far as they bear upon this queslion, are rubbish. We are told that insanity is rare amongst uncivilized peoples, and that in this country 1 in every 500 is mad. Does that statement afford any figures for comparison? What is "common" expressed in numerical relation? ^ijid if it were settled, what would it prove? Not what it is meant to estab- lish, it seems to us. We hear, however, that theoretical considera- tions lead one to suppose tJiat insanity has increased, and that civilization is the predisposing cause. Those theoretical considera- tions, as explamed by Dr. Maudsley, are, that as in a complex CAUSES OP INSANITT. e hui 25 organization like the human bodyj there is a greater liabiHty to disease, and the possibility of many raore diseases, so in the increased complesity of the mental organization, it is reasonable to eipect an increased liability to mental disorder. But why ? In the first place, he assnmes a fact ; and in the second, we know that notwithstanding the increased complexity of structare of the human body, notwith- standing the number of kinds of tissues, and the orderly subordina- tion of parts, that " man seems in his transitions from one climate to another to resemble domestic animals, with this ditTerence, that he bears those changes better in proportion as he is civilized."* Why should not the same principle hold good here ? Why should not the more complex mental organization lead to a more careful mode of life ? Why should not the higher mental development lead, through science, to the diminution of the disease, through cure, by care in breeding, and by the avoidance of those actions which lead directly or indirectly to abnormal mental conditions P There is more earnest living in these days, it is true ; but why the human mind, which haa made for itself the power to be earnest, which has so far overcome barbarism as to have gained the capacity for being " bored, "t should not have at the same time gained the vigour to withstand its unhealthy influences, it is dilEcult to say. To assert that the tendencies to disease only can be transmitted, is to say what is absurd ; but it is to express plainly what seems to . have been tacitly assumed in this case, for the sake of argument. Health is inheritable. And he who says, " I gave my children all the health I got," says something better and nobler than he who says, " I gave my children double the property I got from my father." We confess, it is difficult to see why our present civilization should have produced this bane. That we pet our lunatics, and number them as carefully as David did the people of Israel, is true, and the more we number, the more the plague rages. Tliat the number of lunatics in asylums at the present time is greater than it was in times past is true, but it jjroves nothing but that asylum accommodation is much increased. That the number calculated to be in England at the present time is greater than it was some years ago, only suggests a more efficient system of ascertaining the actual amount of lunacy throughout the country, or that phases of life are 26 MEDiCAl JDRISPttTTBENOE OF INSANITY. now recognised as insanity which were formerly classed under the head, sanity. But all the statistics that can be procured are utterly untrustworthy. It seems to us, however, that another ailment tells against the supposition that civilization is a predisposing cause of insanity. Imbecility is the form that mental unsoundness usually assumes in uncivilized countries, while in countries which are advanced ia civilization, mania is more common. Surely, then, if the mania has increased under the influence of civilization, imbecility must have decreased in the same proportion. It is surely unfair to ask to be allowed to run with the hare, and at the same time to hunt with the hounds. If civilization has to bear the blame of the one, it ought to have the merit of the other. Again, it is assumed that the conditions of life are less healthy now than of yore. Some gentlemen somewhat inconsistently ascribe insanity in man to the awful struggle to get rich, and ascribe the same disease in woman to the want of this struggle. But how does our age differ from others in this respect? Had they no struggles in time past? The struggle for bread with the gnawing tooth of hunger for a spur? Is the death-struggle less deleterious to mental health than the miser's grasp ? But the struggle sharpens wits : men are " moulded through their faults" and their misfortunes. Adversity wears a jewel in its head. Even this struggle for money, which takes not a few of our fellows into the dust and mud by day, makes nature more and more man's handinaiden. One author* endeavours to show that the law of nature which throws aside the weak and useless, and gives life's battle to the strong, causes insanity. He illustrates this principle by the domi- nion of man over weak woman — shows that some women, under the present system, must sin to live, and that marriage is the true and pure woman's goal; he asserts that, in consequence of various circumstances, they cannot all get married, and, having no real work to do, that which was meant for honey, turns to gall : " sweet wants" have been in the heart in vain; desires have withered, because there was no answer to those demands of nature. That marriage is the chief cud of a woman's eiisfencc, is, according to this author, due to the fact that for centuries women have suffered deprivation of liberty, have been in servitude to man, and have been taught that to minister in one way to man's enjoyment was • Dr. Maudslcf, in bii ' Psyoliology ind Pnthologj of Miiiii' CAUSES OF INSANITY. 27 their higfaeat function — that, when this hope fails, the heart aiid braJB sicken, and they go mad, Nothing is so popular in our days as this kind of reasoning, which is not reasoning at all. One may ask with reference to the above, (1.) Is it a fact, that in con8e(iucnce of this circumstance women do go insane ? (2.) If there are more women, in proportion to the population's calculated number, insane than men ? And if these questions could be answered in the affirmative, one might, upon theoretical considerations, think that as Nature trains by means of conditions, if she trained women to look upon sexual intercourse as a goal. Nature has done wrong ; and Nature is, to say the least of it, a very bad schoolmistress. If it could he shown that the pro- portion between men and women varied at the present time from what it formerly did, there might be some weight in the argument. But as that cannot be shown, it is difficult to see how an education of the ses, by means of conditions, to look upon sexual intercourse as a high function, should not all along have included in its cur- riculum lessons of strength under its deprivation — a strength which would withstand those disturbances which ever rise, according to this author, and which are the proximate causes of insanity. Why Nature, with as good means at her disposal, should teach one lesson and implant certain characteristics in the sei, and refrain from teaching the other, or implanting the other set of characteristics, it is impossible to say. Why, under such circumstances, women should masturbate, become religious, gr go mad, or do all three, it is difficult to see. Overcrowding, and the very great distinction in respect to wealth and luxury, do, along with many other circumstances, lead to insanity ; bat to adduce these tendencies as proofs of the increase of insanity simply on the ground that they arc remotely predis- posing causes, is absurd. If the causes of insanity are used at all in this connexion, it must be only by way of comparison (and that a careful one) with those predisposing causes which existed in times past, with a view from their relative potency (if that can be ascertained without solving the question of increase) to argue as to the number of perverts from sanity to insanity, which each of them made. This is a targe question; assertion will not meet ita demands. The question as to the iuflueiice of civilization is infinitely more 28 MEDICAL JURlSPItUDENCE OF INSAHITT. important in relation to the change of type in relation to synthetic etiology, than to the question of increase. That the paraaile, the conditions of social life, the forms of religion, and the direc- tion of national thought, influence and modify character, aad in that way modify the quality of insanity, is certain. But it is not for us in this place to examine in what way, or to what extent, this is the case. Sex. — Women were at one time thought to be more predisposed to insanity than men. Esqnirol and Haslam agreed that it was so. But at the present time most writers seem to imagine that men are more prone to mental disease than women. Many writers, in their ntter incompetence to deal with figures, which are two-edged swords, have computed the number of patients admitted into one asylum in a certain time, and concluded that the proportion of women to men in these admissions, is likely to be in the proportion of insane women to insane men throughout the world, and hence deduce a theory as to the predisposition. But it ia to be remem- bered that the proportion between the insane of the two seses is not found to be the same in all countries ; and it can be conlidently affirmed, that even in the same country, it varies at different periods. The argument as to the weakness of the female sex making hex more liable to suffer from adverse circumstances, is, as has beea already shown, fallacious. To say that her weakness is brought about by her servitude, and that it is her weakness makes her liable, just in consequence of never having been exposed to risks, is to reason in a circle. One must look at the whole circum- stances. If her servitude has made her weak, it has been by pro- tecting her from certain works and hardships which men have undertaken. If those works and hardships are still undertaken by men, then women, as a class, are not exposed to those circumstancea which can, together with their weakness, lead to insanity. One circumstance must not be regarded as the predisposing cause at insanity in a class where other circumstances are to be set against it. Best is produced by forces that could move. Women in their present state are said to be less liable to those forms of insanity which occur in men, and can be traced to intemperance and othof excesses. But it is their weakness and consequent servitude whicU have kept them from those works which lead to those excesses. It is absurd, therefore, to say that sex or its weakness predisposes to I CAOSES OF ISSAKITT. 29 insamtj. TVe should say that tlie numbers of men and of women who go insane, differ little, if at all, and that it is impossible to argue that sex has any influence as a predisposing cause in the production of maanity. Age. — Children become insane. Wherever there is a mind at all, it may become liable to mental disorder. All the diseases which occur in adults, with the exception of general parnlyais, have been observed in children. Idiocy, however, is the most common form of insanity in early life ; and not unfrequently, where unusual mani- festations of mental activity have occurred at birth, after the convulsions caused by dentition or gastro-intestinal irritation, imbecility has taken the place of the undue excitement of the faculties. Instances of insanity, however, previous to puberty, are rare. It is not uncommon in girls upon the appearance of the menstrual secretion, especially if it is delayed beyond the usual time for miiking its apjjearaHce. Insanity is most frequent at the age when man is at his best, — from 35 to 50 is the stratum of time in which his activity is greatest, and in which, owing to the fact of his activity, he is most exposed to the exciting cause of the disease. " Man's first word," says Hare, " is ' Yea ;' his second, ' No ;' his third, ' Yes.' " And so the diseases of a life correspond to this process of thought. Idiocy is the absolute affirmation — the very acme of assent. Mania is a universal " No ;" and senile dementia is the same blank assent again. Acute forms of mental disease in advanced life are rare. It requires strength to go mad. Educul'wn. — Education is not simply learning to read. The most important lesson a man can Jearn in youth is to be healthy. Not always to be thinking one needs a pill, but to be thoroughly unconscious of the existence of a stomach, which, like one's friends, only obtrudes itself when it is going to annoy. That educatiuii should not make a man clever and had, is surely true ; and that it should try to make him clever and good — which is the exact anti- thesis of insanity, which is bad and stupid beyond the reach of punishment — is surely the true function of education. But education only too often is conducted upon such universal principles that individuality is altogether overlooked; and very frequently ten- dencies which were latent, and migiit in time and with careful training have been eradicated, are made actual and living, and d to insanity, by and through a pernicious system of education. 30 MEUICAI, JURISPttUDENCE OF INSANITY. Education, properly conducted, migbt do something to make a com- promise between the future and the past. Men inherit debts from nature which many have to pay with death, many with insanity. Education ought to husband and cultivate the assets, and too often it only Iiastens the end, which is on its way. We have not space to say more concerning education as a predisposing cause. nereditary tendency. — So powerful is hereditary predispoaition, that in almost every case one can find that the taint has a history. It seems like a river that may dip under the earth for a while, but will dash out on the plain of time a little further down. But it is not insanity only tliat predisposes to msanity. It grows from slips as well as from the bulb. And epilepsy, hysteria, and neuralgia in the parent, are found to predispose to insanity in the children. Nay, more, it is certain that diseases which do not in the parent specially alfect tiie nervous system, as phthisis, scrofula, syphilis, do in the offspring, in so fat eis they conduce to a delicate nervous constitution, predispose to insanity. Tlie question as to the hybridity of diseases, if we may so say, is one of much interest and importance. Like other hybrids, however, the prolificacy of the insane seema limited. As to the proportion of cases in which hereditary predisposition is observable, many opinions have been hazarded. Dr. Burrows says that he found an hereditary tendency in six sevenths of his patients. Moreau argues that it is detectable in nine tenths of the insane. Eaquirol stated that a predisposition to insanity is more readily transmitted through the mother than tlirough the father j and Dr. Pagan* has observed that children born before the appear- ance of mental alienation in the parent are less likely to suffer from the disease than those bom after the outbreak of the first attack. Pregnancy may be regarded as a predisposing cause of insanity. Many cases are on record in which insanity has come on during pregnancy in which suicide has been attempted ; and in many cases the nervous irritability, and other pecuharities which occur in tha course of gestation, have passed into one of the forms of monomania. Many women look forward with dread to the approaching confine- ment, which, together with the effect produced by the inffuence of I I ' Pngan's ' Molical JurwpruJence,' p. 36. CAHSES OP INSANiTV. 31 the organa of reproduction, is sufficient in man; cases to bring on insanity. Delivery has, however, a better right to be considered as a pre- disposing cause of mental derangement. In the divisions of puerperal insanity into that which occur? during pregnancy, that which occurs at the period of parturition, and that which occurs durnig lactation, the greater number of recorded cases fall under the second of those three heads. At this period women are pecu- liarly liable to attacks of insanity. Frequently the form of insanity, or the kind of delusion, is in some vFay connected with, and depen- dent upon, the peculiar condition of tlie organs affected.* In many cases the mothers show a strong aversion to see their children, and often the hatred is so intense as to prompt to acts of violence. The explanation of the freqaency of insanity at this period, on the ground that the loss of personal charms, and the consequent extinction of the hope of being still the object of devotion as beretoforej may lead to morbid feehngs through mortified vanity, which is given in some books, is absurd and unsatisfactory. Surely the physiological causes are sufficient to account for the predisposition which exists at this period. This seems borne out by the fact, that women at the menstrual period are more prone to attacks of mental disease than at other periods — a circumstance which probably is the cause of the physiological connexion between the moon and lunacy. When lactation ceases, as well as during the time when women are nursing children, there is a tendency to mental excitement which frequently passes into insanity. Many women are insane at the period of giving birth to cliildren, and at no other time suffer from mental unsoundness. Tbe cure of puerperal insanity is very fre- quent, and we believe that, in good hands, no case of childbirth insanity would last more than a few months if it was treated in its earlier stages. All those physiological conditions which occur at delivery, during lactation, when lactation ceases, and at that period of life when the menstrual secretion stops, render women more susceptible to the influences of the exciting causes of insanity. To assert that the loss of good looks, and the sorrow of wounded vanity consequent thereon, have not any influence in predisposing to mental disease, would merely be io assert. But that it ought to be • SoG EviJonce of Sir Jnmw T. Simpion in Monlaunt v. Mordnunt. 32 MEDICAL JUEI3PEUDENCE OF IN8ANITT. considered as a prominent proximate cause of insanily, where there are adequate physiological conditions to account for the genesis of the disease, is to mistake the relative imporlancc of two claasos of causes. Religion. — Some writers have placed religion amongst the list of those things which predispose to insanity. They might, with e^aal justice, have placed life as the predisposing cause of all insaotty. It is true that certain forms of religious excitement do tend to foster insanity, but it is equally true that certain kinds of life lead directly to the abnormal coudition of mind which we call insanity. It seema to us that religion should be looked upon not as n cause conducing to disease, but as one of those causes which has a most sanitto'jr effect, not as a series of circumstances tending to mental degeneracy and insanity, hut as a series of circumstances directly tending to mental improvement and health. Yet we do not deny the fact, that those somewhat excited religious gatherings which have taken place of late years, in which the Lord Jesus is expected to be found in the midst of many fears, much shouting, and an occasional attack of hysteria, do tend directly to mental unsoundness. We would not argue that the extreme form of lligh-Churchism— the most material form of Christian worship, in which symbolism really often loses its soul, and has nothing but the body left — that the constant and all- absorbing exercises of that form of religion, accompanied as it ia with much unhealthy self-examination, and a self- bruising asceticism, will not in many cases predispose to insanity. But we do argue, that religion in its fullest sense, and religion as patterned in the life of Him whose name is connected with the creed of this country at the present time, is not calculated to predispose to insanity, but that, on the contrary, it ia calculated to predispose to the most perfect mental health, that it is necessary to that perfect health, and that the human mind finds in that creed, when it is thorougldy under- stood and earnestly beheved, the most thorough and perfect guide to a life of soberness and chastity, faith and well-doing, wfaich are the very conditions of health in the individual practising according to these rules, and of its transmission to those that are to come after them. It is the fashion among a certain class of shallow thinkers to hold that sanity consists in the absence of all prejudices — even Voltaire's one prejudice, the pn'jiidiee de Bieu^&ad so to those persons rehgion and its systems seem preju dice -manufactories, CAUSES OP IKSANITV. 33 and thus causes which predispose to insanity. Prejuilice^ ! if it were not for prejudices, not a man on earth would be sane, not a man on earlh would he. These small men themselves are prejudiced ogainst prejudices, — let them reason about that ! Before we cease speaking of the predisposing canse^i of insanity, we may say that whatever has the eS'ect of debilitating the physical structure, or the moral and intellectual faculties, has more or less tendency, according to the character of the individual, to predispose to mental disease. Moral vices, excessive mental strain, great anxiety, and unusual excitement, all predispose to alienation of mind. Individual temperament, in tha widest sense of tlie term, must bo taken into considerdtion in every case. II. Proximate or Excil-ing Cnuses, — An exhaustive treatment of the exciting causes of insanity can only find place in a work on the pathology of mind. In this place the mention of some of the causes which lead directly to insanity must suffice. It must be remembered that the cause which in one case may be looked upon as exciting, must, in another case, be regarded as predisposing. Malformations of the brain — dependent, it may be, upon morbid changes in the skull, the defective development or the arrest of growth of this organ — are all causes which operate powerfully to produce mental unsoundness. The brain-weight in microcephalous idiocy is not only small when compared with the brain-weight of healthy individuals, hut the relative weight of the brain to the body of the microcephalic idiot is very much Iras than the relative weight of the brain to the body of a person in normal health. Injuries to the he-ad which have produced lesion in the structure of the brain, or which have caused disease which has led to a partial disorganization of the part, may be looked upon as exciting causes of mental unsoundness. Tumours in the brain, and many of Ihe alterations produced by organic disease in the cerebrum and ils membranes, also proximately conduce to insanity. Starvation and exposure to intense pain, extreme fatigue, aa well as apoplexy, palsy, epilepsy, and convulsions of all kinds, are, as it were, open doors to insanity. The sympathy which exists between every part of the bodily organism — " Kacb p«rt i^lls the fiirthfat IjrotliiT. For head with Toot hxtli private sinilj " — nds in many cases to abnormal mental action, either on account of inctional derangement, or on account of the structural disease of 3 ;ji MEDICAL JUniSPRlTDENCE OF INSANITY. some remote part. But there seems tu be a more iatimate "private amitj" between the brain aud its neighbours, ihe stomach, the liver, the intestines, and uterus, tlian there is between the head and foot. Insanity grows hke a graft upon many other diseases, but in certain cases the existence of insanity at tlie same time as a bodily disease does not seem compatible. losanity arises not unfrciiuently ujion the suppresBJon of an accustomed discharge, and often accompaniea irregularities iu the menstrual secretion. Intimately connected vith the causes above enumerated are those to which the name "moral" has been given, and which operate banefully upon mental health through the brain. Strong emotions aud passions, every circumstance in menial life which is calculated to malce a deep impression, and appropriate a large amount of the free mental energy, may, upon occasion, become a cause of insanlfy. Attention, whose " very quality," according to Goethe, " is that at the moment it makes a notliing all," — attention, whicli really is the faculty which distinguishes the great man from the small, so that any man might be great if he only knew how and to what to direct his attention, may, where it too constantly makes " a nothing all," degenerate into the mental unsoundness of a fiscd idea. Disappointed love, terror, pride, ambition, anger, jealousy, avarice, all that is good and noble, as well as all that is mean and disgusting, may be a cause of insanity, and the very intensity aud constancy of the emotion are the elements which tend to make it the bane of this fever-hfe, rather than the antidote. "The wine is good, hut the vessels are old or crazy." It is to bo remembered that in relation to such cases the effects are very often very near in point of time. Terror, that in one not predisposed to mental disease might cause convulsions, wil] often, in one foredoomed to rave, cause an almost immediate attack of mania. Joy, when very intense, sometimes causes insanity. The " happy medium" must have more joy in it than this dangerous extftme, and would lead us to " welcome each rebuff," or, as n somewhat bold author put it, thank God for our corns. A case is o» record which tells the story of two lovers who had made each other perfectly happy, and, possibly fearing what Shelley calls " love's sad satiety," killed themselves. The incursion of those diseases which are caused by sorrow or jealousy is somewhat slower. Sorrow not only steals "the natural hue of health from vermiel hps," and "the lustrous passion from the falcon eye," but steals the something which givea I CAUSES OF IKSANITY. 35 I to the eye and sweetness to the vermiel liji. Excessive grief saps the foundation of the mind, as it were, with tears, and every room-faculty gets damp and mouldy. The individual eeeks L.jwclu8ioQs, hugs the painful ideas, foregoes bis usual exercise, KiToida a laugh as he would a devil ; he loses appetite, digestion, I tfid sleep, and illusions and delusions spring from such soil. We lave already examined some of those general causes, which are the I'great outcomes of human nature in time, as predisposing to insanity. We have shown the extreme clilhcultj of estimating the effect of those widespread causes; but, notwithstanding the difficulty, it is necessary for the medical querist to make t!ie endeavour, especially vith regard to such causes as are to be found in intense political Bcitemeut and enthusiasm; remembering, Jiowever, that it b which, like casks that have lost their hoops, are constitu- tionally weak, that give way nnder the influence of such excitement. Tliat there is some peculiar sympathy between man and man which emphasises individual sentiment, which modifies individual thoughts, is a fact. It is proved by the extraordinary conduct of mobs, the Itnthusiasm and death -forget fulness of armies, by the knee-made rvency of worshipping congregations. That the excitement which (lists at certain periods of political importance sliould be increased ' an extraordinary extent by its widespread participation with \hns, was what we were prepared to expect, remembering the well- inarked tendency of excitement to increase until actual exhaustion draws the rein. But none could have anticipated the extraordinary outbursts of excitement which have taken place, anil which are chronicled in the histories of nations — excitements which have all the marks of frenzy, and might easily be considered as a species of insanity. Even in our own country, iu times not very long gone by, the nerves of cool, wise men quivered with the sympathy of humanity, because other men's hearts beat, and other men's brains throbbed with party feeling and political fervour. Just so a harp, untouched by human hands, will send out a httle sound, if there is the music of a brass band near. But how infinitely greater was the sliock of such world-actions as the devolution in trance. Esquirol has observed, that the more prominent events of French history during the half century before the date at which his words were uttered might be illustrated by cases in the lunatic asylums of that wntry. Just as a storm tears down trees', and the rivers carry them 36 MEDICAL JURTSPRDDENCE OF IN3ANITT.J to the sea, where they are buried and made stone mummies off are for times to come a record of the storm, and of the trees it blew over, — so in the wards of insane hospitals may indices to the politictil rtorms of the past be found at the present time. The extraordinarj' influence of conjoined action, of conjoined excitement, or of con- joined depression, is well understood ; and that it leads to insanitjr Among many, as if by the continuance of the same powerful influence, is a fact. That such induencea ma^ account for epidemics of insanity su^esta itself as a probable solution of tliat psychologicai difficulty. We know that certain common physical influences powerfully affect the frequency of epileptic fits and paralytic disorders. We know, however, that common mental influences more powerfully affect sucli nervous disorders as hysteria ; and it is to be argued that the same relation of causes to the persons influenced would produce effects corresponding to the symptoms of epidemics of insanity. It is use- less to quote the threadbare story of the seven suicides at the Hdlel des Invalidefl. But we may mention that which occurred at Ver- sailles, where, in 1793, when the population was only SU.OUO, no less than 1300 suicides occurred,* aud many othera of a similar character are upon record. Three cases of attempted suicide occurred in Sheffield in one day only a few montlis ago.t That ench events arise from the causes above alluded to, we are inclined to believe ; add Uiat most of the explanations usually offered of such phenomeitft are unsatisfaetory, we confidently assert. A more minute analysis of the con»ei;ti3 a P OS • • 1^-- t-* 7S o o O) 3 S P o ^ s o o^ -►* s s 1?"5 • cd. • 13 Conseque] mental iniuries • • :;a fc. o r-i 8 ^ ^ "V ^ s V Qi 1 'S 0? O) s —J o t-. .25 p-1 c o ca S o -a O I *ti L o< o CO "V B oo CO a \ OF UNSOUNDNESS OF MIND. 43 Class II. Idiophrenic Insanity. We may add another classification of mental diseases which has found some favour in the eyes of the medical profession. We need not point out its errors, which are obvious. Class I. — Insanity resulting from"^ __. . . , r 1 . • J J idiocy, conffenital and arrested or impau*ed de- > • j velopment of the brain. J ^ ( 1 ) Sthenic and asthenic idiopathic insanity. (2) Phrenic insanity (inflammatory). (3) General paresis. (4) Paralysis with insanity. (5) Traumatic insanity. (6) Epileptic insanity. Epileptic insanity. Insanity of masturbation. Insanity of pubescence. Climacteric insanity. Ovarian and uterine insanity. Insanity of pregnancy. Puerperal insanity. Post-connubial insanity. Hysterical insanity. .Enteric insanity. Lcucopsoitos (from aberration) Post-febrile insanity. .Insanity of lactation. {Insanity of tuberculosis. Syphilitic insanity. rCretinism. 1 Delirium tremens. Insanity of alcoholism. Insanity from opium-eating. '^Rheumatic. Pellagrous. Metastatic insanity from healing of long- established issues. Class III. Sympathetic Insanity. Class IV. Anaemic Insanity. Class V. Diathetic insanity. Class VI. Toxic Insanity. Class VII. Metastatic Insanity. ^ote.— Professor Laycock's *' Nosological Index," first published in bis work on * Medical Observation and Research,' 2nd edit. p. 842, although eminently suggestive, is of too complex and theoretical a character to be available for practical purposes. 41 MEDICAL JUIilSPRUDENCE OP INSANITy. In the first of these methods the mental pecnliaritiea of the patient are the ground of claasificatioD ; tu the latter the mental symptoms are pat aside and disregarded, and the forme of disease are classified ac- cording to their sop|msed pathological causes and the relation of theee causes to the bodily organism. No classification is perfect. We must endeavour to obtain that which will be most useful to those who would treat disease, and to those who would understand in what cases mental aberration or defect will modify the relations of un individual to Uis fellow-countrymen, to his properly, and to the state. The classification quoted above which is based upon the pathological cause of the disorder has a look of science about it which will deceive many. It is a fact proved by the everyday eiperience of those who have to do with mental disejiee that we find many patients whose insanity, although resulting from exactly similar causes, differs the one from the other in every possible jiarticular. Uesides, is it not evident that, to arrive at any conclusion with regard to the cause, we must take into consideration the mental peculiarities of the patient, and thus rise to the classification which pretends to be ijidependent of mental symptoms, through the very classification of peculiarities of mental condition which it pretends to discard ? In the above classification it is obvious that there are grave mistakes which present themselves even to those who are only partially acquainted with nosology. Thus, to place Idiopathic Insanity as a sub-class under Idiophrenic Insanity shows how weak the system is. A classification which is understood to be framed according to pathological causes has taken care to have a class where all maladies which cannot be thus classified are to be placed. How large this class is it is impossible to say, but any classification which has under it a class which it is impossible to classify seems to us as satisfactory in its way as an argument which demands the concluaiou as a datum. Again, under Class 3, Sympathetic Insanity, we find the sub-classes Climacteric Insanity and Fost-contmbial Insanity. To pretend to classify diseases according to their patho lineal causes, and theu to state as a cause a whole system of life, or a bodiljr condition existing for years, is surely unphilosophical. It would be as correct to give as a sub-ckss " insanity arising from previous conduct." But the errors are too many to allow us to do tbem the justice of ]K)ialing them out, and too obvious to require it. Upon tlio B'holc, consideration induces us to adopt the first of OP UNSOUNDNESS OF MIND. 45 these two classifications. It is certainly of the utmost importance that a classification should be adopted for the purposes of medical jurists which is easily understood, and the ground of which is to be found in easily observed symptoms. Only in this way will the great gulf which separates medical men and lawyers be bridged over. When^ however^ mental peculiarities^ as inferred from conduct^ are taken as the basis of the methodical arrangement of kinds of uisanity, or of patients labouring under them^ into certain groups^ little difficulty is likely to arise ; as to a lawyer, insanity is to be inferred from certam acts, not from the existence of a certain cause. It must be remembered that all classifications are defective, and can only be defended on the ground of convenience and expediency, not upon that of absolute correctness or truth. In many cases much difficulty will be found in assigning some mental disorder to any one of the classes above enumerated, and care must always be taken to appreciate the fact that these words are not absolute partitions between diseases. In many cases these peculiarities which have served aa a distinguishing feature of one class are found mixed with, or modified by those which have served as the distinguishing features of another. A classification is like a walking-stick, a thing to be of assistance. Yet some children ride on a walking-stick and some men make a hobby of a classification. It is mental weakness which is the cause in each case. 46 MEDICAL JURISPRUDENCE OF INSANITY. CHAPTER IV. AMENTIA AND ITS LEGAL RELATIONS. Amentia has been divided into two distinct kinds — Idiocy and Imbecility. The distinction between these two is far from being accurate. In many cases the utmost dii&culty arises in determining the precise degree of mental defect which amounts to idiocy; as, indeed, there is often much difficulty in determining what amount of simple weakness of intellect amounts to imbecility. The question is full of difficulties. We will treat of these two forms of mental defect separately. Idiocy. — Idiocy is, according to medical men, a state in which, from defective structure of the brain, the individual has been utterly incapacitated from acquiring any such experience as would fit him in any way to fulfil the most trivial duties of his social position. And according to Bacon, " An idiot is a fool or a madman from his nativity, and one who never had any lucid intervals.; and such an one is described as a person that cannot number twenty, tell the days of the week, does not know his father or mother, &c. But these are mentioned as instances only; for idiot or not, being a question of fact, must be tried by a jury on inspection."* Well, an idiot is a person so thoroughly without mind that all mental cultivation has been and is out of the question. It is as difficult to make money without some capital either in money or the power to labour, as to acquire knowledge without a brain. To dis- tinguish idiocy clearly from dementia, with which it is sometimes confounded, it must be remembered that the former is a congenital absence, or at least serious defect, of all the faculties of mind, while • See also Lord Hatherly in Harrod v, Harrod, 1 Kay and Jo. 4; Co. Litt. 274 a, Fitzroy N. B., 233 b, ed. 1794; 1 Hale, P. C. 29; Lord Tenterden, C. J., in Ball v. Kannin, 1 D. and CI., 393, S.C. 8, BIL, N.S., 1; 4 Rep., 124; Lord Hardwicke, C, in Lord Donegal's case, 2 Ves., 408, 1 Bl., Com. 304. AMENTIA AND ITS LEGAL RELATIONS. 47 dementia may be regarded as the gradual obliteration of faculties which have been possessed. Idiots of the lowest type have simply a physical existence, and even that is modified by bodily infirmity, and often by anaesthesia, which would lead to death unless they were very closely watched. In a higher form of idiocy, or a mental condition more nearly approaching to ordinary intelligence, the patients have sensations of heat and cold, hunger and thirst. But it is somewhat difficult to form classes of idiots by reason of the attribute of intelligence possessed by them in a greater or less degree. They almost always agree in these things : they have misshapen heads, large gaping mouths, and their other features are not unfrequently ill-formed and distorted. As for ex- pression I Expression is only thought become external to itself in the flesh, and therefore idiots' faces are marked by an utter want of all expression, and there is little or no power of speech. Some of them, however, utter cries in which ingenuity has found close resem- blance to the sounds made by inferior animals. Their limbs and trunk are imperfectly developed, their complexion is generally sallow and unhealthy. Very often one or more of the senses is defective^ sometimes one of them is entirely wanting. Only in the rarest cases is the head of full size and well formed. They usually die before the age of thirty.*^ In idiots it is usual to say that the power of will is entirely deficient ; but we shall see more clearly, in considering the legal relations of idiots, what is meant by this phrase. They are sometimes governed by impulses, and at the age of puberty manifest the sexual passion in ways as ofiensive as the ordinary normal indication of what Goethe calls 'Hhe presentment of sweet wants'' is beautiful. They are exceedingly irritable, and subject to the most violent fits of passion, and have none of that exquisite sympathy which prevents them from injuring the feelings of another. Imita- tion influences them not a little, as it does monkeys. It is a power which is always strong in the weak. In Switzerland idiocy is often accompanied by one special kind of bodily deformity. The thyroid gland becomes enlarged, and this enlargement is known as goitre or bronchocele. But besides this deformity there are others. The stature is generally dwarfed ; the belly protuberant ; the legs small ; the arch of the palate high and narrow ; the mouth, from which the saUva is suffered to escape, large and * Esquirol, ' Maladies Mentales,' toI. ii, p. 284. 48 llEDICAl. JDEISPRUDENCE OF INSANITY. misshaiTcn ; the teeth irregular ; llie voice harsh and high pitched ; the ejes st|uiiititig ; the gait feeble and unsteady ; the aexoal power weak, or aitogetlier absent. Persons afflictBd bj this disease are in Switzerland and Savoy called cretins, and in France eagoU. It is ascribed to local peculiarities^ and is said to prevail rnostlyin v^eys lying among hills, although it has been argued that it only occurs where the people are living upon or drinking the waters which flow over a calcareous formation. Tlie best opinion seems to be that this mental deficiency, co- existing with this physical defect, is developed some time after the birth of the child. In some cases it is complicated by spinal distor- tion, in some by hydrocephalus. There is a division of cretins into three classes, but for all the purposes that such a work as this is intended to subserve enough has been said concerning this very curious variety of idiocy. The legal relations of idiots need not occupy much attention. It almost follows, from what has been said, that an idiot labours under complete civil disabihty.* The conveyances of idiots are void.f An idiot cannot make a will.]; An idiot cannot contract marriage.S Kor can an idiot be elected member of Parliament. |J It is, however, true that an idiot cannot appear in an action at law by altomey, and even when an attorney is employed for them the idiot should be described as appearing in jterson, or by guardian, according to the nature of the case. If An adult idiot can consent to carnal connec- tion, and is not, as female children are, held incapable of giving consent.** The reason why idiols should not be held criminally responsible a of Amcricn, while idiota e, by the conaUtuUim of » TDtc at elecUoni. • It \t somewlint cnrioua that in (lie United Statta Hre deprived at aluioat nil theif civil rights, they x Bcrersl or the >Ute>, left iu Uie enjoymeot of Che right t But uw Thompson o. Lcnch. Cnrth., 435. t 1 Hale, P.C. 220; Buc. Abr. Idiot, a. 1; Beverley-a caic, 4 Co. Rep., IMIi; Williami, Ex., 16; 4 lluma' Kcc. I:AW, 55; lugrnm n. Wyatt, 1 Haeg Ecc.. 384. § Roll. Ab., 357 ; IS Qeo. 1 1, c. 30 ; Browning d. Roan, S Phill. 90. See aim Rcotch Law, Fraaer i, 48 and 226, Jobngtan n. Brown, Nov. 15, 1S23, lod Frrg. I[«p.. p. 229; 8iiUivsn c. Sullivan, 2 Hag, p. 246. II Com. Jouru., 1625 j Com. Dig. P«rl. D. 9; Shcph. Elect.. 109. i Co. Litt. 136 b; 2 Siiund, 213 n; Oolda p. Sanwim, 5 Tnuut, ESI, k loutJo may, however, appear by attorney, Beverley's eaic, Hmnphrrya B. Griffith*, S Mee and W., 89. •' R. B, Byun, 2 Coj, Cr. Cn., 115, per Piatt. B. AMENTIA AKD ITS LEGAL liELATlONS. 49 ict which they maj comtoit is obvious. The law takes upon itself to punish crime because it is voluntary, iutentioniil,aL(l malicious. Whenever any act criminal in its nature is committed, the law pre- sumes that the individual was acting wilfully, that the acta were done with some motive oi intention, and that that motive or intention was malicious. Of course any one of these presumptions is liable to be rebutted. By proof of duress you rebut the presumptiou of the voluntary cbarac - ter of the act. By proof of fraud or imposition the motive may he shown to be other than that which reading back, a» it were, horn the act in question would have been supposed. If, then, any of the^e presumptions be rebutted, the crime is disproved. It is quite evident that there is notliing in the character of the act itself which indicates its criminal nature. What in one case is called murder^ and punished with death, is in another case called justifiable homi- cide, and rewarded by a money payment. Now the proof of idiocy does, by a necessary inference, disprove the existence of will, as it is understood by us, and of malice, or intention, as it is defined by law. And these presumption s, which exist in ordinary cases, having been rebutted, the criminal character of any act done by an idiot is disproved. It seems a fair conclusion to come to in reference to all those cases that, where approval can be vouchsafed, there also can punish- ment be, under the opposite circumstances, awarded. In the case of an idiot it would be as absurd to feel a moral approbation upon the ground of any act, as it would be in the case of a steam-engine to indulge in the same feeling upon the ground of any of its motions. Their acts have no moral character. The principles that enable men to take cognisance of crime at all are found in the fact that a certain ujiiformily esists in the mental conditions of all men. This uniformity, with its subject variety, ia called the normal condilinn. It is calculated that ail meu shun pain ; that the pursuit of pleasure is universal. Aud if any very large section of mankind were not so constituted as to be thus operated upon by pleasure and pain, the law would utterly fail with regard to them. It is true that every man follows a different pleasure — every man dreads a different pain. Some dread every- thing from the great unknown future ; others dread everything from the little present. StiU the law is founded upon this principle, and 50 MEDICAL .lURISPRUriENCE OF INSANITV. iU punish men ts are awarded upon this ground. But such a fact ifflpliea that those to whom an enaclment addresses itself possess a certain amount of knowledge. If a man does not possess sufficient experience to conduct the ordinary afTairs of life, if he does not comprehend the most simple and ordinary propositions, then it would be absurd to expect him to be ioQucnced by consideratioue which require for their comprehension a somewhat considerable mental power. To an idiot who does not gain any experience from having once fallen in the fire — who does not understand words, acta of parliament, are not in existence. And to many imbeciles who have the power of speech, who have some powers of acquisition, the pro- position tliat if they do something just now they will sulTer something in the time to come, is utterly incomprehensible. It ia upon these principles that the law, which is n great lathe upon which humaa conduct is to be shaped, in accordance with certain principles, regards idiots as irresponsible for their criminal acts. And it ia only in the application of these principles to the cases in which mental defect is not very marked, ca-'es in which the individual manifests considerable intelligence, and at the same time great intellectual weakness, that any ditflculty arises. ImbecHiiy. — Imbecility is unsoundness of mind occurring in early childhood. Idiocy we have seen is congenital. Many writers have endeavoured to distinguish idiota from imbeciles by other means. Gcorget regards the use of speech as a distinguishing characteristic of the imbecile, and the ordinary impression that the imbecile has more mind than the idiot seems to have been adopted by scientific observers as a good means of differentiating thews classes. So much may u few months or years of sanity, when a child has just come into the world, do for the mind of the hnlf- ripened man. Others have thought that they were founding a dis- tinction upon another and better principle when they thought that imbeciles were to be regarded as different from idiots in that the/ had a capacity for instruction. But Georget's distinction ia pre- cisely aimilar, for the fact that an imbecile lias speech indicates the past fact of the capacity for instruction. Many men amuse them- selves by dressing propositions in different words, as children do by dressing dolls in different dresses. But the truth is that no real distinction exists between the two, although for convenience they may be kept apart by means of the I AMENTIA AND ITS LEGAL RELATIONS. 51 two designations. The probability is that imbecility like idiocy ia congenital, but that the defect not being so marked in the former as in the latter, being a defect leas in degree although the same in kind, that it is not at once observed ; and that it ia only when the prepress of the child in mental stature is seen to be slower than it is in the case of a simply stupid child, that the imbecility is sus- pected, and the date of its inception is fixed as that of the observation instead of that of the birth. This is as if we asserted that the planet Uranus began to be on the 13th March, 1781, when Sir William Herschel observed it for the first time. Besides it ia well to be aware that this distinction is entirely arbitrary, as in manj cases it is iinpossible to diatingnish a minor degree of idiocy from a major degruo of imbecility- Just aa aome people differ from others in the amount of their capacity, in their mental power, so do imbeciles, and so nearljr do some imbeciles approach in intelligence the more atupid of the sane that it is sometimes almost impossible to say whether t!ie indi- vidual should be classed with idiots or fools. The degree of defect is likely to be accurately indicated by the number of words thejr are capable of using. Indeed, we may judge of the power of ordinary sane men by simply numbering the words they habitnally u»e. It must be habitual use and not aucb a use aa might be prepared for by means of n eram with reference to thia census. The fact that Shakespeare has used 15,000 worda, that Milton has used 8000, and that many ordinary day labourers are incapable of using more than 300, throws some light upon this suggestion, and when we go lower in the scale we find it still better illustrated, for many imbciles can only use one word. One class of imbeciles, then, arc incapable of acquiring or retaining knowledge ; they are unable to understand or appreciate any of the laws of the land, of the customs of society ; they have not sufficient mental power to influence their feelings and emotions by means of reason, and they are incapable of appreciating any of the doctrines of a revealed religion. There seems little reason for applying the tenn imbecile to these. There is another class, however, in which, together with very considerable capacity for the acquisition of know- ledge, and for the retention of memories, there seems to be an entire absence of that power which is used for the determination of the moral qualities of acts. It is very difficult to account for 52 MEDICAL JUBISPBUDEiTE OF INSISITT. the peculiar povers we find m aome indindnals. '■ GfDiiu don what it most; Talent doe* wtwt it can." but perhaps there is some reason for believing that everything " does what it most." That one man who is able to naaon accu- rately about mathematical problems, one whose wits are nimble to discover an " nndistributed middle" in any sieve of argaments, should yet be a stupid man in all the practical affairs of life is a matter for Borne wonder. There is no reason why a man who has attained intense delicacy and skill in any mechanical operation should not retain the same qualities when his energy is applied to some analogoas work. Why, for instance, a man who draws admirably should not write well. And yet so it is, and there is no reason to think that nature has deviated from her ordinary procedure when she has given a man real intellectual capacity in regard to several sets of circumstances, and has still left him a fool with regard to other matters of relation quite as simple and comprehensible. There is no easily understood ground for idiosyncrasies. It would be difficult to explain why a man should in aphasia lose one or two words and those only. Now this affords another class of imbecOes. As we have general imbecility so we have moral imbecility, and, in rare cases, we find simple intellectual imbecility. In this latter class we do not 6nd a perfect moral nature, but there is not the same utter incapacity to ap- preciate all moral distinctions that we find in those of the second class. The "Daft Will Speir," of whom so many stories are told in Scotland, seems to have been one of this class. Ail these anecdotes indicate the possession of much shrewdness, and it is that very shrewdness which makes it so difficult to determine the legal relations of such persons. One day, Will Spier's master said to him, " Well, Will, have yoo had a good dinner to-day ?" {Will had been grumbling some time before), "Ou, very gude," answered Will, "but gin anybody aska me if I got a dram after't what will I say ?" Concerning this idiot, it is said he had a high sense of duty. He was capable of doing little duties, and the charge of the coal stores at the Earl of Eglinton's had been entrusted to him. But even Daft Will was liable to make mistakes, and upon one occasion was reprimanded for I < AMENTIA AND ITS LEGAL RELATIONS. 53 allowing the aupjiliea to run oat before further supplies were ordered. This reprimand made liim moat careful in performing his duties. But his end drew near and the minister came to him. Thinking him reallj in a good frame of mind, the minister asked him, in the presence of the laird and others, if there was not otte great thought which was ever to him the highest consolation in this hour of trouble P " Ou ay," gasped the sufferer, " Lord be thankit, a' the bunkers are fu'." To assert that this individual was incapable of understanding the relations of man to the universe in so far as duty is concerned is to say something that will not be believed. Yet it is impossible to doubt tliftt he was incapable of much improvement by means of education, and the above incident shows how narrow bis sense of his duties was. It is curious liow much of this shrewdness can exist with the possession of very little wisdom. Not unfrequently imbeciles are capable of acquiring with much accuracy a large number of facts in one subject or department. Many have been noted for their powers of calculation, and we have ourselves seen an idiot who could spell almost any word backwards. So rapidly was this accomplished that it was found necessary to take down the letters as he uttered them. lie spelt long and intricate words in this way with precision and accuracy. One thing has to be pointed out with reference to the educational improvement of which imbeciles are capable, and that is that almost all the education which can be bestowed does not improve, but t«nds only to make the imbecile more mischievous and troublesome. Their extra training seems only to teach them how more cunningly to perpetrate tiieir vicious acta. It rather tends to make them more vicious. The reason of this is obvious. Tiie education cannot be carried far enough to establish in the individual any good principles of morals. So, while the intellect has slightly improved, the moral nature is still undeveloped. Only one course of conduct could result from this. It is a question, therefore, whether much educa- tion as it is ordinarily understood iu institutions for idiots and imbeciles should be resorted to. Tiiere has been a somewhat absurd social hunger for edncation. Those national appetites come in very various forms. In Australia there have been land hungers. People bought land without any reason for so dohig. It was as absurd as blie tulipomania. So it is we have been hungering for education 51 MEDICAL JDRISPRUDENCE OF INSAKITY. wilhout coDsiJering whether it is good or bad. We have often been ooDtent if we could make men hsif clever, instead of attempting to make them even a little wise. We have devoted ourselves to the cultivation of the intellect, while we have neglected ail moral training. However that may be, and depend opon it, if it is bo, we will have to sufftT for it in the scourge {of scorpions) which our criminals and lunatics are to this country ; still it is true that this extraordinarj desire for the education of all has had its infiuence even upon out largo idiot asylums ; and possibly the muni&ceuce by which these arc supported has been to some estent due to annual exhibitions of the results of education upon imbeciles. Old people are amoaed by toys. If they see a monkey do what a man docs they laugh. The feeling which appreciates satire in them is gratified. So is it with idiots' improvement; there is pleasure derived in this way whicb ia te]D]iercd by a feeling of somewhat loathing sympathy with the poor children, which is not altogether disagreeble. In this way the question of improvability has been fairly tried, and in a large class with the result that has been above indicated, bi that small class of imbeciles who are only intellectually weak, and who are capa- ble of moral improvement, educ&tiou might he had recourse to with advantage, but certainly without hope of rendering the individual a useful member of society. It is true that many imbeciles who belong to the other classes are capable of beiug delivered from certain acts by the certainty of immediate severe punishment, but most of the penalties which the law can put in force against offenders are too remote in point of time to have any influence upon the actions or conduct of the imbecile. It requires some mental power to be able sufficiently to comprehend the relation between a crime and its punishment by law. Owing to this circumstance less reliance ought to be placed on the fact, that rewards and punishments arc found to be efficacious in a household, or in an institution where imWciles are assembled, at least, when any inference would be drawn from it with reference to the responsibility of the imbecile for his or her criminal acts. The constant presence of a nurse or governess who has threatened the punishment is a very diiferent, and more jirominent and powerful motive to a weak mind than a statute-book threat made by something of which it knows and sees nothing, eicept its representative to the common people, a policeman. AMKfJTIA AND ITS LEGAL RELATIONS. 66 In many cases we find a Bingiilar power of reproducing musical sounds. "We have ourselves seen an idiot girl who could not speak, bat wlio could remember and repeat any music she had once beaid. She sung some music-hall tunes in our presence. It seemed strange, but natural. Concerning the various degrees of capacity and education, very little requires to be said. Some imbeciles can read, write, and count, some can even, it is said, attain to one accomplishment. But they never do profit in the same way from their opportunities that their sane neighbours do. This is what was to be expected. We have heard it said that there was an indication of some injustice in the parable of the lord who left his servants money with which they were to trade during his absence. It will be remembered that the man who had received five talents made five, and the man who had two made two. The man who made two from two evidently did better than he who made five from five, and yet the man who had made the five got the one of him who buried his talent, besides his five. So it is with sane men and imbeciles. The powers of acquisition of the latter arc limited by the very smaU amount of capital they start with, while merely a proportionate progress upon the part of the sane man, to that made by the imbecile, would scarcely be any progress at all. Many imbeciles know the value of money, and are capable of bearing testimony in certain cases, but are usually unable to carry on a connected conversation for any length of time, lu most cases they are incapable of any excellent emotion ; and if they do become attached, are usually very fickle. They are restless and uneasy in their manners, and somewhat incapable, in most instances, of reasoning with reference to the future from the facts supplied by the expe- rience of the past. The greatest number of imbeciles are found amongst the lower orders of society, just as more maniacs are found amongst the better educated. Imbecility is the disease of the dark ages, mania of those which are enlightened by civilization. There is the most marked difference observable in the wards of diiTcrent lunatic asylums as to noise and excitement. In those which contain the patients which have been drawn from the grejit country districts of England, the lunatics are mostly stupid and stolid, while in those whicli contain patients from great centres of industry, there is usually much noise and excitement. Besides these characteristics, maiiy of them become thoroughly SEDiCAL J t or DBLtSTTT. naom. It « vowkrfid hiv ittle bM vS At to be wicked i iLaj of ibem aic draakfa, and Mat nc hmy. l^ftalions of the MOittrinal kndhafcvitk sonc of thta aa fl M« i| i u l cat talaeBee; nd BOttvei rtndi wndd not ittnel the rtlfliuu of a nue iiaB, aat mahrtfuatij goma that raodaet. As; one vho knon H17- tfcnigof ibeorfaMya ™™ ! oofto of thw co owb y amt kaow how ■■Bj aj ttooe aa b oeifa ne PMl t wf ty beiag Mnucd of criraes; of IbcA, ■— nh, npe^ aetan. ■nrdo'. Aad it most ban stnu^ uj one wbcMe ri*r*^"" hn btea oOed to tiw vobject of naental dd- ■ornidMM, bov doaely pcnoBo Lduufjug to the onliiury crimiDal d«H >pproodi to iip b c ft lei in gownl appeuiaec^ ik numnen, in eoodnct, and in aach iDaiiif«tatioiu of intdligeBce as tber maj hare u opportonitf of duplajing. And jtt this is nirdj no good groood for exempting the hita from ponishnieDt, or for sabjectiDg the latter to it, iweiog that a reasonable and clear distinction can be drown be- tween these tvo clases, as ve have E«en in another part of this work. Ilolfhaaer* has made elaborate and almost useless distinctions between what he terms stupiditj (dummheit) aad imbecilitj (blodsinn), and goes still Farther, and divides the former into three difTereot degrees, and the latter into five. There is some ingenaitj displayed id his effort, but much ingenuitv in this world ia throffii away. Georgett has some interesting remarks upon this anbject, whicli have been quoted by many recent writers. Some- times in shabby genteel families, a coat, which was once worn by the father, is adapted to the eldest son, and from him it passes to B younger brother. So it often is in books ; and some recent writers upon the medical jurisprudence of insanity have been much indebtt'd to their predecessors, lliis circumstance makes it un- noccBsary for us to quote from those works. There is, however, a necessity to quote one or two of the cases which have some bearing upon this tulijpct, to enable ua to deduce some general principle from them. The use of such quotations is obvious; there are many minds which precept will not guide, and who will be influenced by example. Medical men will, in following these cases attentively, and considering much of tJic medical evidence, find many examples which it would be well to avoid. In many cases in which the civil competency, as ■ ■ t)ipp)]rotinlo|t1« '" ihren liHuptanwenilaagEii Buf die recLtapQfge,' at. 26 — 16. t ■ nincuuiiin MJ believe. "The term unsoundness of mind," according to Mr. Amos, " in the legal sense, seems to involve the idea of a morbid condition of intellect, or loss of reason, coupled with an incompetency of the person to manage his own affairs ;" and yet he says, iti the same article, " Soundness of mind is a legal term, the ' definition of which has varied, and cannot, even in the present day, be stated with anything tike scientific preci8ion."t With regard to what the law regards as perfect capacity, the averment to be con- tained in a common condidit wiU iadicate a standard. It says that the testator was of "sound mind, memory and understanding, talked and discoursed rationally and sensibly, and was fully capable of any rational act requiring thought, judgment, and reflection." Sir John "Nichol has given an admirable description of the characteristic ■ symptoms of imbecility, in the case of Ingram v. Wyatt,J which ia . worthy of attention. He says : " When imbecility is original, or, as medical authorities say, conat^ the memory is often perfect, especially of trifling and simple circutn-i stances, though the other mental powers remain infantine, or, as the same authorities suppose and express it, ' the brain has more deve- loped itself.' In such an individual the understanding has made little progress with years — it has not matured and ripened in tho • Eidgcwny p. Dflrwiu, B Ves, junior, p, 66. t ' London Mudio«l GaieCte,' vol. viii, pp. 419-121. I I ' Haggnrd'i KccL Rtp.,* i»L AMENTIA AND ITS LEGAL KELATIOIJd. fij lUDal manner; yet even in snch indmdads, nnleaa the imbecility be extreme, Bome improvement will have taken place, aome progress in knowledge bejond mere infancy will have been made, by the help of memory, imitation, and habit. Such an individual will acquire many idea^, will recollect facte and circumstances, and places, and hacknied quotations from books ; wiil conduct himself in an orderly manner; will make a few rational remarks on familiar and trite subjects; may retain self- do minion, and spend his own little income in i)roviding for his wants as a boy spends his pocket money, and yet may labour under great infirmity of mind, and be very liable to fraud and imposition. The principal marked features of imbecility are the same which belong to childhood, of cour«e varying in degree in different individuals — frivolous pursuits, fondness for and stress upon trifles, inertness of mind, paucity of ideas, shyness, timidity, submission to control, acfjuiescenee under influence, and the like. Hence tbese infantine qualities have acquired for this species of deficiency of understanding the name of ' childishness.' Tlie effect is, that where imbecility exists at all, and in proportion to its degree, it becomes necessary, especially in a case exposed to other adverse presumptions, to ascertain its extent with some accuracy ; to see how far the individual was liable to be controlled by influence, to submit to ascendancy, to acquiesce from inertness and confidence in those nets upon the validity of wliich the court has to decide,"* The general principle that proof of imbecility is only to be satis- factorily oblained, in many cases, from the careful investigation of , the whole character and conduct of an individual, frequently extend- I ing over a long course of years, has already been illustrated, but the celebrated case of Mr. W. F. Windham will further illustrate I (his principle. There are also other reasons why this case should be somewhat minutely examined. As the inquiry lasted thirty- four days, as liO witnesses were examined, and as the evidence which waa received extended over the wiiole of the defenilant's life, such an examination is incompatible with the limits of a work of this description. This was a petition for an inquiry into the state of mind of William Frederick Windham, of Felbrigg Hall, Norfolk, instituted • The ariHlyali nf the eviclcDo of John Clnpton, tha decewed i ■ttentinn. in to prore the imbecilHj ■ortb^ or the Kmder'i bett 66 SlEniCAt JCBISrHODENCE OF iNSASITT. by his uncle, hiajor General Charles Ashe Windham, and foarteen 1 other relatives. The order was made on the 23rd November, 1861, \ and the inquiry commenced on the 16th December of the same year. The petitioners alleged that Mr. Windham laboured under coo- ] genital deGciency of intellect ; and it was U|)on the other hand ' asserted that Mr. Windham *s mental coudition, if below the Donnal standard, was due to defective education, and was not the result of congenital impairment of intellect. It was proved that he had been sent to Eton, but that he had profited very little by the means of education which were placed in his power. He was wholly nniike other boys, and when he came of age, in 1 SOI, his conduct was such as to lead to a belief, in the minds of those who were acquainted with his position, that he was insane. It was further proved that he was utterly deficient in business ca]iacity ; that he was extravagant in purchasing articles, which he did not require, at eiarbitant prices and in unnecessary quantities; that in conseerfect]y capable of foreseeing the consequences of auy act which he may eoinmit, and of regulating his conduct, under ordinary circumstances, with mtionnl forethought, " 8tli. That he believes iu the great truths of religion, but ii confused as to the doctrine of rewards and punishments. " 9tb. That he labours under no delusions or hallucinations recog- nisable as such. " 10th. That he exhibits no signs of labouring, ordinarily, nndci overpowering passions or morbid propensities. " Ilth. That his general appearance and manners are such as art usually associated with partial mental defect or eccentricity." (Signed) "J. CiticiixoN Brownb."" Yet Cuthbert Carr was lield to be irresponsible. Certainly not upon any well -understood legal definitions of insanity. Indeed, almost at the same lime that Cuthbert C'arr was held incapable of pleading at Durham, Henry Gahbites was tried for murder at Leeds, and Mr. Justice Lush said, with reference to a test for the irrespoi sibility of insane persons, " la all cases every man was presumed he sane until the contrary was proved, and that to establish a defer on the ground of insanity it must be clearly proved that at the time of committing the act the party accused was labouring under such • ■ Newcistlu Cbn 1 AMENTIA AND IT9 LEGAL RELATIONS. 77 reason or disease of mind as not to know the nature or tiuality of the act he was comrailting, or that, if he did know that, he did not know right from wrong." * It was certainly not upon the principles laid down by Mr. Justice Lash that Cuthbcrt Cnrr escaped tlie punishment of his atrocious act. And we would be inclined to point to it as a case in which, through a want of appreciation of the true principles which ought to govern the admission of the plea of inaanity or imbecility, justice has not been done. It seems to us iiiipossible to distinguish in anj way between the menial condition of Cuthbert Carr and the man who in the same year was found guilty of a similar offence at Alton, and who was sentenced to death and executed. In many respects the crimes committed by these two men reJembied each other. The Alton murderer, who was a clerk in a solicitor's office, upon seeing some children playing by a roadside one 6ne aftemoou, persuaded one of them, a girl of eight or nine years of age, to go with him into an adjoining hop garden, and got rid of the other children by distributing some halfpence amongst tbem. Shortly after that time he was met returning to his office, where he mnde an entry in his diary to the following effect ; — "Killed a little girl ; it was fine and hot." The child had meanwhile been missed, and her parents became alarmed and a search was instituted. It was oscertained timt she had been last seen on her way to the hop field, and in that field the dismembered fragments of her body were found scattered here and there. Some parts of the body could not be found at all. The vagina was missing. These are the main facts of this horrible crime, and it is almost impossible, it seems to us, to distinguish in any way between these two criminal acts, except in so far as there seems to have been a miscarriage of justice in the former, while, as the law at present stands, justice seeras to have been done in the latter. ATith the question as to whether the Alton murderer should have been put to death we have, in this place, nothing to do. But that he was not legally irresponsible for the crime he committed is to be inferred from all the principles which have been stated above.t ,' IStli December. 1866. • Reg. r. Qu t The ciise o cowian Medlca-I^l aur la Folie,' pp. IXO—IU, ■e Jmeph Di'lpbine, wli'n:] will lie found ii orgel'a 'Dig- MEDICAL JUHISPEtTOESCE OF ntSANlTT. ON THE PATHOLOGY AND SYMPTOMS OF MANIA. Diseases bave histories, and he who woald rightly understand a disease must knoir ramething of its cause and coume. Msny men hare made a careful study of disease without first arriviu); at any thorough conclusions as to the conditions of health. But as disease b a de|>arture from health, it can only he thoroughly understood by those who know ia what health consists. Any excellent pathology must be preceded by a careful physiology. Perhaps the signiticance of this fact will be the better appreciated in connection with the con- sideration of the commencement of disease. Seeing a thing in the making is the way to understand it when made. The process which goes OQ thus before our eyes is an actual synthesis. So it is that tho observation of the progress of a disease is the easiest way of becoming acquainted with its real nature. Ilow much a thorough knowledge of the beginning of disease might tend to facilitate its cure it would be difficult to speculate. The little deviations from the normal state are the types of greater alienations. Disease has a potential and a kinetic energy. In its progress it parts with ita potential energy and gains kinetic. It is this kinetic phase of disease which is that which is really to be dealt with by the phy- sician, and the excellence of becoming acquainted with disease in its potential form is therefore evident. To know the beginnings of things is to know something of the ends and middles too. Now, in considering a case of insanity we become acquainted with certain peculiarities of conduct, of thoughtj of feeling. If a man believes that he constantly sees dogs, and that they are worrying a cliild— if we become assured of the fact that he really has this delusion — ve become acquainted with a mental symptom of insanity. He is in a condition in which be is unable to distinguish between subjective I PATHOLOGY AND STUPrOMS OP MANIA. 79 tliought aud objettive thought ; in relation to these imagiiiiiiga his subjectivity has become objective. So if a man's conduct is entirely different from that of the rest of mankind, if the motives which influence the actions of ordinary human beings have not the same effect upon him, we infer a certain intellectual obliquity, owing to a similar loss of appreciation of the relativity of the mind and its other matter. As yet, however, all our inferences have only gone a little way ; and the question naturally arises, what is the cause of this loss of power to distinguish between subjective and objective ? Now, the answer invariably given to such questions is, that all these mental symptoms are due to some pathological condition of the nerve centres. True, although much attention has, in recent times, been paid to pathological anatomy, there are many cases of mental unsoundness in which no organic lesion can be discoverfd subsequent to the death of the patient. But little doubt exists in the mind of ' who has considered the subject that all mental unsoundness, whether it be delirium, coma, idiocy, mania, or dementia, is due to • aome morbid condition of the organism. The fact that even after well-marked insanity no pathological change sufficient to account for the mental symptoms which existed during life is discoverable, only proves that the means of research and observation are defective ; and the fact that in proportion to the better acquaintance of pathologists with the anatomy and the sensible qualities of brain, in proportion to the care with which post-mortem examinations have been performed, ■4>as been the rarity of those cases in which the organism presents no ■'Biorbid changes, points to the above explanation as the truth of this I'aiuch disputed matter. That this has been a subject upon which liopinions have differed very widely is a matter of history, aud many I people even at the present day would object to hearing the brain called the organ of mhid. There is some reason for this prejudice, for some enthusiastic physiologists, when it has been granted that mind is dependent upon brain for its manifestations, at once assert the non- I oiistence of mind, and say that thought is a function of brain. That B brain secretes thought is a somewhat fashionable tenet. And it is the horror of this doctrine that induces many people to hesitate before they admit the dependence of mind upon brain for its external mani- festations. Physiologists assert that, whatever mind is, it is brought into connection with matter by means of brain. But the truth of 2 matter is this — that nothing but thought actually exists. But 80 MKDtCAL JCBI8PEUDESCB OP ISSASITT. thought becomes objcctire throngh its oUter bodj. Brain, tboefore, a jiecetsary for the eitemalization of thooght. Tliought exists vitiiont brain, bat it is onlv nude manifest in conduct br means of brain, just as light ma/ exist withoat shadow, but it could not be cognizable to mortal eje without darkness. Mow, 5up[>ose a lamp- flame to shine through n paltemed globe. The li^t throws the shapes which are upon the globe npon the walls of the room. Every flaw in the glass makes a contortion in the nji. And so it is with rmnd and brain. Every pathological condition of brain produces a contortion in the ravs of thought, produces peculiarities in that external thought which we call coudact. In this way there can be nu act done, no thongbt thought, no feeling felt, which is not dependent for its extemalization upon brain, and any abnormal manifestation of thought is dne to some morbid condition of the medium of its esternalization. This seems to be a theory which is compatible with the actual discoveries of science and with the higlier truths of philosophy. These morbid changes may themselves be due to thought. We find that much insanity is owing to mental shocks, to anxiety, and the like. This pathological condition might, to return to our simile, be compared to the cracking of the globe which is about the light, by reason of something connected with the light itself, as, far instance, the heat. But for all our purposes in this plac« it will be sufScient for as to consider a pathological condition of some of the nerve centres as the proximate cause of all insanity. It is veU to remember that insanity may exist while all the bodily functions are healthy, but that it is very frequently associated with epilepsy, apoplexy, and other cerebral disorders ; or that it may arise in the coarse of such diseases as fevers, phthisis, acute rheu- matism, and the like. Thus it is that the morbid action which arises, it may be in the digestive system, is reflected to the brain by that peculiar nervous sympathy which it ought to be the object of medical science to endeavour to understand. This fact does not, however, militate against the theory which has been advanced above, and it explains the position of the philosophic medicists who have argued that the brain is not the seat of insanity. Some have snppDsed that insanity consisted of a morbid condition of the vital principle, and others have gone so far as to assert that insanity was due to a morbid condition of the soul itself. For a long time the methods which were applied to the discovery of the pathology of I I PATHOLOfiy AND STiWPTiDMS OF MANIA. 81 ordinary discasea were not applied to the pathology of inxanity, and it is only very recently that any real Bjstem of pathological exami- nation has been instituted in our large institutions for the inftnoe, which have all along been talked about as magniScent fields for observation, while the only method by which obsenation could be made of the least service to humanity was rarely or never had re- course to. Of course much, very mnch, remains to be done. Robert Browning, borrowing from Goethe, nnconsciously perhaps, speaks of the — " Petlj done, the nndone vnat," and to nothing could this phrase apply with more force tlian the so- called science of the Pathology of Insanity. But the recognition of its importance is certainly an effort directed in the right way. If, then, it is understood that the brain has a certain structure and quali- ties, if it is underBtood that in this respect it is exactly similar to a nerve or a muscle, and that it is its properties and functions which must be the object of the stud; of the morbid anatomift some advance has been made. But, as Professor Bennet has said, " Psychologists con- tent themselves with repeating well-known clinical observations, with the ordinary morbid anatomy or density of the brain, and with the metaphysical speculations which have been pushed as for as, if not further than, human intellect can carry them. Need we feel surprised that the true pathology of insanity is unknown? What we desiderate is a careful scrutiny of the organ. Hitherto the difficulties of such an investigation have been insurmountable, in consequence of our imperfect metliods of research. But let any one possessing a com- petent knowledge of histology and the use of our best microscopes with the opportunities our large asylums offer, only now dedicate himself to the task, and he may be assured that while extending the bounds of science he will certainly obtain an amouut of fame and honour that few can hope to arrive at."* With regard to what has been done in this science of pathology we must be content to say very little in this place. But the recog- nition of the general principles stated above is necessary to the understanding of a complete system of medic^ jurisprudence of In.=anity. Further, in explanation of the statement that frequently • "l.optiirw on MiilBCuliir PlijiiologJ, Polhologj. iind ThcrapeuUcn." Lfctare ~ lett," AjTil 25. 1863. 82 MEDICAL JURISPRUDENCE OF INSANITY. insanity exists in cases where post-mortem esamination can reveal n oi^nic lesion, it ia well to remember that pathologists are agreed that in most cases where changes are observable they are due to a long- continued exaltation of action in the part to which they have givea the name irriiafwn. Abnormal vital action then produces derangement in the functions of the organ in which it occurs, and does not, at the same time, produce any discernible change in it^ appearance. Often we might as well try to discover a change in the hand of an artist, in- dicative of the exaltation of function which ia called skill, as endeavour to find any physical indications of the abnormality of function which is designated disease. But that a change has taken place is surely a perfectly fair inference. "We cannot see or feel the imponderable ether which is in space and which ia the medium for the transmis- sion of light and heat, but we believe in its existence. So it is with those minute changes which have taken place in the organism. One thing is to be remembered, and that is, that there is a perfect paral- lelism between insanity and other diseases. In its causes, its rise, its progress, in its termination in death in chronic disease or in cure, it exactly resembles auy ordinary bodily disorder. In its possible modification by the use of drugs, and even in the possibility of its being influenced by the mental impressions of the individual, there is much that is common between it and ordinary physical disease. Ita inception is generally marked by sleeplessness, sometimes by pain or heat in the head, and not nnfrequentiy by a considerable alteration in the feelings and emotions of the individual affected. Si/mptomi of Mania. — It ia evident that what would be a rational belief to one man would be a delusion to another. That conduct which would be indicative of insanity in one man would be indica- tive of mental health in another, and this fact does not depend upon the mere accidental difl'crences of rank, position, or means, but upon actual differences of mental constitution. A man's thoughts in health bear a certain relation to his environment, and that relation is not the same in any two men. One loves to live in the dusty atmosphere of a museum, while another enjoys risking his life in climbing the Malterhom. One man finds pleasure in dancing, and another only feels happy when he ia beside running brooks which murmur through a green country braided with hawthorn hedges. Tet, notwithstanding this wonderful variety, there is a persistent nnity. AUhough each thinks that his neighbour's enjoyments are rATQOLOGY AND STMnOMS OP MANIA. 83 sbsurd, yet each is in reality influenced by the same motive,t, although they are connected with difTcreiit objects in the world of Bcnse. The past life of each has an influcoce on and determines the flow of energy in the present. The man who lovea dancing probably does it well ; everybody acknowledges that he does it well. And tluB is one of the reasons why he likes it. The exercise of skill is pleasant iu itself; the association with persons of the other ses; the rapid motion; the adaptation of motion to the rhythm of the tune, — all these are ordinary motives. The man who climbs the Jung-Frau is influenced by exactly similar considerationa ; he likea to he talked about. To be thought bold is pleasant. Then he may have got to the top first, or before some others of his ty, or in a shorter time than any one who has been up this year, exertion itself and the consciousness of having overcome diffi- colties, of having surmounted obstacles, — all these are the ordinary inducements of a healthy mind to action. So it is in the case of the who loves the country, or who delights in minerals or stuffed birds. But the unhealthy mind is one wliich is not influenced in the Bame way as that which is in a normal condition. Eccentricity, so long as the motives which induced to the peculiarity in the first instance, and the habit which made permanent this departure from the symmetry of character in the second are healthy, is not a symp- tom of insanity. But where there is a well-marked change of character without any adequate external cause, then it is certain that mental disease of some sort exists. Thus, that a man should be saddened hy a death is natural. That in some characters this sadness sliould continue for a very long period of time, and that habit itself should tend to continue this melancholy, is what we should expect from a careful study of human nature. Indeed, even sorrow becomes in time a luxury, and there is truth in Rogers' hnes : " Qo, you may cnll it madnesa, folly ! Too sluU not cliose tny grief ^wny. Thn-e'i inch a joy in melancholy I wonld not, if I could, be guy." All this is compatible with perfect mental health. But if we find 'an individual suddenly becoming sorrowful without some such external cause; if we find exaggerated fears as to the safety of a soul and the wrath of God ; if we discover a morbid con.^ciousness . of self, then we are in a position to diagnose insanity. Si MF.nK!AL JPRI3PRDDENCE OF INSANITY. Wilhelm Meister thought that the true way to study the c)iaracter of Hamlet, that great psychological riddle, was, in the first place, " to investigate every trace of his character as jt hail shown itself before hia father's death, to endeavour to distinguish what in it was independent of this mournful event, inilepeudent of the terribln events that followed, and what most probably the young man would have been had no such thing occurred."* Now, there is much to be said for a similar method in the study of insanity. A careful com- parison should be instituted — at least, in all doubtful cases — between the cliaracter and disposition of the individual while aane, and tlie character and disposition as influenced and modified by the presence of disease. That this will in all cases yield a light where, but for some such method, there would be darkness, seems to us certain. With regard to the early indications. of the presence of mania, the following statements seem to he true. It is necessary to distinguish between acute mania and acute mania with delirium. The latter has a rapid course either to recovery or death ; the former may continue for months without much danger to life. Mania proper may he preceded hy premonitory symptoms, or it may come on suddenly. One of the most frequent premonitory symptoms is slight dejiression. Guislain believed that this occurred in the great majority of cnses.t This is followed by some peculiarities in conduct, by some stupid busirifss transaction, by something which the in- dividual, if he hud been "quite himself," would not have done. Not unfrequently the individual manifests a strong desire for spirituous liquors, and often yields '.o tliig de-sire. At this stage of the disease there may be slight derangement of the digestive func- tions, of the circulation, and of imtrition. Tlie pain in the head which we have already noticed, aceom]janied by sleeplcsanea!*, agitating dreams, crowding illusions, vertigo, tenderness of the abdomen and gums, are also frequently to be met with. Sabseqiient to this stage eccentricities and extravagances of conduct, of speech, of behaviour, become persistent, and motives which were formerly efficacious as restramts are now utterly futile. The individual loses all sense of propriety and of decency, becomes mischievoos in an extreme degree, wet and dirty in habits, abusive in bnguage. De- generation j»roeeeds, and the little power of control that the in- • Curijlir'* Tmniliition. t Sec nl»o Qeorget, ' Diotiannnire de Me'(lii:iiie," Hrt. " Folie." PATHOLOGY AXD SYMITOMS OF MANIA. 85 dividual vas formerly able to exercise over himself ia lost. The intention of giving trouble and annoyance now no longer exista ; the individual raves iti coherent If ; delusions of the most incon{rrutiU3 and absurd description chu»e one another through the individual's brain; there ia no coherence even in their false beliefs; the lan- gnage is obscene and disgusting, the habila are filthy; their acts are full of the same incoherence that distinguishes their thoughts ; they break windows or pieces of furniture, t«ar clothes, or practise ■elf-abuse. With all this, however, the bodily health of the patient is generally good. If the strength of the individual has been much impaired previous to the commencement of the mania, the violence of the disease may cause death through exhaustion. But if the L constitution is good the mental excitement may continue for weeks lor months without leading to a fatal termination. I It is a curious fact that maniacs, even in their most violent I moments, seem to be somehow conscious of the strange incongruity and I absurdity of tlieir conduct. And even when the fury is at its worst I many of the acts seem to be the result of a bravado, very much like I that which exists in sane men, and which often leads them to do all I xaannct of stupid and even criminal octs. When the disease is at I its height there is an ancesthetic condition of the body. It ' is a peculiarity of all strong emotion that it concentrates attention ; and when attention is concentrated on one thing it is abstracted i from another. Nothing is truer than the fact that we have to go I to meet sensations ; that the mind trysts, as it were, with pain at I the periphery, or it is not felt. So it is not difficult to understand that the strange strength of emotion which we fiud in mania should render the individual insensible to heat or cold, hunger or thirst. Again, the muscular power seems to be considerably developed in all eases of mania. Anything done "with a will" is powerful. I Host of the sane man's acts are only half-acts. Motives there I always are which suggest inaction, and these are almost as powerful L as those which urge to action. It is, as it were, with the force of I the difference between these that a roan works. An ordinary sane I man is always half-hearted in all his doings, aud this makes him I weak. The maniac is in earnest about whatever he does. Conse- I quences do not weigh with him as Ihey do with his sane neighbour, I He is not careful cither of others or himself. It b this that makes I him strong. Enthusiasm is, as il were, a sort of direction of mania to 8G MEDICAL JURlSrEUDENCE OF INBANITY. a smgle purpose. Seme other sjinptoms which are occaaionallj' over- luoked are worthy of mention. The voice of the individual is changed ; the eje has a strange expression which the words " wild" and " glassy" but inefficiently convey. Again, the odour of the skin is to be noted in any complete enumeration of symptoms. As the perfume of the skin of healthy individuals is a source of pleasure, and is intiuiateSy connected with the sexual functions, bo the odour of individuals who labour under mania is disagreeable, and is, along with peculiarly offensive odour of the intestinal excretions, to be accounted for by some chemical change produced in the organism by the nervous disturbance. Again, the appetite is generally good, or, ratherj voracious. The patients become thinner. They occasionally pass a good night, but sometimes pass weeks without indicating the least necessity for slumber. The tongne may be foul, but, on the whole, the general health is good. Enough, however, has been said to enable those who are brought into relation to the insane to recognise this form of insanity. And while it was necessary to say something concerning the most prominent symptoms of mania, it will be understood that this is not the place to dwell particularly upon the phases of each of (he kinds of mania which may be distinguished. Some general description was, however, necessary before classifying the species of mania according to their mental symptoms. This classification is not difBcult. There is evidently a well-marked distinction in nature between the cognitive powers of mind and the dusiring and feeling powers or faculties. The one is the intellectual part of a man's nature ; the other the emotional part. As the operations of these two parts of humanity upon the outside nature which is presented to them are very different, so effects of external nature upon those two classes of powers vary infinitely. This enables us to introduce a broad dis- tinction between the morbid conditions of the brain, which is founded npon the fact that in many cases the intellectual nature of a man alone seemti to be affected by disease; while, in other cases, the intellectual faculties are to all appearance intact, while the emotional are manifested through or by means of a diseased organism. Thus, then, we distinguish between intellectual and moral (emotional) mania. But it will be understood by those who know anything of mind that neither health nor disease is a constant quantity in all the PATHOLOGY AND SYMPTOMS OF MANIA. 87 fiu^ties of mind. Habit digs trenches^ and healthy or diseased energy mn through them as water does in the river course. One man has a good memory^ and another has a bad memory. One man has a memory for dates^ another for faces, and so on. And as we find that men have skill in certain acts in health, we would expect to find that they were incapacitated from doing certain acts by disease. As men argue from the height of the Himalayas and Andes to the depths of the sea, so might we have arrived at some conclusion as to the characteristics of disease from the known qualities of health. And the fact is that observation enables us to confirm our expectations* We find that as the mind may sometimes be said to be wholly sane, so may it be said, upon occasion, to be wholly mad. And as we find one faculty in health towering like a mountain above its neighbours, so in disease we find that, as it were, depth's of disease sinks below the ordinary healthy level of a sound mind. So we find that we have arrived at another principle of classification, and we have under intellectual mania, general in^ tellectual mania and partial intellectual mania; and under moral mania we have general moral mania and partial moral mania. Of these, then, in their order. MEDICAL JDRISrEDDESCE OF INSANITY. CHAPTER VI. ON INTELLECFUAL MANIA. General lutelkHual Mama. — The headiog of this chapter conveys some notion of the meiita! symptoma of this form of insanitj. We have seen that mania is often preceded hy depression — that it is marked by a great change in the desires and feelings and hahits of the individual. In this form of the disease, however, we would expect to find not only a disordered state of the cognitive faculties, but a total perversion of all the emotional tiuahties of the individual. The maniac becomes indifferent to those whom he loved most, insensible to ties which formerly influenced Iiis whole being, and all the kindly affections and noble desires are replaced by the worst characteristics of a depraved disposition, and the most filthy pro- pensities. But still the terrible chaos of thought, broken — as a storm cloud is by shafts of light — by periods of coherence, is the most marked feature in some cases ; and these are the cases of which we would speak in this chapter. M'e have already alluded to the psychical symptoms of the early stages of the disease, but a more minute description is necessary. At first the individual may show symptoms of irritability, and along with this there is a more rapid succession of ideas. This is not simply the healthy increase of mental activity. Almost at ouce there are signs of peculiarity in the association of ideas. Memory is ^salted. As after an earthquake fishes are found on the shore that were never seen before, so in this state of mania, recollections and reminiscences which have not been in consciousness for years return to it. Sometimes at this stage of the disease there is a development of powers of which the individual had not made any use. Thus grave sad men become humorous, kindly men become sarcastic, dull men become eloquent, and shy men bold, Griesinger mentions a case in which a patient, under these ON INTELLECTtUi MANIA. 69 litious, could strikingl; delineate any alight resemblance to animala in the phjaiognomies of those around liiin." These symp- toms are not by any means common. As we have stated above, incoherence is observable, in most cases, from the beginning. Most ideas irbich pass through the mind of the maniac are crude, half- thought, " deformed, uiitinished, and scarce half made up." Tbey are governed and determined to a certain extent by the impressions of sense. We find, however, that the laws which govern the associa- tion of tliese ideas are not those which govern the ideas of a sane man. Sane men's thoughts cling together. There are aUinitiea in their thoughts. They enter, as it were, into cliemicai combination, hut the thoughts of the individual who labours under general intellectual jDania seem to resemble a mechanical mixture in their mental rela- I tions. AVe hear scraps of songs, isolated words, figures, cries, ■enteuces, rhymes, and the bke, all jumbled in the conversation of the maniac. Sometimes a similarity of sound seems to have for a time the power of rescuing something from chaos, and the individual may continue to speak in verse. Utter confusion, then, is the I characteristic of general intellectual mania. Persistent dehrious I conceptions cannot be said to exist in it, the false impressions are as unstable as everything else. The condition of mind i* apparently a constant stampede of ideas. The fleeting delusive and illusive beliefs are constant in this disease. They may exist with regard to the surroundings of the individual— they may affect the feeling of self. Thus we frequently find the patient believes himself to be a king, or Mahomet, or God. The extraordinary increase of mental activity conveys the impression of pleasure, of grandeur, of magni- I ficence, to the individual, and influences his delusions. Not f uncommon are such assertions as, " I am made of wood," " I am in everything," " The world is my body," which are connected with the same mental impressions, and are due to a want of the power of discriminating between the objective and the subjective. It is m evident that to subjectivity alone — if a separate existence of sub- ■ jectivity in the flesh was possible — self would be the all; and in Kthis diseased state subjectivity is more prominent than objective existences. But in alt these delusions and illusions there is the characteristic of instability. They do not remain. Maniacs are " to one thing constant never." There is no time allowed for the forma- ■ . > Orieaingvr ou ' Mciitnl DiaiMiiea,' New Sjd. Soc. ed., p. 293. 1)0 SH':mCAL .lURISPRUDENCE OP INSANITY. tioii of a habit. There is generallj- a waut of conviction in the reality of the delusions present to the conaciousiiess of the individual himself. Maniacs often laugh at the incongruity of what they them- selves say. Still some circumstances remain to be mentioned with regard to the intellectual pecoliarities of this disease. It frequently happens that in spite of incoherence of the most marked character, the memory secras to be under the influence of the ordinary laws of association. The individual remembers many eveuts and circum- stances with perfect accuracy. Dr. Guy relates the case of a lady concerning whomi he was consulted, Siie had suffered from mania for a long term of years, and was subject to paroxysms of extreme violence. " In one of these paroxysms slie had destroyed some valuable papers belonging to her husband, and yet after the lapse of twenty years, during an interval of extreme tranquillity, she reverted to the occurrence, and expressed her regret at what had happened ;"* and what Mr. Ersktne saidt shows that the fact has been appreciated by lawyers. He said ; " In all cases which have filled Westminster Hall with the most complicated considerations, the lunatics and other insane persons who have been the subjects of them have not only had memory in my sense of the expression — they have not only had the most perfect knowledge and recollection of all the relations they stood in towards olhers, and of the acts and circumstances of their hves, but have in general been remarkable for subtlety and acuteness. Defects in their reasonings have seldom been traceable — the disease consisting in delusive sources of thought — all their deductions within the scope of their malady being founded on immoveable assumptions of matters as realities either without any foundation whatever, or so distorted and disfigured by fancy as to he nearly the same thing as their creation." This not only shows what it was quoted to indicate, but it also shows that in the legal profession the matter is only very partially understood even by those who have brought much ability to bear upon the question. Mr. Erskine has evidently been influenced by what Locke says of the insane, that, " having joined together some ideas very wrongly, they mistake them for truths, and they err as men do who argue right from wrong principles."! '^^^^ this is not the case those who know • r.Hv's ■ Forcini.- MeJicinc,- p. 170, S.iil td. t 8 HurgrHVc^B St«te Tml», 323. tEamy, ItDuk II, i:li. li, § 13. I ON INTFLlECTUAl HAKIA. 91 the characteristics of mania are aware. But it is true (hat the person who suffers from mania has sufficient power of reminiscence to be able to recall and describe events which happened in the remote past, that he knows all that is taking place around him, and he will sometimes remain calm for a few moments, will listen to what is said, and will even laugh at a joke. Ainl some can even reason con- cerning their state of mind during the continuance of the attack. Jacobi mentions a patient who said, " It is actually terrible when the thoughts so run into one another in one's head."* It is necessary — custom is a sort of law — to say something of the illusiouB and delusions of mania. Most of the explanations of these phenomena which have been given seem to us eminently unsatisfactory. We have already said that the mind goes to meet sensation. Even looked at in the light of Professor IJain's system— of what might be called a transcendental physiology — and has been called " a natural history of mind," this assertion is true. He finds that it is a fact of the human organism, that there is a power of generating active nerve- currents from within outwards, which seems to be a necessity of mere sensation. And it has been remarked that this theory is not unhke that of Kant himselfj who showed that intellectual function was, in fact, (he greater part, if not the whole, of sensuous affection. If this be so, (and we cannot doubt its accuracy) the whole question of illusions and delusions becomes clear. Just as in dreams the objective is dissociated from the subjective, 90 in insanity the individual's subjectivity, being so much strengthened by the progress of disease, impresses its own character upon the objective facts of the universe. It is as if a king said to all foreigners who came to his frontie]', " Before you cross the boundary you must wear the dress of my subjects." So it is with mind : every sensation is dressed, ia shaped — it may be deformed and distorted, by mind, and so it comes to the audience chamber, consciousness, with precisely the same guarantees of reality as any of the sensations which are con- veyed to the mind of the insane person. " Error," says Cousiu,+ " is one of the elements of thought taken for the whole of thought. Error is an incomplete truth converted into an absolute truth." The subjective impression of the lunatic has become objective to him. There is a want of harmony between the a priori forms _ • Die Hnnptforan'ii der Seeleustorungen. ' HUtur; of IliiloBoplij.' AppleUm &. Co,, New York, 1852., vol. I, p. 146. 92 MEDICAL JIIKISPEUDKNCE OF INSANITy. oF thought, and the other of thought, which is the ouier of * miiid. Thus Kaot is right when lie says, "The senses do not deceive us at all, it is only the judgment which deceives us." Thus, when the rustling of leaves is mistaken for whispers, when the child tries to catch at the moon as it would at a bright object on the table, when a shadow is mistaken for a substance — all these things are due to errors of judgment. This is welt illustrated by Feuch- terslehen, who says, when speaking of illusions of the sense of touch : " Among the illusions of touch of a psychical nature, may be reckoned the well-known experiment with a Httle ball of marble, which, being moved between two fingers laid across each other, appears double, because the judgment ascribes the segments of the ball felt in opposite directious to two objects."* So it is with delusions, between which and illusions the distinction is more apparent than real. It is the subjective becoming objective, as in the case of illusions. That this is common even in a healthy state is proved by any popular entertainment of wizard magic, by any popular work on optical illusions, and by the experience of many persons who are quite able to observe their own mental processes with accuracy and intelligence. Thus, Pascal believed in a fiery gulf or abyss close by his writing table.t Trousseau mentions a gentleman who, " although perfectly sane, had an irresistible desire to shriek." He yielded to this desire very frequently. J Swcdenborg saw spirits,} and Goethe relates that during a ride on horseback lie saw, as in a waking dream, himself riding to meet himself in a hght grey dress. || And we ourselves know a gentleman who has the power of recalling any scene he has looked upon. He says that this vision is quite difierent from ordinary memory, and that it is as real as any of the impressions conveyed in ordinary sight. Many children have the power of projecting their own thoughts on the darkness. The painter Spinelle, who had represented the devil in a most frightful form, at length fancied he saw him in reality. And Blake, who painted demoniacal forms, is said to have had visions of them.K That • ' Medical Psjcbology.' Sjd. ed., p. 231. t Mentinned in CouoUj'a ' Indications of liimoitj,' p. 316. J Lectnreg, p. 151. . S Emereon's ' RepresentBtive Men.' || Vol. nvi, p. 83. ^ Some vorj- iiHeveating cnsea ofilluaion wiU W fomid in Sir David Brew 'Natand Magic* ON IN'TELLKPTCAL MANTA. 93 ' of the extraordinary phenomena of second sight may be accounted fur by the fact of the possession of this power seems to us certain. One or two more observations may be made with re-gard to the di9ting:ui»hing characteristics of mania; and the whole of this description will, it seeind to us, throw light upon the phenomena of insanity in general. Thus, it may be remarked that many of the strange actions of a madman or maniac are due to his delusions ; but many of these are to be ascribed to the simple overflow of energy, which cannot find vent in any ordinary healthy channel, and which produces excessive muscular activity. The madman's acts and the sane man's laugh are closely connected in their psychological aspects. Again, the acta of the person who is maniacal are very often such as no sane person would believe to be suited to the attainment of the object which may be in view. The insane person gains nothing by the experience of failure. Quoad his insanity, he is not moulded by his faults. These are the characteristics of mania in so far as they seem to be necessary to the application of all the medico-legal questions which can arise, and to the decision of all points with regard to the legal relations of the individual, labouring under general intellectual mania, to the state. Par(ial!H(ellectualMani/i,er Moaonwnia. — Monomania probably is due to an abnormal increase of the rapidity of thought in one direction towards the external objective universe. As in every other case, we find the type of this disease in healtiiy mental action ; we are al! conscious of the facility which is acquired in any mental process by the constant exercise of the mental function. Life like water runs most easily where it has run before. The will shapes actions in clay, but they are cast in bronze or iron without the intervention of the will. And so it is — as with idols — those gods which we have made with our own hands rule and infiuence our life. Now, health seems to be a kind of unstable equilibrium of forces. When- ever that e(iuilibrium is deranged, then comes disease — aberration. A top when in motion is resting in a position of unstable equilibrium. But if it has a bias, if it is not symmetrical, it rocks, and it will come to rest the sooner. So it is with life and its symmetry. Too much bias in the fiesh is disease. Thus it is that the increased rapidity of mental actions or of thoughts with regard to one object of objects causes a decreased rnpiilily of the exercise of other 91 MEDICAL JUEISPKUDENCE OP INSANITY. important mental functions. But want of use is abuse, and abasti soon causes disease. It is in this way that wliat in health may lead, to discoveries, to the advancement of science, or to tlie manifestation of genius by means of words, when it becomes automatic or un- healtliy leads to exalted predominant ideas and mono maniacal misconceptions. There is no more common form than this, and it is frequently manifested in relation to aelf-consciousness. When self- consciousness becomes a prominent object of thought it will invariably lead to pride. And nothing is more frequent in thia class of cases tiian to find individuals believing themselves to be kings or queens, persons of the highest rank and greatest influence, great discoverers and propounders of new systems of philosophy, new creeds, and new sciences. All these beliefs will be found to be intimately connected with the life of the individual. The life, however, is not the events only, but the thoughts. Too many persons, in searching for the causes of morbid impressions, in tracing the evolution of insane thoughts, have been too much inclined to regard the external environment of the individual as alone of any importance, and have neglected to study the thoughts, which are □ut unfrequently antagonistic to circumstances, and are not always the direct reflection of the objective phenomena. Ail these beliefs, and the many rapid thoughts which accompany them, are associated with pleasurable sensations. This is common to all states where there is an increased rapidity of thought, and it is equally true that pain is the concomitant of retarded mental activity. Spinoza has said that happiness is always a progress towards ]>crfection; misery a falling back. But that theory does not seem to be borne out by the facts of the disease that is under consideration. Disease cannot be an approach towards perfection, and yet many monomaniacs, when under the inituence of disease, will tell you that they never felt better in their lives. If a man is unreasoningly self-conscious, if no rebuke, no indignity, no insult can take from him that intense feeling of seif-aatiafaction, of great mental and bodily well-being which results from the overflow of energy into a certain mental channel, of course he is happy. Happiness is dependent upon motion for its manifestation. Laughter is an overflow of mental energy into the muscles; and ordinary language marks the commonness of the observation. So it is that there are not unfrequently marked symptoms in monomania which I I I ON INTETiLECrnAL MANIA.. 95 alogoiis to the signs of the presence of mania. All strong emotion tends to become cstemal, and ia the extornalbation of feelings the belief in human and personal power has been found, and the pleas ureableneas of its exercise has been experienced. But there will always be a modification of these maniaeal manifestations hy other intense ideas, in the form of disease that is under consideration. "The maniac," says Griesinger, "with simple exaltation of the sexual instinct, seeks to gratify his desire in the most direct manner; he attacks every female who comes in his way, and the nyuipho- maniac makes obscene advances to every visitor. In monomania, on the contrary, the exalted sexual instinct before it passes into action is guided by new ideas and opinions (of a morbidly exalted kind) which occupy the mind. The patient will then only gratify his desires in the sense of his over estimate of self and of certain delirious ideas ; he only pays his addresses to princesses and illus- trious ladies. The female patients have imaginary love adventures with princes and kings,"' Monomania is a disease of that part of the disposition in which the man principally lives, for it surely can be more truly said that a man lives in his thoughts than in the material circumstances that surround him. It ia in monomania, therefore, that illusions and delusions are most common, and it is in this form of the disease that these morbid impressions ore most persistent, The awful abnor- mality of genuine mania produces such a "sea of troubles" that no delusion can remain long in possession of the individual. Tiiere is a rabble of ideas. Each delusion or illusion is jostled from its place by a host of others. But in monomania there is a peculiar per- sistence about the morbid impressions. The illusions are always the same. The individual believes that he sees a face which haunts him ; hears voices which drive him to do some act ; he is sur- rounded by odours, and the like. The delusions are persistent. The individual believes that the Holy Ghost has been incarnated in a canary bird, or that some worthless object is of enormous value. Still, although these impressions are persistent, there is much rationality in monomaniacs. Concerning many subjects ibey are able to reason with great accuracy, and sometimes with intelligent breadth of conception, which is a higher quality of reasoning than * ' HentHl Pfltholog; Bud Tburmpenlii-i' (Urieiinger), p. 305, New Sj'dcubmn 96 MKDICAL JURISPRITDENCE OF INSANITY. mere accuracy. There is a verj evident difference between mono- mania and mania proper. The manners of the monomaniac are not distraught ; they are generally calm, their conversation is generally intelligent, and such excitement as occasionally exists it due, as in sane individuals, to an external motive. It may be, however, that the external motive is misunderstood in consequence of the illusion or delusion of the individual. Of course there is harmony between the manners and conduct of the monomaniac and bis diseased imaginings. Monomania of pride finds expressions in gestures which to the individual himself do not seem to have any of the characteristics of grimace. Many persons in asylums are allowed to gratify their harmless liking for gaudy raiment and trappings of ribbons, and their words and gestures are possibly exaggerated in consequence of this indulgence, "A. change of skin," says Victor Hugo, "is often a change of soul." But of course their conduct is regulated by their insane ideas, and is a manifestation of the presence of the disease. The other symp- toms, which are not to be found in the conduct of the patient, very much resemble those which are characteristic of mania. When the attack is recent there is generally a feverish condition present, and this is followed by sleeplessness, constipation, and sometimes cerebral congestion. It is very rarely the case that a fixed idea which has existed in the mind for some time is irradicated. We find that the deeper rooted a prejudice is the more diflRcolt ia it to root it up. We find that the longer an idea has had possession of us the more ditBcult is it for US to get rid of this dominant impression. Many persons who have learned to reason ably concerning almost every subject find it as impossible to reason themselves out of some of the superstitions of their childhood as it is to reason themselves out of the belief in the toothache when it is actually present. It is, therefore, not diflicult to believe that these fixed ideas which we have in another place called prejudices in the flesh, should be leas accessible to reason, that they ahouiJ be less amenable to treatment, and that in many cases the disease should defy all efforts which are undertaken with a view to its cure. When the delusions are somewhat obliteraled by loss of memory and other mental weakness or by incoherence, the chances of recovery are very small. The chronic monomaniac does not manifest the same mental excitement that has been mentioned as ON INTEU-KCTUAL MANIA. 97 s sjmptoin of the earlier stages of the disease. The strange fixed delusion remains along with a somewhat stupid calm, and wiili a normal physical condition. Not unfreqnently, however, monomania is followed by a state of profound dementia. There is much interest connected with those cases in which insanity is manifested by the loss of language, while all the other mental facnUies remain intact. This phenomenon is sometimes shown in relation to single words. A person may drop some words, as it were, out of their vocabulary, or the mental effort which is meant to call up one word may have the effect of calling up another, and that one which seems to ordinary indi- viduals utterly dissociated from that which ought to have found place in the sentence. Thus, if a man wishes to use the word "yes," the word "house" be invariably substituted for the simple alTirmative, it may, to the individual thus using it, seem to have al! the significance of the other word. This disease, which can be traced to a derangement of those laws which have to do with association, and with those powers which have to do with the perception of the relations of identity and diA'crence, must hove, in time to come, much bearing upon the questions with regard to the relations of insane persons to the state, and an opportunity will arise which will enable us to state some opinions which ought to guide the admission or recognition of such facts in courts of law. In this place it is sufficient to point out the existence of such a limited disease as aphasia, as it was necessary to point out the fact that insanity is very often partial in a very marked manner, and to recognise the affinity which seems to exist between certain abnor- mal conditions and certain healthy functions. Much has been said concerning the connection between bodily disease and mental affection. We have the phenomenon of dreams described and explained upon a similar principle. A man dreams he ia in the coils of a boa- constrictor, and awakes to find that the sheet is wound tightly round him. Another dreams that he is in hetl, and awakes to find that the candle with which he was reading has set lire to the bed-curtains, And such anecdotes pass for reasoning. So it is that the case given by Esquirol is thought to throw great light on the phenomena of monomania. This is the case of a woman who, during life, believed she was pregnant with the devil, and in whose womb, after death, there was found a mass of hydatids.* H baa ja»t Ikcd mentioned to na. A womnu wlia wasconflued iaalnnUic 98 MEDICAL JTRISrECDENCE OF INSANITY. But it is an incontrovertible fact that many illosions and deltuions are, bo far as we can say, entirely unconnected with any physical impressions, and that, notwithstanding what has been said to the contrary, many of these are dissipated by the skilful apphcation of aigmnents. " I have often," says one who has devoted a long life to the treatment of mental disease, " done as much good by a kind or clever word, or by well-put irony or ridicule, as by drugs or specifics." One of Mr. Maury's patients, after thinking him- self cured of a serpent in his bowels by means of a pretended surgical operation, suddenly took up the idea that the creature had left its ova behind ready to be hatched into a brood of young ones. He was again restored, however, by the dexterous reply of the physician, who assured him that the snake was a male one.* It is surely as reasonable to expect that in some cases false mental impressions might be educated out of a man just as the evil tendencies which a man has at birtb may be eradicated hy means of ' a process of training- Those who deny the former must deny the latter. To many it seems unscientific to treat a symptom. But what do we know of any disease except its symptoms ? We know a man by his actions, and a disease by its symptoms. As we are content in education if we can shape and modify a man's actions, and arc conscious that thus we will modify the individual, so will we, by modifying the symptoms, change and influence the disease itself. And the very best systems of medicines can hope to do no more than this. Why the intellectual symptoms should not be treated it would he difficult to say. To show that some medical men have not failed to recognise the importance of the true use of the highest kind of moral treatment we may quote one or two cases. " E. W — , a yonng woman who had been a schoolmistress, laboured under acate dementia. Dementia seems to be the death of the soul; a person can digest, but not think. The face, muscles, move the jaws, but never shape themselves in that wondrous mosaic of expression. E. W — sat or stood, she did not care to move; there was not sufficient zeal in her to make her live, she had not enthusiasm enough to wish to die. Tonics, shower-baths, electricity, rsjIuqi l)eliev(>d that ahe waa delivprvd of doUti, and «&b id the habit of iktIieriDg them upon any of tho male oSicen of the inatitntlon. After her death it wa« ditcovercd tliat the had aiilTered (rota enhtrgement and tbic:kellitig of the neck of the womb and wasting of the OTBries. • ■ Medico-Cliirurjjical Review,' a, p>., vol. ixl, p. 5M. I w ON INTELLECTDAL MANIA. 99 stimulants, were tried and failed. Hera was a dead soul in a drooping, dying body. One morning, however, upon the occasion of the nsual medical visit to the wards, she accosted the physician. She said, 'Doctor, I am better,' and she smiled. Smiles are the oruaments of health's temple; joy-, not sorrow, .is divine. There was some activity and energy in her movements and gestures. The story of her improvement and recovery was as follows ; she explained the circumstances herself. " At tea-time upon the previous evening, she said, she was in her usual state — conscious of all that was taking place around, but incapable of originating any action, and bowed down by a great weight— saturated by inactivity. A strange nurse entered the ward to relieve one of the ordmary nurses, who was going out on leave. It was a part of this nurse's duty to feed E. W — with her tea; during the meal she conversed with another nurse as she placed the morsels in E — 's mouth. In the course of the conversation she mentioned that she was somewhat strange to her duties, having just come from Lincoln, her native town. It was E, W — 's native town, and the mention of it raised the ghosts of a hundred dead events — ■ of pleasant days of youth and love, perhaps — memories of home, with well-known faces about the hearth. " A modern author has said, ' Home is the honey of this world- hive, which cures the stings the bees have given.' And if it is so, sweet memories are the mead that is made from it. flame ! to it not a magic word ? All your ' prestos I' are frippery in comparison with that one word. It will bring tears into wanderers' qres and smiles into dying faces, and so it brought smiles and health to the soulless woman. There was sunshine in her life from that moment ; she is now energetic, industrious, and of sound mind."* The statement of this case, although suited to popular exposition, is certainly excellent, and so admirable is the paper as a whole, and so closely connected are the cases there described to the subject in hand, that we feel entitled to make somewhat copious extracts. " M, — , a man with a very prominent nose, with sunken eyes. and nervous twitching hands, was confined in a lunatic asylum. How many men kill themselves because they are afraid of deati) t M. — was iji terror of being put to deatli ; and an imagination, Tbe Oeutleinau'B Mugiitiiiv ' fur Miiri^h 1H71, No. 34, a. ■.. p. 4«U. 100 MEDICAL JUmSPEUDENCB OP INSANITT. probably in the leading siringa of bis trade associations, suggested that tie was to be "boil'd down." He had a conacience, and he looked upon this frightful death as a recompense for those " wild oats" be had sown in his jouth. To sow wild oats, and jonrself to be garnered into a cauldrou ! Inventive Nemesis ! Naturally the poor man snffered ; who can be comfortable when they stand by while the furnace is being heated seven times? His misery ran into motion, as most pain does, and he would walk up and down and press and wring his hands, repenting as hard as he could for his sins, thinking, perhaps, to appease that boiling-down Nemesis, He would moan and rock himself for hours, and crave assistance from all who would listen to him. There is not much sympathy amongst lunatics." " Once he was taken to the laundry to assist in carrying some clean clothes. A sad day, that I He reached the door, and there before him was a huge boiler, with its fire (hke a mouth under its boiler brain) glowing underneath it. He shrieked and fled. Oh! great 1^ ! the head cannot say " I have no need of thee." More heads have been kept safe from blows by legs than by their next neigh- bours, arms. Well, he Bed, naturally believing that his hour was come, and that the laundry was the place of execution, to which he had been unfairly decoyed. One day the medical man of the esta- blishment noticed that his patient derived considerable comfort and Batisfaction from assurances of protection, and that in conscqneiice of the^e assQrancea he seemed to regard hira as in some way con- nected with his fate. The assurance was an assertion to that effect. It was, however, not sufficiently definite ; and so one day he an- nounced with some formality to M. — that he was reprieved, and that his execution was postponed for two days. M. O — had faith aa well as conscience, and he believed, and was, during the con- tinuance of those two days, comparatively happy and comfortable. Of course he could not be quite happy ; but to be boiled down two days hence is an infinity of bliss in comparison with being boiled down at once. Time is always hope, and hope is heaven. But the sands of two days ran out, and be became restless and unhappy as the time of his immunity came to an end. His medical man again visited him, and assured him that he would be spared for three days. Tears ran down hia cheeks on each side of his great water-shed nose, and his thanks were warm and earnest. The visible pleasure of the I ^^^_ ani w ON INTELLECTUAL MANIA. 101 tempted his physician to be too kind ; and when by various reprieves he had reached a week, making those dead reprieves a stair by which to rise to higher things, he generously lengthened the time to a fortnight. M. — 'a joy was great. A fortnight ! Eternity ! But it was too long. When ten days had sped he again began to fear — he could not realise it, bo that he had to be reduced again to two days. From this beginning, however, he was conducted up to a fortnight, three weeks, a month, three months, with perfect auceese. One evening, however, the physician was sent for. M. O — was in agony ; there he was wringing his hands again, and piteonsly moaning. The time of the reprieve had run out, and the superintendent had neglected to renew it. Soon, however, he began to smile at the reprieves, but still asserted that he could not be comfortable without them. Subsequently their term of duration was much increased, and they ultimately became unnecessary. The man now works in le laundry beside the cauldron. He stokes its devouring maw !" B — was fed by means of the stomach pump three times a day fcr as many weeks ; for he was brave enough in his fury to meet that snail-death, hunger. What a grand enthusiasm for death he had ! Once he inflicted a blow upon his head by means of a plumber's hammer. It was bo severe as to take him near to death's door, and for some weeks he was confined to bed. During his illness and tedious recovery, another patient was admitted into the asylum. This man's name was F — , and Le was one of those who longed to get anywhere out of the world. This man was associated with B — under the care of a special attendant. It occurred to his physician to put F — undt-r the care of B — . B — was made responsible for F — 's safety ! Strange ! It seems almost a joke to keep two people out of the grave by tlie struggle which each makes to get in first, A weird safety to he jostled away from dealii's door I Strange as it may se-em, however, this exi}edient liad the desired effect, B — took F — by the arm and walked him off, and since that time has devoted himself exclusively to the care of this much less dangerous patient. F — has more than once endeavoured to ■huMe off this mortal coil, and liis attempts have always been frustrated by B — , who has never, since he has become the guardian of another's life, seemed to entertain any hostile intentions with regard to his own. In this case, interest in the life and welfare of lother has reared anew an interest in his own. His own Ufe has 102 MEDICAL JDBISrRDDENCE OF INSANITT. been saved, in all probability, by his endeavours to save that of another. la cot reward the contre coup of a good action ? There is a great, deep, pathetic humour about this guardianship. B — , the most dangerous, most pertinacious, suicidal patient in the Institution watching Y — ! There is a detestable meanness in a thief catching a lliief ; but there is pathos in one suicide frustrating the attempts of another I If F — oni^ lifted his hands to his throat B — put them down. If he approached the fireplace B — intercepted bim. If he cast his eye on a dinner-knife, B — , ever watchful, winked, and laid bold of him. When he refuses bis food, B — , if necessary, insists upon his taking it, or assists in its forcible administration by means of a stomach pump. "They sleep in adjoining beds in the dormitory set apart for patients who are believed to labour under suicidal tendencies; and often in the course of the night B — rises, and on his bare feet on the cold floor will go noiselessly to see that F — is all right, lu all his watchings he is kind, yet firm. It is a great thing to assist a neighbour to do right, and in that way make the home temptations to do wrong less urgent. Such acts are ' twice blessed.' " * There is certainly much interest in these cases, as tliey not only indicate the forms that monomania may assume, but also point out the true uses of moral treatment. Altliough in most cases of simple monomania the intellectual powers seem unaffected, except in so far as the single delusion or illusion is concerned, and the individual seems to reason as accurately as he would do in a state of normal health, still in many cases the disorder is not so limited, and the- morbid ideas are not confined to a single subject. It is scarcely possible that such a mental parasite as a delusion could coexist with complete mental health. Upon most subjects a man can scarcely reason fully or well without making use of almost all his knowledge. When, therefore, a large portion of that garnered experience is rendered useless by the existence of a false and persistent mental impression, the deductions of reason are likely to he the less trust*, worthy. The reasoning of a half man is never so good as the reasoning of a whole man. Of course the influence of a delusion, or of a false impression of sense, upon the life of the individual, varies in proportion to the influence of the thoughts of the same individual upon the same subject. Thus, if a man beheved that he • TliPre are othrr infcreeting cnsea siveii in tliU article. I ON INTELLECTUAL MANIA. 103 constantly heard the whisper of a silk dress^ and was otherwise perfectly sane^ one could understand that such a belief could have little or no influence upon the actual life of the individual. But if a man believed that his own wife had entered into a conspiracy against him — if his disposition was so far changed by disease as to make him hate and suspect those persons whom he had formerly loved and trusted — it would be impossible to calculate the influence of such a diseased condition upon the life of the person thus affected. This is a fact, which the use of such words as monomania or partial mania are v^ry apt to conceal from those who are only partially acquainted with medical psychology, and it is a fact that it is very important each medical man should duly appreciate. MEDICAL JURISPRITDENCE OP INSANITY. CHAPTER YII. ON MORAL MANIA. That the one black sheep which is within the fold of a respectable houaehold should be whitewashed, may, to piebald brothers and aisters, seem a desirable thing. That a family moving in good society, and living in a good street, should, in the event of one of ita members committing a crime, have recourse to the family physician rather than to the police, and should look upon the act as a symptom of disease and not as a crime in the true sense of the word, seems a very natural proceeding. For a long time insanity was looked upon as the work of God's hand, while, even at the present day, the devil is regarded as the mechanist of crime. If, then, a family has an opportunity of mistaking the hand of the devil for that of God, it will probably embrace it. Many a one when asked, like Sam Weller, if lie can see the individual who was guilty of contempt of court, and knows that that individual is a relation, and had laid himself open to punishment, will look at the ceiling, and say " No I" Heaven knows that the grandest things upon earth are those dear home-eyes which will not see our faults — those dear lips that are "no thoroughfare" for reproaches, and those dear heads which are armouries full of defences of our errors, which would fain find a leaning to virtue in all our vices, and the mental darkness caused by the shadow of Gud's hand in that night of the moral life in which the devil rides. But although friends may be breakwaters about the home-harbour, it is the duty of a government to punish crime, and in order to do so it is neces- sary to distinguish crime from iasauity. Is there, then, such a disease as moral mania? — a disease the symptom of which ia crime — and if there is such a disease, how is it to be distinguished from immorality P Pinel was the first who Oy MORAL MANIA. 105 asserted that t}iete were "manj maniaca who betrayed no lesion whatever of the nnderatanding, but were under the dominion of iostinctive and abstract furj, as if the affective faculties alone had Eurtained injury ;" and very many writers since his time have dis- tinguished between intellectual and moral insanity. Some have argued that this disease is exclusively contined to the moral sense, that it may coexist with a perfectly healthy condition of every other faculty, and that the only symptom which manifests the presence of disease is depravity in a somewhat exceptional degree I That twenty convictions would prove a man mad, the law has as yet denied. That if the disease is manifested by no other symp- toms than the commission of criminal acts, the individual shall be liable to the consefjuences of those acts, the law has upon more than one occasion asserted ; and although many loud voices have been raised against the law on account of that denial and that assertion, the principle laid down seems to us to be sound. Nay, further, although we admit that crime is in many cases a sign of the presence of disease, and although we think that in most cases in which it is so, the history of the individual, and the presence of insanity or nervous disease in the parents will establish the fact of moral insanity in the individual under examination ; we are of opinion that only on very rare occasions should moral insanity stand between the individual and the consequences of his criminal acts, for it seems to us certain that pnnisbment is in most cases one of the means of care, and that moral maniacs may be restrained from criminal acts by an adequate system of discipline ! The philosophy of the subject seems somewhat defective. We find frequent assertions that this disease consists in a morbid per- version of natural feelings, or habits, or moral dispositions, and that it is unaccompanied by any lesion of the intellect; that it is a disease of the moral sense, and various other assertions of similar import. Writers have not taken the trouble to ascertain, in the first instance, whether there be a mora! sense or not; they have not endeavoured to discover whether it is possible that reason, wlicn directed in one particular direction, can be affected viith disease, while in other directions it can be exercised under all the conditions of health. It is an easy thing to take for granted, and then to assume as proved, Ethics is the science of the laws of our "actions looked at with 106 MEDICAL JURISPRUDENCE OF INSANITY. regard to their morality or immorality, and presupposes a know- ledge of man as a moral ag;. For ose almoit can chiiiige the Btomp of nature." One ethical philosopher has well said — "Do right, and trust to God lake it easy." So it ia that many acta become so easy in the Ldoing, require so little eiTort of consciousness, that they are said to Kbe done unconsciously, or, in other words, out of the ordinary rela- r tion to thought in point of lime. Thtae acts we may call antomatic or impulsive. The constant modified exercise of any of the muscles, will, in the time to come, tend to the same modified exercise under the influence of a comparatively insignificant exciting cause. And thus in all the manifestations of mind, whether they be connected with impressions on the senses, with the result of the processes of thought, or with one's actions as a moral agent, there is a liability to pass partially out of the power of will or motive — for we are using these two words in the same sense — a liability to recur under J the in6ucnce of what would in time past have been an inadequate «timulus, and to become what may be called involuntary or im- ■pnlsive. But this is much more speedily done under the influence of disease than in the conditions of health. The infinite variety of the actions that one is called upon, while in a healthy state, to perform, protects the individual from the effects that follow habitual action in one direction. But it can easily be under- stood that the presence of a delusion must greatly modify many of the relations of motives to conduct; and the same effects I will be produced by the influence of unrestrained habit, or of hereditary tendency. So powerful is hereditary tendency that we may be said to inherit ready-made habits ; so powerful is it that a father may weaken the power of will, or weaken those powers by which men judge of motives, in his offspring. It is stated as a fact that Oxford, the regicide, believed that he was St, Paul, and that his grandfather had done the same. An interesting example of an hereditary propensity to steal — which descended from a real thief, who could refrain from pilfering when paid to do so, to his son and jgmndson — is given in Dr. Julius Steman's very excellent work on 112 MEDICAL JPKISPBUDEKCE OP INSANITT. ' Hereditary Disease,' and other examples of a similar tendency to the rej)roduction of morbid propensities will be found in Mr. F. Hill's ' Reports on Prisons/ We find voices, features, even acquired skill, modified by the past, so that the handwriting of one individual member of a familj' has in some cases been found to resemble that of some ancestor whose writing he had never had a opportunity of seeing. All this seems to us to explain what we mean by the " depraved impulse," as present in many cases of moral insanity, and what, in this relation, we understand by defective volition. That disease has the power of withdrawing certain acts from the influence of will, and that in many cases it so much in- cai)acitate9 the individual as to place him so thoroughly under the influence of one set of motives as to make any action arising there- from rapid and unhesitating, ia, we believe, the only true explana- tion which can be given of those diseased impulses which find place in the minds of the insane ; and we are furtiier inclined to interpret the apparently motiveless character which belongs to such impulsive actions as, in truth, due to the strength of the motive to which they owe their existence. In this life our course ia not a clear one. Duty is often difficult to do. "We have the choice of Hercules at every turning point of our life. The more one knows of the possibilities of the future, the more careful will one be in fashioning the actualities of the present. And Shakespeare says — " Riglitly to be grBnt Ii not to itir without great argiimeDt." It is to the ignorant that choice is easy : it is to the wise that choice is difficult, A child finds no difficulty in choosing between a bank-note and a lolljpop, and from the impulsive way which it grasps at tlie latter, we think it is uninfluenced by motives, the fact being that it is influenced by the motives of actual enjoy- ment powerfully, and by those of remote contingency not at all. So it arises that an overwhelmingly powerful motive has, to the eyes ot those who are in the habit of connecting choice of motives with struggle, the same appearance as no motive at all. Our idea of choice is the swaying of the scales, not the kicking of the beam by one of the scales ; so that we have, in thought, connected actions which spring from a very strong motive with the expression " motiveless," because struggle, resistance, is the sign of humanity I m ON MOEAL MANIA. 113 in the bands of cauae, while yielding is the sign of inanimate matter under similar circumBtimces. We beheve that this explanation of an " irresistible impulse " is conformable to all the circumstances which attend their manifesta- tion, as far as they have been accurately observed ; and we further believe that, with such an explanation as the above, courts of taw would, in connection with the various cases, be satisfied of the existence of morbid impulses; and it would be admitted that persistency of criminal tendency, and the commission of criminal acts in spite of repeated punishments, and in spite of every human reason to believe that the connection between future acts of crime and punishment would be invariable — all point to the existence of disease. A few cases are added to show that the real ground for exempting from punishment has not been sufficiently nnderstood, and to illastrate the phenomena of this disease. ' An only son of a weak and indulgent mother was encouraged the gratification of every caprice and passion of which an untutored and violent temper was susceptible. Tlie impetuosity of his disposition increased with his years. The money, with which he was lavishly supplied, removed every obstacle to the indulgence of bis wild desires. Every instance of opposition roused him to acts of fury. He assailed his adversaries with the audacity of a savage. Bought to reign by force, and was perpetually embroiled in disputes and ijuarrels. If a dog, a horse, or any other animal offended him, he instantly put it to death. If ever he went to a ffite, or any other public meeting, he was sure to excite such tumults and quarrels as terminated in actual pugilistic encounters ; and he generally left the scene with a bloody nose. Tbia wayward youth, however, when unmoved by passion, possessed a perfectly sound judgment. When he became of age, he succeeded to the possession of an extensive domain. He proved himself fully competent to the management of his estate, as well as to the discharge of bis relative duties, and he even distinguished himself by acts of beneficence and compassion. Wounds, law suits, and pecuniary compensations were generally the consequences of bis unhappy propensity to quarrel. But an act of notoriety put an end to his career of violence. Enraged with a 'Oman who had used offensive language tc^rn, he precipitated her well. Prosecution was commenced against him ; and on t!ie [deposition of'a great many witnesses who gave evidence to his lU MEDICAL JURISPnUHENCE OP INSANITY. furious deportment, he waa condemned to perpetunl confinement in the Bicfitre."* Allhongh tliia caae ia recorded by Pinel, it seems to us aoything but a Batisfactory illustration of moral insanity ; and it is somewhat strange that it has been quoted in that connection by some more recent writers on the subject, " Strong passions," seem to us all that is made out in the case just quoted ; and if that [ilea is to open the door of a lunatic asylum instead of that of a prison, courts of law may shut their doors. That the strong passions were unrestrained in youth, that a defective education led to careless self-control, that the means of gratifying passions made them strong — just as in a country's economy, plentiful supply strengthens demand — that habit strengthened more and more what tendency had made in clay, seems all that can be gathered from the facts of this case. The same story might be told of many of those persons one meets each day and never excite a suspicion of insanity. We suspect that the money, of which he had much, and the domiun, which was extensive, had something to do with his incarceration in the BicStre. A case mentioned by tloffbauert better illustrates what we understand by moral mania. It is a well-known case, and we therefore content ourselves by referring to it. We epitombe a case given in an article upon the subject under consideration, in the ' Medical Mirror.'I W. B — was twenty-seven years of age. He had been eight times in the house of correction. His father was an epileptic, and he himself had been subject to convulsions when teething, and at intervals during Ms after-life. He tortured animals, picked out the eyes of a kitten with a fork. lie lied and stole. He waa expelled from school as too bad to be kept. He afterwards consorted with the worst characters, was drunken, debauched, dishonest. He attempted, or pretended, to commit suicide. He was utterly false and untrustworthy. He delighted in torturing those patients who were, like himself, confined in the lunatic asylum, and who were too weak to resent injury with violence, lie was indelicate in the presence of females, and attempted a rape on hia mother and on his sister. Yet, with all, he was intelligent, exceedingly cunning, and " Pinel, 'Sat I'AUeaatiDu Mcntale,' p. 1S6, a. 159. t HoffbBuer'i ' Medecine legale,' ». 126, p. 132. i " Notes on Moral Insnnitj," •Metlkal Mirror,' vol. iv. No ilviii. I ON MORAL MANIA. 115 while he vas actuall; the victim of epileptic seizures, be was prone to feign Gts, and did it with considerable ability. In spite of careful watching he repeatedly effected hia escape. Was exceedingly vain ; and, in the presence of some persona, aeeraed to be exceedingly devout. lie was ingenious in excusing hia errors ; and, although exceedingly mischievous, was careful to avoid disagreeable conse- quences. All these facts indicate the presence of disease ; and, we are inclined to believe, that the case above quoted is one in every respect typical of general moral mania; and yet it is not one in which, it seems to us, looking at the function of government as we have described it above, even the presence of this morbid state should protect fiom the consequences of criminal acts. la ail the circumstances of the case we have partially described, two things are observable: — 1. A fear of personal inconvenience, a dislike of ordinary punishments, and many of the ordinary motives of human nature — as, self- aggrandisement, sexual indulgence, the praiae of those whose praise is ordinarily thought of value, [lersonal vanity, and the like; and, 2. An intelligence of such a high order as to enable him thoroughly to understand the relation between a found- out crime and its punishment, for he invariably tried to conceal the commission of the criminal act by lies, hypocrisy, and various clever expUnations. And either of those two conditions of health seems to us — where no uncontrollable impulse is proved — to indicate a fit object for punishment. And the writer of the article from which the case is quoted, evidently, although a medical man, tends to the same opinion, for he says,* " Humane and well-devised punishment must follow all their (the morally insane) misdemeanours; and they must be made to feel tliat, iu certain matters, subjection to a domi- nant system is an inevitable necessity. The gradual formation of habit is, above all things, to be aimed at." It is quite evident that many snch individuals exist amongst us, with a heritage, if not oE actual disease, yet of accumulated crime, which is the clay iu the hands of that potter. Time, of which insanity is made, who do not restrain their morbid impulses on account of the fear of punishment. But because the law has, by various punishments, failed to make a man honest, to regard liim when he again steals as exempted from punishment on account of the number of bis crimes — and because it has failed, to do damage to its declaration by rendering the connec- ■ Page 739. 11 fi MEDICAL JTBISPttTTDENCE OF INSANITY. tion of crime and punishment less invariable, aeems absurd. It is just because this consequent and antecedent are not invariably and inevitably connected that some meu commit crime, and that those who have a tendency to commit crime through strong passions, habit, or disease, are not restrained. It is trae, there are some iusauc persons whom an invariable sequence will not teach the lesson of life, and whom the pain which is the invariable consequent of violently striking one's head purposely gainst a stone wall, will not teach to refrain from that act. When such a state of mind exists, whether it arises from imbecility or mania — intellectual ot moral — it is absurd to punish. In most of the cases of moral mama which have been brought under our notice, the tendency to sin is, doubtless, due to disease; but it is not so strong that an absolute certainty of proxiimite suffering could not restrain from the com- mission of the criminal act — indeed in many cases it is not stronger than the teuilencj which exists in those persons that circumstances have brought lo sin, and that habit has made criminals ; and as it is for the latter class that laws are enacted, it seems to us, the former class are co-heirs with them in the advantages to be derived from the infliction of punishment. Another case may be quoted to illustrate this position; it is a case "where, with great natural shrewdness, general information, and gentlemanly manners, where no delusion or incongruity of thought can be detected, there exists an inveterate desire to torment and irritate those around ; to enjoy the dissension and disputes which ensue, and to violate every rule of decency and delicacy by obscenities of look, word, and action, when these objecU can be accoiaplhheil toil/tout deteclUm."* We imagine that the case just quoted, and the following case, which we take from Prichard,t prove that in many of the relations of the morally insane to the State, they may, for all the purposes of just governmental discijiline, be regarded as sane; and that, in many respects, those who are afllicted with moral insanity must be treated in the same way as those in whom we can only discover moral turpitude. "Mr. H. P — had been for many years c<-nfined in a lunatic asylum, when, an estate having devolved upon him by inheritance, it became necessary to subject him anew to an investigation. He was examined by several physicians, who were unanimous in the opinion • ' Crichton luslitution Rtjiort ' for 1850, p. 26, t ' CyclopEedia ot Practical Medicine, Art. lueauil;,' p. 834. I ON MOEAL MANIA. 117 r lie was a lunatic ; but a jury considered him to be of sound miad, attributing his peculiarities to eccentricity, and he was con- sequently set at liberty. The conduct of this individual waa the most eccentric that can be imagined ; he scarcely performed any action in the same manner aa other men ; and some of bis habits, in which he obstinately persisted, were singularly filthy and disgusting. For every peculiar custom he had a quaint and often ludicrous reason to allege, which indicated a strong mixture of shrewdness and absurdity. It might have been barely possible to attribute all these peculiarities, aa well as the morbid state of temper and affec- tions, to singularity in natnraT character, and to the peculiar circum- stances under which this person had been placed. But there was one conviction deeply fixed on his mind, which, though it might likewise be explained by the circumstances of bis previous history, seemed to constitute an instance of maniacal cieluaion. Whenever any person, whom he understood to be a physician, attempted to feel his pulse, he recoiled with an expression of horror, and exclaimed, ' If you were to feel my pulse you would be lord paramount over me for the rest of my life.' " " The result has proved," this author goes on to say, " that confinement is not always necessary in cases of this description. Mr. If. P — has remained at liberty for many yearsj and his conduct, though extremely singular, has been without injury to himself or others." This is one case, and many others might be collected in which an illiterate jury have, in spite of medical evidence, sucoeeded in doing the right thing ; but it is also a case which shows how very fre- quently moral insanity is connected with intellectual delusion. Indeed, we are convinced that many observers have not — in their anxiety to prove the fact of a iiud of iaisanity which exists indepen- dently of any prominent intellectual symptoms — been sufficiently carefal to look for signs of the existence of that which they did not wish to see. Many people, like Nelson — when he was told that there was a signal from the Admiral's ship commanding bis return — put the telescope to their blind eye, and say, " 1 cannot see any- thing," So Dr. Ray* quotes the case of the Earl Ferrers, who was executed in 1760t for the murder of his steward, in illustration of rhat he regards as moral insanity. Dr. Ray does not, in the • • Medio! Juriiprndeoce of Iiwanitj,' p. 119. t See ' Hargrave'i State Trials,' vol. i, p, 47B. 118 MEDICAL JTHISFBITDENCB OF INSAmTT. description he gives of the condition of the accused — ia which he asserts that the disease was in a more advanced condition — state that it was proved that his lordahip was occasionally insane, and incapahle, from his insanity, of knowing what he did, and of judging of the consequences of his actions. He laboured under the delusion that his relations and friends had formed a conspiracy against him, and he regarded Johnson, his victim, as an accomplice. His conduct was of snch a character as to convince those who knew him of his insanity. Tliat the verdict of guilt; may have been erroneous, and that the sentence and execution may have beea inespedicntj is true, hut that the accused laboured ander moral mania seems to us false. In another place we point out the relation of those afHicted with intellectual mania to the Stat«; here we would — while we praise the caution of our courts of law in hesitating to recognise moral insanity, and point out that, from the rarity of cases in which this disease is unaccompanied by very prominent intellectual symptoms, very little injustice has been done, in consequence of the law's unwillingness to recognise this kind of insanity — censure the dogged persistence of lawyers who will not, even in the present state of medical psychology, and with the amount of evidence which has been accumulated, admit that there can, or ought to be, a recognition of such a form of disease by our criminal law. I ON PABTIAL MORAL MANIA, CHAPTER VIJI. ON PARTIAL MORAL MANIA, ^ Althovoh it is difficult to see how oae set of mental operations, M, for instance, those which go to determine a difference between right and wrong, can be affected with disease while in all other respects the mind is sane ; still it is a fact that a maa's relations to external nature may be distorted in so far as one series or class of •cts are concerned, while in other classes of acts or impressions those lelations may be in a perfectly normal condition. A man may be blind without losing the use of bis ears. But still it is not altogether correct to say that a man can be morally insane while at the same time he is intellectually normal. For, as what we know of mind is only thought, we cannot regard a mind which always thinks wrongly with respect to certain matters, although in other matters its process may be without error, as in its intellectual wholeness complete. I now propose to consider a class of cases in which even a more Jimited species of acts is aff'ected by disease — a class of cases in which only one or two of the social relations of the individual are interrupted by the presence of the abnormal conditions of brain. Although it is difficult to separate a man's feelings from bis thoughts, it is not difficult to make a distinction between various desired or passions in relation to their objects. Thus, if we found morbidity only mani- fested in relation to the appropriative tendeucy in human nature, it would be reasonable, for the sake of convenience, to distinguish such a manifestation of disease from that in which the tendency to destroy one's own iife was found to be the most prominent mental feature. It is really madness in relation to the same mind and thought, whether its symptom be ateaUng a handkerchief or cutting one's throat; but as there are different kinds of skill acquired by different parts of Ihe body, so there are different propensities I I I 120 MEDICAL JtTElSPBUDEKCE OP ISSASm. acquired b; mind. Skill is the direction of energy to the educt part, partial moral mania seems to be the direction of morbid energy, or enei^ manifest under abnormal circumstances, through certain tendencies of disposition. And the most con?enient means of classiScatioa is presented by the similanty of the most prominent features or symptoms of the disease in different cases, as it is these features and iheir object that call attention to that part of the dis- position which is primarily affected. The disposition is jnst the stereotyped edition of a man. ^liile a man is yonng and under favorable circomstances, his tendencies are only movable types. If ire say a man's disposition is good, it is that the circumstances of the past have biassed him — like a bowl — to run over this green world in a direction we think heavenward. This ia disposition in the lamp. But we all know how infinitely the various rooms of the bouse — dis- position, so to apeak — vary in different individuals. W e find one man liking solitude and the great lessons it teaches, while another Kerns to enjoy his neighbour's elbows in his side as he is jostled in the market-place. One man has great ventures forth in the waves' hands, and prays that the wind may bring home his ships, and that his coffers may be at their golden tlood tide. Another man lives in the shadow of great quiet hills, with nothing but books for friends, and would rather hear the babble of the streams than the chirp of nil the coins in the world. One man imagines that " To breathe u Bot to live," vhile another man thinks that " well fed " is the acme of happiness, and never to want, the highest perfection. It is the sum of all a man's tendencies to the external that we designate his " disposition ;" and wheii we use such words as "miser," or "glutton," we mean to express, with as much exactness as one word can, the whole dispo- sition of an individual. To say that a man whose disposition impels him to choose what is bad rather than what is good, is a bad man, and a stupid man, seems to be warranted by the dictionary meanings of words. We see many who choose the evil and eschew the good every day of their lives, and we see others who prefer the good of the spirit to the good of the body. But bberty is an excellent thing, and if we were all compelled by law upon all occasions to do well we would make the milleuium a seven months' child — a consummation not to be desired. 80 we are all allowed to choose what is bad, if is (hEOICU librIrT ON PARTIAL MORAL MANIA. 121 We prefer itj eo long as our choice neither directly nor indirectly tends to injure other people. When disposition would impel us to the choice of something which belongs to another and, when we appro- priate the article to our own use, law steps in and, for tiie reason that it is convenient that folk should be able to possess without molestation what belongs to them, punishes ua, in order to prevent the formntion of such unsocial (in the wide sense) dispositions. Such is the principle of our law, and whether the disposition is a result of disease or not, so long as punishment is calculated to lestrain, so long should it be had recourse to. But it is true that a disposition may get too strong for a man. He may, even when the strongest reasons for refraining from a certain act exist [e.ff. the presence of witnesses and the certainty of punishment), be unable to restrain his propensity. And where such a fact can be satisfactorily proved it seems to as, after careful con- sideration of the subject, that the individual should be held irrespon- sible for such acts. Partial insanity, then, may, according to medical men, be traced to an abnormal increase of vital energy in any part of the mental organism, which will probably be manifested in an excessive activity of that state of consciousness with which the part afiected is con- nected, or, what seems to ua more probable, will in all likelihood manifest itself through those channels of mental life in which the greatest amount of mental energy has been wont to flow, or, in other words, be directed by the disposition oF the individual. In relation with this statement it must be remembered that a man's disposition ia not always an open book from which a runner might read, that it is not always formed by overt acts — although in many cases these are the scaffoldings of disposition — but is often built up in secret by the coral insects of thought. It must be remembered also that a disposition is not omnipotent, and that many wise men constantly act in direct opposition to the tendency of their nature ; but where the true disposition can be ascertained it will, we imagine, be found the channel through which the excessive mental energy generated under the influence of disease will flow. It is true that [frequently the disease seems rather to change the character of le individual, and a man that was scrupulously honest before be- imes a thief; a philanthropist, a persecutor. But these facts, the :uth of which we admit, only bear out our statement, for it seems 122 MEDICAL JCEISPaUDENCB OF ISSANITY. I flow to US a law of the manifestation of energy that its exce&sive under the influence of disease, tlirough a channel in relation to which it is excessive, is productive of a result contrary to that which the ordinary healthy passage of energy would be expected to cause. If fifty people try to get through a doorway suited for the passage of one person at a time, not one gets exitj and that although the door is wide open and there are flfty persona wishing to get through. So it is with energy. As long as the disposition-channel — to make a phrase — is suf&cieut to allow the exercise, say of generosity, it manifesta itself in good works ; but when it has, owing to the excessive activity of mind, became too limited, there is a display of excessive mean- ness in all the actions of the individual, so that oar assertion that it is the disposition of the individual that influences the manifesta- tion, and gives a character to the symptoms, is borne out by facts. In the following remarks upon partial moral insanity I shall attempt to describe — 1, kleptomania; 2, erotomania; 3, oinomania; i, pyromania — 5, suicidal mania ; and 6, homicidal mania ; belJer- ing that these are at the present time the forms of disease which it is most important thoroughly to understand, and which it is the ' duty of those who write upon the medical jurisprudence of insanity j most minutely to explain. Kleptomania. — The idea of property, as we have it in our time^ was not built in a day, any more than Rome was. That it has been built seems certain. In the first instance it may have been ac- quired from the undoubted possessory feeling a man has with regard to his own body. A man would recogQise his hands as his own, and from that rudimentary notion of self-possession anything that could minister to the welfare of self would, in time, become associated with the idea of property. Food would probably be that with which this advanced idea of property would be connected. But the real development of the notion of " mine" must have arisen from tha remembrance of some want in the past, and its satisfaction in atimo nearer the present, and from a suSicient appreciation of the course of nature to believe that such a want might arise in the future, whea its satisfaction might be difficult. The man who really first had property was he who thought, " I am not hungry just now, but I may be in time to come. I have more food than I can eat just now, and I may not have enough to eat in time to come." But he found out that it was ne^-essary to remeinber where the food was I ON PAETUr. MOItAL MANIA. 123 it necessarj to hide the food and mark the place, so that he might find it again ; and it was this fact of it being bidden that waa the law that gave him the true feehng of ownership. But if food was "owned," and men began to think that possession gave a right to property, why should not the implements with which the food was procured be a subject of property ? The hunter transferred the skin to hie back or stretched it over a pole to shelter him, and so pro- perty increased. Thea began the differences of the language of property. At first property in food only gave the pleasure of satiafactioQ of appetite, and then of tast« ; then when the hunter came for it again he had the satisfaction of feeling that by his in- genuity he had "earned bis blessings," that be had done better than his neighbours by making the present live, as it were, on the past ; then came pride in the shape of the instrument, in its orna- mentation, in the glossy hide, in tlie antlers, in his house or wigwam. in the cleverness of his bartering exchanges, and in the stores he bad laid up against the time to come. And so his feehngs ramified, as it were, so the idea of property grew and strengthened, for feel- ings are strong In proportion to the number of actual or possible associated sensations. Then came money 1 and it was looked upon as valuable, not in proportion to the one real pleasure which it could procure, but as equal to all the possible pleasures which it might procure, and hence to be regarded as indefinitely advantageous. It is in this way that the present idea of property has been formed, and in this way has the moral condition of man been raised — first, by the enlargement of his sphere of activity ; second, by the belief in the security of the future. The enlargement of the sphere of activity is of the utmost importance to humanity. It is good genuine work, be it with hand or bead, that best forms character : and in order that a man may work he must believe in a future for which the present labour is providing comparative comfort. It is this anticipation of a future which is most characteristic of humanity, which best distinguishes man horn the lower animals. Is it not this anticipation that opens the gate of heaven to us — is it not the hopes and fears which come with this expectation which make night I hideous ? — 80 homhlj to bIibIic out disj Willi thuugbla bejond Uie t< icboa oC oat loiili." 131 MEDICAL JDRISPEUDBNCE OF INSANITX. Is it not this that makes man bend his knee to Him who formed H past and the present and the future — a world that is ours just nowJ and a world that may be ours hereafter ? It is odIj the lower auimala that live entirely in the present, and the present is always small. It is like a room, and humaait; has made windows in its walls by which it surveys both the landscapes of eternity, while the brutes are content to live in the little close darkne^ of to-day. The present is great only because it can be made to con- tain glimpses of the past and of the future. Property, then, in possible only to those who have a future. It is something only in relation to time. But property must be respected by others than the proprietor, and in order that it may be respected it mast be distinguishable. It must also be transferable, else property would be valuable only to a limited esteiit ; and the transference of pro- perty must he safe, and ought in every country to be easy. And so from the rude beginning which we have described we arrive ia time at a stage where there is a necessity for law, or " a rule of civil conduct prescribed by the supreme power in a state, commanding what is right, and prohibiting what is wrong."* ~ It is unnecessary to go further into the question as to thai formation of the idea of property, or of the means which have 1 been taken to render the acquisition and the subsequent possession of property secure. Enough has been said above to enable us to explain the connection of the idea of property with certain diseased conditions which may be brought under the notice of the medioB jurist. After property has been acquired, after the municipal law hM J forbidden theft and prescribed penalties in case the established rights of property should be violated, many persons are still found to be stupid enough to attempt to deprive their neighbours of their goods by means of fraudulent taking. But there are others who, ] through the disordering effects of disease, fail to perceive the relation in i which they stand to the property of another, who fail to perceive the real connection that exists between owner and goods, to the exclusion of other individuals, or, even while they do understand the whole gist of the idea of property and possession, are, from their inability to be * " Lan" U defined as " any thing laid down. b. c.> ru a rule of action— « rule impDBed, flied, or eatnblUlied, ducreed or det«naiaed." — ' BicbaidsoD't Die.' 1 ' Blackstone'a Commentaries,' p. 14, n i ON PAETIAL MORAL MANIA. 125 I im influenced by ordinary motivea, which are the poiots of buinanity's compasSj unable to refrain, from the mere pleasure which arises from the act of appropriation. Very early in history we find instances of stupid hoarding under the iniluence of disease, and soon we find theft as a syroptom of insanity. That avarice which sits " Upon ■ camell loadan bU with ijold : Two iron coffen bong on eitlier side, With precioui metal ftill a« thej might hold, And in his kp K heap of coin he told i For of bi« wicked pi.'lf his gad hemide, And onto hell himtelffor monej' sold j Accnrsrd lunry was all hii trade, And right and wrong in eqoall liall&unce tniide,'' is compatible with health, in the ordinary sense of the word, may be true ; but that such men as John Elwes, who at night was heard in his chamber as if struggling with some one, and saying, " I will keep my money, I will ! Nobody shall rob me of my property," and who lived in wretched poverty, aithough he died worth £80(1,000 ; as Thomas Cooke, «ho never did a generous act, except dying and leaving £127,205 Three per Cent. Consolidated Bank Annuities for some one else to use ; or as Daniel Dancer, the history of whose life and littleness ia as well known as the story of his great wealtii,* are in [wrfcct health, in the truer and deeper aense of the word, we would emphatically deny. But the question of hoarding, save in so far as it is connected with theft, does not properly fall under our notice in this place. Notwithstanding what some extreme thinkers say, we are com- pelled to believe that larceny, which is "a wrongful removal" (taking and carryiog away} of the jiroperty of another, whether it be effected without consent or by consent obtained by intimidation or fraud, so as the owner consent not in the latter case to part with his entire right of property, hat with the temporary possession only,t is not necessarily connected with insanity. But, at the same time, we must admit that theft may become a symptom of, and often is indulged in consequence of, morbid mental conditions, i No difficulty occurs where kleptomania, or the propensity to * See Henry Wilion't ' Wonderrul Chaiacten,' vol. ii, p. 38. t 'Cr. h. Cora. iOx Rep.,' p. 60. 126 MEDICAL JURISrEUDENCE OF INSANITY. steal (using the word propensity in the meaning we have attached to it by our explanation of impulse aad tendency), is only a symptom of well-marked mental disease. Thus, in the case of Renaud, which is quoted by Marc,* no difficulty could have arisen. The patient's ideaa seem to have been yery limited, indicating the existence of imbecility. The conclusion of the commissioners (MM. Denis and Marc) who examined him, was — " 1. That hia moral facul- ties were so feeble as to constitute a state of imbecility, which, however, did not preclude a certain degree of cunning when he delivered himself up to his propensity, or when he endeavoured to deny the acts which arose from it. 2, That it is exceedingly probable that Renaud experienced at times maniacal excitement, and it was especially in this exalted state that he twice attempted theft. 3. That in any case the menfal condition of this individual did not appear to allow of the supposition that he had that degree of discernment and moral liberty vrhich forms a necessary condition of criminality." An interesting report on a case of mental derangement with kleptomania, by Dr. Max Mauthner, is printed in the second volume of the ' Medical Critic and Psychological Journal,' which, although it is too long to quote, throws some hght on the subject under con- sideration. Frichard mentions a case in which the wife of a man of large fortune was in the habit of stealing upon all occasions when she visited shops for the purpose of purcliasing. In this case paralysis and softening of the brain existed. So inveterate was the habit that the husband, as he could not shape his wife to do right in conformity with opportunities, tried to shape tlie opportnnities to the disposition of his wife, and went to reside in the country. The case of L. H — , who was confined in a lunatic asylum, and which has not as yet been reported, will further exemplify this class. She was extremely irritable upon certain occasions, but nnder ordinary circumstances was exceediagly morose. Her face was fixed in a "puckered" frown. She was, however, well educated, and could converse rationally upon many subjects. She was suspected of a morbid desire to acquire and hoard up, and upon a search being instituted fifteen bags were found concealed about her person. The number of articles contained in those fifteen bags (or those of them that were minutely examined) was 1182. Most of • Maro, ■ De lu Folic,' vol. i, p. 170. ON PARTIAL MORAL MANIA. 127 tte articles were utterly worthless. We may meution soma of them. There were 104 fragments of paper, 82 sewing needles, 18 gloves (mostly old), 12 moulds for wax leaves, J 9 buttons (of various kinds), 60 feathers, 8 parcels of dried flowers, 4 pilis, 3 fragments of dried fish, 138 fragments of ribbon, 9 bottles, 61 lozenges, &c. &c. In such cases, where the habitual theft is only a symptom of well-marked mental disease, little difficulty can arise. Where the individual who steals labours under a delusion, either that the property really belongs to him {as ia very frequently the case when an individual labours under general paralysis in one of its stages) , or that it has been stolen from him, and that he is only exercising the legal right of recaption, or that he has been commanded by God to take possession of cert.iin articles, courts of law wiU not hold the individual responsible for liis acts of theft, but will exempt him from the punishment declared by law. Such cases evidently Fall within the rule of law stated in an earlier part of this work, viz. that if an accused person labour under " a partial delusion only, and is not in other respects insane, he must be considered in tlie same situation as to responsibility as if the facts with respect to which the delusion exists were real."* So far, then, there is no difficulty or uncertainty, but in those cases in which there is no other symptom of insanity except this diseased propensity to acquire property, — which is very frequently accompanied by the hoarding propensity, showing that it is in- timately connected with the true primitive idea of property, — where the theft is the only sign of the presence of morbid conditions, the questions as to whether disease is the exciting cause of the larceny, and if so, whether it should be regarded as exempting the individual from punishment, arc much more difficult of solution. That auch cases do occur is certain, A clergyman, who occupied a very excellent position in Edinburgh about forty years ago, who had distinguished himself by his learning and piety, and who, to use a " stock " phrase, was universally respected, was in the habit of stealing Bibles, and nothing but Bibles. He manifested no other symptom of insanity, and when questioned as to his conduct excused his acts on the ground that it was necessary to propagate the gospel. Well, it may not have been 128 MEDICAL JUaiSPEUDENCE OF INSANITT. SO mad an idea after all to thiiik that theft of Bibles was calculate to do God service. How mauj people, sane enough withal, h»ve attempted to propagate truth with a sword, as if human hearts needed to be ploughed before they would yield a harvest,* " There are persons," aaya Dr. Rush, " who are moral in the highest degree as to certain duties, but who, nevertheless, hve under the influence of some one vice. In one instance a woman ' exemplary in her obedience to every command of the moral 1 except one — she eouid not refrain from stealing. What made thia vice more remarkable was that she was in easy circumstances, aai not addicted to extravagance in anything. Such was the propensil to this vice that, when she could lay her hands on nothing moifll valuable, she would often at the table of a friend fill her pocketa secretly with bread. She both confessed and lamented her crime ."t A case has come under our own notice which has many features in common with that just quoted. Mr. M — was an individual of high rank. He was the owner of an excellent estate, and was as wealtliy as most of his neighbours in the county in which he resided* _ He was never suspected of being insane, and the only evidence o£'j mental unsoundness that could have been obtained was a confessicH upon the part of some of his servants that he was "sometin peculiar." Yet this gentleman was in the habit of appropriat " towels." He invariably, when visiting or on a journey, packed t^ towels he found in his bedroom in hia portmanteau. And when I returned home the stolen articles were, by iU otm directions, retun to their real owners. Marc mentions the case of a young lady of rank who was addict to stealing handkerchiefs, gloves, and the like. She mourned over bai propensity, wept, repented, and stole again. There was no sympton of any impairment of intellect,! Victor Amadens, King of Sar-«] dinia, was in the habit of stealing objects of little value.§ And a unpublished case has come under our notice where the propenaitrj ■ Ad int«restiug csae of i book-ateuler will be fannd in the 6th vol, 2nd weritt of the ' Animlei MMii'D-PajchologiqueB,' p, 666. Soma tasca of kleptomaaia n bofouudin the aame journal, for April, 1856. t ' Medical Inqnlriei sad ObservatioiiB,' vol 1, p. 101. t Hare, Tol. ii, p. 254. S Hare, Tol. ii, p, 251. Soe other caiet in Mare, p. 855, 862, 26*, i ToL i, 308. ON PARTIAL M02AL MANIA. 12! to acquire by theft manifested itself only in relation to pins. The case mentioned by Pri chard ia well known, where the individual would not eat unless the food waa stolen, so that his at- Ifindaut had to humour hia appetite by placing his food in a comer, where it seemed hidden, but could be purloined without difficulty. These and many other cases which might be quoted * show that theft may be the only symptom of disease, for surely we are entitled to infer the presence of mental alienation in a case where the motivea to theft are so obscure, so unlike those which ordinarily govern the actions of men, as to defy all predication of an individual's action from the ordinary experience of the conduct of mankind. That where a clergyman, who is in every other respect strictly con- scientious, who is guided by an earnest desire to comply with the commands of a strict code of duty, steals Bibles, and nothing but Bibles, when he steals them with a view to disseminate religious doctrines, one of the most imperative of which is " Thou sbalt not st€al," that we should regard such a person as insane with respect to that act seems to us a necessary consequence of thought. That a gentleman of rank and fortune should steal linen from his friends and hot«l- keepers, and that subsequent to the theft be should command their return, seems to us sufficient evidence of morbid mental con- ditions. The relation of such individuals to the civi! and criminal Jaw of the country in which they reside is a question which will be considered in a subsequent chapter, and tlie answer to which may be surmised from what has already been said. But in the mean time we are considering whether there is a marked condition of mind which in its relation to circumstances manifests itself solely in con- nection with the idea of property, and we are of opinion that the cases quoted above, and those which have been referred to, prove that such is the fact. To show that it may exist as a premonitory symptom of a more serious disease, we may mention the case given by Fodere.t It is that of a servant in his own family, who could not help secretly stealing from himself and others articles even of trifling value. She was, at the same time, modest, intelligent, and religious, and was aware that she did wrong. He placed her in » Several CUM given In Gall 'On tlie Functioiu of tlie Brain,' ^ t Initi da M^eciue L^le,' f. i, p. 237. Quoted in - Kay'i prml«nc«,' p, 129. Medical }qt I 130 MEDICAL JURISPRUDENCE OF INSANITY. an hospital, consideriiig he^ insane, and after apparent restoration and a long trial he again took ber into bis service. Gradually, in spite of herself, tbe instinct again mastered her, and in the midst of 80 incessant struggle between her vicious propensity on the one hand and a conscientious horror of her condition on tbe other, she vas suddenly attacked with mania, and died in one of ita paroxysms. A similar case b mentioned by Morel.* " I was once able to establish the non- responsibility of a patient who bad stolen in church the ornaments and tbe most insignificant objects of ceremonial, and who presented no other symptom of disease than a marked stat« of congestion, great self-content, and a silly laugh ; the patient had no delusion, there was only a great intellectual weakness and the most complete indifference as to the fate which justice would award ; only three or four months after his acquittal an attack of acute mania with delirium of grandeur, trembling of the tongue, and other symptoms of progressive paralysis, justified my prognostic." And a case is given by Prichard of a gentleman of fortune who resided at Scarborough, and who, amongst other peculiarities, was in the habit of stealing any articles of no value to him, and making little use of them afterwards, who died of general paralysis. Yet it is necessary clearly to distinguish between such cases and between thefts properly so called. We are far from admitting that every one who steals is a kleptomaniac ; we do not even go so far aa to assert that every kleptomaniac should be held irresponsible for his thefts ; and we assert that in all cases where theft is the sole symptom of the disease the individual should be held, in every re- spect, responsible for the commission of every other crime except that of larceny. Several rules may, however, be given for tbe detection of real disease as the exciting cause of tbe criminal act. We would caution medical men and other persons who have to deal with such questions from paying too great attention to the existence of some stnpiditr in the esecution of the crime in question as a proof of the existence of insanity. This is too frequently done. People liave got into a habit of using the word "insane" upon occasions which are far from being sufficiently adequate to warrant its use. I'olk say of a neighbour, if he does some act which they consider foolish, " He must be mad." • ■ TraiW dea Mulaiiet Mentalas," p. 110. ON PARTIAL MOEAL MANIA. 131 And from this somewhat wholesale importation of the word into ordinary use the menning haa become somewhat less definite. Because a man leaves a knife with his name upon it lying beside the victim's throat that it has just cutj all the people cry, he is in- sane. Because a man who murders his neighbour appropriates his clothes, and within a few days after the commission of the offence pawns the dead man's property, every self- constituted judge pro- nounces the man quite mad. Is it not the fact that, unless the criminal did some foolish thing, the commission of the deed never would have been associated in thought with him ? Is it not a fact that al! the inmates of our prisons indulge, not in repentance of the crimes for which they are incarcerated, but constantly regret some little bungled circumstance in connection with the act on account of which they are undergoing sentence P — not saying, " Would I had never done the deed," as a true man ought to say ; but saying, " If I had not left the door open, if I had not dropped my hat, if that man had not heard his screams." But are such circumstances to be taken as a proof of the existence of insanity ? There are very few who are not blinded by the rnles of what they think a science, who would advance such a proposition. Neither is tlie association with the crime of one or two unusual circumstances to be regarded as an indication of insanity. An individual of the name of Campbell, who resided in a northern town a good many years ago, was proved to have stolen various articles. It was also proved that the articles bad been stolen with the view of supporting a mother, who was en- tirely dependent upon the exertions of the accused ; and, further, it was ascertained that upon one occasion, when crossing the church- yard in the dreary dark of a winter nightfall, while upon his way to commit one of the crimes with which he was charged, and being wholly unconscious that he was observed, he knelt down and prayed earnestly for a blessing on his undertaking. Sympatliy was excited — the man stole for hia mother, and he prayed to God to bless him while stealing — he must be mad 1 But, nevertheless, Campbell was hanged. And although the punishment by death for the crime of theft seems to be unwarranted by any law of God, of nature, or of expediency, which ought to guide a legislature, it seems to us that the esemption of the accused from all punishment upon the ground of imanity, as proved by the facts above stated, would have been ill- advised. Many individuals day and night use this great engine. 133 MLDTCAL JtrRISPBUPENCE OF INSANlTta prayer — the lever of the moral world — to hoist them up in the socid world. Many people pray night and morning for Heaven's blessing npon acts which every Balaam prophet of our time has declared shall be cursed. What a marvellous revelation it would be if the thoaghts that run through men's heads, or well over their lips, when they are on their knees, were made known. Surely a man with a mistaken idea of morality is not to be thought mad. A man who thinks that the end will justify the means, and who prays that the means ma; be blessed because the end is worthy of God's blessing, is not to be looked upon as a dement. Neither is it well to decide the question of insanity or crime, as taken in connection with theft, simjjly upon the fact that the individual has only been in the habit of appropriat- ing one kind of article. When such is the case the qnestion ought to be considered in relation to the individual's capability, so far as opportunities went, to steal any other kind of articles. An old woman, Nickie Frizzel by name, lived in the castle- crowned town of Stirling some fifty years ago. Boys, whose imaginations helped to the conclusion that a crutch and nut-cracker jaws were the truest attributes of a witch, looked upon her as " ower grit wi' the dieL" But even friends of the devil must die, and Nickie Frizzel paid her little debt of nature when it was overdue by some years. She died, and her house was searched. Many articles were found in her pos- session which had come into it by the back door of theft, and not by the front door of purchase. But the fact which eicitcd most cari- osity was the discovery of a washing-tub full of " peries," or peg- tops, which had, it was surmised, been stolen from the boys as she passed on her daily rambles. No wonder they thought her a witch ! But the discovery of all these peg-tops does not convince us thai Nickie Frizzel was «o« compos. But instead of saying at length who ought nut to be looked upon as mad, even though they steal, W( had, perhaps, better say who ought to be considered as of nngouae mind under snch circumstances. The positive is generally a sbortei road than the negative in such cases. 1. The means, the position, the rank of the individual, should b< taken into consideration. We know that poverty and want are under ordinary circumstances, incentives to procure food or mane' in the most accessible way, which for the poor is not unfrequently V theft. If hunger gnaws a man it would he a severe moralist wh would censure the appropriation of food. Man seems to have %iA ON PARTIAL MORAL MANIA. 133 of right to live, as much as he can have a right, when standing in God's presEDCe ; and when that right is menaced by undermining hunger there is at least aome excuse for theft. But the law is to prevent theft, and the law properly looks upon want as the most powerful incentive to honest work, and not to dishonest pilfer- ing. Although it ahoukl always lead to industry, and not to dishonesty, it does not always do so. The temptation to steal is great. It is so easy, and does not look very wrong; the man you take from has enough and to spare, and you well-nigh perish with hunger. Thus it is that poverty is a real inducement to commit crime. Sad though it be, it is true ! Now, if we find a man of wealth appropriating to himself some article that, in comparison to his means, is of Uttle value, we are surely warranted in supposing that his motive is somewhat different from that of the man to whom the same article or sum of money would be, as it were, life and that "chance" which opens the world's door to man. It is certain that motive is to be judged as much by the position of the person wish* big, as hj the object wished for. What is a crust of bread after a good dinner? — what is it not after a long fast? So we say that the position and means of the individual suspected of labouring iindei kleptomania are to be carefully considered. And not only his social position, but that " position" which is his entire relation to the ei- temal world. An old copper coin, utterly valueless to anybody except to a boy, who might lake it to play buttons with, would, in the eyes of an antiquary, be, as it were, the nucleus of a hundred pleasant feelings, and in that way have value in his eyes. For, aa Shakespeare says,* — " Wbat a onght, but sa 'lii valocii ?" In this wide sense of the word position, a man's rank, his cir- cumstancea at the time, his relations to the individual stolen from or to any individual who might possibly be suspected of the theft, the circumstances of the theft — for the manifestation of cleverness or skill in the perpetration may be a perfectly healthy motive inducing to the crime— must all be considered. But if, as in one of the above-mentioned cases, an individual steals towels, and no or- dinary motive likely to influence him individually or a healthy person circumstanced as he is, can be discovered, there is a strong probability that the individual stole in consequence of disease. 134 MEDICAL JCttlSPBUDENCE OF INSANITY. 2, The value of tbe article taken should be ascertained. la manj cases of true kleptomania the value of the article stolen does not seem to be of much importance. To the true thief the value ia all important. Before going further, we would say that these tests altogether fonn a net which will catch the thief and allow the insane to go. Not one of these will alone be sufficient to decide the question of sanity or insanity, and in many instances they ranj altogether fail. With regard to the value, the case* of the ladj who only took pins and concealed them in the hem of her dress is certainly UiuBtrative, And we may refer the readers to the case of L. H — , mentioned in an earlier part of this work, and to the case of the lady who stole bread, which we quoted on the authority of Dr. Rush, as further showing that in very many cases the mere morbid desire to become possessed of something is so strong as to make the choice of the article according to the ordinary standard of value ft matter of no importance. It is strange that the morbid desire to acquire should iu many cases be limited so as to operate only in re- lation to one class of objects. But we generally find, if we choose to seek, the type of the same law in the maaifestations of disease that are to be found in the actions which are the ordinary outcome of a state of health. Men's desires always " clot," as it were. They live ia the light of gratification and they grow to that hght. Men's desirea have to be cut by the cloth the world gives them, and resignation is the obsequy of desire. We have to go without many things we want, and the inevitable is agood argument against our beating our- selves against the immovable bars. But education and birth, and all a man's circumstances, shajie a man's desires until his mind is like an island with many long peninsulas running from it, one seeking the south with its summer and flowers, the other the north with its fierce winds and dreary snows. Men's minds, in so far as desire is concerned, difi'er infinitely. One man wants fame, another money, another love. One longs for a life in town, another for a life in the country. And so, as we narrow the sphere, one man will read no books that have not to do witb the absolute, while another will read nothing but tales of how bad people were converted and turned out of the broad path into the narrow one. One man will have nothing but diaper-pattems for his carpet, while another glories to be walking over worsted flowers and ferns. If such limitations are • 'Reporti Crichton Ir i ON FAETIAL MORAL MANIA. 135 compatible with health, we should expect in many cases to find still narrower pursuits under the influence of disease. If men who have the means of collecting many tilings concerning wliich hnman interest might be felt, devote themselves to the collection of postage Btamps, why should we wonder that others, under the influence of disease, while the propetiaity to thieve gives them the means of obtaining many things, the possession of which is fraught with pleasure, should have all their energies directed to the acqui- sition of pins or table-clotbs ?* 3. The precautions taken by the individual will occasionally throw light upon the question as to whether disease is present or not. Some kleptomaniacs steal openly. They make no attempt at con- cealment. But cases do occur where much ingenuity is manifested upon the part of the individual to conceal the act from the knowledge of others. The occasions of the theft will have some bearing on the question in connection with the history of the individual, the probability of insanity as judging from the existence or non-exist- ence of predisposing and exciting causes.t Gall met with four ex- amples of women who when pregnant stole, or were impelled to steal, and who were perfectly honest at other times. The precautions taken to avoid suspicion are, however, often indicative of the pre- sence rather of mora! turpitude than of moral insanity. i. Very frequently the kleptomaniac is not unwilling to avow the act. Many confess that they know that what they are doing is wrong, but say that they have a mad longing to possess themselves of every- thing they see. J Some plead inability to resist the temptation to steal when they see certain articles, and make no attempt at denial. And in connection with such confessions, we may often find the individual restoring the stolen goods to the real owner. When such restitu- tion takes place without the presence of motives which would influ- ence an ordinary man, such as probability of detection or the like, it is very strong corroborative evidence of the hypothesis that the • Mure, rol, ii, p, 366, mentiom tha case of n tnedloa! man H-hose lilepto- minia ttu muiifeat»d In itealing table-clotbs >tn